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Patho Exam 2 - Chapter 3
Terms in this set (93)
First Line of defense
intact skin, mucous membranes and their secretions
-innate / nonspecific
Second line of defense
protective cells and fluids; inflammation and phagocytosis - nonspecific /innate
what are lymphocytes
T and B cells
what are Leukocytes
white blood cells
What are neutrophils
fight off extracellular bacterial infections through phagocytosis; in the blood
What are macrophages
Infection-fighting organisms; in lymph.
What are band cells
-will see this on a lab report because body is fighting infection so body starts making more neutrophils to compensate
what are the vasodilation chemical mediators?
What is vasodilation
widening of blood vessels
What are the chemical mediators that cause increased vascular permeability?
complement C3a and C5a
what is increased vascular permeability
blood vessels become leaky
what are the chemical mediators that cause pain?
What are the non-specific tests for inflammation?
ESR and CRP values (neither test identifies the source)
What is the normal range for WBC
Why would a lymphocyte count increase
Lymphocyte = t and b cells would increase due to intracellular bacterial infection or viral/fungal infections
Why would a b cell count increase
Why would a monocyte cell go up
for chronic inflammation only
What is ESR?
Erythrocyte sedimentation rate - fibrinogen causes greater stickiness of RBCs so they clump faster - not a specific indicator but shows inflammation process is ongoing
What is the prothrombin time range?
11.2 seconds to 13.2 seconds
What is RICE
rest, ice, compression, elevation
What is the treatment of inflammation?
Reduce blood flow
block the action of chemical mediators
What is the action of aspirin?
Works the same as NSAIDS; inhibits conversion of arachidonic acid to prostaglandins and to suppress inflammation,etc
What is the action of acetaminophen?
Inhibits prostaglandin synthesis in central nervous system
Which organs should be watched with NSAID/Aspirin use?
Kidneys and stomach (Gastric ulcers)
Which organs should be watched with acetaminophen use?
What is the action of glucocorticoids
suppresses second line defense
Suppresses chemical mediators
Suppresses lymphocytes (3rd line)
Why can glucocorticoids be bad?
suppresses immune response
Can cause hyperglycemia
increases osteoclast activity
need to titrate off not quit cold turkey to allow body to adjust
What is the inflammatory phase of healing?
Acute Inflammatory response
Cover the wound - hemostasis, platelets released, blood vessels constrict,
What is the proliferative phase of healing?
Clean the debris (PMNs/ Macrophages/ Remove necrotic tissue)
Restore structural integrity
(provisional matrix, granulation tissue)
Rebuild ECM (basement membrane, connective tissue)
What is the remodeling phase of healing?
Restore Functional integrity
-- resolution, repair, regeneration
--- maturation of cells
-- degradation of provisional matrix
how quickly does resolution happen?
within a few days
which takes longer resolution or regeneration?
regeneration takes longer
what is replacement?
deposit of scar tissue depending on extent of damage functional integrity may not be able to be restored (replacement because not original tissue)
What is an example of a secondary infection?
decubitous ulcer (bedsore) heals from the bottom up
What are some complications of healing?
What is dehiscence?
A separation of the wound incision
What are keloids?
Great protrusion of scar tissue that extends beyond wound edges and may form tumor-like masses of scar tissue
What are adhesions?
bands of scar tissue that form between or around organs (most common in peritoneal surgery (liver - small intestine))
Rule of 9's adult
Head = 9%
Chest (front) = 9%
Abdomen (front) = 9%
Upper/mid/low back and buttocks = 18%
Each arm = 9% (front = 4.5%, back = 4.5%)
Groin = 1%
Each leg = 18% total (front = 9%, back = 9%)
What is a first degree burn?
-Superficial burn involving the epidermis -Caused by sunburn and minor flash injuries -No edema, no blisters
What is a second degree burn?
epidermis and partial thickness of the dermis are involved.
area is painful and blisters are present
What is a third degree burn?
full thickness of the dermis, and potentially deeper tissues are involved
area is painless, white, and charred
What is a fluid shift?
Rapid shifts between ECF and ICF; can kill within a few hours through hypovolemia and shock
what is hypovolemia?
low blood volume
What is the initial treatment for burns
Remove source of injury / stop burning process
What is treatment for minor burns?
cleanse, cover, dress (change daily), analgesics for pain
What is the treatment for major burns
IV fluids - watch for fluid shift
What is the pathophysiology of Rheumatoid Arthritis?
Combo of genetic and triggering event to cause autoimmunity
- Antibodies attack other antibodies creating immune complex which lodge in synovial fluid and cause inflammation
Which is caused by mechanical advantage osteoarthritis or RA?
is rheumatoid arthritis bilateral or unilateral?
what are the manifestations of RA?
Bilateral inflammation in joints
Redness, heat, swelling
Rheumatoid Factor - Antibody to IG
- Rest/activity balance
- Heat cold therapy
- Joint replacement
- Analgesics (early on)
- Glucocorticoids (on/off)
- Bio response modifiers (humira/enbrel)
- Disease modifying anti-rheumatic drugs (horrible drug affects cell synthesis and is not selectively toxic)
What are Bio response modifiers?
Category of drugs which works on autoimmune diseases especially if they have inflammatory component
Which disease is associated with Bouchard's nodes? Which knuckle does it affect
2nd (more proximal)
Which disease is associated with Heberden's nodes? Which knuckle does it affect?
First (more distal)
What is a major difference between Acute and Chronic gastritis?
Acute is caused by an irritant, occurs over shorter time and is reversible
What is the pathophysiology of acute gastritis?
Due to exposure of irritant (aspririn/alcohol)
Inhibits production of protective gastric mucosa
-- mild erythema
-- gastric perforation
What are the manifestations of acute gastritis?
Loss of appetite
What is the definition of hematemesis
vomiting of blood
What is a hematocrit?
% of RBC in a given volume
What is the diagnosis for acute gastritis
medical history (use of aspirin, NSAIDS, conditions resulting in ischemia of gastric mucosa)
physical exam - abdominal tenderness
Lab - hemoglobin and hematocrit
What is the treatment for acute gastritis?
- remove irritant
-- proton pump inhibitors (prilosec)
- reduce acid production (zantac)
What are the examples of chronic gastritis?
what is the pathophysiology of h pylori chronic gastritis
gram neg. bacteria
-transmitted person to person via stool/saliva
-enzyme is produced neutralizing gastric acid/ able to survive in the stomach
- production of toxins that destroy mucosal barrier
- inflammatory response
- mucosal lining of stomach thins
- gastric acid production and secretion is impaired
Chronic gastritis - h pylori manifestations
loss of appetite
what is dyspepsia
chronic gastritis - h pylori diagnostics
biopsy of gastric tissue
antibodies in blood
fecal antigen (most reliable)
chronic gastritis - h pylori treatment
treat with multiple antibiotics
proton pump inhibitors to raise pH of gastric mucosa
chronic gastric autoimmune pathophysiology
antibodies made to gastric parietal cells
intrinsic factor inhibited
chronic gastritis - autoimmune manifestations
symptoms of pernicious anemia
chronic gastritis autoimmune diagnostics
antiparietal or anti IF antibodies
low b12 levels in blood
chronic gastritis treatment
b12 intramuscular injections monthly
what are two examples of inflammatory bowel disease
what is the typical location of crohn's disease in patients
small intestine and ascending colon
what is the typical location of ulcerative colitis in patients
what is the typical pattern of lesions in crohn's disease
what is the typical pattern of lesions in ulcerative colitis
what is the typical depth of lesions in crohn's disease
what is the typical depth of lesions in ulcerative colitis
what type of diarrhea is associated with crohn's disease?
what type of diarrhea is associated with ulcerative colitis
Is bowel obstruction associated with crohn's disease?
is bowel obstruction associated with ulcerative colitis
which is a higher cancer risk crohn's disease or ulcerative colitis
what are the manifestations of crohn's disease
-rapid stool transit time
-loss of absorptive capability due to inflammation
-occult or hidden blood in stool may be possible
what are the diagnostic criteria of crohn's disease?
diagnostic tests: sigmoidoscopy
xray would show cobblestone pattern of mucosa
what is the treatment for crohn's disease?
-meds to suppress inflammatory response
- meds to suppress immune response
- avoid spicy food
- eat diet high in cals and proteins and low in fat and fiber during periods of exacerbation
What are the manifestations of ulcerative colitis?
impaired water and electrolyte absorption
What is the diagnostics of ulcerative colitis
xrays (detect colonic dilation, ulcers, perforation, obstruction)
change in # of bowel movements
What is the treatment of ulcerative colitis
adequate fluid intake
avoid milk, caffeine and spicy food
surgery - perforation/obstruction
what is the number one cause of pancreatitis
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