Dr Julia Marian HSC 4555 Notes ENTIRE COURSE I Chapter 1 Intro to pathophysiology a Etiologies origin what started the diseased state Idiopathic unknown disorder Iatrogenic derived from treatment medicine given surgery etc i ii iii Congenital at birth can be genetic ex Fetal alcohol syndrome iv Inherited genetic can be at birth but continues to last ex Downs syndrome Huntington s v Degenerative progressively worse ex Muscular dystrophy Immunologic infection ex Auto immune vi vii Metabolic affecting metabolism ex Diabetes viii Metaplastic cancer ix Physical agent induced external ex Poisoned radiation car accident trauma inducing x Psychogenic mental state psychological not neurological ex Stress or panic attacks Psychogenic does not cause an actual problem Internal inside body b c External outside body d Pathogenesis creation of suffering injury disorder Initial stimulus i ii Etiology factors iii Ending sequence e Clinical manifestations factors determined f Clinical stages i Signs objective observed heard measured ii Symptoms subjective feelings iii Syndrome set of signs and symptoms that develop a disorder without etiologic i Latent asymptomatic period of time between exposure of organism to etiology factor and appearance of signs symptoms can last a long time ex 10 years ii Prodromal period of time where first signs symptoms appear unspecific onset of disease iii Subclinical disease stage established patient functions normally due to compensatory mechanisms different signs and symptoms appear usually more severe iv Acute phase signs and symptoms reach severity for specific disease process the body is able to fix the injury until it becomes overwhelmed which is when it reaches the acute phase g Framework i Acute short 6 months usually more severe ii Chronic long 6 months iii Acute flare ups of disease which are more severe of baseline chronic disorder iv Exacerbation sudden increase in severity v Remission decline in severity permanent after 5 years vi Convalescence recovery period vii Sequela subsequent pathological condition associated with disease same system viii Atherosclerosis coronary syndrome ix Complication new separate process resulting from a pathologic change of original disease secondary injury in separate system x Tibial fracture fat embolism h In the standard deviation chart i Sample population represents NORMAL ii Typo also on the chart it should say 2 5 SD not 2 SD i Epidemiology i Endemic native to local region ii Epidemic spreads to many individuals at the same time iii Pandemic spreads to large geographic area j Prevention i Primary hand washing vaccinations reduce exposure 1 preventions of a healthy person is to keep them healthy ii Secondary detections screenings management 1 Knowing you have a family risk factor for a disease 2 Ex Breast cancer screenings iii Tertiary rehab supportive care disability reduction restoration therapeutic physical therapy 1 Prevent blindness amputation for diabetes II Chapter 4 a Introduction i General cellular responses to environmental changes injury 1 Reversible cell injury change back to original function state a Mild short lived change b Cell returns to normal afterwards c Results in swelling or intracellular accumulations 2 Cellular adaptation not considered irreversible a Sub lethal but persistent insult causes cell to adapt in structure function b Generally reversible c Results in atrophy hypertrophy hyperplasia metaplasia or dysplasia 3 Irreversible cell injury Injury prolonged and severe a b Overwhelms cell defenses c Results in apoptosis or necrosis b Reversible Cell Injury Hydropic Swelling doesn t work due to lack of energy i Usually first manifestation of reversible injury ii Malfunction in Na K ATPase pump causes influx of Na into cell creating osmotic gradient that leads to excess water entry into the cell resulting in cell swelling Injuries causing energy loss will cause malfunction of ATPase pump iii iv Extracellular fluid 140 Na 4 or 5 K 1 Too much Na going into the cell too much H2O going into the cell c Reversible Cell Injury Hydropic Swelling i Microscopic large and pale cytoplasm dilated E R and mitochondria water filled vacuoles if severe ii Macroscopic tissue swelling organ enlargement megaly 1 A Normal kidney cuboidal cells 2 B Early renal ischemia surface blebs and cell swelling d Reversible Cell Injury Intracellular Accumulations i Cell injury from excess accumulations in cell due to toxicity immune response occupy space needed for other cell functions Inclusions classified as ii 1 Normal substances fat glycogen proteins etc does not mean normal accumulation normal substance abnormally accumulating 2 Abnormal substances byproducts of defective metabolism synthesis 3 Pigments and non degradable products a Lipofuscin pigment normal substance accumulates to skin cells to i Fatty liver intracellular lipid vacuoles Fat is normal substance Ex Binge drinking make color change damaging e Reversible Cell Injury Intracellular Accumulations result stop drinking and liver returns to normal ii Liver is common site of abnormal cell inclusions f Reversible Cell Injury Intracellular Accumulations i Lung silicosis silicon dust accumulation gray in the picture is the cellular accumulations g Cellular Adaptation Atrophy a without trophy size so atrophy means decreased growth i Decreased cell size and decrease in differentiated cell functions in order to minimize the cell s energy and nutrient consumption ii General causes 1 Disuse immobilization 2 Denervation heart brain kidneys lower leg 3 4 Nutrient starvation 5 Ischemia blood flow perfusion hypoxia is oxygen flow Interruption of endocrine signals adrenals thyroid gonads dependent on trophic hormones 6 Persistent cell injury 7 Aging 8 The picture shows atrophy the cells look the same as in same order and organization but the size is smaller h Cellular Adaptation Hypertrophy Increased cell mass and functional capacity in response to excess stimulation i ii Can occur as 1 Physiological response skeletal muscle tissue exercise reproductive organs trophic hormones 2 Pathophysiological response heart high blood pressure liver toxins 3 Puberty pregnancy 4 Megaly enlarged organ i Cellular Adaptation Hypertrophy i A Left ventricular hypertrophy B Normal heart ii You can tell its left ventricular hypertrophy because the RIGHT side of the heart is on the LEFT side of the picture the muscle around the ventricle is smaller and pumps blood to the lung the other sides muscle is