Systems Pathology Flashcards
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
What bodily process makes heart failure worse
Renin release
adh- water retention
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
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
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
What is pulmonary hypertension caused by
Emphysema Destroys alveolar walls Loss of lung Capps Failure of lung ventilation Hypoxia Pulmonary arteries constrict =hypertension
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
What are the two main problems in heart failure
Impaired function as a pump=
Fluid congestion
Inadequate blood flow to tissues
What is the general structure of the liver
Heptocytes Sinusoids Portal tracts- aa portal vv and bile ducts Central veins Acinar architecture
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)
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
Name seven responses to liver injury
Fatty change
Hepatocyte necrosis
Cholestasis - alkaline phosphatase indicates
Inflammation
Fibrosis
Regeneration ( with fibrosis makes cirrhosis)
Neoplasia
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
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
What are the causes of chronic liver damage
Hepatitis B C and D
Autoimmune disease
Drugs
Metabolic disease eg wilsons or a1 antitrypsin defiency
What is stage and grade of chronic hepatitis
Grade- severity of necrosis and inflammation
Stage- extent of fibrosis
What is cirrhosis
Fibrosis
Nodules of regenerated hepatocytes
Distorted liver architecture - not linked in cytoskeleton
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
What is jaundice
More than 50um bilirubin in plasma
Yellowing of skin, sclera and mucous membranes
Kernicterus- deposits in brain leading to nerve degeneration
What types of jaundice are there
Haemolytic
Intrahepatic
Obstructive
Physiological jaundice of newborn
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
