NURS 5315 Advanced Pathophysiology

NURS 5315 Advanced Pathophysiology Ovarian cancer site of metastasis? - Correct Answers Peritoneal surfaces, omentum (fold of peritoneum connecting the stomach with other abdominal organs), *liver* The increased NADH/NAD+ ratio in the liver from ethanol causes: - Correct Answers 1. Pyruvate -- lactic acid, causing lactic acidosis 2. Oxaloacetate -- malate. This prevents gluconeogenesis and leads to hypoglycemia 3. Glyceraldehyde-3-phosphate -- glycerol 3- phosphate and combines with fatty acids to form triglycerides in the liver, known as hepatosteatosis 4. Decreases citric acid cycle production of NADH and leads to using Acetyl-CoA for ketogenesis and lipogenesis What can Reactive Oxygen Species cause? - Correct Answers Heart disease, Alzheimers, Parkinsons, Amyotrophic Lateral Sclerosis (ALS), CV disease, HTN, HLD, DM, ischemic heart disease, HF, OSA. Lipid perioxidation, damage proteins, fragment DNA, less *protein synthesis*, chromatin destruction, damage mitochondria What is the body's defense against ROS? - Correct Answers Antioxidants (Vitamin E, Vitamin C, cysteine, glutathione, albumin, ceruloplasmin, transferrin) How are free radicals produced? - Correct Answers 1. Normal cellular respiration 2. Absorption of extreme energy sources (radiation, UV light) 3. Metabolism of exogenous chemicals, drugs, and pesticides 4. Transition of metals 5. Nitric oxide acting like a chemical mediator and a free radical action potential - Correct Answers Process of conducting an impulse. Activates the neuron -- the neuron depolarizes -- then repolarizes Threshold potential - Correct Answers Point at which depolarization must reach in order to initiate an action potential Hypokalemia and action potentials - Correct Answers HYPERpolarized (more negative, ex. -100). Less excitable. Decreased neuromuscular excitability: weakness, smooth muscle atony, paresthesia, cardiac dysrhythmias Hyperkalemia and action potentials - Correct Answers HYPOpolarized (more positive, ex: closer to 0). More excitable. Peaked T waves. When resting membrane potential=threshold potential, it is BAD = cardiac standstill, paresthesia, paralysis Hypocalcemia and action potentials - Correct Answers Increased permeability to Na+. More excitable. Tetany, hyperreflexia, circumoral paresthesia, seizures, dysrhythmias. Hypercalcemia and action potentials - Correct Answers Decreased permeability to Na+. Less excitable. Weakness, hyporeflexia, fatigue, lethargy, confusion, encephalopathy, depressed T waves Atrophy - Correct Answers Occurs as a result of decrease in work load, pressure, use, blood supply, nutrition, hormonal stimulation, or nervous stimulation. Once the cell has decreased in size, it has now compensated for decreased blood supply, nerve supply, nutrient supply, hormonal supply, and has achieved new homeostasis. Cells are alive but have diminished function and may lead to cellular death. Atrophy examples - Correct Answers Physiologic atrophy- shrinking of the thymus gland during childhood. Disuse atrophy- someone that ends up being paralyzed Hypertrophy - Correct Answers Increase in SIZE of cells, which will lead to increase in size of organ. Caused by hormonal stimulation or increased functional demand. Hypertrophy examples - Correct Answers physiologic hypertrophy- skeletal hypertrophy when a person does heavy work or weight lifting / when a kidney is surgically removed, the other kidney increases in size pathologic hypertrophy- cardiomegaly results from an increased workload in hypertensive patients / *left ventricular hypertrophy* Hyperplasia - Correct Answers Increase in NUMBER of cells. Results from increased rate of mitosis. Can ONLY happen in cells that are capable of mitosis (cell division). Hyperplasia examples - Correct Answers 1. Thickening of skin because of hyperplasia of epidermal cells. 2. Hormonal hyperplasia- occurs in estrogen dependent organs like uterus and breast. 3. Compensatory hyperplasia- liver regenerates, callus on skin 4. Pathologic hyperplasia- estrogen is unopposed by progesterone and the endometrial lining undergoes hyperplasia and increased risk for endometrial cancer Dysplasia - Correct Answers abnormal changes in the size, shape, and organization of mature cells due to persistent, severe cell injury or irritation Dysplasia examples - Correct Answers Pre cancer pap smears often show dysplastic cells of the cervix that must undergo treatment. Metaplasia - Correct Answers Changed cell that is REVERSIBLE (one cell is replaced by another cell). Exposure to chronic stressors, injury or irritation, like smoking or hydrochloric acid from heart burn Metaplasia examples - Correct Answers Most common is change from columnar cells to squamous cells (chronic smokers). Less common is change from squamous to columnar cells, like in Barrett Esophagus caused by heart burn. Carcinoma in situ - Correct Answers Pre-invasive epithelial malignant tumors of glandular or squamous origin. Sites including cervix, skin, oral cavity, esophagus, and bronchus Hypoxic injury - Correct Answers 1. Decrease in oxygen in the air (high altitudes, asphyxiation, drowning) 2. Loss of hemoglobin function (hemorrhage or sickle cell anemia) 3. Decrease in production of red blood cells (anemia or leukemia) 4. Diseases of cardiopulmonary systems (ischemia, blood supply loss, arteriosclerosis) Hypoxic injury clinical manifestations - Correct Answers 1. Increased CK (muscle and heart) 2. Increased LDH (muscle, liver, lung, heart, RBC, brain) 3. Increased ALT and AST (liver) 4. Increased troponin (heart) Reperfusion injury - Correct Answers Oxygen supply is restored to ischemic tissues. Triggers oxygen intermediates which causes cell membrane damage and mitochondrial calcium overload. Xanthine dehydrogenase -- xanthine oxidate. This makes large amounts of free radicals, superoxide, and hydrogen peroxide. Causes cell membrane damage and *mitochondrial calcium overload* Reperfusion injury clinical manifestations - Correct Answers White blood cell count is impaired. Seen in tissue transplantation, ischemic syndromes of the heart, liver, intestines, kidneys, and cerebrum. Free Radical - Correct Answers Molecules that have an unpaired electron on its outer shell. This makes the molecule unstable.