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Flashcards in Pathophysiology Deck (138):
1

Pathophysiology

Study of the functioning of an organism in presence of disease

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Cell

Basic self sustaining unit of the human body

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Three Main Parts of Cell

Cell Membrane
Cytoplasm
Nucleus

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Cell Membrane

Consists of fat and protein
-surrounds dell and protects nucleus and organelles

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Organelles

Functional structure within the cells cytoplasm

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Inside of Organelle

Ribosomes, ER, Golgi Complex, Lysosomes, Peroxisomes, Mitochondria, Nucleus

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Ribosomes

Contain RNA and protein
-Responsible for controlling cellular activities
-interact with other amino chains to form proteins
-when attached to ER they for, rough ER

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ER

Network of tubules, vesicles and sacs
-Smooth ER builds fats
-Rough builds proteins

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Golgi Complex

Synthesis and packaging of various carbohydrates and complex protein molecules such as enzymes

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Lysosomes

Membrane bound vesicles that contain digestive enzymes
-intracellular digestion that breaks down organic debris, (bacteria) that have been taken into the cell

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Peroxisomes

Found in high concentrations in liver and neutralize toxins such as alcohol

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Mitochondria

Metabolic center of cell no produce ATP, major energy source in the cell

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Nucleus

Contains DNA in the chromosomes and RNA

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Epithelium

Covers external surfaces and lines hollow organs such as intestines, blood vessels and bronchial tubes
-absorb nutrients
-secrete body substances (sweat)

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Endothelial Cells

Epithelial cells that line vessels
-help regulate blood flow and have a role in blood clotting

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Connective Tissue

Binds other types of tissue to one another
-separated by non living extracellular matrix consisting of protein fibers and fluid
-collagen main protein in fluid
-adipose tissue is a connective tissue mainly made of large amounts of lipids (fats)
-blood is connective

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Muscle Tissue

Characterized by ability to contract
-Enclosed by fascia, envelope of fibrous material
Skeletal: striated volunTary
Cardiac: striated involuntary
Smooth: nonstriated involuntary

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Nerve Tissue

Transmit nerve impulses
Central and Peripheral

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Homeostasis

Same and steady

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Apoptosis

Normal cell death in which old cells are replaced by new cells

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Cell Signaling

Way that the cells communicate electrochemically to each other by releasing molecules (such as hormones) that bind to protein receptors on the cell surface.
In result, a triggered chemical reaction occurs and initiates a biological reaction

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Baroreceptors

Respond to changes in pressure usually within heart or main arteries

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Chemoreceptors

Sense changes in chemical composition of the blood, especially reduced oxygen levels and elevated CO levels

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Five Primary Ways to Release Heat

Convection, conduction, evaporation, radiation and respiration

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Ligand

"To tie or bind"
Are molecules that bind to receptor sites to form more complex structures
-Endogenous or Exogenous Ligands: produced by body or given into body

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Hormones

Substances found in tiny amounts by one specialized group of cells and then carried to another organ or group of cells and then carried to another organ or group to perform regulatory functions

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Endocrine Hormones

(Thyroid hormones and adrenal) carried to their target by the blood

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Exocrine Hormone

Reach target by a specific duct that opens into an organ (stomach acids and perspiration)

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Paracrine Hormones

(Histamines) diffuse through intracellular spaces to reach their target

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Electrolytes

Dissolved mineral salts that dissociate in a solution yielding ions (sodium, potassium, clalcium, chloride)
-have important role in cell signaling and in generating the Nervous System action potential

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Ions

Positive charge: cation
Negatively charged: anion
Body fluids are suppose to be electrically neutral

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Atrophy

Decrease in cell size due to loss of sub cellular components which results in a decrease in the size of the organ or tissue
-actual number of cells remain unchanged but decrease in an attempt to cope with a new steady state
-coasted immobilized limb loses muscle and shrinks in size

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Hypertrophy

Increase in the size of the cells due to synthesis of more subcellular components which creates an increase in size of a tissue or organ
-left ventricle may hypertrophy from increased pressure

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Hyperplasia

Increase in actual number of cells in an organ or tissue usually resulting in increase in size of organ or tissue
-a callus is hyperplasia of the keratinized layer of the epidermis in response to increase friction or trauma

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Dysplasia

Alteration of size shape and organization of cells is most often found in epithelial cells where they have undergone atypical, irregular inflammation or irritation.
-development of cervical dysplasia in women is strongly associated with exposure to certain viruses

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Metaplasia

Reversible cellular adaptation in which one or more cell type is replaced by another adult cell type.
-the airway of smokers and cilia may be replaced by meta plastic epithelium after burned away

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Body Weight

50-70% is fluid

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Intracellular Fluid

75% of body weight in fluid

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Extracellular Fluid

25% of body weight in fluid
-interstitial and intravascular
-interstitial: surrounds tissue cells and includes cerebrospinal, and synovial fluid
-intravascular: found within blood vessels but outside the cells

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Solvent and Solute

Water and Salt

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Passive Transport

Movement of substance by diffusion from area of high concentration to area of low concentration

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Active Transport

Movement via transport molecules, or pumps, that require energy to move substances from an area of low concentration to area of high concentration

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Osmosis - how water moves between ICF and EXF

Movement of a solvent from an area of low solute concentration to an area of high solute concentration through a selectively permeable membrane to equalize solute to solvent

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Hypertonic Solution

Higher osmotic pressure due to having a higher solute concentration

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Hypotonic Solution

Lower osmotic pressure due to having a lower solute concentration

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Isotonic Solutions

Normal Saline e.g and lactate ringers

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Intracellular Fluid controlled In two ways

By proteins and compounds that cannot escape and the sodium potassium pump
-most intracellular charges are negatively charged so they attract positively charged ions like potassium and because potassium is osmotically active, they can pull water into the cell. Even until it ruptures.

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Sodium Potassium Pump

Responsible for checks and balances of water being brought in by continuously removing three sodium ions from the cell for every two potassium cells that are moved back into the cell
-if Pump is damaged due insufficient potassium, sodium accumulates and causes the cells to swell
-ATP used to make the exchange happen

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Plasma

Makes up 55% of blood
91% water and 9% plasma proteins
-plasma proteins: albumin which maintains osmotic pressure; and fibrinogen and prothrombin which assist with clotting

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Capillary Hydrostatic Pressure

Pushes water out of capillary into interstitial space. Cause pressures differ, more water is pushed out of arterial end and more is absorbed through venous end.

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Tissue Colloidal Pressure

Draws fluid into the interstitial space

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Edema

Occurs when excess fluid builds up in interstitial spaces
-Many causes: increased capillary hydrostatic pressure from
Allergic Reactions
Venous Obstruction
Increased vascular volume
Increase adrenocorticol hormones
Sodium retention
Pregnancy
Gravity from long sitting

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ADH

Antidiuretic Hormone or "vasopressin"

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RAAS

Renin-angiotensin-aldosterone system
-complex feedback mechanism responsible for kidneys regulation of sodium in the body
-high it is secreted, low it is reabsorbed

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Osmoreceptors

Monitor extracellular fluid osmolarity
-located primarily in Hypothalmus
-when extrcellular osmolarity is too high they stimulate production of ADH

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Blood Osmolarity

When increased pituitary gland secretes ADH which stimulates the kidneys to reabsorb water decreasing the osmolarity of the blood

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Renin

Protein that released by kidneys into blood stream as a response of changes in blood pressure, blood flow, and globular filtration rate.
When renin is released, it converts plasma protein angiotensinogen to angiontensin 1.

In the lungs, angiotensin 1 is rapidly converted to angiotensin 2 by Agiontensin-Converting Enzyme.
Angiotensin 2 then stimulates sodium resorption by renal tubules and constricts renal blood vessels, slowing kidney blood flow and decreasing the glomerular filtration rate.
In result, less sodium is reabsorbed in the blood

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RAAS

Renin + plasma protein angiotensinogin = agiontensin 1 => lungs + ACE => angiotensin 2 + renal tubules = sodium reasorption

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Baroreceptors

Monitor hydration and are located in the carotid artery, kidneys, and aorta

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Volume sensitive receptors

Located in the atria so when intravascular pressure increases, the atria stretches and causes a release of atrial natriuretic proteins

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Natriuretic Proteins

Increase when the body contains too much sodium and water which inhibit the ADH and promote excretion of sodium and water by the kidneys

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Sodium and Chloride

Where sodium goes, Chloride follows
-together they make table salt but when in water they dissasociate

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Tonicity

Tension exerted on a cell as a result of water movement across the cell membrane

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Hyponatremia

Low sodium level caused by sweating, exercise, vomiting, diarrhea

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Potassium

Major intracellular cation necessary for muscle control, regulation of all muscles, acid base balance, and maintain osmolarity in cells
-hypokalemia: from fluid loss, shifts into cells from insulin, Epi and others. Causes, muscle weakness, fatigues, muscle cramps,
-hyperkalemia: renal failure, ace inhibitors, nsaids inhibit secretion. Causes, peaked t waves can administer calcium, Albuterol, fluids, and bicarbonate

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Calcium

98% found in bones
-provides strength and stability for collagen and ground substances.
-calcium enters through GI tract and is absorbed in the blood
-hypocalcemia: hypoparathyroidism, alcoholism, diuretic Therapy. Causes, spasm of skeletal muscles, cramps, laryngospasm, seizures, prolongation of QT interval
-hypercalcemia: excess ingestion, hyperparathyroidism, cancers. Causes, constipation and frequent urination. Give fluid of NaCl.

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PTH

Parathyroid Hormone, regulates uptake of calcium in intestines, kidneys, and works with calcitirol to stimulate osteoclasts activity

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Acid

Can give up hydrogen ion
-less than 7 ph
-H+

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Base

Can accept hydrogen ion
-OH-
-greater than 7 ph

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Acidosis

Kidneys secrete H+ and retain K+

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Alkolosis

Kidneys secrete K+ and retain H+

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Buffers

Molecules that modulate changes in pH by neutralizing excessive buildup of acids and bases

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Bone Buffer

Bone acts as buffer to absorb excess acids and release calcium into the circulation

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Strong or Weak

Depends on how it disassociates in water

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Buffers

Proteins, phosphate ions, and bicarbonate

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Eliminate Acid

Excess acids are given off in the form of gas from the lungs

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Eliminate Base

Mainly give excess base off from kidneys

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Three primary buffers

Bicarbonate in blood, respiratory, and renal system

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Bicarbonate

Forms with H+ To from carbonic acid and disassociates in water to form carbon dioxide to be exhaled

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Four types of OF presentations of acid base imbalance

Respiratory alkalosis/acidosis
Metabolic alkalosis/acidosis

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Respiratory Acidosis

Hypoventilation
Causes: Signs and Symptoms
airway obstruction. Red skin
Cardiac arrest. CNS depression
Opiate OD. Bradypnea
Drowning. Nausea vomiting
CHF
Head Injury
Chest Trauma
CO poisioning
-can cause fatal disrhythmias due to accumulation of potassium
-COPD causes acidosis over time as inhibition of gas exchange occur

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Respiratory Alkalosis

Caused by hyperventilation
Causes: S&S:
Drug overdose, aspirin. loc
Fever. Light headed ness
BVM. Carpalpedal spasm
Hypocalcemia. Tingling face lips
Nausea Vomiting. Chest pain
Anxiety. Blurred vision

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Metabolic Acidosis

Any acidosis not caused by respiratory
-Lactic Acidosis: anaerobic metabolism from hypoperfusion of tissues
-Ketoacidosis: develops when cells are forced to switch to use fatty acids as energy
-Acetlysalicylic OD: aspirin, 10-30g, is overdose, stimulates brain to hyperventilate and renal compensatory
-Alchoholic Keto: anti freeze and wood alcohol
Causes: vasodilation, CNS depression, headaches, hot skin, tachypnea, nausea vomiting

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Metabolic Alkalosis

Excessive loss of acid from increased urine output or from acid in stomach
-Stomach loses acids
-Drinking large amounts of water
-Alkaline substances such as atacids
Causes: confusion, tremors and cramps, bradypnea, hypotension

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Hypoxia Injury

Caused from air, CO, red blood cell loss, or cyanide poisoning
-when hypoxia for more than minutes, cells produce mediators that are harmful to other tissues
-free radicals produced as mediator: are missing an electron so the attack cells to find missing electron

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Infectious Injury

Virulence: measures Disease causing ability of a microorganism

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Bacteria

Phagocytes: white blood cells that engulf and consume foreign material such as cellular debris and microorganisms

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Pyrogens

Released by white blood cells when they attach to a cell to destroy causing a fever

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Apoptosis

Normal cell death

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Necrosis

Result of morphologic changes that occur following cell death in living tissues

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Long QT Syndrome

Cardiac conduction system abnormality characterized by prolongation of the QT interval on ECG
-Causes syncope, death

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Gout

Abnormal accumulation of Uris acid due to a defect in metabolism

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Kidney Stones

Small amounts of Uris acid or calcium salts that accumulates

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Cardiogenic Shock

Occurs when heart can not circulate enough blood to maintain adequate peripheral oxygen delivery.
-Causes: MI, Large Ventricular Defect, Dysrhythmias

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Obstructive Shock

Blood flow becomes blocked in heart or great vessels
-Causes: tamponade, tumor, PE

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Hypovolemia Shock

Circulating blood Volume is not enough to deliver adequate oxygen and nutrients to the body
-Causes: fluid loss, vomiting/diarrhea, blood loss

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Distributive Shock

Wide Spread of dilation of vessels
-Causes: anaphylactic, sepsis, neurogenic ( spinal cord injury)

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Lymphatic system

Network of capillaries and ducts that help maintain fluid environment of the body

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Lymph

Thin watery substance that bathes tissues of the body

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Five Types of Leukocytes

-Basophils: histamine granules released during inflammation
-Eosinophils: damage or kill invaders and can trigger bronchospasm
-Neutrophils: most abundant ,55-70% of leukocytes, protect body against invasion, and infection. They are readily attracted to foreign antigens and eat them by phagocytosis
-Monocytes: produce macrophages which scavengers for the tissues
-Lymphocytes: mediate acquired immune response

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Antigen

Foreign substance

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Antibody

Binds to an antigen to hopefully destroy it

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Cell Mediated Immune Response

Characterized by the formation of a population of lymphocytes that can attack and destroy foreign material

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T-cell Lymphocytes

Recognize antigens and contribute to the immune response in two ways
1: by secreting cytokines that attract other cells
2: by becoming cytotoxic and killing infected or abnormal cells

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Killer T Cells

Destroy the antigen
Help rid the body of cells that have been infected by viruses and cells that have been transformed into cancer cells

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Helper T Cells

Activate many immune cells

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Suppressor T Cells

Suppress the activity of other lymphocytes so they do not destroy normal tissue

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Memory T Cells

Remember the reaction for the next time it is needed

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Lymphokine-producing cells

Work to damage cells, they destroy cells that have been infected by virus

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Active Hyperemia

Causes increased vascular pressure which causes the blood vessel to expand in an inflammatory response
-when the wall expands it becomes thinner causing fluid to leak from the vessel causing edema
-results in warm to touch because the vessels dilate and are closer to the skin

111

Mast Cells

During inflammation they degranulate and release a variety of substances
-primary stimuli is trauma, chemical agents, and immunologic substances ( antigen )

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Mast Cells cont.

Following degranulation, mast Cells release vasoactivamines which increase vascular permeability, vasodilator, and can cause bronchoconstriction, nausea, vomiting
-histamine and serotonin: released quickly

113

Prostoglandins

Mast Cells synthesize these
-comprise about 20 lipids that are composed of fatty acids.
-found in vertebra tissue and act as messengers in reproduction, inflammatory response and pain from trauma
-aspirin and nsaids inhibit prostaglandin synthesis which leads to reduced inflammation and pain

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Coagulation System

Vital role in formation of blood clots in the body and facilitates repair

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Coagulation cont.

Inflammation triggers the coagulation cascade initiating a series of complex reactions that encourage fibrin formation
-simultaneously the fibronolysis cascade is activated to dissolve the fibrin and create fibrin split products

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Fibrin

Is the protein that bonds to form the fibrous compound of a blood clot

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Kinin System

Leads to formation of The vasoactive protein bradykinin from kallikrein.
Kallikarein found in plasma, urine, and tissue inactive but when active can cause dilation, change BP, modulate salt and water excretion by kidneys

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Polymorphonuclear Neutrophils

Inflammatory cells that involve both an intravascular and extravascular phase

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Intravascular

Move to the sides of blood vessels and attach to endothelial cells

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Extravascular

Leukocytes move to the site of inflammation and kill organism

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Margination

Loss of fluid from blood vessels into inflamed or infected tissue gives blood remaining in vessels more viscosity which slows the flow of blood and produces stasis

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Activaton

Mediators of inflammation trigger the appearance of selectins which stimulates bone marrow to produce more WBC and increase Leukocytes count

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Adhesion

PMN's attach to endothelial cells by selections and integrins

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Transmigration

The pmn's permeate the vessel wall, passing into interstitial spaces

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Chemotaxis

PMN's move toward inflammation

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Hypersensitivity

Response of the body to any substance to which a patient has increased sensitivity

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Allergy

Hypersensitivity reaction to presence of an allergen

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Autoimmunity

Production of antibodies or T cells that work against the tissues of ones own body producing hypersensitivity reactions or autoimmune diseases

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Isoimmunity

Formation of T cells in response to others tissues
-seen with rejection of t cells

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Rh Factor

Antigen present in the red blood cells of about 85% of population
Must be Rh positive or negative to receive that type of blood along with ABO

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Type A

Contains type A surface antigens and plasma containing B antibodies

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Type B

Contains type B surface antigens and plasma containing A antibodies

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Type O

Have neither A or B surface antigens but have type A and B antibodies

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Stress

General Adaptation Syndrome

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Stage 1

Alarm:
Release catecholamines

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Stage 2

Resistance:
Body adapts to release of catecholamines by releasing corticosteroids hormones that increase the blood glucose and maintain blood pressure
-Glucocorticoid and Mineralcorticoid
Body also increases metabolism to compensate

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Stage 3

Exhaustion:
Adrenal Glands become depleted giminishing level of glucose resulting in mental and physical exhaustion

138

Hypothalamic-adrenal-pituitary axis

Major part of the neuron doctrine system that controls reaction to stress