Pathophysiology Intro

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Hyper vs. Hypo

Back 1

Hyper- too much of
Hypo- not enough of

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itis, osis, opathy

Back 2

inflammation, abnormal condition, disease

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idopathic, iatrogenic, nosocomial

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no known cause
physician induced
hospital acquired

Front 4

disease and syndrome vs. normalcy

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disease= set of signs and symptoms
syndrome= multitude of underlying problems
normalcy= body in homeostasis

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etiology

Back 5

causes or reason for disease
**can be used to classify disease** inherited, congenital ...

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pathogenesis

Back 6

development or evolution of disease

Front 7

manifestation of disease

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signs= objectively identifiable changes **measureable**
symptoms= subjective feelings
**can't measure**

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factors that influence disease

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extrinsic factors= outside body
- diet, meds
intrinsic factors= inside body
-age, sex, heredity

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single gene disorders

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can affect any tissue/organ system
Ex. kidney disease

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autosomal dominant genetic disorders

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doesn't depend on sex, expresses itself
only need one bad gene
delayed onset, doesn't skip generations
structural protein problem

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autosomal recessive genetic disorders

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doesn't depend on sex, hides
need two bad genes, carriers present
early onset, can skip generations
enzymatic deficiency, functional proteins

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sex linked disorders

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carried on X most often
more common in male b/c of one X
*unequal X activation* - body shuts off one X
most common- red green color blindness in males

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mitochondrial gene disorders

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passed through maternal line
extremely rare

Front 14

chromosomal abnormalities

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substitution- one base swaps for another
deletion- drops out amino acid, changes chain
aneuploidy- abnormal number of chromosomes
translocation- structural abnormalities from exchange of nonhomologous chromosomes

Front 15

aneuploidy

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abnormal number of chromosomes
Trisomy 21 is most common- down syndrome
caused in meiosis- break doesnt happen right= 2x or not enough chromosomes
** cancer **

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translocation

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genetic material exchanged between nonhomologous chromosomes

Front 17

Robertsonian translocation

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short arm exchanged with long arm of chromosome
creates metacentric chromosome= two long arms
lose fragment of two short arms

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results from robertsonian translocation

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child gets one long, one short from one parent... gets one long, one robertsonian translocation, one short from another = trisomy 21
** can be any chromosomal pair **

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causes of cellular injury

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-hypoxic injury= not enough O2
-chemical injury= heavy metals, free radicals
-physical injury= mechanical, thermal, radiation, electric shock
-infectious injury= bacteria, virus, fungi, parasites
-immunological and inflammatory injury

Front 20

terminology of cellular changes

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atrophy- decrease in cell size
hypertrophy- large cells
hyperplasia- extra cells
dysplasia- adult cells, abnormal size and shape
metaplasia- juvenille cells, grow rapidly

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common themes/ results of cell changes

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ATP depletion- cant run things properly
defects in membrane- Na in, K out
increased intracellular Ca- mineralization
increased free radicals- damage to membrane

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manifestations of cellular injury

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accumulate water- large and cloudy cell, rupture, cell degenerates
accumulate lipids- turn yellow, negatively affect metabolic processes
atrophy- cell breaks apart and digests self

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cell death (necrosis)

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nuclear changes appear most obvious

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pyknosis

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shrunken, irregular, dark staining nucleus

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karyorrhexis

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fragmentation of nucleus

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karyorrlysis

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dissolution of nucleus

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coagulative necrosis

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** most common **
cells retain shape, tissues remain shape
ischemia- dry gangrene
diabetes, frostbite

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liquifactive necrosis

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** most common in brain **
infection breaks down and turns to soup

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caseous necrosis

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cells degenerate but fragments remain
-mycobacterium infections

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apoptosis

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programmed cell death
normal, deletes excess cells
NOT accompanied by inflammation

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Inflammation

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acute- short lived
chronic- long lived
local- one area
systemic- body wide

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causes of inflammation

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infection
trauma
immune hypersensitivity reactions

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purpose of inflammation

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destroy and remove insult
wall of and contain damage
stimulate immune response- BAD
promote healing

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characteristics of inflammation

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acute- redness, heat, swelling, pain
chronic- granuloma formation: scar tissue, massive number of macrophages to heal

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local inflammation progression

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tissue injury--> release of histamine and prostaglandins--> vasodilation (heat/redness) or increased capillary permeability (pain/swelling)
OR
tissue injury--> release of leukocytes inducing factor-->margination and diapedisis of WBC--> PUS --> healing

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mediators of inflammation

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histamine- mast cells
activated factor 12- clotting system
** bradykinin=pain**
archidonic acid = LOX and COX

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local inflammatory response

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margination and diapedesis of WBC
vascular respone- increased permeability
endothelial cells separate = PUS

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results of water movement

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interstitial swelling pulls lymphatic vessel flaps apart, fluid drained and equilibrium reached
lymphangitis- inflammation of lymph nodes

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cell membrane breakdown

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1. cell damaged--> phospholipids break down by phospholipase = arachidonic acid
2. LOX and COX produced from breakdown of arachidonic acid
3. LOX = leukotrines ** can't inhibit **
4. COX= prostaglandins = inhibited by glucacorticoid
5. prostaglandins breaks down into prostacykin and thromboxane = vasodilate or vasoconstrict

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fatty acids

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omega 6= animal fat= produce leukotrines 4 and prostaglandins 2, more inflammation
omega 3= salmon= produce leukotrines 5 and prostaglandins 3, less inflammation

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systemic manifestations of inflammation

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fever= resetting body temp in hypothalamus
increased HR and WBC
loss of some organ function
pain

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chronic inflammation

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1. persistence of infection
2. WBC death and fibroblast activation= produce collagen
3. Pus
4. tissue repair= scar= granuloma

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exudates

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PUS
serous- protein in interstitial fluid
fibrinous- fibrinogen accumulates on serous surface
mucinous- mucous membranes
** all acellular**
neutrophils- production of pus **cellular**

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wound healing

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1st intention- acute, small period of time to heal
2nd intention- chronic, granuloma, long period of time
3rd intention- rare, start at 2nd, surgery to remove granuloma, back to 1st

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indications of would healing

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abscesses, boils, carbuncles (deep infections)
cellulitis- swelling of cells
mixed pus from wound

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factors that delay wound healing

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ischemia
nutrition deficiency
age, meds
dehiscence- opening of wound from early removal of stitches
evisceration- intestinal tract out through wound

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complications of healing

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scaring:
-strictures: band of scar tissue around hollow organ
-contratures: muscle scaring
adhesion- collagen spitting out
keloids- buildup of surface collagen