NURS 5315: ADV PATHO EXAM 1 WITH VERIFIED ANSWERS

NURS 5315: ADV PATHO EXAM 1 WITH VERIFIED ANSWERS "E. inadequate oxygenation of tissues P. decrease in mitochondrial function, decreased production of ATP increases anaerobic metabolism. eventual cell death. C.M. hypoxia, cyanosis, cognitive impairment, lethargy - CORRECT ANSWER Hypoxia injury" "E. normal byproduct of ATP production, will overwhelm the mitochondria- exhaust intracellular antioxidants P. lipid peroxidation, damage proteins, fragment DNA C.M. development in Alzheimer's, heart disease, Parkinson's disease, Amyotrophic Lateral Sclerosis - CORRECT ANSWER Free radical and ROS" "E. mood altering drug, long term effects on liver and nutritional status P. metabolized by liver, generates free radicals C.M. CNS depression, nutrient deficiencies-Mag, Vit B6, thiamine, PO4, inflammation and fatty infiltration of liver, hepatomegaly, leads to liver failure irreversible - CORRECT ANSWER Ethanol" "Na and H2O enter cell and cause swelling. Organ increases in weight, becomes distended and pale. Associated with high fever, hypocalcemia, certain infections - CORRECT ANSWER Oncosis" "Liver and germ cell tumors - CORRECT ANSWER Alpha Fetoprotein Origin" "GI, pancreas, lung, breast tumors - CORRECT ANSWER Carcinoembryonic Antigen" "prostate tumors - CORRECT ANSWER Prostate Specific Antigen" "from epithelial tissue- renal cell carcinoma - CORRECT ANSWER Carcino-" "from connective tissue- chondrosarcoma - CORRECT ANSWER Sarco-" "preinvasive epithelial malignant tumors of glandular or squamous cells- cervix - CORRECT ANSWER Carcinoma in situ" "Multiple organs including brain - CORRECT ANSWER Lung ca metastasis" "Liver, lungs - CORRECT ANSWER Colorectal ca metastasis" "Liver, lungs, brain - CORRECT ANSWER Testicular ca metastasis" "Bones (especially lumbar spine), liver - CORRECT ANSWER Prostate ca metastasis" "Liver, bones, lymphatics - CORRECT ANSWER Head and neck ca metastasis" "Peritoneal surfaces, diaphragm, omentum, liver - CORRECT ANSWER Ovarian ca metastasis" "Lungs - CORRECT ANSWER Sarcoma metastasis" "intracellular K+ is released into bloodstream - CORRECT ANSWER Cell lysis effect on K+" "cellular ATP is diminished, opening K+ channels and allowing K+ to leave cell - CORRECT ANSWER Exercise effect on K+" "excretion and absorption of K+ is regulated by tubule system - CORRECT ANSWER Kidneys effect on K+" "mag inhibits the potassium channels, keeping balance. when mag is low, more K+ exits the call, and is excreted via the kidneys. - CORRECT ANSWER magnesium and potassium" "E. increased acid production, loss of bicarb, diminished renal excretion of hydrogen C.M hyperventilation (compensatory), h/a, n/v/d, dehydration, hypotension pH <7.4 HCO3 <22 - CORRECT ANSWER metabolic acidosis" "E. GI loss, diuretic use C.M. slow, shallow respirations, irritability, twitching, s/s of hypokalemia pH >7.4 HCO3 >26 - CORRECT ANSWER metabolic alkalosis" "E. cns depression, airway abnormalities C.M. restless, confused, seizures, tachycardia pH <7.4 PaCO2 >44 - CORRECT ANSWER respiratory acidosis" "E. usually anxiety, PE, chf, salicylate OD, illegal drugs C.M. light-headed, confused, tetany pH >7.4 PaCO2 <38 - CORRECT ANSWER respiratory alkalosis" "Paired genes on autosomal chromosomes - CORRECT ANSWER Allele" "Outward appearance of an individual - CORRECT ANSWER Phenotype" "A map of ones specific genes - CORRECT ANSWER Genotype" "Two or more alleles which occur with an appreciable frequency in a population - CORRECT ANSWER Polymorphic" "Two dominant or recessive alleles - CORRECT ANSWER Homozygous" "When both a dominant and a recessive allele are present - CORRECT ANSWER Heterozygous" "Trait seen in phenotype - CORRECT ANSWER Dominant" "Trait not seen in phenotype - CORRECT ANSWER Recessive" "first 22 of 23 chromosomes - CORRECT ANSWER Autosomal chromosomes" "23rd pair of chromosomes - CORRECT ANSWER sex-linked chromosomes" "E. Increase in cell size P. Caused by hormonal stimulation or increased functional demand, which increased the cellular protein in the plasma membrane, endoplasmic reticulum, myofilaments, and mitochondria (not cellular fluid) Physiologic: skeletal muscle hypertrophy for persons doing heavy work/weight lifting. one kidney removed, the other kidney increases in size to accommodate for workload Pathologic: cardiomegaly from HTN/L ventricular hypertrophy - CORRECT ANSWER Hypertrophy" "ischemia which progresses to hypoxia. Intracellular enzymes such as CK, LDH, AST, ALT, troponin - CORRECT ANSWER Hypoxic Injury Clinical Manifestations" "decreased O2, loss of H/H, decreased RBC production, disease of heart/lungs, ischemia - CORRECT ANSWER Hypoxic Injury" "-most muscle cells, including heart excrete what enzyme - CORRECT ANSWER CK enzymes" "- muscle cells, liver cells, heart cells, RBCs, brain secrete what enzyme - CORRECT ANSWER LDH" "- liver cells (s) - CORRECT ANSWER AST enzymes are found where?" "- liver cells (L enzyme) - CORRECT ANSWER ALT enzymes are found where?" "- cardiac cells - CORRECT ANSWER Troponin enzymes are found where?" "spectrum of cell changes after the cell dies - CORRECT ANSWER Necrosis" "necrosis which results from sudden insufficiency of arterial blood flow - CORRECT ANSWER Infarct" "liver cell, ketogenesis occurs in the mitochondria of the hepatocyte result of unavailability of glucose - CORRECT ANSWER Role of the hepatocytes" "Ketogenesis is the formation of ketone bodies and occurs mostly in the mitochondria of the hepatocytes (liver cells) - CORRECT ANSWER Role of the mitochondria" "lack of glucose -occur from the depletion of carbohydrate stores or may occur bc the cell is not able to use glucose but the individual is hyperglycemic (type 2 DM) - CORRECT ANSWER Triggers for ketogenesis" "processed by hepatocytes and undergoes transformation to 3 ketone bodies: Acetoacetate, Acetone and B-hydroxybutyrate (basis of ketoacidosis) -States of starvation or uncontrolled DM, cells do not receive enough glucose to produce energy, resulting in acceleration of the B-oxidation cycle and increasing oxidation of fatty acids or energy. B-oxidation cycle results in formation of acetyl-CoA - CORRECT ANSWER Role of Acetyl-CoA" "size or direct extent of the primary tumor - CORRECT ANSWER T:" "tumor cannot be evaluated - CORRECT ANSWER Tx:" "carcinoma in situ - CORRECT ANSWER Tis:" "no signs of tumor - CORRECT ANSWER T0:" "size and/or extension of the primary tumor - CORRECT ANSWER T1, T2, T3, T4:" "degree of spread to regional lymph nodes - CORRECT ANSWER N:" "lymph nodes cannot be evaluated - CORRECT ANSWER Nx:" "tumor cells absent from regional lymph nodes - CORRECT ANSWER N0:" "regional lymph node metastasis present; (at some sites: tumor spread to closest or small number of regional lymph nodes) - CORRECT ANSWER N1:" "tumor spread to an extent between N1 and N3 (N2 is not used at all sites) - CORRECT ANSWER N2:" "tumor spread to more distant or numerous regional lymph nodes - CORRECT ANSWER N3:" "presence of distant metastasis - CORRECT ANSWER M:" "no distant metastasis - CORRECT ANSWER M0:" "metastasis to distant organs - CORRECT ANSWER M1:" "Apprehension, confusion, decreased DTR, diaphoretsis, headache,n/v, restless,tachy, tremors, dyspnea-with rapid, shallow respiration - CORRECT ANSWER Resp acid s/s" "Hyperventilation, fever, like vet failure, sepsis(especially gram-) - CORRECT ANSWER Resp alk causes" "Decreased LOC, seizure, coma, hyperreflexia, carpopedal spasm, tetany, arrhythmia, angina - CORRECT ANSWER Respiratory alkalosis" "Anxiety, diaphoresis, dyspraxia, ECG changes, hyper reflexes, parasthesias, restlessness, tachy, tetany - CORRECT ANSWER Resp alk s/s" "pH <7.35 Paco2 >45 Bicarbonate normal - CORRECT ANSWER Resp acid level Uncompensated" "pH normal Paco2 >45 BBicarb >26 - CORRECT ANSWER Resp acid compensated" "pH >7.45 Paco2 <35 Bicarbonate normal - CORRECT ANSWER Resp alk Uncompensated" "pH normal Paco2 <35 Bicarbonate <22 - CORRECT ANSWER Resp alk Compensated" "pH <7.35 Paco2 normal Bicarb <22 - CORRECT ANSWER Metabolic acid Uncompensated" "pH <7.35 Paco2<35 Bicarb <22 - CORRECT ANSWER Metabolic acid Compensated" "pH >7.45 Paco2 normal Bicarb >26 - CORRECT ANSWER Metabolic alk Uncompensated" "pH normal Paco2 >45 Bicarb >26 - CORRECT ANSWER Metabolic alk Compensated" "Intravascular, interstitial, intracellular - CORRECT ANSWER Fluid Compartments" "- Extracellular fluid (ECF) that is within the blood vessels - blood plasma - 5% of total body water - CORRECT ANSWER Intravascular" "-Water moves between plasma and interstitial space by osmosis and hydrostatic pressure, occur across the capillary membrane -The major forces for filtration are within the capillary. - CORRECT ANSWER Intravascular pattern of fluid shift" "hydrostatic pressure promotes the movement of about 10% of fluid along with small amount of protein into lymphatics which eventually returns to the circulation - CORRECT ANSWER Interstitial pattern of fluid shift" "- Fluid inside the cell - 40% of total body water - CORRECT ANSWER - Intracellular fluid (ICF)" "Water moves between ICF and ECF compartment by osmosis - CORRECT ANSWER Intracellular pattern of fluid shift" "facilitates the outward movement of water from the capillary to the interstitial space - CORRECT ANSWER Capillary hydrostatic pressure (BP)" "osmotically attracts water from the interstitial space back into the capillary - CORRECT ANSWER Capillary (plasma) oncotic pressure" "facilitates the inward movement of water from the interstitial space into the capillary - CORRECT ANSWER Interstitial hydrostatic pressure" "osomotically attracts water from the capillary into the interstitial space - CORRECT ANSWER Interstitial oncotic pressure" "- The measure of solute concentration in a solution (basically the concentration of plasma) aka Tonicity - CORRECT ANSWER Osmolality" "amount of pressure of force that is exerted by solute molecules of a given compartment -pulling passive force - CORRECT ANSWER Osmotic pressure" "280-295 mOsm/kg - CORRECT ANSWER plasma osmolality" "responsible for osmotic balance of ECF space - CORRECT ANSWER - Na" "responsible for osmotic balance of ICF space - CORRECT ANSWER - K" "Movement of water b/w compartments from an area of low concentration of solutes to an area of high - CORRECT ANSWER Osmosis" "Amount of pressure or force exerted by solute molecules of a given compartment - CORRECT ANSWER Osmotic Pressure" "S/S edema, tightness of the skin, puffiness of eyes, rales - CORRECT ANSWER Fluid Volume Excess" "Sitting or standing in one position, DVT, steroid drugs, CHF, Kidney disease, cirrhosis, - CORRECT ANSWER Edema Etiology" "S/S Swelling or puffiness of tissue, shiny skin, increased abdominal size, dyspnea, SOB, chest pain - CORRECT ANSWER Edema" "Excessive accumulation of fluid within the interstitial space - CORRECT ANSWER Edema" "It facilitates the outward movement of water from the vascular space to the interstitial space. It is determined by blood pressure and blood volume - in Edema, hydrostatic pressure is increased due to a venous obstruction or retention of Na - CORRECT ANSWER Hydrostatic Pressure" "It osmotically attracts water from the interstitial space back into the capillary - in Edema, oncotic pressure is decreased due to a loss or diminished production of albumin - CORRECT ANSWER Oncotic Pressure" "responsible for absorption and excretion of Na - CORRECT ANSWER renal tubular system" "- Regulated by ADH, hypothalamus, RAAS, Kidneys - CORRECT ANSWER Sodium Disorders" "most common electrolyte imbalance in hospital 3 types: isotonic, hypertonic, hypotonic (euvolemic, hypovolemic, hypervolemic) Mild (126-130): anorexia, apathy, restlessness, nausea, lethargy, muscle cramps Moderate (120-125): agitation, disorientation, headache Severe (<120): seizure, coma, a reflex is, incontinence, death - CORRECT ANSWER Hyponatremia" "Shifts potassium intracellularly, it functions by increasing the rate the sodium potassium pump moves these ions across the membrane. Mainly by dietary intake. - CORRECT ANSWER Insulin" "Hydrogen enters cell and is exchanged for potassium, allowing potassium to escape during acidosis, vice versa for alkalosis, to maintain ionic balance. H+ moves ICF and K+ moves ECF to maintain ionic balance. - CORRECT ANSWER Acid Base Balance effect on K+" "Stimulants of beta 2 receptors by albuterol increase the activity of the sodium potassium pump and shift potassium into the cell resulting in hypokalemia. Alpha adrenergic receptors cause a shift out of the cell and may lead to hyperkalemia. Beta 2 antagonist cause shift into cell space as well. - CORRECT ANSWER Adrenergic Agonists" "Hyperosmolality will cause a shift of potassium out of the cell. This mechanism is dependent on osmosis. When the intracellular space has a high osmolality water will flow from intracellular space to the intravascular space = high level of potassium in the cell and triggers potassium to shift to the extracellular space causing hyperkalemia. - CORRECT ANSWER Osmolality" "Release intracellular potassium - CORRECT ANSWER Cell Lysis" "depletes cellular ATP, which open the potassium channels in the muscle cells, which in turn allows potassium to shift out of the cell. - CORRECT ANSWER Exercise" "Kidneys responsible for maintaining potassium balance.Renal tubular system controls excretion and absorption of potassium - CORRECT ANSWER renal control" "E: As extracellular K+ is depleted, the intracellular K+ diffuses out of the cell easily → cell becomes hyperpolarized which it is then less likely to depolarize and transmit impulses, a greater stimulus is needed to depolarize and conduct impulses. Decrease in neuromuscular excitability. Affects resting membrane potential of cells. (more negative). Causes: diuretics, nephrotoxic, drugs, diarrhea, laxative abuse, hyperglycemia, and increased levels of aldosterone and alkalosis CM: K<3.5 but >3.0: no symptoms K<3.0: cardiac dysrhythmias, weakness, parathesias, confusion, respiratory difficulty, constipation, depression, muscle cramps. - CORRECT ANSWER Hypokalemia" "Commonly caused by end stage renal failure, medications (ACE inhibitors, NSAIDS), tissue trauma (Rhabdomy.), adrenal insufficiency, hypoxia, digitalis overdose, insulin deficits. - CORRECT ANSWER K > 5.5" "- regulated by 3 hormones: parathyroid (PTH), vit D, and calcitonin - rigidly controlled. - inverse relationship: if one increases= other one decreases - CORRECT ANSWER Calcium and Phosphorus" ">10mg/dl E: Causes decreased cell permeability to Na+, causing the threshold potential to become more positive and further from the membrane potential, meaning more stimulus is required to initiate an action potential. Causes: hyperparathyroidism and at times cancer of the bone resulting from breast cancer, lymphoma or myeloma CM: polyuria, renal stones, nausea, vomiting, constipation, weakness, fatigue, confusion, coma, hyporeflexia, lethargy, encephalopathy, a shortened QT segment and depressed, widened T waves on EKG. - CORRECT ANSWER Hypercalcemia -" "<8.5mg/dl E: Causes increased cell permeability to Na+ causing a progressive depolarization. The threshold potential becomes more negative and closer to the resting membrane potential, requiring a smaller stimulus for an action potential. The cells are more likely to initiate an action potential; they are excitable. Causes: Hypoparathyroidism, renal failure, acute pancreatitis, vitamin D deficiency, CM: Tetany (cont. muscle spasm), hyperreflexia, circumoral paresthesia, seizures, dysrhythmias Chvostek's sign - tap facial nerve just below temple leads to twitching of nose or lip Trousseau's sign - contraction of hand and fingers when arterial blood flow in arm occluded for 5 minutes - CORRECT ANSWER Hypocalcemia" "Hyperparathyroidism, cancers of the bone originating from breast cancer, myeloma or lymphoma Polyuria, renal stones, nausea, vomiting, constipation, weakness, fatigue, confusion, coma - CORRECT ANSWER Hypercalcemia" "Measured should be slightly greater than calculated If >10, then other solutes present If >50, then fatal - CORRECT ANSWER Osmolar gap" "ph < 7.4 and HCO3 < 21 E: Increased H+ load - Decreased H+ excretion - Uremia, distal renal tubule acidosis; Concentration of non-carbonic acids increases or bicarbonate is lost from ECF or cannot be regenerated by the kidneys. Causes: ketoacidosis (DM, starvation), Lactic acidosis (shock-hypoxemia), ingestions ((high osmolar gaps) (ammonium Cl-, ethylene glycol, methanol, salicylates, paraldehyde); HCO3 loss - Diarrhea, renal failure, proximal renal tubule acidosis CM: Decreased myocardial contractility, decreased cardiac output, catecholamine resistant hypotension, hyperkalemia; Oxyhemoglobin dissociation curve shifts right. - CORRECT ANSWER metabolic acidosis" "Etiology:Free Radical- have unpaired electron in its outer shell, making molecule unstable and highly reactive. aka being oxidized ROS-byproduct of ATP production in the mitochondria Clinical Manif: FR- to stabilize self, it will steal an electron from another molecule or give up an electron. The free radical will often steal an electron from another molecule, making that molecule a free radical ROS- can overwhelm mitochondria and exhaust intracellular antioxidants, causing cell injury/disease Patho: ROS are produced by absorption of high energy sources such as radiation or UV light, have role in development of Alzheimer's, Parkinson's, Amyotrophic Lateral Sclerosis (ALS). ROS cause lipid peroxidation, damage proteins which maintain ion pumps and cellular transport, fragment DNA and causes less protein synthesis, cause chromatin destruction, and damage mitochondria. Antioxidants are our body's defense against ROS- re - CORRECT ANSWER Free Radical and Reactive Oxygen Species (ROS)" "Etiology: ETOH is metabolized to acetaldehyde in the cytoplasm of the cell, enzyme alcohol dehydrogenase (ADH) helps with conversion Clinical Manifestation: adverse effects on liver and causes nutritional disorders. acute effects in the liver include inflammation, fatty infiltration, hepatomegaly, acute liver necrosis and suppressed fatty acid oxidation. liver failure is irreversible effect of chronic abuse Patho: Conversion oxidized niacin (NAD+) is reduced to NADH. In the mitochondrial acetaldehyde is further converted by ADH to acetate and further oxidized niacin (NAD+) is reduced to NADH. the increased NADH/NAD+ ratio in the liver causes the following Pyruvate change to lactic acid causing lactic acidosis Oxaloacetate converted to malate, preventing gluconeogenesis leading to fasting hypoglycemia Glyceraldehyde to glycerol which combines with fatty acids and forms triglycerides, leads to triglycerides in the live - CORRECT ANSWER Ethanol" "Cellular Effect:- the sum of cellular changes after local cell death and the process of cellular self-digestion (autolysis)- rapid loss of plasma membrane, organelle swelling, mitochondrial dysfunction, lack typical features of apoptosis Clinical Implications:- induced by nonspecific trauma or injury- necroptosis - programmed necrosis- associated with development, tissue damage during acute pancreatitis, and retinal detachment; and provides an innate immune response to viral infection- this challenges the historic view of necrosis as passive cell death occurring in a disorganized or unregulated manner - CORRECT ANSWER Necrosis" "Cellular Effect:necrosis which results from sudden insufficiency of arterial blood flow Clinical Implications:- irreversible myocardial injury (MI) - CORRECT ANSWER Infarct" "Cellular Effect: programmed cell death, normal process Clinical Implications: Death by apoptosis causes loss of cells in many pathologic states including: Severe cell injury, Accumulation of misfolded proteins, Infections (part. viral), Obstruction in tissue ducts dysregulated apoptosis - excessive or insufficient apoptosis. ex: survival of mutated cells can increase cancer risk. Increased apoptosis is known to occur in ischemic injury (MI and stroke)- prevents cellular proliferation resulting in a gigantic body - CORRECT ANSWER Apoptosis" "Most of the ethanol in the body is broken down in the liver by an enzyme called alcohol dehydrogenase (ADH), which transforms ethanol into a toxic compound called acetaldehyde (CH3CHO), a known carcinogen. However, acetaldehyde is generally short-lived; it is quickly broken down to a less toxic compound called acetate (CH3COO-) by another enzyme called aldehyde dehydrogenase (ALDH). Acetate then is broken down to carbon dioxide and water, mainly in tissues other than the liver. *The enzymes cytochrome P450 2E1 (CYP2E1) and catalase also break down alcohol to acetaldehyde. However, CYP2E1 only is active after a person has consumed large amounts of alcohol, and catalase metabolizes only a small fraction of alcohol in the body. Small amounts of alcohol also are removed by interacting with fatty acids to form compounds called fatty acid ethyl esters (FAEEs). These compounds have been shown to contribute to damage to the - CORRECT ANSWER Ethanol Metabolism Pathway" "Alcohol is metabolized by alcohol dehydrogenase (ADH) into acetaldehyde, then further metabolized by aldehyde dehydrogenase (ALDH) into acetic acid, which is finally oxidized into carbon dioxide (CO2) and water ( H2O).[6] This process generates NADH, and increases the NADH/NAD+ ratio. A higher NADH concentration induces fatty acid synthesis while a decreased NAD level results in decreased fatty acid oxidation. Subsequently, the higher levels of fatty acids signal the liver cells to compound it to glycerol to form triglycerides. These triglycerides accumulate, resulting in fatty liver. - CORRECT ANSWER Hepatocellular damage:Fatty Liver" "Alcoholic hepatitis is characterized by the inflammation of hepatocytes. Between 10% and 35% of heavy drinkers develop alcoholic hepatitis. This is called alcoholic steato necrosis and the inflammation appears to predispose to liver fibrosis. Inflammatory cytokines (TNF-alpha, IL6 and IL8) are thought to be essential in the initiation and perpetuation of liver injury by inducing apoptosis and necrosis. One possible mechanism for the increased activity of TNF-α is the increased intestinal permeability due to liver disease. This facilitates the absorption of the gut-produced endotoxin into the portal circulation. The Kupffer cells of the liver then phagocytose endotoxin, stimulating the release of TNF-α. TNF-α then triggers apoptotic pathways through the activation of caspases, resulting in cell death. - CORRECT ANSWER Hepatocellular damage:Alcoholic Hepatitis" "Cirrhosis is a late stage of serious liver disease marked by inflammation (swelling), fibrosis (cellular hardening) and damaged membranes preventing detoxification of chemicals in the body, ending in scarring and necrosis (cell death). Acetaldehyde may be responsible for alcohol-induced fibrosis by stimulating collagen deposition by hepatic stellate cells.[2] The production of oxidants derived from NADPH oxi- dase and/or cytochrome P-450 2E1 and the formation of acetaldehyde-protein adducts damage the cell membrane.[2] Symptoms include jaundice(yellowing), liver enlargement, and pain and tenderness from the structural changes in damaged liver architecture. Without total abstinence from alcohol use, cirrhosis will eventually lead to liver failure. Late complications of cirrhosis or liver failure include portal hypertension (high blood pressure in the portal vein due to the increased flow resistance through the damaged - CORRECT ANSWER Hepatocellular damage:Cirrhosis" "Role: liver cell, ketogenesis occurs in the mitochondria of the hepatocyte Clinical Implications: result of unavailability of glucose - CORRECT ANSWER Role of the hepatocytes" "Role: Ketogenesis is the formation of ketone bodies and occurs mostly in the mitochondria of the hepatocytes (liver cells) Clinical Implications:- level of ketone bodies too high, pH drops = ketoacidosis (commonly seen in uncontrolled DM1 and alcoholics - CORRECT ANSWER Role of the mitochondria" "Role:lack of glucose Clinical Implications:occur from the depletion of carbohydrate stores or may occur bc the cell is not able to use glucose but the individual is hyperglycemic (type 2 DM) - CORRECT ANSWER Triggers for ketogenesis" "Role:processed by hepatocytes and undergoes transformation to 3 ketone bodies: Acetoacetate, Acetone and B-hydroxybutyrate (basis of ketoacidosis) Clinical Implications:States of starvation or uncontrolled DM, cells do not receive enough glucose to produce energy, resulting in acceleration of the B-oxidation cycle and increasing oxidation of fatty acids or energy. B-oxidation cycle results in formation of acetyl-CoA - CORRECT ANSWER Role of Acetyl-CoA" "Role:Oxaloacetate is also used in gluconeogenesis, during starvation & uncontrolled DM oxaloacetate levels are insufficient due to gluconeogenesis... this depletion furthers the amount of acetyl-CoA which activates ketogenesis Clinical Implications:Oxaloacetate (an intermediate) is involved in: Citric acid cycle*gluconeogenesis*urea cycle*amino acid synthesis*fatty acid synthesis - CORRECT ANSWER Effect on oxaloacetate" "Origin:proteins secreted by liver and germ cell tumors - CORRECT ANSWER Tumor Marker:Alpha Fetoprotein" "Origin:GI, pancreas, lung, breast, ect - CORRECT ANSWER Tumor Marker:Carcinoembryonic Antigen" "Origin:Germ cell - CORRECT ANSWER Tumor Marker:Beta Human Chorionic gonadotropin" "Origin: Prostate - CORRECT ANSWER Tumor Marker:Prostate Specific Antigen" "Definition:arise from epithelial tissue Ex:Adenocarcinoma: arising from ductal/glandular glands - CORRECT ANSWER Carcino- (prefix)" "Definition:connective tissue Ex:malignant cancers of the skeletal muscle are known as rhabdomyosarcomas - CORRECT ANSWER Sarco- (prefix)" "Benign tumors generally named according to the tissue from which they arise Ex:- benign tumor of fat cells is a lipoma- smooth muscle of uterus is leiomyoma - CORRECT ANSWER -oma (suffix)" "Definition:-preinvasive epithelial malignant tumors of glandular or squamous cell origin- localized to the epithelium- not yet malignant- 3 fates: can remain stable for long time, progress to invasive/met CA, or regress and disappear Ex:- # of sites including cervix, skin, oral cavity, esophagus and bronchus- in breast, ductal carcinoma in situ (DCIS) fills the mammary ducts but has not progressed to local tissue invasion - CORRECT ANSWER Carcinoma in Situ" "multiple organs, including brain- via portal vein, LV - CORRECT ANSWER Lung" "liver - via mesenteric lymphatics, portal venous system,lungs - via IVC, RV, PA - CORRECT ANSWER Colorectal" "lungs, liver, brain- lymph to periaortic area to subclavian vein to RV - CORRECT ANSWER Testicular" "bones (especially lumbar spine), liver - regional lymph and veins which drain to batson plexus - CORRECT ANSWER Prostate" "bones, lung, brain, liver- axillary, transpectoral and internal mammary lymph - CORRECT ANSWER Breast Ca Metastasis sites" "lymphatics, liver, bones - direct extension - CORRECT ANSWER Head and Neck" "peritoneal surfaces, diaphragm, omentum, liver- direct extension, peritoneal seeding, mesenteric veins - CORRECT ANSWER Ovarian" "lungs- IVC, RV, PA - CORRECT ANSWER Sarcoma" "in transit lymphatics, lung, liver, brain, GI tract- regional lymphatics - CORRECT ANSWER Melanoma" "Metastasis is the spread of cancer from the site of the original tumor to distant tissue. Metastasis contributes significantly to pain and suffering from cancer and is the major cause of death in cancer patients. Mechanisms important in local invasion include recruitment of macrophages and other cell types to the primary tumor, where they promote digestion of connective tissue capsules and other structural barriers by secreted proteases; changes in cell-to-cell adhesion, often by changes in the expression of cell adhesion molecules such as cadherins and integrins, making the cancer cell more slippery and mobile; and increased motility of individual tumor cells. The mechanism of capsular dissolution is unclear. To transition from local to distant metastasis, the cancer cell must also be able to invade local blood and lymphatic vessels, a task facilitated by stimulation of neoangiogenesis and lymphangiogenesis by facto - CORRECT ANSWER Evaluate and describe the mechanisms of cancer metastasis and the implications for clinical practice." "Local invasion: Cancer cells invade nearby normal tissue. Intravasation: Cancer cells invade and move through the walls of nearby lymph vessels or blood vessels. Circulation: Cancer cells move through the lymphatic system and the bloodstream to other parts of the body. Arrest and extravasation: Cancer cells arrest, or stop moving, in small blood vessels called capillaries at a distant location. They then invade the walls of the capillaries and migrate into the surrounding tissue (extravasation). Proliferation: Cancer cells multiply at the distant location to form small tumors known as micro metastases. Angiogenesis: Micrometastases stimulate the growth of new blood vessels to obtain a blood supply. A blood supply is needed to obtain the oxygen and nutrients necessary for continued tumor growth. - CORRECT ANSWER Cancer cell metastasis usually involves the following 6 steps:" "The measure of solute concentration in a solution, in humans it is basically the concentration of the plasma. - CORRECT ANSWER Osmolality" "The movement of water "down" a concentration gradient, that is, across a semipermeable membrane from a region of higher water concentration to a region of lower water concentration. - CORRECT ANSWER Osmosis" "The amount of pressure or force that is exerted by solute molecules of a given compartment. The higher the osmolality the higher the osmotic pressure. This is a pulling force and will pull water into a compartment. This is the force that must be overcome by hydrostatic pressure to oppose osmosis. - CORRECT ANSWER Osmotic Pressure" "The force within a fluid compartment- the mechanical force of fluid against the walls of the compartment, i.e. blood pressure. This is a pushing force and pushes fluid outside the compartment. - CORRECT ANSWER Hydrostatic Pressure" "The force which helps to keep water/fluid within a compartment. It contributes to osmotic pressure and is exerted by plasma proteins. The main plasma protein is albumin. - CORRECT ANSWER Oncotic Pressure" "The amount of blood within the arterial space which effectively perfuses the organs and tissues. - CORRECT ANSWER Effective Arterial Blood Volume" "Secreted by the pituitary gland in response to a water deficit, Na excess or a low BP. It causes the kidneys to reabsorb H2O thus increasing plasma volume. With fluid loss (vomiting, diarrhea or excessive sweating) a decrease in blood volume and blood pressure occurs. Baroreceptors (located in Right and Left atria, large veins, aorta, pulmonary arteries and carotid sinus), signal the hypothalamus to release ADH. - CORRECT ANSWER Antidiuretic Hormone" "The person produces less urine causing the blood volume to increase. - CORRECT ANSWER Renin Angiotensin Aldosterone System" "Released from the atria or ventricle of the heart. Works opposite of the RAAS to decrease blood volume - CORRECT ANSWER Natriuretic Hormones" "Promotes urinary excretion of Na and H2O thus decreasing blood volume. - CORRECT ANSWER Natriuretic Hormones" "Dehydration from vomiting or diarrhea and sweating - CORRECT ANSWER etiology of Fluid Volume Deficit" "Poor skin turgor, dry mucous membranes, sunken eyes, sunken fontanels, decreased urine output and fatigue - CORRECT ANSWER clinical manifestations of Fluid Volume Deficit" "Intake or retention of fluid that exceeds fluid needs. Can be caused by renal failure. - CORRECT ANSWER etiology of Fluid Volume Excess" "skin tightness, eye puffiness, rales on ausculation - CORRECT ANSWER clinical manifestations of edema" "Increased capillary hydrostatic pressure caused by thrombophlebitis, hepatic obstruction, right heart failure, tight clothing, prolonged standing, CHF and renal failure, liver disease, protein malnutrition (from decreased production of plasma proteins), glomerular disease, trauma, hemorrhage, burns and cirrhosis - CORRECT ANSWER etiology of edema" "Generalized edema (uniform distribution of fluid throughout the body), dependent edema (fluid accumulation in gravity dependent areas of body), localized edema (limited to site of injury) Edema is identified by swelling and puffiness,weight gain, dehydration from sequestering of fluids. - CORRECT ANSWER clinical manifestations of edema" "mild - CORRECT ANSWER Serum Na level: 125-135 mEq/L severity" "anorexia, apathy, restlessness, nausea, lethargy, muscle cramps. - CORRECT ANSWER Serum Na level: 125-135 mEq/L clinical manifestations" "moderate - CORRECT ANSWER Serum Na level: 120-125 mEq/L. severity" "agitation, disorientation, headache - CORRECT ANSWER Serum Na level: 120-125 mEq/L. clinical manifestations" "severe - CORRECT ANSWER Serum Na level: < 120mEq/L severity" "seizures, coma, areflexia, incontinence, death - CORRECT ANSWER Serum Na level: < 120mEq/L clinical manifestations" "ed intake of potassium ased entry of K+ into cells ased losses of body K+ - CORRECT ANSWER hypokalemia" "Increase in ECF K+ concentration > 5.5 mEq/L. d/t efficient renal excretion, excesses of total body K+ are relatively rare. Acute increases in serum K+ concentration are handled quickly through an increase in cellular uptake and renal excretion of body K+ excess. Causes: Excessive intake; shift of K+ from ICF to ECF; Decreased renal excretion. CM: weakness, syncope (fainting), paresthesia (numbness/tingling) of extremities, paralysis, cardiac arrest; Peaked T waves resulting from cell hypopolarized = more excitability producing impulses easier and quicker. RMV -90mv to -80mv - CORRECT ANSWER hyperkalemia" "Magnesium inhibits potassium channels; therefore, loss of magnesium results in movement of potassium out of the cell, with renal excretion resulting in hypokalemia. Hypomagnesemia- will cause renal wasting of potassium. In the setting of hypokalemia, it can make treatment of the hypokalemia very difficult and needs to be treated. - CORRECT ANSWER Magnesium and Potassium" "* About 40% is in the free or ionized form (5.5 to 5.6 mg/dl), which has the most important physiological functions. * The fractions of serum calcium that are freely ionized or bound to plasma proteins are influenced by pH. * Acidosis: increases levels of ionized calcium * Alkalosis: increases protein-bound calcium and decreases ionized calcium (hypocalcemia symptoms) * Most is located in bone, the remainder is in plasma and body cells. * About 50% of circulating is bound to plasma protein, primarily albumin. - CORRECT ANSWER Calcium and Ionized Calcium" "* Total fraction of calcium circulating in the blood is small (9.0 to 10.5 mg/dl) * About 50% is bound to plasma proteins, primarily albumin. * Alkalosis causes symptoms of hypocalcemia because the change in pH enhances protein binding of ionized calcium. * Hypoalbuminemia lowers total serum calcium levels by decreasing the amount of bound calcium in the plasma because there is less protein available for binding - CORRECT ANSWER Calcium and Albumin" "ANS: A Hydrostatic pressure is the mechanical force of water pushing against cellular membranes. In the vascular system, hydrostatic pressure is the blood pressure generated in vessels by the contraction of the heart. Blood reaching the capillary bed has a hydrostatic pressure of 25 to 30 mm Hg, which is sufficient force to push water across the thin capillary membranes into the interstitial space. The remaining options do not correctly identify the process described. PTS: 1 REF: Pages 29-30 - CORRECT ANSWER 22. The movement of fluid across the arterial end of capillary membranes into the interstitial fluid surrounding the capillary is an example of which fluid movement process? a. Hydrostatic pressure b. Osmosis c. Diffusion d. Active transport" “E. Cells decrease in size P. Still functional; imbalance between protein synthesis and degradation. Essentially there is an increase in the catabolism of intracellular organelles, reducing structural components of cell Physiologic: thymus gland in early childhood Pathological: disuse (muscle atrophy d/ decrease workload, pressure, use, blood supply, nutrition, hormonal stimulation, or nervous stimulation) - CORRECT ANSWER Atrophy" "E: cells increase in number, mitosis (cell division) must occur, size of cell does not change Phys: increased rate of division, increase in tissue mass after damage or partial resection; may be compensatory, hormonal, or pathologic Patho: abnormal proliferation of normal cells usually caused by increased hormonal stimulation (endometrial). increase of production of local growth factors Ex: removal of part of the liver lead to hyperplasia of hepatocytes. uterine or mammary gland enlargement during pregnancy - CORRECT ANSWER Hyperplasia" "E. Not true adaptation; Cells abnormal change in size, shape, organization (classified as mild, moderate, severe) P. caused by cell injury/irritation, characterized by disordered cell growth. aka atypical hyperplasia or pre-cancer, a disorderly proliferation Physiologic: N/A Pathologic: squamous dysplasia of cervix from HPV shows up on pap smear, breast cancer development; pap smears often show dysplastic cells of the cervix that must undergo laser/surgical tx - CORRECT ANSWER Dysplasia" "E: reversible change, one type of cell changes to another type for survival P: reversible; results from exposure of the cells to chronic stressors, injury, or irritation; Cancer can arise from this area, stimulus induces a reprogramming of stem cells under the influence of cytokines and growth factors Ex: Patho: Columnar cells change to squamous cells in lungs of smoker or normal ciliated epithelial cells of the bronchial linings are replaced by stratified squamous epithelial cells.; Phys: Barrett Esophagus- normal squamous cells change to columnar epithelial cells in response to reflux, aka intestinal metaplasia - CORRECT ANSWER Metaplasia" "In transit lymphatics, lung, liver, brain, GI tract - CORRECT ANSWER Melanoma metastasis" "Local invasion, followed by invasion of surrounding tissues. Cells then may invade blood and lymphatic vessels. They must survive in circulation, then enter and survive in a new location. Then the cells can multiply and form a new tumor. - CORRECT ANSWER Mechanisms of ca metastasis" "T= tumor size >/= correlates with metastatic ability N= whether lymph nodes are involved M= extra nodal involvement (liver, lungs) - CORRECT ANSWER TNM staging system" "In venous system- 20% - CORRECT ANSWER Intravascular fluid compartment" "The measure of solute concentration in a fluid. 280-295 mOsm - CORRECT ANSWER Osmolality" "Surrounds the cells and bathes them in nutrients- 20% - CORRECT ANSWER Interstitial fluid compartment" "Within the cells- 40% uk - CORRECT ANSWER Intracellular fluid compartment" "Passive- the movement of water from an area of low concentration of solute to one of higher concentration - CORRECT ANSWER Osmosis" "Pulling- the amount of pressure or force that is exerted by solute molecules of a given compartment - CORRECT ANSWER Osmotic pressure" "Blood pressure- pushes fluid outside of the vessels, the force of fluid against the walls of a compartment- venous obstruction, Na and water retention - CORRECT ANSWER Hydrostatic pressure" "Colloid pressure keeps water inside the compartment, attracts water from interstitial space back into the capillary- losses or diminished albumin - CORRECT ANSWER Oncotic pressure" "The amount of blood within the arterial space- ECF changes will cause changes in the EABV in the same direction - CORRECT ANSWER Effective arterial blood volume" "Activated by low blood volume, triggers release of renin which converts angiotensinogen to angiotensin 1. ACE converts angiotensin 1 to angiotensin which causes arterial vasoconstriction and stimulates release of aldosterone. Aldosterone stimulates renal Na reabsorption and K+ excretion. Water is retained, less urine is produced, blood volume increases. - CORRECT ANSWER Renin Angiotensin Aldosterone System" "ANP and BNP- released by heart- works opposite RAAS to decrease blood volume, promotes urinary excretion of Na and water - CORRECT ANSWER Natriuretic hormones" "Dehydration- intake is not enough for body's needs C.M. Poor skin turgor, dry mucous membranes, sunken eyes, sunken fontanelles, decreased urine output, fatigue - CORRECT ANSWER Fluid volume deficit" "Fluid intake exceeds body's needs C.M. Edema, rales, HTN, weight gain, bounding pulses, intake> output, JVD, restlessness or anxiety - CORRECT ANSWER Fluid volume excess" "Accumulation of fluid within the interstitial space- venous obstruction, Na and water retention C.M. can be localized or dependent, tightness of skin, facial swelling, rales, decreased wound healing, increased risk of pressure sores, weight gain - CORRECT ANSWER Edema" "K+ enters cell with glucose transport. Monitor Type II DM for hypokalemia - CORRECT ANSWER insulin effect on K+" "albuterol, beta blockers, and alpha adrenergic antagonists cause K+ movement into the cell. Alpha adrenergic receptors shift K+ out of the cell - CORRECT ANSWER Adrenergic agents effect on K+" "hyperosmolality causes water to shift out of cell via osmosis. K+ will also shift out, causing hyperkalemia. - CORRECT ANSWER Osmolality effect on K+" "lack of O2 causes decrease in mitochondrial function, causing decrease ATP production and increases anaerobic metabolism (generating ATP from glycogen), eventually anaerobic metabolism will stop and the cell will die. Reduction of ATP impairs Na/K pump, leads to increased Na/Ca in cell, K is diffused out of cell, water diffuses into cell causing swelling, ribosomal dilation and malfunction occur. Ribosomes produces protein and when it malfunctions causes decrease in protein synthesis. Death will occur if injury is not stopped. - CORRECT ANSWER Hypoxic Injury Pathophysiology" "have unpaired electron in its outer shell, making molecule unstable and highly reactive. aka being oxidized - CORRECT ANSWER Free Radical Etiology" "byproduct of ATP production in the mitochondria - CORRECT ANSWER Reactive Oxygen Species ROS Etiology" "to stabilize self, it will steal an electron from another molecule or give up and electron. The free radical will often steal an electron from another molecule, making that molecule a free radical - CORRECT ANSWER Free Radical and Clinical Manafestations" "can overwhelm mitochondria and exhaust intracellular antioxidants, causing cell injury/disease - CORRECT ANSWER Reactive Oxygen Species (ROS) Clinical Manafestations" "may by initated with in cells by (1) absorption of extreme energy sources such as radiation or UV light; (2) the occurrence of endogenous reactions, such as redox reactions in which oxygen is reduced to water have role in development of Alzheimer's, Parkinson's, Amyotrophic Lateral Sclerosis. Antioxidants are our bodies' defense, reducing agents that provide missing electron that can stabilize the ________ - CORRECT ANSWER Free Radical and Pathophysiology" "cause lipid peroxidation, damage proteins which maintain ion pumps and cellular transport, fragment DNA and causes less protein synthesis, cause chromatin destruction, and damage mitochondria. - CORRECT ANSWER Reactive Oxygen Species (ROS) Pathophysiology" "ETOH is metabolized to acetaldehyde in the cytoplasm of the cell, enzyme alcohol dehydrogenase (ADH) helps with conversion - CORRECT ANSWER Ethanol Etiology" "adverse effects on liver and causes nutritional disorders. acute effects in the liver include inflammation, fatty infiltration, hepatomegaly, acute liver necrosis and suppressed fatty acid oxidation. liver failure is irreversible effect of chronic abuse - CORRECT ANSWER Ethanol Clinical Manafestations" "Conversion oxidized niacin (NAD+) is reduced to NADH. In the mitochondrial acetaldehyde is further converted by ADH to acetate and further oxidized niacin (NAD+) is reduced to NADH. the increased NADH/NAD+ ratio in the liver causes the following 1.Pyruvate change to lactic acid causing lactic acidosis 2. Oxaloacetate converted to malate, preventing gluconeogenesis leading to fasting hypoglycemia 3. Glyceraldehyde to glycerol which combines with fatty acids and forms triglycerides, leads to triglycerides in the liver, aka hepatosteatosis 4. decreases citric acid cycle production of NADH which leads to utilization of Acetyl-CoA for ketogenesis (causing ketoacidosis) and lipogenesis (causing hepatosteatosis) - CORRECT ANSWER Ethanol Pathophysiolody" "cellular swelling, cellular injury because with most injuries there is some amount of O2 deprivation causing hypoxic injury - CORRECT ANSWER Oncosis Effects and Clinical Implications" "Oxaloacetate is also used in gluconeogenesis, during starvation & uncontrolled DM oxaloacetate levels are insufficient due to gluconeogenesis... this depletion furthers the amount of acetyl-CoA - CORRECT ANSWER Effect on oxaloacetate" "Liver and germ cell tumors - CORRECT ANSWER Alpha Fetoprotein (AFP)" "GI, pancreas, lung, breast, ect tumors - CORRECT ANSWER Carcinoembryonic Antigen CEA" "Germ cell tumors - CORRECT ANSWER Beta Human Chorionic gonadotropin B-hCG origin" "Prostate tumors - CORRECT ANSWER Prostate Specific Antigen PSA" "arise from epithelial tissue - CORRECT ANSWER Carcino- (prefix)" "connective tissue (muscle and bone tissue) malignant cancers of the skeletal muscle are known as rhabdomyosarcomas - CORRECT ANSWER Sarco- (prefix)" "arise from ductal or glandular structures - CORRECT ANSWER adeno (prefix)" "-preinvasive epithelial malignant tumors of glandular or squamous cell origin -# of sites including cervix, skin, oral cavity, esophagus and bronchus in breast, ductal carcinoma in situ (DCIS) fills the mammary ducts but has not progressed to local tissue invasion - CORRECT ANSWER Carcinoma in Situ" "originates from precursor cells or blasts (immature or embryonic tissue). Ex: children, neuroblastoma, retinoblastoma - CORRECT ANSWER -blastoma (suffix)" "multiple organs, including brain - CORRECT ANSWER Lung Sites of Metastasis" "liver, lungs - CORRECT ANSWER Colorectal Sites of Metastasis" "lungs, liver, brain - CORRECT ANSWER Testicular Sites of Metastasis" "bones (especially lumbar spine), liver - CORRECT ANSWER Prostate Sites of Metastasis" "lymphatics, liver, bones - CORRECT ANSWER Head and Neck Sites of Metastasis" "peritoneal surfaces, diaphragm, omentum, liver - CORRECT ANSWER Ovarian Sites of Metastasis" "lungs - CORRECT ANSWER Sarcoma Sites of Metastasis" "in transit lymphatics, lung, liver, brain, GI tract - CORRECT ANSWER Melanoma Sites of Metastasis" "Cancer cells invade nearby normal tissue. - CORRECT ANSWER Local invasion:" "Cancer cells invade and move through the walls of nearby lymph vessels or blood vessels. - CORRECT ANSWER Intravasation:" "Cancer cells move through the lymphatic system and the bloodstream to other parts of the body. - CORRECT ANSWER Circulation:" "Cancer cells stop moving, in small blood vessels called capillaries at a distant location. They then invade the walls of the capillaries and migrate into the surrounding tissue - CORRECT ANSWER Arrest and extravasation:" "Cancer cells multiply at the distant location to form small tumors known as micrometastases. - CORRECT ANSWER Proliferation:" "Micrometastases stimulate the growth of new blood vessels to obtain a blood supply. A blood supply is needed to obtain the oxygen and nutrients necessary for continued tumor growth. - CORRECT ANSWER Angiogenesis:" "It is a force within a fluid compartment (the mechanical force of fluid against the walls of the compartment, ex: BP) - CORRECT ANSWER Hydrostatic Pressure" "- a pushing force, pushes fluid outside the compartment - CORRECT ANSWER Hydrostatic Pressure" "The force which helps to keep fluid/water within a compartment aka (colloid osmotic pressure) - CORRECT ANSWER Oncotic Pressure" "- contributes to osmotic pressure and is exerted by plasma proteins, mainly albumin - CORRECT ANSWER Oncotic Pressure" "In conditions where plasma proteins are reduced, e.g. from being lost in the urine or from malnutrition, there will be a reduction in oncotic pressure resulting in excess fluid buildup in the tissues (edema). - CORRECT ANSWER Oncotic Pressure" "Amount of blood within the arterial space which effectively perfuses the organs and tissues - CORRECT ANSWER Effective Arterial Blood Volume (EABV)" "- volume changes in the ____ compartment will cause changes in the _____ in the same direction - CORRECT ANSWER ECF, EABV" "Acts as a potent stimulus to ADH secretion even in the presence of hypo-osmolality. - CORRECT ANSWER Decreased arterial pressure" "It plays an important role in homeostasis by regulation of water, glucose and salt in the blood. It is released when body is dehydrated; secreted by the pituitary gland in response to a water deficit, Na excess or low BP; It causes the kidneys to reabsorb water, thus increasing plasma volume - CORRECT ANSWER ADH" "hormone secreted from the adrenal cortex and increases renal Na resorption and K excretion - CORRECT ANSWER Aldosterone" "It is activated by low blood volume. It regulates blood pressure and fluid balance - CORRECT ANSWER Renin Angiotensin Aldosterone System (RAAS)" "low blood volume triggers release - CORRECT ANSWER Renin" " - CORRECT ANSWER RAAS" "Hormones released from the atria or ventricle of the heart. - CORRECT ANSWER Natriuretic Hormones" "It decreases blood volume by promoting urine excretion of sodium and water (opposite of RAAS) - CORRECT ANSWER Natriuretic Hormones" "Have been found to be useful markers in differentiating patients presenting with acute onset of breathlessness and also as prognostic markers in patients with congestive cardiac failure. - CORRECT ANSWER Natriuretic peptides" "Trauma, dehydration, increased output, decreased intake, burn, sepsis, DKA, gastroenteritis, diabetes insipidus - CORRECT ANSWER Fluid Volume Deficit Etiology" "Hypotension, decreased skin turgor, dry mucous membrane, sudden weight loss, weak, rapid pulse, change in mental status, decreased urine output, hypovolemic shock. - CORRECT ANSWER Fluid Volume Deficit S/S" "Results from loss of body fluids from ICF and ECF - CORRECT ANSWER Fluid Volume Deficit Pathophysiology" "occurs when fluid intake of fluid retention exceeds the bodies fluid needs - CORRECT ANSWER Fluid Volume Excess" "CHF, Hepatic failure, renal failure, low protein sources, nephrotic syndrome, corticosteroids, liver cirrhosis - CORRECT ANSWER Fluid Volume Excess Etiology" "It is due to shifts in fluid from interstium to plasma, reduce excretion of sodium and water, excessive retention of sodium and water from chronic renal stimuli. - CORRECT ANSWER Fluid Volume Excess Pathophysiology" "Review the anion gap - if high, it's most likely from lactic acidosis, ketoacidosis, or renal failure. Normal anion gap (hyperchloremic acidosis) usually from diarrhea, saline administration in large volumes, NSAIDS, ACE inhibitors, or trimethoprim. - CORRECT ANSWER Ca++ bound to albumin decreases leading to an increase in ionized Ca++." "ph > 7.4 and HCO3 >28 E: loss of hydrochloric acid, normally H+ serves as a trigger for the pancreas to produce HCO3 which it gets from the blood, if H+ is lost, the pancreas doesn't remove HCO3 from the blood, causing a build up of HCO3 and alkalosis; Occurs when bicarbonate concentration is increased, usually due to a decrease in acid. Causes: Diuretics (promote H+ loss leading to NA+ and HCO3 reabsorption, the build up leads to alkalosis). Can also be from diarrhea or laxative abuse or vomiting or gastric suctioning, hyperaldosteronism, diuretics, CM: Hypokalemia symptoms, hypocalcemia symptoms, cardiac arrhythmias, hypoventilation; Oxyhemoglobin dissociation curve shifts left. - CORRECT ANSWER Metabolic Alkalosis" "ph < 7.4 and Pco2 >45 E: Restoration of adequate alveolar ventilation removes excess CO2. Alveolar hypoventilation, CO2 is retained (hypercapnia)m increasing H+ and producing acidosis. Cyanosis does not occur unless there is hypoxemia, skin may be pink from vasodilation from the elevated CO2 level. Causes: Respiratory depression (brainstem trauma, over sedation), paralysis of respiratory muscles (Guillain-Barre, polio, ALS, MS), airway obstruction, disorders of lung parenchyma (ARDS, COPD, PE, pneumonia) CM: Headache, lethargy, blurred vision, tremors, convulsions, coma. - CORRECT ANSWER Respiratory Acidosis" "ph > 7.4 and Pco2 < 35 E: Alveolar hyperventilation and decreased concentration of plasma CO2 (hypocapnia) Must identify underlying disturbance Causes: Hypoxemia (PE, CHF, high altitude), fever, gram negative sepsis, severe anemia, hyperventilation, hepatic failure, salicylate OD, catecholamines, nicotine, progesterone, mechanical ventilation CM: Dizziness, confusion, paresthesias, seizures, coma. - CORRECT ANSWER Respiratory Alkalosis" "Etiology:decreased O2,loss of Hgb or Hgb function, decreased RBC production, disease of heart/lungs, ischemia Clinical Manifestations: ischemia which progresses to hypoxia. Intracellular enzymes as follows: CK-most muscle cells, including heart,LDH- muscle cells, liver cells, heart cells, RBCs, brain,AST- liver cells,ALT- liver cells Troponin- cardiac cells Patho: lack of O2 causes decrease in mitochondrial function, causing decrease ATP production and increases anaerobic metabolism (generating ATP from glycogen), eventually anaerobic metabolism will stop and the cell will die. Reduction of ATP impairs Na/K pump, leads to increased Na/Ca in cell, K is diffused out of cell, water diffuses into cell causing swelling, ribosomal dilation and malfunction occur. Ribosomes produces protein and when it malfunctions causes decrease in protein synthesis. Death will occur if injury is not stopped. - CORRECT ANSWER Hypoxic Injury"