Chapter 26 Clinical Pathophysiology Flashcards
- reaction of vascularized tissue in the body to local injury or insult.
- Protective attempt to remove harmful stimuli
Inflammation
Chemical irritants or toxins
Mechanical or physical trauma
Altered or damaged cells
Microorganisms
Causes of inflammation
Redness
Fever
Swelling
Signs and symptoms of ACUTE INFLAMMATION
long-term damage
as in Cancer and lung disease
Signs and symptoms of CHRONIC INFLAMMATION
Vascular and Cellular
Components of inflammatory response
component of inflammatory response that causes
Dilation of the microvasculature
allowing increased permeability of macromolecules into the tissue space
may cause EDEMA
VASCULAR component
component of inflammatory response that causes
MARGINATION
CELLULAR component
Leukocytes relocate to the endothelium wall
Margination
white blood cells
Leukocytes
mast cells-release produces vasodilation/increased permeability
Histamine
- inactive form in plasma
- activation leads to different inflammatory cascades
Factor XII(Hageman factor)
cascade that causes THROMBIN FORMATION-FIBRINOGEN TO FIBRIN
coagulation cascade
peptide=VASCULAR DILATION/INCREASED PERMEABILITY
BRADYKININ
cascade that causes BRADYKININ production
Kinin cascade
cascade that causes PLASMIN production
Fibrinolytic cascade
cascade that causes
MEMBRANE ATTACK/inflammatory mediators=chemotaxis,phagocytosis, histamine release
complement cascade
fatty acid-precursor to COX and LOX
Arachidonic acid
pathway that
Prostaglandins and thromboxanes
Cyclooxygenase pathway
COX pathway
pathway that produces
LEUKOTRIENES
Lipoxygenase pathway
LOX pathway
COX product that promotes
VASODILATION/INCREASED PERMEABILITY
Prostaglandin
COX product that promotes PLATELET AGGREGATION(repair)
Thromboxanes
LOX product that promotes
CHEMOTAXIS-VASODILATION-INCRESED PERMEABILITY
Leukotrienes
fluid in interstitial spaces
Edema
composes 50-60% body weight
BODY WATER
2/3 of body water
Intracellular component
1/3 of body water
-interstitial space separated by capillary wall
Extracellular component
controls normal exchange in the compartments
hydrostatic and osmotic pressure
regulate hydrostatic and osmotic pressure
plasma proteins
__________hydrostatic pressure causes EDEMA
INCREASED
__________osmotic pressure
causes EDEMA
DECREASED
increased blood volume
Congestion and hyperemia
passive-drainage is interrupted EX: VALVULAR STENOSIS
Congestion
active-Increased blood flow EX:ACUTE INFLAMMATION
Hyperemia
blood out of the circulatory system
Hemorrhage
trauma;
vascular wall damage resulting from disease;
or malfunction of the body’s normal mechanism to maintain hemostasis(CLOTTING)
CAUSES OF HEMORRHAGE
accumulation of blood bruise to subdural hematoma
Hematoma
<0.3 cm
Petechiae
0.3 and 1 cm
Purpuras
> =1 cm
Ecchymoses
pathologic process of blood clotting
Thrombosis
formed clot
Thrombus
Virchow’s triad
Decreased blood flow
Injury
Coagulation changes
- movement of dislodged mass/embolus
- most common-deep veins
Embolism
emboli from blood clots
Thromboemboli
ischemic necrosis
Infarction
lack of adequate blood supply
Ischemia
thickening of the arterial wall by lipid plaques
Atherosclerosis
inadequate blood flow=decreased perfusion
Shock
-cold, mottled skin; mental status changes; and oliguria
SIGNS and SYMPTOMS of SHOCK
SHOCK from hemorrhage or trauma
Hypovolemic Shock
SHOCK from low volume produced by body
Distributive Shock
SHOCK from INFECTION
Septic shock
SHOCK from ANAPHYLAXIS
Anaphylactic
SHOCK from MEDICATIONS
Neurogenic
SHOCK from cardiac malfunction-commonly caused by myocardial infarction or cardiac arrhythmias
Cardiogenic Shock
SHOCK from blood flow that is interrupted or obstructed
Obstructive shock
GOAL OF THERAPY for shock
restore blood flow
STAGE OF SHOCK where
body feedback mechs are activated
Nonprogressive stage
STAGE OF SHOCK where
damage/less compensation
Progressive stage
damage/ mababa bayad pa, progressive palang
STAGE OF SHOCK where
sustained injury beyond repair
Irreversible stage
CAUSES OF DEVELOPMENTAL DEFECTS
DD GEMI Genetic or chromosomal abnormality Environment Multifactorial Idiopathic
intrinsic cause
Malformations
MALIC
- defects in the form, shape, or position of a body part
- abnormal mechanical forces placed on the fetus during development.
Deformations FORM SHAPE POSITION MECHANICAL FORCES
defect in cellular organization or arrangement.
Dysplasias
extrinsic exposures
Disruptions
ex ex disrupt
missing or extra chromosomes commonly from NONDISJUNCTION
aneuploidy
- most common numerical abnormality
- Error in cell division/meiotic segregation
- less commonly caused by MOSAICISM and Robertsonian translocation of Chrom 21/14
DOWN SYNDROME-Trisomy 21
-missing or additional genetic material
Structural abnormalities
MA/Structural
- translocation of chromosomes 9 and 22 occurs
- chronic myelogenous leukemia
Philadelphia chromosomes
environmental agents
Teratogens
Tera sa environment
infection-cat feces-undercooked meats
Toxoplasma gondii
growth and mental retardation
Radiation
ILAWAN MO ANG UTAK MO
deformities such as limb abnormalities and congenital heart defects
DM/HTN while pregnant
overgrowth or abnormal proliferation of cells
Neoplasia NEOVERGROWTH
Carcinogens alter/mutate DNA
Neoplasm ALTERASM
failure of organ formation during embryo development
Agenesis
FAILURE EMBRYO AGENT
failure of organ or tissue development
Aplasia
PLAISURE of org/tiss development
enlargement or overgrowth of an organ or tissue because of an increase in CELL SIZE
Hypertrophy
enlargement in the size of an organ or tissue because of cellular PROLIFERATION
Hyperplasia
BREAKDOWN of a given body tissue or organ.
Atrophy
CHANGE IN CELL TYPE
Metaplasia
ABNORMAL MATURATION/ORGANIZATION/ARRANGEMENT or DIFFERENTIATION of cells
Dysplasia
slower growing non-invasive
Benign neoplasm
rapid invading disrupting
Malignant neoplasm
Invasion into surrounding tissue/distant sites
Metastasis
physical or chemical agents capable of causing genetic mutations
Carcinogens
Carcinogens
Tobacco and tobacco smoke Radiation (e.g., ultraviolet rays from the sun) Viruses (e.g., human papillomavirus) Asbestos Certain pesticides Certain heavy metals (e.g., lead)
codes for proteins that control cell proliferation, differentiation, and elimination
Proto-oncogenes
defective and mutated POG
Oncogenes
is a single nucleotide change in the DNA sequence that results in a change in a single amino acid in a protein
Point mutation
overexpression of the encoded protein.
Gene amplification
inappropriate expression of the gene.
Chromosomal translocation
recessive-Mutation of both alleles=inactivation of the protein
Tumor suppressor genes
corrects errors during cell duplication
DNA repair genes
wasting syndrome loss of body fat and mass~often by malignancy
-generalized weakness, weight loss, anorexia, and fever
Cachexia
Hypertension
> 130/80mmHg
no cause identified-more common HTN
Primary HTN
known cause-HTN
Renal artery stenosis, chronic renal disease, and hyperaldosteronism
Secondary HTN
- JG cells of the kidney converts Angiotensinogen to Angiotensin 1 in
- RESPONSE TO decreased renal arteriolar pressure or blood flow
RENIN
Angiotensin I to II
ANGIOTENSIN CONVERTING ENZYME
potent direct vasoconstrictor
-stimulates aldosterone
ANGIOTENSIN II
responsible for sodium and water retention=INCREASED BLOOD VOLUME&VASCULAR RESISTANCE
ALDOSTERONE
Sympathetic NS regulation mechanism
CATHECOLAMINES
- secreted by the atria of the heart in response to increased blood flow.
- increases urinary excretion of sodium and water
- decrease in blood pressure
ATRIAL NATRIURETIC PEPTIDE
potent vasodilator
NITRIC OXIDE
VASOCONSTRICTOR=HYPERTENSION
ENDOTHELIN
PRODUCTION OR USE of insulin is IMPAIRED
Diabetes mellitus
transport of glucose
- beta cells of the islets of Langerhans of the pancreas - release~serum glucose levels
INSULIN
DM TYPE
IMMUNE-mediated *idiopathic-most common in children/adolescent
DM TYPE 1
DM TYPE
insulin resistance & secretion deficiency
DM TYPE 2
Gestational diabetes Drug-induced Genetic defects Exocrine pancreas disease Endocrinopathies Infections
Secondary DM types
SYMPTOMS
ACUTE DM
polyuria-increases urine output polydipsia-thirst from dehydration polyphagia-hunger caused by calorie and glucose loss in urine fatigue weight loss
most commonly seen in type 1 disease
DKA
free fatty acids from lipid breakdown~KETONE BODIES-ACIDOTIC STATE
lipolysis
CHRONIC DM TYPE of complication with HIGHER RISK OF-hypertension,myocardial infarction, stroke, and coagulopathies
MACROVASCULAR
CHRONIC DM TYPE of complication where there is
Formation of advanced glycosylation end products
Sorbitol formation in cells through the polyol pathway
Oxidative stress as a result of hyperglycemia
MICROVASCULAR
fat elevation in the blood
Hyperlipidemia
ormed and secreted by the liver. They are rich in triglycerides and are eventually converted to lowdensity
lipoproteins.
VLDLs
formed by catabolism of VLDLs
major transporters of cholesterol from the liver to tissue.
LDLs
“good cholesterol”
secreted by the liver and intestine into the blood,
where they take up cholesterol and transport it back to the liver; there it
is excreted into bile
-formed from exogenous fat sources and solubilized in
the intestinal epithelium
-carry lipids to muscle and adipose tissue.
Chylomicrons
chronic airway inflammatory disorder
attacks
bronchospasms,
mucus hypersecretion, and inflammation
ASTHMA
allergic irritant
release of histamine and leukotrienes from mast cells
ASTHMA
ASTHMA TREATMENT
ACUTE:SABA
MAINTENANCE/CHRONIC:ICS