EXAMS 2 Flashcards
Cardiac output
stroke volume X heart rate
stroke volume
preload, afterload, contractility
the volume of blood pumped during every contraction of the heart. anytime your heart beats, how much blood is pumped
Pulmonary
both ventilation and perfusion needed for gas exchange (a V/Q mismatch if either is inadequate)
Tissue oxygenation
need above plus normal capillary flow, acid-base, normal O2 content, electrolytes, temperature
what is V/Q mismatch
when part of your lungs receives oxygen without blood flow or blood flow without oxygen. eg choking
When the heart beats too rapidly,
it pumps less efficiently
systemic circulation
blood supply to all body functions
pulmonary circulation
circulation of blood between the heart and lungs
pressure between pulmonary and systemic circulation
pulmonary has lower pressure (18mmHg) than systemic circulation (90mmHg)
what happens to our aveolis when we breathe out
When we breathe in and out, our aveolis don’t completely close cus of surfactant. Babies are not born with this.
Primary gas exchange units
alveoli
alveolocapillary membrane
space between the aveoli and RBC.
aveoli has to be in close contact with the RBC.
fluid filling in those spaces due to infections like pneumonia will lead impairment f GAS EXCHANGE
what is hypercapnia
too much CO2 in bloodsteam by inadequate breathing
two types of insufficient exchange of gasses
Hypoxemia = low oxygen content = Hypercapnia = too much CO2 in blood
neurological system
the cns and the respiratory center in the brain regulates how we breathe
how does Chronic hypoxemia adapt
Chronic hypoxemia adapt by having increased ventilation
chronic hypoxemia aslso lead to the increase in production of RBC
peripheral vasoconstriction?
mild hypoxemia
METABOLIC ACIDOS
= lack of oxygen can lead to conusion or mental problems
pulmonary vasoconstriction
chronic hypoxemia. example is chronic hypoxemia is cyanosis.
what is dyspnea
difficultiy breathin
what is Hyperventilation
fast breahting to compensate for the lost of oxygen
as a result, theres less CO2 = respiratory alkaylosis
difference between Hypoxema and hypoxia
hypoxemia is low oxygen content in the blood
hypoxia means low oxygen content in bodily tissues.
common portal of viruses
nasal mucosa and conjunctional surfaces of the eyes
types of influenza vaccinations
trivalent inactivated influenza (INJECTION)
- live, attenuated influenza vaccine (INTRANASALY)
what is pneumonia
respiratory disorders involving inflammation of lung structures (ALVEOLI and BRONCHIOLES)
type A influenzas
- most common
- CAN AFFECT MULTIPLE PEOPLE
- CAUSES MOST SEVERE DISEASES
subtypes of TYPE A influenza
hemagglutin (H) and neuraminidase (N)
SURFACE ANTIGENS
infectious agents causing pneumonia
bacteria and viruses
non infectious agents that causes pneumonia
gastric secretions that end up in the lungs
factors that facilitates development of pneumonia
- exceedingly virulent organism
- a large inoculum (culture)
- impaired host defense. whether they are immunocompromised of immunocompetent
classifications of pneumonia
- according to the source of the infection. where you get the infection from, hospial or community
- according to the immune system of the host. weak immune system most likely to expericne severe reactions
what is tuberculosis
commonly affects the lungs. worlds foremost cause of death from a single infectious agent
CAN AFFECT BRAINS, KIDNEYS AND BONES AS WELL
myobacterium tuberculosis
virus that causes tuberculosis.
has a waxy capsule which makes it get harder to get rid off.
CAN STAY ALIVE IN ANIMATED SUSPENSION FOR YEARS
forms of tuberculosis
mycotuberclosis horminis also known as human TB
- congested areas
- Airborne infection spread by minute droplet nuclei harbored in the respiratory secretions of persons with active tuberculosis
bovine tuberculosis
- Acquired by drinking milk from infected cows; initially affects the gastrointestinal tract
- has been virtually eradicated
respiratory disorders in children
upper airways infections
- Viral croup
- Spasmodic croup
- Epiglottis
lower airways infections
- Acute bronchiolitis
Impending Respiratory Failure in Infants and Children
- Rapid breathing
- Exaggerated use of the accessory muscles
- Retractions
- Nasal flaring
- Grunting during expiration
what is pleura effusion
abnormal accumulation of fluid in the pleural cavity
parietal pleura
lines the thoracic wall and superiror aspect of the diaghphram
visceral pleura
covers the lungs
pleura cavity
spaces between two layers and contains thing layer of seorus fluid
FLUID PREVENTS FRICTION
causes of lung cancer
primary: lung tumors 95%
secondary via mestastasis
smoking
asbestos = fibers from workplaces
treatment of tuberculosis
combination of drugs and can take up to 18 months.
positive tuberculin doesnt idifferentiate past, latent or active disease
what is chylothorax
lymphatic fluid formed in digestive system acummulates in the pleura
- treat conservatively with meds, surgery or pleurodesis
what is atelectasis
partial collapse of the lung due to alveolis being surpressed
lung compression that occurs in pneumothroax or pleura effusion
atelectasis can also be incomplete expansion of the lungs
what is emyema
pus in the cavity
what is pneumothorax
collapse of the lung due to increase pressure of the pleura cavity
what is spontaneous pneumothorax
occurs when an airfilled blister on the lung surface raptures
what is traumatic pneumothorax
- any trauma that penetrates the penetrates the lungs from outside. can be gunshot, blow
CAN BE PENETRATING (gunshot OR NON PENETRATING (blow)
what is tension pneumothorax
occurs when the intrapleural pressure exceeds atmospheric pressure. basicaaly when there is odee pressure in the lungs as compaired to outside
what is primary atelecatasis
failure of the lung to expand fully at birth
what is secondary atelectasis
- develops in neontal period or later in life PNEUMOTHORAX
what is hemothorax
blood in the pleura space. can be drained with chest tube
types of fluids in pleural effusion
transudate = low proteins= high hydrostatic pressure/low oncotic pressure
exudates = high protein= inflammation and CAPILLARY PERMEABILITY
- chyle
- blood
what is thoracentesis
removal of fluid or air from around the lungs
what is asthma
affects the airways of the lungs not necessarily the lungs
what is dyspnea
difficulty breathing
majority cause of asthma
- majority of asthma are due to environemental factors
what is status asthmaticus
BRONCHOSPAMS not reversed by unsual measures = life threatning
omnious signs of impending death
silent chest (no audible air movement) and PaCO2 greater than 70mmHg
Chronic Obstructive Airway Disease
- Inflammation and fibrosis of the bronchial wall
- Hypertrophy of the submucosal glands
- Hypersecretion of mucus
- Loss of elastic lung fibers
Impairs the expiratory flow rate, increases air trapping, and predisposes to airway collapse
Alveolar tissue
Decreases the surface area for gas exchange
Loss of elastic lung fibers
Impairs the expiratory flow rate, increases air trapping, and predisposes to airway collapse
EMPHYSEMA
atopy
genetic tendency to develop allergic reaction
Pulsus paradoxus
when youre having an active attack of asthma and theres not pulses
polycythemia
refers to an increase in RBC in the body
what is Cystic Fibrosis
An autosomal recessive disorder involving fluid secretion in the exocrine glands and the epithelial lining of the respiratory, gastrointestinal, and reproductive tracts = not just lungs. GI tract, respiratory tracts
cause of cystic fibrosis
Mutations in a single gene on the long arm of chromosome 7 that encodes for the cystic fibrosis transmembrane regulator (CFTR), which functions as a chloride (Cl−) channel in epithelial cell
manifestations of cystic fibrosis
- Pancreatic exocrine deficiency
- Pancreatitis
- Elevation of sodium chloride in the sweat
- Excessive loss of sodium in the sweat
- Nasal polyps
- Sinus infections
- Cholelithiasis
what are Diffuse Interstitial Lung Diseases
A diverse group of lung disorders that produce similar inflammatory and fibrotic changes in the interstitium or interalveolar septa of the lung
types of Diffuse Interstitial Lung Diseases
- Sarcoidosis
- The occupational lung diseases
- Hypersensitivity pneumonitis
- Lung diseases caused by exposure to toxic drugs
what is Pneumoconioses
The inhalation of inorganic dusts and particulate matter
Occupational Lung Diseases
- Pneumoconioses
- Hypersensitivity diseases
- Byssinosis
Hypersensitivity diseases of occupational lung diseases
The inhalation of organic dusts and related occupational antigens
what is byssinosis
cotton workers; has characteristics of the pneumoconioses and hypersensitivity lung disease
development of pulmonary embolism
A blood-borne substance lodges in a branch of the pulmonary artery and obstructs the flow
types of pulmonary embolism
- Thrombus: arising from DVT
- Fat: mobilized from the bone marrow after a fracture or from a traumatized fat depot
- Amniotic fluid: enters the maternal circulation after rupture of the membranes at the time of delivery = after delivering a baby, amniotic fluid can end up in the blood. Rare but can occure
Cor Pulmonale
- Right heart failure resulting from primary lung disease and long-standing primary or secondary pulmonary hypertension
- Involves hypertrophy and the eventual failure of the right ventricle
- Manifestations include the signs and symptoms of the primary lung disease and the signs of right-sided heart failure.
Acute Respiratory Distress Syndrome
A number of conditions that produces pathologic lung changes that include diffuse epithelial cell injury with increased permeability of the alveolar–capillary membrane
causes of acute respiratory distress syndrome
- Aspiration of gastric contents
- Major trauma (with or without fat emboli)
- Sepsis secondary to pulmonary or nonpulmonary infections
- Acute pancreatitis
- Hematologic disorders
- Metabolic events
- Reactions to drugs and toxins
Impaired ventilation
- Upper airway obstruction
- Weakness of paralysis of respiratory muscles
- Chest wall injury
Impaired diffusion
- Pulmonary edema
- Respiratory distress syndrome
causes of respiratory failure
- impaired ventilation
- impaired matching or ventilation and perfusion
- impaired diffusion
Tracheostomy
Surgically created stoma (opening) used to
- Establish a patent airway
- Bypass an airway obstruction
- Facilitate secretion removal
- Permit long-term mechanical ventilation
- Facilitate weaning from mechanical ventilation
Types of Chronic Obstructive Pulmonary Disease
- emphysema
- chronic obstructive bronchitis
what is emphysema
- Enlargement of air spaces and destruction of lung tissue
- Types: centriacinar and panacinar
what is chronic obstructive bronchitis
Obstruction of small airways
what is Bronchiectasis
Permanent dilation of the bronchi and bronchioles
- secondary to persisting infection or obstruction
manifestations of bronchiectasis
- atelectasis = partial collapse of the lungs
- Obstruction of the smaller airways
- Diffuse bronchitis
- Recurrent bronchopulmonary infection
- Coughing; production of copious amounts of foul-smelling, purulent sputum; and hemoptysis
- Weight loss and anemia are common.
what is hemoptysis
spitting pf blood originated from lungs or bronchial tubes
wha makes up the blood basics
Blood is composed of formed elements and plasma.
- Formed elements
- Plasma
- Serum
- Hematocrit
Functions of the hematopoietic system include
transport, communication, temperature, defense, and clotting.
Red cells are produced in the……….
red bone marrow after birth
Until 5 years of age, almost all bones produce red cells to meet growth needs; after 5 years, bone marrow activity gradually declines.
After 20 years, red cell production takes place mainly in the membranous bones of the vertebrae, sternum, ribs, and pelvis.
The heme molecule is converted……
to bilirubin and transported to the liver.
The red blood cell life span
- The red blood cell has a life span of approximately 120 days.
- It is broken down in the spleen.
- The degradation products (iron and amino acids) are recycled
Regulation of erythropoiesis
is through erythropoietin (EPO) that stimulates bone marrow to increase RBC production in response to low oxygen
oxygen-binding component of hemoglobin.
iron
Erythropoiesis requires
- requires vitamin B12 (cobalamin), folate (folic acid) and iron.
Folate and Vitamin B12 are required for DNA synthesis.
what is Thrombopoiesis
- the process of forming platelets.
Platelets are derived from fragmentation of megakaryocytes and are important in hemostasis.
what is Thrombopoietin
is a growth hormone released from the liver that stimulates thrombopoiesis
thrombocytopenia may give rise to
purpura and petechiae (rash or spots due to bleeding).
Exposure of these stem cells to environmental cues (hormones, growth factors)
may give rise to many types of cells
Lineages
Bilirubin
The heme unit is converted to bilirubin.
Bilirubin is insoluble in plasma and attaches to plasma proteins for transport. ( UNCONJUGATED )
Removed from the blood by the liver and conjugated with glucuronide to render it water soluble
(Conjugated)
Jaundice
Red blood cell count (RBC)
Measures the total number of red blood cells in 1 mm3 of blood
Percentage of reticulocytes
normally approximately 1%)
Hemoglobin
grams per 100 mL of blood
Measures the hemoglobin content of the blood
Hematocrit TEST
Measures the volume of red cell mass in 100 mL of plasma volume
Polycythemias
Too many RED BLOOD cells
Normal number of cells with altered components
Sickle Cell
Too few RED BLOOD cells
Anemias
anemia size
Identified by terms that end in “-cytic”
Macrocytic, microcytic, normocytic
Hemoglobin content
- Identified by terms that end in “-chromic”
- Normochromic and hypochromic
The classification of anemia usually based on?
the size of the rbc, mcv and MCH, normocytic, microcytic, and macrocytic, but it does not mean bigger size is better.
what is Pernicious anemia
- Caused by a lack of intrinsic factor made by the gastric parietal cells and is required for vitamin B12 absorption
- Results in vitamin B12 deficiency
Pernicious anemia neurological manifestations due to nerve demyelination
Weakness, paresthesias of feet and hands, ↓ vibratory and position senses, ataxia, muscle weakness, and impaired thought processes
increasing dietary cobalamin (vitamin B12) pernicious anemia
Increasing dietary cobalamin does not correct this anemia if intrinsic factor is lacking or if there is impaired absorption in the ileum
what is folic acid?
- Folic acid is required for DNA synthesis
- RBC formation and maturation
Folic Acid Deficiency
Common causes are Dietary deficiency
- Malabsorption syndromes
- Increased requirement (i.e., pregnancy)
- Alcohol abuse and anorexia
Loss during hemodialysis
Gluten is a protein found in wheat, rye, and barley. It may also be in other products like vitamins and supplements, hair and skin products, toothpastes, and lip balm.
what is celiac disease (genetic)
Celiac disease is an immune disease in which people can’t eat gluten because it will damage their small intestine. If you have celiac disease and eat foods with gluten, your immune system responds by damaging the small intestine.
Treatment is a diet free of gluten.
folic acid deficiency serum folate level
Serum folate level is low but vit b12 is normal
We can treat them by replacement therapy or eat the food with larger amount of folic acid
most common type of anemia
Iron Deficiency Anemia
Nutritional iron deficiency Metabolic or functional deficiency Progression of iron deficiency causes: Brittle, thin, coarsely ridged, spoon-shaped nails A red, sore, painful tongue
Normocytic anemia:
Acute and chronic Blood Loss
Anemia resulting from blood loss may be caused by either acute or chronic problems
Acute blood loss occurs as a result of sudden hemorrhage
When acute blood loss is more gradual
- the body maintains its blood volume by slowly increasing the plasma volume, but then the number of RBCs is significantly diminished
Consequently, blood transfusions (packed RBCs) may be needed if the blood loss is significant.
When anemia exists after acute blood loss…
When anemia exists after acute blood loss, dietary sources of iron will probably not be adequate to maintain iron stores.
Therefore oral or parenteral iron preparations are administered
Some causes of chronic blood loss:
- Bleeding ulcer
- Hemorrhoids
- Menstrual and postmenopausal blood loss
Blood Transfusion complications
Not linked into one baseline hemoglobin level but recommended for HCT < 30
- Fluid overload
- Blood-borne infection
- Exposure to donor leukocytes
Acute hemolytic transfusion reaction
Incompatibility
Hypothermia – ventricular dysrhythmias
what is Sickle Cell Disease
Inherited structural abnormality in the hemoglobin
- Crystal-like, elongated, rigid cell causes occlusion in the microcirculation
- Sickling in response to cold, dehydration, hypoxia, infection, and acidosis
Treatment of Sickle Cell Crisis
- Oxygen administration
- Aggressive intravenous fluid hydration
- Prompt treatment of infection with broad-spectrum antibiotics
RBC transfusions are not usually required - Pain control with around-the-clock narcotics
- Folic acid supplementation
- Hydroxyurea
- Hematopoietic stem cell transplantation (HSCT) is promising towards finding a cure for Sickle Cell Disease
Polycythemia Vera
A condition in which the red blood cell mass is increased.
Relative polycythemia
results from a loss of vascular fluid and is corrected by replacing the fluid
Primary polycythemia
a proliferative disease of the bone marrow with an absolute increase in total red blood cell mass accompanied by elevated white cell and platelet counts
Secondary polycythemia
is caused by other disease processes that induce hypoxia. For these, the underlying cause is treated. These include: chronic heart and lung disease, living at high altitude, sleep apnea
RBCs and platelets are formed
in the marrow and released into circulation.
lifespan of WBC
The life span of WBCs is relatively short; constant renewal is necessary to maintain normal blood levels.
Conditions that decrease availability of stem cells or hematopoietic growth factors produce a decrease in WBCs.
Leukopenia deficiency of leukocytes
Neutropenia
Granulocytopenia
Aplastic anemia
Anemia, thrombocytopenia, and agranulocytosis
RBCs and platelets are formed in the
the marrow and released into circulation.
whats is Infectious Mononucleosis
Self-limited lymphoproliferative disorder
Causes and Characteristics
of infectious mononucleosis
- Caused by the B-lymphocytotropic EBV, a member of the herpes virus family; transmitted in saliva
- Characterized by fever, generalized lymphadenopathy, sore throat, and the appearance in the blood of atypical lymphocytes and several antibodies
- Highest incidence in adolescents and young adults
Treatment is symptomatic and supportive.
Neoplastic Disorder of Hematopoietic and Lymphoid Origin
Represent the most important of the white cell disorders
Hodgkin disease
Reed-Sternberg cells are present.
Reed-Sternberg cells are derived
from B lymphocytes
Non-Hodgkin disease
Reed-Sternberg cells are not present.
Symptoms of Hodgkin Disease
- Stage A
Lack constitutional symptoms - Stage B (40% of persons with Hodgkin disease)
Significant weight loss, fevers, pruritus, or night sweats
ADVANCED STAGES
- Fatigue and anemia
- Liver, lungs, digestive tract, and CNS may be involved.
Categories of Non-Hodgkin Lymphomas
- Low-grade lymphomas
Predominantly B-cell tumors - Intermediate-grade lymphomas
Include B-cell and some T-cell lymphomas
- High-grade lymphomas Largely immunoblastic (B cell), lymphoblastic (T cell), Burkitt, and non-Burkitt lymphomas
what are Leukemias
Malignant neoplasms arising from the transformation of a single blood cell line derived from hematopoietic stem cells
Lymphocytic leukemias
lymphocytes
Myelocytic leukemias
granulocytes
monocytes
chronic leukemias
Malignancies involving the proliferation of well-differentiated myeloid and lymphoid cells
Types of chronic leukemia
- Chronic lymphocytic leukemia (CLL)
- Chronic myelogenous leukemia (CML)
Acute lymphocytic (lymphoblastic) leukemia (ALL) Chronic lymphocytic leukemia (CLL)
- Both involve immature lymphocytes and their progenitors in the bone marrow, the spleen, lymph nodes, CNS, and other tissue.
Acute myelogenous (myeloblastic) leukemia (AML)
Chronic myelogenous leukemia (CML)
Both involve the pluripotent myeloid stem cells in bone marrow and interfere with the maturation of all blood cells.
Factors Affecting the Likelihood of Achieving Remission
- Age (most significant prognostic variable)
- Type of leukemia
- Stage of the disease at time of presentation
Multiple Myeloma definiation
A plasma cell dyscrasia characterized by expansion of a single clone of immunoglobulin-producing plasma cells and a resultant increase in serum levels of a single monoclonal immunoglobulin or its fragments
Main sites involved
in multiple myeoma
- The bones and bone marrow
- Proliferation and activation of osteoclasts that lead to bone resorption and destruction
- Pathologic fractures
- Hypercalcemia
