NR283 Pathophysiology Study Guide for Exam 1
Chapter 01
1. Describe the cellular adaptations made in each of the following processes:
Atrophy- refers to a decrease in the size of cells, resulting in a reduced tissue mass.
Hypertrophy- refers to an increase in the size of individual cells, resulting in an enlarged tissue mass
Hyperplasia- is defined as an increased number of cells resulting in an enlarged tissue mass.
Dysplasia- is the term applied to tissue in which the cells vary in size and shape, large nuclei are frequently present, and the rate of mitosis is
increased.
Metaplasia- occurs when one mature cell type is replaced by a different mature cell type.
2. Discuss causative factors of each of the above cellular adaptations.
Atrophy- reduced use of the tissue, insufficient nutrition, decreased neurologic or hormonal stimulation, and aging. EX: is the shrinkage of
skeletal muscle that occurs when a limb is immobilized in a cast for several weeks.
Hypertrophy- increase may be caused by additional work by the tissue, as demonstrated by an enlarged heart muscle resulting from increased
demands. A common example of hypertrophy is the effect of consistent exercise on skeletal muscle, leading to an enlarged muscle mass.
Excessive hormonal stimulation may also stimulate cell growth.
Hyperplasia- hypertrophy and hyperplasia occur simultaneously, as in the uterine enlargement that occurs during pregnancy.
Hyperplasia may be a compensatory mechanism to meet increased demands, or it may be pathologic when there is a
hormonal imbalance.
In certain instances there may be an increased risk of cancer when hyperplasia occurs.
Dysplasia- Dysplastic changes often are encountered in epithelial tissue of the cervix and respiratory tract, where they are strongly associated
with common neoplastic growths and often are found adjacent to cancerous cells.
Metaplasia- an adaptive mechanism that provides a more resistant tissue—for instance, when stratified squamous epithelium replaces ciliated
columnar epithelium in the respiratory tracts of cigarette smokers.
3. Identify the most common cause of cellular injury.
• Ischemia, a decreased supply of oxygenated blood to a tissue or organ, due to circulatory obstruction
Decreased oxygen in the tissue may occur locally because of a blocked artery or systemically because of respiratory impairment. Cells with a
high demand for oxygen, such as those of the brain, heart, and kidney, are quickly affected by hypoxia (reduced oxygen in the tissue). A severe
oxygen deficit interferes with energy (ATP) production in the cell, leading to loss of the sodium pump at the cell membrane as well as loss of
other cell functions.
4. Describe cellular injury caused by infection and inflammation.
Infectious diseases cause cell injury through the actions of microorganisms (living organisms too small to be seen with the naked eye) such as
bacteria and viruses. Certain types of intracellular microorganisms induce a type of cell death referred to as pyroptosis. Pyroptosis differs from
apoptosis in that pyroptosis results in the lysis or dissolution of the cell, releasing destructive lysosomal enzymes into the tissue, which
cause inflammation (swelling, redness, and pain) as well as damage to nearby cells and reduced function. The apoptotic bodies formed through
apoptosis do not cause an inflammatory response as they are quickly engulfed through phagocytosis. Some genetic defects or inborn errors of
metabolism can lead to abnormal metabolic processes. Altered metabolism leads to the accumulation of toxic intermediary compounds inside the
cells, ultimately destroying them.
1
,5. Describe the major mechanism of tissue damage caused by chemical injury.
Chemicals from both the environment (exogenous) and inside the body (endogenous) may damage cells, either by altering cell membrane
permeability or producing other reactive chemicals, known as free radicals, which continue to damage cell components. I
6. Discuss the manifestations of the four major types of necrosis, and give examples of the tissue types affected by each type of necrosis.
Necrosis is the term used when a group of cells die and cause further damage due to cellular disintegration.
• Liquefaction necrosis refers to the process by which dead cells liquefy under the influence of certain cell enzymes. This process occurs when
brain tissue dies or in certain bacterial infections in which a cavity or ulcer may develop in the infected area
• Coagulative necrosis occurs when the cell proteins are altered or denatured (similar to the coagulation that occurs when cooking eggs), and the
cells retain some form for a time after death. This process typically occurs in a myocardial infarction (heart attack) when a lack of oxygen causes
cell death
• Fat necrosis occurs when fatty tissue is broken down into fatty acids in the presence of infection or certain enzymes. These compounds may
increase inflammation.
• Caseous necrosis is a form of coagulation necrosis in which a thick, yellowish, “cheesy” substance forms. Tuberculosis (TB) offers an
interesting example of caseous necrosis
7. Discuss apoptosis.
Apoptosis refers to programmed cell death, a normal occurrence in the body, which may increase when cell development is abnormal, cell
numbers are excessive, or cells are injured or aged.
Cells self-destruct, appearing to digest themselves enzymatically, and then disintegrate into vesicles called apoptotic bodies. These vesicles are
quickly engulfed through phagocytic activity without eliciting an inflammatory response.
8. Discuss the types of tissue necrosis.
Gangrene refers to an area of necrotic tissue, usually associated with a lack or loss of blood supply that is followed by invasion of bacteria.
Necrotic tissue can provide a good medium for infection by microorganisms. Such an infection frequently occurs after an
infarction in the intestines or in a limb in which blood supply is deficient and bacteria are normally present. Depending on
its location, gangrene may be described as wet or dry.
Dry gangrene is often caused by coagulative necrosis in which the tissue dries, shrinks, and blackens.
Wet gangrene is a result of liquefaction causing the tissue to become cold, swollen, and black.
Gas gangrene is caused by the buildup of gases within tissue and further reduces blood supply.
Gangrenous tissue frequently must be removed surgically (eg, by amputation) to prevent the spread of infection to other parts of the body.
Chapter 02: Fluids and Electrolytes, Acids and Bases
1. Discuss the two functional fluid compartments of the body.
Fluid is distributed between the intracellular compartment (ICF), or fluid inside the cells, and the extracellular compartment (ECF).
ECF includes the following:
• Intravascular fluid (IVF) or blood
• Interstitial fluid (ISF) or intercellular fluid
• Cerebrospinal fluid (CSF)
• Transcellular fluids present in various secretions, such as those in the pericardial (heart) cavity or the synovial cavities of the joints
2
, 2. Discuss the ways water moves between plasma and interstitial fluid.
Water moves between the vascular compartment or blood and the interstitial compartment through the semipermeable capillary membranes,
depending on the relative hydrostatic and osmotic pressures within the compartments
A major factor in the movement of water through cell membranes is the difference in osmotic pressure between the cell and the interstitial fluids.
As the relative concentrations of electrolytes in the interstitial fluid and intracellular fluid change, the osmotic pressure also changes, causing
water to move across the cell membrane by osmosis. For example, if an erythrocyte is placed in a dilute hypotonic solution (low osmotic
pressure), water may enter the cell, causing it to swell and malfunction.
3. Describe the causation, pathophysiologic process, and clinical manifestations of edema.
Causes:
Increased hydrostatic pressure
Decreased plasma oncotic pressure
Decreased production or loss of plasma proteins
Increased capillary membrane permeability
Obstruction of lymph flow
Pathophysiologic Process:
Hydrostatic pressure increase as a result of obstruction or water/salt retention
Venous obstruction pushes fluid into the capillaries
Fluid in the tissues accumulate and cause swelling
Clinical Manifestations:
-Local Edema
Swelling in a local area such as a finger
Can occur within an organ system such as: cerebral, pulmonary and cardiovascular
-Generalized Edema
Uniform distribution of fluid in gravity areas such as legs and feet
Pitting edema: a pit left in the skin after finger has been removed
4. Discuss the regulatory processes for sodium and water balance in the body, including the role of antidiuretic hormone, renin-angiotensin-
aldosterone
Antidiuretic Hormone:
- A relatively small (peptide) molecule that is released by the pituitary gland at the base of the brain after being made nearby (in the
hypothalamus). ADH has an antidiuretic action that prevents the production of dilute urine
-Helps to retain sodium, chlorine, etc.
Renin-angiotensin-aldosterone
- a mechanism in which sodium and water levels are regulated in the body which can release:
renin
the conversion of angiotensin to angiotensin I to angiotensin II
-aldosterone
- also helps the kidney to increase water and sodium reabsorption
Atrial Natriuretic hormone:
-a protein hormone that is synthesized are released in the atria in response to high sodium, high fluid levels and high blood levels
- promotes sodium excretion and cause vasodilation
5. Identify the basic causes and clinical manifestations of hypernatremia, hyponatremia, hyperkalemia and hypokalemia, hypocalcemia,
hypercalcemia
Sodium related:
Hypernatremia
Hypernatremia is an excessive sodium level in the blood and extracellular fluids (more than 145 mEq per liter).
Causes of Hypernatremia
Excess sodium results from ingestion of large amounts of sodium without proportionate water intake or a loss of water from the body that is faster
than the loss of sodium.
Specific causes include the following:
3
Chapter 01
1. Describe the cellular adaptations made in each of the following processes:
Atrophy- refers to a decrease in the size of cells, resulting in a reduced tissue mass.
Hypertrophy- refers to an increase in the size of individual cells, resulting in an enlarged tissue mass
Hyperplasia- is defined as an increased number of cells resulting in an enlarged tissue mass.
Dysplasia- is the term applied to tissue in which the cells vary in size and shape, large nuclei are frequently present, and the rate of mitosis is
increased.
Metaplasia- occurs when one mature cell type is replaced by a different mature cell type.
2. Discuss causative factors of each of the above cellular adaptations.
Atrophy- reduced use of the tissue, insufficient nutrition, decreased neurologic or hormonal stimulation, and aging. EX: is the shrinkage of
skeletal muscle that occurs when a limb is immobilized in a cast for several weeks.
Hypertrophy- increase may be caused by additional work by the tissue, as demonstrated by an enlarged heart muscle resulting from increased
demands. A common example of hypertrophy is the effect of consistent exercise on skeletal muscle, leading to an enlarged muscle mass.
Excessive hormonal stimulation may also stimulate cell growth.
Hyperplasia- hypertrophy and hyperplasia occur simultaneously, as in the uterine enlargement that occurs during pregnancy.
Hyperplasia may be a compensatory mechanism to meet increased demands, or it may be pathologic when there is a
hormonal imbalance.
In certain instances there may be an increased risk of cancer when hyperplasia occurs.
Dysplasia- Dysplastic changes often are encountered in epithelial tissue of the cervix and respiratory tract, where they are strongly associated
with common neoplastic growths and often are found adjacent to cancerous cells.
Metaplasia- an adaptive mechanism that provides a more resistant tissue—for instance, when stratified squamous epithelium replaces ciliated
columnar epithelium in the respiratory tracts of cigarette smokers.
3. Identify the most common cause of cellular injury.
• Ischemia, a decreased supply of oxygenated blood to a tissue or organ, due to circulatory obstruction
Decreased oxygen in the tissue may occur locally because of a blocked artery or systemically because of respiratory impairment. Cells with a
high demand for oxygen, such as those of the brain, heart, and kidney, are quickly affected by hypoxia (reduced oxygen in the tissue). A severe
oxygen deficit interferes with energy (ATP) production in the cell, leading to loss of the sodium pump at the cell membrane as well as loss of
other cell functions.
4. Describe cellular injury caused by infection and inflammation.
Infectious diseases cause cell injury through the actions of microorganisms (living organisms too small to be seen with the naked eye) such as
bacteria and viruses. Certain types of intracellular microorganisms induce a type of cell death referred to as pyroptosis. Pyroptosis differs from
apoptosis in that pyroptosis results in the lysis or dissolution of the cell, releasing destructive lysosomal enzymes into the tissue, which
cause inflammation (swelling, redness, and pain) as well as damage to nearby cells and reduced function. The apoptotic bodies formed through
apoptosis do not cause an inflammatory response as they are quickly engulfed through phagocytosis. Some genetic defects or inborn errors of
metabolism can lead to abnormal metabolic processes. Altered metabolism leads to the accumulation of toxic intermediary compounds inside the
cells, ultimately destroying them.
1
,5. Describe the major mechanism of tissue damage caused by chemical injury.
Chemicals from both the environment (exogenous) and inside the body (endogenous) may damage cells, either by altering cell membrane
permeability or producing other reactive chemicals, known as free radicals, which continue to damage cell components. I
6. Discuss the manifestations of the four major types of necrosis, and give examples of the tissue types affected by each type of necrosis.
Necrosis is the term used when a group of cells die and cause further damage due to cellular disintegration.
• Liquefaction necrosis refers to the process by which dead cells liquefy under the influence of certain cell enzymes. This process occurs when
brain tissue dies or in certain bacterial infections in which a cavity or ulcer may develop in the infected area
• Coagulative necrosis occurs when the cell proteins are altered or denatured (similar to the coagulation that occurs when cooking eggs), and the
cells retain some form for a time after death. This process typically occurs in a myocardial infarction (heart attack) when a lack of oxygen causes
cell death
• Fat necrosis occurs when fatty tissue is broken down into fatty acids in the presence of infection or certain enzymes. These compounds may
increase inflammation.
• Caseous necrosis is a form of coagulation necrosis in which a thick, yellowish, “cheesy” substance forms. Tuberculosis (TB) offers an
interesting example of caseous necrosis
7. Discuss apoptosis.
Apoptosis refers to programmed cell death, a normal occurrence in the body, which may increase when cell development is abnormal, cell
numbers are excessive, or cells are injured or aged.
Cells self-destruct, appearing to digest themselves enzymatically, and then disintegrate into vesicles called apoptotic bodies. These vesicles are
quickly engulfed through phagocytic activity without eliciting an inflammatory response.
8. Discuss the types of tissue necrosis.
Gangrene refers to an area of necrotic tissue, usually associated with a lack or loss of blood supply that is followed by invasion of bacteria.
Necrotic tissue can provide a good medium for infection by microorganisms. Such an infection frequently occurs after an
infarction in the intestines or in a limb in which blood supply is deficient and bacteria are normally present. Depending on
its location, gangrene may be described as wet or dry.
Dry gangrene is often caused by coagulative necrosis in which the tissue dries, shrinks, and blackens.
Wet gangrene is a result of liquefaction causing the tissue to become cold, swollen, and black.
Gas gangrene is caused by the buildup of gases within tissue and further reduces blood supply.
Gangrenous tissue frequently must be removed surgically (eg, by amputation) to prevent the spread of infection to other parts of the body.
Chapter 02: Fluids and Electrolytes, Acids and Bases
1. Discuss the two functional fluid compartments of the body.
Fluid is distributed between the intracellular compartment (ICF), or fluid inside the cells, and the extracellular compartment (ECF).
ECF includes the following:
• Intravascular fluid (IVF) or blood
• Interstitial fluid (ISF) or intercellular fluid
• Cerebrospinal fluid (CSF)
• Transcellular fluids present in various secretions, such as those in the pericardial (heart) cavity or the synovial cavities of the joints
2
, 2. Discuss the ways water moves between plasma and interstitial fluid.
Water moves between the vascular compartment or blood and the interstitial compartment through the semipermeable capillary membranes,
depending on the relative hydrostatic and osmotic pressures within the compartments
A major factor in the movement of water through cell membranes is the difference in osmotic pressure between the cell and the interstitial fluids.
As the relative concentrations of electrolytes in the interstitial fluid and intracellular fluid change, the osmotic pressure also changes, causing
water to move across the cell membrane by osmosis. For example, if an erythrocyte is placed in a dilute hypotonic solution (low osmotic
pressure), water may enter the cell, causing it to swell and malfunction.
3. Describe the causation, pathophysiologic process, and clinical manifestations of edema.
Causes:
Increased hydrostatic pressure
Decreased plasma oncotic pressure
Decreased production or loss of plasma proteins
Increased capillary membrane permeability
Obstruction of lymph flow
Pathophysiologic Process:
Hydrostatic pressure increase as a result of obstruction or water/salt retention
Venous obstruction pushes fluid into the capillaries
Fluid in the tissues accumulate and cause swelling
Clinical Manifestations:
-Local Edema
Swelling in a local area such as a finger
Can occur within an organ system such as: cerebral, pulmonary and cardiovascular
-Generalized Edema
Uniform distribution of fluid in gravity areas such as legs and feet
Pitting edema: a pit left in the skin after finger has been removed
4. Discuss the regulatory processes for sodium and water balance in the body, including the role of antidiuretic hormone, renin-angiotensin-
aldosterone
Antidiuretic Hormone:
- A relatively small (peptide) molecule that is released by the pituitary gland at the base of the brain after being made nearby (in the
hypothalamus). ADH has an antidiuretic action that prevents the production of dilute urine
-Helps to retain sodium, chlorine, etc.
Renin-angiotensin-aldosterone
- a mechanism in which sodium and water levels are regulated in the body which can release:
renin
the conversion of angiotensin to angiotensin I to angiotensin II
-aldosterone
- also helps the kidney to increase water and sodium reabsorption
Atrial Natriuretic hormone:
-a protein hormone that is synthesized are released in the atria in response to high sodium, high fluid levels and high blood levels
- promotes sodium excretion and cause vasodilation
5. Identify the basic causes and clinical manifestations of hypernatremia, hyponatremia, hyperkalemia and hypokalemia, hypocalcemia,
hypercalcemia
Sodium related:
Hypernatremia
Hypernatremia is an excessive sodium level in the blood and extracellular fluids (more than 145 mEq per liter).
Causes of Hypernatremia
Excess sodium results from ingestion of large amounts of sodium without proportionate water intake or a loss of water from the body that is faster
than the loss of sodium.
Specific causes include the following:
3
