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Pathophysiology > pain, sleep, temp, and sensory function > Flashcards

pain, sleep, temp, and sensory function Flashcards

1
Q

what is pain?

A

active tissue damage. sensory info as a through, emotion, feeling
- no correlation between amount of tissue damage and amount of pain

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2
Q

nociceptive pain

A
  • nociceptor receptors
  • sharp, distinct pain
  • triggers nociceptors (pain receptors)
  • somatic: joints, muscle, skin
  • visceral: organs (tumors/obstruction). fewer nocireceptors. broad, referred pain
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3
Q

neuropathic

A
  • pain without a stimulus
  • nociceptive can lead to neuropathic
  • central: central or peripheral NS
  • peripheral: neuropathies (DM/GB disease)
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4
Q

Large A Fibers

A
  • initial, immediate, sharp pain
  • a stab or cut
  • myelinated fibers travel fast impulses
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5
Q

small c fibers

A
  • prolonged, dull pain, achy, persistent

- non-myelinated, slower impulses

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6
Q

good side of pain

A

analgestic: we produce these pain-relievers ourselves
* Endorphins: exercise, runner’s high
- neuropeptides that inhibit transmission of pain impulses in the spinal cord and brain by binding to opiod receptors

  • Enkephalin: less potent than endorphins
  • weaker anelgestic but more potent and longer lasting than morphine
  • dynorphin: inhibits but can also INCITE pain
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7
Q

nociceptors

A
  • “free nerve ending”
  • dermis, muscle, joints, viscera
  • respond to chemical, mechanical, and thermal stimuli
  • large A/delta fibers - detect touch, vibration, thermal and sharp pain
  • small c/unmyelinated - long-lasting dull pain
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8
Q

nociception pain pathway

A
  1. transduction - tissue damage releases substances that bind to nociceptors and activate small C fibers
  2. transmission - from small c fibers –> spinal cord –> brain stem –> thalamus –> cerebral cortex
  3. perception - in the cerebral cortex detect pain.
  4. modulation - inhibit or control pain. brain releases endorphins down spinal cord
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9
Q
  1. transduction
A
  • tissue damange
  • sensitizing substances - prostaglandins, bradykinis, substance p (all cause pain)
  • action potential - wave of depolarization
  • SMALL C starts action potential
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10
Q
  1. Transmission
A

tissue damange –> spinal cord –> brain stem and thalamus –> cerebral cortex

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11
Q
  1. Perception
A

awareness of pain

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12
Q
  1. modulation
A

endogenous - from within body

  • inhibition of nociceptive impulses SMALL C
  • brain stem (endorphins, serotonin) –> spinal cord (block signals at spinal cord)
  • norepinephrine stops anticipated pain
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13
Q

pain - gate control theory

A
  • small c fibers - pain (diffuse, burning, aching, itches). = open pain gate –> heat pad, itching, etc. stimulates large A
  • Large A - touch, vibration, thermal inhibition of pain = close pain gate = exogenous modulation
  • large A beats nocicpetors to stimulus and blocks pain
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14
Q

endogenous vs exogenous pain

A

endogenous = down spinal cord. (still nociceptors)

exogenous = outside of body, rubbing, itching, heat (still nociceptors)

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15
Q

acute pain

A
  • immediate, harmful alert, acute anxiety
  • tissue damage, self-limiting, ends with healing
  • SOMATIC: superficial, sharp, well-localized
  • VISCERAL: referred pan, decreased nociceptors. internal organs, abdoment, skeletal, poorly localized. nausea and vomiting, hypotension, restlessness and shock
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16
Q

referred pain

A

pain in one location referrs pain to another areas associated with it

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17
Q

chronic pain

A

chronic inflammation/injury

  • greater than 3 months
  • related to tissue damage, inflammation or injury of nervous system
    a) intermittent = comes and goes, chronic migraines
    b) persistent = continual, lumbago. sacrolumbar pain
    c) neuropathic - brain’s perception of pain
  • hyperalgesia = hypersensitibity to stimuli
  • allodynia - perception of pain w/o stimuli (fibromyalgia)
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18
Q

Fever

A
  • means presence of a foreign body
  • resetting of hypothalamic thermostat
  • heat = muscle contractions
  • exogenous pyrogens (endotoxins) = increase in hypothalamus temperature control
  • endogenous pyrogens = mast, basophils. body processes
    BENEFITS: kills pathogenic microorganisms (denaturing and inhibiting) & incrases reactions and pathways in cells that may increase dense mechanisms)
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19
Q

hyperthermia

A

high body temp

  • NOT mediated by pyrogens, no resetting of the hypothalamic set point
  • nerve damage at 105
  • death at 109
  • heat cramps = increase in sweating, pulse, blood pressure, electrolyte loss
  • Heat exhaustion = dizziness, wekaness, nausea, confusion, syncope
  • heat stroke = cerebral edema, degeneration of CNS, necrosis and death
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20
Q

malignant hyperthermia

A

rare, inherited muscle disorder

  • anesthesia
  • precipitated by inhaled anesthetics and neuromuscular blocking agents. increase o2 and lactic acid
  • incrased muscle contractions, body temp
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21
Q

hypothermia

A

body temp below <35 c

  • decreases response and reactions
  • produces depression of CNS and resp systems, vasoconstriction, microcirculation, coagulation and ischemic tissue damage
  • severe - ice crystals form within the cells and rupture and death
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22
Q

Sleep

A

temporary state of restful unconsciousness with spontaneous arousal

  • two main stages:
  • REM: 60-90 mins, dreams. awake, very active brain
  • non-REM: stages 1-4, deep restful sleep. 6-8 hours for deep, restful sleep
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23
Q

sleep disorders

A
  • insomnia: inability to fall or stay asleep
  • sleep disordered breathing
  • obstructive sleep apnea = obese, overweight
  • nocturnal paroxysmal dyspnea = shortness of breath, postural dependent (CHF)
  • Hypersomnia: too much sleep
  • primary hypersonmnia - no root cause
  • secondary hypersomnia - something induces it. drugs, meds.
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24
Q

visual dysfucntion

A

from cranial nerves III (oculomotor), IV (cochlear), VI (abducens)
* strabismus: lazy eye. cases diplopia (double vision)
* Nystagmus: eyes shaking or twitching
CAUSES: inner ear, cerebellum, CN, drugs, retinal disease, cerbical cord disease

25
Q

alterations in refractions

A
  • myopia: nearsightedness (long eye ball, focus in front of the retina) can’t see far, only near
  • hyperopia - farsigntedness (focus behind retina, fat eye ball). can’t see close, only far
  • astigmatism: uneven corneal curvature (no single retinal focus). blurry vision
26
Q

the ear

A 
cochlear = hearing
vestibules = balance
27
Q

ear infections

A
  • otis externa: outside of tympanic membrane
  • infection of outer ear
  • prolonged moisture exposure and bacteria (swimmers ear)
  • otitis media: infants and children
  • acute - pain, fever, inglamed tympanic membrane with middle ear fluid
  • tubes
28
Q

ear - proprioceptive dysfuction

A
  • vestibular nystagmus: eyeball movement, overstimualtino of semicircular canals ( spin way too fast)
  • Vertigo: spining senstation to inflammation of semicircular canals. meniere’s disease. neuro disorders, changes in elevation, pressure on inner ear by tumor)
29
Q

aphasia

A

loss of language and speech, basic communication

  • CVA/stroke, brain tumor, infection, head injury, dementia
  • symptom of brain damage, not a disease itself
30
Q

boca area

A

mouth, motor speech

31
Q

wernickie’s area

A

sensory, understanding speech and written word

32
Q

4 categories of aphasia

A
  1. anomic/amnesia aphasia: can’t come up with name/word.
  2. expressive aphasia: damage to brocas area. difficulty conveying thoughts through speech or writing
    * ischemia, damage to brocas area
  3. receptive aphasia: bilateral, difficulty in understanding spoken or written language. wernickie
    * ischemia, damage to wernickie area
  4. global aphasia: most severe. both broca and wernickie. lose comprehension and expression of speech
    * damage to both brocas and wernickie
33
Q

cognition

A

full consciousness: awareness of self and environment

  • arousal: state of awareness. mediated by RAS. consciousness
  • thought: all cognitive functions. awareness of self, enviro, afective state/mood
34
Q

decorticate posturing

A

flexed arms up

  • severe brain damage symptom
  • symptoms contralateral to lesion
  • damage to cortical tract
35
Q

decerebrate posturing

A

extended arms and adducted

  • damage to upper brainstem and has worse prognoses that decorticate.
  • symptoms are ipsilateral (same side)
  • upper brainstem
36
Q

brain stem death

A

never recover nor maintain internal homeostasis

  • midrbain, medulla, pons
  • affects vital reflexes (breathing, heart rate, BP)
  • vegetative state - on life support
37
Q

cerebral brain death

A

coma survivors

  • can breath, heart beat
  • minimal conscious state
  • locked-in syndrom = lack of expression cannot speak or write but can totally understand speech and written word
38
Q

seizures

A
  • Partial: only part of the brain affected
  • focal and unilateral
  • Generalized: bilateral, symmetic
  • absence: spacing out for a few minutes
  • tonic clonic: ridig and relaxed state, convulsice, grand mal
  • epileptic: chronic reoccurrence of grand mal/tonic clonic
39
Q

Increase Intracranial Pressure (ICP)

A
  • Hydrocephalaus: excess fluid within cranial vault, subarachnoid space, or both
  • interference in CSF flow. decreased reabsorption, increased fluid production, or obstruction.
  • infancy through adulthood
40
Q

Coup Countercoup Injury

A

coup = initial impact
countercoup = secondary response
- stretch and pull brain tissue and neurons
- shreds veins and nerves

41
Q

cerebral concussion

A
  1. chemical injury with loss of ATP
  2. scary of neurons
    most common type of TBI
    - micro tearing of brain tissue
    - 2/3 of head injury deaths
    - no major broken blood vessels
    - no active bleeding, no LOC
    * damages neurons, chemical injury with ATP Loss
    - brain heals by scarring
    - confusion, amnesia, dizziness, fatigue, change in personality
42
Q

Brain Trauma

A
  • contusion/hematoma
  • brain bleed
  • broken blood vessels
  • direct contract (severe blunt trauma)
43
Q

Epidural Hematoma

A
  • arterial bleeds
  • b/n scull and dura
  • BBB doesn’t break
  • lucid interval - no there symptoms but headache
  • fast bleed
  • blunt trauma, car accident
44
Q

Subdural hematoma

A
  • venous bleed
  • below dura but above pia
  • slow bleed
  • most common and most fatal
  • increased ICP = lack of o2, hypoxia
  • BBB is broken = leukocytes and macrophages, inflammation, liquify brain tissue
  • elderly alcoholics - slips and falls
  • shaken baby syndrome
45
Q

Intracerebral hematoma

A
  • small arteries/veins
  • inside brain tissue/hemisphere
  • slow
  • produces symptoms quicker - decreased cognition, LOC, confusion
  • loss of BBB = liquefactive necrosis
  • penumbra = self limiting bleed
  • little to no change in ICP, bleeding doesn’t spread
  • CVA
46
Q

spinal cord trauma

A
  • quadriplegia - cervical and down damaged
  • paraplegia - below t1
  • hemiplegia - stroke, half of body affected
47
Q

degenerative disc disease

A

herniated nucleus pulposis

  • dorsal pinching = dull achy pain/shooting pain
  • ventral pinching = muscle weakness and pain
48
Q

circle of willis

A

collateral flow in brain. if there is damage or blockage in area still all areas can receive blood

49
Q

CVA/stroke

A

most frequent neuro disorder

  • ischemia = infarction. death of brain tissue
  • hemorrhage
  • > 65 years
  • > men
  • > african americans
50
Q

inflammation of the CNS

A
  • meningitis: infection of the meninges
    1. bacterial: pia mater, arachnoid, subarachnoid, ventricles and CSF
  • systemic blood stream or direct extension from an infected area
    2. aspetic: viral meningitis
  • enterovirus, mumps, herpes simplex, west nile, influenza
    3. fungal: chronic, less common
  • Encephalitis: infection of the brain
  • caused by arthropod-borne viruses and herpes simplex type 1
51
Q

Degenerative Diseases

A
  • dimentia
  • mild cognitive impairment
  • alzheimers disease
  • parkinsons
  • amyotrophic lateral sclerosis
  • multiple sclerosis
  • gullain-barre
  • senility: decreased cognitive function
  • dementia, mental impairment of elderly
  • MCI - loss of memory, recognition, mental calculations, mental pressing
52
Q

AD – Alzheimer’s Disease

A

Initial symptoms = memory loss (dementia); secondary (later) = motor function loss

Has strong genetic component

Tau tangles and Amyloid plaques inhibit brain neuron transmission = neurons deteriorate/degenerate = brain atrophy

53
Q

PD – Parkinson’s Disease

A

Initial symptoms = motor function loss; secondary (later) = memory loss (dementia)

Loss of dopamine production/release

Dopamine balances (counteracts) Acetylcholine (AcH) (think muscle contraction…)

Loss of inhibition by dopamine causes more action by AcH = muscle TREMORS

54
Q

ALS – Amyotrophic Lateral Sclerosis (Lou Gehrig’s)

A

Primary symptom = muscle weakness

Degeneration of somatic motor neurons (loss of voluntary skeletal muscle control)

Rapidly progressive - leads to respiratory failure and death
- normal intellectual and sensory function until death

55
Q

MS – Multiple Sclerosis

A

Primary symptom = muscle weakness

Demyelination of CNS neurons

Autoimmune disease = cyto t’s damaging oligo’s

Slower degeneration than ALS

56
Q

GB – Guillan Barre

A

Primary symptom = muscle weakness

Demyelination of PNS neurons

From infection (usually EBV virus)

  • acute peripheral neuropathy results in limb weakness.. progress in days to weeks
  • ## demyelination of peripheral neurons
57
Q

MD – Muscular Dystrophy

A

Primary symptom = muscle weakness

Muscle protein (dystrophin) problem (=musculoskeletal, not really neuro problem)

Duchenne MD = Most common in kids

Myotonic MD = most common in adults

58
Q

MG – Myasthenia Gravis

A

Primary symptom = muscle weakness

Autoimmune disease = Ab to AcH receptor = blocks/destroys = low muscle function

Pathophysiology (13 decks)

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