NSG 533 Pathophysiology Exam 1 QUESTION AND SOLUTIONS LATEST UPDATE 2023

NSG 533 Pathophysiology Exam 1 QUESTION AND SOLUTIONS LATEST UPDATE 2023 What are the five essential components of pathophysiology? - ANSWER 1. Etiology (Causative mechanisms) 2. Epidemiology (risk factors and distribution in populations) 3. Pathogenesis (disease mechanism) 4. clinical manifestations (signs, symptoms and diagnostic criteria) 5. Outcomes (cure, remission, chronicity, or death) The "why" of disease- what is the reason for it- what caused it to happen? May be simple/complex. - ANSWER etiology Looks at the pattern of disease among groups or aggregates or populations. This component of disease represents the relationship between numerous population characteristics (e.g. age, ethnicity, socioeconomic status, geographic location) and the incidence and prevalence of disease. - ANSWER Epidemiology Involves the sequence of events that occurs between the stimulus event(s) and the manifestations of the disease. - ANSWER pathogenesis Tell an individual and their health care provider that something is wrong. e.g. Signs and symptoms - ANSWER Clinical manifestations Are relatively easy to understand if you review their definitions (cure, remission, chronicity, or death) - ANSWER Outcomes What are the 4 common mechanisms that characterize all cell injury and death? Give 2 examples of each. - ANSWER 1. ATP depletion- Ischemia and Anemia 2. Oxygen and oxygen-derived free radicals- Chemical and radiation injury, ischemia reperfusion injury, microbial killing by phagocytes, and cellular aging 3. intracellular calcium and loss of calcium steady state- Ischemia and certain chemicals 4. Defects in membrane permeability- Certain medications that can lead to liver or kidney damage The disease mechanism that is the basis of much of the disease today- and most of the cases involve hypoxia. Refers to the inability of the cell to produce adequate energy to fuel normal activities of that particular cell type (cell membrane pumps and protein synthesis) and function. - ANSWER ATP depletion A very inefficient method of ATP production (yields 2 ATP) - ANSWER glycolysis Is a very efficient method of ATP production (yields 36 ATP) - ANSWER Oxidative Phosphorylation What is the most common method of impairing oxygen and ATP production? - ANSWER hypoxia Can lead to irreversible cell injury directly through impairment of energy production in the cell. - ANSWER Ischemia What are the cellular events that occur with ischemia-induced- hypoxic injury? - ANSWER 1. The amount of ATP production within the mitochondria declines 2. The drop in ATP causes NA-K- ATPase pump on CM to fail. Which then leads to increase in NA+,H2O, and Ca+ in cell and decrease in K+ in cell. 3. Increase in water in cell causes cell and it's organelles to swell. 4. When RER swell it's ribosomes fall off and protein synthesis stops. 5. ATP production through phosphorylation declines and glycolysis (anaerobic metabolism) increases. When glycolysis increases in the cell glycogen stores are depleted. 6. Glycolysis also produces lactic acid as by-product. Glycolysis also = intracellular pH decline ( the cell functions within narrow range of pH and even slight drop can incapacitate the cell). 7. Drop in pH causes clumping of nuclear material called pyknosis. Leads to fragmentation of the nuclear material (karyorrhexis) and then to dissolution of nuclear membrane (karyolysis). Decline in pH= rupture of already swollen lysosomes and release of proteolytic enzymes= autodigestion of cell contents and cell membrane. 8. Disruption of CM also increases Ca+ influx into the cell and organelles= activate proteases, endonucleases, and phospholipases that proceed to destroy the cell. Unstable compounds with an unpaired electron in its outer ring. They have a particular affinity for lipid substances. They combine avidly with cell or organelle membrane. "Drill a hole" in the membrane of cell. They are normal byproducts of cellular metabolism, and they are always present in the body. - ANSWER Free radicals Chemically reactive molecules that are formed as natural oxidant species in cells during mitochondrial respiration and energy generation. Most sources come from the mitochondria. Made during the process of making ATP. - ANSWER Reactive oxygen species (ROS) Remove free radicals and ROS from our system. - ANSWER Antioxidants When free radicals are produced in amounts that overwhelm our antioxidants or when antioxidants are decreased. - ANSWER Oxidative Stress What can occur within the cell when injury is induced by free radicals? - ANSWER 1. membrane damage 2. protein modifications 3. mutations in DNA 4. Damage to cell signaling pathways Genetic disturbances can be _______ if they involve the germ cell line of an individual - ANSWER inherited Genetic disturbances can also be _______ by exposure to some mutagenic/ carcinogenic environmental factors - ANSWER acquired Enzymes secreted by microorganisms can breakdown cell membranes once introduced into the body= _______ Allows the organisms to dissolve surrounding tissues and allows them to move deeper into the tissues, blood, and lymphatics. - ANSWER lysis by enzymes Certain viruses, once they have infected a cell, will cause membrane rupture as newly produced viral particles (virions) leave the host cell= ________. Sometimes referred to as lytic viruses. Examples include HIV and Hep B. - ANSWER Lysis by virus Involve the abnormal accumulation of substances that are normally found in the body (endogenous agents) or not normally found in the body (exogenous agents). - ANSWER Metabolic derangements Give 2 examples of endogenous accumulations in the body. - ANSWER 1. Lipids: Fatty changes occurs most often in liver cells but can also be problem in myocardial cells. Liver handles fats and synthesizes complex fats and lipoproteins. Slow accumulation of fat within hepatic or myocardial cells usually does not impair the function of those cells until the problem is extreme. However, fatty change can occur in acute basis and can lead to acute heart or liver failure. 2. Bilirubin: Pigment released when RBCs break down/destroyed. Bilirubin is released/diffuses into blood where it is called unconjugated (indirect) bilirubin. Unconjugated bilirubin is fat-soluble and can't be eliminated through kidney (urine). So, it's taken up by liver cells bound to a substance called glucuronic acid and becomes bilirubin glucuronide or conjugated (direct) bilirubin. Conjugated bilirubin is water-soluble and can be eliminated through the kidney. Describe the 2 ways in which conjugated bilirubin leaves the liver cells. - ANSWER 1. As concentration of conjugated bilirubin in the liver cells increases, it begins to diffuse out of the cell into the blood (down its concentration gradient). 2. In addition, some of the conjugated bilirubin becomes part of a substance called bile; bile exits the liver cell through the hepatic duct and common bile duct and then into the duodenum. Explain 3 problems that may result in hyperbilirubinemia. - ANSWER 1. Excessive amounts of Hgb breakdown occur, as with hemolytic anemia or after birth when babies rapidly destroy their excess RBC mass. This results in excessive amounts of unconjugated bilirubin being delivered to the liver at a rate greater than the liver can handle. Unconjugated bilirubin accumulates in the blood. This is referred to as hemolytic jaundice. 2. Second problem area occurs when the amount of bilirubin released from RBC breakdown is normal, but the liver cells are sick and are unable to uptake unconjugated bilirubin from the blood, conjugate it, and/or excrete it into the bile. This is called hepatocellular jaundice because the problem is within the liver cell. 3. The third problem occurs when there is an obstruction to the flow of bile in the hepatic and/or common bile duct. Conjugated bilirubin accumulates in the liver cell and more diffuses into the blood than normal. This is called obstructive jaundice. In obstructive jaundice, stools will be clay colored and urine very dark. Bilirubin levels may be very high with no apparent ill effect. However, CNS abnormalities can result from extremely high and prolonged levels of bilirubin. Normally, bilirubin crosses the BBB extremely slow and with great difficulty. In infants, especially pre-term infants, bilirubin crosses the BBB much more easily. Bilirubin is extremely toxic to nerve tissue and exposure can lead to significant neurologic deficits/death. What is