Exam 1 Patho

total body water
sum of fluids within all body compartments

all fluid within cells (2/3)

all fluid outside the cells (1/3)

space between cells and outside the blood vessels

blood plasma

drinking, ingestion of water from food, water deprived from metabolism
primary source of body water

renal excretion (urine), stool, vaporization from skin and lungs

distribution and amount

Infants = TBW 75-80%
Children + adolescents = TBW 60-65%

Decreased TBW
decreased muscle mass; increase fat cells
decreased ability to regulate sodium and water balance

Young and old are vulnerable to water imbalance

Sodium

Sodium (Na), water, and glucose

Plasma proteins (albumin)

Blood pressure

swelling of fluid in between cells -> within the interstitial space
occurs with local infection or trauma

thick/hardened skin

darker skin -> ashy sometimes purple
lighter skin -> red, blistering-looking "ruddy-rust look"

large indention for a while
water is mobile and can be translocated with finger pressure

fever, diarrhea, and increased respiratory rate (can cause dizziness)

more visible, can see it happen
urine and feces

not visible, don't see it happening
vaporization of lungs and skin (occurs without awareness)

movement of water across a semipermeable membrane

amount of hydrostatic pressure required to oppose the osmotic movement of water

(1) Type and thickness of the membrane
(2) Size of molecules
(3) Concentration of molecules
(4) Solubility of molecules within membrane

refers to fluids outside the body
measured in volume L

refers to fluid inside the body
measured in weight kg

Kidneys ability to produce a concentrated or dilute urine

pushes water
arises from heart contraction
favors movement of plasma water into ISF

AKA Colloid osmotic pressure
plasma proteins
helps maintain plasma volume

Pulls water at end of arterial and venous ends of capillary
movement of water into interstitial space causes accumulation of water into tissue (edema)

localized and generalized

limited to site of trauma (in your foot)

uniform distribution (whole body, left and right side heart failure)

loss or trapping of ECF into transcellular space (serous cavities)
pericardial sac, peritoneal cavity, pleural cavity
muffled sounding

excessive fluid into the pleural cavity

excessive fluid in the peritoneal cavity
big, big belly that you can drain liters off

term used for fluid in the serous cavities (blood, plasma proteins, inflammatory cells (pus)

ADH--antidiuretic hormone

thirst is absent

decrease thirst sensation

excessive thirst
have low sodium levels
urinates a lot

(vasopressin) secreted from pituitary

Plasma osmolality increases
water deficit
sodium excess
circulating blood volume decreases and BP drops

change in water content resulting in cellular swelling/shrinking

same concentration of particles as ICF or ECF

swelling
lower concentration of particles/dilute

shrinking
higher concentration of particles

135-147 mEq/L

3.5-5.5 mEq/L

9.0-10.5 mg/dL

2.5-4.5 mg/dL

1.8-2.4 mg/dL

ECF

Water and Cl

the kidneys through voiding or urination

Na

enters the GI tract and eliminated through the kidneys, GI Tract and skin

dietary sources / salt

vomiting
diarrhea
fistula (wound) drainage and GI suction
loss skin integrity (burns) -> big loss, as fast as you pump it in, it comes back out

ECF

Na balance
Cl and Na usually chane in direct proportion to one another

increased HCO3 (bicarbonate) level to balance anions and cations in the ECF
commonly due to GI loss

related to hyponatremia or elevated bicarbonate concentrate
develops with vomiting and loss of hydrochloric acid
sodium deficit related to restricted intake or use of diuretic

occurs clinically
too much sodium and too little bicarbonate
no specific symptoms
causes irregular heart rate

ICF

about 40 mEq, average intake is 60 to 100 mEq through
meats, dried fruits, fruit juices (orange), bananas, avocados, potatoes, strawberries

gain fluid and retain so much fluid

maintains cell electroneutrality and cell osmolality
directly affects cardiac muscle contraction and electrical conductivity
aids in neuromuscular transmission of nerve impulses

calcium

milk and dairy products
need vitamin D to absorb calcium

affects activation and excitation
contraction of cardiac and skeletal muscles
enhances bone strength and durability

ICF
closely related to Ca and P

bone

all green vegetables, grains, nuts, meat and seafood

powers the Na/K pump
transmits electrical impulses across nerves and muscles
muscle relaxation after contraction
**maintains normal heart rhythm
relaxes lung muscles that open airways

skin
linings of gastrointestinal, genitourinary and respiratory tracts
first lines of defense

Sloughing off of cells
Coughing and sneezing -> protect resp. tract
Flushing -> urination carries away cells
Vomiting -> gets poison/preformed toxins out of syst.
Mucus and cilia -> move things out

synthesized and secreted saliva (enzymes), tears, ear wax, sweat, mucus
normal bacterial flora -> inside or outside

Inflammatory response

infection
mechanical damage
ischemia
nutrient deprivation
temperature extremes
radiation

tissue death due to loss of blood flow

redness, heat, pain, swelling, loss of function

occur within seconds:
vascular response -> circulation
increased vascular permeability
WBC adherence

blood vessel dilation
increased vascular permeability and leakage
white blood cell (greater than 11,000 when infection) adherence to the inner walls of the vessels and migration through the vessels

Initiate healing

rapid and nonspecific protective response to cellular injury
only occurs in vascularized tissue

redness, swelling, heat, pain, loss of function

accumulation of fluid and cells

significant potent activators of inflammatory response
release histamine and antihistamine
first response in the inflammatory process

produce protective layer that kicks in the inflammatory response
vasoactive amine that causes temporary, rapid constriction of large blood vessels and the dilation of the postcapillary venules

block histamine response to regulate the amount
counters histamines

leukotrienes
prostaglandins
platelets

mast cell products

can destroy pathogens directly
activates and collaborates with every component of the inflammatory response
results in anaphylactic-toxic fragments that target cell lysis
part of plasma protein systems

forms fibrinous meshwork at an injured or inflamed site
prevents the spread of infection (localizes microbes)
main substance is an insoluble protein called fibrin
how the body stops bleeding
part of plasma protein system

functions to activate and assist inflammatory cells
primary kinin is bradykinin -> associated w pain, helps dilate

defense against parasites

natural killer (NK) cells
engulf and destroy microorganisms

leakage of circulating components into the tissue

watery exudate / liquid, yellow-red
indicated early inflammation
blister

thick, clotted
indicates severe or more advanced inflammation

pus: indicates a bacterial infection / green like cottage cheese
large number of leukocytes accumulate
abscess (walled-off lesion)

exudate contains erythrocytes (blood)
indicated bleeding

Caused by exogenous and endogenous pyrogens
act directly on the hypothalamus
increase host's susceptibility to endotoxins
systemic manifestation of inflammation

increased number of circulating leukocytes

released from liver

increased duration
lasting weeks or longer, regardless of cause

unsuccessful acute inflammatory response
persistent irritation from chemicals, particulate matter or physical agents

dense infiltration of lymphocytes and macrophages
if macrophages cannot protect the host, the body walls off the site and forms a granuloma

returning injured tissue to the original structure and function

replacement of destroyed tissue with scar tissue ->
mainly composed of collagen to restore the tensile strength of the tissue

cleaning the dissolved clots, microorganisms, erythrocytes and dead tissue cells
scrape off hard, leathery type to heal -> want red dark pigment

filling in the wound
sealing the wound (epithelization)
shrinking the wound (contraction)

development of granulation tissue
fibroblasts are the most important cell during this phase--synthesize and secretes collagen
contraction--noticeable 6 to 12 days after injury
no longer leaks serous fluid, will be dry

wounds that heal under conditions of minimal tissue loss
surgical incision; ends approximated (closed)
put edges of wounds together: staple, glue, sew

wounds that require a great deal more tissue replacement
leave open to heal from inside out
burns, large surface sounds, infection

dysfunction happens during inflammatory response

hemorrhage -> bleeding
fibrous adhesion
infection
excess scar formation
wound sepsis
hypovolemia *******
anti-inflammatory steroids -> good short-term, bad long-term

impaired collagen matrix assembly -> keloid scar
impaired epithelialization -> anti-inflammatory steroids, hypoxemia, and nutritional deficiencies
impaired contraction -> contracture

wound pulls apart at the structure line
excessive strain and obesity
increases risk of wound sepsis
wound disruption

extrusion of viscera or intestine through a surgical wound
wound disruption

reversible response to a cell--accommodating both normal and abnormal demands and conditions

the uterus enlarges to accommodate a fetus and cell
reverts to the same size, never exactly the same

Aubrey's body adapted to malnutrition (from a young age) and caught up to her and caused stomach cancer

reversible response to physiological (normal) and pathologic (adversead) changes
adaptations to pathological conditions are usually only temporarily successful

atrophy
hypertrophy
hyperplasia
dysplasia
metaplasia

decrease in cell size
decrease organ size if enough cells shrink

normal in early development

results from decrease workload, pressure, use, blood supply, nutrition, hormonal/neural stimulation

laying in bed and not using legs will cause legs to shrink/shrivel

increase in cell size
increases organ size

physiologic--results from increased demand, stimulation by hormones, growth factors

pathological--results from chronic hemodynamic overload (heart working overtime)

increase in number of cells
increased rate of cellular division (help regenerate liver)

compensatory--enables organs to regenerate
hormonal--in organs that respond to endocrine hormonal control

hormonal--abnormal proliferation of normal cells

abnormal changes in size, shape, organization of mature cells
may be reversible if triggering stimulus is removed
tissue appears disorderly but is not cancer (beign)

if changes penetrate basement membrane

reversible replacement of one mature cell type by another
associated with tissue damage, repair, regeneration
reprogramming of stem cells or undifferentiated mesenchymal cells

occurs if cell unable to maintain homeostasis
reversible--cells recover
irreversible--cells die

single most common cause of cellular injury

Ischemia--reduced supply of blood
reduced oxygen content in ambient air
loss of hemoglobin
decreased production of red blood cells
diseases of the respiratory and cardiovascular systems
poisoning of the oxidative enzymes within the cells

total lack of oxygen caused by obstruction (a clot)

reperfusion injury
cellular injury and death caused by restoration of blood flow and oxygen

causes oxidative stress
free radical is electrically uncharged atom or group of atoms with an unpaired electron that damage

lipid peroxidation
protein alteration
DNA DAMAGE *****
mitochondrial effects

xenobiotics--toxic, mutagenic, carcinogenic
carbon tetrachloride
lead
carbon monoxide
ethanol
mercury
social or street drugs

over-the-counter and prescribed drugs
opioid abuse
leading cause of child poisoning is medications

air pollution (indoor and outdoor)
heavy metals (lead, cadmium and arsenic, mercury)
ethanol (fetal alcohol syndrome, fetal alcohol spectrum disorders)

result of application of mechanical force to body
results in tearing, shearing, or crushing of tissues
motor vehicle accidents and falls
contusions
lacerations
fractures

incised wound
stab wound
puncture wound
chopping wound
gunshot wounds

caused by a failure of cells to receive or use oxygen
suffocation -> choking asphyxiation
strangulation -> hanging, ligature, and manual strangulation
chemical asphyxiants -> carbon monoxide, cyanide, hydrogen sulfide
drowning

pathogenicity of microorganism

invasion and destruction
toxin production
production of hypersensitivity reactions

necrosis or apoptosis

rapid loss of plasma membrane structure, organelle swelling, mitochondrial dysfunction, lack typical features of apoptosis
may be regulated or programmed
autolysis (autodigestion)

protein denaturation
albumin is transformed from gelatinous, transparent state to a firm opaque substance
infarct -> death of tissue

neurons and glial cells of the brain
cells digested by own hydrolases -> digest by own juices
tissues become soft and liquefied
triggered by bacterial infection -> staphylococci, streptococci and e. coli

results from pulmonary tuberculosis infection
combination of coagulative and liquefactive necrosis -> coughing up blood clots and liquid

breast and abdominal organs
action of lipases
fatty acids combine with elements to create soaps
tissue appears opaque and chalky white

death of tissue from severe hypoxic injury
dry -> skin becomes dry and shriveled, brown or black
wet -> area becomes cold, swollen and black
gas gangrene caused by clostridium

programmed cell death
active process
physiologic vs pathologic
normal part of aging -> skin loses elasticity

self-destructive and a survival mechanism
cytoplasmic contents delivered to lysosomes for degradation
contributes to the aging process

weakness, decrease stamina, and functional decline in older adults
increases vulnerability to falls, disability, disease, death

death of entire body
postmortem changes diffuse
occurs 24-48 hours after death

skin becomes pale and yellowish
1st stage

decrease in body tem
2nd stage

stiffening of the body/muscles
3rd stage

gravity causes blood to accumulate/settle how body is positioned
4th stage

tissues and organs of body lose gases and liquids
5th stage

organic matter of body is broken down into elemental matter and recycled into earth's biosphere
6th stage

various tissues of the body have degraded and decayed to the point of exposing the skeleton
7th stage