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Review
Test 3
102
Pathology
Undergraduate 1
03/19/2013

Additional Pathology Flashcards

 


 

Cards

Term
What are the layers of the heart?
Definition
  1. Pericardium- Fibrous sac that covers the heart
  2. Myocardium- Muscle layer
  3. Endocardium- Membrane that lines the heart

 

Term

Tell me about the Myocardium

(Sarcomers)

(intercalted disc)

Definition
  • Sarcomers- contracts heart interwoven in myocardium then called Synctium- all these fibers will wrk together so we have good even smooth contractions= good start top to bottom
  • Intercalted disc- connect sarcomers provide easy conduction for action potential from one fiber to the next keep their from being a delay.
Term
How do myocardial cells contract?
Definition
  1. Small amount of extracellular calcium move in cell as action potential begins.
  2. This opens up SR releases large amounts of intracellular CA+ into the cytosplasma.
  3. Intracellular free ca+ attaches to troponin.
  4. Troponin turns and becomes thick filament
  5. Actin and myocin hook up causing cell shortening
  6. ATP comes to start power stroke
  7. After power stroke myocin lets go
  8. filament turns away and muscle moves
Term
What actually allows actin and myocin to cross bridge and hook up?
Definition
The intracellular calcium attaching to Troponin and twisting
Term
What happens during systole?
Definition

Isololumetric contraction= vessels has been loaded full of fluid stretches- stretch creates contraction amount og stretch determins strenght of contraction

  1. Ventricals fill with blood and contract
  2. Pushes through tricuspid & mitral closing= closing is 1st heart sound
  3. Semilunar valve open and allows blood to flow into aorta and pulm artery out of the heart
Term
What happens during diastole
Definition
  1. Ventricles relax pressure on pulm and aortic valve stop they close = 2nd heart sound
  2. Blood enters atria and flows thru av valves into ventricals
  3. Atrial kick forces blood into ventricals
Term
How does blood fill ventricals?
Definition
Atrial kick
Term
Why is diastole so important what is happening?
Definition
Coronary Artery Perfusion Blood gets to muscles
Term
What are the three things that give the meaning to life/ CO
Definition
  1. Preload- Volume(what comes back to heart)/ Stretch of the heart.
  2. Afterload- Pressure work of heart(BP)
  3. Conctractility-( Orderly Progression of electrical single from top to bottom)
  • HR- determins time in diastole and filling time of ventricle and perfusion of arteries
  • Rythem-Orderly Progression of the electrical single from to bottom
Term
What is the difference b/t arteries and veins?
Definition
  • Arteries- thick muscle layers can control easier, Left ventrical is the pump
  • Veins -can exspand more they depend on one way valves and skeletal muscle for movement
Term
What is Nitric Oxide?
Definition
Constantly secreted into leument to protect against clotting and vasonconstriction d/t it constantly tries to relac muscle to control vessels
Term
Exsplain endothelial control
Definition

Nitric oxide causes constant smooth muscle relaxation making vessels bigger on the other side we have vasonconstrictors like endothelins, ang 2 and PG that are constricting and making vessel smaller.

(We have constant regulation by way ofr hormones)

Term
What is interstitium?
Definition
It is fluid filled tissue  that is between the organs, it is how we get stuff to cells that are not directly against a capillary.
Term
What is arthosclerois
Definition
Hardening of the gruel (plaque) inside the itimal layers of the the arteries.
Term
What is the plaque made of that is in the arteries and how does it get their?
Definition
  1. High levels of lipid in the blood
  2. Endothelial cell injury
  3. Migration of inflammatory cells(macrophages engulf LDL)
  4. lipid accumulation and smooth muscle proliferate-(macrophages engulf as much lipid as they can and turn into foam cells that are still secreting inplammatory mediators.
  5. Platelets form a patch over the top muscle
  6. Collegen comes and tries to heal fibrous cap.
  7. Vessel occlude and eventually rupture and move down stream to clog vessel.
Term
Things that make a plaque more vulnerable= more easy to rupture/
Definition
  1. Large lipid core
  2. thin fibrous cap- very easy to knock off
  3. fissured cap- cap with a bruise/ grove wrosion
  4. inflammation within  cap
  5. superficial endotheial wrosion- plaate aggregation-
Term
If plaque in HRT @ coronary arterie  and ruptures what will happen?
Definition
forms clot and causes occulsion @coronary artery= MI
Term

Women c/o pain in LLE

  1. Foot cool pale
  2. reports red/ warm sitting
  3. pain with walking
  4. skin LLE shinier then RLe
Definition
  1. no b/f weak pedal pulse
  2. b/f decreased
  3. 0 prostiglandin
  4. lose fat layer under skin can
  5. t maintain tissues
Term
What is an Aneurysm?
Definition
Break in any way - blood gets inside lumen causes rupture/ hemmorage. Wall of artery gets weakns and stretches
Term
What is the big deal w/ varicose veins why do we not like them?
Definition
Harber clots
Term
What is a stationary blood clot called?
Definition
Venous Thrombus
Term
Whats happens when a venouse throbus break of and moves?
Definition
PE- break off and goes to lung
Term
What 2 things regulates BP?
Definition
  1. Neural control- lower pons and medulla cardivascular center rapid short term regulation.
  2. Peripheral control- Barorecepters in carotid and aortic arch respond to pressure changes SNS heart rate and vasoconstric
Term
Explain RAA
Definition
  1. Decreased BP
  2. renin release angiotensinogen activates
  3. angiotensis 1 this hooks up to ace in the lungs
  4. Angio 2 is released causes strong vasoconstriction
  5. aldosteron is released to save sodium and water and excrete K+ causing a increase in blood volume/afterload
Term
What does ADH do?
Definition
Released from posterior pituary d/t increased serum osmolarity, stops excretion of NA & H20 which increases blood volume
Term
What does ANP do?
Definition

Released d/t over stretched atria

increase NA+/water excretion= vaso dil decreased preload & after load= decreased BP

Term

Classification of BP

  1. Normal
  2. pre-hyp
  3. stage1
  4. stage2
Definition
  1. 120/80
  2. 120-139 0r 80-89
  3. 140-159 or 90-99
  4. >160 or >100
Term
What is pericarditis?
Definition
inflamation of pericardium
Term
What is Pericardial effusion
Definition
fluid build up in pericardium sac
Term

What is problem with pericardial effusion

& How can we fix this problem?

Definition

Fluid gets build up in pericardial sac causing Tampnade= heart can't move at all d/t decreased space d/t the increase in fluid.

 

Tube drain or window

Term
What are the 3 types of chest pain you can have with coronary heart diffusion
Definition
  1. Stable anginia-Pain when heart 02 demaind increases if this person stops activity the will go away
  2. Variant angina-Pain when artery spasm, not associated with activity not due to arterosclerosis
  3. Unsable anngina-Pain at rest or increase or in stable anginia, pain now does no stop when you stop activity.
Term
Unstable anginia turns into what and why does this happen?
Definition
Acute Coronry Syndrome= Demand >Supply
Term
What are S/s with patient who has ACS
Definition
  • chest pain
  • SOB- d/t blood settles in lungs- NOT 02 PROBLEM
  • Diaphoreses d/t sympathetic ns release epi & norepi
  • n/v d/t vasoncontriction of bv and decreased blood flow to gut and kidney
Term
What change on EGD monitor do you see with a patient who has ACS?
Definition
ST elevation and abnormal q wave
Term
Stemy elevation leads to MI... How do you know when someone has had a MI?
Definition
Necotic tissue
Term
How do i know when i have necrotic tissue?
Definition

Look @ cardiac markers

CK-MG elevated

Troponin less then 4% GOLD STANDARD

Term
What is difference b/t transmural and subendocardial mi?
Definition
  1. Transmural Mi=stemy= st elevation complete occlution entire thickness of  muscle
  2. Subendocardial mi= no stemy or st elevation= only part wall.
Term
What do you do for someone that has a mi?
Definition

Morphine= vasodilation

oxygen= increase suplly

Nitrates= dialate coronary arteries and bring blood flow to the heart

aspirin= antiplatelet

  • also want to start on heparin drip to stop clot from getting bigger does not break it
Term
Interventions for acute coronary syndrom
Definition
  1. Thrombolysis= BEST break down clot, could avoid mi must catch right away to get this drug 2-3 hrs.
  2. PCI(percutaneous coronary intervention) cath femoral artery, run it to coronary artery
  • PTCA- heart cath ballon open up artery jam plaque back in wall
  • PTCA w/ stent
  • ( 6 months people will go back to their normal life)
  1. CABG- Different vessel and bypass the clot
Term
ACS eventually leads to HEART failure how does this happen?
Definition

Inability of heart to pump enough blood to meet the demand on of the body.

  • FIRST SYSTEM
  1. Cardiac output is decreased heart fails
  2. Hypothmus know this do it activates baroreceptors and SNS
  3. nor and epi increase Heart rate & contractility
  4. cardiac output increases
  • SECOND SYSTEM
  1. RAS activated and decrease GFR
  2. Kidney holds on to fluid
  3. Preload and after load are increased
  4. cardiac output increases
Term
What did the exsessive beathing of the hrt and angiotension 2 cause?
Definition
Muscle Hypertrophy and Cardiac remodeling which is BAD
Term
What happens during right sided heart failure
Definition

Fluid back up in body

  • hematomegly
  • ascietes
  • splenomegly
  • anorexia
  • sbq edema
  • JVD
Term

What happens to the lungs during LEFT and RIGht sided hrt failure

 

Definition

You can't get 02 blood to body

  • fatique
  • obliguria
  • increased hrt
  • restless
  • confusion
  • anxiety
Term
What is left sided hrt failure
Definition

Fluid builds up in the lungs

  • dyspnea on excertion
  • orthopena
  • cough
  • paroxymal noctura dyspnea
  • cyanosis
  • basilar crackles
Term
What is pulmonary edema
Definition
Blood backs up in pulm vessek and causes increase BP.
Term
The high pulmonary pressure (pulm edema)in vessel where does it go?
Definition
Alveoli sacs... RBC come in and cause pink frothy sputum... You have failed your patient will hear crackles
Term
What is the difference b/t a stenotic and regurgiant valvue.
Definition

Stenotic- can't open- hear a murmur of blood shooting through narrown opening when the valve should be opened

Regurgiant- can't close- hear a murmur of blood leaking through valve when shoould be closed

Term
When looking at electric of hrt whad do you look at what do you want to look at on your rythem strip
Definition
Look at speed and direction ... or will have disorderly progression in hrt
Term
What is cardiogenic shock all about
Definition
Shock caused by hft failure or degenerative shock- heart fails to pump enough blood aduequetly
Term
What is the problem with cardiogenic shock?
Definition
The hrt muscle its self caused decreased perfusion and decreased 02
Term
Cardiac shock is not caused by what??
Definition

Mediators

it is how ever caused by

  • Decreased c/o= decreased perfusion
  • tissue hypoxia= anarobic metabolism and little energy
  • lactic acid builds up= tissue damage
  • inflammatory process= decreased cardiac output
  • decreased circ volume= decreased cardiac output
Term
What is the difference b/t cardiac and distribuative shock
Definition

Where it starts @.

Distribuative start when their is bad perfusion

Cardiac starts at the heart.

Term
Treatment of Cardiogenic shock
Definition
  1. Posiitive inoptrop- increase cardiac putput increased force of contraction.(becare ful have to balance out ability of hrt)
  • Dobutamin- drug that increases force of contraction
  1. Fluid restriction- Diuretic decrease fluid decrease the prload which decreases force of contraction
  2. Intra- aortic ballon pump- support heart take over wrk of hrt letting it to rest
Term
What are the three elements of urine formation
Definition
  1. Filtration- where blood enters bowmans capsule intial formation of urine( no plasma protien, RBC, WBC this stays in blood)
  2. Reabsorption- You had gotten rid of everything but you pull fluid back in to try and create near perfect blood. (electrolytes, water, bicard, acid)
  3. Secretion-final adjusments we have almost perfect blood put things back in urine we really don't need occurs in distal tubuls
Term
What is the Juxaglomerular apparatus and what does it control
Definition

Controls urine flow by controling BP & BV

  1. Macula densa- checks NA
  2. J-cells- chck BF

Controls GFR

Term
What doe the Jcells look at
Definition
They look at BF if BP is low the RAA process begins
Term

What does ANP & BNP Do?

 

Definition

causes kidneys to stop reabsorbing Na+ & Water

(acts as a diuretic) sodium and water will be loss in urine decreasing blood volume, afterload, BP & stretch of the heart

 

Term
ANP and BNP occure because of over streched what?
Definition

ANP= overstretch atria

BNP= over stretched Ventricals

Term
If you have Kidney disease why would you develop anemia and weak bones
Definition

Anemia= d/t no erythropoetin

Weak bones d/t no vitamin d activation d/t kidney disease, which is used to reabsob calcium.

Term
Serum creatinin 2.4 is this good or bad.
Definition

I don't know i want to know what it was yesterday.

  • Serum creatinin norm is .8-1.2 - serum creatinin represents kidney function it is the end product of muscle metabolism. Gold standard

yesterday it was 3.4 so 2.4 is comming down

Term
What is bad about haver a cysts in your kidney
Definition
It blocks BF causes too much fluid in tissues and this leads to compartment syndrome
Term
What is Polynephritis
Definition
It is infection of kidney pelvis and PARENCHYMA ( essential tissue of the kidneys which is nephron and collecting ducts.
Term
What is ACUTE P-Nephritis
Definition
Kidney infection caused by gram- neg bacteria can lead to sepsis
Term
What is Chronic P-nephritis
Definition

Progressive process

Chronic inflammation creates obstruction

prevents healing of tubes

promotes inflam process ( not normal tissue scar tissue)

HTN contribuites to risk and progression

can lead to kdney failure

Term

What is Glomerulonphritis what causes the ITIS

 

Definition

IT is damage to glomerulus and happens in two ways- Both cause inflamation

  1. membrane antibodies- these are antibodies that form against the glomerular protiens- type 2 hyper sensitivity
  2. Complex decomposition- this is where cirulating immune complexes lodge in glomerulus and block formation of urine- type 3
Term
Whatis very common characterist of Glomulonphritis
Definition
Periorbital edema
Term

What happens to Glomerulus during glomerulonephritis

 

Definition
Not working well allows protein and RBC through because it is allowing things to be filtered that should not be- leads to urine getting clogged, decreased output of urine, which leads to NA and water retention and HTN- loss of plasma protiens= periorbital edema
Term
What is Nephrotic syndrom
Definition
The collection symptoms that are causes by glomerular disease( glomerularnephritis)
Term
What are the 4 aspects of N- syndrome
Definition
  1. edema- from fluid retention and protein loss
  2. Hyperlipidemia- liver crank out cholesterol to try and replace plasma proteins
  3. hypercoagibility- alters levels of clotting facter, exsess factors are loss in urine, but their is a decrease in urine their for incauses increase in factor consintration. 
  4. Decreased immune competance- loss of globuline & complement protiens loss albumin which needs to be carried around.
Term
What can happen to patient with necrotic syncrome
Definition
clots and infection
Term
Why is acute renal failure different then chronic
Definition
Chronic can't get better and acute possible can
Term
What are the 3 causes of Acute renal faliure?
Definition
  1. prerenal- decreased blood supply to kidney(shock dehydration, vasoconstriction)
  2. intrinsic or intrarenal- tubular function decrease(ishemia, toxins)
  3. post renal- urine flow is blocked cause build up and leading to compartment syndrome(stones, tumors)
Term
By far what is the most common cause of ARF?
Definition
Acute tubular necrosis- ishemic or toxic injury which is intrinsic or intrarenal
Term
What happens to your kidneys when you have ATN what are the phases
Definition
  1. Onset- first decrease in urine
  2. Maintance- Anything from olguira or anuria (decreased or 0 urine) bun creatine , K all rise
  3. Recovery- repairs itsself and returns to normal function
Term
What is not good about the recovery phase
Definition
Even though you have tons of output the kidney has lost its ability to reasborb properly until it relearns you must replace all fluid that is lost.
Term
What is Azotemia and Uremia
Definition

Azotemia- accumulation of nitrogenous waste lab values

Uremia- clinical manifestation of renal failure

Term
When do you know you have to have hemodialysis
Definition
K greater then 7
Term
As if acute tubular necrosis wasn't bad enough while the person is going though those phases what orther things can happen that you should watch out for
Definition
  1. Neurilogical problems- seziures, MSC, coma death
  2. Fluid and electrolyte imbalance- bun creating potassium all rise
  3. Cardiovascular and resp problem- cirrculatory overload.

 

Term
Other consequences or CRF
Definition

Renal osteodysttrophy-vit d not activated so can't absorb calcium , decreased Ca causes increased PTH, increase PTC caused increase bone ca loss, so increased phosporus causes decreased ca levels.... GET RID OF PHOSPHEROUS

Gastestinal disorders- metalic taste in mouth, gastrits ulcers d/t increase ammonia, increased pth increase gastric secretions

Uremic encephalophaty-muscle weakness, decrease mental, malaise coma death

Term

What is hemodialysis

 

Definition
Osmosis and diffusion to correct metabolic imbalances- quickly filters blood
Term
What is peritoneal dialysis
Definition
Make use of semi perm membrain in body, mild form of renal failure only for acute not chronic. Cath in gut very sterile
Term
What is contnous renal replacement therapy( ultrafiltration)
Definition

this is for patient that can't handle regular dialysis- main purpose to get fluid off d/t AT necrosis or fluid over load

....DO it slowly

Term
How does the gut work
Definition

Movement

breaking down

absorption

  • keeps dangerous gut content out of blood
Term
What is gerd
Definition
Sphincter is weak and does not close properly and causes stomach content to flow back into esophagus
Term

What is so bad about GERD

can we cure this?

and it leads to?

Definition

It causes Barrets Esophogus which is a velvet pink lining pressence of gobulet cells that normaly are musouc cells in small intestine.

  • Can't cure just stop reflux
  • monitor for dysplasia leads to esophageal CX
Term
5 Types of Bleeding
Definition
  1. Franhemotenisi- bright red from esophagus about stomach
  2. Coffee ground- in stomach with partial digetstion
  3. Occult- intesting with blood mixing in stools can't see this
  4. Malena- intestin large amount blood tary stool
  5. Hemachezia- Rectum blood coats stool not in stool
Term
What is peptic Ulcer disease cause by
Definition

H- pylorie- bacteria in gut secrets urease

NEDS TO BE TREATED WITH MULTIPLE DOSES OF ATB

Term
What is the enresult of imflamation and obstruction cycle
Definition
malabsorption
Term
What 4 things happens if you dont releive inflammation with  obstruction
Definition
  1. Hemorrage- anemia
  2. Perferation- peritonitis
  3. decrease mucosal function- mealabsoption
  4. decrease bacterial containment- sepsis
Term
What is the Main difference with the two inflammatory bowl diseases
Definition
  1. Ulcerative collitis- the problem is the mucousa lining
  2. Chrons- goes all the way thru tissue(transmural) the gut more dangerous..more likely to die with infection
Term
What is the basic difference with the types of  malabsorption syndrome
Definition

One we create surggial and the other is gynetic

  1. Surgically produced treated with time- dumbing syndrome/short bowel
  2. Genetically- Celiac intolerance to gluten, Tropical nothing to do with what you eat.
Term
What are the  functions of the liver
Definition
  1. Carb metabolism- sugar stored as glycogen converted to glucose- to make fats
  2. Protein metabolism- synthesied from amino acids
  3. Fat metabolism- Synthesied and oxidied for energy packaged to lipoproteins
  4. Process and stores vitaming and minerals
  5. Synthesies clotting factors and stimulates Blood cell production- clotting facter made in liver
  6. Drug and hormon metabolism- detox and inactivates
  7. Immune system support- kuffer cells
  8. Bile production- waste products dumbed in bile
  9. Most important>>converts ammonia to urea
Term

Structure of the liver

 

Definition
  • Venous & arterial supply
  • Along with all the rich resourses coming in liver we also have a nice supply of arterial blood loaded with 02
  • Hepatic cels lie along vessels with good access to resourses from the blood
  • Products come through back way thru sinus soid and out central vein
  • many sinousids that come to gether empty into one vein= lobule
  • back side of cells is bile duct
Term

Liver Failure shows what disorders?

 

Skin

Renal

Hepatic encephalapathy

Definition
  1. jaundic, cherry red palsm, spider nevi
  2. Heporenal syndrome & decreased renal perfusion
  3. increase ammonia and toxin leves in head will see ASTERIXIS( flapping hands)
Term
What are three stages of Alcoholic liver disease
Definition
  1. Fatty liver(steatosis)- liver can't metabolize fat d/t getting rid of alcohole
  2. Alocoholic hepatitis- Liver inflammed d/t build up of fatty spots(edema obstruction mediators hepatocyte failure.
  3. Cirrhosis- fibrous scar tissue that blocks sinusoids and bile canal THIS CAN'T BE TURNED AROUND
Term
How do veins drain into hepatic portal system
Definition
  • Fibrotic tissue that builds up from liver makes hard for blood to get into liver
  • Blood backs up into stomach esophagus and intest
  • venous systems tries compensate and finds aternate routes for blood
  • Veins get stretch out varices forms.. bleeding occurs
  • Will now have bleeding in stomach or esophagus
Term
3 Problems with the tamponade therapy
Definition

aspiration

affixiation

esophageal erosion

Term
name 3 reasons why ascites forms
Definition
  1. decreased in colloid osmotic pressure(lack of plasma proteins in blood)
  2. increased in hydrostatic pressure( and mesentary)
  3. aldosterone and adh remains in blood (retain NA & Water)
Term
What problem does ascites cause
Definition
Breathing problems d/t diaphram being pushing up from the extra blood that is under high pressure no colloid osmotic pressure to pull fluid in so fluid moves to peritonial space.
Term
Pancratitis is?
Definition
  1. inflammation from a stone that is blocking common bile duct  backs up into pancreas activated digestive enzymes( HUGE INFLAM EVENT)
  2. Alcohole
  3. idopathic
Term
Autodigestion in the pancrease from pancreatitis causes 2 life threating events what are they?
Definition
Hypvolemia and hypocalcemia
Term
Concept map Portal HYP
Definition

1. increases pressure peri cap leads to ascites

2. Shunting of blood leads to blood going other places causes varices collateral chanells, caput medusae hemrroids.

3. Shunting of amonia leads to Hrpatic encephalopathy

4. This cause Splenomegaly which leads to anemia, leukopenia, thrbocypenia  along with ammune system problems

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