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Goljan Lecture Notes > Chapter 2: Cellular Reaction to Injury > Flashcards

Chapter 2: Cellular Reaction to Injury Flashcards

1
Q

MCC of ischemia

A

thrombus in muscular artery

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2
Q

2nd MCC of tissue hypoxia

A

hypoxemia

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3
Q

Ventilation defects

A

Respiratory distress syndrome

Creates an intrapulmonary shunt

If give 100% O2, pO2 did not increase –> SHUNT

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4
Q

Perfusion defects

A

PE

Increase in dead space

If give 100% O2, pO2 did GO UP

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5
Q

3 things to remember for CO

A
  1. decrease in O2 saturation
  2. left shift in O2 sat. curve
  3. blocks cytochrome oxidase
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6
Q

The 3 C’s for cytochrome oxidase

A
  1. cytochrome oxidase
  2. cyanide (blocks cyt oxidase)
  3. CO (blocks cyt oxidase)
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7
Q

Left shift in Hb curve

A

CO, methemoglobin, HbF, decrease in 2, 3- BPG, alklalosis

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8
Q

Uncoupling agents

A

Dinitrylphenol (chemical for preserving wood)
Alcohol
Salicylates

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9
Q

Additional risk/sign of uncoupling agent

A

hyperthermia

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10
Q

What happens when there is respiratory acidosis?

A

Hb stays same
O2 saturation decreased
partial pressure of O2 decreased (d/t pO2 decreased)

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11
Q

What happens when there is anemia?

A

only Hb is affected

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12
Q

What happens when there is CO/methemoglobin?

A

Hb normal
O2 sat decreased
pO2 normal

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13
Q

Tx for CO poisoning

A

100% O2

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14
Q

Tx for methemoglobin

A

IV methaline blue or vitamin C

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15
Q

MC cancer from radiation

A

leukemia d/t hydroxyl free radicals

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16
Q

MCC drug induced fulminant hepatitis

A

Tylenol OD

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17
Q

Coagulation necrosis results from

A

Sudden cutoff of blood supply to an organ (ischemia)

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18
Q

Gangrenous necrosis types

A

wet and dry

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19
Q

MCC nontraumatic amputation

A

diabetes d/t enhanced atherosclerosis (esp. popliteal artery)

DRY gangrene

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20
Q

Wet gangrene complicated by…

A

infective heterolysis –> liquefactive necrosis

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21
Q

Good consistency = pale infarct

A

coagulation necrosis

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22
Q

Loose consistency of tissue

A

hemorrhagic infact

bowel, testes, ESP. lungs

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23
Q

MCC of bowel infarction

A

adhesions from previous surgery

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24
Q

2nd MCC of bowel infarction

A

small bowel trapped in indirect hernial sac

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25
Liquefactive necrosis
think neutrophils! occurs in the BRAIN
26
Caseous (Cheesy consistency) necrosis
mycobacterial infection or fungal infection ONLY lipids in cell wall --> cheesy appearance
27
enzymatic fat necrosis
unique to pancreas!
28
traumatic fat necrosis
usually breast tissue or adipose tissue NOT cancer (cancer is usually painless while this is usually painful) Can result in calcifications
29
Fibrinoid necrosis is the result of what kind of damage?
Immunologic damage
30
What are examples of fibrinoid necrosis?
Henoch-Scholein purpura Rheumatic fever Rheumatoid arthritis
31
MCC fatty change in liver?
alcohol
32
Zone in liver affected by yellow fever
Zone 2
33
Zone in liver affected by acetaminophen OD?
Zone 3 (around central vein) b/c gets least amount of O2 --> cannot combat free radical injury
34
2 types of metabolic acidosis seen in alcoholics
1. lactic acidosis (b/c driving pyruvate into lactate) | 2. increased synthesis of ketone bodies b/c excess acetyl CoA
35
What is the main ketoacid?
beta hydroxybutyric acid
36
Why does alcohol produce fatty change?
In glycolysis, around run 4, get intermediates dihydroxyacetone phosphate (NADH rxn) and is forced to come glycerol 3-phosphate --> makes TGs *basically increased VLDL
37
What is the mechanism for Kwashiorkor Syndrome?
Decreased protein intake --> cannot make apolipoproteins to put around VLDL to get it out of the liver and into the bloodstream --> accumulation of VLDL in liver --> fatty liver and protuberant belly
38
Dystrophic calcification means...
tissue gets damaged --> abnormal calcification
39
What is an example of dystrophic calcification?
enzymatic fat necrosis
40
MCC aortic stenosis
bicuspid aortic valve --> hemolytic anemia
41
Metastatic calcification in cases of...
hypercalcemia | hyperphosphatemia
42
MCC hypercalcemia (outside of the hospital)
hyperparathyroidism
43
MCC hypercalcemia (inside the hospital)
malignancy induced hypercalcemia
44
Difference b/t dystrophic and metastatic calcification
Dystrophic calcification puts calcium into damaged tissue while metastatic calcification puts calcium into NORMAL tissue
45
What does high levels of phosphate in blood do?
Drives calcium into the cells --> very bad This is why pts with kidney failure need dialysis
46
What causes spherocytosis?
Defect in spectrin protein --> no biconcave disc shape
47
What are examples of ubiquintation?
``` Mallory bodies (liver) Lewy bodies (Parkinson's Dz) neurofib tangles (Alheimers Dz and Jacob Crutzfelt) ```
48
What are the different cell types and describe them?
Labile - cell division is via a stem cell Stable - in resting, G0 phase Permanent - can no longer get into the cell cycle, permanently differentiated
49
What is the most variable stage of the cel cycle?
G1 phase
50
Does glucagon or insulin phosphorylate or dephosphorylate?
Glucagon is a phosphorylator while insulin is a dephosphorylator.
51
What is the key area to control in the cell cycle?
transition from G1 to S phase
52
Rb suppressor gene is located on which chromosome?
chromosome 13
53
What is the function of the Rb protein?
prevents the cell from going from the G1 to the S phase
54
p53 is located on which chromosome?
chromosome 17
55
No. 1 most important gene in cancer
p53
56
What changes occur in the cell during the S phase?
Everything doubles | 2N => 4N
57
What occurs during G2 phase?
when tubular is made
58
What drugs act on S phase?
Ergot alkaloids | Methotrexate
59
What drugs act on G2 phase?
Etoposide | Bleomycin
60
What drugs act on M phase?
Gresiofulvin Paclitaxel Vincristine and Vinblastine Colchicine
61
HIV + person with dyspnea and white out of the lung on a drug --> ends up with cyanosis. Which drug is it?
Dapsone
62
What kind of growth alteration occurs in hydronephrosis?
Compression atrophy b/c of increased pressure on the cortex and medulla --> produces ischemia --> decreased blow flow and atrophy of renal tubules
63
What is the mechanism of atrophy in Lou Gehrig's disease?
knock off neurons to the muscle --> no stimulation --> atrophy
64
What are causes of atrophy to the brain?
atherosclerosis (MC) | degeneration of neurons (Alzheimers Dz, related to beta amyloid protein which is toxic to neurons)
65
What change in the adrenal cortex results from hypopituitarism?
Adrenal cortex atrophy
66
What happens to the thyroid if you take too much thyroid hormone?
atrophy of thyroid b/c no TSH
67
Definition of hypertrophy
Increase in SIZE, not number
68
Definition of hyperplasia
Increase in NUMBER
69
Definition of metaplasia
replacement of one adult cell type by another e.g. mucosal cells replace squamous cells of lower esophagus --> Barretts esophagus (precursor to adenocarcinoma)
70
Name examples of metaplasia
1. mucosal cells replace squamous cells of lower esophagus --> Barretts esophagus (precursor to adenocarcinoma) 2. Lining of mainstream of bronchus (ciliated columnar, pseudo stratified columnar --> turns into squamous) 3. goblet cells in the stomach --> precursor to adenocarcinoma
71
MCC adenocarcinoma of the stomach
H. pylori
72
MC precursor lesion to endometrial carcinoma
d/t unopposed estrogen
73
Does prostatic hyperplasia lead to cancer?
NO
74
What is the process of cancer formation?
metaplasia --> dysplasia --> cancer
75
What two parasites cause cancer and how?
1. clonesis sinesis --> cholangiocarcinoma (Chinese liver fluke) 2. shistosoma hematoabia --> bladder cancer by causing the transitional epithelium to undergo squamous metaplasia
76
What is the precursor lesion for squamous cell carcinoma?
actinic keratosis

Goljan Lecture Notes (4 decks)

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