rrd 2 Flashcards
alterations in fluids and solutes, altered cellular and tissue biology, altered cellular proliferations
interstitium + cells = ?
tissue
the body receives about _____ mL of fluid intake normally per day (usually orally) and it enters the _______ compartment from the ______ of the gut.
2100, plasma, capillaries
once in the plasma compartment, water is circulated to the _____ and various _______ take place.
tissues, fluid shifts
what are the fluid shifts that take place in the tissues?
- water shifts from the blood into the tissue
- water shifts from the tissue into the blood
depends on the needs of the body
goal of fluid shifts
- maintain homeostasis between fluid compartments
- fluid concentration in all the compartments are kept the same or near-same
some fluid is excreted as part of products such as?
urine, feces, sweat, exhaled air
osmosis
- movement of water between compartments
- ruled by osmolality
rule of osmosis
water will always want to move from a more dilute compartment to a more concentrated compartment - CONCENTRATION CALLS
concentration is the ____ as osmolality so ______ orders!
same, osmolality
osmolality
- measurement of how concentrated a compartment is
- proportion of solutes-to-water that are in that compartment’s fluid
we can measure the solute concentration of the plasma compartment by doing a ____ and thus, have an idea about what fluid shifts to anticipate since osmolality rules osmosis.
serum osmolality
tonicity
- interchangeable with salinity
the normal tonicity/salinity of blood is?
normal saline concentration (NaCl) is 0.9%
if the tonicity of the blood is higher than 0.9%, the patient is ______. the blood is some way ____ concentrated than usual.
hypertonic or hyperosmolar, more
if the tonicity of the blood is lower than 0.9%, the patient is ______. the blood is in some way _____ concentrated than usual.
hypotonic or hypoosmolar, less
normal tonicity is ____. any fluid that has a saline concentration of 0.9% is _____ to normal blood.
isotonic
nickname for any saline fluid that is isotonic to the blood is ?
normal saline or NS
a bag of 0.45% NaCl is?
hypotonic
a bag of 3% NaCl is?
hypertonic
osmotic pressure
- pressure exerted by all the solutes in a compartment
- correlates with osmolality (higher the osmolality, the higher the osmotic pressure)
oncotic pressure
- colloidal osmotic pressure
- same principle as osmotic pressure but refers to protein molecules
water is pathologically LOST by the body: ______ concentration/osmolality in the plasma space (blood). what is the fluid shift?
increased, tissue-to-blood fluid shift
water is pathologically GAINED by the body or protein is lost: concentration of plasma space/blood is ______. what is the fluid shift?
decreased, blood-to-tissue fluid shift
common mechanism for an increase in blood osmolality is
loss of water
pathologic water loss can occur via?
- inadequate intake
- increased output
examples of increased output causing water loss?
- vomiting
- diarrhea
- increased urination
pathway of pathologic water loss
1). disease causing continuing water loss from the body
2). water loss from blood
3). increased blood osmolality
4). water loss from cells
5). dehydration
in certain intestinal infections, a microbe causes disruptions in the capillaries that line in the intestine. this causes water to ___ from the capillaries into the lumen of the intestines.
LEAK
- increase in fecal liquid is what causes diarrhea
as water leaks from the local capillaries, blood of the entire circulatory system is becoming _______ concentrated than the surrounding tissues all over the body.
MORE
since the plasma compartment (bloodstream) has a higher osmolality than the tissue compartment, water will be ________ the plasma compartment.
PULLED INTO - T to B shift
water being pulled into the plasma compartment leaves the tissue cells in what state?
dehydrated and shrunken
S&S caused by T to B fluid shift
- dehydration/fluid volume deficit
- poor skin turgor
- sunken eyes
- sunken fontanels in babies
- diminished urinary output (oliguria) and urine concentration increases
- low BP
- acute CNS changes: restlessness, confusion, unconsciousness, convulsions
what is skin turgor? what does it mean to have poor skin turgor?
- state of flexibility or tightness of skin cells due to how much water they have
- skin is pulled up and snaps back = good recoil and elasticity - adequate hydration
- poor skin turgor = skin is loose and little recoil, tents up when pulled = dehydration
lab work with dehydration will look like?
- high serum osmolality
- hyperosmolar blood
what intrinsic hormonal compensatory mechanisms does the body have to correct fluid volume deficient (and/or low BP)?
RAAS (renin-angiotensin-aldosterone system) and ADH (antidiuretic hormone secretion)
what is RAAS?
1). the kidneys secrete increased renin
2). renin stimulates secretion of angiotensin I -> becomes angiotensin II with the help of ACE (angiotensin-converting enzyme)
3). angiotensin II stimulates peripheral vasoconstriction and increases secretion of aldosterone from the adrenal gland
when do the kidneys increase renin secretion?
- when blood osmolality is high (and/or)
- when fluid volume in the circulation is low due to blood loss (and/or)
- BP is low
peripheral vasoconstriction
- less blood will flow into constricted blood vessels in the periphery
- blood stays in central circulation
what does aldosterone do?
1). causes kidney tubules to hold on to Na+
2). water follows Na+ back into circulation instead of going out with urine
3). urine output decreases
4). water in blood and general circulatory vol increases
RAAS causes _____ circulatory fluid volume and compensates for the initial problem of ____ fluid volume, ____ total blood volume, and/or ___ BP.
increased, low
when fluid volume is high, the RAAS is?
suppressed
what does ADH do for fluid volume deficit?
assists RAAS
decreased blood osmolality comes from?
pathologic water GAIN or protein LOSS
pathologic increase of water in the circulation result in the ____ of the blood and ____ serum osmolality.
dilution, lower
the vascular compartment is the ______ to change its composition.
first
blood changed to lower osmolality than tissue, so water is pulled?
B to T fluid shift
pathologic accumulation as excess fluid being pulled into the tissue is called?
edema
edema can impair what because of?
body processes like healing and oxygen exchange because of increased distance for nutrients and waste products to move btw capillaries and cells
steps of pathologic water gain/excess water to result
1). disease cause overall water gain to body
2). water gain to blood
3). decreased osmolality
4). water gain to tissue - edema
5). overall fluid overload
general steps of pathologic protein loss
1). disease cause loss of protein from body
2). deceased oncotic pressure (and osmolality) of blood
3). water gain to tissue (edema)
general situations that cause excess water in the blood and eventually tissues
- excess intake of fluid
- low output
- hormonal problems such as SIADH
what does excess intake of fluid look like?
- psychotic water drinking (“water intoxication”)
- too much IV fluid
how does low output cause excess water?
inability to process and/or get rid of appropriate amt of water (like kidney failure) causes water to accumulate
what is SIADH?
syndrome of inappropriate antidiuretic hormone
possible etiologies of SIADH
- ectopically-produced ADH (ex: from small-cell bronchogenic cancer)
- various drugs like gen anesthetics (SIADH can be seen in post-op recovery)
- trauma to brain (brain tumors, head injury etc. swells brain, puts pressure on piturary)
mechanism of action of excess water due to SIADH
- abnormally high levels of ADH
- hold onto water too much by abnormally decreasing urination
- results in increased vascular fluid volume
S&S of excess water due to SIADH
decreased urine output (oliguria)
which solutes most affect fluid shifts by their loss?
- Na+ (lost by excess sweating or certain disease processes)
- proteins (hypoproteinemia: protein loss in blood)
causes of hypoproteinemia
- diminished protein production and intake
- plasma protein loss
where does diminished protein production come from?
certain types of liver diseases (cirrhosis) causes liver to not produce proteins
what does diminished protein intake cause?
protein malnutrition states such as kwashiorkor
mechanism of plasma protein loss from certain kidney diseases like glomerulonephritis
- glomeruli of kidneys lose the ability to keep protein molecules in blood where they belong
- large number of proteins spill out into urine (proteinuria)
sequelae of plasma protein loss
- less proteins in the blood (hyporoteinemia)
- plasma compartment lower concentration
- vascular space hypoosmolar and low oncotic pressure next to tissue
- water B to T fluid shift
- edematous
- at risk for major nutritional problems bc does not have enough proteins to create muscle mass + maintain protein-based processes
S&S caused by B to T fluid shifts (fluid volume overload/excess)
edema occurs
- under skin
- in lung tissue
- acute CNS changes changes related to swelling of brain cells
edema under skin looks like?
skin of feet and/or hands will appear tight & puffy (peripheral edema)
- indentation from poking skin = pitting edema
edema in lung tissue looks like?
- pulmonary edema manifests as cough and/or SOB and/or crackles
acute CNS changes related to swelling of brain cells causes?
- restlessness
- confusion
- unconsciousness
- convulsions
see ____ serum osmolality in lab work due to edema
low
compensatory mechanism to correct fluid overload is?
natriuretic peptide system (NPS)
what is NPS?
1). fluid volume high, right atrium and left ventricle detect that too much fluid is reaching them
2). secrete ANP (atrial natriuretic peptide) and BNP (b-type natriuretic peptide)
3). peptide reach kidneys via circulation and simulate them to increase urination (diuresis)
4). fluid volume goes down
when fluid volume is ____, NPS is suppressed.
low
birth and growth of cells
most: well-defined growth and development of structure and function
as programed by their genetic makeup, cells have different degrees of ________
differentiation
the development of cells is helped along by many hormones such as?
erythropoietin and other growth mediators
cell death can be the culmination of _____ cycle of cell and/or aging process OR can be a result of a ______ event
normal, pathologic
apoptosis
- normal cell death
- a form of programmed death or cell suicide
- body gets rid of cells that have been worn out, developed improperly, or have genetic damage
many events and/or triggers can cause injury to cells, upsetting _____, causing some degree of cell _______, and often resulting in some disease or disorder.
homeostasis, dysfunction
types/causes of injury to the cell
- ischemia
- CO poisoning
- free radicals
- abnormal cellular accumulation (uric acid and fat)
- abnormal cellular proliferation (cancer)
- chemicals, genetic, hypoxia, nutrition, infections, immunologic rxns
abnormal cell death (____) occurs when a cell is injured and reaches the _____ point on the spectrum.
necrosis, irreversible
when there is minor injury to the cell, the injurious changes are?
- reversible
- cell returns to normal or near-normal homeostasis
Inflammation, with various degrees of cell ______and cellular ______, depending on severity of injury can be reversible or irreversible.
swelling, leakage
cellular injury is a ______ in which cellular ____ is affected to a varying degree.
continuum, homeostasis
what are the influences that affect cellular injury?
- type of cell, level of differentiation, ability to adapt
- type, severity, duration of injury
the commonality of all injury to cells/tissues is _____, which is one of the first steps to healing.
inflammation
no matter what the cause of the injury, the result is always?
some level of disruption to the metabolic pathway
sequalae of disruption of metabolic pathway?
- cellular swelling and leakage
- cellular function abnormalities or complete shut-down
pathway of disruption to metabolic pathway
1). Injury to cell
2). metabolic pathway disrupted
3). cell has less ATPs
4). malfunction of Na/K pump on cellular membrane
5). Na+ enters cell freely (while K+ freely goes out)
6). water follows Na+ into cell
7). cell swells and cell membrane loses integrity
8). cell leakage of intracellular substances
what happens at the same time of the cell swelling and leaking when there is a disruption to the metabolic pathway?
1). cell swells
2). ER dilates
3). ribosomes detach
4). disrupted protein synthesis
5). cell fxns become abnormal and/or shut down completely
what is part of almost every disease process in some way?
injury and inflammation of various tissue
example of injury and/or inflammation as part of a disease process
1). (cellulitis) staph aureas attack on skin cells
2). skin cells are injured
3). inflammation
4). metabolic pathway of local cells disrupted
5). water enters cells pathologically
6). cells leak and malfunction
7). S&S of painful, weeping, excoriated areas of skin
as water is pathologically coming in, intracellular substances that are pathologically leaking ___ into immediate surrounding area tissue can eventually find their way into ____ of area and thus into _____ .
out, capillaries, bloodstream
_____ lab measurements of intracellular substances are sometimes used as diagnostic and prognostic tools. the higher the _______ measurement, the _____ the damage is.
serum, serum, worst
creatine kinase (CK)
- enzyme found in most muscle cells (including heart)
- catalyzes transference of phosphate groups btw ADP and ATP
myoglobin
found in most muscle cells
troponin
a type of protein molecule only found in heart muscle
ischemia
oxygen deprivation to cells (hypoxia) due to a decrease in arterial circulation to the area
underlying mechanisms of ischemia is ______ and/or ____ arteries. can be ____ or _____.
narrowed, blocked, acute, chronic
acute ischemia
hypoxia to tissues from sudden lack of blood supply
examples of acute ischemia
- arterial embolus
- sickle cell crisis
arterial embolus
- clot that travels in the arteries
- gets lodged in a smaller blood vessel (arteriole or capillary)
- distal tissues to become hypoxic quickly
sickle cell crisis
abnormally shaped RBCs get stuck in capillaries and decreases blood supply to joints (ischemic pain)
chronic ischemia
better tolerated bc tissues can adapt to some degree over time
examples of chronic ischemia
- gradual narrowing of arteries from atherosclerosis
- slow-developing clot (thrombus) in leg artery or coronary artery
what happens when any ischemic situation (acute or chronic) is not treated?
infarction
infarction
cell death that is specifically caused by lack of arterial blood supply to an area
how does infarction happens when a coronary artery is clogged with a clot?
1). ischemia to tissues beyond/distal to the clot
2). ischemia not treated
3). progresses to anoxia
4). infarct of distal tissue (Myocardial Infarction “MI)
how does infarction happen when the artery to the foot is narrowed by atherosclerosis?
1). ischemia to distal tissues
2). infarct of distal tissues
how does tissue damage happen when there is unrelieved pressure on the skin (lying immobile)?
1). prevents skin capillaries from receiving oxygenated blood (ischemia)
2). tissue injury and breakdown = pressure ulcer/stasis ulcer/bed sore/ decubitus
when hypoxia is caused by an arterial circulation problem/interruption, what is it called? what does it lead to?
ischemia, infarct
hypoxia can lead to?
necrosis
CO is an _____, _____ gas produced by an incomplete combustion of fuel. People in high risk situations can inhale CO and ________ array of S&S.
odorless, colorless, suffer
each RBC has about _____ Hgb molecules that each bind to _____ O2 molecules.
300, 4
when RBCs are carried to the tissues by the arteries, what do they do?
Hgbs release their O2 to the cells
CO has a high affinity for ______ compared to oxygen. when it binds to _____, what does it form?
Hgb, carboxyhemoglobin (HgCO)
HgCO prevents _____ from binding to ____. tissues become ______, leading to _____.
O2, Hgb, hypoxic, cell damage
S&S of CO poisoning
- most relate to nervous system and depend of % of HgCO in body
- headache
- giddiness
- confusion
- seizures
- coma
treatment of CO poisoning
100% O2 by oxygen mask and/or hyperbaric chamber until HgCO levels come down to normal
______ is a byproduct of the breakdown of nucleotide purines found in all cells.
uric acid
____ is a substance converted from ammonia, which is a protein breakdown byproduct.
urea
abnormal cellular accumulations
when substances accumulate in the cells pathologically, can interfere with normal cellular functions and cause cell injury
examples of abnormal cellular accumulations
- lipids from fatty liver from dz processes like alcoholism
- urates (uric acid) accumulation from gout
gout
systemic disease caused by buildup of uric acids in the blood (hyperuricemia)
uric acid is the breakdown product of _____, an organic compound found in all of out cells. normally. we excrete excess uric acid in ____.
purine, urine
people with gout are unable to process ______ effectively. _____ crystals accumulate and settle in joints, causing ____, ____, ___>
uric acid, uric acid, inflammation, swelling, pain
where does uric acid crystals often settle?
- first metatarsal joint of the big toe
- in the ankle joint
treatment for gout
- medications
- diet low in found that is high in purines (red meat, cream sauce, red wine)
free radicals
- vandal
- separate molecule species bc don’t behave like normal atoms or molecules
- act different bc spin-off of abnormal, accelerated, and/or uncontrolled rxns, esp redox rxns
typical generators of free-radical-producing rxns
- simple aging
- environmental pollutants
- certain drugs and alc abuse
- various types of radiation damage (too much sun)
- certain foods (high in preservatives and charred meat_
example of a free radical
superoxide (created in our body esp during rapid redox rxns of ETC)
how does free radicals reacting with lipids in cell membranes cause problems?
lipid peroxidation damage to cell membrane, lead to leaky cells
how does free radicals attacking proteins cause problems?
attack proteins like transmembrane proteins needed for ion pumps
how does free radicals damaging DNA cause problems?
- altered protein synthesis and cause gene mutations
- mutations can lead to cancer or damage to mitochondria (alters metabolism)
how to counteract free radicals?
- vitamins like C and E can stop wild molecule behavior of free radicals
- body can defuse free radicals by using enzymes (superoxide = superoxide dismutase)
direct causes of cellular injury (mechanical trauma)
- contusions (bruises)
- hematomas (collection of blood in soft tissues or an enclosed space)
- abrasions (scrapes)
- lacerations (tear or rip in skin)
cell proliferation
- multiplication or reproduction of cells, resulting in rapid expansion of a cell population
- part of the normal growth and development of cells
example of cell proliferation
- hematopoietic system (birthplace of blood cells) in bone marrow
- basic stem cells differentiate into different types of blood cells that mature, proliferate, and released into blood
____ cell proliferation includes dz processes such as ____
altered, cancer
tumor
abnormal mass of tissue that is NOT NEEDED
tumor used interchangeably with?
neoplasm
benign tumors
- slower growth than malignant cells
- area of growth well-encapsulated + non-metastasizing
- cells in area of growth fairly well-differentiated + usually resemble tissue they come from
example of benign tumor
lipoma - benign neoplasm from encapsulated area of fat cells that overgrown
malignant tumor is interchangeable with?
cancer
key characteristic of malignant tumors
very rapid growth rate of cells that are poorly differentiated
malignant tumors can occur in ______ and/or ____ can occur.
a specific site, metastasis
example of a malignant tumor growing in a specific site
local malignant tumor like cancerous skin lesion
metastasis
- propensity of malignant cells to invade sites distant to immediate area
- major cause of illness + death from most human malignant dz
example of a cancer being wide-spread by nature
leukemia
oncology
study or field of cancer
basic etiology of cancer is?
gene mutations
the gene mutations that cause cancer is prompted by what factors?
- normal aging
- heredity
- environmental, from free radicals and carcinogens
- invading organisms
how does normal aging factor into cancer?
wear and tear of cells -> older age increases the number of “hits” to DNA
example of a heredity cause to cancer
certain kinds of breast cancer runs in families
where do the free radicals and carcinogens that prompt cancer come from?
- use of tobacco, alcohol, and certain drugs
- ingestion of certain dietary substances (nitrates in preservatives)
- air pollution
- UV light (sun)
- ionizing radiation
- occupational hazards (abestos_
what invading organisms prompt cancer?
- some species of HPV (human papillomavirus) cause cervical cancer in women and are linked to mouth/throat cancer
- HBV and HCV cause hep B and C and increase risk of liver cancer
no matter what the initiating factor that causes accumulation of genetic hits/mutations, when sufficient mutations have occurred, _____ can develop.
cancer
what is the genetic mutation that sets cancer into motion?
oncogene
the oncogene promotes?
clonal proliferation
clonal proliferation
a rapid increase in growth and development
how does the oncogene promote clonal proliferation?
- stimulating cells to overreact to growth factor signals to cause wild, rapid dup with very little diff
- overriding normal braking signals
- stimulating the development of tumor cells’ own blood supply (angiogenesis)
instead of differentiating into a specific tissue type with a specific function, cancer cells do not _________. they stay in a _____ stage of development and continue to _____.
differentiate, younger, replicate.
anaplasia
loss of differentiation
how does angiogenesis contribute to cancer killing people?
cancer cells divert nourishment from other cells
examples of diagnostic tests for cancers
- CAT scans
- MRIs
- biopsies
- tumor and genetic markers
tumor markers
substances in the body produced by cancer cells or released by cancer-damaged tissue that can be found in blood, spinal fluid, or urine
tumor markers can be?
hormone, enzyme, antigen, antibody, gene
PSA (prostate specific antigen) is a?
- tumor marker
- glycoprotein found in prostate gland cells that are released into the blood when cancer invades the prostate
- can help detect prostate cancer early
genetic markers
genetic abnormalities that are found in some people that predict odds of having certain types of cancer
chronic myeloid (myelocytic or myelogenous) leukemia develops because of?
translocation of pieces of the chromosome, causing it to get shortened
Philadelphia chromosome
short chromosome
the genes on the chromosome related to chronic myeloid leukemia code for?
WBC creation
the chromosome related to chronic myeloid leukemia being shortened or squashed causes?
1). disruption in normal coding
2) overproduction of leukocytes in the bone marrow + release to blood
3). extreme leukocytosis
4). leukemia
CML diagnosis is _____ when bone marrow sample is taken and the _____ chromosome is seen in the WBCs
clinched, Philadelphia
leukocytosis
- generic term that means condition of too many WBCs in blood
- can develop in many disease processes
leukemia is a ____. one sign of leukemia is ____>
diagnosis (the disease in itself), leukocytosis
biopsies can help to ____ and then ___ the tumor (how far along it is in its growth). knowing the _____ is important in ____ and _____.
diagnose, stage, staging, treatment, prognosis
TNM staging
- T: size of tumor
- N: extent of lymph nodes involvement
- M: metastasis (“mets”), spread to other tissues beyond local lymph nodes
levels of T of TNM
- T0: no cancer cells
- T1-T3: cancerous tumor size, increasing severity and poorer prognosis with higher #
levels of N of TNM
- N0: no lymph node involvement
- N1-N3: nodes involved (usually ones closest to the cancer site, increasing severity and poorer prognosis w/ higher #)
levels of M in TNM
- M0: no metastasis
- M1-M3: mets present, increasing severity and poorer prognosis with higher #
T0N0M0 means?
growth that is entirely benign
benign tumors classification/naming
- first part of name is usually tissue involved
- usually ends in oma
- ex: lipoma (fatty tissue growth) or leiomyoma (benign tumor of smooth muscle)
malignancies classification/naming
- named according to cell type of origin in addition to oma
- usually has root words like carcino, sarco, or blasto
malignancies involving epithelial tissue usually have _____ plus _____ of origin.
carcinoma, organ
examples of epithelial tissue malignancies
- surface epithelium: carcinoma; hepatocellular carcinoma or basal cell skin carcinoma
- glandular tissue: adeno, adenocarcinoma
benign tumor of the gland would be?
adenoma
malignancies involving connective tissue usually have ______ plus organ of origin
sarcoma
examples of connective tissue malignancies class/name
- bone: osteosarcoma
- cartilage: chondrosarcoma
- blood vessels: hemangiosarcoma
osteoma
benign bone tumor
malignancies involving muscle tissue usually have specific muscle type plus _____ plus ____>
sarcoma, myo
examples of muscle tissue malignancies class/name
- leiomyosarcoma (smooth)
- rhabdomyosarcoma (striated/skeletal muscle)
malignant tumors involving neural tissue usually have a specific nerve type plus ________.
blastoma (blast refers to any cell early in development)
example of neural tissue malignancies class/name
- neuroblastoma: malignant tumor of nerve cell
neuroma
benign nerve cell tumor
malignancy of lymph tissue
lymphoma
is Hodgkin’s lymphoma benign or malignant?
malignant - type of lymphatic cancer
malignant skin cancer
melanoma
example of malignancy of hematological tissue
leukemia (WBCs cancer)
S&S of cancer
- pain
- fatigue due partly to angiogenesis of tumor cells
- cachexia due to angiogenesis and other factors
- hematologic alterations
pain S&S of cancer
- inflammation and nerve irritation in the area causes pain
- initially might not be pain bc malignant cells don’t crowd other cells - just kill of other cells and take over space
how does fatigue S&S of cancer work?
the angiogenesis of tumor cells - tumor cells leech nutrition from normal cells by diverting blood supply
what is the cachexia S&S of cancer?
- a syndrome that includes anorexia, early satiety, weight loss, weakness, altered cellular metabolism
- patients have sunken features and generally malnourished appearance
examples of hematologic alterations S&S of cancer
- anemia
- leukopenia
- thrombocytopenia
adaptation
process of accommodating to a new situation the body is undergoing, or creating a new state to accommodate changes in the environment/situation; temporary or permanent
adaption can be a response to?
- physiologic conditions
- pathologic conditions
physiologic condition in which adaption is a response looks like?
- normal
- ex: tissues of the uterus enlarge and increase in pregnancy
pathologic conditions in which adaptation is a response looks like?
- abnormal
- ex: high BP cause the heart to enlarge bc has to work harder to maintain cardiac output in the face of more resistance
forms of adaption
- atrophy
- hypertrophy
- hyperplasia
- metaplasia
- dysplasia
atrophy
disease or shrinkage in cellular size
physiologic atrophy
occurs in early development (ex: thymus gland)
pathologic atrophy often occurs as result of decreases in ______ _____ - an area or organ is ___ ___ _______ very much to do its work, so the cells _____.
work load, no longer stimulated, shrink
example of atrophy
disuse atrophy
when does disuse atrophy happen?
- patient in bed for a long time or immobilized in some way
- having a case (cells shrink while cast is on, then slowly grow back to normal when cast is off and stimulated to work again)
hypertrophy
increase in size of cells and consequently size of organ
hypertrophy is caused by ____ _____ or increased ______ _______, which results in ____ of cellular ______, not cellular fluid.
hormonal stimulation, functional demand, accumulation, proteins
physiologic examples of hypertrophy
- heavy work, working out leads to hypertrophy of skeletal muscles
- kidney removed leads to other kidney increases function and size of cells
pathologic example of hypertrophy
- hypertrophy of left ventricle due to from it trying to fight against hypertension (HTN)
- cardiac hypertrophy
cardiac hypertrophy is a compensatory resp to a bad situation. as a large muscle, the heart can overcome the ______ presented by ____. eventually the heart can get too ____ and will _____.
resistance, HTN, big, decompensate
hyperplasia
increase in number of cells resulting from increased rate of cell division
physiologic example of hyperplasia
- certain organs can regenerate using hyperplasia
- ex: removal of part of liver leads to hyperplasia of liver cells (hepatocytes); even with removal of 70% of liver, regeneration is complete in 2 wks
pathologic hyperplasia
- benign prostatic hyperplasia (BPH); man gets older, prostate enlarges from increase #s of cells
- pathology that is very common in men over 50
metaplasia
- reversible replacement of one mature cell by another type of less differentiated (less specialized) mature cell
- happens when cells are being subjected to chronic injury or irritation
metaplasia example
- normal columnar ciliated epithelial cells of bronchial linings in smokers’ lungs are replaced by stratified squamous epithelial cells
- reverse and normalize when irritant is removed
dysplasia
abnormal changes in size, shape, and organization of mature cells due to persistent, severe cell injury or irritation
dysplasia is sometimes called _____ because the cells are much less _______ than normal, but not quite as _____ and _____ as cancer cells.
pre-cancer, differentiated, undifferentiated and disorganized
the ____ the differentiation, the lower the function, the _____ specialized, the _____ likely to divide and proliferate, _____ potential to be disorganized and cancer like
less, less, more, more
example of dysplasia
PAP smears can revel dysplastic cells of cervix that often must undergo laser-type treatment or close watching to make sure they do not deteriorate into cervical cancer
immobility
an alteration in mobility as result of an acute (recent surgery, bone fracture, pneumonia, or new disease state) or chronic illness (sequel from a stroke/BA or long-standing disease)
most disease and rehabilitative states involve some degree of?
immobility
the longer a patient remains _____, the ____ the level of debilitation that will occur
immobile, greater
what systems (that were specifically mentioned) are involved with the potential complications of immobility?
- integumentary
- musculoskeletal
integumentary complications of immobility
risk for the development of pressure ulcers (ischemia) and/or skin breakdown
musculoskeletal complications of immobility
muscle cells shrink when no longer stimulated to do much work - disuse atrophy
treatment/nursing interventions for immobility
- frequent repositioning/turning of bedbound patients
- encourage early activity and ambulation
- check skin for breakdown
- use of protective devices for the skin, feet/heels/elbows
- ensure adequate nutrition and hydration
- educate patients + families on the risks of immobility
