4CompetencyIntegrates comprehensive knowledge of pathophysiology of major human systems.
5IntroductionHomeostasis: body maintains internal environment in steady state of balance.Disease: abnormal structural or functional change within body.Pathophysiology: study of disease.Teaching TipsPhysiology is very complicated. It is the basis of life and has great effect on our application of patient care.
6IntroductionPathology: medical science that deals with all aspects of disease.Pathologist: physician who specializes in pathology.Teaching TipsPhysiology is very complicated. It is the basis of life and has great effect on our application of patient care.
7Hierarchical Structure of the Body Cells: smallest unit of life made up of molecules (made up of atoms).Tissue: similar cells that perform common function.Organ: group of tissues working together to perform similar function.Organ system: group of organs working together to perform common or similar function.
8Hierarchical Structure of the Body Organism: group of organ systems functioning together.Human being is organism with 11 different organ systems.Humans are social creatures.Population: all the organisms of same species residing in distinct geographic area.
9Hierarchical Structure of the Body Community: total of all living organisms occupying defined geographic area.Ecosystem: community and its physical environment.Biome: geographic area with similar climatic conditions.Biosphere: portion of Earth where life is found.Points to EmphasizeIt is important to demonstrate that students must understand the concepts presented to know how patients will respond to treatment and to disease.
11Disease Predisposing Factors to Disease Age Gender Genetics Lifestyle Environment
12Disease Risk Analysis Cannot control genetics, gender, age. Can control lifestyle and environment.Minimizing predisposing factors can slow effects of age.Data can be used to modify risk factors that can be modified.Risk analysis used to look at person's whole life.
13DiseaseDiseasePathogenesis: sequence of events that leads to development of disease.Idiopathic: predisposing factors cannot be identified.Etiology: occurrences, reasons, variables of a disease.Clinical presentation: manifestation of a disease.
14DiseaseDiseaseSymptom: what patient tells you about disease—subjective complaint.Sign: objective finding you identify through physical examination.Syndrome: specific constellation of signs and symptoms.Diagnosis: assumption disease will follow prescribed course.
15Disease Disease Acute: sudden onset. Chronic (insidious): slower onset.Complications: abnormalities that result from original problem.Sequelae: complications common or expected.Prognosis: expected outcome.
16Disease Classifications of Disease Infectious Immunologic Inflammatory IschemicMetabolicNutritionalGenetic
17Disease Classifications of Disease Congenital Neoplastic Trauma Physical agentsIatrogenicIdiopathic
19Disease at the Chemical Level Big Bang theory: universe began with explosion of a primeval atom.Chemical evolution: simple chemicals present in primordial atmosphere and ocean combined to form larger, more complex chemicals.Led to formation of complex chemicals able to self-replicate.
20Disease at the Chemical Level Marked transition from chemical evolution to biological evolution.Once biological evolution began, natural selection began.Self-replicating chemical surrounded by membrane; cellular life began.
21Disease at the Chemical Level The Chemical Basis of LifeAtom: fundamental chemical unit.Within atom are subatomic particles: electrons, protons, neutrons.Protons and neutrons: exist within nucleus of atom.Electrons: smaller particles; orbit nucleus.Teaching TipsUtilize diagrams and draw the structures on the board so students can visually see what it is you are describing.
22Disease at the Chemical Level The Chemical Basis of LifeElement: substance that cannot be separated into simpler substances.Atomic number: number of protons in nucleus of atom defines element.Periodic table of elements: elements classified by their atomic number.Isotopes: elements have same number of protons; vary in number of neutrons.
24Disease at the Chemical Level The Chemical Basis of LifeMass number: total number of neutrons and protons in atom.Radioactive isotopes: combinations of neutrons and protons make nucleus unstable.Radioactive decay: nuclei break down and emit radiation (alpha, beta, gamma rays) until atom regains stability.
25Disease at the Chemical Level The Chemical Basis of LifeHalf-life: time it takes for parent isotope to decrease by one-half.Orbital: specific shape; can hold two or more electrons.Electron shells: levels numbered starting with closest shell to nucleus.
26Disease at the Chemical Level The Chemical Basis of LifeValence shell: outermost shell of atom.Valence electrons: in valence shell.Noble gases: helium, neon, argon, krypton, xenon, radon.
27Disease at the Chemical Level Chemical BondingAtoms become stable by bonding to other atoms.Covalent bond: equal sharing of electrons.Molecule: substance made up of atoms held together by covalent bonds.Ion: atom or molecule that acquired electrical charge.
28Disease at the Chemical Level Chemical BondingCation: atom or molecule with missing electrons and net positive charge.Anion: atom or molecule with extra electrons and net negative charge.Ionic bond: opposite charges attract; bonds form between atoms of opposite (positive/negative) charges.
29Disease at the Chemical Level Chemical BondingMetallic elements: lose electrons.Nonmetallic elements: gain electrons.Polar bond: unequal covalent bond; molecule is polar molecule.Hydrogen bond: attraction between slightly positively charged hydrogen atom and slightly negatively charged oxygen atom.
30Disease at the Chemical Level Inorganic and Organic ChemicalsInorganic: do not contain carbon.Organic: do contain carbon (90% of all known chemicals).Major elements of living systems:Carbon (C)Hydrogen (H)Oxygen (O)Nitrogen (N)
31Disease at the Chemical Level Inorganic and Organic ChemicalsCompound: chemical union of two or more elements.Major compounds of living systems:CarbohydratesProteinsNucleic acidsLipids
32Disease at the Chemical Level Classes of Biological ChemicalsCarbohydratesProvide majority of calories in diets.Divided into sugars; polysaccharides.Monosaccharides: simple sugars.Glucose, fructose, galactose.Disaccharides: complex sugars.Sucrose, lactose, maltose.
33Disease at the Chemical Level Classes of Biological ChemicalsCarbohydratesPolysaccharides: starches, cellulose, glycogen.Starches: polymers of glucose.Amylose, amylopectin.Cellulose: most abundant organic molecule in the world; major structural material of plants.
34Disease at the Chemical Level Classes of Biological ChemicalsCarbohydratesGlycogen: important polysaccharide; stored in liver and skeletal muscle.Glycogenolysis: controlled by hormones glucagon and epinephrine
35Disease at the Chemical Level Classes of Biological ChemicalsProteinsNitrogen-based complex compounds; basic building blocks of cells.Growth and repair of living tissues.Amino acids: smaller building blocks.Peptide bonds: two amino acid molecules join and molecule of water released.
37Disease at the Chemical Level Classes of Biological ChemicalsProteinsPeptide: protein chain of less than 10 amino acids.Polypeptide: chain of greater than 10 amino acids.Levels of structure: primary, secondary, tertiary, quaternary.
39Disease at the Chemical Level Classes of Biological ChemicalsProteinsEnzymes: proteins; speed up chemical reactions.Substrate binds to enzyme, forming enzyme-substrate complex.Cofactors: nonprotein substances; aid in conversion of substrate to end product.Coenzymes: organic cofactors.
40Disease at the Chemical Level Classes of Biological ChemicalsNucleic AcidsDeoxyribonucleic acid (DNA): contains genetic instructions for life.Two long polymers (nucleotides) joined by paired substances (nucleobases).Genetic code: four nucleobases and sequence of these encodes information.
42Disease at the Chemical Level Classes of Biological ChemicalsNucleic AcidsGenes: code specific amino acid sequence; make up specific protein.Number of chromosomes in cell nucleus varies with type of organism.
43Disease at the Chemical Level Classes of Biological ChemicalsNucleic AcidsRibonucleic acid (RNA): chemical similar to DNA; major role in protein synthesis.Nucleotides: five-carbon sugar molecules.Nitrogen bases: cadenine, cytosine, guanine, thymine uracil.
46Disease at the Chemical Level Classes of Biological ChemicalsNucleic AcidsAdenosine triphosphate (ATP): nucleotide; one of monomers of RNA.Principal source of energy for most energy-utilizing activities of cells.Phosphate bonds in ATP highly unstable.
47Disease at the Chemical Level Classes of Biological ChemicalsLipidsChemicals that do not dissolve in water; nonpolar.Function in long-term storage of biochemical energy, insulation, structure, control.Triglycerides: rich sources of energy for body.
48Disease at the Chemical Level Classes of Biological ChemicalsLipidsTriglycerides: saturated or unsaturated.Phospholipids: form membrane that surrounds cells.Steroids: basic unit is cholesterol.Anabolism: constructive phase of metabolism.Catabolism: destructive phase of metabolism.
49Disease at the Chemical Level Classes of Biological ChemicalsWaterUniversal solvent; polar molecule.Transports substances throughout body.Helps to maintain constant body temperature.
51Disease at the Chemical Level Acids and BasesDissociation reaction: compound or molecule breaks apart into separate components.Acids: substances that give up protons during chemical reactions.Bases: substances that acquire protons during chemical reactions.Acid-base reaction: transfer of protons.Critical Thinking QuestionsWhy is acid-base balance important to our bodies? How much of a role do the kidneys play?
52Disease at the Chemical Level Acids and BasesWater: ability to act as acid or base.Mole: molecular weight.Logarithm: base number raised to certain power.pH scale: degree of acidity or basicity (alkalinity) of a substance.
54Disease at the Chemical Level Acids and BasesBuffer SystemsCounter body's normal production of acids; prevent variations in body's pH.Buffer: substance dissolved in water that counteracts changes in pH.Carbonic acid-bicarbonate buffer systemProtein buffer systemPhosphate buffer system
55Disease at the Chemical Level Acids and BasesBuffer SystemsCarbonic acid-bicarbonate buffer system: regulates pH of blood.Buffer changes in pH caused by organic acids and fixed acids in extracellular fluid (ECF).Can function only when respiratory system and control centers functioning normally.
56Disease at the Chemical Level Acids and BasesBuffer SystemsProtein buffers depend on ability of amino acids in protein chain to react to changes in pH.Hemoglobin buffer system helps to prevent changes in ECF pH when PaCO2 is rising or falling.
57Disease at the Chemical Level Acids and BasesBuffer SystemsPhosphate buffer system limited in ECF; major role in stabilizing pH of urine.Acid-base balance tightly controlled.Excess hydrogen ions bind to water molecules; removed through exhalation of carbon dioxide from lungs or removed via kidneys.
58Disease at the Chemical Level Acids and BasesChange in pH occurs, buffer systems react fastest.Respiratory and renal systems help correct problem.Potassium levels and hydrogen ion levels major aspect of pH.
60Disease at the Chemical Level Acid-Base DisordersAny significant deviation of pH outside normal operating parameters (7.35–7.45).Two body systems: respiratory system and renal system.Critical Thinking QuestionsThe renal system and acid-base balance play an important role in many medical patients. How do these processes regulate the body's response to changes in homeostasis?
62Disease at the Chemical Level Acid-Base DisordersAcidosis: excess of acids in body.Alkalosis: excess of base in body.Respiratory acid-base disorders: inequality in carbon dioxide generation in peripheral tissues and carbon dioxide elimination in respiratory system.Respiratory acidosisRespiratory alkalosis
63Disease at the Chemical Level Acid-Base DisordersMetabolic acid-base disorders: production of organic or fixed acids or conditions that affect levels of bicarbonate in ECF.Metabolic acidosisMetabolic alkalosis
64Disease at the Chemical Level Acid-Base DisordersRespiratory acidosis: respiratory system cannot eliminate all carbon dioxide generated through metabolic activities in peripheral tissues.Increase in PCO2; decrease in pH.Hypercapnia: elevation in plasma CO2 level.Decrease in respiratory rate, tidal volume, or combination of the two.
65Disease at the Chemical Level Acid-Base DisordersRespiratory alkalosis: respiratory system eliminates too much carbon dioxide through hyperventilation; hypocapnia.Hyperventilation: emotional situations, metabolic disorders, medical conditions, environmental factors, or combination.
66Disease at the Chemical Level Acid-Base DisordersMetabolic acidosis: deficiency of bicarbonate (HCO3-) in body.Kidney: major role in maintaining stable pH levels.Metabolic alkalosis: uncommon; due to increase in HCO3- levels or decrease in circulating acids.Knowledge ApplicationsWhy is it important to understand acid-base balance in the renal patient?How does dialysis affect the balance of pH in the body?
68Disease at the Cellular Level Basic unit of all living organisms.Nucleus: central portion of cell.Organelles: structures within nucleus that carry out biological processes.Prokaryotic cells: do not contain nucleus or organelles.Eukaryotic cells: contain nucleus and organelles.Teaching TipsIt helps to use diagrams or drawings to demonstrate the parts of the cell as well as the transport of substances.
70Disease at the Cellular Level The Plasma Membrane and CytoplasmPlasma membrane: consists of chemicals; phospholipids.Cell membrane: lipid bilayer.Cytoplasm (cytosol): fills inside of cells; water, salts, organic molecules, enzymes that catalyze biochemical reactions.
71Disease at the Cellular Level The Plasma Membrane and CytoplasmIntracellular fluid: water component of cytoplasm.Membrane proteins:LinkersEnzymesReceptorsTransporters
72Disease at the Cellular Level Plasma Membrane FunctionsCells adhere to each other or stick together; cell adhesion molecules (CAMs).Cell-cell recognition; ability of cell to distinguish one type of cell from another.Maintains structural integrity of cell.
73Mechanism of Transport across the Plasma Membrane
74Disease at the Cellular Level Plasma Membrane FunctionsRole in communications between cells.Regulates movement of substances into and out of cell.Simple diffusion: random movement of molecules from region of higher concentration to region of lower concentration.
75Simple diffusion is the random movement of molecules from a region of higher concentration to a region of lower concentration. Solutes diffuse across the membrane until equilibrium is reached on both sides.
76Disease at the Cellular Level Plasma Membrane FunctionsRate of diffusion proportional to concentration gradient across membrane.Osmotic gradient: movement of water across semipermeable membrane.Osmosis: movement of water molecules from area of high water concentration to area of low water concentration.
77Disease at the Cellular Level Plasma Membrane FunctionsFree water: water free of solute.Water: universal solvent.Isotonic: concentrations of solutions on both sides of semipermeable membrane are equal.Hypertonic: solution on one side of membrane more concentrated than solution on other side.
78Disease at the Cellular Level Plasma Membrane FunctionsHypotonic: solution on one side of membrane less concentrated than solution on other side.Osmosis generates pressure: osmotic pressure.Osmolarity: concentration of solute particles in solution.
79Disease at the Cellular Level Plasma Membrane FunctionsFacilitated diffusion: no expenditure of metabolic energy; transport assisted by integral proteins in plasma membrane.Carrier proteinsIon channelsPoints to EmphasizeDiffusion is a very important concept. Be sure to stress the concept and the understanding of it.
80Disease at the Cellular Level Plasma Membrane FunctionsActive transport: cell moves solute across plasma membrane against concentration gradient.Carrier protein; energy in form of ATP.Sodium-potassium pump: transport of sodium ions out of cell and potassium ions into cell, against concentration gradient.
81Disease at the Cellular Level Plasma Membrane FunctionsEndocytosis: plasma membrane encircles substance to be ingested.When separated from cell membrane, vesicle released into cell.Phagocytosis: cell engulfs large particles or bacteria.
83Disease at the Cellular Level Plasma Membrane FunctionsPinocytosis: cell engulfs droplets of fluid carrying dissolved substances.Exocytosis: large molecules leave cell by becoming encircled in membrane vesicle.
84Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesSevere derangements in fluid and electrolyte status can result in death.Water: most abundant substance in body (60%); total body water (TBW).Intracellular fluid (ICF): all fluid found inside body cells.
86Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesExtracellular fluid (ECF): all fluid found outside body cells.Intravascular fluid: fluid found outside cells and within circulatory system.Interstitial fluid: all fluid found outside cell membranes; not within circulatory system.
87Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesTotal body water and distribution vary with age and physiologic condition.Infant's TBW is 75 to 80% of body weight; 65% TBW average adult.Elderly, like very young, at high risk for dehydration and disorders related to electrolyte imbalances.
88Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesIntake: water coming into body.Output: water excreted from body.To maintain homeostasis, intake must equal output.Thirst regulates fluid intake.Body maintains fluid balance by shifting water from one body space to another.
89Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesDehydration: abnormal decrease in total body water.Gastrointestinal lossesIncreased insensible lossIncreased sweatingInternal lossesPlasma losses
90Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesFluid replacement based on fluid and electrolyte deficits.Dehydrated patient: dry mucous membranes, poor skin turgor, excessive thirst.Overhydration: edema; heart failure may be present.
91Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesElectrolytes: substances that dissociate into electrically charged particles when placed into water.Ions: charged particles.Cations: ions with positive charge.Anions: ions with negative charge.
92Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesCationsSodium (Na+)Potassium (K+)Calcium (Ca++)Magnesium (Mg++)
93Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesAnionsChloride (Cl-)BicarbonatePhosphateElectrolytes measured in milliequivalents per liter (mEq/L).
94Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesBody's fluid compartments separated by cell membranes.Semipermeable; selectively permeable.Compounds with small molecules (H2O) pass readily through membrane; larger compounds (proteins) restricted.
95Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesMovement of fluids through membrane enabled by pores in membrane.Electrolytes do not pass through membrane as readily as water due to their electrical charge.Water moves across cell membrane to dilute area of increased electrolyte concentration.
96Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesMovement of water more rapid than movement of electrolytes.Within extracellular compartment, movement of water between plasma in intravascular space and interstitial space function of forces in capillary beds.
97Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesBlood plasma generates oncotic force.Hydrostatic pressure: blood pressure; force against vessel walls created by contractions of heart.Filtration: hydrostatic pressure forces some water out of plasma and across capillary wall into interstitial space.
98Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesEdema: accumulation of water in interstitial space.Decrease in plasma oncotic forceIncrease in hydrostatic pressureIncreased capillary permeabilityLymphatic channel obstruction
99Disease at the Cellular Level The Cellular Environment: Fluids and ElectrolytesEdema: localized or generalized.Sign of underlying disease or problem; edema itself causes problems.Antidiuretic hormone (ADH) or vasopressin: chief regulator of water retention and distribution.
100Disease at the Cellular Level Intravenous TherapyIntroduction of fluids and other substances into venous side of circulatory system.Replace blood lost through hemorrhage.Electrolyte or fluid replacement.Medications directly into vascular system.
101Disease at the Cellular Level Intravenous TherapyBlood: fluid of cardiovascular system.Transports nutrients, oxygen, hormones, heat.Plasma: liquid portion.Blood cells: formed elements.Red blood cells: erythrocytes.White blood cells: leukocytes.Platelets: thrombocytes.
102Disease at the Cellular Level Intravenous TherapyErythrocytes: hemoglobin; transports oxygen; 99% of blood cells.Hemoglobin: iron-based compound that binds with oxygen.Leukocytes: responsible for immunity and fighting infection.Thrombocytes: major role in blood clotting.
104Disease at the Cellular Level Intravenous TherapyPlasma can be separated from formed elements by centrifugation.Hematocrit: percentage of blood occupied by erythrocytes.Most desirable fluid for blood loss replacement is whole blood.
106Disease at the Cellular Level Intravenous TherapyBlood often fractionated (separated into parts); packed red blood cells used.Typed and cross-matched to prevent severe allergic reaction.Transfusion reactions: discrepancy between blood type of patient and blood type of blood being transfused.
107Disease at the Cellular Level Intravenous TherapyIntravenous fluids: colloids and crystalloids.Colloid: proteins; remain in intravascular space for extended period.Plasma protein fraction (Plasmanate)Salt-poor albuminDextranHetastarch (Hespan)
108Disease at the Cellular Level Intravenous TherapyCrystalloids: primary compounds used in prehospital intravenous fluid therapy.Isotonic solutionsHypertonic solutionsHypotonic solutionsIntravenous replacement fluids: needs of patient; underlying problem.Critical Thinking QuestionsHow does IV fluid affect the balance of water and electrolytes?
109Disease at the Cellular Level Intravenous TherapyMost commonly used solutions in prehospital care:Lactated Ringer's solution.Normal saline (0.9% sodium chloride).5% dextrose in water (D5W).Lactated Ringer's solution and normal saline used for fluid replacement.
110Disease at the Cellular Level Organelles and Their FunctionsNucleus: largest organelle; contains cell's genetic information.Genetic information encoded by base sequences on DNA molecule.DNA controls cell functions and production of specific proteins.Genetic information on threadlike structures called chromosomes.
112Disease at the Cellular Level Organelles and Their FunctionsHumans: 46 chromosomes (23 pairs).Nuclear envelope: double membrane encases nucleus.Nucleoplasm: chromatin and materials inside nucleus.Nuclear pores: openings in nuclear envelope.
113Disease at the Cellular Level Organelles and Their FunctionsNucleolus: region of DNA active in production of ribosomal RNA (rRNA).Ribosomes: synthesis of polypeptides and proteins.Endoplasmic reticulum: network of tubules, vesicles, sacs; interconnect with plasma membrane, nuclear envelope, other organelles in cell.
114Disease at the Cellular Level Organelles and Their FunctionsRough endoplasmic reticulum (RER): contains ribosomes during protein synthesis.Smooth endoplasmic reticulum (SER): without ribosomes.Endoplasmic reticulum: role in replenishment and maintenance of plasma membrane.
116Disease at the Cellular Level Organelles and Their FunctionsGolgi apparatus (Golgi complex): processes proteins for cell membrane and other cell organelles.Lysosomes: “garbage disposal system” of cells.Break down foreign substances and invaders; degrade worn-out organelles.Process macromolecule products.
117Disease at the Cellular Level Organelles and Their FunctionsVacuoles: membrane-bound organelles used for temporary storage or transport of substances.Peroxisomes: generate and degrade hydrogen peroxide (H2O2); highly toxic to cells.Detoxify harmful substances; regulation of oxygen tension within cell.
118Disease at the Cellular Level Organelles and Their FunctionsMitochondria: “powerhouses” of cells; provide energy needed for all of cell's biochemical processes.Cellular respiration.Cristae: inner membrane folds form shelves within mitochondria.
119Disease at the Cellular Level Cytoskeleton/Internal Cell StructuresMicrotubules: long, hollow rods made of protein tubulin.Microfilaments: made from protein actin.Centrioles: cylindrical structures composed of groups of microtubules.
121Disease at the Cellular Level Cytoskeleton/Internal Cell StructuresCytoskeleton: three-dimensional structure; serves as skeleton for cell.Cilia: hair-like structures that move in back-and-forth motion.Flagella: much longer than cilia; move in undulating, wavelike manner.
122Disease at the Cellular Level Cellular Respiration/Energy ProductionDigestive system breaks down nutrients: carbohydrates, proteins, lipids.Cellular respiration: aerobic; requires oxygen.Fermentation: anaerobic; does not require oxygen.
123Disease at the Cellular Level Cellular Respiration/Energy ProductionOxidation: loss of electrons from one atom to another.Reduction: gain of electrons by one atom from another.Three biochemical processes glucose molecule must pass to produce energy through cellular respiration: glycolysis, citric acid cycle, electron transport.
124Disease at the Cellular Level Cellular Respiration/Energy ProductionGlycolysisOccurs in cytoplasm; breakdown of six-carbon sugar glucose.Energy-using and energy-yielding phases.Citric acid cycle (Kreb's cycle or tricarboxylic acid [TCA] cycle):Completely oxidizes remainder of glucose molecule.
125Disease at the Cellular Level Cellular Respiration/Energy ProductionElectron Transport ChainFive types of carriers.Electrons transferred from one molecule to next; energy released.Passed to oxygen; ultimate electron acceptor.
126Disease at the Cellular Level Cellular Respiration/Energy ProductionFermentationBreakdown of glucose without oxygen.Final electron acceptor is pyruvate, not oxygen.Very inefficient.Lactic acid fermentation.Alcohol fermentation.
127Disease at the Cellular Level Cellular Response to StressCellular adaptation: physiologic and structural changes to cell, in response to change or stress.HyperplasiaHypertrophyAtrophyMetaplasia
128Disease at the Cellular Level Cellular Response to StressHyperplasia: increase in number of cells in tissue or organ.Hormonal hyperplasia: stimulation by hormones.Compensatory hyperplasia: increase in tissue mass following tissue injury or loss.Can be pathological.
129Disease at the Cellular Level Cellular Response to StressHypertrophy: increase in size of cells in tissue or organ.Due to creation of more structural components within cell.Physiologic hypertrophy: increased physical demand.Pathological hypertrophy: abnormal stress.
130Disease at the Cellular Level Cellular Response to StressAtrophy: decrease in size of cell.May be physiologic (effect of hormones) or pathological (result of disease or injury).Metaplasia: cell can change from one adult cell type to another adult cell type; reversible.Protects organism from stress.Teaching TipsThe cellular response to stress can be likened to other physiologic processes. Use examples of this when discussing these topics.
131Abnormal cell responses to stress include hypertrophy, hyperplasia, atrophy, metaplasia, and dysplasia.
132Disease at the Cellular Level Cell Injury and Cell DeathCells stressed to point they can no longer adapt, or exposed to toxic agents, cell injury results.Cell injury irreversible; cell death occurs.Irreversibly damaged cells undergo necrosis or apoptosis; normal process of keeping body healthy.
133Disease at the Cellular Level Cell Injury and Cell DeathIschemia: diminished blood flow.Hypoxia: decreased availability of oxygen.Cellular respiration impaired; energy production limited to glycolysis.
134Disease at the Cellular Level Cell Injury and Cell DeathOxygen free radicals steal electrons from other compounds and generate new species of free radicals.Process can continue until components of cell are used up.Various chemicals, including drugs, can cause injury to a cell.
135Disease at the Cellular Level Cell Injury and Cell DeathApoptosis: cellular program activated; causes release of enzymes that destroy genetic material within nucleus of cell and selected proteins in cytoplasm.Can be physiologic or pathological.Dysplasia: abnormal or disordered growth in a cell.Precursor to development of cancer.
137Disease at the Tissue Level TissuesTissue: group of cells that serve common purpose.Epithelial, connective, muscle, nervous.Histology: study of tissues.Histopathology: study of abnormal or diseased tissue.
138Disease at the Tissue Level TissuesGerm layers: all tissues of the body derived from three cell lines in embryonic development.Endoderm: innermost germ cell layer; gives rise to epithelial tissue.Mesoderm: middle germ layer; gives rise to numerous body tissues.
139Disease at the Tissue Level TissuesEctoderm: outermost germ layer; gives rise to all tissues that cover body surfaces as well as nervous system.Epithelium: derived from all three germ layers.Epithelial tissues: cover body surfaces.
140Disease at the Tissue Level TissuesConnective tissues: framework on which epithelial tissue rests and within which nerve and muscle tissue embedded.Muscle tissues: movement of substances through organism.Nerve tissues: coordinate activities of the body.
141Disease at the Tissue Level TissuesEpithelium forms barrier between organism and environment.Epithelial tissue covers external and internal body surfaces; lines passageways that communicate with outside.
142Disease at the Tissue Level TissuesEpithelial tissue:Provides physical protection.Controls permeability.Provides special senses.Produces specialized secretions.
144Disease at the Tissue Level TissuesEach type of epithelium has special purpose in organism.Simple epithelium: single cell layer thick; provides limited protection.Stratified epithelium: several layers thick; provides greater degree of protection.
145Disease at the Tissue Level TissuesSquamous epithelium: tissues with thin and flat cells.Cuboidal epithelium: cells cube-like or square shape.Columnar epithelium: cells tall and more slender.
154Disease at the Tissue Level TissuesNervous tissue: found in brain, spinal cord, peripheral nerves.Conducts electrical impulses from one part of body to another; controls numerous body functions.Neurons: transmit electrical impulses.Neuroglia (glial cells): support, insulate, protect neurons.
156Disease at the Tissue Level NeoplasiaAbnormal tissue growth; cells grow and multiply in uncontrolled fashion.Tumor: mass of uncontrolled cell growth.Primitive nonspecialized cells (stem cells) mature into specific cell types, depending on function.
157Disease at the Tissue Level NeoplasiaDysplastic (atypical) cells: develop abnormal growth patterns.Tumors benign or malignant.Metastasis: malignant cells shed to other areas of body through bloodstream.Cancer locally invasive; recurrence common.
158Abnormal cell development, progressing to invasive cancer.
159Disease at the Tissue Level NeoplasiaCancers: epithelial or connective tissue origin.Oncogenic factors: carcinogens and radiation.Oncogenic viruses: produce cancers.Genetics responsible for some cancers.
162Disease at the Tissue Level NeoplasiaEnvironment is risk factor.Hormones play role in development of certain cancers.Carcinogenesis: process of developing a malignant neoplasia.Initiation: event begins transformation from normal tissue to cancer.
163Disease at the Tissue Level NeoplasiaPromoter: carcinogen or any factor associated with cancer development.Necessary for continued development of tumor and speeds up process.Progression: malignancy exists and cells anaplastic in appearance.Followed by growth, local tissue invasion, possible metastasis.
164Disease at the Tissue Level NeoplasiaOnce cancer develops, it becomes invasive.Cancer spreads along tissue planes; attaches to various tissues.Spread of tumor cells makes treatment difficult; often causes death.Cancer cells graded by degree of cell differentiation present.
166Disease at the Organ Level Genetic and Other Causes of DiseaseInherited traits determined by deoxyribonucleic acid (DNA).Inherit genetic structure from parents.Every one of person's somatic cells contains 46 chromosomes.Sex cells contain 23 chromosomes.23 chromosomes from father; 23 chromosomes from mother.
167Disease at the Organ Level Genetic and Other Causes of DiseaseSome diseases purely genetic.Multifactorial disorders: diseases caused by combination of genetic and environmental factors.Clinical practitioners and epidemiologists study disease.Effects on individualsEffects on populations
168Disease at the Organ Level Diseases Involving Genetic and Other Risk FactorsImmunologic disordersCancerEndocrine disordersHematologic disordersCardiovascular disorders
169Disease at the Organ Level Diseases Involving Genetic and Other Risk FactorsRenal disordersRheumatic disordersGastrointestinal disordersNeuromuscular disordersPsychiatric disorders
170Disease at the Organ Level HypoperfusionHypoperfusion (shock): condition that is progressive and fatal if not corrected.All forms of shock have same underlying pathophysiology at cellular and tissue levels.Perfusion: constant, necessary passage of blood through body's tissues.Critical Thinking QuestionsHow can we relate shock to the changes happening at the cellular level?Try to describe shock by taking it all the way to the cellular components.
171Disease at the Organ Level HypoperfusionInadequate perfusion of body tissues: hypoperfusion (shock).Perfusion dependent on functioning and intact circulatory system.The pump (heart)The fluid (blood)The container (blood vessels)
173Disease at the Organ Level HypoperfusionHeart: pump of cardiovascular system.Factors affecting stroke volume:PreloadCardiac contractile forceAfterloadPreload: amount of blood delivered to heart during diastole.
174Disease at the Organ Level HypoperfusionPreload affects cardiac contractile force.Greater volume of preload, the more ventricles stretched.Catecholamines enhance cardiac contractile strength.Afterload: resistance against which ventricle must contract.
175Disease at the Organ Level HypoperfusionCardiac output: amount of blood pumped by heart in 1 minute.Stroke volume × heart rate = cardiac output.Blood pressure: dependent on cardiac output; peripheral vascular resistance.Peripheral vascular resistance: pressure against which heart must pump.
176Disease at the Organ Level HypoperfusionBody strives to keep blood pressure constant by compensatory mechanisms and negative feedback loops.Blood: fluid of cardiovascular system; viscous fluid.Consists of plasma and formed elements (red cells, white cells, platelets).
177Disease at the Organ Level HypoperfusionBlood transports oxygen, carbon dioxide, nutrients, hormones, metabolic waste products, heat.Adequate amount of blood required for perfusion.Natriuretic peptides (NPs): long-term regulation of sodium and water balance, blood volume, arterial pressure.
178Disease at the Organ Level HypoperfusionAtrial natriuretic peptide (ANP); brain natriuretic peptide (BNP).Blood vessels (arteries, arterioles, capillaries, venules, veins) serve as container of cardiovascular system.Blood flow through vessels regulated by peripheral vascular resistance and pressure within system.
179Disease at the Organ Level HypoperfusionOxygen brought into body via respiratory system.Oxygen from alveoli diffuses across alveolar-capillary membrane and into bloodstream.Red blood cells “pick up” this oxygen.Oxygen-enriched blood then circulates back to heart.
180Disease at the Organ Level Movement and Utilization of Oxygen (Fick principle)Adequate inspired oxygen.Appropriate movement of oxygen across alveolar-capillary membrane into arterial bloodstream.Adequate number of red blood cells.Proper tissue perfusion.Off-loading of oxygen at tissue level.
181Alveolar Gas Exchange Animation Questions:1. Where does gas exchange occur in the lungs?2. What physiologic process facilitates oxygen and carbon dioxide exchange?3. List one important anatomical property of the alveoli that encourages gas exchange.4. How are arterial oxygen levels measured?Click here to view an animation on the topic of alveolar gas exchange.Back to Directory
182Disease at the Organ Level HypoperfusionWaste products of cellular metabolism carried away by blood.Carbon dioxide leaves bloodstream during oxygen-carbon dioxide exchange.Wastes expelled into lymphatic system.Wastes cleansed from blood by kidneys and excreted as urine.
183Understanding ARDS Video Questions:1. Describe what is meant by ARDS.2. What causes ARDS?3. How does ARDS affect exhaled carbon dioxide levels?4. How does ARDS affect arterial oxygen levels?Click here to view a video on the topic of ARDS.Back to Directory
184Disease at the Organ Level The Pathophysiology of HypoperfusionInadequate pumpInadequate fluidInadequate containerUnderlying causes: infection, trauma and hemorrhage, loss of plasma through burns, severe cardiac arrhythmia, central nervous system dysfunction.
185Disease at the Organ Level The Pathophysiology of HypoperfusionUltimate outcome of shock: impairment of cellular metabolism.Cells not receiving enough oxygen or are unable to use it effectively.Change from aerobic metabolism to anaerobic metabolism.Primary energy source for cells: glucose.
186Disease at the Organ Level The Pathophysiology of HypoperfusionWithout oxygen, when glucose breakdown stops after glycolysis, cellular stores of ATP used up much faster than can be replaced; cellular metabolism gravely impaired.Sodium-potassium pumping mechanism fails.Cell membrane ruptures; cellular death soon follows.
187Disease at the Organ Level The Pathophysiology of HypoperfusionSame factors that reduce delivery of oxygen to cells reduce delivery of glucose to cells.Glucose prevented from entering cells remains in blood (hyperglycemia).Depletion of proteins in gluconeogenesis causes organ failure.
188Disease at the Organ Level The Pathophysiology of HypoperfusionImpaired use of oxygen and glucose leads to cellular death.Cellular death will lead to tissue death.Tissue death will lead to organ failure.Organ failure will lead to death of individual.
189Disease at the Organ Level The Pathophysiology of HypoperfusionCompensation: in shock, fall in cardiac output, detected as decrease in arterial blood pressure by baroreceptors, activates body systems that attempt to reestablish normal blood pressure.Renin-angiotensin system: aids body in maintaining adequate blood pressure.
190Disease at the Organ Level The Pathophysiology of HypoperfusionCompensated shock: to restore normal circulatory volume; if excessive bleeding managed and shock state has not progressed too far.Decompensated shock: if conditions causing shock too serious, or progress too rapidly, compensatory mechanisms may not be able to restore normal function.
191Disease at the Organ Level The Pathophysiology of HypoperfusionIrreversible shock: shock state may progress to condition where correction is no longer possible.Cardiac depression: critical factor in downward spiral of decompensation.Depression of vasomotor center of brain: consequence of reduced blood pressure.
192Disease at the Organ Level The Pathophysiology of HypoperfusionMetabolic wastes released into slower-flowing blood.Capillary cells suffer from lack of oxygen and nutrients, and acidosis.Cellular deterioration progresses to tissue deterioration, which progresses to organ failure.
193Disease at the Organ Level Types of ShockShock classified according to cause.Cardiogenic shock: inability of heart to pump enough blood to supply all body parts.Most common cause of cardiogenic shock is severe left ventricular failure.Presence of pulmonary edema, altered mentation, oliguria.Points to EmphasizeShock is inadequate perfusion. It is important to discuss that early intervention can reverse many of the signs of shock.
194Disease at the Organ Level Types of ShockHypovolemic shock: loss of intravascular fluid volume.Internal or external hemorrhageTraumatic injury; long bone or open fracturesSevere dehydrationPlasma loss from burnsExcessive sweating; diabetic ketoacidosis
195Phases of Hypovolemic Shock Animation Questions:1. How is shock defined?2. List the four phases of shock presented in the animation.3. What is meant by irreversible shock?Click here to view an animation on the topic of hypovolemic shock.Back to Directory
196Disease at the Organ Level Types of ShockHypovolemic shock:“Classic” signs of shock.Mental status altered.Skin becomes pale.Blood pressure normal; then falls.Pulse rapid, slowing and disappearing.Cardiac arrhythmias may develop.
197Disease at the Organ Level Types of ShockNeurogenic shock: injury to either brain or spinal cord.Cause of neurogenic shock: central nervous system injury.Treatment same as for other types of shock: support of airway, oxygenation, ventilation, maintenance of body temperature, intravenous access.
198Disease at the Organ Level Types of ShockAnaphylactic shock: severe allergic response; occurs very rapidly.Death can occur before patient can get to hospital; prompt intervention critical.Signs and symptoms can affect: skin, respiratory, cardiovascular, gastrointestinal, nervous systems.Treatment is pharmacological.
199Disease at the Organ Level Types of ShockSeptic shock: begins with septicemia (sepsis); infection enters bloodstream and is carried throughout body.Dysfunction of more than one organ system (multiple organ dysfunction syndrome).Signs and symptoms progressive; most susceptible: lungs, respiratory system.
200Disease at the Organ Level Multiple Organ Dysfunction SyndromeMODS: progressive impairment of two or more organ systems resulting from uncontrolled inflammatory response to severe illness or injury.Sepsis and septic shock most common causes.Any severe disease/injury that triggers massive systemic inflammatory response.
201Disease at the Organ Level Multiple Organ Dysfunction SyndromePrimary MODS: organ damage results from specific cause resulting from episode of shock, trauma, surgery.Secondary MODS: next time there is insult, primed cells activated, producing exaggerated inflammatory response.Inflammatory response enters self-perpetuating cycle.
202Disease at the Organ Level Multiple Organ Dysfunction SyndromeSecondary insult triggers exaggerated neuroendocrine response.As result of release of inflammatory mediators and toxins and plasma protein cascades, a massive immune/ inflammatory and coagulation response develops.
203Disease at the Organ Level Multiple Organ Dysfunction SyndromeEffects at cellular and tissue levels cause breakdown of organ systems.Does not occur in one intense crisis; develops over weeks.No specific therapy.Early recognition; supportive measures.
204Part 6 The Body's Defenses Against Disease and Injury
205The Body's Defenses Against Disease and Injury Self-Defense MechanismsInfectious AgentsBacteriaVirusesFungiParasitesPrionsPoints to EmphasizeThe body has powerful resources to protect itself. Through medicine, we can augment these systems and help our patients overcome the illnesses they face.
206The Body's Defenses Against Disease and Injury Infectious AgentsBacteriaSingle-cell organisms.Can reproduce independently; need host to supply food and other support.Can be cultured and identified in hospital laboratories.Categorized according to appearance; after staining with dyes (Gram stains).
207The Body's Defenses Against Disease and Injury Infectious AgentsBacteriaCause many common infections.Antibiotics kill or inhibit growth of bacteria.Many bacteria release poisonous chemicals (toxins).Exotoxins: proteins secreted and released by bacterial cell during growth.Critical Thinking QuestionsWhy are some bacteria resistant to antibiotics?
208The Body's Defenses Against Disease and Injury Infectious AgentsBacteriaEndotoxins: trigger inflammatory process and produce fever.Septicemia (sepsis): systemic spread of toxins through bloodstream.
209The Body's Defenses Against Disease and Injury Infectious AgentsVirusesCause most infections.Much smaller than bacteria; only seen with electron microscope.Cannot grow without assistance of another organism.Incapable of metabolism.Critical Thinking QuestionsHow do vaccines disrupt or affect the physiology of viruses?
210The Body's Defenses Against Disease and Injury Infectious AgentsVirusesIf does not find host cell, virus will die.Do not produce toxins.Very difficult to treat.Cannot be treated with more than symptomatic care.
211The Body's Defenses Against Disease and Injury Infectious AgentsFungi (yeasts and molds): more like plants than animals.Rarely cause human disease other than minor skin infections.Mycoses: fungus infections.
212The Body's Defenses Against Disease and Injury Infectious AgentsParasitesProtozoa to large intestinal worms.Treatment depends on organism and location.PrionsDiffer from viruses.Smaller; made entirely of proteins; do not have protective capsids.
213The Body's Defenses Against Disease and Injury Three Lines of DefenseAnatomic barriersInflammatory responseImmune response
214Three Lines of Defense Against Infection and Injury
215Characteristics of the Inflammatory and Immune Responses
216The Body's Defenses Against Disease and Injury The Immune ResponseDetects antigens as foreign.Produces antibodies that combine with antigens to control or destroy them.Immunity: long-term protection against specific foreign substances.Natural immunity not generated by immune response.
217The Body's Defenses Against Disease and Injury The Immune ResponseNatural immunity: inborn; part of genetic makeup of individual or species.Acquired immunity: develops as outcome of immune response.Active acquired immunity: generated by host's immune system after exposure to antigen; long-lasting.
218The Body's Defenses Against Disease and Injury The Immune ResponsePassive acquired immunity: transferred to person from outside source; temporary.Immunoglobulins: antibodies.Primary immune response (initial): first exposure to antigen.Secondary immune response (anamnestic): second exposure.
219The Body's Defenses Against Disease and Injury The Immune ResponseLymphocytes responsible for recognizing foreign antigens, producing antibodies, developing memory.B lymphocytes: do not attack antigens directly.Humoral immunity: long-term immunity to specific antigens.
220The Body's Defenses Against Disease and Injury The Immune ResponseT lymphocytes: do not produce antibodies.Cell-mediated immunity: recognize presence of foreign antigen; attack it directly.Lymphocytes: circulated through body as part of lymphatic system.
221The Body's Defenses Against Disease and Injury Induction of the Immune ResponseImmunogens: antigens that trigger immune response.Not every antigen is immunogen.Sufficient foreignnessSufficient sizeSufficient complexityPresence in sufficient amounts
222The Body's Defenses Against Disease and Injury Induction of the Immune ResponseHLA antigens: body recognizes as self or foreign.Major histocompatibility complex (MHC): chromosome 6.Determines suitability (compatibility) of tissues and organs grafted or transplanted from donor.
223The Body's Defenses Against Disease and Injury Induction of the Immune ResponseRh factor: Rh antigen D.Incompatibility between Rh positive and Rh negative blood can cause harmful immune responses.ABO blood groups: two types of antigens may be present on surface of red blood cells; A and B.
224The Body's Defenses Against Disease and Injury Induction of the Immune ResponseBlood type A carries only A antigens.Blood type B carries only B antigens.Blood type AB carries both; universal recipient.
225The Body's Defenses Against Disease and Injury Induction of the Immune ResponseBlood type O carries neither; universal donor.
228The Body's Defenses Against Disease and Injury Humoral Immune ResponseLymphocytes generated from stem cells in bone marrow.T lymphocytes: cell-mediated immunity.B lymphocytes: humoral immunity.Specialization of B cells: processes of clonal diversity and clonal selection.
229The Body's Defenses Against Disease and Injury Humoral Immune ResponseMature B cells produce memory cells.All antibodies are immunoglobulins.Structure of immunoglobulin molecules: Y-shaped chains.Antibody: direct or indirect effect on target antigen; inactivation or destruction of antigen.
230The Body's Defenses Against Disease and Injury Humoral Immune ResponseDirect Effects of Antibodies on AntigensAgglutinationPrecipitationNeutralizationIndirect Effects of Antibodies on AntigensEnhancement of phagocytosisActivation of plasma proteins
231The Body's Defenses Against Disease and Injury Humoral Immune ResponseAntibodies serve four main functions:Neutralization of bacterial toxins.Neutralization of viruses.Opsonization of bacteria.Activation of inflammatory processes.
232The Body's Defenses Against Disease and Injury Humoral Immune ResponseClasses of ImmunoglobulinsIgM: largest immunoglobulin.IgG: “memory”; recognizes repeated invasions of antigen.IgA: present in mucous membranes.IgE: least-concentrated immunoglobulin.IgD: very low concentrations.
233The Body's Defenses Against Disease and Injury Humoral Immune ResponseAntigenic DeterminantsIsotypic antigens: species-specific.Allotypic antigens: can differ between members of same species.Idiotypic antigenic: can differ within same individual.Monoclonal antibody: produced in laboratory; pure and specific to single antigen.
234The Body's Defenses Against Disease and Injury Humoral Immune ResponseSecretory immune system (external or mucosal immune system): lymphoid tissues beneath mucosal endothelium.Protect body from pathogens inhaled or ingested.
235The Body's Defenses Against Disease and Injury Cell-Mediated Immune ResponseT cells do not produce antibodies.Attack pathogens directly and create temporary immunity.Travel through thymus gland.T cells become specialized: clonal diversity and clonal selection.
236The Body's Defenses Against Disease and Injury Cell-Mediated Immune ResponseMature T CellsMemory cells: secondary immune responses.Td cells: transfer delayed hypersensitivity.Tc cells: cytotoxic.Th cells: helper cells.Ts cells: suppressor cells.
237The Body's Defenses Against Disease and Injury Cellular Interactions/Immune ResponseImmune and inflammatory responses are interacting, not separate.Antigen-presenting cells (macrophages) interact with Th (helper) cells.Th (helper) cells interact with B cells.Th (helper) cells interact with Tc (cytotoxic) cells.
238The Body's Defenses Against Disease and Injury Cellular Interactions/Immune ResponseCytokines: proteins produced by white blood cells; “messengers” of immune response.Monokine: cytokine released by macrophage.Lymphokine: cytokine released by a lymphocyte (T cell or B cell).
239The Body's Defenses Against Disease and Injury Cellular Interactions/Immune ResponseSequence of processes necessary before immune response can begin:Antigen processing (by macrophages).Antigen presentation (by macrophages).Antigen recognition (by T cells or B cells).
240The Body's Defenses Against Disease and Injury Cellular Interactions/Immune ResponseAntigen processing: ingestion of invading organism; breakdown of its antigens.Antigen-presenting cells (APCs).T cell receptor (TCR): antigen-specific.CD4 or CD8 receptors: respond no matter what antigen presented.
241The Body's Defenses Against Disease and Injury Cellular Interactions/Immune ResponseT cells and B cells not differentiated until antigens in system react with appropriate receptors on cell surfaces.Ts (suppressor) cells help suppress immune responses.
242The Body's Defenses Against Disease and Injury Fetal and Neonatal Immune FunctionTo protect child in utero and during first months after birth, maternal antibodies cross placenta into fetal circulation.As immune system matures, levels of immunoglobulin begin to rise.
243The Body's Defenses Against Disease and Injury Aging and the Immune ResponseAs human body ages, immune function begins to deteriorate.Primary assault on T cell function.Men and women over age 60 have decreased hypersensitivity responses; decreased T cell response to infections.
244The Body's Defenses Against Disease and Injury InflammationBody's response to cellular injury.Immune response develops slowly; inflammation develops swiftly.Immune response specific; inflammation nonspecific.Immune response long-lasting; inflammation temporary.
245The Body's Defenses Against Disease and Injury InflammationImmune response: one type of white blood cell (lymphocytes); inflammation: platelets and white blood cells.Immune response: one type of plasma protein (antibodies); inflammation: several plasma protein systems.Immune response and inflammation interdependent.
246The Body's Defenses Against Disease and Injury InflammationInflammation/immune response both considered part of immune system.Phases of inflammation:Phase 1: Acute inflammationPhase 2: Chronic inflammationPhase 3: Granuloma formationPhase 4: Healing
247The Body's Defenses Against Disease and Injury InflammationFour Functions of InflammationDestroy and remove unwanted substancesWall off infected and inflamed areaStimulate immune responsePromote healing
248The Body's Defenses Against Disease and Injury InflammationAcute inflammation: triggered by any injury (lethal/nonlethal) to body's cells.Blood vessels contract and dilate.Vascular permeability increases.White cells and plasma proteins destroy invader and heal injury site.
249The Body's Defenses Against Disease and Injury InflammationMast cells activate inflammatory response through degranulation and synthesis.Degranulation: mast cells empty granules from their interior into extracellular environment.Physical injury, chemical agents, immunologic and direct processes.
251The Body's Defenses Against Disease and Injury InflammationHistamine: vasoactive amine (organic compound) released during degranulation of mast cells.Chemotactic factors: chemicals that attract white cells to site of inflammation.Chemotaxis: attraction of white cells.
253The Body's Defenses Against Disease and Injury InflammationWhen stimulated, mast cells synthesize: leukotrienes and prostaglandins.Leukotrienes: slow-reacting substances of anaphylaxis (SRS-A); actions similar to histamines.Prostaglandins: increased vasodilation, vascular permeability, chemotaxis; cause pain.
254The Body's Defenses Against Disease and Injury Plasma Protein SystemsPlasma proteins: proteins present in blood.Immunoglobulins (antibodies): key factors in immune response.Plasma protein systems critical to inflammation: complement system, coagulation system, kinin system.
255The Body's Defenses Against Disease and Injury Plasma Protein SystemsCascade: first action stimulated; that action causes next action, which causes next action until final action completed.Complement proteins lie inactive in blood until activated.Take part in almost all events of inflammatory response.Classic and alternative pathways.
256The Body's Defenses Against Disease and Injury Plasma Protein SystemsClassic pathway: activated by formation of antigen-antibody complex during immune response.Alternative pathway: begins without development of antigen-antibody complex.Much faster than classic pathway; acts as part of first line of inflammatory defense.
257The Body's Defenses Against Disease and Injury Plasma Protein SystemsCoagulation system (clotting): forms network at site of inflammation.Composed of protein called fibrin.Fibrinous network stops spread of infectious agents and products of inflammation.Forms clot that stops bleeding.
258The Body's Defenses Against Disease and Injury Plasma Protein SystemsExtrinsic pathway of coagulation: injury to vascular wall or surrounding tissues.Intrinsic pathway of coagulation: exposure to elements in blood itself.Continue toward same end product: fibrin.
259The Body's Defenses Against Disease and Injury Plasma Protein SystemsKinin system: chief product, bradykinin.Vasodilation, extravascular smooth muscle contraction, increased permeability, chemotaxis.Plasma kinin cascade: triggered by factors associated with coagulation cascade.
260The Body's Defenses Against Disease and Injury Plasma Protein SystemsControl of plasma protein systems:Inflammatory response essential for protection of body from unwanted invaders.Functioning must be guaranteed.Inflammatory processes powerful; potentially very damaging to body.Must be controlled and confined to site of injury or infection.
261The Body's Defenses Against Disease and Injury Plasma Protein SystemsMost inflammatory processes interact.Substance or action that activates one element tends to activate others.Inflammatory processes have to be both reliably started and stopped.
262The Body's Defenses Against Disease and Injury Cellular Components of InflammationExudate: collective term for all helpful substances.Sequence of events in inflammationVascular responseIncreased permeabilityExudation of white cells
263The Body's Defenses Against Disease and Injury Cellular Components of InflammationGranulocytes: appearance of bag of granules; multiple nuclei.Neutrophils, eosinophils, basophils.Monocytes: single nucleus; change and mature when involved in inflammation.Become macrophages.
265The Body's Defenses Against Disease and Injury Cellular Components of InflammationAll granulocytes and monocytes are phagocytes; blood cells that ingest other cells and substances.Neutrophils: first phagocytes to reach inflamed site.Eosinophils: primary defense against parasites.
266The Body's Defenses Against Disease and Injury Cellular Components of InflammationBasophils: function within blood as mast cells do outside blood.Release histamines and chemicals that control constriction and dilation of vessels.Platelets: act with components of coagulation cascade to promote blood clotting.
267The Body's Defenses Against Disease and Injury Cellular ProductsLymphokines: cytokines produced by lymphocytes.Stimulate monocytes to develop into macrophages; critical phase of inflammatory response.Monokines: cytokines produced by macrophages and monocytes.
268The Body's Defenses Against Disease and Injury Cellular ProductsInterleukin-1: lymphocyte-stimulating factor.Interferon: cytokine critical in body's defense against viral infection.
269The Body's Defenses Against Disease and Injury Systemic Responses of Acute InflammationFever, leukocytosis, increase in circulating plasma proteins.Fever: increase in temperature can create environment inhospitable to invading microorganisms.Fever: increases susceptibility of infected person to effects of endotoxins.
270The Body's Defenses Against Disease and Injury Chronic Inflammatory ResponsesChronic inflammation: inflammation that lasts longer than two weeks.Caused by foreign object or substance that persists in wound.May accompany persistent bacterial infection.Prolonged by presence of chemicals and other irritants.
271The Body's Defenses Against Disease and Injury Chronic Inflammatory ResponsesLarge numbers of cells degranulate and die.Infiltrate tissues; sometimes forming cavity that contains dead cells, dead tissue, tissue fluid (pus).Granuloma: walls off infection.Tissue repair and scar formation final stages of inflammation.
272The Body's Defenses Against Disease and Injury Local Inflammatory ResponsesVascular changes and exudation.Exudate has three functions:To dilute toxins released by bacteria and toxic products of dying cellsTo bring plasma proteins and leukocytes to site to attack invadersTo carry away products of inflammation
273The Body's Defenses Against Disease and Injury Resolution and RepairResolution: complete restoration of normal structure and function.Regeneration: proliferation of remaining cells.If resolution not possible, repair takes place, with scarring being end result.
274The Body's Defenses Against Disease and Injury Resolution and RepairDebridement: phagocytosis of dead cells and debris; dissolution of fibrin cells (scabs).Primary intention: minor wounds.Secondary intention: extensive wounds.Reconstruction: initial wound response, granulation, epithelialization, contraction.
275The Body's Defenses Against Disease and Injury Resolution and RepairFirst step of healing: sealing off of wound by clot (scab).Repair begins with granulation.Epithelial cells move in under scab, separating it from wound surface.Provides protective covering for healing wound.
276The Body's Defenses Against Disease and Injury Resolution and RepairSix to 12 days after injury, contraction begins as wound edges begin to move inward.Maturation: scar tissue remodeled; blood vessels disappear, leaving avascular scar; scar tissue becomes stronger.Discussion TopicsFollow an injury (such as a laceration) through the entire process from initial insult to resolution while describing the phases involved.
277The Body's Defenses Against Disease and Injury Resolution and RepairDysfunctional healing: insufficient repair, excessive repair, new infection.Causes: diabetes, hypoxemia, nutritional deficiencies, certain drugs.Positioning, exercises, surgery, drugs can sometimes help to prevent or correct dysfunctional wound healing.
278The Body's Defenses Against Disease and Injury Age and Mechanisms of Self-DefenseNewborns and elderly particularly susceptible to problems of insufficient immune and inflammatory responses.
279The Body's Defenses Against Disease and Injury Variances in Immunity/InflammationHypersensitivity: exaggerated and harmful immune response.Allergy: exaggerated immune response to environmental antigen.Autoimmunity: disturbance in body's normal tolerance for self-antigens.Isoimmunity (alloimmunity): immune reaction between members of same species.Critical Thinking QuestionsWhat is the mechanism of a severe allergic reaction? How does this relate to the immune system?
280The Body's Defenses Against Disease and Injury Variances in Immunity/InflammationOriginal insult (exposure to antigen).Genetic makeup; determines susceptibility to insult.Immunologic process that boosts response beyond normal bounds.Immediate hypersensitivity reactions.Delayed hypersensitivity reactions.
281The Body's Defenses Against Disease and Injury Variances in Immunity/InflammationMechanisms of Hypersensitivity ReactionType I: IgE-mediated allergen reactionsType II: tissue-specific reactionsType III: immune-complex-mediated reactionsType IV: cell-mediated reactions
282The Body's Defenses Against Disease and Injury Variances in Immunity/InflammationH1 receptors on target cells promote inflammation when contacted by histamine.H2 receptors inhibit inflammation when contacted by histamine.
283The Body's Defenses Against Disease and Injury Clinical Indications of IgE-Mediated ResponsesSkin: flushing, itching, urticaria, edemaRespiratory system: breathing difficulty, laryngeal edema, laryngospasm, bronchospasmCardiovascular system: vasodilation and permeability, increased heart rate, increased blood pressure
284The Body's Defenses Against Disease and Injury Clinical Indications of IgE-Mediated ResponsesGastrointestinal system: nausea, vomiting, cramping, diarrheaNervous system: dizziness, headache, convulsions, tearing
285The Body's Defenses Against Disease and Injury Variances in Immunity/InflammationAnaphylactic reactions are life threatening.Tissue-specific antigens: exist on the cells of only some body tissues.Four mechanisms by which Type II tissue-specific reactions attack cells.
286The Body's Defenses Against Disease and Injury Variances in Immunity/InflammationType III immune-complex-mediated reactions: antigen-antibody formed when antibody in blood or suspended in body secretions meets and binds to specific antigen.Systemic and/or localized.
287The Body's Defenses Against Disease and Injury Variances in Immunity/InflammationType IV reactions: activated directly by T cells; do not involve antibody.Lymphokine-producing T cells (Td cells); cytotoxic T cells (Tc cells).
288The Body's Defenses Against Disease and Injury Variances in Immunity/InflammationHypersensitivity/Targeted AntigenAllergy/environmental antigensAutoimmunity/self-antigensIsoimmunity/other person's antigensAllergens: antigens that are targets of allergic reaction.
289The Body's Defenses Against Disease and Injury Variances in Immunity/InflammationAutoimmunity: breakdown in body's tolerance for self-antigens; immune system attacks body's own cells.Isoimmunity: one member of species has immune reaction to cells from another member of the same species.
290The Body's Defenses Against Disease and Injury Autoimmune and Isoimmune DiseasesGraves' diseaseRheumatoid arthritisMyasthenia gravisImmune thrombocytopenic purpuraIsoimmune neutropeniaSystemic lupus erythematosus (SLE); lupusRh and ABO isoimmunization
291The Body's Defenses Against Disease and Injury Deficiencies: Immunity/InflammationCongenital (primary) immune deficiency develops if development of lymphocytes in fetus or embryo is impaired or halted.Acquired (secondary) immune deficiencies develop after birth; do not result from genetic factors.
292The Body's Defenses Against Disease and Injury Deficiencies: Immunity/InflammationNutritional deficienciesIatrogenic deficienciesDeficiencies caused by traumaDeficiencies caused by stressAcquired immunodeficiency syndrome (AIDS)Human immunodeficiency virus (HIV)
293The Body's Defenses Against Disease and Injury Deficiencies: Immunity/InflammationReplacement TherapiesGamma globulin therapyTransplantation and transfusionGene therapy
294The Body's Defenses Against Disease and Injury Stress and DiseaseStress: state of physical and/or psychological arousal to a stimulus.Stressor: stimulus/cause.General adaptation syndrome (GAS)Stage I: AlarmStage II: Resistance, or adaptationStage III: ExhaustionDiscussion TopicsHow does the mind affect the healing process or cause illness?
295The Body's Defenses Against Disease and Injury Stress and DiseasePhysiologic stress: chemical or physical disturbance in cells or tissue fluid produced by a change; requires response to counteract disturbance.Stressor that initiates disturbance.Chemical or physical disturbance stressor produces.Body's counteracting response.
296The Body's Defenses Against Disease and Injury Stress ResponsesStress response: initiated by a stressor.Hormones released in response to stressCatecholamines (norepinephrine and epinephrine)CortisolBeta endorphinsGrowth hormoneProlactin
297The stress response: effects on the sympathetic nervous, endocrine, and immune systems.
298The Body's Defenses Against Disease and Injury Stress ResponsesEffects of catecholamines prepare body for “fight-or-flight” in response to stressor.
302The Body's Defenses Against Disease and Injury Stress ResponsesComplex interaction among nervous, endocrine, and immune systems.
303Stress- and Immune-Related Diseases and Conditions
304Stress- and Immune-Related Diseases and Conditions (continued)
305The Body's Defenses Against Disease and Injury Stress, Coping, and Illness InterrelationshipsPhysiologic stress: caused by events that directly affect body.Psychological stress: unpleasant emotions caused by life events.Those who cope positively with stress have reduced chance of becoming ill; those who don't have greater chance of becoming ill.Critical Thinking QuestionsIs there a correlation between mental status and illness? Do patients suffering mental health illnesses suffer more illness, according to this theory?
306Summary Cell: basic unit of life. Contains all components to turn nutrients into energy, remove waste products, reproduce, carry on other essential life functions.Body's cells interact via electrochemical substances: hormones, neurotransmitters, neuropeptides, cytokines.
307Summary Cells exist in fluids and electrolytes. When something interferes with normal cell function, cell environment, or cell intercommunication, disease can begin or advance.Groups of cells that perform similar functions form tissues.Group of tissues functioning together is an organ.
308Summary Group of organs that work together is an organ system. Perfusion of tissues necessary to provide essential nutrients to cells and to remove wastes.Inadequate perfusion: hypoperfusion or shock.
309SummaryIf shock not corrected, creates downward spiral toward irreversible shock, possible multiple organ dysfunction syndrome (MODS), death.Cells injured: hypoxia, chemicals, infectious agents, immunologic/ inflammatory injuries.Diseases: genetic or environmental factors; combination of factors.
310Summary Homeostasis: body's normal dynamic steady state. Cells adapt through atrophy, hypertrophy, hyperplasia, metaplasia, dysplasia.Negative feedback mechanisms work to correct, or compensate for, shock.Body's chief means of self-defense is immune system.
311SummaryImmune and inflammatory responses: attack and destroy infectious agents.Immune response system: hypersensitivity reactions; immune deficiency disorders.Stress can also contribute to disease.