NURS 5315 Advanced Pathophysiology
fg fg fg
Ovarianfgcancerfgsitefgoffgmetastasis?
Peritonealfgsurfaces,fgomentumfg(foldfgoffgperitoneumfgconnectingfgthefgstomachfgwithfgotherfga
bdominalfgorgans),fg*liver*
ThefgincreasedfgNADH/NAD+fgratiofginfgthefgliverfgfromfgethanolfgcauses: 1.fgPyruvatefg--
>fglacticfgacid,fgcausingfglacticfgacidosis
2.fgOxaloacetatefg-->fgmalate.fgThisfgpreventsfggluconeogenesisfgandfgleadsfgtofghypoglycemia
3.fgGlyceraldehyde-3-phosphatefg-->fgglycerolfg3-
fgphosphatefgandfgcombinesfgwithfgfattyfgacidsfgtofgformfgtriglyceridesfginfgthefgliver,fgknownfgasfghepatost
eatosis
4.fgDecreasesfgcitricfgacidfgcyclefgproductionfgoffgNADHfgandfgleadsfgtofgusingfgAcetyl-
CoAfgforfgketogenesisfgandfglipogenesis
WhatfgcanfgReactivefgOxygenfgSpeciesfgcause?
Heartfgdisease,fgAlzheimers,fgParkinsons,fgAmyotrophicfgLateralfgSclerosisfg(ALS),fgCVfgdise
ase,fgHTN,fgHLD,fgDM,fgischemicfgheartfgdisease,fgHF,fgOSA.fgLipidfgperioxidation,fgdamagefgproteins,
fgfragmentfgDNA,fglessfg*proteinfgsynthesis*,fgchromatinfgdestruction,fgdamagefgmitochondria
Whatfgisfgthefgbody'sfgdefensefgagainstfgROS?
Antioxidantsfg(VitaminfgE,fgVitaminfgC,fgcysteine,fgglutathione,fgalbumin,fgceruloplasmin,fgtra
nsferrin)
Howfgarefgfreefgradicalsfgproduced? 1.fgNormalfgcellularfgrespiration
2.fgAbsorptionfgoffgextremefgenergyfgsourcesfg(radiation,fgUVfglight)
3.fgMetabolismfgoffgexogenousfgchemicals,fgdrugs,fgandfgpesticides
4.fgTransitionfgoffgmetals
5.fgNitricfgoxidefgactingfglikefgafgchemicalfgmediatorfgandfgafgfreefgradical
actionfgpotential Processfgoffgconductingfganfgimpulse.fgActivatesfgthefgneuronfg--
>fgthefgneuronfgdepolarizesfg-->fgthenfgrepolarizes
Thresholdfgpotential
Pointfgatfgwhichfgdepolarizationfgmustfgreachfginfgorderfgtofginitiatefganfgactionfgpotential
Hypokalemiafgandfgactionfgpotentials HYPERpolarizedfg(morefgnegative,fgex.fg-
100).fgLessfgexcitable.fgDecreasedfgneuromuscularfgexcitability:fgweakness,fgsmoothfgmusclefgatony,fgp
aresthesia,fgcardiacfgdysrhythmias
Hyperkalemiafgandfgactionfgpotentials
HYPOpolarizedfg(morefgpositive,fgex:fgcloserfgtofg0).fgMorefgexcitable.fgPeakedfgTfgwaves.fg
Whenfgrestingfgmembranefgpotential=thresholdfgpotential,fgitfgisfgBADfg=fgcardiacfgstandstill,fgparesthe
sia,fgparalysis
Hypocalcemiafgandfgactionfgpotentials
IncreasedfgpermeabilityfgtofgNa+.fgMorefgexcitable.fgTetany,fghyperreflexia,fgcircumoralfgpares
thesia,fgseizures,fgdysrhythmias.
Hypercalcemiafgandfgactionfgpotentials
DecreasedfgpermeabilityfgtofgNa+.fgLessfgexcitable.fgWeakness,fghyporeflexia,fgfatigue,fglethar
gy,fgconfusion,fgencephalopathy,fgdepressedfgTfgwaves
Atrophy
Occursfgasfgafgresultfgoffgdecreasefginfgworkfgload,fgpressure,fguse,fgbloodfgsupply,fgnutrition,fghor
monalfgstimulation,fgorfgnervousfgstimulation.fgOncefgthefgcellfghasfgdecreasedfginfgsize,fgitfghasfgnowfgco
mpensatedfgforfgdecreasedfgbloodfgsupply,fgnervefgsupply,fgnutrientfgsupply,fghormonalfgsupply,fgandfgh
, asfgachievedfgnewfghomeostasis.fgCellsfgarefgalivefgbutfghavefgdiminishedfgfunctionfgandfgmayfgleadfgtofgc
ellularfgdeath.
Atrophyfgexamples Physiologicfgatrophy-fgshrinkingfgoffgthefgthymusfgglandfgduringfgchildhood.
Disusefgatrophy-fgsomeonefgthatfgendsfgupfgbeingfgparalyzed
Hypertrophy
IncreasefginfgSIZEfgoffgcells,fgwhichfgwillfgleadfgtofgincreasefginfgsizefgoffgorgan.fgCausedfgbyfghor
monalfgstimulationfgorfgincreasedfgfunctionalfgdemand.
Hypertrophyfgexamples physiologicfghypertrophy-
fgskeletalfghypertrophyfgwhenfgafgpersonfgdoesfgheavyfgworkfgorfgweightfgliftingfg/fgwhenfgafgkidneyfgisfgsur
gicallyfgremoved,fgthefgotherfgkidneyfgincreasesfginfgsize
pathologicfghypertrophy-
fgcardiomegalyfgresultsfgfromfganfgincreasedfgworkloadfginfghypertensivefgpatientsfg/fg*leftfgventricularfgh
ypertrophy*
Hyperplasia
IncreasefginfgNUMBERfgoffgcells.fgResultsfgfromfgincreasedfgratefgoffgmitosis.fgCanfgONLYfghap
penfginfgcellsfgthatfgarefgcapablefgoffgmitosisfg(cellfgdivision).
Hyperplasiafgexamples 1.fgThickeningfgoffgskinfgbecausefgoffghyperplasiafgoffgepidermalfgcells.
2.fgHormonalfghyperplasia-fgoccursfginfgestrogenfgdependentfgorgansfglikefguterusfgandfgbreast.
3.fgCompensatoryfghyperplasia-fgliverfgregenerates,fgcallusfgonfgskin
4.fgPathologicfghyperplasia-
fgestrogenfgisfgunopposedfgbyfgprogesteronefgandfgthefgendometrialfgliningfgundergoesfghyperplasiafgandf
gincreasedfgriskfgforfgendometrialfgcancer
Dysplasia
abnormalfgchangesfginfgthefgsize,fgshape,fgandfgorganizationfgoffgmaturefgcellsfgduefgtofgpersistent
,fgseverefgcellfginjuryfgorfgirritation
Dysplasiafgexamples
Prefgcancerfgpapfgsmearsfgoftenfgshowfgdysplasticfgcellsfgoffgthefgcervixfgthatfgmustfgundergofgtrea
tment.
Metaplasia
ChangedfgcellfgthatfgisfgREVERSIBLEfg(onefgcellfgisfgreplacedfgbyfganotherfgcell).fgExposurefgtofg
chronicfgstressors,fginjuryfgorfgirritation,fglikefgsmokingfgorfghydrochloricfgacidfgfromfgheartfgburn
Metaplasiafgexamples
Mostfgcommonfgisfgchangefgfromfgcolumnarfgcellsfgtofgsquamousfgcellsfg(chronicfgsmokers).fg
Lessfgcommonfgisfgchangefgfromfgsquamousfgtofgcolumnarfgcells,fglikefginfgBarrettfgEsophagusfgcausedfgb
yfgheartfgburn.
Carcinomafginfgsitu Pre-
invasivefgepithelialfgmalignantfgtumorsfgoffgglandularfgorfgsquamousfgorigin.fgSitesfgincludingfgcervix,fgs
kin,fgoralfgcavity,fgesophagus,fgandfgbronchus
Hypoxicfginjury 1.fgDecreasefginfgoxygenfginfgthefgairfg(highfgaltitudes,fgasphyxiation,fgdrowning)
2.fgLossfgoffghemoglobinfgfunctionfg(hemorrhagefgorfgsicklefgcellfganemia)
3.fgDecreasefginfgproductionfgoffgredfgbloodfgcellsfg(anemiafgorfgleukemia)
4.fgDiseasesfgoffgcardiopulmonaryfgsystemsfg(ischemia,fgbloodfgsupplyfgloss,fgarteriosclerosis)
Hypoxicfginjuryfgclinicalfgmanifestations 1.fgIncreasedfgCKfg(musclefgandfgheart)
2.fgIncreasedfgLDHfg(muscle,fgliver,fglung,fgheart,fgRBC,fgbrain)
3.fgIncreasedfgALTfgandfgASTfg(liver)
4.fgIncreasedfgtroponinfg(heart)
fg fg fg
Ovarianfgcancerfgsitefgoffgmetastasis?
Peritonealfgsurfaces,fgomentumfg(foldfgoffgperitoneumfgconnectingfgthefgstomachfgwithfgotherfga
bdominalfgorgans),fg*liver*
ThefgincreasedfgNADH/NAD+fgratiofginfgthefgliverfgfromfgethanolfgcauses: 1.fgPyruvatefg--
>fglacticfgacid,fgcausingfglacticfgacidosis
2.fgOxaloacetatefg-->fgmalate.fgThisfgpreventsfggluconeogenesisfgandfgleadsfgtofghypoglycemia
3.fgGlyceraldehyde-3-phosphatefg-->fgglycerolfg3-
fgphosphatefgandfgcombinesfgwithfgfattyfgacidsfgtofgformfgtriglyceridesfginfgthefgliver,fgknownfgasfghepatost
eatosis
4.fgDecreasesfgcitricfgacidfgcyclefgproductionfgoffgNADHfgandfgleadsfgtofgusingfgAcetyl-
CoAfgforfgketogenesisfgandfglipogenesis
WhatfgcanfgReactivefgOxygenfgSpeciesfgcause?
Heartfgdisease,fgAlzheimers,fgParkinsons,fgAmyotrophicfgLateralfgSclerosisfg(ALS),fgCVfgdise
ase,fgHTN,fgHLD,fgDM,fgischemicfgheartfgdisease,fgHF,fgOSA.fgLipidfgperioxidation,fgdamagefgproteins,
fgfragmentfgDNA,fglessfg*proteinfgsynthesis*,fgchromatinfgdestruction,fgdamagefgmitochondria
Whatfgisfgthefgbody'sfgdefensefgagainstfgROS?
Antioxidantsfg(VitaminfgE,fgVitaminfgC,fgcysteine,fgglutathione,fgalbumin,fgceruloplasmin,fgtra
nsferrin)
Howfgarefgfreefgradicalsfgproduced? 1.fgNormalfgcellularfgrespiration
2.fgAbsorptionfgoffgextremefgenergyfgsourcesfg(radiation,fgUVfglight)
3.fgMetabolismfgoffgexogenousfgchemicals,fgdrugs,fgandfgpesticides
4.fgTransitionfgoffgmetals
5.fgNitricfgoxidefgactingfglikefgafgchemicalfgmediatorfgandfgafgfreefgradical
actionfgpotential Processfgoffgconductingfganfgimpulse.fgActivatesfgthefgneuronfg--
>fgthefgneuronfgdepolarizesfg-->fgthenfgrepolarizes
Thresholdfgpotential
Pointfgatfgwhichfgdepolarizationfgmustfgreachfginfgorderfgtofginitiatefganfgactionfgpotential
Hypokalemiafgandfgactionfgpotentials HYPERpolarizedfg(morefgnegative,fgex.fg-
100).fgLessfgexcitable.fgDecreasedfgneuromuscularfgexcitability:fgweakness,fgsmoothfgmusclefgatony,fgp
aresthesia,fgcardiacfgdysrhythmias
Hyperkalemiafgandfgactionfgpotentials
HYPOpolarizedfg(morefgpositive,fgex:fgcloserfgtofg0).fgMorefgexcitable.fgPeakedfgTfgwaves.fg
Whenfgrestingfgmembranefgpotential=thresholdfgpotential,fgitfgisfgBADfg=fgcardiacfgstandstill,fgparesthe
sia,fgparalysis
Hypocalcemiafgandfgactionfgpotentials
IncreasedfgpermeabilityfgtofgNa+.fgMorefgexcitable.fgTetany,fghyperreflexia,fgcircumoralfgpares
thesia,fgseizures,fgdysrhythmias.
Hypercalcemiafgandfgactionfgpotentials
DecreasedfgpermeabilityfgtofgNa+.fgLessfgexcitable.fgWeakness,fghyporeflexia,fgfatigue,fglethar
gy,fgconfusion,fgencephalopathy,fgdepressedfgTfgwaves
Atrophy
Occursfgasfgafgresultfgoffgdecreasefginfgworkfgload,fgpressure,fguse,fgbloodfgsupply,fgnutrition,fghor
monalfgstimulation,fgorfgnervousfgstimulation.fgOncefgthefgcellfghasfgdecreasedfginfgsize,fgitfghasfgnowfgco
mpensatedfgforfgdecreasedfgbloodfgsupply,fgnervefgsupply,fgnutrientfgsupply,fghormonalfgsupply,fgandfgh
, asfgachievedfgnewfghomeostasis.fgCellsfgarefgalivefgbutfghavefgdiminishedfgfunctionfgandfgmayfgleadfgtofgc
ellularfgdeath.
Atrophyfgexamples Physiologicfgatrophy-fgshrinkingfgoffgthefgthymusfgglandfgduringfgchildhood.
Disusefgatrophy-fgsomeonefgthatfgendsfgupfgbeingfgparalyzed
Hypertrophy
IncreasefginfgSIZEfgoffgcells,fgwhichfgwillfgleadfgtofgincreasefginfgsizefgoffgorgan.fgCausedfgbyfghor
monalfgstimulationfgorfgincreasedfgfunctionalfgdemand.
Hypertrophyfgexamples physiologicfghypertrophy-
fgskeletalfghypertrophyfgwhenfgafgpersonfgdoesfgheavyfgworkfgorfgweightfgliftingfg/fgwhenfgafgkidneyfgisfgsur
gicallyfgremoved,fgthefgotherfgkidneyfgincreasesfginfgsize
pathologicfghypertrophy-
fgcardiomegalyfgresultsfgfromfganfgincreasedfgworkloadfginfghypertensivefgpatientsfg/fg*leftfgventricularfgh
ypertrophy*
Hyperplasia
IncreasefginfgNUMBERfgoffgcells.fgResultsfgfromfgincreasedfgratefgoffgmitosis.fgCanfgONLYfghap
penfginfgcellsfgthatfgarefgcapablefgoffgmitosisfg(cellfgdivision).
Hyperplasiafgexamples 1.fgThickeningfgoffgskinfgbecausefgoffghyperplasiafgoffgepidermalfgcells.
2.fgHormonalfghyperplasia-fgoccursfginfgestrogenfgdependentfgorgansfglikefguterusfgandfgbreast.
3.fgCompensatoryfghyperplasia-fgliverfgregenerates,fgcallusfgonfgskin
4.fgPathologicfghyperplasia-
fgestrogenfgisfgunopposedfgbyfgprogesteronefgandfgthefgendometrialfgliningfgundergoesfghyperplasiafgandf
gincreasedfgriskfgforfgendometrialfgcancer
Dysplasia
abnormalfgchangesfginfgthefgsize,fgshape,fgandfgorganizationfgoffgmaturefgcellsfgduefgtofgpersistent
,fgseverefgcellfginjuryfgorfgirritation
Dysplasiafgexamples
Prefgcancerfgpapfgsmearsfgoftenfgshowfgdysplasticfgcellsfgoffgthefgcervixfgthatfgmustfgundergofgtrea
tment.
Metaplasia
ChangedfgcellfgthatfgisfgREVERSIBLEfg(onefgcellfgisfgreplacedfgbyfganotherfgcell).fgExposurefgtofg
chronicfgstressors,fginjuryfgorfgirritation,fglikefgsmokingfgorfghydrochloricfgacidfgfromfgheartfgburn
Metaplasiafgexamples
Mostfgcommonfgisfgchangefgfromfgcolumnarfgcellsfgtofgsquamousfgcellsfg(chronicfgsmokers).fg
Lessfgcommonfgisfgchangefgfromfgsquamousfgtofgcolumnarfgcells,fglikefginfgBarrettfgEsophagusfgcausedfgb
yfgheartfgburn.
Carcinomafginfgsitu Pre-
invasivefgepithelialfgmalignantfgtumorsfgoffgglandularfgorfgsquamousfgorigin.fgSitesfgincludingfgcervix,fgs
kin,fgoralfgcavity,fgesophagus,fgandfgbronchus
Hypoxicfginjury 1.fgDecreasefginfgoxygenfginfgthefgairfg(highfgaltitudes,fgasphyxiation,fgdrowning)
2.fgLossfgoffghemoglobinfgfunctionfg(hemorrhagefgorfgsicklefgcellfganemia)
3.fgDecreasefginfgproductionfgoffgredfgbloodfgcellsfg(anemiafgorfgleukemia)
4.fgDiseasesfgoffgcardiopulmonaryfgsystemsfg(ischemia,fgbloodfgsupplyfgloss,fgarteriosclerosis)
Hypoxicfginjuryfgclinicalfgmanifestations 1.fgIncreasedfgCKfg(musclefgandfgheart)
2.fgIncreasedfgLDHfg(muscle,fgliver,fglung,fgheart,fgRBC,fgbrain)
3.fgIncreasedfgALTfgandfgASTfg(liver)
4.fgIncreasedfgtroponinfg(heart)
