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Patho Exam 1 Review Notes
Cellular Adaptation
Atrophy: Physiologic: thymus gland atrophy (childhood) o Can be both physiologic or pathologic o Physiologic ▪ Ex: Thymus glade (childhood) o Pathological ▪ Bed rest. Mobility is huge. Get up and walk. That prevent the atrophy in the muscle. Hypertrophy: (increase in size of cell) Another cellular adaptation that can actually be beneficial is hypertrophy of myocardial cells such as in endurance training – this is referred to as physiologic hypertrophy. Versus Pathologic hypertrophy that occurs secondary to HTN. ▪ Physiologic hypertrophy
- Ex: endurance training ▪ Pathological hypertrophy
- Ex: hypertension – myocyte increase in size Hyperplasia: (increase in # of cells) Compensatory: removal of 70% of liver – can regenerate in about 2 weeks. Pathological: endometrial hyperplasia o Increase in the number of cells ▪ Compensatory hyperplasia adaptation
- Ex: 70% of liver can be removed and still function. Can regenerate in about 2 – 4 weeks. ▪ Pathological hyperplasia
- Ex: endometrium hyperplasia – like endometriosis:
2 | P a g e impact a women’s ability to reproduce and is very painful
4 | P a g e the RBC
- Programmed death o EX: inflammatory process – dismantle the neutrophils
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- Physiological natural occurrence o Physiologic way of eliminating unwanted cell Necrosis: Irreversible injury: Ex.: Mr. Bax r/t arteriosclerosis, Hypoxia #1 cellular injury (MI), and Myocardial infarction
- Irreversible damage o Ex: Cellular death
- Pathologic
- Hypoxia is the #1 cellular injury. o Ex: MI (myocardial infarction) Necrosis leakage of contents. Apoptosis Dismantling
Cellular Metabolism
- ATP is important to metabolism
7 | P a g e accumulation of sodium and calcium and diffusion of potassium out of the cell. ▪ Sodium and water then can enter the cell freely, and cellular swelling results. ▪ What happens when oxygen reserves are depleted? Anaerobic metabolism (glycolysis)
8 | P a g e Free Radicals
- Free radicals o A free radical is an electrically uncharged atom or group of atoms having an unpaired electron. o Unstable o Goes around trying to find an electron to capture so they can become stable. They steal the molecule. The molecules that they go after proteins, lipids, and carbohydrates – key membranes and nucleic acids o They attack that cellular membrane thus damaging that cell. o The body actually produces antioxidants ▪ Sometimes the body is overwhelmed by the free radicals and thus diseases ensues - Some of the disease are cardiovascular systems causing hypertension, ischemic heart disease, heart failure, and diabetes mellitus ▪ Antioxidant is a molecule that is stable enough to donate an electron to these free radicals, it can actually neutralize
10 | P a g e o Lysosomes – are the digestive system of the cells ▪ Enzymatic digestion of cellular organelles which include nucleus and nucleolus that ensues the halting synthesis of DNA and ribonucleic acid RNA. If leaking or cell damage will end of to killing that cell (DNA cell death) o Ethanol – toxin to the body, talking about chronic alcohol abuse (long term). Liver enzymes metabolize ethanol to acetaldehyde which causes hepatic cellular dysfunction. Peroxisomes helps detoxify ethanol – if not functioning properly the ethanol is turned to fat in the liver (thus the term fatty liver) o Radiation – keep you lead aprons on. Protect yourself and your patient. Radiation goes right for the DNA. Remember without DNA everything stops in that cell Aging of the cells and tissues
- Aging o Physiologic ▪ Muscular atrophy (called sarcopenia ) - Very dependent on how well we care for ourselves in our lives that will impact how we age. Also, genetic impacts aging (nature vs nurture) - Teach our elderly patient to get up and walk and strengthening exercises.
11 | P a g e ▪ Stiffness or rigidity of systems
- Peripheral vascular resistance increases (hypertension)
13 | P a g e by the cardiac system) is higher than the capillary oncotic pressure. In other words, tissue perfusion. If it continues to build there, the body has edema, so the body has to balance that.
14 | P a g e o Huge player is plasma protein and the main player for the protein is called albumin. Low plasma albumin keeps water moving back into capillary, keeps water from moving out. Keep balance. o Low plasma albumin causes edema as a result of a reduction in plasma oncotic pressure. Players vs Edema ▪ Hydrostatic pressure ▪ Oncotic pressure ▪ Capillary permeability ▪ Lymphatic system Natriuretic peptides, RAAS, ADH
- Fluid Volume Deficit o Natriuretic peptides ▪ Main players of natriuretic peptides - Atrial natriuretic peptide (ANP) produced by the myocardial atria – volume is increased in the atria and these peptides are released - Brain natriuretic peptide (BNP) produced by the myocardial ventricles ▪ When it is senses decrease blood pressure which goes along with decrease cardiac output and it increase sodium and water excretion thus it will increase BP and increase maintaining sodium
16 | P a g e ▪ Urodilatin with the kidney.
- Renin angiotensin-aldosterone system (RAAS) [aldosterone Na+] o When circulating blood volume or blood pressure is reduced, renin, an enzyme secreted by the juxtaglomerular cells of the kidney, is released in response to sympathetic nerve stimulation and decreased perfusion of the renal vasculature. o As soon the kidneys sense that decrease in cardiac output. The kidneys expect 20-25% of that cardiac output. If they don’t get it they start pumping out renin. Renin has the next role is angiotensin. Angiotensin I converted angiotensin II in the lung then aldosterone is pumped out by the adrenals. The aldosterone is the main hormone that is released to increase perfusion. ▪ How does it do this? Aldosterone hangs onto sodium. We know where there is sodium there is water. Sodium hung onto, so the body conserved onto the water then increases blood pressure and circulating blood volume. Just the opposite what the peptides do. o Aldosterone – think of sodium o ADH – think of water ▪ Secretion of antidiuretic hormone (ADH) and the perception of
17 | P a g e thirst are stimulated by an increase in plasma osmolality. ▪ Increase in that osmolality - conserving that water. Fluid deficits and dehydration
- Body needs that perfect balance – water intracellularly and extracellularly balance to perform at its peak function
- Marked Water deficit is manifested by signs and symptoms of dehydration (decreased perfusion, all related to cardiac output [stroke volume x heart rate
19 | P a g e ▪ Tachycardia – weak pulses (compensatory) ▪ Postural hypotension (orthostatic hypotension [lying 110/60 then sit them up and BP bottoms out]). Inability for the body to compensate for that decreased fluid that is necessary for equilibration and homeostasis of the body
- Vulnerable populations to fluid volume deficit
20 | P a g e o Infants: total body water is the same, but the distribution is different. Extracellular fluid has a higher percentage than an adult. 75-80% TBW (baby Thompson – diarrhea – increased extracellular fluid o Obese patient (BMI >30): fat is water repelling. Very little water is in the adipose cells therefore more body weight has less total body water. o Older – thirst sensation is diminished.
