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General Principles of Pathophysiology

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What is the "Powerhouse" of the Cell & What does it do?
The Mitochondrion. Converts Oxygen and Glucose into energy called ATP. Adeno Triphosphate.
What makes up the Human Cell?
Cytoplasm
Organells
Nucleus
Endoplasmic Reticulum
Golgi Apparatus
Mitochondion
Lysosomes
Perkosomes
Endoplasmic Reticulum
A network of small channels within the cell.
*Rough-Synthesis of Proteins
*Smooth Synthesis of Lipids & Carbohydrates.
Golgi Apparatus
Located near the Nucleus. Resposible for synthesis and packaging of secretions such as mucus and enzymes.
DNA
Deoxyribonucleic acid. large molecule nucleic acid found mainly in the chomosomes of the nucleus. Carrier of genetic information. Must be constantly copied and transferred to the cells.
Organelle
Functional units of the cell.
Lysosomes
Contain digestive enzymes. Functions include protection against disease & production of nutrients, breaking down bacteria & organic debris & releasing unusable sugars & amino acids.
Perkosomes
Similar to Lysosomes. Abundant in the liver. Absorb & neutralize toxins such as alcohol.
Chromatin
Tangles of Chromosome filaments containing DNA. Located in the Nucleus.
Differentiation
Causes Cells to be Specialized
7 Major Functions of Cells
Movement: Performed by Muscle Cells
Conductivity: Function of Nerve Cells
Metabolic Absorption: Take in nutrients that pass through the body
Secretion: (glands) hormones, mucus, sweat, Saliva
Excretion: breakdown nutrients & expel waste
Respiration: take in oxygen
Reproduction: enlarge, divide & reproduce themselves.
Tissues
A group of cells that perform a similar function
Epithelial Tissue
Most Prolific. Line inside and outside of body.
Functions: Secretion, Absorption, Diffusion, Filtration
Types: Skin, Mucus Membranes, Lining of intestinal tract
Muscle Tissue
Capability of contaction when stimulated
3 types:
1)Cardiac: spontaneous without stimulation
2) Skeletal- voluntary, striated
3) Smooth: involuntary (intestines, blood vessels)
Cell Hierarchy
Cells-Tissues-Organs-Organ Systems-Organism
Components of the Cardiovascular System
Heart(pump), Blood Vessels, Blood
Components of the Respiratory System
Lungs, Nose, Larynx, Pharynx, Trachea, Bronchi, Bronchioles, Pleura, Alveoli, Diaphragm
Components of the Gastrointestinal System
(GI)
Kidneys, Ureters, Bladder, Urethra
Components of the Reproductive System
Female: Ovaries, Falopian Tubes, Uterus, Vagina
Male: Testes, Prostate, Seminal Vesicles, vas deferens, penis
Components of the Nervous System
Brain, Spinal Cord, All peripheral nerves
Components of the Endocrine System
Pituitary Gland, Pineal Gland, Pancreas, Testes, Ovaries, Adrenal, Thyroid, Parathyroid
Components of the Lyphatic System
Spleen, Lymph Nodes, Lyphatic Channels, Thoracic Duct, Lymph Fluid
Components of the Musculoskeletal System
Primary skeletal muscles, bones, cartilage, connective tissue
Homeostasis and Energy
A significant amount of energy is needed to maintain the order (homeostasis)that is evident in structures (anatomy) and functions (physiology) of the organism
Kinetic Energy
Necessary to maintain homeostasis, obtained by breaking down biochemical bnds of cells and tissues.
Anabolism
Building up of biochemical substances to produce energy
Catabolism
Breaking down of biochemical substances to produce energy
Metabolism
The total changes that take place during physiological processes
Disease
When something interferes with the electrochemical messages cells send to each other.
Endocrine Glands
a.k.a. Ductless Glands. Pituitary, Thyroid, Parathyroid & Adrenal, islets of langerhorns, testes, ovaries. Secrete hormones into the circulatory system where they travel to target organs or tissue.
Exocrine Glands
Secrete sweat, saliva, mucus, and digestive enzymes onto the epithelial surface through ducts.
Signaling
Intercellular Communication
endocrine
paracrine
autocrine
synaptic
Endocrine Signaling
Hormones
Paracrine Signaling
Non-endocrine, Non-hormonal.
Involves chemical mediators by certain cells that act only on nearby cells
Autocrine Signaling
Cells secrete substances that may act uop themselves
Synaptic Signaling
Cels secrete neurotransmitters.
ex: norepinephrine, acetylcholamine, seratonin, dopamine. Transmit across synapses (connection between nerve cells)
receptors
Receive hormones & neurotransmitters, Chemoreceptors respond to chemical stimuli. ex: brain respond to ↑ CO₂
Baroreceptors
Respind o pressure changes. Located in Aortic Arch & Carotid Sinuses along artery. Sences to change in bp. Causes cardiac center in Medula to alter heart rate
Alpha & Beta Adrenic Receptor
On the surface of the cells of the Bronchi, Heart, Blood Vessels. Respond to neurotransmitters & medications. Causes a variety of cardiovascular & respiratory responses.
Afferent & Efferent
Afferent: Move toward the center of an organ or tissue

Efferent: Move away from the center of an organ or tissue
Interaction of Systems
Stressors on a body system are INPUTS.

Response to the INPUT is the EFFECTOR/OUTPUT
Negative Feedback Loop
Body mechanisma that work to reverse or compensate for a pathophysiological process, or to reverse any physiological process.

When the output of a system corrects the situation that created the input

Feedback negates the input caused by the original stressor
Decompensation
When output of effector organse are ineffective in correcting the input condition.

Feedback system doesn't or can't restore homeostasis
Positive Feedback
Enhances rather than negates the efects of input. ex: follicular development in females.
Control Systems
nervous system & Endocrine system work together to maintain homeostasis

Nervous system response in rapid

Endocrine response in longer
Pathology
Study of Disease and its Cause
Pathopysiology
The physiology of disordered function
Cellular Adaptation
Ability of body to change to meet its needs. Adaptation to external stressors result in alterations in structure & function at the cellular level.
Atrophy
Decrease in cell size. May occur from disease, decrease in nutrients, ischemia, decrease blood supply
Hypertrophy
increase in cell size to meet increasing demands. Most commonly affects cells of heart & kidneys.
Hyperplasia
Increase in number of cells, resulting from increased workload. Also includes Mitosis (DNA Dup.)in nucleus. Very commonly seen in Hypertrophy.
Metaplasia
Replacement of one type of cell by another type of cell. (not normal). Commonly seen in respiratory tract as a result from ciggarette smoke. high risk of malignancy.
Dysplasia
Changing structure of cells. Change in cell size, shape or appearance caused by an external stressor. High risk of malignancy. Cells must be killed.
Cellular Injury
Cell injury can change cell function. 7 most common:
Hypoxia, Chemical, Infectious, Immunologic/Inflammatory, injurious Physical, Injurious Nutritional, injurious genetic.
Cell injury: Hypoxia
Most Commin cause of injury.
-Lack of environmental oxygen
-occluded airway
-COPD
-CHF
-Arterial Blockage (ischemia)
Cell Injury: Infectious
Pathogens; Disease & infection causing bacteria, viruses, fungi & parasites
Virulence
Power of Microbe to cause disease.
Dependent on:
Pathogens ability to contain or destroy cells.
Ability to produce toxins.
Ability to produce hypersensitivity (allergic reactions)
Pathogen vs. Body
What are the 3 outcomes
1. pathogen wins
2. pathogen and body battle to a draw
3. body defeats pathogen
Cellular Swelling
Caused by injury or a change to the permeablilty of the cell membrane with resulting inability to maintain stable intra and extracellular fluid and electrolyte levels.
Most frequent cause of injury.
Will eventually rupture (lyse) and release chemical mediator which will can cause chemical reaction.
Fatty Change
Lipids invade area of injury. An ominous sign of inpending cellular destruction. Commonly occur in Liver, Kineys and Heart.
Cortisone/Cortisol
A steroid hormone made in the liver to treat inflammation. Can cause cells to retain fat.
Signs and Symptoms of Cellular Injury
Fatigue/Malaise
Altered Appetite (increase or decrease)
Fever
increased heart Rate (with fever and pain)
Lab tests may reveal increased white blood cell count.
Apoptis
Response in which an injured cell releases enzymes that engulf and destroy itself
Necrosis
Cell Death. 4 types:
Coagulative
Liquefactive
Caseous
Fatty
gangrenous
Coagulative necrosis
Generally from Hypoxia. albumin becomes opaque like an egg white. Commonly occurs in the kidneys, heart, adrenal glands.
Liquefactive necrosis
Cells become liquid and contained in walled cysts. Common in ischemic death of neurons and brain cells
Caseous necrosis
Common in TB take on cottage cheese like consistency.
Fatty necrosis
Common in Breast and Abdomen structures. Fatty acids combine with calcium, solium & magnesium ions to create soap. Soponification. The dead tissue is opaque and white.
Gangrenous necrosis
Dry Gangrene: affects skin, dry, shrunken. Common in lower ext.
Wet Gangrene: liquefactive, usually internal organs
Gas Gangrene: Result of bacterial infection. Gas bubbles in cells. Can cause death from shock.
Acid-Base balance Formula
H+ + HCO3 ↔ H2CO3 ↔ H2O + CO2

Hydrogen ion + bicarbonate ion ↔ carbonic acid ↔ Water + carbon dioxide
Acid base Values
Ph= 7.35 - 7.45 (↑Alk./↓ Acid)
Bicarbonate (base/metabolic)= 18 - 24 (↑Alk./↓ Acid)
Co2= 35 - 45 (acid/respiratory)(↑Acid/↓ Alk.)
Hydrogen H+
Cells produce Hydrogen (when cells break down they release more H) increase in H causes body to be metabolic.

20:1 = 20(HCO3):1(H+)
Buffer System
Body tries to buffer system out. The fastest mechanism
Two components of this system are bicarbonate ion HCO3- and carbonic acid H2CO3 and are normally in equilibrium with hydrogen H+
Respiratory mechanism
If buffer system cannot balance system
2nd buffer system
Increased respirations cause increase elimination of CO2 which causes a decrease in hydrogen ions and an increase in pH.
Kidney Mechanism
Last buffer system. seen in extreme illness.
Metabollic Acidosis
Acidity caused by an increase in acid due to production on metabolism or from causes such as voliting, diarrhea, diabetes or medication

↑H+ + HCO3 → ↑ H2CO3 → H2O + ↑CO2
Metabollic Alkalosis
Alkalinity caused by an increase in plasma bicarbonate resulting from causes including diuresis, vomiting, or ingestion of too much sodium bicarbonate.

↓H+ + HCO3 → ↓ H2CO3 → H2O + ↓CO2
Respiratory Acidosis
Acidity caused by abnormal retention of carbon dioxide resulting from impaired ventillation.

↓Respiration = ↑CO2 + H2O → ↑ H2CO3 → ↑H+ + HCO3
Respiratory Alkalosis
Alkalinity caused by excessive elimination of carbon dioxide resulting from increased respirations.

↑respirations = ↓CO2 + H2O → ↓H2CO3 → ↓H+ + HCO3
Where Water is Found and its percentages
Intracellular Fluid = 75%
Extracellular Fluid = 25%
Intravascular = 7.5%
Interstitial = 17.5%
Dehydration and its causes
Decrease in body water

GI Loss (vomiting)
insensible Loss (perspiration)
Sweating
Internal Loss (3rd space; peritonitis, pancreatitis, bowel obstruction)
Plasma Loss: burns, surgical drains & fistulas
Overhydration
Retention of abnormally high amount of body fluid.
Major sign is edema.
in severe casses, heart failure may occur.
Electrolytes
Substance that, in water, separates into electrically charged particles
Sodium Na+
Most prevalent Cation in extracellular fluid.
Water follows sodium.
Important in transmission of neuron impulses.
Hypernatremic, Hyponatremic
Potassium K
Most prevelent intracellular cation.
Important for muscle contraction.
hyperkalemia, hypokalemia.
Calcium Ca++
Works with solium.
Allows solium to do its job. Helps cells to work appropriately.
Hypercalcemia, Hypocalcemia
Magnesium Mg++
Closely associated with phosphate.
Hypermagnesemia, hypomagnesemia.
Cloride Cl+
Negative charge balances the positive charge of cations.
Major role in fluid balance and renal function.
Associated with Solium.
Bicarbonate HCO3
Bicarbonate is the principal buffer of the body. It neutralizes the highly acidic hydrogen ion.
Phosphate HCO4
important in body energy stores. Closely associated with magnesium in renal function. Acts as a buffer primarily in the intracellular space most like bicarbonate.
Isotonic
Equal in concentration of solute molecules, solutions may be isotonic to eachother.

Body always works to keep itselve isotonic.
Hypertonic
Having greater concentration of solute molecules; one solution may be hypertonic to another
Hypotonic
having a lesser concentration of solute molecules; one solutions may be hypotonic to another
Osmotic Gradient
The difference in concentration between solutions on opposite sides of a semipermeable membrane
Diffusion
The movement through a membrane from an area of greater concentration to an area of lesser concentration
Osmosis
Movement of water from higher concentration to lower concentration.
Solutes
Because water is a solute, it moves from an area of lower solute concentration to an area of higher concentration
Osmolity
Value of water
Active Transport
Movement of a substance across the cell membrane against the osmotic gradient (toward the side of higher concentration of that substance)
Faster that diffusion.
Requires energy
Facillitated Diffusion
Certain molecules can move across the cell membrane with assistance of "helper proteins". Ex: glucose.
Depending on the substance, this process may or may not require energy.
Osmotic Pressure
The pressure exerted by the concentration of solutes on one side of a membrane that, if hypertonic, tends to pull water from the other side of the membrane
Oncotic Force
A form of osmotic pressure exerted by the large protein particles, or colloids, present in blood plasma.In the capillaries, the plasma colloids tend to pull water from the interstitial space across the capillary membrane into the capillary. Oncotic force is also called colloid osmotic pressure
Hydrostatic Pressure
Blood pressure or force against vessel walls created by the heartbeat. Hysrostatic pressure tends to force water out of the capillaries into the interstitial space.
Filtration
Movement of water out of the plasma across the capillary membrance into the interstitial space.
Net Filtration
The total loss of water from blood plasma across the capillary membrane into the interstitial space. Normally net filtration is Zero.
Edema and causes
Excess fluid in the interstitial space. Severe edems can result in dehydration.
Caused by:
a decrease in plasma oncotic force.
An increase in hydrostatic pressure.
Increase capillary permeability.
Lymphatic Channel obstruction
Blood Components
Red blood Cells 45%
Plasma 54%
White blood Cells & Platelets 1%
Hematocrit
The percentage of blood occupied by erythrocytes
plasma
The liquid part of the blood
Erithrocytes
Red blood cells; which contain hemoglobin, which transports oxygen to the cells
leukocytes
White Blood Cells which play a key role in the immune system and inflammatory responses.
Types:
Monocyte
Eosinophil
Basophil
Neutrophil
Lymphocytes
Platelets
Thrombocytes
Platelets, which are important in blood clotting
Transfusion reaction
occur when there is a discrepancy between blood type of the pt. and blood being transfused.
A rapid IV fliud infusion should be started.
S&S:
Fever, Chills, Hives, Hypotension, palpitations, tachycardia, flushing, headaches, LOC, N/V, SOB.
HBOCs
hemoglobin-based oxygen carrying solutions
IV fluids that have the capability to transport oxygen and are compatible with all blood types. (not used in Prehospital care)
Colloids
Substances such as proteins or starches consisting of large molecule aggregates that disperse evenly within a liquid without forming a true solution.
Not used in Prehospital setting
Crystalloids
Substances capable of crystallization. In solution, unlike colloids, they can diffuse through a membrane such as a capillary wall.
Tonicity
Solute concentration or osmotic pressure relative to the blood plasma or body cells
Effects of IV fluids on red blood cells
Hypertonic (dextran/plasmanate)cell becomes crenated (shrunken.
Isotonic (NaCl, Lactaed Ringers) Normal cell.
Hypotonic (D5W) Swollen, Lysed.
Most Commonly Used Solutions in Prehospital Care
Lactated Ringers: Isotonic
NaCl (normal saline): Isotonic
D5W (dextrose in water): Hypotonic
How many chromosomes in a human somatic cell?
46 Chromosomes, 23 pairs. 23 from mother, 23 from father. Sex cells only contain 23 chromosomes.
Clinical factors of Disease
Host: congenital
Agent: pathogen
Environment: lifestyle, culture, demographics
Epidemiology Factors of Disease
incidence:number of new cases in a given period.
Prevalence: proportion of the total population.
Motality: the rate of death from the disease
Morbidity
An illness or abnormall condition or quality.
Immunologic Disorders
More prevalent among those with a family history of the disorder but also involves other risk factors. ex: Rheumatic Fever, Allergies, Asthma
Cancer
A wide variety of family history and environmental factors are included among risk factors.
Endocrine Disorder
Most common is Diabetes. Both Family Hx, and Lifestyle.
Hematologic Disorders
Genetic factors. ex: Hemophilia, Hemochromotosis.

Anemia: not genetic.
Rheumatic Disorder
Gout- may be both genetic and environmental. Sever arthritic pain caused by crystals in the joints. High levels of uric acid.
Hypoperfusion
Shock is a condition that is progessive and fatal if not corrected. inadequate perfusion of the body tissues.
Shock
Hypoprofusion: occurs 1st at the cellular level. If allowed to progress, the tissues, organs, organ systems and ultimately the entire organism is affected.
Preload
Amount of blood delivered to the heart during diastole. Depends on venous return.
Cardiac Contractile Force

Frank Starling's Mechanism
The greater the volume of preload, the more the ventricles are stretched. The greater the stretch, the greater the contraction.
Catecholamines
Epinephrine and norepinephine, hormones that strongly affect the nervous and cardiovascular systems, metabolic rate, temp., and smooth muscle.

Controlled by the sympathetic nervous system
Afterload
The resistence a contraction of the heart must overcome in order to eject blood; in cardiac physiology, defined as the tension of cardiac muscle during systole.
Cardiac Output
The amount of blood pumped by the heart in 1 minute (computed as stroke volume (sv) x heart rate (hr))
Peripheral Vascular Resistence
The resistence of the vessels to the flo of vlood: increased when the vessels constrict, decreased when the vessels relax.
Compensatory mechanism
the body keeps bp relatively constat using baroreceptors.
Precapillary Sphincter
Located at the origin of the capillary. Responds to local tissue conditions such as acidosis and hypoxia and opens as more artial blood is needed.
postcapillary Sphincter
opens when blood is to be emptied into the venous system
Partial Pressure of oxygen

PaO2
Present in air in the alveoli of the lungs is greater that the partial pressure of oxygen in the blood within the pulmonary circulation.
Thoracic Duct
Common trunk of many lymphatic vessels in the body. Begins high in the abd. enters the chest through the diaphram and goes up into the neck.
Aerobic Metabolism
The second stage of metabolism, requiring the presence of oxygen in which the breakdown of glucose (Krebs cycle) yieldsa high amount of energy (ATP)
Anaerobic Metabolism
The 1st stage of metabolism hich does not require oxygen, in which the breakdown of glucose (glycolosis) produces pyruvic acid and yields very little energy.
Fick Principle
The movement and utilization of oxygen by the body is dependent upon:
-Adequate concentration of inspirted oxygen.
-appropriate movement of O2 across alveolar/capillary.
-Adequate number of RBC to carry the O2
-Proper tissue perfusion
_Efficiant off-Loading of O2 at the tissue level.
Stages of Shock
Compensated
Decompensated
Irreversible
Compensated Shock
Early stage of shock during which the body's compensatory mechanisms are able to maintain normal perfusion.
Decompensated Shock
Advanced stages of shock when the body's compensatory mechanism are no longer able to maintain normal perfusion; also called progressive shock
irreversable Shock
Shock that as progressed so far that no medical intervention can reverse the condition and death is inevitable. Clayton stages extremely aggressive intervention may reverse shock (very rare)
Types of Shock
Cardiogenic
Hypovolemic
neurogenic
Anaphylactic
Septic
Cardiogenic Shock
Shock caused by insufficient cardiac output; the inability of the heart to pump enough blood to perfuse all parts of the body.
usually result of severe left ventrical failure secondary to AMI or CHF.

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