Acute and Chronic Inflammation, Wound Healing, and Cellular Adaptations, Exams of Pathophysiology

Download Acute and Chronic Inflammation, Wound Healing, and Cellular Adaptations and more Exams Pathophysiology in PDF only on Docsity! PATHOPHYSIOLOGY TEST WITH ANSWERS. Download to score PAIN. Chronic pain – diffuse, dull, burning or aching sensation and transmitted by c fibers. Long term. C fibers receive thermal, physical, and chemical stimuli from muscle, tendons, the myocardium, and the digestive tract as well as from the skin. Referred pain – occurs when an individual locates the pain at a site other than the actual origin. Phantom pain – pain or another sensation such as itching or tingling that occurs after amputation. Neuropathic Pain – caused by trauma or disease involving the peripheral nerves. Paresthesia, nerve pain, hands or feet are asleep. SKIN: First line of defense: non-specific, mechanical barrier, unbroken skin, mucous membranes. prevents excessive fluid loss, controls body temperature, synthesizes Vitamin D. Second Line of Defense – non- specific, phagocytosis, inflammation, interferon Third line of defense – specific defense, cell mediated – t cells and cytokines. Humoral b cells and production of specific antibodies or cell mediated immunity. Layers of the Skin: Epidermis – avascular, dermis, SubQ (hypodermis) Cellulitis – infection of the dermis and SubQ tissues. • Usually secondary to an injury • Frequently in lower trunks and legs Signs and Symptoms : Area becomes red, swollen and painful • Red streaks may develop, running along lymph vessels proximal to infected area Necrotizing Fasciitis – characterized by bacterial invasion with rapid tissue destruction and septic shock. (flesh eating disease) mixture of aerobic and anaerobic bacteria usually at site of infection. - Severe inflammation and tissue necrosis - Usually caused by virulent strain of gram positive, group A beta- hemolytic streptococcus - History of minor trauma or infection in the skin. - Very painful infected area rapidly increases in size, dermal gangrene is apparent. Impetigo – small red vesicles, rapidly enlarged, vesicles rupture. Yellowish-brown • Anemia (low hemoglobin) • Circulatory problems • Certain chronic diseases • Presence of other disorders such as diabetes or cancer • Irritation, bleeding, or excessive mobility • Infection, foreign material, or exposure to radiation • Chemotherapy treatment • Prolonged use of glucocorticoids Healing by primary intention: The process involved when the wound is clean, free of foreign material and necrotic tissue and the edges are held close together creating a minimal gap between edges Healing by secondary intention: There is a large break in the tissue and consequently more inflammation, a longer healing period and formation of more scar tissue. Example: compound fracture. Basic concepts and processes – the major component of the body is water, essential to homeostasis, place for metabolic reactions, transportation system for the body, facilitating movements of body parts. • Homeostasis—the maintenance of a relatively stable internal environment regardless of external changes Disease Process: • Diagnosis - Identification of a basic disease • Evaluation of signs and symptoms • Laboratory tests • Etiology - Causative factors in a particular disease • Congenital defects, Inherited or genetic disorders, Microorganisms, Immunologic dysfunctions, Degenerative changes, Malignancy, Metabolic, nutritional problems, Trauma, burns, environmental factors Characteristics of Disease: • Pathogenesis - Development of the disease • Clinical Manifestations - Clinical evidence with signs and symptoms • Local: at site of the problem • Systemic: general indicators of illness, i.e. fever Disease Progression: • Onset of disease • Sudden/acute • Insidious: gradual, vague or mild signs • Acute disease • Short-term, develops quickly. Less than 6 months in duration. • High fever, severe pain etc. • Chronic disease • Develops gradually • Milder symptoms, often intermittent with acute episodes (For instance Asthma is usually controlled but then there is a sudden asthma attack) body), microorganisms (bacteria, viruses, and parasites), nutritional deficits, imbalance of fluids or electrolytes . • Ischemia - Deficit of oxygen in the cells • Apoptosis – programmed cell death (it occurs naturally in the body) • Hypoxia – reduced oxygen in tissues, nutritional deficits • Pyroptosis – results in lysis causing nearby inflammation Cell Damage occurs in two Stages. 1. Initial Cell Damage – causes an alteration in a metabolic reaction which leads to loss of function of the cell. 2. Necrosis ? • Necrosis – Dying cells cause further damage due to cellular disintegration. Causes – liquefaction necrosis dead cells liquefy under the influence of certain cell enzymes. Coagulative necrosis – when the cell proteins are altered or denatured and the cells retain some form for a time after death Fat necrosis – fatty tissue is broken down into fatty acids in the presence of infection or certain enzymes Causeos necrosis – form of coagulation necrosis in which a thick yellowish cheesy substance forms. • Infarction: Area of dead cells as a result of oxygen deprivation. In a myocardial infarct (heart attack) the cardiac muscle cells are often killed. Ischemia can lead to infarction. ( Infarction is Irreversible) • Gangrene: Area of necrotic tissue that has been invaded by bacteria. Can be wet, dry, or gaseous gangrene. (when dead tissue is invaded by bacteria). Fluid, Electrolyte, and Acid-Base Imbalance: • The major component of the body is water • Essential to homeostasis • Place for metabolic reactions • Transportation system for the body • Facilitating movements of body parts • Fluid Compartments: Intracellular compartment – fluid inside the cells; major intracellular component is potassium Extracellular compartment – sodium outside of the body. includes intravascular fluid Interstitial fluid Cerebrospinal fluid Transcellular fluids Various secretions 60% of an adult’s body weight is water 70% of an infant’s body weight is water • The amount of water entering the body should equal the amount of water leaving the body. • Fluid intake: ingestion of solid food or fluids • Fluid loss: urine, feces, perspiration, exhaled air • Fluid circulates throughout the body via filtration and osmosis. • Dependent on membrane permeability • Water moves between compartments via: • Can also result from some bacterial toxins or large burn wounds and result in widespread edema. Fluid Excess: 1. Tachypnea greater than 20 breaths per minute (respirations) 2. Edema 3. Low sodium 4. S1S2S3 5. Crackles (abnormal lung sounds) Fluid Deficit: Dehydration: • Insufficient body fluid – inadequate intake Excessive loss Both • Fluid loss often measured by change in body weight • Dehydration more serious in infants • Water loss may be accompanied by loss of electrolytes and proteins (diarrhea) • Increased What causes dehydration? • Vomiting and diarrhea • Excessive sweating with loss of sodium and water • Diabetic ketoacidosis • Loss of fluid, electrolytes, and glucose in the urine • Insufficient water intake in older adults or unconscious persons • Use of concentrated formula in infants Effects of Dehydration: • Dry mucous membranes in the mouth • Decreased skin turgor or elasticity • Lower blood pressure, weak pulse, and fatigue • Increased hematocrit and other lab work • Decreased mental function, confusion, loss of consciousness Sodium Imbalance • Primary cation in ECF • Hyponatremia-too little sodium in the bloodstream • Hypernatremia-too much sodium in the bloodstream • Normal value in the blood = 135-145 Hyponatremia (Sodium is less than 135) • Losses from excessive sweating, vomiting, diarrhea • Use of certain diuretic drugs combined with low-salt diet Potassium Imbalance: • Excreted primarily in urine • Excess potassium ions in interstitial fluid may lead to hyperkalemia. • Abnormal potassium levels cause changes in cardiac conduction and are life-threatening! • Blood level normal value 3.5-5 mEq/L what causes hypokalemia? Excessive loss caused by diarrhea Diuresis associated with some diuretic drugs Excessive aldosterone or glucocorticoids Decreased dietary intake Acid Base imbalance: Alkalosis – Deficit of hydrogen ions Acidosis – Decrease in serum pH (excess hydrogen ions) Respiratory Acidosis – Pneumonia, airway obstruction, chest injuries, Drugs, chronic obstructive pulmonary disease (COPD) Metabolic Acidosis- Diarrhea, renal disease of failure Effects of acidosis – impaired nervous system function