Foundational Concepts Study Guide PDF

Foundational Concepts ***Pathophysiology***- the study of the abnormal functional changes in the body (cells, tissues, and organs) caused by a disease; Pathology and Physiology. - ***Pathology***- the study of the structural and functional changes in cells, tissues, and organs in the body th...

Foundational Concepts ***Pathophysiology***- the study of the abnormal functional changes in the body (cells, tissues, and organs) caused by a disease; Pathology and Physiology. - ***Pathology***- the study of the structural and functional changes in cells, tissues, and organs in the body that cause a disease or are caused by a disease - ***Physiology***- the study of the function of the body - Pathophysiology looks at: - functional and structural changes - how these changes affect the body - the mechanisms of the underlying disease to assist in prevention - **Etiology**- the cause of the disease; or problem; abnormal functioning - **Consist of *[etiologic factors]***- [biologic agents] (bacteria, viruses), [physical forces] (trauma, burns, radiation), [chemical agents] (poisons, alcohol), [one's genes inheritance], and [nutritional excesses or deficits] - **Pathogenesis**- how the cause of the disease evolves; development and evolution of a disease - **Disease**- an acute or chronic illness that one acquires or birthed with and causes physiologic dysfunction in one or more body systems - **Clinical manifestations**- symptoms and signs - **Morphology**- the structure or form of cells or tissues - **Histology**- study of the tissues and its cells - **Syndrome**- compilation of the signs and symptoms of a specific disease - **Diagnosis**-The process of identifying a disease from its signs and symptoms - **Prognosis**- the probable outcome and chance of recovery from a disease - **Morbidity**- describes the effects an illness has on a person's life - **Epidemiology**- study of the occurrence of a disease in a human population **Clinical course of Disease** - ***Refers to the nature or clinical outcome of a disease*** **Acute disease** - Severe, but self-limiting or resolves on its own **Chronic disease** - Continuous, long-term process - Runs a continuous course and can present with exacerbations and remissions **Subacute disease** - Between acute and chronic - It's not as severe as an acute disease and not as prolonging as a chronic disease **Spectrum of disease severity** **Preclinical stage** - disease is not clinically evident but is destined to progress to a clinical disease **Subclinical disease** - not clinically apparent or visible and is not destined to become it - diagnosed with antibody or culture tests **Clinical diseases** - shown by signs and symptoms **Carrier status** - person harbors a particular disease or trait but does not have any symptoms/signs of it - person can still infect others - status may be of limited duration or be chronic **Three fundamental types of prevention** **Primary Prevention** - directed at keeping disease from occurring by removing risk factors **Secondary Prevention** - detects the disease early when it is still asymptomatic, and treatment measures can effect a cure or stop the disease from progressing **Tertiary Prevention** - directed at clinical interventions that prevent further deterioration or reduces complications of a disease that is already present Ch. 1 **The plasma membrane** - Contains [glycoproteins] - Glycoproteins are surface markers, or antigens, on the plasma membrane that identify cells as "self" from "non-self", meaning protecting the cell from foreign substances that don't belong - Antigens are surface markers on the plasma membrane and has the role of cell recognition and adhesion to the surface of the cell membrane - Red blood cells contain glycoprotein surface markers or antigens that identifies a person's blood type as A, B, O or AB. **Mitochondria** - The "powerhouses" - Contains enzymes that can change carbon-containing nutrients (glucose) into energy that is easily used by cells in the presence of oxygen - This process is referred to as ***[cellular respiration]*** because it requires oxygen - The cells store the energy as phosphate bonds in a substance known as ***[adenosine triphosphate]*** (ATP) - ATP is used in various cellular activities - Energy creation can be anaerobic and aerobic - ***Clinical Connection***: - Byproduct of anaerobic respiration is lactic acid - Acidosis (body fluids being acidic) can become excessive in hypoxic or ischemic (reduced blood flow to a body part) events - Exercise helps make more mitochondria - Contain their own DNA and ribosomes - They are self-replicating - The DNA of the nucleus contains the instructions for the structural proteins of the mitochondria and other proteins needed for cellular respiration - [Mitochondrial DNA is subject to mutation by oxygen-derived free radicals] (unstable molecules that can damage cells, cause illness, and aging) - Mitochondria functions as key regulators of apoptosis - Mitochondria is rich in tissues sch as skeletal muscle, cardiac muscle, smooth muscle, brain, kidney, and liver **Lysosomes** - Can be thought of as the digestive system or the stomach of the cell - They contain powerful enzymes that break down excess and worn-out cell parts, and foreign substances that are taken into the cell - Responsible for proteolysis - These enzymes require an acidic environment; they maintain a pH of 5 - Important to cellular metabolic process - Lack of lysosomes lead to accumulation of harmful substances - Ex: Tay Sach's disease is a terminal (expected to lead to death) genetic disorder of the neurological system - Lysosome deficiency leads to the accumulation of a lipid called ganglioside which causes damage to the nervous system and its tissues leading to a neurodegenerative (neural deterioration) disease. Most children die by age of 5. **Three major cellular mechanisms in proteolysis (breakdown of proteins):** - Lysosomal degradation - Caspase pathway, involved in apoptotic cell death - Proteasome use **Peroxisomes and Proteasomes** - Peroxisomes - Membrane-bound organelle, smaller than lysosomes - Functions to produce and neutralize free radicals - Contains a special enzyme (Ex: catalase) that degrades/deteriorates peroxides in free radicals; converting it from hydrogen peroxide to water and oxygen - Degrades long-chain fatty acids (fatty acid molecule with a carbon chain; fats and oils) - **Adrenoleukodystrophy** is a disorder of dysfunctional peroxisomes in which long-chain fatty acids accumulate in the nervous system. Leads to dementia, paralysis, and death. - Proteasomes - Responsible for the break down of proteins, also known as ***proteolysis*** - Small organelles made up of protein complexes in the cytoplasm and nucleus - They recognize misformed and misfolded proteins that have been targeted for deterioration - Degrades the amino acids polypeptides and proteins - Accelerated protease activity in the cells is seen in **Cachexia** (syndrome of body mass wasting) **Ribosomes** - Ribosomes are the sites for protein synthesis in a cell - **rRna- makes protein** - **mRna- protein "blueprint" from nucleus** - **tRna- assembly of proteins** - **[In severe hypoxia, rRna STOPS MAKING PROTEINS!]** **Other Organelles** **Golgi apparatus** - substances produced in the endoplasmic reticulum are carried here and are packaged into secretory granules or "vesicles" - is thought to make carbohydrate molecules that combine with proteins from the rough ER to make glycoproteins - Processing and packaging of proteins (ex: hormones) - Transport is via secretory vesicles - Receives proteins and other substances from the cell surface by a retrograde transport mechanism (Golgi and ER transport) **Microtubules and Filaments** - Makes up the cytoskeleton that's in the cytoplasm - Provides structural support and allows movement - Microtubules - Formed from protein subunits called tubulin - Long, stiff, hollow structures shaped like cylinders - Can disassemble in one location and reassemble in another (shortening and lengthening) - Function in the development and maintenance of cell formation - Transports mechanisms inside cells - Part of cilia and flagella - Participates in mitosis - Microfilaments - Thin, thread-like cytoplasmic structure - 3 classes of microfilaments - Thin microfilaments: similar to thin actin filaments in muscle - Intermediate filaments: group of filaments with diameter between thick and thin filaments - Thick myosin filaments: are in muscle cells but temporarily exist in some other cells **Nucleus** - Control center of a cell - Contains the instructions to make proteins, and those proteins can make other molecules needed for cellular function and survival - Contains DNA - DNA contains genes - Genes contain the instructions for cellular function and survival - Site for the three main RNA molecules - **Messenger RNA (mRna)**: made from genetic info transcribed/copied from DNA in process called ***[transcription]*** - **Ribosomal RNA (rRna):** the RNA component of ribosomes, which is the site of protein synthesis - **Transfer RNA (tRna):** transports amino acids to ribosomes so that mRNA can be turned into an amino acid sequence in process called ***[translation]***. mRNA template is used to link amino acids to make proteins **Ch 3** **Cellular adaptation** - **A** protective mechanism to prevent cellular and tissue harm because of stressors - **The cell undergoes adaptive changes that allows survival and homeostasis when confronted by stresses** - **Cells may adapt by undergoing changes in size, number, and type\\** **Atrophy** - Decrease in cell size; pathologic and physiologic - Oxygen consumption and protein synthesis decrease - caused by confrontation of decrease in work or adverse environmental conditions - atrophied cells have reduced oxygen consumption and a decrease in other cellular functions by decreasing the number and size of their organelles - seen when insulin and IGF-1 levels decrease; apoptosis may occur - the cytoskeleton of the cell is broken down by the proteasome - adaptive and reversible NOTE: proper muscle mass is maintained by sufficient levels of insulin and insulin-like growth factor-1 (IGF-1). They stimulate growth and limit protein degradation. When these levels are low or are triggered to break down large molecules, catabolic signals are present an muscle atrophy occurs. **Hypertrophy** - increase in cell size; pathologic and physiologic - results from increased workload and commonly seen in cardiac and skeletal muscle tissue which can't adapt to increase in workload through mitosis and formation of more cells - when muscle cells hypertrophy, additional actin and myosin filaments, cell enzymes, and ATP are synthesized - increase of muscle mass from exercise is an example of physiologic hypertrophy - pathologic hypertrophy as a result of disease conditions - Myocardial hypertrophy - Increased glycolysis - Limitations in blood flow - Hypotension - In hypertension, the increased workload required to pump blood against an arterial pressure in the aorta results in an increase of left ventricular muscle mass and need for coronary blood flow - PMI is displaced to left in left ventricle hypertrophy; left chest palpation in cardiovascular physical assessment **Hyperplasia** - Increase in the number of cells; physiological - Occurs in tissues with cells that are capable of mitosis such as - the epidermis - intestinal epithelium - glandular tissue - involves activation of genes that control cell proliferation (cells increase in number through growth and division) and the presence of intracellular messengers that control cell replication and growth - occurs in response to an appropriate stimulus and ceases after stimulus is removed - stimuli may be physiologic or nonphysiologic - Physiologic hyperplasia: - Hormonal: breast and uterine enlargement in pregnancy from estrogen stimulation - Compensatory: the regeneration of the liver that occurs after partial removal of the liver - Nonphysiologic - Due to excessive hormonal stimulation or effects of growth factors on target tissues - Acts as a response of connective tissue in wound healing with fibroblasts and blood vessels contribute to wound repair - Hypertrophy and hyperplasia can occur together in example of a pregnant uterus - Skin warts are another example of hyperplasia, caused by growth factors produced by certain viruses Note: as males age, prostate gland cells increase in number because of testosterone stimulation. As a result, leads to condition known as [benign prostatic hyperplasia] (BPH) occurs **Metaplasia** - One cell type is replaced by another cell type; physiological - involves the reprogramming of undifferentiated stem cells that are present in the tissue undergoing metaplastic changes - occurs in response to chronic irritation and inflammation and allows substitution of cells that are better able to survive under circumstances in which a fragile cell type couldn't - the cell types stay in their same category - reversible when irritant is removed Example: cigarette smoking, Barrett's esophagus **Dysplasia** - disordered and deranged cell growth; cells vary in size, shape, and organization: physiological - associated with chronic irritation or inflammation - abnormal, but adaptive, and reversible after irritating cause is removed - implicated as a precursor for cancer but is an adaptive process and does not necessarily lead to cancer **Neoplasia: "**new growth" - lacks normal controls and regulation - can originate in one organ and spread - Prostate in Men - Breast tissue in Women - Lung leading cause of death in Men and Women **CELL INJURY** - MOST DISEASES START WITH CELL INJURY **Causes:** - Physical agents (mechanical forces, extreme temperature, electrical force) - Biologic agents - Radiation - Nutritional imbalances - Chemical - Poisoning/toxicity - Drugs **Intracellular accumulations** - Stressed cells fill up with unused foods, abnormal proteins, pigments, calcium deposits - Cells cannot immediately use or eliminate the substances **Hypoxia causes ATP depletion** - Brain cells cannot withstand hypoxia for more than 6 minutes - Skeletal muscle can tolerate hypoxia for prolonged periods **Shearing injury** - Constant stress of the pulsatile force of blood flow against arterial endothelium **\*Endothelial injury OR Shearing injury** caused by the forces of hypertension initiates the development of **[ATHEROSCLEROSIS]\*** Note: carbon monoxide binds very tightly to the hemoglobin molecule, decreasing its oxygen-carrying capacity - Thus, the amount of oxygen delivered to the tissues is decreased in carbon monoxide poisoning **Increased intracellular calcium** - Cells maintain low intracellular calcium - When calcium enters a cell: - Acts as a "second messenger" inside cell - Turns on intracellular enzymes, some of which can damage the cell - Open more calcium gates in cell membrane leading to a "calcium cascade" **ARTERIOSCLEROSIS and AORTIC SCLEROSIS** Arteriosclerosis - Calcifications accumulate within long-standing plaque. Can travel in blood stream if pieces are broken off Aortic sclerosis - Thickening and narrowing of the heart valve with consequent blood disruption - Seen in elderly people On mammography, a **[breast lesion containing microcalcifications is often indicative of a malignancy]**. Calcium deposits are seen within the nutrient-deprived cells of a malignant tumor in the breast **Necrosis** The death of most or all cells in an organ or tissue due to disease, injury, or failure of the blood supply **Types of Necrosis** 1. **Coagulative -**firm and opaque 2. **Liquefactive-** walled off liquid goo 3. **Caseous-** cased off cheese globules 4. **Fatty-**opaque, chalky, soapy **Gangrene:** caused by severe hypoxic injury - Large area of necrotic tissue - Dry gangrene: - Lack of arterial blood supply but venous flow can carry fluid out of tissue - Tissue tends to coagulate - Wet gangrene: - Lack of venous flow lets fluid accumulate in tissue - Tissue tends to liquefy and infection is likely - Gas gangrene: - Clostridium infection produces toxins and H2S bubbles **CARCINOGENESIS** - cancer development **Steps in carcinogenesis** - **Initiation:** introduction of the agent - **Promotion:** initiation of uncontrolled growth - **Progression:** permanent malignant changes **Factors** - **Heredity** - **Oncogenes** - **Carcinogens** **Benign cancers** - slow, progressive, localized, well defined, more differentiated/resembles host, grow by expansion, not typically fatal **Malignant cancer** - rapid growing, spreads quickly (metastasis), fatal, highly undifferentiated **Clinical Manifestations: CAUTION** - **C**HANGE IN BOWEL/BLADDER HABITS - **A** SORE THAT DOESN'T HEAL - **U**NUSUAL BLEEDING OR DISCHARGE - **T**HICKENING OR LUMP IN BREAST OR ELSEWHERE - **I**NDIGESTION OR DIFFICULTY SWALLOWING - **O**BVIOUS CHANGE IN A WART OR MOLE - **N**AGGING COUGH OR HOARSENESS