Pathophysiology Final Fall 2024/25 EDITION LATEST SOLUTION GUARANTEED GRADE A+

Stages of General Adaptation Syndrome 1. Alarm 2. Resistance/Adaptation 3. Exhaustion (allostatic overload) Alarm Stage of GAS organism recognizes stress, begins to respond Resistance Stage of GAS organism mobilizes body's resources for coping Exhaustion Stage of GAS only occurs if stress continues and adaptation is not successful allostatic overload the consequences of long-term elevations of stress-related catabolic hormones, including hypertension, wasted muscles, ulcers, fatigue, and increased risk of chronic disease Adaptive coping mechanisms Solves the problem that is causing the anxiety, so the anxiety is decreased. The patient is objective, rational, and productive Maladaptive coping mechanisms Unsuccessful attempts to decrease the anxiety without attempting to solve the problem. The anxiety remains. What is innate immunity? Nonspecific protection against foreign substances indiscriminately. All cells but lymphocytes. What are the three lines of defense in the body? 1. Innate Immunity 2. Inflammation 3. Adaptive Immunity innate immunity Physical, mechanical, and biochemical barriers. Normal microbiome Inflammation a localized response to an injury or to the destruction of tissues Adaptive immunity the ability to recognize and remember specific antigens and mount an attack on them Classical pathway Activated by antibodies Alternative pathway Works with classical pathway, activated in the absence of antibodies Lectin pathway Independent of antibodies, main activator is mannose-binding lectin (MBL) local manifestations of acute inflammation redness, heat, swelling, pain, loss of function Serous exudate Watery exudate: indicates early inflammation Fibrinous exudate Thick, clotted exudate: indicates more advanced inflammation (think surgical site of vaginal infection) Purulent exudate Pus: indicates a bacterial infection Hemorrhagic exudate Exudate contains blood: indicates bleeding Walled-off lesions cysts or abcesses IgG - Most abundant - Crosses placenta IgA - Primarily in blood and secretions IgM - Largest - First antibody produced IgD - Lowest concentration IgE - Low concentration - Defends against parasitic infections - Common cause of allergies monoclonal antibodies Antibodies produced by a single clone of B lymphocytes and that are therefore identical in structure and antigen specificity. What is a titer? concentration of antibodies in serum immediate hypersensitivity reactions - Anaphylaxis - Occurs within minutes to hours after exposure to antigen delayed hypersensitivity reaction May take several hours and are at max severity days after exposure to antigen Type 1 hypersensitivity IgE mediated hypersensitivity Ex: Allergies Type II hypersensitivity Tissue-specific reactions Type III hypersensitivities -Immune complex-mediated, causes tissue damage -Ex: Celiacs, Raynauds, Serum sickness, Arthus reaction Type IV hypersensitivity - Delayed hypersensitivity - T cell mediated - Ex: graft rejection, TB skin test, allergy to poison ivy or metal Acute pain pain that is felt suddenly from injury, disease, trauma, or surgery Chronic pain Pain that lasts more than 3-6 months Neuropathic pain pain from damage to neurons of either the peripheral or central nervous system (pain without stimulation) Causes of Obstructive sleep apnea syndrome? Obesity, male sex, older age, postmenopausal Examples of sleep apnea syndrome - Hypersomnia - Polysomnography What causes narcolepsy? Immune-mediated destruction of hypocretin-secreting cells in the hypothalamus What can untreated obstructive sleep apnea lead to? - Polycythemia - Hypotension - Stroke - Heart failure - Dysrhythmias - Liver congestion - Edema A-delta fibers Localized sharp pain C fibers poorly localized dull pain (most numerous) Strabismus One eye deviates Amblyopia reduced vision in affected eye Diplopia double vision Nystagmus involuntary rhythmic movement Pendular nystagmus Regular back and forth movement of the eye Scotoma Blind spot Cataracts Cloudy area in lens Papilledema Edema of the optic nerve glaucoma High intraoccqular pressure presbyopia loss of vision associated with age hyperopia farsighted astigmatism unequal curvature of the cornea Color blindness - Typically an X-linked trait - Usually Red-green Hemianopia Blindness in half the visual field Hypersomnia Excessive daytime sleepiness Manifestations of hypersomnia - Falling asleep during activities - Impaired mood and cognitive function What is narcolepsy related to? Immune-mediated destruction of hypocretin-secreting cells in the hypothalamus Extrinsic causes of circadian rhythm sleep disorders - Rapid time zone change - Alternating sleep schedule - Changes in total sleep Intrinsic causes of circadian rhythm sleep disorders - Advanced sleep phase disorder - Delayed sleep phase disorder Somnambulism Sleepwalking Night terrors - If seen in children was for brain to mature - CNS immaturity Brain death - Flat EEG - No brainstem function - Cannot maintain homeostasis Cerebral death - Brainstem maintains homeostasis - Death of cerebral hemispheres minus the brain stem and cerebellum What does cerebral death lead to? - Coma - Persistent vegetative state - Minimally conscious state - Lock-in syndrome Retrograde amnesia an inability to retrieve information from one's past Anterograde amnesia an inability to form new memories Global amnesia loss of memories before and after the injury Image processing amnesia cannot use sensory data and language to form concepts, assign meaning or make abstractions Extinction stimulate both sides but only recognize one (like after a stroke) Neglect syndrome hemineglect Agnosia the inability to recognize familiar objects. Aphasia loss of speech expressive aphasia trouble communicating thoughts through speech or writing (motor/speech) receptive aphasia inability to understand spoken or written words (sensory/language) Anomic aphasia difficulty finding words (sensory) Conductive aphasia inability to integrate speech (sensory) Transcortical aphasia cannot use or understand spontaneous speech, but can repeat (motor candor sensory) Global dysphagia Both Broca's and Wernicke's (expressive and receptive) Phases of a seizure Aura (warning), Tonic (muscle rigidity), Tonic-clonic (uncontrollable muscle contractions, perhaps apneic), postictal (recover, LOC improves) prodromal stage of seizure hours to days before Aura phase of a seizure - warning stage - patient may sense onset of seizure Manifestations of poetical seizure state - Headache - Confusion -Dysphagia - Memory loss - Paralysis Dystonic posture abnormal posturing with a rotating or twisting motion Decorticate posture characteristic posture associated with a lesion at or above the upper brainstem. The patient presents with the arms flexed, fists clenched, and legs extended. Decerebrate posture The arms and legs are out straight and rigid, the toes point downward, and the head is arched backward. Basal ganglion posture refers to a stooped, hyperflexed posture with a narrow-based, short-stepped gait. Spastic gait Short steps with dragging of foot. Jerky, uncoordinated, cross-knee (scissor) movement. Cerebellar (ataxic) gait -Wide-based -Staggering or reeling (drunk-like) Basal ganglion gait broad based gait small steps decreased arm swing head and body are flexed and arms are semiflexed and abducted the legs are flexed and rigid basal ganglion and frontal lobe dysfunction Frontal lobe ataxic gait wide-based with increased body sway and falls, loss of control of truncal motion, gait ignition failure, start hesitation, shuffling, and freezing Spinal shock Site lacks continuous nervous discharges from the brain Cause of spinal shock - Cord hemorrhage - Edema - Anatomic transection What does a cervical term in the spinal cord lead to? Quadriplegia What does a thoracic tear in the spinal cord lead to? Paraplegia Manifestations of spinal shock - Loss of reflex function - Flaccid paralysis - Loss of sensation - Loss of bladder/rectal control - transient drop in blood pressure - Bradycardia - Poor venous circulation Cause of neurogenic shock - Above T6 - Absence of sympathetic activity and unopposed PNS tone Manifestations of neurogenic shock - Vasodilation - Hypotension - Bradycardia - Failure of body temp regulation Autonomic hyperflexia (dysreflexia) Sudden, massive reflex sympathetic discharge because descending inhibition is blocked Manifestations of autonomic hyperreflexia - Paroxysmal hypertension (systolic is 300 mmHg), pound HA, sweating at level above lesion, breadycardia Most common cause autonomic hyperreflexia Distended bladder or rectum Manifestations of transient ischemic attacks - Les than 1 hour - Sudden severe HA - Confusion - Numbness - Weakness - Loss of balance Clinical manifestations of subarachnoid hemorrhage - N/V - Change in LOC - One-sided weakness or paralysis - Aphasia - "Worst headache I've ever had" Kernig sign Straightening with the hip and knee in a flexed position produces pain in the back of the neck Brudzinski sign Passive flexion of the neck produces neck pain and increased rigidity Intracellular fluid - fluid within cells - 2/3 TBW Extracellular fluid - fluid outside the cell - 1/3 TBW Interstitial fluid liquid found between the cells of the body that provides much of the liquid environment of the body Transcellular fluid - Synovial fluid - CSF - GI fluids - Pleural fluids - Peritoneal fluids - Urine Serum sodium lab range 135-145 mEq/L Potassium lab range 3.5-5.0 Calcium lab range 8.8-10.5 Magnesium lab range 1.8-3.0 Phosphate lab range 2.5-4.5 Manifestations of hypernatremia - Brain cell shrinkage - Altered membrane potentials - Increased blood pressure Manifestations of hyponatremia - Cell swelling - Altered action potentials - IICP Manifestations of hypokalemia - Skeletal muscel weakness - Smooth muscle atony - Cardiac dysrhythmias - Glucose intolerance - Impaired ability to concentrate urine Manifestations of hyperkalemia - Increased neuromuscular irritability - Restlessness _ Intestinal cramping - Diarrhea - Muscle weakness - Loss of muscle tone - Paralysis Manifestations of hypocalcemia - Increase neuromuscular excitability - Convulsions and tetany - Prolonged QT interval - Cardiac arrest Manifestations of hypercalcemia - Fatigue - Weakness - Lethargy - Sarcoidosis - Tumors - Bone pain - Nausea - Constipation Manifestations of hypophosphatemia - Irritability - Confusion - Numbness - Coma - Convulsions - Respiratory failure - Bone resorption Manifestations of hyperphosphatemia Calcification of soft tissues Manifestations of hypomagnesemia - Behavioral changes - Irritability - Increased reflexes and muscle cramps - Tachycardia - Hypotension Manifestations of hypermagnesemia - N/V - Hypotension - Bradycardia - Respiratory distress - Muscle weakness Renin-angiotensin-aldosterone system -decreased blood pressure causes the juxtaglomerular cells of kidneys to secrete renin which converts angiotensinogen (inactive) to angiotensin I (active) which is then converted into angiotensin II by angiotensin-converting enzyme (ACE) -Angiotensin II stimulates the adrenal cortex to secrete aldosterone - leads to absorption of Na and increased blood pressure -once blood pressure is restored, there is a decreased drive to stimulate renin release Dysphagia difficulty swallowing Achalasia failure of the lower esophagus sphincter (LES) muscle to relax Manifestations of dysphagia - Stabbing pain at level of obstruction - Discomfort after swallowing - Regurgitation of undigested food - Unpleasant taste - Vomiting - Aspiration -Weight loss Manifestations of GERD - Heartburn - Acid regurgitation - Dysphagia - Chronic cough - Asthmas attacks - Laryngitis - Upper abdominal pain within 1 hours of eating Hiatal hernia protrusion of a part of the stomach upward through the opening in the diaphragm Gastroparesis a condition in which the muscles in the stomach slow down and work poorly or not at all, preventing the stomach from emptying normally Symptoms of gastroparesis - N/V - Abdominal pain - Postprandial fullness/bloating Manifestations of pyloric obstruction - Epigastric pain and fullness - N/V - Succussion splash - Malnutrition - Dehydration - Extreme debilitation Simple intestinal obstruction Mechanical blockage of the lumen, usually caused by a lesion Functional intestinal obstruction Failure of intestinal motility, usually after surgery Signs of a small intestine obstruction - Colicky pain - N/V - Caused by post-op adhesions, tumors, hernias, Chron's dz Signs of a large intestine obstruction - Hypogastric pain - Abdomnial distension - Not as common, usually from cancer Lipase breaks down lipids Amylase breaks down starch Trypsin breaks down proteins Chymotrypsin trypsin found in chyme Manifestations of ulcerative colitis CONTINUED...