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Semester 1 Finals > Patho Final > Flashcards

Patho Final Flashcards

1
Q

Concentration of the ICF, ECF, ISF, and plasma

A

ICF = 25L
ECF = 15L
ISF = 12L
Plasma = 3L

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2
Q

Major differences between ECF + ICF

A
  • presence of cell proteins in ICF that cannot permeate the cell membrane to leave the cells
  • unequal distribution of Na+ and K+ and their attendant ions as a result of the action of the NaK ATPase pump
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3
Q

What two factors maintain the body fluid balance?

A
  1. ECF volume
    - helps give enough pressure for blood flow to tissues
    - maintaining salt content in the body is necessary for long-term defense of ECF volume –> ALDOSTERONE
    - lack of “pressure diuresis” keeps volume and pressure steady long term
  2. ECF Na+ concentration/osmolarity
    - helps prevent swelling or shrinking of cells
    - 90% of regulating ECF osmolarity
    - ADH + thirst add H2O to ECF, diluting the salt
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4
Q

osmolarity

A

measure of the concentration of individual solute particles dissolved in fluid

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5
Q

How can you change the osmolarity?

A
  1. Deficit of free water in ECF
    - DEHYDRATION
    - osmolarity = hypertonic
  2. Excess of free water in ECF
    - OVERHYDRATION
    - osmolarity = hypotonic
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6
Q

Causes of hypertonicity, symptoms, effects

A

Causes:
- insufficient water intake
- excessive water loss
- diabetes insipidus

Symptoms/Effects:
- shrinking of brain neurons
confusion, irritability, delirium, convulsions, coma
- circulatory disturbances
lower plasma volume –> lower BP –> circulatory shock
- dry skin, sunken eyeballs, collapsed neck veins, dry tongue

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7
Q

Causes of hypotonicity, symptoms, effects

A

Causes:
- Renal failure –> cannot excrete dilute urine
- Drink water too quickly –> kidneys cannot respond fast enough
- SIADH –> too much ADH secretion –> water retained

Symptoms/Effects:
- WATER INTOXICATION –> swelling of brain cells
confusion, irritability, lethargy, headache, dizziness, vomiting, drowsiness, convulsions, coma, death
- weakness
- circulatory disturbances –> HTN (maybe) and edema

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8
Q

H2O Output - Insensible vs. Sensible Loss

A

Insensible
- NON-neural
- lungs
- non-sweating skin

Sensible
- Neural
- sweating, feces, urine excretion

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9
Q

What stimulates vasopressin? (normal conditions)

A

osmolarity rise

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10
Q

What produces vasopressin? What stores vasopressin?

A

produces: hypothalamus
stores: hypothalamus

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11
Q

hypothalamic osmoreceptors

A

vasopressin-secreting cells and thirst cells

osmolarity increase = vasopressin (ADH) secretion + thirst stimulated
osmolarity decrease = vasopressin (ADH) secretion decreased + thirst suppressed

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12
Q

What stimulates vasopressin? (emergency conditions)

A

drop in volume

  • left atrial receptors monitor pressure of blood flowing through (reflects ECF volume) –> detects major reduction in arterial pressure –> stimulate vasopressin secretion + thirst
    ex. HEMORRHAGES
  • angiotensin II –> stimulates vasopressin secretion + thirst when RAAS system activated to conserve Na+ (secondary)
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13
Q

Normal ABG values (pH, pO2, pCO2, O2 sat, HCO3-)

A

pH = 7.4 (7.37-7.44)
pO2 = 80-100
pCO2 = 36-44
O2 sat. = >95
HCO3- = 22-26

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14
Q

What pH values are deadly?

A

anything outside [6.8 - 8.0]

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15
Q

What is considered acidosis? Alkalosis?

A

Acidosis = below 7.35
Alkalosis = above 7.45

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16
Q

Small changes in pH can produce major disturbances including…

A
  1. dysfunction of enzymes –> work within narrow pH ranges
  2. electrolytes (Na+, K+, Cl-)
  3. hormones
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17
Q

What happens to the excitability of nerve and muscle cells with a fluctuation in pH?

A
  • changes enzyme activity
  • changes K+ levels in body (H+ and K+ compete for secretion into tubules)
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18
Q

Sources of H+ in the body

A
  • carbonic acid formation –> from metabolically produced CO2
  • inorganic nutrients produced during breakdown of nutrients
    proteins in diet –> sulfuric + phosphoric acid
  • organic nutrients resulting from metabolism
    fatty acids (fat), lactic acid (muscles primarily)
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19
Q

The body produces more (acids/bases) than (acids/bases).

A

ACIDS
- foods, metabolism of lipids + proteins, cell metabolism produces CO2

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20
Q

What are the following products?
1. Protein breakdown
2. Anaerobic resp. of glucose
3. Fat metabolism
4. Transporting CO2 as bicarb

A
  1. phosphoric acid
  2. lactic acid
  3. organic acids and ketones
  4. H+

ALL ACIDS

21
Q

What is a buffer?

A

Buffers are solutions which can resist changes in pH when acid or alkali is added

22
Q

Most important buffers

A
  1. phosphate (renal tubular buffer)
  2. ammonia (renal tubular buffer)
    - NH3 (ammonium) is TOXIC
  3. proteins (INTRACELLULAR and PLASMA buffers)
    - HHb predominant protein RBC
  4. bicarbonate (EXTRACELLULAR + renal tubular buffer)
23
Q

Buffers used by the following systems:
1. Respiratory
2. Blood
3. Kidneys

A

Resp. = Bicarb
Blood = bicarb, phosphate, PROTEINS
Kidneys = bicarb, phosphate, AMMONIA

24
Q

Bicarb buffer + function

A

Sodium bicarb (NaHCO3) + carbonic acid (H2CO3)

maintain a 20:1 (HCO3:H2CO3)

25
Most important buffer system in the *plasma*
bicarbonate - 65% of buffering capacity in plasma - 40% of buffering capacity of the whole body
26
Why isn't phosphate buffer the predominating buffer?
very effective, but not found in high concentrations in all tissues (mostly renal tubular and intracellular) - bicarb better --> higher conc. in all tissues plus carbonic anhydrase - low concentration in plasma - easy to shift equation to left or right with an addition of H+ or OH- (H2PO4- <-> H+ +HPO4 2-)
27
Primary ICF buffer
protein buffers - includes HgB carboxyl gives up H+ amino accepts H+
28
What is the primary buffer against carbonic acid changes?
protein buffers
29
Most important buffer system in the *body cells*
protein buffer - HgB 16 histidine residues in albumin 38 histidine residues in HgB function: accept H+ and act as a buffer in RBCs + plasma
30
Ammonia buffer system
inducible in kidneys - can greatly increase ammonia production from glutamine in chronic acidosis
31
Most important buffer system in the *renal system*
ammonia buffer system - excess H+ can be picked up by ammonia system - kidney makes ammonia by breaking down glutamine (AA) - ammonia secreted into the filtrate while the good products are reabsorbed
32
____% of the buffering capacity is in cells ____% is in RBCs ____% of the buffering capacity is in the extracellular space
52% cells 5% RBCs 43% extracellular space - 40% by bicarb buffer, 1% by proteins, 1% by phosphate buffer system
33
What does the respiratory buffering system do?
Controls CO2 levels, while the kidneys secrete bicarb
34
What resp. condition creates an alkaline condition? Acidic conditions?
ALKALINE = hyperventilation - leads to loss of CO2 ACIDIC = hypoventilation - central receptor increases ventilation as CO2 builds up
35
What detects CO2 concentration changes? Where does it send the appropriate signal to?
peripheral receptors
36
Respiratory mechanisms do not work on ________ acids
fixed acids (ex. lactic acid) ONLY volatile acids
37
Kidney excretion
1. EXCRETE large amounts of acid / base 2. CONSERVE and produce bicarb 3. MOST EFFECTIVE regulator of pH kidney fails = pH balance fails
38
How do the kidneys maintain acid-base balance?
overall: regulating pH of blood plasma
39
What are the two roles that the kidneys maintain acid-base balance?
1. reabsorb bicarb from urine 2. excrete H+ into urine
40
What is the major homeostatic control point for maintaining a stable balance?
renal excretion
41
How can the kidneys control acids and bases in acidosis?
intercalated cells - secrete excess H+ - binds to buffers in the lumen (ammonia and phosphate bases) - formation of bicarb Pee it out, bind to other bases in the wall (lumen), or make bicarb via carbonic anhydrase
42
Respiratory mechanisms take _________ to correct Renal mechanisms take _________ to correct
resp = minutes to hours renal = hours to days
43
First line of defense against pH shift
1. bicarb buffer system 2. phosphate buffer system 3. protein buffer system
44
Second line of defense against pH shift
1. respiratory mechanism (CO2 excretion) 2. renal mechanism (H+ excretion)
45
What is an anion gap?
The difference between the measured anions (-) and cations (+) in serum plasma or urine. Calculated to determine the cause of metabolic acidosis. If gap is greater than normal, then noted for a high anion gap metabolic acidosis.
46
What does it mean when if the anion gap is GREATER than the change in [HCO3-] from normal?
metabolic alkalosis is present + gap metabolic acidosis
47
What does it mean when if the anion gap is LESSER than the change in [HCO3-] from normal?
non-gap metabolic acidosis + gap metabolic acidosis?
48
What does a metabolic acidosis represent?
An increase in acid in body fluids] - reflected by a decrease in [HCO3-] and a compensatory decrease in pCO2

Semester 1 Finals (4 decks)

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