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Tumor

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a swelling of a part of the body, generally without inflammation, caused by an abnormal growth of tissue, whether benign or malignant

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Cancer

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A disease in which abnormal cells divide uncontrollably and destroy body tissue.

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Neoplasia Vs. Tumor

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-the formation or presence of a new, abnormal growth of tissue. -a swelling of a part of the body, generally without inflammation, caused by an abnormal growth of tissue, whether benign or malignant.

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Benign

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not harmful in effect: in particular, (of a tumor) not malignant.

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Malignant

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very virulent or infectious.

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Carcinogen

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a substance capable of causing cancer in living tissue.

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Carcinogensis

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process by which tissue is transformed into a cancerous cell.

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Infiltration

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movement into adjacent tissues

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Metastasis

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the development of secondary malignant growths at a distance from a primary site of cancer.

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Tumor Markers

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biomarker found in blood, urine, or body tissues that can be elevated by the presence of one or more types of cancer.

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Benign Tumors

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-Result from Hyperplasia -Well encapsulated, Well differentiated -Noninfiltrative - Do not spread to other sites -Grow slowly -Can damage normal tissue -Tx- dep on site, size, tissue type -surgical excision -ex- uterine fibroids

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Malignant Neoplasms

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-Non-differentiated, nonfunctional cells -Non-encapsulated -Vary in size, shape with large nuclei -Rapid cell growth/mitotic state -Systemic effects common -Spread to adjacent or distant tissues -infiltration - metastasis -Disrupt normal tissue function- compression

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Clonal Proliferation or expansion

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the selection and reproduction of only one type of cell.

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Mutation causes

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cell to acquire characteristics that allow selective advantage over adjacent cells -increased growth rate or decreased apoptosis

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Cancer is...

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predominantly a disease of aging.

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Transformation of normal cells

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-Decreased need for growth factors to multiply -Lack contact inhibition -Anchorage independence -Immortality

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Carcinogenesis

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-Process by which normal cells are transformed into cancer cells

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Stages of Carcinogenesis

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-initiating factors- genetics, exposure result in DNA change -Promotors- dysplasia/ anaplasia evident -Late phase of promotion- mutation becomes immortalized -Progression-continued exposure results in tumor

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Numerous etiological factors of carcinogenesis

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-Viruses -Multi-factoral genetic -Environmental -Inflammation -Personal behaviors/lifestyle choices

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Proto-oncogenes

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Genes that direct protein synthesis/cellular growth

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Oncogenes

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mutant genes

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Tumor-suppressor genes

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encode proteins that in their normal state negatively regulate proliferation -AKA- anti-oncogenes

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Oncogene activation

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point mutation in RAS gene converts from regulated to unregulated -translocations

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Characteristics of Cancer Cells

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-^ # cells -loss of normal arrangement -^ nuclear size and density -^ mitotic activity -abnormal mitosis and chromosomes -initiate dysfunction of other sys.

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Tumor spread

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-direct invasion -metastases to distant organs -metastasis by implantation

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Invasion/infiltration

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-Tumor cell attachment -Secretion of proteolytic enzymes-matrix degradation -Tumor cell locomotion pseudopodia

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Chronic Inflammation

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-Cytokine release from inflammatory cells -Ex. Helicobacter pylori and gastric mucosa

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Tumor associated macrophage

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-Promote tumor survival -Block T-cytotoxic cell and NK function

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Immune System

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protects against cancer

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Immunosuppression

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fosters cancer -Non-hodgkin lymphoma 10x -Kaposi sarcoma 1000x

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Immunosuppressive factors

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increase resistance of the tumor to chemo and radiotherapy

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Viruses

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Activity implicated

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Epithelial

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Carcinoma

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Connective Tissue

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Sarcomas

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Lymphatic Tissue

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Lymphomas

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Glial cells of the CNS

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gliomas

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Blood forming organs

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leukemias

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Pre-invasive epithelial

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carcinoma in situ

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Precancerous conditions

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-leukoplakia -actininc keratoses

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Localized S/S

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-change in confirmation of tissues -localized pain -obstruction of blood or lymphatic flow -tissue necrosis can lead to infections

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Systemis S/S

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-Fatigue -Syndrome of cachexia -Anemia -Leukopenia -Thrombocytopenia -Infection -Generalized pain

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Breast

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lump, dipping of nipple, discharge

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Colon

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Rectal Bleeding Changes in bowel habits

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Brain

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Headaches, Visual/behavioral changes

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Lung

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Recurrent cough/coughing up blood shortness of breath

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ACS warning signs of cancer

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-Unusual bleeding -changes in bowel/bladder habits -change in wart or mole -sore that doesn't heal -weight loss -anemia or low hemoglobin -cough/horseness -solid lump

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tumor associated antigens

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-CEA- colon cancer -PSA- prostate specific antigen

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Stages

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1- no metastasis 2- Local Invasion 3- spread to regional structures 4- distant metastasis

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TNM system

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-T-size of tumor spread -N-lymph note involvement -M- presence of matastasis

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Crisis

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complete disorganization of thought and behavior due to the impact of the word cancer.

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Which of the following statements best characterizes neoplasia A- all neoplasms are cancerous B- benign growths are cancerous C- malignant tumors have slow growth D- Cancer refers to a malignant tumor

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?

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Under what condition can benign tumors become pathological requiring surgical or medical TX? A-infiltration into adjacent tissue B- Become large enough to disrupt fxn of surrounding tissue C-develop into aggressive malignancy D-rapid growth causing tissue ischemia

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?

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Albumin

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water magnet

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Water

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Major component of fluid/electrolyte

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water Where most of the biochemical action is..

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-Dissolved mineral salts=electrolytes -Distributed by osmotic/hydrostatic pressures

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1000 ml of water =

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2.2 pounds or 1 Kg.

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water compositon

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Infant -70% Adult-60% Elderly-50-55%

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main electrolytes in Body Fluid

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Na+ Cl- Mg2+ Ca2+ K+

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Intracellular

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all fluid within cell 2/3

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Extracellular fluid

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1/3 -Intravascular Fluid -Interstitial Fluid -Lymphatics -Transcellular fluid

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Intravascular Fluid

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within vascular bed -Plasma

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Transcellular fluid

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Pericardial heart fluid, synovial joint

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Filtration

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Movement of water from low solute of interstitial fluid to high solute of blood. -based on concentration

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Solutes exert pressure =

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osmotic pressure

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Movement of Water Between Compartments

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1. Low sodium conc. in blood 2. Low osmotic pressure in extracellular fluids 3. Water shifts out of blood 4. More water shifts into cell from low to high osmotic pressure 5-Cell swells, function decreases and then cell ruptures.

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Balance is continuous process:

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1-imbalance intra/extracellular 2-CNS response 3-endocrine response 4-renal response 5-balance restored 6-metabolic processes

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Water moves based on

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Hydrostatic and osmotic pressures

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Hydrostatic

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Push force -maintained by blood pressure

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Osmotic

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-Pull force- holding in -AKA: colloidal pressure -Maintained by plasma proteins and electrolytes -Maintains fluid volume in various compartments

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CNS-

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Thirst mechanism of hypothalamus

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Antidiuretic hormone

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Promotes reabsorption of water

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Aldosterone

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promotes reabsorption of Na+ and water

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Thirst center

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sensitive to changes in plasma osmolarity and sodium levels

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Atrial ; B-Type Natriuretic Peptide

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released by heart to decrease Blood Pressure

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Central Control; Renal;Cardiac Relationship

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-Promote Na/H2O urinary secretion -Renin-Angiotensin-Aldosterone system -ADH -Natriuretic hormones -Aldosterone

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Renin-Angiotensin-Aldosterone System

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-Antidiuretic Hormone (ADH) -Natriuretic hormones -Aldosterone

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The concentration of solute (tonicity)

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-affects fluid shifts between compartments -occurs in extracellular compartment.

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Edema

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Result of excessive fluid in interstitial compartment causing swelling or enlargement of tissues -May be visible(frank) or hidden (occult)

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Dependent

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collects where force of gravity is greatest-sacral , ankle, hand eyes (periorbital)

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Anasarca

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-general all over in extracellular space -Liver failure, Renal failure, Rt Heart Failure

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Central edema

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Related to vascular compartment

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Increased Capillary Hydrostatic Pressure

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-Pressure inside vessel is high (Hydrostatic-push) -Increased volume inside vessel (Volume Overload/Hypervolemia) -Forces fluid from inside vessel to outside -Causes: Hypertension; Renal Failure; CHF, PIH

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Loss of Plasma Proteins

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decrease osmotic pull, decrease albumin, extensive plasma loss

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Obstruction of Lymphatic Circulation

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Removal of lymph glands, Lymphomas

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Increased Capillary Permeability

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-Primary or secondary inflammation -"Third Spacing" Often occult

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Effects of edema

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-swelling -pitting -Increase in body weight -Increase in pain due to pressure on nerves -Impaired arterial/venous circulation -Vascular = Increases workload of heart -Impaired tissue fan -Extreme edema can result in weeping= portal of entry

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Insufficient Intravenous fluid

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insufficient body fluid from inadequate intake or excessive loss of fluids (or both)

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Hypovolemia

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vascular compartment depletion

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Dehydration

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Affects ECF first -more serious problem in infants and elderly b/c lack fluid reserves.

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Isotonic Dehydration

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Lose same amount of electrolytes and water/fluid

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Hypertonic Dehydration

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Lose more H20 than electrolytes -Diarrhea, water deprivation

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Hypotonic Dehydration

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Lose more electrolytes than water -most common when treating Isotonic Dehydration with free water

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dehydration affects

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Affect flow of water between ICF and ECF -osmotic pressure changes between compartments

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Causes of Dehydration: Hyopvolemia

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-vomiting/diarrhea -overuse of diuretic meds. -excessive blood loss -sweating -metabolic disorders -not enough water -Infection/fever

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Signs/Symptoms of Dehydration:Hypovolemia

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-Thirst -Headache -Fatigue -Low urine output/dark -Dry skin -elevated temp -Weight loss

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Loss of electrolytes influences

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water balance because osmotic pressure changes between compartments!

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Treatment of Dehydration-Hypovolemia

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Fluid increase Iv infusion -Isotonic - Hypertonic -Hypotonic

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Volume Deficit

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-sunken, soft eyes -decreased skin turgor -Thirst -weight loss -fatigue, weakness, dizziness, -syncope -increased temp -rapid,weak,thready pulse -hypotension/orthostatic -lab: increased hct(concentrated) increased lytes (variable);dec. uo with high specific gravity

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Excess Contrasted

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-edema: feet,hands, periorbital,ascites -weight gain -pale,gray,ashen color -lethargy -pulmonary congestion: rales/crackles, cough -slow bounding pulse -hypertension -lab: decreased Hct(dilutional); decreased serum NA

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Sodium

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-Principle extracellular cation -Sodium potassium pump -Active Transport -Nerve conduction and muscle contraction -Levels controlled by CNS and Kidney

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Hyponatremia

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-Na+ -135 meq/l -Direct loss of Na or excess of ECF -Excessive water intake -renal failure -Decrease in ECF osmotic pressure allowing fluid to leave ECF and into cells ICF shift. -hormonal imbalance (insuf. aldosterone, excessive ADH secretion)

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Hypernatremia

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Na greater than 145 meq/l -Ingestion of large amounts of Na+ -Large water loss (faster than loss of Na) -Watery diarrhea -loss of thirst mechanism

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Effects of Hypernatremia

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-Convulsions, edema -Thirst, fever, weakness, agitation. -Increases insensible loss...resp Increases.

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Tx: Hypo/Hypernatremia

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-Dependent on cause -If Na less than 120, give 3% NaCl Iv hypertonic -If Na greater than 135 restrict free water, meds.

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Potassium

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K+ 3.5-5.5 meq/l -Major intracellular cation -Nerve conduction and muscle contraction -Crucial in conduction of cardiac electrical impulses -levels affected by acid base

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Potassium Acidosis

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causes hydrogen ions to move into cell and K out to maintain electrical neutrality--Hyperkalemia

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Potassium Alkalosis

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causes hydrogen ions to move out of cell and K to move in---hypokalemia

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Hypokalemia

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potassium less than 3.5 meql -causes cardiac dysrythmias -causes interference with neurmuscular fan -muscle cramping, weakness, impaired renal fxn

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Chloride

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96-106 meq/l most abundant negatively charged ion in ECF -used to confirm acid base balance in body -passively flows with water and sodium

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Calcium

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imp. extracellular cation -balance controlled by parathyroid hormone and calcitonin

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high calcium levels

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= phosphate levels

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alkalosis

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decreases number of free calcium ions causing hypocalcemia

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hypocalcemia

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^ permeability and excitability of nerve membrane -twitching -hyperactive reflexes presence of chvosteks and trousseaus sign -can produce tetany dx-ionized calcium

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Chvosteks sign

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face spasm

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trousseaus sign

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carpopeal spasm

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severe hypocalcemia

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laryngospasm obstructing airway

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Magnesium

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1.5-2.2 -50% stored in bone -serum levels linked to Ca and K+

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Hypomagnesemia

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rare, malabsorption, malnutrition, chronic etoh abuse -

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cardiac dysrythmias

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torsades de pointes

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hypermagnesemia

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depressed neuromuscular fxn.

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phosphate(hp04)

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located in bone and ICG/ECF -bone and tooth mineralization' -needed for metabolic processes -acid base buffer sys. -relationship to calcium

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hyphosphatemia

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renal failure, tissue damage, chemotherapy -effects=hypocalcemia

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Fluid intake

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ingested foods/fluid based solid fluid and iv fluid

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fluid output

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urine, feces, insensible loss, sweating, exhaling

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Pathophysiology Exam 2 Nursing 3050 NSULA – Flashcards

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