Systems Pathology Flashcards by Matilda Russel-Fisher

New York heart association clsssifcation of heart failure

1 no limitation of physical activity
2 slight limitation ( breathlessness/fatigue)
3 marked limitation ( breathless with minimal exercise)
4 severe limitation- symptoms at rest

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What bodily process makes heart failure worse

Renin release

adh- water retention

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Explain cardiac remodelling

Hyper trophy in response to:
Adreneric - increases contractility and hypertrophy but causes myocyte apoptosis and toxicity
Angiotensin 11 - hypertrophy but causes changed ecxpression of contractile proteins
Cytokine TNFa - hypertrophy but remodelling of matrrix and dilation of chambers

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What is left ventricular failure and what causes it

Increases atrial pressure increased pulmonary pressure and SOB :
Acute ventricular dysrhythmias
Myocardial infarction and ischeamia 
Long standing hypertension 
Valve disease ( aortic/mitral) 
Cardiomyopathies and drugs 
Congenital heart diseases

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What causes right ventricular heart failure and how does it manifest

Increased venous pressure, raised JVP and peripheral oedema- liver distension
Causes but left ventricular failure
Massive thromboembolism
Chronic disease- COPD chronic lung disease , pulmonary hypertension
Rare- valve disease

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What is pulmonary hypertension caused by

Emphysema 
Destroys alveolar walls 
Loss of lung Capps
Failure of lung ventilation
Hypoxia 
Pulmonary arteries constrict 
=hypertension

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What is congestive cardiac failure

Combination of LVF and RVF
Commonly causes but ischeamic heart disease plus another cause of LFV
Also caused by cardiomyopathies ( primary gene defect in muscle protein, secondary toxins, metabolic disease, storage disease) and drugs

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What are the two main problems in heart failure

Impaired function as a pump=
Fluid congestion
Inadequate blood flow to tissues

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What is the general structure of the liver

Heptocytes
Sinusoids
Portal tracts- aa portal vv and bile ducts
Central veins
Acinar architecture

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What are the functions of the liver

Carbohydrate metabolism
fat metabolism
Protein synthesis - plasma proteins and catabolism
Bike synthesis- ( jaundice)
Storage or iron vitamins glycogen copper- (haemochromotosis)
Detoxification (drugs or hormone)

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What are the different hepatocytes sensitive to

Centriole hepatocytes supplied by blood depleted in O2
- low oxidase activity
- high esterase activity
Peripheral hepatocytes- well supplied by oxygen
- low esterase activity

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Name seven responses to liver injury

Fatty change
Hepatocyte necrosis
Cholestasis - alkaline phosphatase indicates
Inflammation
Fibrosis
Regeneration ( with fibrosis makes cirrhosis)
Neoplasia

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What are the pathways to acute liver disease

Acute liver damage and systemic shock ( gram -ve sepsis) lead to severe liver cell necrosis
Decline in chronic liver disease might lead to acute decline.
Thesis both then lead to acute liver failure which can lead to liver necrosis

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What does liver necrosis lead to

Release of transaminase 
Failure of bilirubin metabolism 
Failure to detoxify nitrogenous compounds ( encephalopathy) 
Failure to synthesis factors 1972 
Shock with low GFR- renal failure

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What are the causes of chronic liver damage

Hepatitis B C and D
Autoimmune disease
Drugs
Metabolic disease eg wilsons or a1 antitrypsin defiency

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What is stage and grade of chronic hepatitis

Grade- severity of necrosis and inflammation

Stage- extent of fibrosis

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What is cirrhosis

Fibrosis
Nodules of regenerated hepatocytes
Distorted liver architecture - not linked in cytoskeleton

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What are the causes and consequences of cirrhosis

Chronic hepatitis and alcoholic liver disease
Reduced helatocyte function:
decreased synthesis of cogulation factors and albumin
Decreases secretion of bile
Decreased detoxification of nitrogenous compounds
decreased metabolism of steroid hormones
Portal hypertension: splenomegaly
Ascites
Porto-systemic anastomoses

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What is jaundice

More than 50um bilirubin in plasma
Yellowing of skin, sclera and mucous membranes
Kernicterus- deposits in brain leading to nerve degeneration

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What types of jaundice are there

Haemolytic
Intrahepatic
Obstructive
Physiological jaundice of newborn

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What are the functions of the kidney

Excretion of nitrogenous waste
Salt ion and water homeostasis
Secretion of erythropoietin
Secretion of renin

What does disease of the interstituim of the kidney lead to

Chronic kidney disease as it controls interstitial pressure and therefor reabsorption and secretion

What damage could occur to the glomerular apparatus

Charges tbat repel proteins are lost and albumin can enter the filtrate

How does under perfumed kidneys affect the tubule

Needs 02 for atp for active reabsorption

What are the key features of acute renal failure

Oligourea or anuria Electrolyte imbalance - hyperkalaemia and metabolic acidosis Rising blood urea and creatinine

What are the causes of active renal failure

``` Pre- renal causation- reduced renal perfusion from shocks burns/bleeding/sepsis Cardiac failure Intrinsic acute kidney disease A) tubulo-interstituim B) glomerular C) vascular Post renal active kidney injury ```

What is tubulo-interstituim acute kidney disease

Necrosis of tubular epithelium due to reduced perfusion, no ion salt or water pumping takes places so the kidneys swell Can recover from this

What are the glomerular cause | Of acute kidney disease

Glomeruli nephritis Immune complex mediated disease Obliteration of glomerular lamina

What are the vascular causes of acute kidney disease

Vasculitis- immune mediated inflammation and destruction of small vessels DIC Malignant tumour

What is post renal acute kidney injury

``` Acute obstruction of lower urinary tract In males- prostate/ureters Females- ureters Of lumen= stone Wall= tumour of inflammation Extrinsic= tumour/mass ```

Define chronic kidney failure

Slowly progressive and irreversible loss of renal function due to irreversible destruction of a large number of nephrons

What are the symptoms of chronic renal failure

Polyuria Malaise/lethargy Increasing ureamia confusion and eventual coma Electrolyte imbalance- Na and water retention=hypertension

What are the insisting factors to chronic renal failure

``` Age FH Neohrotoxins Diabetes mellitus Urinary infection Primary renal disease Urinary obstruction Cardiovascular disease ```

What are the perpetuation factors for renal failure

``` Hypertension Proteineamia Obesity Anaemia Nephrotoxins Cvd Smoking ```

What are the causes of renal failure

``` congenital kidney disease (polycystic) Chronic renal reflux Diabetic kidney disease Infection with hep B/C malaria TB or HIV Immunological damage to all glomeruli ```

What pa02 and paCO2 define resp failure

O2 less than 8.0 kPa | CO2 more than 6.7kPa

What are the lungs functions and what three mechanisms does it use to achieve these

Supply the body with O2 Remove major waste products Ventilation, diffusion, and circulation

What are the signs of resp failure

Resp compensation ( tachypnoea, accessory muscles, nasal flares, intercostal suprasternal or supra clavicle recession) Increased sympathetic tone- tachycardia, hypertension, sweating End organ hypoxia- altered mental state, confusion, disorientation Bradycardia and hypotension Hb desaturation - cyanosis

What investigations could you do for someone who has resp failure

``` Physical examination Chest imaging FBC Arterial blood gases Urea and electrolytes ```

What is type 1 respiratory failure

Hypoxeamia without hypercapnia More common Ventilation perfusion mismatch

What is type 2 resp failure

Hypoxemia with hypercapnia | Ventilation problem

What is V/Q mismatch

Low units- hypoxaemia and hypercapnia | High- wasted ventilation but doesn't effect has exchange unless severe

What causes v/q mismatch

Impaired diffusion - scarring - emphysema destroys Capp beds Shunting - deoxygenated blood mixes with oxygenated blood which always results in less O2 content ( without hypercapnia)

What are the causes of shunting

Pneumonia Lung collapse Severe pulmonary oedema

What are the causes of type 1 resp failure

``` COPD - chronic bronchitis and emphysema Pneumonia Pulmonary odema Asthma Pulmonary embolism Pneumothorax Broninchiestasis Pneumoconiosis- non organic dust Extrinsic allergic albeolitis ```

What is COPD

Emphysema- dilation of alveolar due to destruction of walls in absence of scarring Chronic bronchitis- excessive bro oval mucus plus cough

What causes type 2 resp failure

COPD Severe asthma Drug overdose and poisoning Primary muscle disorders Head and cervical cord injury Obesity Pulmonary odema

What are the types of resp 2

acute- minutes of hours with no compensation in acid base Chronic- days- weeks Hypercapnia- compensated with normalisation of blood pH and high bicarbonate Hypoxia compensation with increased Hb and pulmonary hypertension

What is cor pulmonale

Alveolar hypoxaemia caused by hypercapnia- constriction Hypertrophy and hyperplasia of pulmonary smooth muscle Increase in pulmonary resistance Increasing after load of right ventricle- RVF and hypertrophy Liver enlargement and peripheral odema

What is the obstructive airway disease

FEV1 / FVC less than 0.75 | Due to asthma or COPD

what is restrictive airway diseas e

FEV1 /FVC normal or FVC is reduced | Fibrosis in the lungs- stiff lungs