Path Random Shit Flashcards
What three ways does insulin resistance cause steatosis (accumulation of fat in hepatocytes)
- Impaired oxidation of fatty acids
- Increased synthesis and uptake of FA
- Decreased hepatic secretion of VLDL
Metabolic syndrome is defined as having at least two of what four things?
- Obesity (over 30 BMI)
- Insulin resistance
- Dyslipidemia
- HTN
Function of adiponectin
Anti inflammatory cytokine produced exclusively by fat cells (thank God I have a lot of it)
- -> enhances insulin sensitivity
- -> is reduced in metabolic syndrome
What 7 cancers are associated with obesity?
- Colon
- Breast
- Endometrium
- Esophagus
- Thyroid
- Kidney
- Gallbladder
- obesity was the direct cause in up to 40% of endometrial and esophageal adenocarcinoma
What 5 mechanisms are thought to be the reason obesity can cause cancer?
- Increased estrogen (breast, endometrial)
- Increased IGF-1 (increased cell turnover and growth)
- Leptin (also promotes cell proliferation)
- mTOR (is a tumor growth regulator, fat cells direct/indirect effect)
- Chronic low level inflammation
*Cancers due to obesity are more fatal than average as well (20% of deaths in women and 14% in men)
What two symptoms result when 20-30% of Hgb is bound to CO?
Headache and exertional dyspnea
What two symptoms result when 60-70% of Hgb is bound to CO?
Coma and death
Emphysema can be thought of as resulting from what?
Inadequate wound repair
- TGF beta polymorphisms can lead to reduced mesenchymal cell response to TGF beta = inadequate repair
What 3 cytokines are implicated in damage due to smoking?
- IL-8
- LTB4
- TNF
What two factors result in collapse of alveoli in emphysema?
Inactivation of alpha1 AT and resulting relative increase in function of neutrophil elastase
- smoking causes inflammation and subsequent neutrophilic invasion
Micro path finding in respiratory bronchilitis?
Macrophages in the airspace; loaded with granular brown/black pigment (carman particles)–> “dusty macrophages”
What are Macrophages due to heart failure loaded with?
Hemosiderin
What is different about lead, mercury, arsenic, and cadmium compared to iron?
Only iron can be stained on H&E
What conditions is basophilic stippling seen in? What are they?
lead poisoning; megaloblastic anemia due to B12 or folate def.
Are persistent ribosomes, mature RBCs shouldn’t have any
What are usual, general manifestations of low-level iron toxicity?
CNS deficits– memory loss, hostility, hyperactivity
- symptoms are worse in children and usually lead to outright deficits (verbal ability, hearing loss, behavior probs) due to greater BBB permeability in little dudes
What are three fairly common issues with high level of lead toxicity?
- Abdominal pain
- Arthralgias
- Renal insufficiency
- on boards look for dat wrist/foot drop due to peripheral Demyelinating neuropathy. anemia is too obvious to have listed it, if you don’t know that by now, YOU FAIL
What is elevated in the RBCs in lead poisoning?
Protoporphyrin–> lead inhibits the enzymes delta-aminolevulinic acid dehydratase and ferrochelatase in heme synthesis
Mechanism of lead’s neurotoxicity?
Competes with Ca (both are divalent) in mitochondrial respiration; also interferes with activation of Protein kinase C (so jacks with 2nd messenger signaling). It is possible nerves also use calcium somewhat to release vesicles of NT, so lead fux with that too
How many MIs does smoking have a role in?
1/3
What are 4 ways smoke helps cause MI?
- Injure endothelial cells= increased permeability to lipids
- Inflammation = pro coagulant state
- Increase HR, BP, and MI (increased myocardial demand for blood)
- Carbon monoxide decreases blood oxygen-carrying capacity
What component of smoked amuses most of the CV harm? (According to Dr. Nipples, oh, Nichols)
Nicotine
3 common causes of steatosis?
Chronic alcohol consumption, obesity, uncontrolled DM
3 ways EtOH causes steatosis?
- Increased NADH/NAD+ ratio due to ethanol metabolism shunts substrates away from fat breakdown to lipid biosynthesis ( enzyme for catabolism of fat need NAD+ to do their thang)
- Impaired assembly/secretion of lipoproteins
- Increased peripheral catabolism of fat
What are two features of hepatitis?
- Acute neutrophilic inflammation
- Dying hepatocytes with pulmonic nuclei
- prob some ballooning hepatocytes as well
What 4 molecules from alcohol use cause hepatitis?
- Acetaldehyde ( induces lipid per oxidation and adduct to proteins, damaging cytoskeleton and membrane function)
- ROS (released from MEOS [CYP2E1], which is induced and thus more active
- TNF (MAIN effector of injury)
- Ethanol itself (cytoskeleton injury =. Mallory-Denk bodies)
Hormone replacement therapy increases the risk of what 2 complications?
- Breast cancer
2. Thromboembolism
Acetaminophen toxicity causes what specific kind of liver damage?
Centrilobular hepatic necrosis (zone3, this is closest to central vein and where CYPs are found the most)
Cirrhosis is defined by the presence of what?
Regenerative nodules of hepatocytes, surrounded by fibrosis and not hooked up to hepatic arterial supply, portal venous circulation, or biliary system
% of alcoholics that get cirrhosis? How long does it take?
Only 15%; usually takes around 15 years
HepatocellulR carcinoma is the cause of death in what % of those with alcoholic liver dz?
3-6%
What are 4 other complication of chronic alcohol use (one is CA, 2 are CNS)
- Breast cancer
- Cerebral atrophy
- Cerebellar degeneration
- Alcoholic cardiomyopathy
Kwashiorkor is caused by what
Protein starvation particularly; these kids usually getting the bulk of their nutrition via carbohydrates
What two conditions are caused by kwashiorkor?
- Edema
- Steatosis
- both due to impaired protein synthesis by liver–> no lipoproteins causes accumulation of lipid in the liver; no albumin production causes edema
What is marasmus?
General starvation of all nutrients in proportion–> these are the ones that look like skin and bones
What is the principal cause of weight loss with cachexia?
TNF
