Download NR507 Patho midterm study guide Chamberlain College of Nursing. and more Exams Nursing in PDF only on Docsity!
Pathophysiology classmates, lets all contribute to filling out the midterm study guide as a team! This not only helps us to fill out the whole study guide quickly but it also is a great way to see important information that maybe you didn’t understand or missed in your own reading!! Also please put page numbers if the information is from the textbook =) Chapters Chapter 1: Cellular Biology Chapter 2: Altered Cellular and Tissue Biology Chapter 6: Epigenetics and Disease Chapter 7: Innate Immunity: Inflammation Chapter 8: Adaptive Immunity Chapter 9: Alterations in Immunity and Inflammation Chapter 10: Infection Chapter 12: Cancer Biology Chapter 13: Cancer Epidemiology Chapter 14: Cancer in Children Chapter 30: Alterations in Hematologic Function in Children Chapter 34: Structure and Function of the Pulmonary System Chapter 35: Alterations in Pulmonary Functions Chapter 36: Alterations in Pulmonary Function in Children Chapter 37: Structure and Function of the Renal and Urologic Systems Chapter 38: Alterations of Renal and Urinary Tract Function Chapter 39: Alterations of Renal and Urinary Tract Function in Children
Epigenetics (Note, Chapter 6 should be reviewed) Epigenetics and its role on human development Compare and contrast Prader-Willi syndrome and Angelman syndrome Cellular Proliferation the role of inactive MLH1 in the development of some forms of inherited colon cancer (p. 1468-1470) p. MLH1 is a deoxyribonucleic acid (DNA) mismatch repair gene, essentially a tumor suppressor gene in this case. If MLH1 is inactive, repair is unable to be made to the DNA mismatches and the hereditary factor of colon cancer (see below) is able to proliferate. Progression from polyps to colon cancer (1) activation of proto-oncogenes (promote cell growth) (2) loss of tumor-suppressor gene activity (inhibit cell growth]); and (3) abnormalities in DNA mismatch repair (MMR) genes (fix errors in DNA replication and recombination Microsatellite instability = genetic hypermutability (predisposition to mutation) that results from DNA MMR. Usually right sided colon proximal to splenic flexure, associated with autosomal dominant hereditary polyposis colorectal cancer. Inflammation as an etiology for cancer-note conditions in which this may occur (p.
Chronic inflammation caused by infiltrating immune cells help to create a permissive tumor progressing environment. Also thought to precede and initiate malignant change in many cancers (colon, liver, lung) Numerous environmentally-linked reasons for inflammation (tobacco smoke, exhaust, asbestos, fine particles in air) and can be linked to many cancers (lung) Chronic inflammation and cancer development = continuous presence of cytokines (soluble factor that affects neighboring cell, can be pro- or anti- inflammatory, interleukins or interferons)(p203-205), chemokines (low- molecular weight peptide that induce leukocyte chemotaxis or directional movement of cells on a chemical gradient)(p203-205), reactive oxygen species (free radical that damages cell membrane)(p59-60), oncogenes (mutant genes that in their normal nonmutant state direct synthesis of protein that positively regulate or accelerate proliferation), amongst others
Diffusing capacity measure of the gas diffusion rate at alveolocapillary membrane Ex. residual volume, total lung capacity, functional reserve capacity. Determine cause of hypoxiua use alveolar-arterial oxygen gradient. Chest xray views air trapping, consolidation, tumors, and cavity formation Relationship of lung compliance and residual volume Chest wall compliance decreases with age losing some of its ability to expand, respiratory muscle strength and endurance decreases. These mechanical changes in the lung and chest wall reduces ventilatory capacity in older adults. As vital capacity decreases, residual volume increases, but total lung capacity remains the same. (see pages 1244-1245) Relationship of lung compliance and residual volume: decreased lung compliance=vital capacity decrease=residual volume increases Ex. as seen in normal aging Shifts in the oxyhemoglobin dissociation- pg. 1241-1242 (Pam Grant) Shifts in the oxyhemoglobin dissociation: (process in which oxygen is released from hemoglobin occurring the body tissues at the cellular level), oxyhemoglobin is when hemoglobin molecules wind with oxygen this occurs in the lungs and is called oxyhemoglobin association or hemoglobin saturation. The shift occurs right or left on the curve. Right shift oxygen moved into the cells such as by acidosis and hypercapnia. A left shift means association in the lungs and dissociation in the tissues by alkalosis and hypocapnia.. When hemoglobin saturation and desaturation are plotted on a graph, the result is a distinctive S-shaped curve known as oxyhemoglobin dissociation curve. Several factors can change the relationship between Pao2 and Sao2, causing the oxyhemoglobin dissociation curve to shift to the right or left. A shift to the right depicts hemoglobin's decreased affinity for oxygen or an increase in the ease with which oxyhemoglobin dissociates and oxygen moves into the cells. The curve is shifted right by acidosis (low pH) and hypercapnia (increased Paco2). A shift to the left depicts hemoglobin's increased affinity for oxygen, which promotes association in the lungs and inhibits dissociation in the tissues. The
curve is shifted left by alkalosis (high pH) and hypocapnia (decreased Paco2). CO2 transport in the blood (see pg. 1243) CO2 transport in the blood: Elimination of co2 by the lungs is important in acid- base balance. Tissues produce co2 as a byproduct of cellular metabolism. It must be removed on acidosis will occur. Co2 diffuses from the cells into the systemic capillaries, from capillaries to venous blood, diffused into alveoli, removal of co2 from lungs by ventilation. (pg 1238) Carried in blood in 3 ways: 1. dissolves in plasma, 2. as bicarbonate, 3. as carbamino compounds. (10% of total CO2 in venous blood, and 5% in arterial blood are carried dissolved in plasma) CO 2 moves into blood, diffuses into red blood cells, and with help of enzyme carbonic anhydrase it combines with water to form carbonic acid, then dissociates into H
and HCO 3 -. The H
binds to HGB, is buffered and HCO3- moves out of the RBC into the plasma. (60% of CO2 in venous blood and 90% in arterial blood are carried in the form of bicarbonate). Remainder combines with blood proteins, HGB in particular, to form carbamino compounds. (30% of CO2 in venous blood and 5% in arterial blood are carried as carbamino compounds). Characteristics of alveoli (see pg 1229) Primary gas exchange units of the lung Oxygen enters the blood here and CO2 is removed Lungs contain 50 million alveoli at birth& 480 million by adulthood Characteristics of alveoli gas exchange airways off the bronchioles where o2 enters blood and co2 is removed from.
pushing up the diaphragm and decreasing the volume of the thorax. The internal intercostal muscles pull down the anterior ribs, decreasing the AP diameter of the thorax. Results of increased work of breathing : accessory muscle use creates more negative intrathoracic pressure (to get air in) and more positive pressure on expiration (pushing air out) caused by disease Know terms Vital capacity (VC), max amount of air a person can expel from lungs after max inhalation Total lung capacity volume of air in lungs at end of maximal inspiration…. Also equals vital capacity plus residual volume Functional capacity ability to perform aerobic work during max o2 intake Residual volume volume of air remaining in lungs even after forceful expiration Functional residual capacity (FRC) volume of air present in lungs at end of passive expiration. An important test in pts with COPD to measure the elasticity of their lungs and chest wall Renal Alterations Types of nephrons and their functions- Page- 1320- (Nephron is the functional unit of the kidney)
- Superficial cortical nephrons- 85% of all nephrons, located mainly in the cortex, extend partially into the medulla
- Midcortical nephrons- with short or long loops
- Juxtamedullary nephrons- lie close to and extend deep into the medulla, important in concentrating urine Page 1327 says The nephron can perform many functions simultaneously as follows: 1. Filters plasma at glomerulus. 2. Reabsorbs and secretes different substances along tubular structures. 3. Forms a filtrate of protein-free fluid
(ultrafiltration). 4. Regulates the filtrate to maintain body fluid volume, electrolyte composition, and pH within narrow limits. Overall renal physiology Substances that are actively secreted by the renal tubules Activation of the renin-angiotensin system Glomerular filtration rate Pg- 1334- provides the best estimate of functioning renal tissue Formulas: GFR x plasma concentration of insulin = insulin concentration of urine x vol. of urine per unit of time (24hrs) GFR (ml/min)= insulin concentration of urine x vol. of urine per unit of time (24hrs) / plasma concentration of insulin GFR (ml/min)= urine creatinine x vol. of urine per unit of time (24hrs) / plasma creatinine Mesangial cells Renal system anatomy Why plasma proteins should be absent from the urine Effects of urinary tract obstruction- hydronephrosis and a decreased glomerular filtration rate Effect of urinary retention Most common type of renal stone Epispadias Glomerulonephritis Nephrotic syndrome (Chapter 6, pgs 183-188) Also, please look up Histone Modification on YouTube, explains this process WAY better than the book!!!!!! EPIGENETICS - the study of heritable changes in gene expression/phenotype caused by something OTHER than changes in DNA sequence.
and inactive from the mother (in normal cases). These diseases are created when one copy of the gene (from mother or father) is imprinted or silenced. If one copy is deleted, there will be no gene expression which leads to disease. Cancer (Chapter 12) Environmental factors such as diet, exercise, exposure to chemicals, drinking, smoking, obesity, medications, carcinogens, and toxins in our water and soil can lead to modifications of epigenetics leading to cancer and other diseases. Totipotent stem cells: The most important stem cell type as it has the potential to develop into any cell in the human body. (p.370) Most versatile Can replicate an unlimited amount of times without losing potency Ideal for cell/gene therapy and replacement of diseased cells (p. 384) Inflammation and cancer: Inflammation and immune system plays a critical role in cancer Chronic inflammation can lead to cancer Ulcerative Colitis -> threefold increase change of colon CA Viral hepatitis-> liver cancer Chronic asthma-> lung cancer *GI inflammation secondary to H.Pylori leads to an increased change of gastric carcinoma Mucosa associated lymphoid tissue lymphoma (MALT). Inflammation -> inflammatory cells migrate -> release cytokines and growth factors -> proliferation -> new vessel growth -> healing Chronic inflammation can lead to continued proliferation and malignancy Ethanol and neural stem cells: Alcohol inhibits neural stem cell differentiation by altering cellular pathways Mechanisms of Defense
( p.290) Infectivity: the proportion of persons exposed to an infectious agent who become infected Normal microbiome is injured which results in loss of protective barrier Decreased immune system which can lead to increased susceptibility True pathogens can pass normal defenses and directly cause infection Pathogens must have an adequate number in order to cause infection Infection process: (300-301) Colonization -> invasion -> multiplication -> spread Hemolytic disease of the newborn (p.1059) HDN occurs only if antigens on fetal erythrocytes differ from the antigens on maternal erythrocytes. If mother and baby have antigenically incompatible erythrocytes, mothers blood will create antibodies against fetal erythrocytes. If sufficient amounts of antibody (IgG) cross the placenta and enter fetal blood, it can cause wide spread antibody-mediated hemolysis or splenic removal If fetus is blood type A or B, the ABO incompatibility can cause HDN Anti-Rh antibodies are formed when fetus is Rh positive and mother is negative First pregnancy has very little manifestations Second has more complications due to the increase in fetal erythrocytes detached from placenta during the first birth. Erythroblastosis fetalis- hemolysis in the fetus's liver and spleen and immature nucleated cells are released Hydrops fetalis- death of fetus and exhibits gross edema Clinical manifestations include pale newborn secondary to anemia, splenomegaly, CV failure and shock. Hyperbilirubinemia due to erythrocyte destruction Coombs test is best used to evaluate risks. Injection of RhoGam to help prevent mother from producing antibodies.
Nephrons: the functional unit of the kidney (filtering units) help remove excess water, wastes and other substances from your blood help return substances like Na, K, or Phos whenever your body needs it Each kidney contains roughly 1.2 million nephrons each nephron composed of glomerulus and renal tubule Tubular structure that involves renal corpuscle, proximated convoluted tubule, loop of Henle, distal tubule and collecting duct -> creates urine. Three kinds of nephrons:
- Superficial cortical nephrons: accounts for 85% of nephrons, which extend partially into the medulla.
- Midcortical nephrons: have short of long loops.
- Juxtamedullary nephrons: lie close to and extend deep into the medulla and are important for the process and concentration of urine Renal physiology Starts at pg 1322 (Check out this video on kidney physiology) https://youtu.be/KWHasxDRf Glomerulus: capillaries that reside in the bowman’s capsule along with mesangial cells (responsible for contracting and regulating glomerulary blood flow). Together they create the renal corpuscle. Glomerular filtration membrane is responsible for filtering select blood components through its 3 layers
- Inner layer is the glomerular endothelium
- Middle is glomerular basement membrane
- Visceral epithelium Glomerular filtration occurs when plasma filtrate from the glomerulus passes through the membrane into Bowman space to form urine Flows into the proximated convoluted tubule and into the loop of Henle. In the loop of Henle, descending is highly permeable to water and not ions. The ascending portion of the loop is permeable to ions and not water. The thick ascending portion is responsible for transporting ions and passing urine into the distal convoluted tubule
The distal convoluted tubule extends from the distal portion of the loop of Henle into the collecting duct. The collecting duct is a large tubule that descends down the cortex through the renal pyramids into the medulla, draining urine into the major calyx. The collecting duct contains principal cells (absorb Na and H2O, secrete K) and intercalated cells (secrete hydrogen and reabsorb K). Urine is then collected in the renal pelvis then funneled into the ureter. Peritubular capillaries ->glomerulus -> Bowmans capsule -> proximal tubule -> loop of Henle -> distal convoluted tubule -> collecting duct -> renal pelvis -> ureter Afferent arteriole: flows INTO glomeruli Efferent arteriole: flows OUT of glomeruli THREE MAJOR RENAL PROCESSES
- Glomerular filtration
- Tubular reabsorption
- Tubular secretion Substances that are actively secreted by renal tubule Choline Creatinine Histamine Methyl guanidine Para- aminohippurate PCN Steroid glucuronides Thiamine
Mesangial cells mesangial matrix lie between and support the glomerular cappilaries contract like smooth muscle cells to regulate glomerular capillary blood flow. Phagocytic properties that release inflammatory cytokines and growth factors. together with the glomerulus and bowmans capsule make up the renal corpuscle. Renal system Anatomy watch this video https://youtu.be/GUF34vrQK8c Why shouldn’t there be plasma protein in urine? If protein is present in the urine, it is a sign of glomerular injury as the glomerulus should not allow protein to pass into the process. Injury to the glomerulus is a significant cause of CKD and ESRF Effects of urinary tract obstruction Common causes include: stones, strictures, congenital compression, tumors, and abdominal inflammation Upper urinary tract leads to dilation of the ureter, renal pelvis, and calyx proximal to the blockage Dilation of the ureter is hydroureter and dilation of the renal pelvis leads to hydronephrosis. Dilation is an early response to obstruction Increased pressure builds up in the glomerulus leading to decrease in filtration. Prolonged obstruction can lead to detrimental effects on renal function and the nephrons Urinary Retention: What is urinary retention?
Urinary retention is when the bladder (where you store your urine or 'water') does not empty all the way or at all. It can be acute (sudden) or chronic (long-term). Acute means it comes on real quick or is very bad. Chronic means you have had it for a while. The acute form is an emergency. You need to see a doctor right away. The chronic form occurs most of the time in older men, but it can also occur in women. What causes chronic urinary retention? There is more than one cause. It can happen when something blocks the free flow of urine through the bladder and urethra. The urethra is the tube that takes urine from the bladder out of the body. The problem can also be caused by using drugs such as antihistamines (like Benadryl®), antispasmodics (like Detrol®), and tricyclic antidepressants (like Elavil®) that can change the way the bladder muscle works. Passing your urine occurs when the brain tells the bladder muscle to tighten. This squeezes urine from the bladder. The brain then tells the sphincter muscles to relax. This lets the flow of urine go through the urethra and out of the body. Anything that gets in the way on the path from the brain to the nerves that go to the bladder and the urethra can also cause this problem. Urinary retention from nerve disease occurs at the same rate in men and women. Blockage. In men, a blockage can be caused when the prostate gland gets so big that it presses on the urethra. This is the most common cause of the chronic form in men. One cause in women is a bladder that sags. This is called a cystocele. It can also be caused when the rectum sags into the back wall of the vagina. This is called a rectocele. Some causes can happen to both men and women. The urethra can get narrow. This is called a stricture. Urinary stones can also block the flow of urine. Infection and swelling. In men, an infection of the prostate can cause it to swell. This causes it to press on the urethra to block the flow of urine. A urinary tract infection (UTI) can cause swelling of the urethra to cause this problem. Diseases spread by having sex (called STDs) can also cause swelling and lead to retention. Nerve causes. The bladder may not work right because there is a problem getting the messages from the brain to the bladder and urethra through the nerve pathway. Causes include stroke, diabetes, multiple sclerosis, trauma to the spine or pelvis, pressure on the spinal cord from tumors and a herniated disk. In women, vaginal childbirth can sometimes damage nerve pathways that control going. If you have had a thin tube called a catheter put in you in the past, you may be at greater risk for this condition. Your risk is also higher if your doctor has used any other special device on you, such as an ureteroscope or cystoscope. Drugs. Some types of drugs affect bladder muscle function as a side effect and can cause this problem. These include drugs called anticholinergics, the older drugs for depression, antihistamines, some blood pressure-lowering drugs, antipsychotics, hormonal agents, and muscle relaxants.
alpha-blockers and 5-alpha reductase inhibitors (finasteride and dutasteride). Also, surgery to take out the prostate or reduce its size may be tried. Transurethral resection of the prostate is the most common type of surgery when this problem is due to an enlarged prostate. During this surgery, the doctor puts a tool through a catheter. He or she threads it up the urethra and takes out a section of the prostate. There are other ways to treat this problem that are not surgery. They use energy sources such as microwaves and lasers to break up the blockage. For women with cystocele or rectocele as the cause, mild or moderate cases may be treated with exercises that strengthen the pelvic floor muscles. They also may be treated by putting in a ring called a vaginal pessary to support the bladder. Your doctor may suggest estrogen therapy if you are past menopause. Surgery may be required for more severe cases to lift the sagging bladder or rectum. For a urethral stricture, opening the urethra with catheters and balloons may be tried. Surgery using a knife or laser that is moved through the urethra to make a cut to open the stricture is also an option. A stent (a mesh tube) can also prop open a closed urethra in men. If the retention is due to a nerve-related issue, you may need to use a catheter on yourself at home. Renal stones: Calcium stones (urolithiasis) are the most common type of renal stone (80%) Genetic and environmental factors Can form in supersaturated urine or detach from interstitial sites Causes are due to: hypercalcuria, renal tubule acidosis, crystal growth inhibitor deficiencies, and alkaline urine Epispadias:
P. 1379
Epispadias and exstrophy of the bladder are the same congenital defect but expressed to a different degree. The dorsal urethra is not fused in epispadias and has failed to form into a tube. In male epispadias the urethral opening is on the dorsal surface of the penis. urethral opening may be small and situated behind the glans (anterior epispadias), or a fissure may extend the entire length of the penis and into the bladder neck (posterior epispadias) In females a cleft along the ventral urethra usually extends to the bladder neck. Glomerulonephritis- inflammation of the glomerulus caused by primary glomerular injury (immunologic responses, ischemia, free radicals, drugs, toxins, vascular disorders, and infection) or secondary injury (systemic diseases, such as diabetes, lupus, CHF, HIV). pg 1353 Acute : inflammation that damages the glomerular capillary filtration membrane including the endothelium, basement membrane, and epithelium (podocytes) mesangial expansion component of it Classic s/s - sudden onset of hematuria (smoky, brown-tinged urine) including RBC casts and proteinuria 3-5g/day w/ albumin, and in severe cases accompanied by edema, HTN, impaired renal fx (oliguria=UO of 30 ml/hr or less) Diagnosing -s/s, abnormal urinalysis, reduced GFR ( plasma urea, cystatin C, creatinine concentrations, or renal creatinine clearance), renal biopsy, electron and immunofluorescent microscopy. Treatment - treating primary cause (immune responses) and correcting problems such as edema and HTN. Antibiotics for infection, corticosteroids to decrease antibody synthesis and suppress inflammation, and cytotoxic agents to suppress immune response, and anticoags for controlling fibrin crescent formation in rapidly progressing glomerulonephritis. Patho : immune mechanism cause: (1) deposition of circulating antigen- antibody immune complexes on the glomerulus (2) antibodies reacting in
