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182 terms

Pathophysiology

STUDY
PLAY
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
adaptive immunity
normally silent and responds to the presence of infectious microbes by becomingactive expanding and generating potent mechanism of neutrilization
lymphocytes and their products
major components of adaptive immunity
humoral immunity
B lymphocytes secrete antibodies that eliminate extracellular microbes
cell immunity
T lymphocytes either activat macrophages to destroy phagocytosed microbes or kill infected cells
polymorphnuclear leukocytes
PMNs
plasma cells, memory cells
B cells give way to
monocytes, mast cells, PMNs
myeloid precursor cells give way to
T cells
60-70% of lymphocytes in peripheral blood
T cells
recognize only peptide fragments of protein antigens that are displayed on other cellsb ound to proteins of the MHC
CD4
secrete cytokines that help B cells to produce antibodiee
B cells
10-20% of circulating lymphs
B cells
synthesize Immunoglobins (IgM,IgG,IgA, IgE and IgD)
IgA
major isotype in mucosal secretions
IgE
isotype present in the circulation at low concentrations and is also found attached to the surfaces of tissue mast cells
IgD
isotype expressed on the surface of B cells but not secreted
macrophage is found in tissue whereas monocyte is found in blood stream
differentiate between monocyte and macrophage
langerhans cells
Immature DCs reside in epithelia where they are strategically placed to capture entering microbes
follicular DCs
located in germinal centers of lymphoid follicles in the spleen and lumph nodes. Bear receptors for the Fc tails of IgG which trapsantigen bound to antibodies and complement
NK cells express inhibitory receptors which recognize MHC molecules that are expressed by healthy cells
How do NK cells know which cells are healthy
Class I MHC
present on all nucleated cells meaning that all virus infected cells can be detected and eliminated by CTLs
Class II MHC
expressed by only APCs (notably dendrite cells) and macrophages and B cells. bind to peptides derived from proteins synthesized outside the cell
Class III MHC
include complement components; genese encoding TNF and lymphotoxin
display peptides for recognition by T cells
main function of MHC
DP,DQ,DR
three subregions of HLA-D present in class IIMHC
6 (3 maternal and 3 paternal)
how many class I HLA molecules can a heterozygois individual express
NK
what is the first line defense against neoplastic or virus-infected cells
cytokines
secreted by llymphocytes, epithelial and mesencymal cells, mediate their effects by binding tp specific high affinity receptors on their target cells
Autocrine
act on same cell that produced cytokine
paracrine
act on adjacent cells
endocrine
act on distant cells, systemic effect
pleiotropic
causing many different effects
redundant
same activity by different proteins
antagonistic
regulate the intensity and type of an immune response