GP 6,7,8 Flashcards
how much of the 60% of fluid body weight is made of intracellular fluid?
40% intracellular fluid
how much of the 60% of fluid body weight is made up of extracellular fluid?
20% total
plasma 4%
interstitium 16%
what is the extracellular matrix also called
intersitium
what is the extracellular matrix made up of?
-structural (collagen type I, elastin)
-adhesive (fibronectin, laminin)
-absorptive components (glycosaminoglycans, proteoglycans)
what is the difference between lymphatic and venule interendothelial junctions
venules or arterioles allow movement of fluid between blood and interstitum where as lymphatic vessel junctions allow things to pass but can also expand and shut/seal it off
what controls fluid movement in the body?
-hormones
-receptors
-osmotic and hydrostatic forces
-integrity of the vascular system
what hormones in the body control fluid movement
-RAAS (vasoconstriction and water retention)
-artial natriuretic peptide (ANP) by cardiomyocytes (promoting renal sodium and water excretion and stimulating vasodilation)
what receptors in the body help regulate/control fluid movement and where are they located?
-osmoreceptors in hypothalamus
-baroreceptors in blood vessels
what is shock
cardio vascular collapse
circulatory failure
-systemic hypoperfusion due to macro- and/or micro-circulatory failures
what are the steps toward the outcome of shock
hypotension > impaired tissue perfusion > cellular hypoxia > anaerobic metabolism > cellular degeneration > cell death
what are the two types of macrocirculatory failure shock
cardiogenic
hypovolemic
what is cariogenic shock and what are some examples
-failure of the heart to adequately pump blood
- myocardial infarction, ventricular tachycardia, fibrillation, arrhythmias, hic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), cardiac output obstruction (pulmonary embolism, aortic stenosis), pericardial tamponade
what is hypovolemic shock
reduced circulation of blood volume by massive blood loss or fluid (vomiting, diarrhea or burns) leading to decreased vascular pressure and tissue hypoperfusion
main difference between macro and micro circulatory failure
macro is decrease volume of the heart but micro total blood volume is the same it is just being maldistributed
what type of shock is microcirculatory failure and explain what it is
blood maldistribution
-decrease peripheral vascular resistance and polling of blood in vascular peripheral tissue
what are three types of blood maldistribution shock
- anaphylactic shock: generalized type I (Ig E) hypersensitivity
- septic shock: most common type- endotoxemia
- neurogenic shock: trauma, particular trauma to nervous system, electrocution, fear , emotional stress
what does DIC result in pathologically
- small blood clot formation inside blood vessels throughout body
- consumption of coagulation proteins and platelets > disruption of normal coagulation causing abnormal bleeding
- clots plug normal blood flow to organs (kidneys, distal extremities) > ischemic injury
what is acute respiratory distress syndrome ARDS
multifactorial source of injury to respiratory capillary endothelium (generally primary) and epithelium (diffuse alveolar damage, necrosis, often secondary)
what does TLR-4 do to the endothelium and monocytes/macrophages in septic shock
-when LPS (of gram negative bacteria) bind to endothelium it down-regulates the anticoagulants (tissue factor pathway inhibitor and theombomodulin)
-when LPS binds to monocytes/macropahges it increases production of IL-1,IL-6, TNF
what are some inciting causes of ARDS
endotoxemia, sepsis, disseminated pulmonary infections, extensive trauma, burns, transfusions, DIC, pancreatitis, aspiration of gastric contents
what is happening during neurogenic shock
if there is trauma, spinal cord injury, fear, electricity > the body triggers generalized autonomic nervous system > sympathetic tone gets lost and the parasympathetic tone dominates, vasodilation > massive peripheral vasodilation w bradycardia > pooling of blood > hypoperfusion
stages in development of shock
-compensation: heart rate increases, peripheral vasoconstriction, ADH and angiotensin II released > increased blood pressure and blood is diverted to vital tissue
-progression: anaerobic metabolism > acidosis , vasodilation
-irreversible: cell and tissue necrosis, leading to multi-organ failure and death
what is metaplasia
-reversible exchange within a tissue of one mature cell type (differentiated adult cells) for another mature (adult) cell type (changing cell types)
-requires “reprogramming” of reserved cells (stem cells)
what is dysplasia
-atypical differentiation, disorderly arrangement
-may be partially reversible
-it often develops at sites of chronic inflammation
*disorganized
steps in neoplastic transformation
- initation: irreversible genetic change in replicating cell population
- promotion: reversible; do not affect DNA directly, create an environment that gives initiated cells a growth advantage over the rest of the population
- progression: irreversible/reversible, conversion of benign tumor to an increasingly malignant tumor and ultimaelty to metastatic tumor (promoting own blood supply, proliferating, detaching and moving to distant sites)
what are the heritable alterations contributing yo carcinogenesis
DNA mutation
epigenetic changes
chromosomal alt
what origin are -carinoma from
epithelial origin
what origin are -sarcoma from
mesenchymal origin
know this list
what is the bengin and malignant neoplasms for glandular epithelium
-benign: adenoma
-malignant: carcinoma
what is the benign and malignant neoplamsmic terms for squamous epithelium
-bengin: papilloma
-malignant: squamous cell carcinoma
what is the benign and malignant neoplasmic terms for liver
-benign: hepatoma
-malignant: heptatocellular carcinoma
what is the benign and malignant neoplamic term for skeletal muscle
-bengin: rhabdomyoma
-malignant: rhadomyosarcoma
what its benign and malignant neoplamic term for smooth muscle
-benign: leiomyoma
-malignant: leiomyosarcoma
what is the bengin and malignant neoplasmic term for bone
-benign: osteoma
-malignant: osteosarcoma
what tumor-like lesion is hamartoma
disorganized, mature tissue in normal location
what tumor-like lesion is choristoma
disorganized, ,nature tissue in abnormal location (ectopic)
know this
what is the descriptor word for this tumor
pedunculate
polypoid
descriptor word for this tumor
papillary
decriptor word for this tumor
ulcerated
descriptor word for this tumor
sessile
attached to base without stalk
descriptor word for this tumor
annular
ring shaped
descriptor word for this tumor
fungating
marked ulceration and necrosis, bad smell
describe the pattern of this histological image of this tumor
sheets (common for round cell tumor)
describe the pattern of this histological image of this tumor
packets
common in neuroendocrine tumors
describe the pattern of this histological image of this tumor
nests
common in invasive carcinoma
describe the pattern of this histological image of this tumor
cords
often seen in epithelial tumors
describe the pattern of this histological image of this tumor
lobules
common in some epi tumors
describe the pattern of this histological image of this tumor
acini
indicative of glandular epithelial origin
describe the pattern of this histological image of this tumor
lobules
indicative of glandular epithelia origin
describe the pattern of this histological image of this tumor
cystic
seen in some glandular tumors
describe the pattern of this histological image of this tumor
whorls
seen in mesenchymal (connective tissue) tumors
describe the pattern of this histological image of this tumor
papillary
glandular tumors
describe the pattern of this histological image of this tumor
bundles
typically mesenchymal tumors
take a look
what is the mechanism for invasion, stepping from benign to malignant
-impairment of cell adhesion
-basement membrane (basal lamina) degradation via proteases
-extension into permissive tissue, cleavage of basement membrane protein generates novel sites that bind to receptors on tumor cells and stimulate migration
stages of invasion and metastasis
- transformed cells must detach from main mass, adhere to and penetrate the basement membrane and enter the cellular matrix
- intravastion- extension through endothelium, interaction with lymphoid cells and coating with platelets (formation of tumor emboli)
- extravasation- extension back through endothelium, formation of metastatic deposit, and angiogenesis
what are the common metastatic routes to go other places in the body
- hematogenous (preferred routes for sarcomas)
- lymphatic (preferred by carcinomas)
- transcoelomic exfoliation and implantation (mesotheliomas)
what is the paraneoplastic syndrome associated with apocrine adenocarcinoma of the anal sac
hypercalcemia
what is your diagnosis?
-neoplastic round cells
-solid sheets
-basophilic cytoplasmic granules
-eosinophils present
routes for hematogenous to get to places in the body
diagnosis and route of metastasis
cholangiocellular carcinoma with transcolemic exfoliation and implantation
diagnosis and route of metastasis
humeral osteosarcoma with metastasis to lung
paraneoplastic syndrome
symptom complexes that cannot be directly attruvited to local or distant tumors
ex hypercalcemia
what are the primary effects of tumors
-loss of function: metastatic or primary tumors in lungs leading to impaired respiration
-pain and discomfort: specific sites such as bone
explain mechanism of septic shock
most common cause is endotoxins that produce gram - bacteria, the LPS from the gram - bacterial cell wall forms a complex with blood proteins and LPS binds to TLR-4
what is morphological diagnosis and tissue change
endocardiosis
myxomatous metaplasia
what is the diagnosis
oligodendrolioma
what is your diagnosis
lymphoma (round cell tumor)
classify this hemorrhage
petechial hemorrhage
capillaries vs lymphatics
-capillaries: atertial-venous transition, tissue to blood nutrient and waste transition
-lymphatics: bind end capillaries that dump into venous system, low pressure valved that depend on forces like muscle contraction to maintain flow, large gaps that allow fluid and proteins to move in and out of interstitium
when LPS induces a high production of TNF, IL1, IL6/IL8, NO, PAF what occurs
they promote high systemic vasodilation and increased vascular permeability > intravascular plasma protein loss decreased oncotic forces > additional intravascular fluid loss > toxins and cytokines induce loss of peripheral vascular tone > hypotension > hypoperfusion > septic shock
what are some heritable alterations that contribute to carcinogenesis
DNA mutations
epigenetic changes
chromosomal alterations
spindle cells are usually associated with what type of neoplastic cell
sarcoma
brain tumors are usually named for the cell type in the brain, what are the names for astrocytes and oligodendorcytes
astrocytoma
oligodendroglioma
