Patho Ch 4-6 – Flashcards
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What is the study of functional or physiologic changes in the body that results from disease process?
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pathophysiology
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What are the two ways a cell can die?
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induced to commit suicide, killed by injurious agents
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Is there inflammation with apoptosis?
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no
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What cells undergo apoptosis?
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cells infected with viruses, cells of the immune system, cells with DNA damage, cancer cells
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What is the most common cause of acute cell injury?
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reduced level of oxygen
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Cells that are more active require more _____.
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oxygen
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What is ischemia?
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deficit of oxygen in cells (localized hypoxia due to poor blood flow)
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What is hypoxia?
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decrease in oxygen to tissue
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Can necrosis be reversible and nonreversible?
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yes
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If ischemia is severe, what does is progress to?
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infarct
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What are causes of cell necrosis/ ischemia/ hypoxia?
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thrombus, embolus, trauma, infections
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What is a blood clot that forms in a vein?
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thrombus
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What is anything that travels through the blood vessels?
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embolus
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What is liquefactive necrosis?
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dead cells that can liquefy under the influence of digestive hydrolytic cell enzymes (from dead cells of neutrophils)
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What is pus made of?
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dead leukoctes (neutrophils and necrotic tissue)
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What is an abscess?
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a collection of pus, commonly in the presence of bacteria
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What organ can have liquefaction necrosis without bacteria?
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brain
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What is coagulative necrosis?
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when cell proteins are altered or denatured, commonly caused by hypoxia, cells retain some form for a time after death
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What is a white infarct?
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arterial insufficiency
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What is a red infarct?
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venous insufficiency
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What can coagulative necrosis lead to?
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dry gangrene
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What can dry gangrene lead to?
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wet gangrene
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What does caseous mean?
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cheeselike
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What is caseous necrosis?
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combination of coagulative and liquifactive necrosis, tissue resembles clumped cheese
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Chronic injury to cells can cause what two categories of conditions?
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atrophy and accumulation
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What is the first line of defense in the body?
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mechanical barrier, unbroken skin and mucous membranes, secretions wuch as tears and gastric juices
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Is the first line of defense specific or non-specific?
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non-specific
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What is the second line of defense?
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phagocytosis and inflammation
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Is the second line of defense specific or non-specific?
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non-specific
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What is the third line of defense?
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production of specific antibodies or cell-mediated immunity
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Is the third line of defense specific or non-specific?
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specific
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What is the purpose of inflammation?
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intended to localize and remove an injurious agent, whatever it may be
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What are causes of inflammation?
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direct physical damage, caustic chemicals, ischemia or infarction, allergic reactions, extremes, foreign bodies, infection
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What are the 5 cardinal signs of inflammation?
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heat, redness, pain, loss of function, swelling
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What is the cause of redness and warmth from inflammation?
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increased blood flow to the damaged area
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What is the cause of swelling from inflammation?
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shift of protein and fluid into the interstitial space
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What is the cause of pain from inflammation?
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increased pressure of fluid on nerves, release of chemical mediators (bradykinins), stimulation of pain receptors by prostaglandins
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What is the cause of loss of function from inflammation?
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may develop if cells lack nutrients, edema may interfere with movement
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What are the three major processes of inflammation?
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mobilization of body defenses, containment and destruction of pathogens, tissue cleanup and repair
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What is the purpose of the mobilization of defenses?
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to get the defensive leukocytes to the site quickly
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What is local hyperemia?
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increasing blood flow beyond normal rate which is a way to get leukocytes quickly to the area
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What is the effect of histamine released by mast cells?
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local vasodilation and separation of endothelial cells which increases capillary permeability
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What is diapedesis?
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leukocytes crawling through gaps in the endothelial cells to enter tissue fluid
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How does containment of an infection work?
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fibrinogen that filters into tissue fluid, clots and forms a sticky mesh that walls off microbes
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How does containment help with destruction of pathogens?
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pathogens are trapped in a fluid filled pocket with antibodies and phagocytes
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What type of cell is the first to arrive on the scene of an infection?
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neutrophils
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By what methods to neutrophils kill bacteria?
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phagocytosis, respiratory burst, secrete cytokines for recruitment of macrophages and additional neutrophils
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What is neutrophilia?
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a higher number of neutrophils in the blood (5,000-25,000)
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What is the function of monocytes?
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the primary agents of tissue cleanup and repair (engulf and destroy bacteria, damaged host cells and dead and dying neutrophils)
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When do monocytes arrive at the scene of infection?
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8-12 hours after
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Once monocytes arrive at the scene, what are they called?
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macrophages
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How does edema contribute to tissue cleanup?
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compresses veins and reduces venous drainage, forces open valves of lymphatic capillaries- promoting lymphatic drainage)
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Where is platelet-derived growth factor secreted from?
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blood platelets and endothelial cells in injured area
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What is the function of platelet-derived growth factor?
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stimulates fibroblasts to multiply, synthesizes collagen
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What is the function of the lymph system in helping clean up an infection?
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the lymphatics collect and remove bacteria, dead cells, proteins and tissue debris better than blood capillaries
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What is serous exudate made of?
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watery, consists mostly of fluid, some proteins and white blood cells
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What is the cause of serous exudate?
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allergic reactions, burns
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What is fibrinous exudate?
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thick, sticky, high cell and fibrin content, risk of scar tissue
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What is purulent exudate?
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thick, yellow-green, contains more leukocytes, cell debris and microorganisms
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What is purulent exudate indicative of?
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bacterial infection
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What is the cause of a bloody exudate?
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if the blood vessels are damaged
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What are granulomas a product of?
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chronic inflammatory response
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What is the function of hyperemia?
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delivers oxygen, amino acids and other necessities for protein synthesis
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What is the function of increased heat from inflammation?
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increases metabolic rate, speeds mitosis, and tissue repair
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What is the function of a fibrin clot?
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forms a scaffold for tissue reconstruction
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What is the purpose of pain in inflammation?
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makes us limit the use of a body part so it has a chance to rest and heal
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What is leukocytosis?
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increased numbers of white blood cells, especially neutrophils
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What is a differential count?
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proportion of each type of white blood cell altered, depending on the cause
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What is C reactive protein?
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a protein not normally found in the blood, but appears with acute inflammation and necrosis within 24-48 hours
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What is the result of increased plasma proteins?
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increased fibrinogen and prothrombin
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What is the result of increased ESR?
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elevated plasma proteins increase the rate at which red blood cells settle in a sample
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What is the change in cell enzymes during inflammation?
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released from necrotic cells and enter tissue fluids and blood: may indicate the site of inflammation
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What are some causes of chronic inflammation?
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acute inflammation that does not fully heal, bacteria (gateway), long-term abnormal immune response
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What type of swelling is in chronic inflammation?
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less -> increases lymphocytes, macrophages, fibroblasts
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Does chronic inflammation increase or decrease collage formation?
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increase- more scar tissue
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Chronic inflammation causes more ____ which increase tissue destruction.
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granulomas
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What are some treatments of inflammation?
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ASA, acetaminophen, NSAIDs, glucocorticoids
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What are the functions of glucocorticoids?
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decreased capillary permeability, enhanced effectiveness of Epi and NorEpi, reduced number of leukocytes and mast cells, reduces immune response
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What are the types of healing?
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resolution, regeneration, replacement
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What is resolution?
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minimal tissue damage
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What is regeneration?
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damaged tissue is replaced with cells that are functional
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What is replacement?
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functional tissue replaced by scar tissue, loss of function
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What is the healing of an incised wound by first intention?
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process that occurs when wound edges close together with a minimal gap, clean wound
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What is healing by second intention?
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increases inflammation, longer healing time, increase in scar tissue formation
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What are the three phases of the healing process?
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fill in, seal, shrink the wound
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What happens in the fill in phase of healing?
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granulation tissue closes the gap, highly vascularized and fragile
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What happens during the seal phase of healing?
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epithelial cells undergo mitosis, grows from the outside in
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What happens in the shrink the wound phase of healing?
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macrophages stimulate fibroblasts to enter, produce collagen and scar
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Scar formation results in loss of what normal and specialized structures?
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hair follicles, nerves, receptors
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Is scar tissue elastic?
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no, can therefore restrict range of movement
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What is an adhesion?
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bands of scar tissue joining two surfaces that are normally separated, prevent normal movement and can cause distortion or twisting
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What is differentiation?
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each cell type differentiates and carries out particular functions
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Structure reflects the ____ of the tissue.
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function
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What is a cellular growth that no longer responds to normal genetic controls (check points)?
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neoplasm or tumor
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How does a tumor or neoplasm affect surrounding cells?
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deprives other cells of nutrition
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The characteristics of each tumor depends on what two things?
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type of cell the tumor arises from, unique structure and growth pattern
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What is a benign tumor?
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differentiated cells that reproduce at a higher rate than normal
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Are benign tumor cells encapsulated?
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yes
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How is surrounding tissue damaged from a benign tumor?
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as a result of compression of adjacent structures
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Where can a benign tumor be life threatening?
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brain
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What is a malignant tumor?
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undifferentiated, non-functional cells, with rapid reproduction (abnormal mitotic figures)
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How does a malignant tumor move?
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infiltrates or spreads into surrounding tissue
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What is the suffix for a benign tumor?
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-oma
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What is the suffix for a malignant tumor?
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-carcinoma
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What are tumor of connective tissue usually termed?
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sarcomas
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Are sarcomas often benign or malignant?
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Malignant
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What are some unique names of malignant tumors?
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Hodgkin disease, Wilms tumor, Leukemia
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How fast do benign tumors grow?
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relatively slow
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Are malignant tumor cells encapsulated?
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no
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Do malignant tumors undergo apoptosis?
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no
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Do malignant tumors have organization?
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no
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What are some characteristics of malignant tumors?
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no contact inhibition, abnormal cell membranes, altered surface antigens, do not adhere to each other (can break loose from mass and invade other tissues)
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What effect do malignant tumors have on blood vessels?
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compresses them leading to necrosis and inflammation around the tumor
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What things can tumor cells secrete?
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enzymes and or hormones which can breakdown proteins and cells
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What is angiogenesis?
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some tumor cells secrete growth factors which stimulate the development of new capillaries in the tumor
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When does pain occur with a tumor?
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when the tumor is well advanced
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What are the effects of obstruction from a tumor?
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bloody supply or lymphatic flow may be restricted, air flow and GI tract as well
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What can tissue necrosis and ulceration from a tumor lead to?
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bleeding or infection around the tumor
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What are warning signs of a tumor?
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unusual bleeding or discharge, change in bowel or bladder habits, change in wart or mole, non-healing sore, unexplained weight loss, anemia or low hemoglobin, persistent fatigue, persistent cough or hoarseness w/o reason, a solid lump (often painless)
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What is cachexia?
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loss of body mass that cannot be reversed nutritionally
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What are systemic effect of malignant tumors?
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weight loss and cachexia, anemia, severe fatigue, effusisons, infections, bleeding, paraneoplastic syndrome
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Why does a tumor cause weight loss and cachexia?
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increased demands from tumor cells on the body
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Why does a tumor cause anemia?
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due to blood loss at tumor site, nutritional deficits may reduce hemaglobin synthesis
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Why does a tumor cause severe fatigue?
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due to inflammatory changes, cachexia and anemia, stress of treatment schedule
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What causes an effusion?
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inflammation causes buildup in body cavities
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Why does a tumor cause infections?
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resistance declines
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Why does a tumor cause bleeding?
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tumor cells may erode the blood vessels
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What is paraneoplastic syndrome?
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tumor cells release substances that affect neurologic function and may have hormonal effects
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A lung carcinoma produces ACTH and looks like what syndrome?
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Cushings
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What are diagnostic tests that can help detect early cancer?
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routine screening, self-exam, blood tests, radiographic, ultrasound, MRI, CT, biopsy
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What is the most dependable confirmation of malignancy?
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biopsy
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What is invasion?
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local spread, tumor cells grow into adjacent tissues
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What is metastasis?
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spread to distant sites via blood or lymph or other body fluids
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What is a Krukenberg tumor?
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a tumor on the ovary that originated from another site (usually GI tract or less common : breast or appendix)
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What is the system use most commonly to stage cancers?
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TNM system
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What does the T in TNM stand for?
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size of primary tumor T1-T4
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What does Tx stand for?
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tumor can not be evaluated
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What does Tis stand for?
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tumor in situ
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What does the N in TNM stand for?
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involvement of regional lymph nodes (Nx, No, N1-N3)
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What does thet M in TNM stand for?
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spread of metastasis of tumor (Mo, M1)
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What is carcinogenesis?
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the process by which normal cells are transformed into cancer cells, varies respect to time
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Cancer is thought to be multi-factorial disease due to what factors?
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evnironmental effects, change in gene expression (heredity), infection in some cases such as cervical and hepatic cancers
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What are the 4 stages in carcinogenesis?
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Initiating factors, exposure to promoters, continued exposure, changes in growth regulation
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What is the "initiating" factors of carcinogenesis?
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causes the first irreversible change in cellular DNA
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Does an initiating factor create an active neoplasm?
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no
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What effect to DNA does exposure to "promoters" have?
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causes further changes in DNA- less differentiation and increased rate of mitosis and/or lack of apoptosis
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How does exposure to promoters present?
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dysplasia or anaplasia, leads to tumor development
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What effect does continued exposure and changes in DNA have?
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results in a malignant tumor
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What effect does changes in growth regulation result in?
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detaching the cells and metastasis
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What are genetic risk factors for cancer?
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breast cancer in the family, retinoblastoma
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What types of cancer can viruses cause?
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hepatic and cervical
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What type of cancer is caused by organic solvents?
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leukemia
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What type of cancer is caused by asbestos?
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lung cancer
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What type of cancer is caused by formaldehyde?
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resp tract
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What type of cancer is caused by aniline dyes?
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bladder cancer
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What are some biological factors that have been shown to cause cancer?
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chronic irritation and inflammation, age, diet, hormones
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What risk reduction behaviors can reduce the risk of cancer?
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limit UV exposure from sun or tanning beds, regular medical and dental exams, self-examination, diet (antioxidants), immunizations
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What is curative treatment?
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complete removal of the tumor
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What is palliative treatment?
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in advanced cancer, reduce manifestations and prolong life
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What is prophylactic treatment?
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removal of parts which are known to be the place of metastases (breast cancer)
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What is radiofrequency ablation (RFA)?
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destroying tumor with probe and high temp
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How does radiation therapy work?
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causes mutations/ alterations in target DNA and prevents mitosis, it also damages blood vessels
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What type of cells is radiation therapy most effective on?
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rapidly dividing cells
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What are methods of administration for radiation therapy?
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external sources (cobalt machine), internal insertion (brachytherapy), instill radioisotope in a solution into a body cavity
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What are adverse effects of radiation?
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bone marrow depression, epithelial cell damage, infertility, non-specific fatigue and lethargy
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What are the effects of bone marrow depression?
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decreased leukocytes, decreased erythrocytes, decreased platelets
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How are chemotherapy drugs effective (how do they work)?
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interfere with protein synthesis and/or DNA replication
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What are adverse effects of chemotherapy?
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bone marrow depression, nausea, epithelial cell damage, damage to specific areas
