Chapter 9 And 10 Flashcards
Cyp450 and benzopyrene
Generates dna binding metabolite from benzopyrene present in cigarette smoke and grilled meats
Oxidized by hyp2e1 which disrupts differentiation of hematopoietic cells resulting in bone marrow aplasia and AML
How does ground level ozone damage
Respiratory epithelium and type 1 alveolar cells ——inflammatory mediators
CO poisoning causes hypoxia then unconsciousness. Describe what happens with hypoxia
Decreased oxygen to brain-neuro prob
Lactic acidosis
Breakdown of heart and skeletal muscle creatine kinase
Chronic CO poisoning
Basal ganglia and lenticular nuclei first
Morphological changes with CO
Brain edema
Punctuate hemorrhage’s
Hypoxia induced neuronal changes
Lead major targets
Bone marrow blood nervous system first Microcytic hypochromic anemia Punctuate wrist drop foot drop Renal interstitial fibrosis Decreased uric acid secretion saturnine gout
Arsenic poison
2-8 weeks
Sensorimotor neuropathy , numbness and pain
Chronic-lung bladder skin cancer
Beryllium
Inhaled
Sarcoidosis like granuloma
Chromium and nickel
Upper respiratory carcinoma
Organic solvents
Leukemia
What is cofactor of Alcohol dehydrogenase . Is this a problem
NAD
Can’t beta oxidation and lactate to pyruvate
Acid and fatty liver
How does alcohol cause hepatic injury through tnf and cytokines from macrophages and Kupffer cells
Causes release of endotoxin lps from gram negative bacteria in intestinal Fluora
Acute alcohol
Subcortical(RAS dependent) -reticular formation -cortical activity
Thennnnnnn lower medulla neurons —respiratory centers respiratory arrest
Acute gastritis and ulceration
Higher levels respiratory arrest
Chronic alcoholism
Peripheral neuropathies
Wernicke
Gi bleeds
Dilated heart alcohol cardiomyopathy
____ adductor have been found in alcohol related tumours. What individuals are most susceptible
Acetylaldehyde
ALDH22
HRT increases risk of what
Ovarian and endometrial cancers
Acetaminophen is made to NAPQI. What metabolizes NAPQI. Clinicaleffects
Glutathione conjugates. It. Glutathione low if have a lot. So NAPQI covalently binds to hepatic proteins and damages things and depletes gsh—SUSCEPTIBLE TO ROS, which you get from cyp
How restore glutathione
N acetylcysteine
Overdose acetaminophen
Centrilobular necoris
Extens to lobules
Liver transplant only hope for survival
Aspirin overdose
Bleed prob
Increase breathing -respiratory alkalosis
Compensatory acidosis uncoupling ox phos and stop Krebs cycle
NAUSEA COMA
Chronic asprin
Acute erosive gastritis gi bleeds and gastric ulceration
Analgesic nephropathy
Asprin and acetaminophen
Tubulointerstitial nephriits, renal papillary necrosis
Analgesic nephropathy
Opiates
Sudden death-depression Pulmonary injury-edema sepsis embolism granuloma Infection SA right sided tricuspid value Skin Kidney amyloidosis
Meth
Releases dopamine in brain inhibits presynaptic neurotransmission at corticostriatal synapses
Slow glutamate release
Euphoria then crash
Violence, confusion psychotic paranoia
MDMA
Euphoria hallucinations 3-6 hours Increase serotonin in cns Post use drop in serotonin Reduces serotonergic axon terminals Increase peripheral effects of dopamine
Marijuana
Increase heart rate. And bp
Angina
Laryngitis, pharyngitis, bronchitis, cough and hoarseness
Cognitive impairments
Threefold increase in amount of tar inhaled compared to cigarette
Bath salts
Amphetamine
Agitation psychosis mI suicied
PCP
Anesthetic
Ketamine
Anesthetic
Burn
Shock sepsis respiratory insuffiency
Infections of burns
PA MRSA candida
Heat stroke progression
Thermoregulatory mechanism fail-sweating ceases body temp rises multiorgan dysfunction death
Presentation heat stroke
Vasodilation, peripheral pooling of blood decreased effective circulating volume
Sustained muscle contractions
Hyperkalemia tachycardia
Arrhythmia
Malignant hyperthermia
Ryr1 mutation Sarcoplasmic reticulum release ca sustained muscle contraction After given succinylcholine Treat with dantrolene INCREEASE RIGHT OF HEAT STROKE
What causes sustained muscle contraction
Nitrosylation of ryanodine receptor
Hypothermia
Below 90 lose consciousness then bradycardia and a fib
Direct cause of injury from hypothermia
Increase na from crystallization of water intra and extracellular ya
Indirect causes of hypothermia damage
Slow chilling-vasoconstriction increased permeability hypoxia and edema
Fast chilling vasoconstriction and viscocity-ischemic injury and degenerative changes in peripheral nerves (ischemia and infarction)
Vascular injury evident after termpature returns to normal
Electrical injur
Burns and ventricular fibrillation
Titanic muscles make hard to let go of a live wire
Morphology of ionizing radiation
Dna damage
Nuclear swelling
Soto plasmid swilling and distortions
Vessels dissolute
Marsumus
Somatic protein compartment issue Albumin normal Muscle and fat are energy sources Leptin low-Hpv axis-cortisol-lipolysis Head too large for body
Kwashiorkor
Visceral protein problem Hypoalbumin low-EDEMA dependents Spare subcutaneous muscle mass Hyperpigmentation /flakey Enlarged fatty liversmall bowel decreased villi and crypts (mitosis index) They mic and lymphoid atrophy
Bone marrow in PEM
Aplastic anemia
Anorexia
Cardiac arrhythmia, sudden death from hypothalamic
Vitamin a defiency
Squamous metaplasia-keratinizing epithelium
Celiac disease
Xeropthalmia
Keratin plaque (bigot)
Desquamation of keratin in urinary tract leaders to renal and urinary bladder infections
Follicular or popular dermatomes vitamin a defiency
Hyperkeratinization of the epidermis with plugging of the adnexal gland ducts
Why is vitamin a a treatment for acute promyleocytic leukemia cells
Bind pml-rar fusion protein that characterize the cancer
Clinical vitamin a defiency
Night blind, epithelial metaplasia keratinization (need vitamin a to differentiate epithelial cells)
Bigots spot
Squamous metaplasia -pulmonary infections, bladder stones, immune, follicular or popular dermatomes
Vitamin a toxicity
Head ache vomit, stupor blurred vision (pseudomotor cerebri)
Weight loss, anorexia, vomiting, bone and joint pain
OSTEOCLASTS-increased bone resorption and increased frequency fractures
Low ca, increase of decrease PTH
Increase
Vitamin d and osteoclast
Increase ca increase osteoclast to make more bone
PTH effect on vitamin d
More
Rickets
Overgrowth cartilage failure of it to mature
Are contours of bone effected in rickets and osteomalatia
Just rickets
TLR activation of macrophages can induce the increase the conversion of ___ to its active form
Vitamin d
Too much vitamin d
Metastatic calcification
Scurvy
Bone disease in growing kids and by hemorrhage’s in healing adults
Iron defiency
Hypochromic microcytic anemia
B1
Decarboxylation reactions
Wernickes
Korsakoff
Beri beri
B6
Myelinated spinal cord
Obesity
T2d, cholelithiasis, cancer
35% Americans obese
Thermogenesis
Leptin induced
What protective hormone is decreased in obese patients that protects against metablic syndrome
Adipolectin
Pomc cart
Energy expenditure msha
Npy agrp
Food intake via 71/5
Pickwickian syndrome
Respiratory problems obese
Hypoventilation
Obesity causes a pro __ state
Inflammatory
Why high animal fat give cancer
Bile and lower stool bulk and fewer fibers to bind harmful carcinogens
Why intrauterine infections the second leading cause of preterm births
Tlr inhibit prostaglandin
Fetal causes of fgr
Torch
Chromosomal congenital
Placental causes of fgr( spare brain)
3rd trimester burden
Umbilical placental anomalies
Multiple gestational
Maternal causes of fgr
Thrombophilias: acquired antiphospholipid syndrome
Preeclampsia
Drugs alcohol malnutrition
DECREASED PLACENTAL BLOOD FLOW
In rds, hypoxemia causes what
Further failure in surfactant synthesis
What makes surfactant
Glucocorticoids, tgf b thyroxine prolactin
How does maternal diabetes effect surfactant
Increased glucose levels in mom increases insulin in baby-inhibit surfactant synthesis
Treat with corticosteroid
Atelectais
Alveoli poorly developed
Eosinophils hyaline membranes
Bronchopulmonary dysplasia
Striking decrease in alveolar septation (large simplified alveolar structure) and a dysmorphic capillary configuration
Reversible impairment in the development of alveolar septation in saccular stage
From hyperthermia, hyperventilation, prematurity , inflammation tnf il1,6,8 and vascular maldevelopment
Infants who recover from rds are at increased risk of what
Pda, intracentricular hemorrhage and necrotizing entercolitis
Pneumatosis intestinalis
Nec
Necrotizing enterocolitis
Is nec multifactorial
Yup usually start after feeding (bacteria introduction so after that
Morphology nec
Terminal ileum, cecum, right colon, submucosal gas bubbbles
Treat nec
Resection, fibrosis
Transcervical infections
Bacterial except herpes
Transplacental infection
Viral parasitic except listeria treponema
Through chorionic villi
Parvovirus B19
Early onset perinatal sepsis
Pneumonia sepsis meningitis
Group b strep
Week
Late onset perinatal sepsis
Late onset listeria and candida
Week to three months
HYDROPS
Anemia and jaundice
Anemia liver and hear damage
Less albumin
Edema, hydrops fetalis anasarxa
Jaundice-hemolysis unconjugated
Anasarca
Generalized edema
Non immune hydrops
Cv defects, abnormalities, anemia,
Turners, 18, 21, due to cv problem
Turners-lymphatics in neck can lead to postnuchal accumulation (cystic hygroma)
Anemia-a thalassemia deletion of a globin
Hydrops associated with anemia
Pale fetus and placenta Hepatosplenomegaly due to cv and congestion Erythroid precursors EXTRAMEDULLARY HEMATOPOIESIS ERYTHROBLASTOSIS FETALIS
Kernicterus
Enlarged brain
Edema
Yellow
Pku normal at birth
6 months mental retardation
Galactosemia
Fail to thrive from birth Cataracts weeks Mental retard 6 months AMINOACIDURIA Less aa transport due to accumulation in kidney
Cf and vit a
Vit a defiency leads to night blindness and squamous metaplasia of ducts of pancreas
Salivary gland cf
Dilation of ducts squamous metaplasia and glandular atrophy and fibrosis
Meconium ileus
5-10% cf
SIDS triple risk
Vulnerable infant (serotonin reticular activating system)
Exogenous stressor
Critical development period
Laryngeal chemoreceptors
Stimulated inhibit cardiorespiratory reflex
Respiratory infection increased secretions
Prone impairs swallowing
Male or female SIDS
Male
Heterotopia(choristoma)
Normal cells in abnormal locations
Hamartoma
Focal growth of tissue that is native to site of origin
Mature and well differentiated but does not follow the architecture of the original tissue
Like a neoplasm
Hemangioma
Hippel lindau
Subsets familial with cerebral cavernous malformations CCM
Lymphangiomas
Hamartomatous or neoplasticism
Cystic and cavernous spaces skin but more likely deeper
Benign
Can grow and encroach on vital tissues
Lymphangiectasis
Dilation of lymph channels
Swelling
Doesn’t extend
Cosmetics
Fibrosarcoma
Same as adult
Excellent prognosis
Etv6-ntrk3 fusion
Teratomas
Malignant potential with amount of immature tissue
Peaks for teratomas
2 and early adult
Most common teratomas of kids
Sacrococcygeal
Girls
Spina bifida most mature
Older get more likely to be malignant
Adult malignant tumor
Mesenchyme hematopoietic nervous system bone kidney
Neuroblastic Germaine mutation
Anaplastic lymphoma kinase alk
Somatic gain of function in alk
Less than 10% of sporadic
Rosetttes
Neuroblastoma
Tumor cells concentrically arranged about a central space filled with NEUROPIL
Galgioneuroblastoma ganglioneuroma
Larger, Schwann
FAVORABLE
Neuroblastoma clinical
Large abdominal mass fever weight loss respiratory bone pain Pro ptosis each Yoshi’s Bladder bowel dysfunction catecholamines BLUEBERRY MUFFIN BABY VMA HVA
Poor prognosis neuroblastoma
Myc Deploidy 1p 11q loss 1p36 loss Trkb (a favorable) Atrx and ptprd genes (neuritogenesis)
Wilms
Most common primary renal tumor of childhood 1-5
Nephrogenic rests precursors
