Pathophysiology

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Pathology

the study of suffering

Etiology

causes of disease

pathogenesis

underlying mechanism of disease

homeostasis

the maintainence of a cell intracellurlar milieu within a fairly narrow range of physiological parameters

cell death

What is one of the most crucial events in the evolution of disease in any tissue or organ?

Hypertrophy

an increase in the size of the individual cell

physiological adaptations

the cells response to normal stimuli by hormones or endogenous chemical mediators
e.g. uterine enlargement in pregnancy

pathologic adaptation

response to stress that allow cells to modulate their structure and function and thus escape injury e.g. Barret's esophagus

Hyperplasia

increased cell numbers; only in cells which are able to divide

Atrophy

decreased cell/organ size due to lack of nutrients which is often in conjuction with decreased synthesis and increased autophagy

metaplasia

change in phenotype of differentiated cells which is often due to chronic irritation
e.g. chronic smokers will have the formation of squamos cell in bronchioles rather than columnar cells

pyknosis

nucleus shrinks; chromatin condenses

irreversible cell damage

ATP can not be produced and the cell membrane is disrupted

Reversible cell injury

cell swelling, fatty change, mitochondrial swelling, dilation of the ER, or loss of microvilla

virus

obligate intracellular organisms that commabdeer the host c ell's biosythetic and replicative apparatus for their own proliferation

latent infection

surviving in some nonreplicating form with potential for reactivation
e.g. herpes vaicella-zoster (chickenpox) reactivates as shingles

residual body

what is left of the digested vesicle after phagocytosis

caspases

proteases which activate apoptosis

diffusion

random molecular movement of substances molecule by molecule. This process is completed either through intermolecular spaces or attached to carrier protein.

Active transport

movement of ions or other substances across the membrane in combination with a carrier protein in such a way that the carrier proteins causes the substance to move against an energy gradient

Simple diffusion

the kinetic movement of molecules or ions occurs through membrane opening or intrermolecular space without an interaction with carrier proteins in the membrane

facilitated diffusion

requires interatction of a carrier protein which shuttles the substance through the membrane along the concentration gradient

osmosis

the process of net movement of water caused by a concentration diference of water

osmotic pressure

amount of pressure required to stop osmosis

protoplasm

the different substances which make up a cell including water, ions, proteins, lipids and carbohydrates

proteins

The second most abundant poperty of a cell

phospate head

hydrophillic end of the cell membrane

lipid tail

hydrophobic endof the cell membrane

ER

funtions to synthesize new proteins molecules and lipid substances

Golgi apparatus

process transported substances from the ER and forms them into lysosomes, secretary vesicles and outher cytoplasmic components

Mitochondria

synthesis of adenisin tri-phosphate through the formation of CO2 and water thus releasing energy

lysosomes

intracellular digestive system which consumes 1) damaged cell structures 2) food particles #) unwanted matter such as bacteria

agenesis

failure of an organ to develope during embroyonic growth and developments

inflammation

a protective response intended to eliminate the intial cause of cell injury as well as the necrotic cells and tissues resulting from the original insult

Acute inflammation

rapid in onset and short duration. It is characterized by fluid and plasma protein exudation and a predominantly neutrophilic leukocyte accumulation.

kinins

increased vascular permeability, smooth muscle contraction, vasodialation, pain

neutrophils

the principal leukocytes in acute inflammation

margination

adhesion to endothelium and rolling along wall

diapedesis

outward passage of blood through intact vessel walls

Emigration

the passing of WBCs through the endothelium and wall of the microcirculation into the injured tissue

chemotaxis

movement toward a chemical stimuli

phagocytosis

a process of ingestion by cells

plasma derived mediators

Complement and Kinin system

cell derived mediators

vasoactive,arachicytokines, reactive oxygen species, arachidonic acid metabolite, platelet-activating factor, cytokines, reactive oxygen species, nitric acid, lysomal enzymes

selectins

receptros expressed leukocytes and endothelium that mediate weak and transient adhesions involved in rolling

integrins

interact with the ligands found on a cells surface which mediates the adhesion of the cell to endothelial surfaces

Interleukin 1 and Tumor necrosis factors

activate the endothelial cells simultaneously to inccrease their expression of ligands for integrans

IL1 TNF

the most important cytokines

vascular reaction and cell response

what are the main component of inflammation

chronic inflammation

long term, lymphocyte and macrophage infultration

recognition, recruitment, removal, regulation and resolution

steps of inflammatory response (5)

heat

calor

redness

rubor

swelling

tumor

pain

dolor

loss of function

functia faesa

transudate

ultra filtered blood plasma more commonly associated with non inflamatory

exudate

increased amount of protein and is seen in an inflammatory state

hydrostatic pressure

driven by volume of fluid

osmotic pressure

driven by volume of plasma proteins

integrans

do not become activated until there is a signal given off from the site of injury once the cell adheres

lysosomal acid hydrolases

what degrades dead microorgainisms
e.g. elastase

histamine or serotonin

arteriolar dialation, increases vascular permeability; vasoactive amine

cyclooxygenase

synthesizing prostaglandins and thromboxanes

lipoxygenase

synthesizing leukotriens and lipoxins

Kinin system

leads to the formation of bradykinin, increases vascular permeability, arteriolar dilation, and bronchial smooth muscle contraction; activated by the Hageman factor

dyseminated intravascular coagulation

mini clots throughout the body resulting in uncontrolled bleeding; often seen in pregnancy and idiopathic patients

virulence factor or host damage

degree of pathology from infectious disease is dependent on...

TSS and MRSA

important staph infections

bartonella henslae

cat scratch fever

pneumocystits jiroveci

PCP

Drug resistant strains

MRSA, VRE, TB, N. gonorrhea

vancomycin resistant enterococcous

VRE

prion

proteinaceous infectious particles that transmit spongiform encephalopathies

prions

these proteins are protease resistant and lack RNA/DNA

Creutzfeldt-Jakob disease

associated with corneal transplant (prions)

Kuru

associated with human canniblaism in a tribal setting (prions)

heart disease

streptococcus viridans causes this

opportunistic infection

candida, aspergillus, mucor, crytococcus

Trichomonas

STI, colonizes vagina and male urethra

intestinal diarrhea

entameba histolytica and GIardia lamblia cause...

Maleria (plasmodium)

can reside in RBC e.g.

toxoplasma

one should always advise women to no change the kitty liter because of this orgainism

roundworms, flatworms, flukes

three classes of worms

helminths

non-segmented and collagenous tegument e.g. ascaris, hookworms, strongyloides and trichinella

lice

pediculosis

mites

scabies

innate defense

first line of defense does not adapt to multiple attacks, phagosytes, complement and many cytokines

Adaptive defense

B and T lymphocytes "memory cells" response improves with each successive attack

skin

low pH (5.5) and the presence of fatty acids inhibit microbial growth along with shedding

impetigo

warm moist skin often results in what infection becasue we skin become more permeadble to microorgainsims

pseudomonas

what microorgainisms like burns

respiratory tract

distance that microorgainisms travel in the system are inversely proportional to their size

neuraminidase

enzyme produced by viruses which lowers the vicosity e.g. influenza, parainfluenza and mumps

H. influenzae, B. pertussis

viruses that have release factors that inhibit ciliary motion

pH, mucous, bile deterents, and normal flora

Normal defenses (4)

Trichonisis

is transmitted in pork and bear meat

Hep A, rotavirus, and norwalk virus

nonenveloped viruses which are resistnat to the digestive juices

Enterotoxins

toxins produced while on the food e.g. certain styphylococcal strains have

Exotoxins

toxins which must be produced inside the body e.g. v. cholerae and toxigenic E. coli

Peyer's patches

lymphoid follicles in the intestinal tract which provides access to the lymph system

salmonella typhi

passes from the damaged mucoa through Peyer's patches and mesenteric lymph nodes and into the blood stream

cysts

_____ is important in the transmission of parasites

hyaluonidase

enzyme produced by streptococci and staphylococci which degrades the extracellular membrane

HPV and dermatophytes

microbes that do not travel beyond the epithelium

Vertical transmission

mother to baby via the placenta or through the cervical orifice

Adhesins

bind bacteria to host cell

Lipoteichoic acide

hydrophobic, bind to buccal epithelial cells (adhesin)

Protein F

bind to fibronectice and facilitates S. pyogenes entry into epitheliaial cells (adhesin)

M proteins

prevents macrophage phagocytosis (adhesin)

fimbriae

---------promotes adherence in gram negative bacteria

Fever, Septic shock, disseminated intravascular coagulation, acute respiratory distress syndrome

CLinical features caused by endotoxins of the LPS (only gram negative)

Corynebacterium diptheriae

exotoxin creates layer of dead cells in throuat where bacteria then grows

Clostridium perfringes

produces lecithinase that disrupts plasma membranes (gas gangrene)

Streptococcus pyogenes

pyrogenic exotoxin which results in scarlatiniform rash (sandpaper rash on chest)

latency, compliment does not osansize them properly, kill macrophage once engulfed

immune evasion methods by microbes

carbohydrate capsule

covers the bacterial antigen and prevents phagocytosis of the orgainism by neutrophils

antigen K (E. coli) and having long polysccharid (gram negative org)

mechanisms of how to prevent the activation of complements

leukotoxin

secretes ------ that kills neutrophils

Suppurative polymorphonuclear inflammation, mononuclear inflammation, cytopathic-cytoproliferative inflammation, necrotizing inflammations and chronic inflammation and scarring

Five histologic patterns of tissue reaction

chlamydia trachomatis

A vaginal deleiver results in neonatal blindness. This is most likely caused by what orgainism?

Rickettsia

causes rocky mountain spotted fever

Coagulative necrosis

cellular components are dead but structure of cell/tissue is preserved;commonly seen with solid organ infarction except in the brain

Liquefactive necrosis

accumulated inflammatory cells and leukocyte enzyme digest tissues; bacterial infections with pus

Gangrenous necrosis

coagulative necrosis of multiple tissue layers common in the extremities. comorbidity may exist with bacterial infections making it liquefactive necrosis as well

caseous necrosis

cheese like complete obliteration of cellular components and structure; TB

fat necrosis

focal areas of fat destruction typically from pancreatic enzyme release

mitochondira

the intrinsic pathway of apoptosis

death receptor pathway

the extrinsic pathway of apoptosis

replicative senescence

terminal non-dividing state of a cell

hypertrophy of cardiac cells

hypertension is the cause of what type of cell adaptations

eosinophils

WBC that is associated with parasitic or immune reactions mediated by IgE

TB

prototype granulomatous disease is...

granulomatous inflammation

distinctive pattern of chronic inflammation characterized by aggregtes of activated macrophages that have a squamous/epitheloid cell appearance;developes a rim of T cells

mast cells

chronic inflammatory cells which exacerbate the tissue release of histamine; commonly seen in atopic (hypersensitive) pts

Tinea

athletes foot, ring worm

low pH and population of lactobacilli

what protects the vaginal tract from pathogens such as yeasts

M. tuberculosis

A microorgainism that is able to escape phagocytic killing by the alveolar macrophages

shigella, salmonella and camplyobacter

the microorgainisms invade and damage the intestinal mucosa and lamina propria resulting in ulceratin, inflammation and herorrhage

candida

causes oral thrush or membranous esophagitis; attracted to stratified epithelial tissues

Fish tapeworm

diphyllobotherium; causes and inron deficiancy

helminths and pneumotoads

microbes which are transported free in the plasma

mononuclear- granulomatous inflammation

Inflammation where there are no more T cells left and the macrophages will not respond to the orgainism e.g. TB

Cytopathic-cytoproliferative inflammation

viral response; damage to individual host cells with no inflammatory response, may result in blister formation and epithelial cells may proliferate and take unusual forms as seen in HPV

Suppurative polymorphonuclear inflammation

rapidly dividing pyogenic bacteria evoke this response; there is increased vascular permeability and chemoattractants from bacteria for neutrophils

Necrotizing inflammation

strong toxin secretion resulting in rapid cell death, e.g. E. hystolytica and herpes viruses produce this type of inflammation

cirrhosis

due to chronic hepatitis

innate immunity

immunity you are born with; mediated by cells and proteins that are always present and poised to fight against microbes

epithelial barriers of the ski, GI tract, respiratory tract, phagocytic leikocytes, NK cells and plasma proteins

major compnents of innate immunity

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