TEST 3 - Advanced Pathophysiology
Summer 2018 UTA 5315
*Cerebellar Tonsillar Herniation* - ANS-*Most common* type of brain herniation
Patho: Downward movement of the cerebellum through the foramen magnum
Signs: *Stiff neck, decreased LOC, respiratory abnormalities, pulse variations*
\3 stages of shock - ANS-1. Nonprogressive. Early shock. In an attempt to maintain
perfusion, heart rate increases & vasoconstriction occurs to maintain perfusion and increase
blood pressure.
2. Progressive. The body is no longer able to compensate. Hypoxia, anaerobic cellular
metabolism (creation of energy with carbs in the absence of oxygen), & production of lactic
acid. MULTI-ORGAN FAILURE OCCURS.
3. Irreversible shock. Organs are permanently and severely damaged. The patient will not
survive.
\4 stages of Chronic Traumatic Encephalopathy - ANS-The higher the number, the more
widespread the tau protein accumulation & worse the disease
Stage I: p-tau neurofibrillary tangles are isolated to cerebral cortex
Stage 4: p-tau proteins are widespread throughout brain
\Acute Confusional State (Delirium) - ANS-Sudden cerebral dysfunction; patient may be
normal one minute and delirious the next.
Signs: Confusion, agitation, memory impairments, distractibility, compulsive behavior,
obsessions
Causes are usually correctable: ETOH withdrawal, drug intoxication, siezures, electrolyte
imbalances (sodium & calcium), hypoglycemia, hypoxia, hypercapnia, infection, head injury
\Acute Coronary Syndrome - ANS-Broad term which emcompasses three diagnoses:
Unstable angina, Non ST Elevation Myocardial Infarction, ST elevation infarction
\Acute Respiratory Distress Syndrome - ANS-Type of respiratory failure which results from
massive lung inflammation and widespread alveolar capillary damage
Damage significantly impairs gas exchange and the patient will have significant issues with
oxygenation
Causes: Pneumonia, sepsis, massive trauma, burns, aspiration, DIC, pancreatitis
\Acute Respiratory Failure - ANS--Hypoxemia resp. failure = PaO2 less than or equal to 50
(norm 80-100)
-Hypercapnia resp. failure = PaCO2 greater than or equal to 50 (norm 35-45)
-In either case, main disfunction is an impairment in diffusion
,\All Hematomas... - ANS--Compress brain tissue
-Increase intracranial pressure
-Brain herniation if bleed is not resolved
\Alzheimer's Disease - ANS-Most common form of dementia
Death occurs 5-10 years after onset
\Alzheimer's Patho - ANS-1. Accumulation of amyloid (starch like protein) in brain
2. Accumulation causes neufibrillary tangles (distortion & twisting of neurons)
3. Senile plaques form
4. Senile plaques lead to disrupted nerve impulse transmission and neuron death
\Anaphylactic Shock - ANS-Results from pathologic immune and inflammatory reaction to an
antigen, leading to widespread VASODILATION.
Type I hypersensitivity.
IgE mediated.
\Anterior Cerebral Artery - ANS-Occlusion of this artery results in *contralateral (opposite of
injury) hemiparesis* and *loss of sensation*; symptoms will be more present in *lower
extremities*
\Anterior Inferior Artery - ANS-Occlusion would cause vomiting, vertigo, nystagmus (eyes
flutter), decreased lacrimation (tears production), decreased taste, decreased corneal reflex,
decreased pain and temperature sensation in face, decreased ipsilateral (same side as
injury) hearing
\Aortic Valve Regurgitation - ANS--Valve is TOO WIDE or TOO NARROW, blood doesn't
pass through effectively, causing back flow of blood into the left ventricle
-Marked by EARLY DIASTOLIC MURMUR (on systole, heart contracts and pushes blood up
the aorta, but on diastole, heart relaxes and ineffective aortic valve is not able to hold blood
up in aorta, so blood falls and makes a swish sound, which is the murmur)
-Most commonly caused by AORTIC ROOT DILATION(starting point of aorta is too wide)
-Other causes: infective endocarditis, rheumatic fever, aortitis from syphilis, coarctation
(congenital narrowing of aorta), aortic dissection (tear), ankylosing spondylitis (inflammatory
arthritis)
-Acute: increases left ventricular end-diastolic pressure (LVEDP) (increased blood back
down in the left ventricle increases pressure), decreased stroke volume (not much blood is
being pushed from left ventricle because blood's backed up and overwhelming left ventricle),
normal or decreased pulse pressure, decreased cardiac output (aorta is not effectively
pumping blood from heart)
Chronic: Body adjusts; LVEDP normalizes, systolic bp increases (compensation: harder
contraction to push blood out of aorta before it falls back down to left ventricle), diastolic bp
decreases (compensation: decreased relaxation of heart to stop blood from seeping back
out of aorta), cardiac output is normal, pulse pressure is increase. Blood ultimately is backed
up into the left atrium and pulmonary circulation.
\Aortic Valve Stenosis - ANS--Most common valvular disease
-Most common causes are aortic valve CALCIFICATION (stiffening) in people over 60;
congenital aortic valve stenosis in people less than 30
-Normal valve 3 cm; symptoms seen when valve less than 1 cm; severe when valve is less
than 0.5 cm
, -Narrowed valve prevents outflow from left ventricle to aorta. This backs up blood to the left
atrium and ultimately floods the lung causing PULMONARY EDEMA
S/Sx: Pulmonary hypertension/edema, poor outflow of aorta to body (aorta sends out
oxygenated blood to body), causing fainting or chest pain
Simplified: Aorta is stiff and can't send out oxygenated blood properly to the body, depriving
tissues of oxygen. Blood gets backed up into lungs, causing pulmonary edema.
\Aseptic Meningitis - ANS-Causitive organism can't be found or it's viral
\Asthma - ANS--Reactive airway disease triggered by an allergic reaction
-IgE mediated reaction
-Airway narrows, causing dyspnea and wheezing
-Results in smooth muscle hypertrophy, goblet cell hyperplasia, thickening and hyalinization
of the basement membranes, proliferation of eosinophils, bronchial mucous plugs.
-Exacerbations often trigged by viral infection.
-RSV is most common asthma trigger for infants and toddlers
\Asthma in Children - ANS--Affects boys more often
-Severity is largely based on socioeconomic status
-Vit D deficiency may play a role in asthma. Vit D is anti-inflammatory and mediates t-cell
immune responses
-RSV is most common asthma trigger for infants and toddlers
\Atherosclerosis Causes - ANS--Begins with tissue injury
Sources of injury:
CIGARETTES (toxins)
Hypertension (increased force of the blood hitting the blood vessel can weaken it)
Diabetes
Hyperlipidemia (lipids take place of endothelial cells lining the blood vessel, initiating an
inflammatory response)
\Atrial Septal Defect
(most common congenital heart defect in adults) - ANS--Most common cause is a patent
foramen ovale (hole) that does not close
-Associated with FETAL ALCOHOL SYNDROME and DOWN SYNDROME
-Sign: Midsystolic murmur at upper sternal border
-Increases risk for EMBOLUS
\Automatisms - ANS-May include lip smacking, chewing, facial grimacing, swallowing
movements, patting, picking, rubbing oneself or clothes
\Basilar Artery - ANS-Occlusion results in *quadriplegia*,
*loss* of voluntary *facial*, mouth, and tongue *movements*
*Consciousness will remain intact.*
*LOCKED-IN SYNDROME*
\Brain hernation - ANS-Pressure in brain moves brain tissue
Potentially deadly
\Brudzinski's Sign - ANS-Severe *neck stiffness*
(*Bruh, I can't move my neck = Brudzinski's*) Sign of MENINGITIS (possibly secondary to
subarachnoid hemorrhage)
\Cardiogenic Shock - ANS-Results in COLLAPSE OF CIRCULATORY SYSTEM secondary
to pump failure. TYPICALLY CAUSED BY MYOCARDIAL INFARCTION. Left ventricular
systole fails and is not able to maintain cardiac output, blood pressure, or perfusion. In any
shock state, vasoconstriction occurs. This increases the workload of the heart, making it
more difficult for the left ventricle to pump blood, worsening the shock state.
Summer 2018 UTA 5315
*Cerebellar Tonsillar Herniation* - ANS-*Most common* type of brain herniation
Patho: Downward movement of the cerebellum through the foramen magnum
Signs: *Stiff neck, decreased LOC, respiratory abnormalities, pulse variations*
\3 stages of shock - ANS-1. Nonprogressive. Early shock. In an attempt to maintain
perfusion, heart rate increases & vasoconstriction occurs to maintain perfusion and increase
blood pressure.
2. Progressive. The body is no longer able to compensate. Hypoxia, anaerobic cellular
metabolism (creation of energy with carbs in the absence of oxygen), & production of lactic
acid. MULTI-ORGAN FAILURE OCCURS.
3. Irreversible shock. Organs are permanently and severely damaged. The patient will not
survive.
\4 stages of Chronic Traumatic Encephalopathy - ANS-The higher the number, the more
widespread the tau protein accumulation & worse the disease
Stage I: p-tau neurofibrillary tangles are isolated to cerebral cortex
Stage 4: p-tau proteins are widespread throughout brain
\Acute Confusional State (Delirium) - ANS-Sudden cerebral dysfunction; patient may be
normal one minute and delirious the next.
Signs: Confusion, agitation, memory impairments, distractibility, compulsive behavior,
obsessions
Causes are usually correctable: ETOH withdrawal, drug intoxication, siezures, electrolyte
imbalances (sodium & calcium), hypoglycemia, hypoxia, hypercapnia, infection, head injury
\Acute Coronary Syndrome - ANS-Broad term which emcompasses three diagnoses:
Unstable angina, Non ST Elevation Myocardial Infarction, ST elevation infarction
\Acute Respiratory Distress Syndrome - ANS-Type of respiratory failure which results from
massive lung inflammation and widespread alveolar capillary damage
Damage significantly impairs gas exchange and the patient will have significant issues with
oxygenation
Causes: Pneumonia, sepsis, massive trauma, burns, aspiration, DIC, pancreatitis
\Acute Respiratory Failure - ANS--Hypoxemia resp. failure = PaO2 less than or equal to 50
(norm 80-100)
-Hypercapnia resp. failure = PaCO2 greater than or equal to 50 (norm 35-45)
-In either case, main disfunction is an impairment in diffusion
,\All Hematomas... - ANS--Compress brain tissue
-Increase intracranial pressure
-Brain herniation if bleed is not resolved
\Alzheimer's Disease - ANS-Most common form of dementia
Death occurs 5-10 years after onset
\Alzheimer's Patho - ANS-1. Accumulation of amyloid (starch like protein) in brain
2. Accumulation causes neufibrillary tangles (distortion & twisting of neurons)
3. Senile plaques form
4. Senile plaques lead to disrupted nerve impulse transmission and neuron death
\Anaphylactic Shock - ANS-Results from pathologic immune and inflammatory reaction to an
antigen, leading to widespread VASODILATION.
Type I hypersensitivity.
IgE mediated.
\Anterior Cerebral Artery - ANS-Occlusion of this artery results in *contralateral (opposite of
injury) hemiparesis* and *loss of sensation*; symptoms will be more present in *lower
extremities*
\Anterior Inferior Artery - ANS-Occlusion would cause vomiting, vertigo, nystagmus (eyes
flutter), decreased lacrimation (tears production), decreased taste, decreased corneal reflex,
decreased pain and temperature sensation in face, decreased ipsilateral (same side as
injury) hearing
\Aortic Valve Regurgitation - ANS--Valve is TOO WIDE or TOO NARROW, blood doesn't
pass through effectively, causing back flow of blood into the left ventricle
-Marked by EARLY DIASTOLIC MURMUR (on systole, heart contracts and pushes blood up
the aorta, but on diastole, heart relaxes and ineffective aortic valve is not able to hold blood
up in aorta, so blood falls and makes a swish sound, which is the murmur)
-Most commonly caused by AORTIC ROOT DILATION(starting point of aorta is too wide)
-Other causes: infective endocarditis, rheumatic fever, aortitis from syphilis, coarctation
(congenital narrowing of aorta), aortic dissection (tear), ankylosing spondylitis (inflammatory
arthritis)
-Acute: increases left ventricular end-diastolic pressure (LVEDP) (increased blood back
down in the left ventricle increases pressure), decreased stroke volume (not much blood is
being pushed from left ventricle because blood's backed up and overwhelming left ventricle),
normal or decreased pulse pressure, decreased cardiac output (aorta is not effectively
pumping blood from heart)
Chronic: Body adjusts; LVEDP normalizes, systolic bp increases (compensation: harder
contraction to push blood out of aorta before it falls back down to left ventricle), diastolic bp
decreases (compensation: decreased relaxation of heart to stop blood from seeping back
out of aorta), cardiac output is normal, pulse pressure is increase. Blood ultimately is backed
up into the left atrium and pulmonary circulation.
\Aortic Valve Stenosis - ANS--Most common valvular disease
-Most common causes are aortic valve CALCIFICATION (stiffening) in people over 60;
congenital aortic valve stenosis in people less than 30
-Normal valve 3 cm; symptoms seen when valve less than 1 cm; severe when valve is less
than 0.5 cm
, -Narrowed valve prevents outflow from left ventricle to aorta. This backs up blood to the left
atrium and ultimately floods the lung causing PULMONARY EDEMA
S/Sx: Pulmonary hypertension/edema, poor outflow of aorta to body (aorta sends out
oxygenated blood to body), causing fainting or chest pain
Simplified: Aorta is stiff and can't send out oxygenated blood properly to the body, depriving
tissues of oxygen. Blood gets backed up into lungs, causing pulmonary edema.
\Aseptic Meningitis - ANS-Causitive organism can't be found or it's viral
\Asthma - ANS--Reactive airway disease triggered by an allergic reaction
-IgE mediated reaction
-Airway narrows, causing dyspnea and wheezing
-Results in smooth muscle hypertrophy, goblet cell hyperplasia, thickening and hyalinization
of the basement membranes, proliferation of eosinophils, bronchial mucous plugs.
-Exacerbations often trigged by viral infection.
-RSV is most common asthma trigger for infants and toddlers
\Asthma in Children - ANS--Affects boys more often
-Severity is largely based on socioeconomic status
-Vit D deficiency may play a role in asthma. Vit D is anti-inflammatory and mediates t-cell
immune responses
-RSV is most common asthma trigger for infants and toddlers
\Atherosclerosis Causes - ANS--Begins with tissue injury
Sources of injury:
CIGARETTES (toxins)
Hypertension (increased force of the blood hitting the blood vessel can weaken it)
Diabetes
Hyperlipidemia (lipids take place of endothelial cells lining the blood vessel, initiating an
inflammatory response)
\Atrial Septal Defect
(most common congenital heart defect in adults) - ANS--Most common cause is a patent
foramen ovale (hole) that does not close
-Associated with FETAL ALCOHOL SYNDROME and DOWN SYNDROME
-Sign: Midsystolic murmur at upper sternal border
-Increases risk for EMBOLUS
\Automatisms - ANS-May include lip smacking, chewing, facial grimacing, swallowing
movements, patting, picking, rubbing oneself or clothes
\Basilar Artery - ANS-Occlusion results in *quadriplegia*,
*loss* of voluntary *facial*, mouth, and tongue *movements*
*Consciousness will remain intact.*
*LOCKED-IN SYNDROME*
\Brain hernation - ANS-Pressure in brain moves brain tissue
Potentially deadly
\Brudzinski's Sign - ANS-Severe *neck stiffness*
(*Bruh, I can't move my neck = Brudzinski's*) Sign of MENINGITIS (possibly secondary to
subarachnoid hemorrhage)
\Cardiogenic Shock - ANS-Results in COLLAPSE OF CIRCULATORY SYSTEM secondary
to pump failure. TYPICALLY CAUSED BY MYOCARDIAL INFARCTION. Left ventricular
systole fails and is not able to maintain cardiac output, blood pressure, or perfusion. In any
shock state, vasoconstriction occurs. This increases the workload of the heart, making it
more difficult for the left ventricle to pump blood, worsening the shock state.
