Patho Test 2.txt

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Patho Test 2.txt
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  1. Immunity's First line of defense
    • Innate Resistance
    • (Natural or Native Immunity)

    • Examples-
    • Physical and mechanical barriers-sloughing off of cells, coughing/sneezing, flushing, vomiting, mucus/cilia
    • Skin
    • Linings of GI, GU, and respiratory tracts
    • Biochemical barriers-saliva, tears, earwax, sweat, mucus
  2. Immunity's Second line of defense
    Inflammation

    Inflammatory response activated to protect body from further injury, prevent infection of injured tissue, and promote healing
  3. Inflammation is caused by:
    • Trauma
    • Infection
    • Surgery
    • Caustic chemicals
    • Heat and cold extremes
    • Ischemic damage
  4. Vascular response to inflammation
    • 1. Vasodilation- slower blood velocity increases blood flod flow to injured site
    • 2. Increased vascular permeability-fluid escapes outside of vessel causing edema,
    • Edema
    • Increased concentration of red blood cells (warmth and redness)
    • 3. White blood cell adherence to the inner walls-migrate thru enlarged juctions in vessel
  5. Goals of Inflammation
    • Limit and control tissue damage
    • Prevent and limit infection and further damage
    • Initiates adaptive immune response
    • Initiates healing thru removal of bacterial products, dead cells, and other products of inflammation
  6. Cellular bags of granules located in loose connective tissues close to blood vessels.
    Mast cell

    Pg. 125:Figure 5-3
  7. Where are mast cells located?
    • Skin
    • Digestive lining
    • Respiratory tract
  8. Activation of mast cell
    • physical injury
    • chemical agents
    • immunologic processes
    • toll-like receptors
  9. Chemicals released from mast cell in two ways.
    • 1. Degranulation-release granules
    • 2. Synthesis-new production and release of mediators in response to stimulus
  10. Mast cell degranulation occurs 2 ways:
    Histamine-vasoactive amine that causes temporary, rapid constriction of large blood vessels and dilation of postcapillary venules. Retraction of endothelial cells lining capillaries

    • Chemotactic Factors-attration "recruit"
    • Neutrophil chemotactic factor:Predominant cells need to kill bacteria in early stages of inflammation
    • Eosinophil chemotactic factor of anaphylaxis-help regulate inflammatory response
  11. Mast cell synthesis of mediators:
    • Leukotrienes
    • Prostaglandins=pain
    • Platelet-activating factor

    (Review pg 126 in text for functions)
  12. Plasma Protein Systems Include:
    • Complement
    • Coagulation
    • Kinin
  13. Complement system:
    • Can destroy pathogens directly
    • Activates or collaborates with every other componenet of inflammatory response
  14. Coagulation (clotting) system
    Forms fibrinous meshwork at injured or inflamed site
  15. Kinin system
    Functions to activate and assist inflammatory cells

    Primary kinin is bradykinin

    Causes dilation of blood vessels, pain, smooth muscle contraction, vascular permeability, and leukocyte chemotaxis
  16. Review Cellular components and products of inflammation
    pgs. 129-134
  17. Cardinal signs for Local manifestations of inflammation
    • Rubor=redness
    • tumor=swelling (histamine releases)
    • calor=heat
    • Dolor=Pain (bradykinin, prostaglandins)

    Results from vascular changes and corresponding leakage of circulating components into tissue
  18. 4 types of exudative fluids:
    • Serous-watery exudate from plasma indicating early inflammation
    • Fibrinous-thick, clotted exudate indicating more advanced inflammation
    • Purulent-contains pus, WBC, protein, tissue debris indicating bacterial infection (yellow, green)
    • Hemorrhagic-leakage of RBC from capillaries indicating bleeding
  19. Systemic manifestations of Inflammation
    • Fever-caused by exogenous and endogenous pyrogens. Pyrogens act directly on hypothalamus, portion of brain that controls body's thermostat
    • Leukocytosis-increased number of circulating leukocytes or white blood cells. Shift to the left refers to ratio of immature to mature neutrophils. Bacteria causes shift to the left and called bands.
    • Increased plasm portein synthesis-increased during inflammation, increased fibrinogen increases Erythrocyte Sedimentation Rate (ESR)
  20. Granuloma
    Consist of central area of amorphous caseous (cheeselike) necrosis that is surrounded by zone of activated macrophages, in which multinucleate macrophages (langerhans giant cells) are present. A wall of fibrin is laid down around granuloma, and the contents eventually breakdown and liquefy.
  21. Inflammation lasting 2 weeks or longer
    Chronic inflammation

    Often related to an unsuccessful acute inflammatory response.

    Chronic inflammation is characterized by dense infiltration of lymphocytes and macrophages. If macrophages are unable to protect the host from tissue damage, the body attempts to wall off and isolate the infected area, thus forming a granuloma
  22. Examples of chronic inflammation
    • splinters
    • sutures
    • viral
    • bacterial
    • TB lesion
  23. Wound healing involves:
    • Filling in the wound
    • Sealing the wound
    • Shrinking the wound
  24. Wounds that heal under conditions of minimal tissue loss
    • Primary intention
    • Paper cut
    • Sutured surgical wound
  25. An open wound involves a great deal more tissue and is known as
    • Secondary intention
    • Abdominal infection
    • Pressure ulcers
  26. Reconstructive phase of wound healing involves
    Begins 3 to 4 days after injury and continues for as long as 2 weeks

    • Fibroblast proliferation-lay foundation
    • Collagen synthesis by fibroblasts
    • Epithelialization
    • Contraction of wound
    • Cellular differentiation
  27. Most important cells during healing because they secrete collagen and other connective tissue proteins, which are deposited in debrided areas about 5 days after entering lesion
    Fibroblasts
  28. Most abundant protein in body
    Collagen
  29. Continued cellular differentiation in wound healing, can persist for years
    Maturation phase
  30. Scar tissue formation and scar remodeling occur during which phase of wound healing
    Maturation phase

    During remodeling, cappillaries disappear, leaving scar avascular
  31. Dysfunctional wound healing during inflammatory response include:
    • Hemorrhage
    • Fibrous adhesions
    • Infection
    • Steriods
    • Hypovolemia
    • Wound Sepsis
  32. Dysfunctional wound healing during reconstructive phase:
    Impaired collagen matrix assembly- keloid scar, hypertrophic scar, scurvy

    Impaired epithelialization-steroids, hypoxemia, nutritional deficiency

    Impaired contraction-burns, can occur in liver constricting vascular flow
  33. Wound disruption
    dehiscence-pulls apart

    • Strain
    • Obesity
    • Increased risk of sepsis
  34. Third line of defense
    Adaptive (acquired) Immunity

    Often called immune response. Develops more slowly than the inflammatory response and is specific and has memory.

    • Involves:
    • Antigen/Antibody

    Humoral and cell-mediated immunity

    Active and passive Immunity

    Cell Mediated T and B lymphocytes
  35. Two types of lymphocytes involved in antigen process
    B lymphocytes- B cells- produce antibodies that enter blood and react with antigen

    T lymphocytes- T cells- attack antigen directly

    Both are extremely speciif and recognize only one specific antigen
  36. Produced by individual after either natural exposure to antigen or after immunization
    Active immunity

    Long lived
  37. Does not involve host's immune response. Occurs when preformed antibodies or T cells are transferred from donor to recipient
    Passive Immunity

    Only temporary because donor's antibodies or T cells are eventually destroyed
  38. Antigens that induce allergic response
    Allergens
  39. Altered immunologic response to antigen that results in disease or damage to host
    hypersensitivity
  40. Four types of hypersensitivity reactions
    Type I: IgE mediated

    Type II: Tissue-specific reactions

    Type III: Immmune complex mediated

    Type IV: Cell Mediated
  41. Seasonal allergic rhinitis and asthma are examples of:
    IgE mediated reaction

    Rate of development-Immediate

    Antibody involved-IgE

    Effector cells involved-Mast cells

    Participation of complement-NO
  42. Autoimmune thrombocytopenic purpura, Graves disease, autoimmune hemolytic anemia are examples of:
    Tissue specific reaction

    Rate of development-Immediate

    Antibody involved- IgG and IgM

    Effector cells involved-Macrophages in tissues

    Participation of complement-Frequently
  43. Systemic lupu erythematosus is an example of:
    Immune complex mediated reaction

    Rate of development-Immediate

    Antibody involved-IgG and IgM

    Effector cells involved- Neutrophils

    Participation of complement-Yes
  44. Contact sensitivity to poison ivy and metals (jewelry) are examples of:
    Cell-mediated reaction

    Rate of development-Delayed

    Antibody involved-None

    Effector cells involved-lymphocytes and macrophages

    Participation of complement-No
  45. Type I hypersensitivity reaction
    IgE mediated-result of excessive or inappropriate production of IgE antibodies after exposure to some type of environmental antigen.

    With initial exposure to antigen, IgE (immunoglobulin) binds to Fc receptor on surface of mast cell. Individual now sensitized to antigen. Antigens cause allergic responses called allergens. With subsequent exposure to antigen, tiny sacs in mast cells called granules break open and release histamine, which then triggers inflammatory response
  46. Most potent mediator of Type I reaction
    Histamine

    • Contracts Bronchial smooth muscles
    • Increases Vascular permeability
    • Increases blood flow to affected area
    • Increased gastric acid secreation (N/V)
  47. Examples of Type I
    • Hay fever
    • Food and drug allergies
    • Bee stings
    • Asthma
    • Anaphylaxis
  48. Clinical manifestations of Type I:
    • Sudden onset
    • GI symptoms
    • Urticaria-hives
    • ENT and respiratory symptoms
    • Anaphylaxis-rapid onset, urticaria, cramps, difficulty breathing. Caused by bronchospasm, angioedema, hypotension, shock. Can be Lethal
  49. Who are atopic individuals?
    • Predisposition to develop allergies
    • Genetic tendency
    • Higher quantities of IgE
    • More Fc receptors on mast cells which connect IgE
  50. Type II:Tissue-specific Reactions
    Blood transfusions-red blood cell reaction

    Specific cell or tissue (tissue specific antigens) is target of immune response. Direct interaction b/t IgG and IgM class antibodies and tissue or cell surface antigens.
  51. Five mechanisms of Type II
    • 1. Cell is destroyed by antibodies and complement
    • 2. Antibody may cause cell destruction through phagocytosis
    • 3. Toxic products produced by neutrophils
    • 4. Antibody dependent cell mediated cytotoxicity (ADCC)
    • 5. Cell malfunctions
  52. Examples of Type II
    Erythroblastosis Fetalis-Rh or Abo incompatibility b/t blood of mother and fetus

    Hemolytic anemia-antibodies produced against red blood cells could be drug induced

    Transfusion reaction-Antibodies produced against donor cells
  53. Type III:Immune complex mediated
    Abnormal creation that forms. ex-autoimmune disorder

    caused by antigen antibody immune complexes formed in circulation and deposited later in vessel walls and other tissue.

    Size influences whether remain in plasma or lodge in tissues where they result in tissue damage.

    Complement activated and neutrophils degranulate enzymes damage tissue. can damage and destroy healthy tissue
  54. Examples of Type III
    • Serum sickness
    • Systemic lupus erythematosus
    • arthus reaction-local reaction
    • Acute glomerulonephritis that follows strept infection
  55. Type IV Hypersensitivity Reaction
    • Mediated by Sensitized T lymphocytes
    • Don't involve antibody
    • Reaction delayed-24-72 hours after exposure
  56. Examples of Type IV reaction
    • Graft rejection
    • Skin test for TB
    • Allergic contact dermatitis- poison ivy and metals
  57. Autoimmunity
    Breakdown of tolerance to own antigens

    • Examples-pg 171 other examples
    • SLE
    • Chronic multisystem inflammatory disease-abnormal antibodies attack RBC's

    Autoantibodies against nucleic acids, erythrocytes, Coagulation porteins, platelets

    Deposition of circulating immune complexes containing antibody against host DNA

    More common in females

    Clinical manifestation-Butterfly rash, Lupus
  58. Common Findings of SLE-serial or simultaneous presence of at least four

    Not just localized-can become systemic
    • facial rash
    • discoid rash
    • photosensitivity
    • Oral or nasophyaryngeal ulcers
    • arthritis
    • serositis
    • renal disorders
    • neurologic dis
    • hematologic disorder
    • immunologic disorder
    • Presence of antinuclear antibody-blood test of ANA-titer. some reaction going on in body if ANA is elevated
  59. alloimmunity
    Immunse sys reacts w/antigens on tissue of genetically dissimilar members of same species

    • ex.
    • graft rejection
    • transplant rejection classified to time:hyper, acute, chronic
    • Hyperacute;immediate rejection
  60. Graft-versus-host disease (GVHD)
    cellular immune system of transplant tissue can attach unrelated recipient tissue
  61. Immune Deficiencies
    Failure of immune mechanisms of self defense

    Primary (congenital) immunodeficiency (Pg 196:Table 7-13)

    Secondary (acquired) immunodeficiency-caused by another illness (cancer, infection) More common
  62. Syndrome caused by viral disease-Human Immunodeficiency virus (HIV).
    Acquired Immunodeficiency Syndrome (AIDS)

    Blood borne pathogen. Increasing faster in women than men.

    • Depletes CD4 Th cells
    • Incidence:Worldwide 5 mill/yr
    • US 31K/yr
  63. Pathogenesis of AIDS
    Retrovirus

    Genetic information stored in RNA rather than DNA

    Contains reverse transcriptase to convert RNA into double stranded DNA

    Integrase inserts new DNA into infected cells genetic material

    Structure:GP 120 proteins bind to CD$ molecule found on surface of CD4 Th cells
  64. Normal CD4 count
    800-1000 cells/mm3
  65. Clinical manifestations of AIDS
    • Antibody 4-7 wks after blood products
    • Antibody 6-14 mo after sexual transmission
    • Window period
    • Can still be infectious

    Early signs-flu symptoms, swollen lymph glands, diarrhea, fatigue
  66. Opportunistic infections (pg 201, Box 7-2)
    Organisms produce infection in persons w/impaired immune function
  67. Neurologic Complications of AIDS
    • Encephalopathy
    • Myelopathy
    • Neuropathy
    • Viral meningitis
    • Opportunistic infections
    • Neoplasms
    • Bleeding
  68. What is pruritus?
    symptoms associated with many disorders (itching)
  69. What can produce itching?
    • Histamine
    • Protease
    • Heat
    • Cold
    • Chemical
  70. What are Pressure Ulcers (Decubitus Ulcers)?
    Ischemic ulcers resulting from pressure, shearing forces, friction, moisture
  71. Common sites for Pressure Ulcers
    • Sacrum
    • Heels
    • Ischia
    • Greater Trochanter
  72. Unrelieved Pressures
    result in the endothelial cell lining capillaries becoming disrupted with platelet aggregation
  73. Four stages of pressure Ulcers
    1-Persistant redness in light pigmented skin, persistant redness w/ blue or purple hues in dark pigment

    2- Partial thickness skin loss involving the epidermis or dermis or both, Abrasion, blister, shallow crater

    3-Full thickness skin loss involving damage or necrosis of subcutanous tissue : Deep Crater w/ or w/o undermining of underlying tissue

    4- Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle bone or supporting structures
  74. Keloids
    • scars that are progressively enlargeing due to excessive collagen
    • shiny, hairless, elevated scars
    • more common in African Americans and Orientals, ages 10-30
  75. When do Keloids appear?
    within 1 year of trama
  76. Inflammatory disorders
    • Allergic Contact Dermatitis
    • Irritant Contact Dermatitis
    • Atopic Dermatitis
    • Stasis Dermatitis
    • Seborrheic Dermatitis
  77. Allergic Contact Dermatitis
    • Common form of cell mediated or delayed hypersensitivity
    • s/s-Erythema, prurites, vesticles
  78. What may cause Allergic Contact Dermitits?
    poison ivy, metals, latex
  79. Irritant Contact Dermatitis
    • Nonimmunologically mediated inflammatino of the skin
    • Severity R/T concentration and exposure time
    • Lesions similar to allergic type
  80. What may cause Irritant Contact dermatitis?
    Acids, soaps, detergents
  81. Atopic Dermatitis is AKA
    Eczema
  82. Atopic Dermatitis
    • more common in Infancy and childhood
    • has increase serum IgE
    • Family history of asthma, hay fever, atopic dermatitis
    • s/s- skin is dry sensitive, itchy, skin pruritus
  83. Stasis Dermatitis
    • occurs as a result of venous stasis and edema
    • Associated with varicosities, phlebitis and vasucular trauma
    • Erythema, pruritus, scaling, petechiae, hyperpigmentation, may progress to ulcerations
  84. Seborrheic Dermatitis
    • Chronic inflammation
    • on scalp, eyebrows, eyelids, ear canals, axilla, chest, back
    • Infants=cradle cap
    • Scaly, whitish, yellow, plaques
    • Pruritus
  85. Papulosquamous Disorders
    • Disorders charasterized by papules, scales, plaques, and erythema
    • Ex-Psoriasis
  86. Bacterial Infections commonly caused by Staph Aureus
    • Furuncles (Boils)
    • Carbuncle
    • Cellulitus
    • Impetigo
  87. Furuncles
    • (Boil)
    • Inflammation of hair follicle, single
    • Red, firm nodule that may progress to a cystic nodule
    • will see pus and necrotic tissue
  88. Carbuncle
    • Collection of infected hair follicles-multiple
    • See them on back of neck, upper back, lateral thighs
  89. Cellulitis
    • infection of dermis and subcutaneous tissue
    • Extension of a skin wound, ulcer, furuncles, carbuncles
    • Will see Erythema, warmth, edema, pain
  90. Impetigo
    • caused by Staph, group A B-hemolytic streph
    • Common in infants and childern-in summer season
    • Vesicles and pustules weep and crust
    • honey color serous liquid
    • Pruritus
    • Communitable
  91. Viral Infections (cause skin lesions)
    • HSV-1
    • HSV-2
    • Herpes Zoster
  92. HSV-1
    • Cold sore or fever blister
    • Nongenital sites--mouth and cornea
    • Vesicles rupture and form crust
    • Dormant in nerve ganglia
    • Recurrence stress, hormones
  93. HSV-2
    • Genital infections
    • Large number are sexually transmitted
    • Vesicles that progress to ulceration
  94. Herpes Zoster is AKA
    Shingles
  95. Herpes Zoster
    • Varicella occurs as a primary infection followed years later by herpes zoster
    • Burning pain, paresthesia localized to the affected dermatome
    • Vesicular eruptions
    • Find Face, cervical, thoracic dermatome
  96. Fungal Infection
    Examples
    • Tinea Corporis
    • Tinea Capitis
    • Tinea Pedis
    • Candida
  97. Tinea Infection
    • fungal infections of the skin and are classified according to thier location on the body
    • can get from animal
  98. Tinea Corporis
    • Body
    • (Ring Worm)
  99. Tinea Capitis
    Scalp
  100. Tinea Pedis
    • Feet
    • (Athlets Foot)
  101. Candida
    • caused by yeastlike fungus Candida Albicans
    • Normally found on mucous membranes, skin , GI tract and Vagina
    • s/s Burning, itching, whitich yellow curdlike substance
    • ex-thrush
  102. Predisposing Factors to Candida
    • moist warm environment
    • antibiotics
    • pregnancy
    • cushing disease
    • diabetes mellitus
    • debilitated states
    • <6 months of age
    • Immunosuppression
  103. Benign Tumors
    • Tumors of the skin are normally associated with aging
    • Seborrheic Keratosis
    • Actinic Keratosis
  104. Seborrheic Keratosis
    • Benign proliferation of the basal cells that produce smooth or waxy elevated lesions
    • more common in older adults
    • on chest, back, face
    • Shades of tan, yellow, flesh colored, brown-black lesions
  105. Actinic Keratosis
    • precancerous tumors associated with exposure to UV radiation of the sun
    • risk=individuals w/ unprotected light skin
    • pigments patchese of rough skin
  106. Nevi
    • Mole
    • pigments and nonpigmented
    • Flat and elevated
    • watch for malignant transformation
  107. Risk Factor for skin cancer
    fair complexion, excessive exposure to the sun, tanning salons, or ultraviolet radiation predisposes a person
  108. Basal Cell Carcinoma
    • caused by sunlight exposure
    • on face, neck
    • slow growth
    • metastatic spread rate
    • more common in men then women
  109. Basal cell lesions..
    • start as nodule
    • Pearly/Ivory
    • Depressed Center and rolled borders
    • progressess to ulceration with waxy borders
  110. Squamous Cell Carcinoma
    • A tumor of the epidermis
    • Malignant potential
    • sun exposure and fair complexion
    • Red, scaly, elevated, irregular borders
    • shallow chronic ulcer
  111. Malignant Melanoma
    • A tumor originating from the melanocytes
    • Rapidly progressive, metastatic
    • intermittent intense sun exposure

    Raised, black, brown most from Nevi or moles shades of red, blue or white
  112. Melanocytes
    cells that synthesize the pigment melanin
  113. Cancer ACDE
    • A=Asymmetry
    • B=Border Irregularity
    • C=Color variation
    • D= diameter >6mm
    • E=Evolving Change
  114. Kaposi Sarcoma
    • Vascular Malignancy
    • Endothelial Cell
    • Purplish brown macules-develop into plaques and nodules
    • Immunosuppression, transplant recipient, AIDS, African middle aged blacks, Jewish descent
  115. Lupus Erythematosus
    • Inflammatory disease with cutaneous manifestations
    • Discoid (cutaneous) is limited to the skin and can lead to SLE
    • Lesions are often located on light-exposed areas of the skin, and photosensitivity is common
    • most common site=face "Butterfly Rash"
  116. Cause of Lupus Erthematosus
    altered immune responce to an unknown antigen
  117. Macule
    • flat, circumscribed area that is a change in the color of the skin
    • ex-freckle
  118. Papule
    • An elevared firm area circumscribed are less than 1 cm in diameter
    • ex-wart
  119. Patch
    • A flat nonplable, irregular shaped macule more than 1 cm in diameter
    • ex-port-wine stain
  120. Plaque
    • Elevated, firm and rough lesion with flat top surface more than 1 cm in diameter
    • ex-psoriasis
  121. wheal
    • elevated irregular shaped area of cutaneous edema
    • ex-insect bite
  122. Nodule
    Elevated firm circumscribed lesion; deeper in dermis that a papule
  123. Tumor
    Elevated solid lesion, may be clearly demarcated; deeper in dermis, more than 2 cm in diameter
  124. Vesicle
    • Elevated, circumscribed superficial not into dermis, filled with serous fluid- less than 1 cm in diameter
    • ex-chickpox
  125. Bulla
    • vesticle more than 1 cm in diameter
    • ex-blister
  126. Pustule
    • elevated superficial lesion similar to a vesicle but filled with purulent fluid
    • ex-acne
  127. Cyst
    • Elevated circumscribed encapsulated lesion, in dermis or subcutaneous layer, filled with liquid or semisold material
    • ex-sebaceous cyst
  128. Telangiectasia
    • Fine, irregular red lines produced by capillary dilation
    • ex- Telangiectasia in rosacea
  129. Scale
    heaped up, keratinized cell, flaky skin, irregular thick or thin
  130. Lichenification
    • rough, thickened epidermis secondary to persistent rubbing, itching, or skin irrritation
    • ex-chronic dermatitis
  131. Exciriation
    • loss of the epidermis, linear, hollowed out, crusted area
    • ex-abrasion, scabies
  132. Fissure
    linear crack or break from the epidermis to the dermis
  133. Erosion
    loss of part of the epidermis, depressed, moist, glistening, follows rupture of a vesicle or bulla
  134. Ulcer
    loss of epidermis and dermis, concave, varies in size
  135. Atrophy
    • thinning of the skin surface and loss of skin markings, skin appears translucent and paper like
    • ex=Aged skin, striae

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