denotes new growth "neoplasia"

-well differentiated cells

-do not reproduce at a higher than normal rate

-well encapsulated

-do not spread to lymph nodes or distant areas

-usually suffix "oma" i.e. adenoma, Lipoma, Leiomyoma

-undifferentiated, non-functional cells and not organized

-rapid reproduction - abnormal mitotic figures

-infiltrate/spread into surround tissue

-spread to lymph nodes/distant sites

cancer arising in epithelial tissue

ex. adenocarcinoma

cancer arising from tissues that developed from embryonic mesoderm

bone, cartilage, muscle

ex. rhabdomyosarcoma

cancers from lymphatic tissue

ex. diffuse large B cell lymphoma

cancers from blood forming cells

ex. acute lymphoblastic leukemia

"CIS"

-preinvasive epithelial tumors of glandular or squamous cell origin

(provides excellent opportunity for early diagnosis)

-cancer has not broken through the basement membrane

-can occur in cervix, skin, oral cavity, esophagus, bronchus

-cancer cells exhibt autonomy

-lass of differentiation (anaplasia)

-abnormal cell membranes

-altered surface antigens

-tumor mass compresses blood vessels

-tumor cells may secrete enzymes or hormones

-inflammation and loss of normal cells

-angiogenesis 

-lack control of mitosis

-do not undergo apoptosis

-no contact inhibition

loss of cell-to-cell communication

-do not adhere to each other and often rbeak loose from mass

-invade other tissues and may spread to distant sites

-collagenase (break down of proteins and cells

-ACTH

-growth factors

development of new capillaries in the tumor

tumor cells "steal nutrients" from healthy cells

-unusual bleeding or discharge

-chnage in bowel or bladder habits

-change in wart or mole

-sore that does not heal

-unexplained weight loss

-anemia or low Hgb and persitent fatigue

-persistent cough or hoarseness w/o reason

-solid lump, often painless anywhere in body

-pain

-necrosis and ulceration

-obstruction

-often a late symptom

-due to: 

compression

stretching of visceral capsule

inflammation (pressure and irritation of nerves)

ischemia

blood in tissue (irritating)

-weight loss

-anemia

-severe fatigue

-effusions

-infections

-bleeding

-paraneoplastic syndrome

-anorexia, fatigue, pain, stress

-increased demands from tumor cells on body

- cachexia (severe tissue wasting)

-blood loss at tumor site

-nutritional deficits may reduce hemoglobin synthesis

-bone marrow depression

-inflammatory changes, cachexia, anemia

-stress of treatment schedule

-psychological factors

-tumor cells may erode the blood vessels

-lack of clotting proteins

(malnutrition and liver involvement)

additional problems associated with certain tumors

-tumor cells release active substances which may affect neurologic function, may affect clotting function, may have hormonal effects

-this syndrome may confuse the diagnosis of cancer, complicate monitoring and treatment and cause change in body image

-early detection

-follow up after treatment (to assess effectiveness of treatment and to detect recurrence)

Hgb and erythrocyte

(general sign of cancer)

(presence is not diagnostic by itself)

CEA = colon cancer

hCG = testicular cancer

AFP = hepatocellular cancer

CA125 = ovarian cancer

PSA = prostate cancer

require biopsy or cell sample

-determine degree of differentiation and tumor type

- most dependable confirmation of malignancy

Malignant tumors spread by

-invasion

-metastasis 

- seeding

-local spread

-tumor cells grow into adjacent tissues and secrete lytic enzymes that break down tissue

-example: uterine carcinoma invades vagina

-spread to distant sites

-via blood or lymph or other body fluids

-regional lymph nodes are usually first site of metastases (micrometastases)

-different cancers are selective for different sites

-due to regional blood and lymph flow, lungs and liver are common sites 

-spread of cancer cells through body fluids or along membranes (usually in body cavities)

-cancer cells break free and travel along membranes/through fluids

examples: ovarian cancer spread through pelvic and peritoneal cavity fluids

-helps determine treatment

-used to estimate prognosis

-common language for communication between health care providers

-essential to standardize comparative studies of clinical trials

T = size of primary tumor

N = involvement of regional lymph nodes

M - metastasis (spread) of tumor

stage 0 = carcinoma in situ

stage I = tumor limited to tissue of origin 

stage II = limited to local spread

stage III = extensive local and regional spread

stage IV = metastasized to other organs or throughout the body

-process by which normal cells are transformed into cancer cells

cancer is though to be a multi-factorial disease due to:

-environmental effects

-change in gene expression (heredity)

-infection in some cases

-initiation

-promotion

-progression

"initiating factors" - procarcinogens

-irreversible change in cellular DNA

-does not create active neoplasm

-must be combined with a promoting event for a cancer to develop and spread

-leads to development of tumor

-exposure to "promoters"

-includes hormones and environmental chemicals and chronic inflammation

-causes further changes in DNA

-depends on the continued exposure to the promoter

-genetic factors

-viruses

-radiation

-chemicals

-biological factors

oncogenes that regulate all growth and basic cell functions

tumor suppressor genes (when functioning normally they suppress oncogenes and malfunction can lead to cancer)

example: breast cancer and leukemia

oncoviruses alter host cell DNA

examples: hepatic cancer, cervical (HPV) cancer

-ultraviolet rays

-x-rays and gamma rays

-radioactive isotopes

-risk is increased with higher cumulative dosage

examples: skin cancer and leukemia

-related to duration and amount of exposure

-organic solvents

-asbestos

-heavy metals

-formaldehyde

-chemotherapy agents

examples: lung cancer, leukemia, bladder cancer

-chronic irritation and inflammation with increased mitosis

-age (increasing)

- diet i.e. high fat: colon cancer and smoked foods: gastric cancer

-hormones i.e. endometrial cancer: estrogen

-limit UV exposure

-regular medical and dental exams

-self-exam

-diet

(increse fiber content, reduce fats, 5-10 servings of fresh fruits and vegetables (these act as antioxidants, which reduce changes to DNA))

curative

palliative

prophylactic 

-eradicates cancers

-best success with small, less aggressive, localized cancers early in course

-reduce s/s

-prolong life - quality over quantity

-used when risk of micrometastases is high

example: radiation therapy following removal of rbeast cancer with no apparent metastases

-removal of tumor and surround tissue

-removal of adequate surrounding tissue may result in changes in function

-minimizes tissue damage

-improves recovery time

-alternative to surgery for small single tumors in solid or fluid-filled organs

-RFA prob inserted into tumor --> radiofrequency waves from probe raise temp. within tumor destroying tumor cells

-can be used in conjunction with locally delivered chemo

-may be used alone or in combination

-causes mutations/alterations in DNA

-most effective in rapidly dividing cells

-some cancers are radioresistant

-may be used prior to surgery to shrink the tumor

-external sources: cobalt machine (radiation for short time to specific site) (gamma knife) (requires multiple treatments)

-internal insertion of radioactive material at tumor site

- instilling radioisotope in a solution into a body cavity to control excessive inflammatory exudate or blood from tumor

-bone marrow depression

-epithelial cell damage

-infertility

(due to abdominal radiation)

-non-specific fatigue and lethargy

(can lead to depression)

bone marrow depression

because

decreased leukocytes - increased risk of infection

decreased erythrocytes - fatigue, tissue breakdown

decreased platelets - excessive bleeding

-antineoplastic drugs

-can be used alone or in combination

-usually combination of two to four drugs 

(each drug interferes with a specific cell cycle)

-drug interferes with protein synthesis and/or DNA replication

-bone marrow depression

(blood test taken before each treatment)

-nausea

(zofran, decadron, stemetil may be given)

-epithelial cell damage

(alopecia)

-damage to specfic areas

(fibrous in lungs due to damage to myocardial cells)

decreased mitosis and increase erythrocyte counts

improve appetite and sense of well being

decrease inflammation and swelling around tumor

inhibit hormone dependent cancers

example: estrogens slow prostate cancer growth

blocking receptors for growth promoters on cancer cells

ex: tamoxifen for breast cancer

augmenting the natural immune response to improve survelillance and removal of abnormal cells

example Herceptin for advanced breast cancer

-change in taste sensation

-anorexia

-vomiting and/or diarrhea from treatments

-sore mouth or loss of teeth

-pain and fatigue

-malabsorption due to inflammation in the digestive tract

-massage

-meditation 

-counseling

-exercise

-therapeutic touch

-raw food macrobiotic diet

-insulin and glucose with chemotherapy

no clinical signs of cancer

(client may expeirence many remissions)

-lung

-colon

-breast

-prostate, lung, colon

-lung is the most common cause of death in men from cancer, with colon second and prostate last (out of those three)

breast, lung, colon

-lung is the most common cause of death, with breast being second and colon last (out of those three)

age

gender

amount of body fat

%'s of body fat for

average adult

women

elderly

obese

infant

60%

50%

45%

even less

70%

intravascular (plasma)

interstitial fluid

lymph

transcellular

fluid enclosed within epithelial layers in body spaces (pericardial cavity as example)

-referred to as the "third space"

found in joints, body cavities and CSF

-thirst

-water excretion

-neural mechanisms

-hormonal mechanisms

-thirst 

-hormonal 

-hypothalmus

(osomoreceptors stimulated by cellular dehydrtion and decrease in blood volume)

hormonal mechanisms

-ADH (vasopression - controls amount of fluid leaving in urine)

promotes reabsorption of water

-aldosterone (determiens reabsorption of both sodium and water)

regulated by angiotensin II which is regulated by a drop in blood pressure

Hormonal - atrial natriuretic peptide (ANP

secreted by atrial myocytes in response to elevated blood pressure

promotes water excretion

water movement within ECF compartment is determined by

filtration - hydrostatic pressure

osmosis - osmotic pressure

-the "push"

-regulated by pressure gradients between blood in capillaries and fluid in interstitial space

- the "pull"

-regulated by the concentrations of osmotic particles that do not diffuse across semi-permeable membrane of capillary wall

excessive amounts of fluid in the interstitial fluid compartment which causes a swelling of tissues

-can be visable or unseen

-worse in dependent areas

-increased capillary hydrostatic pressure

-loss of plasma proteins

-obstruction of lymphatics

-increased capillary permeability 

best way I can describe it:

Increased blood pressure means the heart pushes blood into the arteries more forcefully, when it reaches the capillary there are "holes" that allow the fluid to be pushed out of the capillary into the interstial space, as the blood continues down to the venous end the fluid that was pushed out should return through osmotic pressure, but the push(hydrostatic pressure) is still higher than the pull (osmotic pressure) which doesn't allow fluid to return to the capillary therefore creating edema in the interstital space.

anything that causes high blood pressure

- hypervolemia

-pulmonary edema

-Congestive heart failure

-kidney failure

-pregnancy

-high plasma sodium

-administration of excessive fluids

"less pull" 

best way I can explain it:

Proteins especially albumin "attact water" creating osmotic pressure. When the proteins are not there at the venous end of the capillary to pull the water that was pushed out by hydrostatic pressure then less water returns to venous circulation and accumulates in the interstitial fluid causing edema

kidney disease

malnutirion

malabsorption

liver disease

example: burn patients (protein leaks)

hydrostatic pressure in lymphatic capillaries is increased and is greater than hydrostatic pressure in ISF

prevents removal of ISF by lymphatic system and fluid stays in ISF

tumor compression

infection (scar tissue in node)

surgical removal of lymp node

trauma

increased capillary permeability

increased flow of fluid, solutes, protein into ISF

loss of albumin into ISF increases osmotic pressure in ISF space which pulls more fluid into ISF space

etiologies of increased capillary permeability

inflammatory response

allergic reactions

bacterial i nfections

large burns

-seen with increased hydrostatic pressure, loss of plasma protein, increased capillary permeability

-"dependent edema"

- pitting edema

-anasarca (extreme generalized edema)

-more common with lymphatic circulation obstruction but can also be due to other causes 

-can occur anywhere

-periorbital edema

-ascites

-cerebral edema

-pulmonary edema

-swelling

-pitting edema

-increase in body weight

-lab abnormalities

-functional impairment

-pain

-impaired arterial circulation

-edema in skin

inadequate body fluid due to:

-inadequate intake

-excessive loss

-combo of the two

-vomiting and diarrhea

-excessive sweating with loss of sodium and water

-diabetic ketoacidosis (loss of fluid, electrolytes, and glucose in urine)

-insufficient water intake in older adults or unconscious persons

-concentrated formula in attempt to provide more nutrition to infant

elderly and infants

-lack fluid reserves

-renal function not as good

-larger body surface area of infants

-higher metabolic rate of infants requires more water intake

-poor skin turgor and dry mucous membranes

-sunken eyes

-suken fontanelles

-lower blood pressure, rapid weak pulse

-pale, mottled skin

-incresed Hct

-increased temp

-fatigue

-decreasing LOC

-low volume and high specific gravity of urine

third spacing

shift of fluid from intravascular or intracellular spaces into non-functional transcellular compartments (body cavities)

-fluid is not lost from body but becomes no longer available as circulating blood volume

-helps regulate extracellular osmotic pressure

-nerve impulse conduction

-muscle contraction

-acid/base balance (sodium bicarbonate buffer)

- < 135 mEq/L

- sodium deficit or water excess (dilutes sodium concentration)

deficit in sodium results in 

- a decrease in the osmotic pressure of the ECF

-water shifts into cells- cells will eventually swell/rupture-lose function

-plasma volume decreases - results in s/s of hypovolemia

etiologies of sodium deficit

- loss of excessive sodium from excessive sweating/ DA, vomiting

-diuretics that increase sodium loss in urine

-addison's disease, adrenal insufficiency

water excess

-water content of ECF increases resulting in diluting ECF sodium - creates hypotonic ECF enviornment

-water shifts into cells

-swelling/rupture of cells and loss of function

etiologies of water excess

- excessive intake

-dilute formula

-chronic renal failure

-inappropriate use of D5W

-syndrome of inappropriate anti-diuretic hormone

SIADH

- syndrome of inappropriate anti-diuretic hormone

- brain tumors, head trauma, bronchogenic carcinoma, surgery, drugs

s/s of hyponatremia

- imapired nervve impulse conduction

-fatigue, muscle cramps, abdominal pain/cramps, nausea and vomiting

-decreased ECF volume (low BP)

-shift of fluid to ICF space (swelling of neurons, confusion, headache, weakness, lethargy, seizures)

hypernatremia

> 145 mEq/L

-excessive sodium intake or deficit of ECF water

increase in serum sodium results in

etiologies of excessive sodium

-inappropriate use of hypteronic saline solution (treating acidosis with sodium bicarbonate)

-oversecretion of aldosterone 

-oversecretion of ACTH

etiologies of deficit of ECF water

-fever

-increased rate of respiration

-diabetes insipidus (decreased secretion of ADH

-DM with hyperglycemia

-water diarrhea 

-inadequate thrist mechanism 

s/s of hypernatremia

-thirst, dry mucous membranes

-decreased urine output (unless due to lack of ADH)

-weakness, agitation

-edema

-eleaved BP

functions of potassium

-regulates intracelluar fluid balance

-membrane potential

-nerve impulse conduction

-muslce contraction

-metabolic reactions

-cardiac muslce contraction 

potassium levels are controlled by

-kideny

-aldosterone

-acid-base balance

-insulin

hypokalemia

etiologies of hypokalemia

-excessive losses (GI losses, diarrhea, bulemia nervosa)

-renal losses (diuretics, excessive secretion of aldosterone)

-deficient intake (anorexia nervosa, alcoholism)

-insulin therapy 

-alkalosis 

s/s of hypokalemia

-problems with neuromuscular function (weakness,fatigue, paresthesias (pins and needles))

-weakness of respiratory muscles 

-decreased GI motility (anorexia, nausea)

-cardiac dysrhythmias (prolonged PR interval, flattening of T wave, depression of ST interval)

hyperkalemia

etiologies of hyperkalemia

- renal failure

-lack of aldosterone

-use of potassium-sparing diuretics

-leakage of intracellular K+ to ECF space with extensive tissue trauma (crush injuries or burns)

-severe acidosis 

s/s of hyperkalemia

-fagtigue

-msucle weakness - paralysis

-paresthesias

-cardiac dysrhythmias (cardiac arrest)

calcium

-99% in bone

-serum calcium (total calcium ionized and bound)

-ionized calcium (free calcium) is important form physiologically (4-5 mEq/L)

functions of calcium

-strength to bones

-blood clotting

-metabolic processes

-nerve impuluse transmission

-muslce contraction

calcium levels are controlled by

-PTH

-calcitonin

-vitamin D

-phosphate level

hypocalcemia

etiologies of hypocalcemia

-malnutrition/malabsorption (vitamin D/calcium)

-deficient serum albumin (binds to albumin in blood)

-alkalosis

-blood transfusions

-renal failure (elevated phosphate which causes lowered calcium and failure to activate vitamin D which impairs calcium absorption)

s/s of hypocalcemia

-muscle spasms and hyeractive reflexes

--carpopedal spasms (atypical contraction of fingers/toes)

--chvostek's sign

--trousseau's sign

--tetany

--laryngospams

- cardiac arrhythmias (weak contractions)

hypercalcemia

etiologies of hypercalcemia

-calcium release from bone due to destruction of bone by malignant bone tumors

-bronchiogenic carcinoma secretion of PTH

-hyperparathyroidism

-immobility (demineralization of bone)

-milk-alkali syndrome (excessive intake of milk and antacids (calcium carbonate))

s/s of hypercalcemia

-depression of neuromuscular activity 

-weakness, lethargy

-anorexia

-personaility changes

-interferes with ADH (polyuria, thirst)

-cardiac dysrhythmias

-weakened bones/pathological fractures 

-increased bone strength if due to excessive intake of calcium

normal value of magnesium

causes and s/s hypomagnesemia

-results from malabsorption or malnutrition often associated with alcoholism

-use of diuretics, diabetic ketoacidosis, hyperthyroidism, hyperaldosteronism

causes and s/s of hypermagnesemia

-occurs with renal failure

-depresses neuromuscular function

-decreased reflexes

-cardiac arrhythmias

normal vaule of phosphate

functions of phosphate

-bone and tooth mineralization

-important in metabolism (ATP)

-phosphate buffer system

-integral part of cell membrane

-reciprocal relationship with serium calcium

causes of hypophosphatemia

causes of hyperphosphatemia

-renal failure

-tissue damage

normal value of chloride

causes of hypochloremia

-usually associated with alkalosis 

--early stages of vomiting (loss of hydrochloric acid)

--loss of chloride causes shift of bicarbonate ions from RBC into ECF

-excessive sweating

causes of hyperchloremia

-buffer pairs in blood

-respiratory system

-kidneys

-sodium bicarbonate

-phosphate system

-hemoglobin

-protein system

20:1

(20 represents the bicarbonate and 1 represents the H+)

acidosis

-excess hydrogen ions

-decrease in serum pH

-can be respiratory or metabolic

--respiratory = increase in CO2 levels

--metabolic = increase in non-respiratory acids or decrease in amount of serum bicarb

-deficit of H+ ions

-increase in serum pH

-can be respiratory or metabolic

--respiratory = decrease in CO2

--metabolic = decrease in amount of non-respiratory acids or increase in serum bicarbonate

-renal and respiratory adjustments to changes in pH that act to maintain the normal range of pH

-usually limited and usually short term

-does not remove the cause of the imbalance

-causative problem becomes more severe

-additional problems occur

-compensation mechanisms are exceeded or fail

-acute problems (pneumonia, airway obstruction, chest injuries, drugs that depress the respiratory control center)

-chronic respiratory acidosis (COPD)

compensation of respiratory acidosis

-increased respiratory rate

-increased renal excretion of H+

-increased reabsorption of HCO3 (will see increase in serum HCO3)

-pH should return to normal range

-diarrhea (loss of bicarb from intestines)

-increase in non-carbonic acids (Shock, DKA, renal disease or failure)

-increased respiratory rate

-increased renal reabsorption of bicarb (level may still be low because it is being used to buffer extra acids)

-headache

-lethargy

-weakness

-confusion

-coma and death

causes of respiratory alkalosis

-hyperventilation (blow off too much CO2)

caused by anxiety, high fever, overdose of aspirin

head injuries

brainstem tumors

-kidneys hold onto H+

-kidneys excrete more bicarb (HCO3)

-loss of hydrochloric acid from stomach

-hypokalemia

-excessive ingestion of antacids

-kidneys hold onto acids

-kidneys excrete more HCO3

-restlessness

-muscle twitching

-tingling and numbness of fingers

-tetany

-seizures

-coma

-visual representation of chromosomes arranged in order of size

-used in diagnosis of chromosomal disorders

-actual genetic info carried by the indivdual 

-all cells except the gametes of an individual have the same genotype

-not all genes are expressed in all cells

-expression of genes

-appearance of the individual's characteristics

-disroders present at birth

could be genetic, inherited (chromosomal) disorders or developmental disorders

-single gene expression (traite controlled by one set of alleles)

-chromosomal defect (chromosomal anomalies usually result from an error during meiosis)

-multifactorial (polygenic expression

-both parents must pass on defective gene

-males and females equally affected

-

-storage diseases (Tay Sachs)

-PKU

-sickle cell disease (also incomplete dominant)

-cystic fibrosis 

-no carriers, individuals with defective gene have the disease

-affected parent has 50% chance of passing on defective gene

-unaffected indivudals do not pass on the trait

-some are not apparent at birth or early in life (huntington's disease)

-males and females can be affected

-no carriers

-50% chance child will be born with disease

-not as common as x-linked recessive disorder

-disorders affect males

-females are typically the carriers

(if mother is a carrier and father is affected then can see females with disease)

duchenne muscular dystrophy

color blindness

hemophilia A

- leading cause of mental retardation and miscarriage

-often arise during meiosis

-can involve autosomes or sex chromosomes

-

-birth defect

-loss of pregnancy

-if all info on affected chromosome is present the individual may not show signs of the defect

Abnormal structure of chromosome

Deletions

-chromosome breaks and DNA is lost

-gamete with abnormal chromosome then unites with gamete with normal copy of chromosome

example: Cri du Chat 

abnormal structure of chromosomes

duplications 

-usually see less serious consequences with duplication of genetic material than with loss

abnormal structure of chromosomes

inversions

-two breaks occur in a chromosome and have re-insertion of the missing fragment at its original site but in an inverted order

-usually don't result in serious consequences unless genetic material is influenced by the other genes it is closee to

abnormal structure of chromosomes

translocations

-interchange of genetic material between non-homologous chromosomes

robertsonian translocations

-only involves loss of the short arms of chromosomes 13-15, 21 or 22 and subsequent fusion of the long arm of another non-homologous chromosome with the remaining long arm of one of the chromosomes mentioned above

-this type of translocation between long arm of chromosome 21 and 14 is a cause of down syndrome

-missing or extra chromosome

-usually the result of non-disjunction (when chromosomes fail to divide properly during meiosis

one one chromosome out of the pair of chromosomes is present

monosomy of any autosome is not compatible with post-natal survival 

ex. turner syndrome

one extra copy of the chromosome is present

ex. trisomy 21

-risk of developing a multifactorial disorder can be influenced by lifestyle, environmental influences or the presence of other diseases

-presence of the genetic info in a person's genome is a risk factor for developing the disease but does not mean the person will develop it

-disorders that disrupt the normal development of a child (disruption of normal embryological/fetal development)

-linked to teratogens (a variety of drugs and environmental agents that are capable of damaging the developing embryo/fetus

-most critical time is first 2 months (organogenesis)

-alcohol

-cocaine

-thalidomide

-mercury

TORCH

-toxoplasmosis

-other (HBV, mumps, rubella, varicella, gonorrhea, syphilis)

-rubella

-cytomegalovirus

-HSV

-non-disjunction

-robertsonian translocation

-mosaicism

(risk increases with maternal age)

triple/quad screen test and/or first trimester screen test (ultrasound + maternal blood screening) used to screen for the risk

-amniocentesis or chorionic villous sampling is used to confirm the disorder prior to birth

-small head, round face, flat facial profile

-slanted eyes and epicanthic fold

-large tongue, high arched palate

-small hands, single palmar crease

-short stature

-muscles tend to be hypotonic, loose joints

-shortened 5th finger

-delayed developmental stages

-cognitive impairment ranges from mild to major

delayed or incomplete sexual development (males infertile, females have lower rate of conception)

-family history of a specific disease

-previous birth to child with abnormality

-ethnic groups to with high risk for specific disease

-pregnant women over 35 years of age

-ultrasound (detects malformations of head, extremities, organs and placenta

-amniocentesis (amniotic fluid contains fetal cells which can be karyotyped, performed 15-20 weeks)

-chorionic villus assay (sample is obtained - fetus's cells can be karyotyped and analyzed, performed at 10-12 weeks)