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final
patho/physio
181
Physiology
Professional
12/04/2008

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Term
alcoholic liver disease complications
Definition
- alcoholic encephalopathy
- portal hypertension
- bleeding esophageal varices
Term
cirrhosis
Definition
- end-stage of chronic liver disease
- much of functional liver replaced by fibrous tissue (diffuse fibrosis and conversion of normal architecture into abnormal nodules)
- normal flow through liver disrupted
Term
manifestations of cirrhosis
Definition
- hepatomegaly
- weight loss, anorexia
- jaundice
Term
hepatomegaly
Definition
big liver
Term
complications of cirrhosis
Definition
- portal hypertension
- splenomegaly (thrombocytopenia)
- ascites
- esophageal varices (bleeding)
- spider angiomas (diluted arterioles)
- palmar erythema (redness on palms
- encephalopathy
Term
portal hypertension
Definition
- sustained portal vein pressure >12mmhg (normal bt 5-10)
Term
3 causes of portal hypertension
Definition
- any condition increasing resistance to hepatic blood flow
- prehepatic
- posthepatic
- intrahepatic
Term
prehepatic portal hypertension
Definition
obstruction of portal vein before entering liver
Term
posthepatic portal hypertension
Definition
- obstruction through any veins beyond liver lobules
- ex: clot in hepatic vein, right sided heart failure, so return isn't good
Term
intrahepatic portal hypertension
Definition
- obstruction w/in liver (cirrhosis)
Term
ascites
Definition
increased fluid in peritoneal cavity; late stage manifestation of cirrhosis and portal hypertension (increased Na retention therefore increased water retention)
Term
contributing factors to ascites
Definition
- increased capillary P from portal hypertension and obstruction of flow through liver
- retention of Na and water by kidneys
- decreased colloidal P (impaired albumin synthesis from failing liver)
Term
tx of ascites
Definition
- dietary restriction of Na and water
- diuretics (increased urination)
- paracentesis - drain out fluid from abdomen
Term
complication of ascites
Definition
spontaneous bacterial peritonitis
Term
spontaneous bacterial peritonitis
Definition
- seen in persons w both cirrhosis and ascites
- peritoneal cavity infected w bacteria from blood, lymph, or through bowel wall
- serious infection; high mortality even w antibiotics
Term
splenomegaly
Definition
- result of shunting of blood into splenic vein
Term
what are the results of splenomegaly
Definition
- sequestering of large numbres of blood elements and development of hypersplenism
- decreased life span and numbers of formed elements in the blood (thrombocytopenia, anemia, leukopenia)
Term
thrombocytopenia
Definition
decreased blood platelets
Term
anemia
Definition
decreased rbcs
Term
leukopenia
Definition
decreased wbcs
Term
what does increased P in portal vein lead to
Definition
development of large collateral channels for flow
Term
collateral channels
Definition
bt portal and systemic veins supplying lower rectum and esophagus and the umbilical veins of falciform ligament
Term
what results from collateral channels
Definition
- hemorrhoids
- caput medusae
- portopulmonary shunts (bypass pulmonary caps)
Term
what is clinically most important concerning collateral channels
Definition
connections to esophagus - esophageal varices (weakens vessels and subject to rupture)
Term
surgical shunts
Definition
portosystemic or TIPS
Term
esophageal varices
Definition
P in portal vein increased due to obstruction, causing collateral channel development
Term
what are is the result of esophageal varices
Definition
causes reveral of flow (back-up) and formation of thin-walled varicosities (in submucosa of esophagus)
Term
why are esophageal varices subject to rupture
Definition
- can result in massive, fatal hemorrhage
- common in ppl who have cirrhosis
- complicated by liver disfx (failure to produce coagulation factors) and splenomegaly (thrombocytopenia)
Term
hepatic encephalopathy
Definition
- common in pts w cirrhosis
- failing liver unable to metabolize neurotoxins (ammonia, particularly)
- totality of CNS manifestations of liver failure ( ranges from lack of mental alertness to confusion, coma, convulsions)
Term
what is the most severe clinical consequence of liver disease
Definition
liver failure
Term
two types of liver failure
Definition
- acutely (fulminant hepatitis)
- chronic, progressive (cirrhosis)
Term
how much loss of hepatic fx is needed for failure to occur
Definition
80-90%
Term
tx for liver failure
Definition
- eliminate OH intake, prevent infections; carbos and calories to prevent protein breakdown; correct fluid/electrolyte imbalances; decrease ammonia production
Term
two manifestations of liver failure
Definition
- disorders of synthesis and storage fx
- disorders of metabolic and excretory fx
Term
cholelithiasis
Definition
- gallstones (sixe: grain of sand to 1" diam)
- precipitation of substances in bile (especially cholesterol and bilirubin)
Term
risk factors for cholelithiasis
Definition
- women
- native americans
- over age 40
Term
contributing factors to cholelithiasis
Definition
- bile composition abnormalities
- bile stasis
- gallbladder inflammation
Term
signs and sxs of cholelithiasis
Definition
- many asymptomatic
- sxs when bile flow obstucted
- diff for small and large stones
Term
small stones signs and sxs
Definition
- pass into common duct: indigestion, biliary colic (pain in the right upper quadrant)
- stone may become lodged: acute cholecystitis (repeated episodes: chronic cholecystitis)
Term
large stones signs and sxs
Definition
- more likely to obstruct flow, causing jaundice
Term
typsin and chymotrypsin
Definition
- substrate: proteins
- action: proteins to peptides
Term
carboxypeptidase
Definition
- substrate: proteins
- action: removes last aa from carboxy end of peptide
Term
lipase
Definition
- substrate: fat
- action: converts triglycerides into fatty acids and monoglycerides
Term
pancreatic amylase
Definition
- substrate: polysaccharide
- action: converts polysaccharides into glucose and maltose
Term
RNAse and DNAse
Definition
- substrate: nucleic acid
- convert nucleic acids into nucleotides
Term
acute pancreatitis
Definition
- activated pancreatic enzymes escape into pancreas and surrounding tissue (i.e. autodigestion of pancreas)
Term
causes of acute pancreatitis
Definition
- usually develops from gallstones (stones in common duct ) or OH abuse
- hyperlipidemia
- hyperparathyroidism
- infections
- drug-induced
- abdominal and surgical trauma
Term
signs and sxs of acute pancreatitis
Definition
- abrupt onset: initial symptom = severe epigastric pain radiating back
- abdominal distenstion, hypoactive bowel sounds
- loss of fluid vol into retroperitoneal, peripancreatic space, abdominal cavity
- tachycardia, hypotension, clammy skin
- mild jaundice
Term
dx of acute pancreatitis
Definition
- serum amylase (rise w/in first 24hrs; elevated for 72hrs)
- serum lipase (rise w/in first 24-48 hrs; elevated 5-14d)
- urine amylase (increased urinary clearance)
- increased wbc
- hyperglycemia (islets, increase glucose, decreased insulin)
- increased bilirubin (if block duct)
Term
complications of acute pancreatitis
Definition
- acute respiratory distress syndrom
- acute tubular necrosis (kidney disfx)
- hypocalcemia
Term
prognosis of acute pancreatitis
Definition
- age, increased wbc, increased bg, infection
Term
tx of acute pancreatitis
Definition
- prophylactic antibiotics
- fluid replacement
- pain relief/smooth muscle relaxation
Term
two types of chronic pancreatitis
Definition
- chronic calcifying
- chronic obstructive
- both are progressive destruction of pancreas
Term
two types of chronic pancreatitis
Definition
- chronic calcifying
- chronic obstructive
- both are progressive destruction of pancreas
Term
two types of chronic pancreatitis
Definition
- chronic calcifying
- chronic obstructive
- both are progressive destruction of pancreas
Term
chronic pancreatitis
Definition
- presistent, recurring epigastric pain
- develop malabsorption (due to disfx of enzymes) syndrome and diabetes
Term
blood
Definition
- tissue composed of water, solutes, cells, formed elements and dependent upon gender and size
Term
fxs of blood
Definition
- transportation
- fight infection
- clotting
- buffers internal pH
- maintains normal body T
Term
two ways blood fxs as a transporter
Definition
- carries oxygen and nutrients to cells
- carries secretions and wastes away from cells
Term
what are the 3 main constituents of blood
Definition
- plasma
- cells
- platelets
Term
what are the components of plasma
Definition
water, proteins, ions, glucose, lipids, aa, vits, globulins, albumin, hormones, dissolved gases
Term
what are the components of cells in the blood
Definition
- rbcs (erythrocytes), wbcs (leukocytes)
Term
what is the main fx of rbcs
Definition
- provide Hb for O2 binding
Term
what is the main fx of wbcs
Definition
- fights infection
Term
what are the 5 types of wbcs
Definition
- lymphocytes (B and T)
- monocytes/macrophages
- neutrophils
- eosinophils
- basophils
Term
platelets
Definition
- mostly in bone marrow
- only pieces circulate in blood
- fragments of megakaryocytes
- blood clotting
Term
what are the fxs of the plasma
Definition
- liquid portion of blood; transport medium
- transports inorganic and organic substances
Term
what are the fxs of the plasma proteins
Definition
- albumins establish osmotic gradient bt blood and interstitial fluid
- other proteins buffer pH changes
- globulins (alpha, beta, and gamma): roles range from blood clotting to transport
- gamma globulins: role in immunity as antibodies
- fibrinogen: key factor in blood clotting
Term
what do rbcs lack that most other cells have
Definition
nucleus, organelles, and ribosomes
Term
why does the shape of rbcs contribute to its fx
Definition
- has large surface area and is thin which are both advantageous for diffusion
- the plasma membrane is flexible which helps the rbcs slide through capillaries
Term
two parts of hb
Definition
- globin and heme
Term
globin of hb
Definition
- protein made of 4 highly folded polypeptide chains
Term
heme of hb
Definition
- 4 Fe-containing, non protein groups
- each Fe atom bound to one globin polypeptide and can combine w one molecule of O2 gas
- molecule is bright red when combine w O2 (this is why blood is red)
Term
other than Fe, globin, and O2, what else can Hb bind to?
Definition
CO2, CO, NO, and H+
- buffers blood pH by binding H+
Term
why can rbcs in circulation not reproduce
Definition
- no nucleus therefore no cellular division
- avg life span is 120d
Term
where are old rbcs destroyed
Definition
- spleen
Term
erythropoeisis
Definition
production of new rbcs
Term
where is the site of erythropoeisis
Definition
bone marrow
Term
how does bone marrow produce new rbcs
Definition
- pluripotent stem cells in the red marrow differentiate into all the diff types of blood cells
- regulatory factors act on hemopoietic (blood-producing) red marrow to govern the type and number of cells produced and discharged into the circulation
Term
what stimulates an increased rate of erythrocyte production
Definition
- low level of O2 delivery to tissues (including kidney)
- hypoxia
Term
what controls erthyropoiesis
Definition
- erythropoietin (EPO)
- hormone produced by kidneys
- takes about 1 wk to see fx
Term
overall definition of anemia
Definition
- reduction below the normal capacity of blood to carry oxygen
- NOT A DISEASE; indicative of disease
Term
types of anemia
Definition
- nutritional anemia
- pernicious anemia
- aplastic anemia
- renal anemia
- hemorrhagic anemia
- hemolytic anemia
Term
nutritional anemia
Definition
- caused by dietary deficiency of a factor needed for erythropoeisis (e.g. iron or folic acid)
Term
pernicious anemia
Definition
- due to inability to absorb adequate amts of vit B12 from the digestive tract
- low absorption of B12 due to lack of "intrinsic factor"
Term
aplastic anemia
Definition
- due to failure of bone marrow to make adequate numbers of rbcs
- can be caused by radiation, viral infection, bone marrow CA, chemical exposure, etc
Term
renal anemia
Definition
due to kidney disease
Term
hemorrhagic anemia
Definition
- due to loss of significant amts of blood (acute or chronic)
- normochromic, normocytic, low hct, high reticulocyte ct
Term
hemolytic anemia
Definition
- due to the rupture of many rbcs
- sickle cell disease can make rbcs fragile and vulnerable to hemolysis
- normochromic, normocytic, low hct, v. high reticulocyte ct
Term
how can someone acquire hemolytic anemia
Definition
- drugs, chemicals, toxins, venoms, infections (malaria)
- often immune-mediated (Abs to rbcs)
Term
polycythemia
Definition
- excess circulating rbcs
- produces an elevated hct
Term
primary polycythemia
Definition
- caused by tumorlike condition in the bone marrow
- increases blood viscosity up to 7x normal, which may reduce O2 delivery to tissues and increases TPR
Term
what does TPR stand for
Definition
- total peripheral resistance
Term
secondary polycythemia
Definition
- erythropoietin-induced adaptive (appropriate) mxn to improve the O2-carrying capacity in the blood
Term
what are some conditions other than polycythemia that can elevate the hct
Definition
- dehydration due to heavy sweating or diarrhea
Term
megakaryocytes
Definition
- lacks nuclei, but have organelles and cytosolic enzymes
- synthesize and store secretory products
- produce platelets
Term
hemostasis
Definition
- arrest of bleeding
- platelets play a major role
Term
thrombopoietin
Definition
- increases megakaryocyte numbre
- overall production not well understood
- produced by liver
Term
3 steps of hemostasis
Definition
- vascular spasm
- platelet plugging
- blood coagulation
Term
vascular spasm
Definition
- vascular constriction, reduces blood flow through damaged vessel
Term
platelet plugging
Definition
- platelets aggregate on contact w exposed collagen in damaged wall of vessel; bind to VWF which carries factor involved in clotting cascade
- stimulated by ADP
- other substances from blood vessel endothelium inhibit platelet aggregation, keeping the process under control
Term
coagulation (blood clotting)
Definition
- reinforces platelet plug and converts blood to a gel in area of vessel damage
- ultimate step in clot formation: conversion of fibrinogen into fibrin
- fibrin threads trap rbcs, forming clot
Term
what organ produces fibrinogen
Definition
- liver
Term
clot
Definition
- a meshwork strengthened by cross-linkage from factor XIII (fibrin-stabilizing factor)
Term
thrombin
Definition
- formed from precursor, prothrombin, via activation of Factor X
- conversion involves clotting cascade
Term
thrombin fxs
Definition
- converting fibrinogen to fibrin
- activating factor 8
- facilitating its own formation via positive feedback
- enhancing platelet aggregation
Term
clotting cascade
Definition
-- series of steps involving 12 clotting factors which leads to final conversion of fibrinogen to fibrin
Term
clotting factors
Definition
- proteolytic enzymes in series of rxns called the clotting sequences
- one factor in sequence activated, which in turn activates another factor, and so on
Term
what are the last two steps of the clotting cascade
Definition
- prothrombin converted to thrombin
- fibrinogen converted to fibrin
Term
what are the two pathways of the clotting cascade
Definition
- intrinsic
- extrinsic
Term
intrinsic pathway of the clotting cascade
Definition
- 7 steps: all elements found in blood; blood vessel damage
- meets extrinsic pathway at factor x
Term
extrinsic pathway of the clotting cascade
Definition
- shortcut of 4 steps; factors external to blood; tissue damage
- meets intrinsic pathway at factor x
Term
what is clot retraction
Definition
- after clot formed
- contraction of platelets in clot causes fibrin mesh to shrink and fluid (serum) to be squeezed from clot
Term
amplification
Definition
- occurs in the clotting process
- one molecule can activate 100 molecules in the next step, etc
- advantage of multi-step process
Term
what is a clot short-term soln
Definition
- fibroblasts form scar tissue for vessel repair
Term
clot dissolution
Definition
- clot slowly dissolved by plasmin (enzyme)
- phagocytic wbcs remove products of dissolving clot
Term
how does plasmin dissolve a clot
Definition
- made in liver as inactive precursor (plasminogen)
- plasminogen activated in cascade fashion
- amongst factors in cascade is factor xII (hageman factor), same factor involved in clot formation
- when clot formed, activated plasmin trapped in clot, slowly breaking down fibrin mesh
Term
tPA
Definition
- tissue plasminogen activator
- prevents inappropriate clot formation
- derived from tissues
- plasmin fxs continually to prevent inappropriate clot formation
Term
what can result from inappropriate clotting
Definition
- thromboembolism
- caused by roughened surfaces on a vessel
Term
hemophilia
Definition
- conditions causing excessive bleeding
Term
3 main causes of hemophilia
Definition
- deficiency of any factor in clotting cascade (factor VIII)
- platelet deficiency
- vit K deficiency
Term
how does platelet deficiency cause hemophilia
Definition
- thrombocytopenia purpura
- causes hundres of small, confined hemorrhagic areas in body
Term
two forms of hypercoaguable states
Definition
- conditions creating increased platelet fx
- conditions causing increased clotting activity
Term
what two places will hypercoaguable states cause a predisposition to thrombosis
Definition
- arteries (due to trubulence - platelets)
- veins (due to stasis - platelets and fibrin)
Term
what are effects of increased platelet activation
Definition
- endothelial damage
- increased platelet sensitivity to adhesion, aggregation factors
Term
what are some factors which will cause a disturbance in platelet flow
Definition
- atherosclerosis
- smoking
- HTN
- DM
- elevated blood lipids/cholesterol
Term
primary disorders affecting coagulation components when there is an increased clotting activity
Definition
- genetic mutations in factor V and prothrombin most common
- deficiencies in antithrombin III, protein C, protein S less common
Term
secondary disorders affecting coagulation components when there is an increased clotting activity
Definition
- acquired
- stasis: immobilized or postsurgical pt
- MI
- CA
- hyperestrogenic states, oral contraceptives
Term
4 categories of bleeding disorders
Definition
- platelet defects
- coagulation defects
-disseminated intravascular coagulation
- vascular disorders
Term
2 types of platelet defects
Definition
- thrombocytopenia
- thrombocytopathia
Term
thrombocytopenia
Definition
- decreased numbers of circulation platelets
- increased bleeding risk (petechiae, purpura)
Term
thrombocytopathia
Definition
- impaired platelet fx
Term
petechiae
Definition
bruise
Term
purpura
Definition
largely bruised area
Term
3 causes of thrombocytopenia
Definition
- decreased platelet production in bone marrow
- increased platelet pooling in spleen
- decreased platelet survival due to immune or nonimmune mxns
Term
cases in which decreased platelet production in bone marrow would occur
Definition
- aplastic anemia, leukemia, radiation, HIV
Term
cases in which increased platelet pooling in the spleen would occur
Definition
- splenomegaly due to cirrhosis, portal HTN, and lymphomas
Term
cases in which a decreased platelet survival would occur
Definition
- antiplatelet Abs (self Ags or platelets from blood transfusions or pregnancy)
Term
2 main causes of thrombocytopathia
Definition
- inherited disorders
- drug induced
Term
what inherited disorder causes thrombocytopathia
Definition
- von Willebrand disease
Term
what drugs might induce thrombocytopathia
Definition
- aspirin and other NSAIDS bc they inhibit TxA2 production
- clopitogrel/ticlopidine bc they inhibit ADP
- GPIIb/GPIIIa inhibitors bc they block the receptor
Term
two ways to have coagulation defects
Definition
- impaired synthesis
- hereditary disorders
Term
how does impaired synthesis lead to coagulation defects
Definition
- liver disease: liver produces most coagulation factors
- vit K deficiency: factors VII, IX, X, prothrombin are vit K dependent
Term
what hereditary factors can lead to coagulation defects
Definition
- hemophilia A: factor VIII
- von Willebrand disease: factor VIII-vWF
Term
von Willebrand disease
Definition
- VWF
- autosomal therefore both men and women are affected
- typically goes unnoticed
- much more common than hemophilia
Term
disseminated intravascular coagulation (DIC)
Definition
- paradoxical rxn of coagulation and hemorrhage
- activation of clotting cascade via thrombin generation resulting in systemic fibrin formation
- anticoagulant system overwhelmed
- microvascular thrombosis
- massive clot formation uses all coagulation proteins and platelets
- hemorrhage
- fibrinolytic system activates and leads to more bleeding
Term
microvascular thrombosis
Definition
= vessel occlusion and tissue ischemia
Term
what does systemic fibrin formation mean?
Definition
- clots are formed EVERYWHERE
Term
4 types of vascular disorders
Definition
- hemorrhagic telangiectasia
- scurvy (vit C deficiency)
- cushing's disease
- senile purpura
Term
hemorrhagic telangiectasia
Definition
- uncommon autosomal dominant disorder
- thin-walled, dilated capillaries and arterioles; vessels not anatomically correct
Term
scurvy (vit C deficiency)
Definition
- poor collagen synthesis in endothelial wall; results in fragile vessel walls; Vit C is necessary for collagen synthesis
Term
cushings disease
Definition
- protein wasting and loss of tissue support due to excess cortisol; cortisol uses up proteins that make up vessel walls therefore vessel walls are weaker
Term
senile purpura
Definition
- bruising in the elderly caused by aging
Term
reticulocyte
Definition
- matures over 24-48hrs to mature rbcs
- high reticulocyte numbers = increased erythropoiesis
Term
what four things can be tested in a lab in regards to blood levels
Definition
- hb
- hct
- MCV
- reticulocyte count
Term
MCV
Definition
- mean corpuscular vol
- size of rbcs
Term
manifestations of anemia
Definition
- impaired oxygen transport w resultant compensatory mxns
- reduction in rbc indices and Hb levels
- signs and sxs of pathology causing anemia
Term
4 types of deficient rbc production anemias
Definition
- Fe-deficient anemia
- pernicious anemia
- folic acid anemia
- aplastic anemia
Term
Fe-deficient anemia
Definition
- dietary deficiency of Fe, loss of Fe (bleeding), increased demand
- microcytic, hypochromic
- low ferritin caused by low Fe
Term
pernicious anemia
Definition
- B12 deficiency
- due to inability to absorb adequate amts of B12
- low absorption of B12 due to "intrinsic factor"
- macrocytic, normochromic
- vegetarians
Term
folic acid anemia
Definition
- req'd for DNA synthesis and RBC maturation
- macrocytic, normochromic
Term
aplastic anemia
Definition
- due to failure of bone marrow to make adequate numbers of RBCs (all blood cells affected, though)
Term
chronic disease anemias
Definition
- complication of chronic infections, inflammation, CA
- normocytic, normochromic, decreased reticulocyte numbers
Term
theory behind chronic disease anemias
Definition
- actions of macrophages, lymphocytes in response to cell injury cause short life span, deficient RBC production in response to EPO, low serum ion
- chronic renal failure
- HIV
- CA
- rheumatoid arthritis
Term
2 possible txs of anemia
Definition
- transfusion therapy
- blood donations
Term
5 types of transfusion therapy
Definition
- whole blood
- packed RBC
- leukocyte poor RBC
- washed RBC
- frozen rbcs
Term
frozen rbc as a type of transfusion therapy
Definition
- glycerol keeps RBCs from freezing and then glycerol is washed away
- can last up to 10 yrs
- great for rare blood types
Term
two types of blood donation
Definition
- autologous
- donor blood
Term
autologous donation
Definition
- donating you own blood
Term
3 types of autologous donation
Definition
- predeposit
- hemodilution
- intraoperative salvage
Term
predeposit
Definition
- donating you own blood 6 wks in advance before a surgery
Term
hemodilution
Definition
- removing blood before surgery then put back after; common in open heart surgery
Term
intraoperative salvage
Definition
- in middle of surgery and reinfused during surgery
Term
what 3 things is donor blood tested for
Definition
- ABO surface Ags
- Rh types
- Infection risks
Term
polycythemia
Definition
- excess circulation rbcs producing elevated hct
Term
absolute polycytehmia
Definition
elevated hct due to increased total rbc mass (primary or secondary)
Term
primary polycythemia
Definition
- polycythemia vera
- proliferative disease of pluripotent cells in bone marrow
Term
secondary polycythemia
Definition
- EPO-induced adaptive (appropriate) mxn to improve the O2-carrying capacity of blood
Term
relative polycythemia
Definition
- elevated hct due to loss of plasma vol
- e.g. dehydration due to heavy sweating, diarrhea
Term
signs and sxs of polycythemia
Definition
- increased blood viscosity: CO and blood flow reduced
- hypertension common (overcoming viscosity): HA, inability to concentrate, vision, hearing trouble as a result of decreased cerebral blood flow
- venous stasis: dusky redness (even cyanosis)) of lips, fingernails, mucous membranes
- thromboembolism
Term
polycythemia tx
Definition
- primary, reduce viscosity via: phlebotomy to decrease rbc vol or suppress bone marrow fx via chemotherapy reduces wbc and platelet counts
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