Patho 2 Unit 2-3

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jaredseehawer
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151420
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Patho 2 Unit 2-3
Updated:
2012-05-01 13:48:12
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bio347
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Stuff for quiz 3. ARDS through the first slide of Alcoholic Liver Disease
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  1. What is acute resp. distress syndrome (ARDS)?
    Diffuse alveolar damage

    Decreased arterial oxygen pressure and lung compliance

    Massive inflammation response in lungs
  2. Is there l. heart failure with ARDS?
    Nope

    Development of diffuse pulmonary edema without l. heart failure.
  3. What cells mediate the actual injury associated with ARDS?
    Neutophils and macrophages are involved in mediating the injury in most cases.
  4. Is ARDS an inspiratory or expiratory disease?
    Inspiratory
  5. What are common conditions associated with ARDS?
    Infection (sepsis)

    Physical injury (near drowning, burns)

    Inhaled irritants (smoke)

    Hematologic conditions (multiple transfusions)

    Shock
  6. How does ARDS start? (i.e. the pathogenesis)
    Can be either:

    Injury to capillary endothelium (sepsis)

    or

    Injury to alveolar epithelium (viral/bacterial pneumonia)

    or

    Both! (damaging pulmonary burns)
  7. What is the result of the massive inflammatory response that occurs with ARDS?
    Formation of hyaline membranes in the alveoli
  8. What are the clinical features of ARDS?
    Symptoms os severs distress and dyspnea occur within 24 hours

    X ray shows diffuse consolidation (leakage of fluid) of the lungs

    Patients requrie ventilators
  9. What is the mortality rate of ARDS?
    1/3 die w/i days

    1/3 die of penumonia and heart failure w/i weeks

    1/3 recover with fibrosis of the lungs (contraction atelectasis)
  10. Why are the lungs at risk for infections?
    Constantly exposed to outside air

    Nasopharyngeal flora regularly aspirated

    Previous lungs disease make the lung more vulnerable
  11. What are some of the lungs defenses against infection?
    Nose hairs

    Mucus blanket and ciliated epithelium

    IgA in upper resp. tract

    Alveolar macrophages

    Lymph node immune response
  12. What are the 2 risk factors for pulmonary infection and examples for each?
    Inhibition of mucociliary system caused by smoking, chronic bronchitis, or general anesthesia

    Destruction of bronchial epithelium caused by aspiration of gastric contents, inhalation of toxins, or physical trauma
  13. What is pneumonia?
    An inflammation of alveoli, interstitial tissue, and/or bronchioles due to infection by pathogens or irritation by chemicals or other agents (sterile pneumonia).
  14. How prevalent is pneumonia?
    Occurs in 4 mill people a year

    6th leading cause of death

    Most common cause of death due to infection
  15. What is sterile pneumonia?
    Non infectious pneumonia
  16. What are the 3 infectious subclassifications of penumonia?
    Viral

    Bacterial

    Mycotic (fungal)
  17. What are the 2 differect radiological classifications of pneumonia?
    Alveolar vs. Interstitial
  18. What are the 2 etiological classifications of pneumonia?
    Infectious vs. non infectious
  19. What is alveolar pneumonia? What is it's origin?
    Infection resulting from exudates in the lumen of the alveoli

    May lead to consolidation (so full of shit it can't get oxygen)

    Bacterial in origin
  20. What is intersitial pneumonia and what is its origin?
    Inflammation affects the alvolar septa

    Diffuse and bilateral

    Viral origin
  21. What are the 2 types of alveolar penumonias?
    Bronchopneumonia: patchy distribution affecting more than one lobe

    Lobar pneumonia: part or all of one lobe filled with exudate
  22. What are 3 unclassified pneumonias?
    Aspiration: inhalation of gastric contents

    Atypical: mycoplasma pneumoniae kills alveolar septa

    Hypostatic: bacterial infection + pulonary edema (happens to bed-ridden)
  23. What are 2 examples of bacterial pneumonias?
    Legionnaire's Disease: problem with macrophage cytoplasm leads to massive consolidation and necrosis

    Pneumococcal Pneumonia: inflammation leading to alveolar edema; bacteria like to live in the edema, leads to consolidation; try killing these bacteria and they release toxins
  24. What is croup?
    Acute laryngotracheobronchitis

    Usually occurs in children during the winter time

    85% viral

    Marked by barking cough

    Resolves w/i 24-48 hrs
  25. What is tuberculosis?
    Bacterial inflammation causing granulomas and tubercle formation that trap dormant organisms which can spread throughout the body if the immunity is impaired.
  26. Describe the incidence rate of tuberculosis
    Was low in the 50s and 80s but increased between 85-92.

    Foreign born americans at 7x more risk
  27. What is bronchogenic carcinoma?
    95% of primary lung tumors, leading cause of cancer deaths in US

    90% develop metastasis (bone, brain and liver)

    Paransoplastic syndromes often occur

    5 yr survival rate is only 13-15%
  28. What are the 4 major bronchogenic carcinomas?
    In order by prognosis:

    Squamous cell lung carcinoma (25-40%)

    Adenocarcinome (20-40%)

    Small cell (20-25%)

    Large cell (10-15%)
  29. Describe squamous cell carcinoma
    Most commonly found in men

    Associated with tobacco smoking

    Easier to detect early

    Spreads slowly
  30. Describe adenocarcinoma
    Most common in women and nonsmokers

    Associated with scarring
  31. Describe small cell carcinoma
    Strongest correlation with tobacco smoking

    Detectable metastasis

    Can't be completely removed

    Paraneoplastic syndromes often seen
  32. Describe large cell carcinoma
    Most anaplastic and likely to metastasis

    Poorest prognosis
  33. Why are liver disorders so serious?
    Other organs are critically dependent on the metabolic function of the liver.
  34. What is functional unit of the liver?
    Lobule
  35. What 3 vessels make up the portal triad?
    Hepatic a.

    Portal v.

    Bile duct
  36. Describe the blood flow through the liver
    Blood flows through the periphery though the sinusoids (wide leaky openings) toward the central vein
  37. What are Kupffer's cells?
    Macrophages of the liver
  38. What are the 4 major functions of the liver
    Excretion of bile

    Metabolism of carbs, fats, and proteins

    Storage of carbs and fats

    Sythesis of albumin, coagulation, and transport proteins
  39. What does hypoalbuminemia lead to?
    Decreased albumin leads to hypoproteinemia which can lead to edema
  40. What does the liver filter from circulation?
    the liver removes from circulation, metabolizes, and detoxifies many drugs, hormones, and metabolites.
  41. What is hepatotopism?
    When certain viruses seek and destroy the liver
  42. Describe liver cell regeneration
    Liver cells can regenerate

    These cells can giver rise tumors but are more often affected by metastasis.

    Bile can form gallstones
  43. What is cirrhosis?
    Regeneration of liver cells is affected by fibrosis and nodules form instead of healthy tissue.
  44. How is bilirubin created?
    Lysis of old RBCs by Kupffer cells

    Iron is removed and red pigment is lost for a yellow pigment

    Bilirubin is released into the blood and binds to albumin (unconjugated (not water soluble))

    Gets taken up by liver and conjugated (water soluble)
  45. What is the primary function of bilirubin?
    Conjugated bilirubin is excreted in bile into the intestine where it emulsifies fat.
  46. What happens to bile salts throughout digestion?
    Bile salts are nearly all reabsorbed and returned to the liver
  47. What is jaundice?
    Icterus

    A symptom, not disease, characterized by yellow disoloration of skin and mucosa

    Caused by elevated bilirubin levels
  48. What are normal bilirubin levels and when does jaundice occur?
    Normal: < 1.2 mg/dl

    Jaundice: > 2-3 mg/dl
  49. What are the 3 classifications of jaundice?
    Prehepatic (unconjugated hyperbilirubinemia)

    Hepatic (mixed conjugations, viral, drugs, cirrhosis)

    Posthepatic (conjugated hyperbilirubinemia, obstructive)
  50. Describe jaundice in newborns
    • Physiologic:
    • Transient and benign during 1st week of life
    • Mild unconjugated hyperbilirubinemia

    • Pathologic:
    • > 15 mg/dl
    • Premmies
    • Often need phototherapy
  51. Multiple episodes of mild liver injury may have an ______ effect.
    Accumulative
  52. How is liver injury viewed histologically?
    Fat accumulation

    Necrosis of liver cells
  53. What is liver failure?
    Impairment of 90-90% of liver function.
  54. What is viral hepatitis?
    Diffuse inflammation throughout liver lobules

    Associated with swelling and necrosis of liver cells

    Can presenet itself with any combo of illness and jaundice
  55. What are the 5 types of viral hepatitis?
    A - infectious

    B - serum

    C - uh oh

    D - Delta

    E - Fecal-oral
  56. What is HAV and its incubation period?
    Self-limiting infection with available vaccine

    Transmitted typucially through fecal contamination of food and water

    Incubation: 2-6 weeks
  57. What is HBV and its incubation period?
    Usually eliminated but 10% become chronic carriers and may develop chronic hepatitis; available vaccine

    Transmitted through blood and body fluids

    Incubation: 6wk - 4mo
  58. What is HCV and its incubation period?
    Infection unabale to be eliminated and most become chronic carriers, develope chronic hepatitis and cirrhosis; no available vaccine

    Transmitted through blood and body fluids

    Incubation: 35-65 days
  59. How can one get cirrhosis w/o ever touching a drink?
    HCV
  60. What is fatty liver?
    Fat accumulation on liver cells that imparis function

    Commonly caused by excessive alcohol and toxins

    Reversible if injurious agent removed
  61. What are 3 different forms of alcoholic liver disease?
    Alcoholic fatty liver

    Alcoholic hepatitis

    Alcoholic cirrhosis

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