PathoPharm Exam 1
atrophy - Cell shrinkage due to decrease in workload of the cell
causes for atrophy - Disuse (arm in a cast), denervation (paralyzed limb), loss of endocrine
stimulation (effects of menopause on the uterine cells), malnutrition and ischemia (cells shrink to
conserve energy and become more efficient)
Hypertrophy - Increase in cell size due to increased workload of cell
Causes of hypertrophy - Excessive work of the cell (skeletal muscles increasing due to exercise; left
ventricular hypertrophy due to prolonged HTN), compensation (one kidney removed, remaining
kidney enlarges to compensate)
Hyperplasia - Increase in the number of cells; can only in occur in cells that have the ability to
perform mitosis
Causes of hyperplasia - Increased functional demand/workload (liver cells growing in number after
partial resection); excessive hormonal stimulation or other growth factors (increased breast and
uterine size in pregnancy)
Metaplasia - Mature cell type is replaced by a different mature cell type that is better suited for
demands; most often reversible when irritant is removed
Causes of metaplasia - Chronic irritation/inflammation (stratified epithelia replaces ciliated cells in
the airway of smokers); hormonal changes (cervix cells in puberty or due to chronic irritation)
Dysplasia - Abnormal, deranged cellular growth; precursor to cancer, but can be reversible
Causes of dysplasia - chronic irritation and inflammation (most common in uterine cervix and
respiratory tract)
Etiologies of cell injury - Physical trauma, temperature extremes, electrical injury, chemical damage,
radiation damage, biological agents, and nutritional factors
,Mechanisms of cell injury - Free radical production, impaired O2 delivery or utilization (ATP
depletion), and the destructive effects of uncontrolled calcium release (issues with calcium
homeostasis)
Apoptosis - process of programmed cell death; natural cellular process that aids in organism's
growth/development
Necrosis - Abnormal form of cell death (not part of the naturally programmed process)
Normal serum sodium level - 135-145 mEq/L
Hyponatremia serum level - <135 mEq/L
Hyponatremia signs/symptoms - (S.A.L.T. L.O.S.S.)
Stupor/coma
Anorexia/decreased appetite/N&V
Lethargy
Tendon reflexes decreased and Tachycardia/Thready pulse
Limp muscles (weakness)
Orthostatic hypotension
Seizures and headaches
Stomach Cramping (hyperactive bowels)
Treatment of Hyponatremia - Restrict (H2O) and Replace (Na)
Med adjustment if needed (ex. diuretics, lithium)
Monitor fluid balance (I&Os, daily weights, serum sodium level)
Hypernatremia serum level - >145 mEq/L
Hypernatremia signs/symptoms - (F.R.I.E.D.)
, Flushed skin, Fever (low-grade), Fatigue
Restless, irritable, anxious, confused (seizures and coma if severe)
Increased fluid retention & BP
Edema, Extreme thirst
Decreased urine output, Dry mouth (swollen, dry tongue and increased muscle tone if severe)
Treatment of Hypernatremia - Restrict Na intake
Gradual lowering of Na and increase of fluids through isotonic or hypotonic fluids infused SLOWLY
(could cause CNS symptoms like confusion and cerebral edema)
Two main types of hyponatremia - - Hypertonic (same amount of Na in the ECF, but SHIFT of H2O
from ICF to ECF due to presence of other solutes (like glucose) dilutes Na; H2O being pulled from
CELLS)
- Hypotonic (retention of/pulling H2O back from the KIDNEYS)
Hypertonic hyponatremia - Increased plasma lipids, proteins, or glucose in the ECF displace water
balance (pulls it from the cell) and thus decrease sodium concentration in the ECF
Hypovolemic hypotonic hyponatremia - Both H2O AND Na are lost from ECF (ex. Excessive sweating)
Hypervolemic hypotonic hyponatremia - seen when hyponatremia is accompanied by edema-
associated disorders such as decompensated heart failure, advances liver disease, and renal disease
(because although total body Na is increased, the effective circulating volume is often seen as
inadequate by the baroreceptors so they increase ADH which retains Na and thereby increases H2O
retention = dilutes Na)
Euvolemic hypotonic hyponatremia - retain water with dilution of Na+ while maintaining ECF (ex:
SIADH or diabetes insipidus)
Chemical agents of cell injury MOA - Can block enzymatic pathways, cause coagulation of tissues, or
disrupt osmotic or ionic balance of the cell
Biological agents of cell injury MOA - Able to replicate and continue to produce injury (range from
submicroscopic viruses to larger parasites), can be incorporated into DNA machinery, can interfere
with ATP production, can release endotoxins that cause cell injury and death
atrophy - Cell shrinkage due to decrease in workload of the cell
causes for atrophy - Disuse (arm in a cast), denervation (paralyzed limb), loss of endocrine
stimulation (effects of menopause on the uterine cells), malnutrition and ischemia (cells shrink to
conserve energy and become more efficient)
Hypertrophy - Increase in cell size due to increased workload of cell
Causes of hypertrophy - Excessive work of the cell (skeletal muscles increasing due to exercise; left
ventricular hypertrophy due to prolonged HTN), compensation (one kidney removed, remaining
kidney enlarges to compensate)
Hyperplasia - Increase in the number of cells; can only in occur in cells that have the ability to
perform mitosis
Causes of hyperplasia - Increased functional demand/workload (liver cells growing in number after
partial resection); excessive hormonal stimulation or other growth factors (increased breast and
uterine size in pregnancy)
Metaplasia - Mature cell type is replaced by a different mature cell type that is better suited for
demands; most often reversible when irritant is removed
Causes of metaplasia - Chronic irritation/inflammation (stratified epithelia replaces ciliated cells in
the airway of smokers); hormonal changes (cervix cells in puberty or due to chronic irritation)
Dysplasia - Abnormal, deranged cellular growth; precursor to cancer, but can be reversible
Causes of dysplasia - chronic irritation and inflammation (most common in uterine cervix and
respiratory tract)
Etiologies of cell injury - Physical trauma, temperature extremes, electrical injury, chemical damage,
radiation damage, biological agents, and nutritional factors
,Mechanisms of cell injury - Free radical production, impaired O2 delivery or utilization (ATP
depletion), and the destructive effects of uncontrolled calcium release (issues with calcium
homeostasis)
Apoptosis - process of programmed cell death; natural cellular process that aids in organism's
growth/development
Necrosis - Abnormal form of cell death (not part of the naturally programmed process)
Normal serum sodium level - 135-145 mEq/L
Hyponatremia serum level - <135 mEq/L
Hyponatremia signs/symptoms - (S.A.L.T. L.O.S.S.)
Stupor/coma
Anorexia/decreased appetite/N&V
Lethargy
Tendon reflexes decreased and Tachycardia/Thready pulse
Limp muscles (weakness)
Orthostatic hypotension
Seizures and headaches
Stomach Cramping (hyperactive bowels)
Treatment of Hyponatremia - Restrict (H2O) and Replace (Na)
Med adjustment if needed (ex. diuretics, lithium)
Monitor fluid balance (I&Os, daily weights, serum sodium level)
Hypernatremia serum level - >145 mEq/L
Hypernatremia signs/symptoms - (F.R.I.E.D.)
, Flushed skin, Fever (low-grade), Fatigue
Restless, irritable, anxious, confused (seizures and coma if severe)
Increased fluid retention & BP
Edema, Extreme thirst
Decreased urine output, Dry mouth (swollen, dry tongue and increased muscle tone if severe)
Treatment of Hypernatremia - Restrict Na intake
Gradual lowering of Na and increase of fluids through isotonic or hypotonic fluids infused SLOWLY
(could cause CNS symptoms like confusion and cerebral edema)
Two main types of hyponatremia - - Hypertonic (same amount of Na in the ECF, but SHIFT of H2O
from ICF to ECF due to presence of other solutes (like glucose) dilutes Na; H2O being pulled from
CELLS)
- Hypotonic (retention of/pulling H2O back from the KIDNEYS)
Hypertonic hyponatremia - Increased plasma lipids, proteins, or glucose in the ECF displace water
balance (pulls it from the cell) and thus decrease sodium concentration in the ECF
Hypovolemic hypotonic hyponatremia - Both H2O AND Na are lost from ECF (ex. Excessive sweating)
Hypervolemic hypotonic hyponatremia - seen when hyponatremia is accompanied by edema-
associated disorders such as decompensated heart failure, advances liver disease, and renal disease
(because although total body Na is increased, the effective circulating volume is often seen as
inadequate by the baroreceptors so they increase ADH which retains Na and thereby increases H2O
retention = dilutes Na)
Euvolemic hypotonic hyponatremia - retain water with dilution of Na+ while maintaining ECF (ex:
SIADH or diabetes insipidus)
Chemical agents of cell injury MOA - Can block enzymatic pathways, cause coagulation of tissues, or
disrupt osmotic or ionic balance of the cell
Biological agents of cell injury MOA - Able to replicate and continue to produce injury (range from
submicroscopic viruses to larger parasites), can be incorporated into DNA machinery, can interfere
with ATP production, can release endotoxins that cause cell injury and death
