Patho 2

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Patho 2
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2012-10-11 23:09:50
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patho exam 2 shelby anderson
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  1. plasma protein
    albumin (Mg and Ca), globulins (antibodies), clotting factors (mainly fibrinogen)
  2. Red blood cell function
    • carry oxygen
    • lives about 120 days
    • biconcavity- for optimal SA/volume for optimal gas exchange
    • reversible deformity- 7-8 microns able to squeeze through 2 micron capillary to release the oxygen and go back to original shape
  3. RBC value
    4.2-6.2 million (~5 million)
  4. Hgb value
    12-17 g/dl (~15grams)
  5. Hematocrit Hct value
    36-52% (~45%)
  6. Fixed relationship of red blood cells
    • 5 mil RBC  x3
    • 15 grams Hgb   x3
    • 45% Hct
  7. WBC value
    5,000-10,000
  8. Granulocytes
    phagocytes (they all eat stuff)
  9. Agranulocytes
    immunocytes
  10. Neutrophils/PMNs/Polys value
    57-67 %
  11. Neutrophils
    • eat bacteria
    • segments- adults
    • bands/stabs- teens
  12. Eosinophils value
    1-4%
  13. Eosinophils
    • eat parasites/worms
    • involved with allergies
  14. Basophils value
    <1% involved with inflammation
  15. Monocytes value
    • 3-7%
    • chronicity
  16. Platelets value
    • 140,000-340,000
    • live 5-7 days
  17. Hematopoiesis
    Pluripotent stem cell- renews itself before it commits, then proliferation, and differentiation.  The stem cell has the potential to be anything

    Ex: bacterial infection signals bone marrow to make more neutrophil (polys)
  18. Erythropoiesis
    • uncommited pluripotent stem cell
    • erythroblast--> normoblast--> retic ( good indication of erythropoietic activity)
  19. Hemoglobin
    • 2 pairs of polypeptic chains (globulins
    • four colorful iron complexes
    • adult hemoglobin A- 2 alpha and 2 beta chains
  20. Vitamin B12
    IF- intrinsic factor needed for absorption-- gastric issues= B12 abs issues
  21. Folic acid
    no storage and shows acutely deficiencies
  22. Normal destruction of erythrocytes
    • Macrophages of MPS-- spleen and liver
    • leaves behind the heme and thereleases bilirubin which unprocessed goes on to the liver to be excreted.  a build up of bilirubin in tissues = jaundice)
  23. anemia definition
    • reduction in the total number of erythrocytes in the circulating blood or in the quality or quantity of hemoglobin
    • impaired production
    • acute or chronic blood loss
    • increases destruction
    • combination of all
  24. MCV (mean cell volume)
    • volume or size of the RBC
    • macrocytic, microcytic, or normcytic
    • 80-90fl
  25. MCH value
    27-31 pg
  26. MCHC value
    32-36%
  27. Anisocytosis
    red cells are present in various sizes
  28. poikilocytosis
    red cells are present in any shape
  29. Classic signs of ANEMIA
    • pallor
    • fatigue
    • weakness
    • dyspnea on exertion (DOE)
    • dizziness

    • tend to be adrenergic- tachycardia (Beta 1) chronotropic
    • palpation inotropic (beta 1)
    • vasocontriction Alpha
    • increase breathing
    • increased production of ADH- retain water, dilute sodium
  30. Macrocytic anemias (2)
    B12 (pernicious anemia) and folate deficiecies
  31. Microcytic hypochromic
    • iron def
    • sidero
  32. normocytic normochromic
    • aplastic anemia
    • pasthemorrhagic anemia
    • hemolytic anemia
    • anemia of chronic disease/inflammation

    values that would be low RBC Hgb and Hct-- but they would all be normal just not enought of them
  33. Pernicious anemia
    macrocytic normochromic anemia

    • LOW hct, high MCV (large)
    • vitamin b12 def- malabsorption
    • sore tongue, hyperbilirubinanemia--jaundice, hepatosplenomeagly- enlarged lvier and spleen
  34. Folate deficiency anemia
    • macrocytic, normochromic
    • low hct
    • high MCV (large)

    • body stores almost no folate
    • alcholics are at risk
  35. Iron deficiency anemia
    • microcytic hypochromic 
    • 6 low values: RBC, hemo, hct, MCV, MCH, MCHC

    • bleeding or paracsitic infection
    • impaired capillary circulation
    • neuromuscular changes- numbness or tingling
    • koilonychia- spoon shaped nails

    • mostly nonspecific symptoms
    • responding to treatment? reticulocytes would increase
  36. Aplastic anemia
    • normocytic normochromic
    • (bone marrow failure)
    • classic signs
    • PANCYTOPENIA- aeverything is low RBC, WBC and platelets
    • most commonly secondary
  37. Post hemmorrhagic anemia
    • normocytic normochronic
    • acute blood loss- surgery, trauma, GI bleed

    • volume depeletion- fluid vol deficit
    • hypovolemic shock0 stage II adrenergic

    treat- stop bleeding, treat shock (need volume and oxygen), transfusion
  38. hemolytic anemia
    • normocytic normochromic
    • premature destruction of RBC-- bilirubin, can't be handeled in a positive way goig into the tissues and results in jaundice
    • erythropoient is normale and sometime accelerated to compensate for destruction
    • acquired
    • hereditary- sickle cell anemia* most common
    • drug induced

    • remove cause
    • blood transfusions
    • remove spleen?
  39. anemia of chronic disease
    • most common in hosp patient
    • mild to moderate-- infection, malignancies..... AIDS, bacterial endocarditis, chronic inflamm disease, RA, Lupus, IBS, others
    • manifestations of iron ded anemia , could be micro hypo KOLINKYIA (mostly nonspecific symptomsresponding to treatment? reticulocytes would increase)
    • RBC life span, disurbance of iron cycle
    • process of elimination
  40. Mood
    • long-term emotional state that affects perception of self and world
    • patients complain about mood not affect
    • anger, fear, disgust, sadness, depression, and other
  41. Affect
    observed or reported feeling state, typically transient, not the smae as mood, shorter term
  42. Anxiety
    • primary emotion
    • other emotions may be generated by anxiety
    •     shame, guilt, grief
    • universal emotion
    • 25% of population
    • everyone has experienced this
  43. Mild anxiety
    • enhanced ability to deal with stress
    • heightened awarenes, problem solving abilities
    • attention to detail- over looked detail
    • increased curosity
    • alert, a little more confident
    • logic intact
  44. Moderate anxiety
    • hesitation, procrastination, BLOCKING
    • narrow perception field- tunnel vision
    • change in voice pitch accelerated rate of speech
    • selective attention- block out pain
    • frequent change in topics
    • repetitive questioning
    • joking
    • increased RR, HR
    • dry mouth
    • palpitations- pounding, almost see heart beating
    • restlessness
  45. Severe anxiety
    • highly disoriented perceptual and cognitive function- sense
    • focus on small detail, irrevelent details
    • cannot see connection
    • cannot concentrate as well
    • fear of losing control- want to get up and leave or run
    • sense of impending doom, know something is wrong but dont know exactly what
    • diaphoretic, hyperventilation, urinate, nausea, tremors, dizziness, headache, dialted pupils
    • cannot learn at this level
    • extreme discomfort, vomiting, incontinence
  46. Sources of anxiety
    • threats to biologic integrity- actual or impending interferance with basic needs (food,drink, shelter, warmth, safety, health)
    • threats to self security or self esteem- unmet expectations, unmet needs for status and prestige, anticipated disapproval from SO, inability to gain or reinforce self respect, suddent unexpected sever treat to sense of security, self esteem, and well-being, guilt, discrepancies with self identity/behavior
  47. Responses to anxiety
    constructive- problem solving (coping behaviors)destructive- destructive- defense mechanisms (never solve problem, reemerges again and again
  48. Defense mechanisms
    • almost all are generated unconsciously
    • not aware of source of behaviors that are troubling
    • can contribute to problems in functioning

    when defense reduces uncomfortable anxiety it reinforces the use of the mechanism
  49. denial
    • defense mechanism
    • remove experience or feeling form some upsetting
    • event/ from consciousness and pretend its not there
    • EX: sleep
  50. projection
    • defense mechanism
    • transferring blame for one's own unacceptable ideas,
    • feeling to someone else
    • EX: delusions
  51. regression
    • defense mechanism
    • reverting to an earlier level of behavior
    • EX: childlike
  52. reaction formation
    • defense mechanism
    • actions opposite of true unacceptable feelings
    • EX: i like that class, then not show up... do the
    • opposite of what you say
  53. displacement
    • defense mechanism
    • displace feelings and fears to an object symbolic of
    • one that is feared
    • EX:"I hate this textboo!" or take it out
    • on people who are unrelated to the situation
  54. rationalization
    • defense mechanism
    • replacing acceptable reasons for treatening true
    • reasons
  55. repression
    • defense mechanism
    • dismissing unacceptable thoughts, feelings, memories
    • from consciousness
    • EX: i'll worry about that later
  56. sublimination
    • defense mechanism
    • expressing repressed desires in a sociall acceptable
    • way
    • EX: surgeon wants to cut, cuts the table.. like
    • people being dependent on you, become nurse
  57. hemostatic components
    • platelets
    • vascular endothelium
    • clotting/coag factors
  58. properties of normal vascular endothelium that prevent clotting
    • smooth texture
    • negative charge that repel platelets and coltting things
    • secretes anticoagulation substance
  59. fibrinolysis
    automatic, programmed time clock break down of clot to facilite blood flow (7-10 days)

    form and stay put for healing to take place and then disappeare to allow blood flow
  60. sequence of events following vascular damage
    • immedate vasoconstriction/vasospasm- narrows thing very briefly
    • platelete are first responders to plug hole ( anything more than minor hole coagulation cascades happen next)
    • intrinsic pathway- triggered by inside of vessel
    • extrinsic pathway- stimulated by tissue thromboplastim (in tissues)
    • final common pathway- fibrin thread across platelet plug

    fibrinolysis 7-10 days after
  61. where are plasma proteins made (albumin)
    in the liver-- liver patients bleed!
  62. Fibrin degradation products
    • FDPs- consequence of clot breakdown
    • D-dimer lab test
    • increase=excessive FDP=increase fibrinolysis (clot breakdown)
    • could be dangerous-- bleeding (DIC)
  63. partial thromboplastin time (PTT/aPTT)
    • measures the intrinsic and final common pathways
    • monitors coagulation in persons thaking th e coagulation med Haparin
    • mean of 60 seconds-- rarely used
    • aPTT mean is 30 seconds

    people who have liver problems and not on coags
  64. Unfractionalted heparin
    0.3-0.7 units/ml

    IV heparin
  65. Prothrombin time (PT)
    • extrinsic and final common pathway (use INR)
    • coumadin warfarin
    • normal mean= 12 seconds

    a lot of variability in lots (maniufacturer) look at INR
  66. International normalized ratio (INR)
    • clinical decisions better and more often made on INR
    • normal is 1
    • extrinsic pathway****
  67. epistasis
    nose bleed
  68. ginfical bleedings
    bleeding gums
  69. mucosal bleeding
    mucosal bleeding
  70. hemoptysis
    cough up blood ( pulmonary blood)
  71. hematemesis
    • vomit bright red blood- frest upper gi bleed
    • fromt he stomach or esophagus
  72. coffee ground emesis
    vomit digested old blood
  73. hematechezia
    • bright red bloody stools
    • lower gi bleed
  74. melena
    • black tarry
    • digested blood, upper gi bleed
  75. hematuria
    blood in the urine
  76. Thrombocytopenia, causes
    platelet counts <140,000

    • <50,000 bleeding potential
    • <20,000 spon bleeding

    • cause:
    • defective platelet production
    • desordered platelet distribution
    • acclerated platelet destruction (DIC)
  77. Qualitiative platelet dysfunction
    • enought platelets but htey dont operate normally
    • congenital
    • acquired- meds-- inhibits ADP, and related to uremia- BU*N and creat increased- dont behave normally in dirty blood
  78. quantatitive platelets dysfunction
    • thrombocytosis >340,000
    • primary= myeloproliferative disorder of precursor cell
    • secondary- splenectomy
    • CLOTTING
  79. Alteration of coagulation, which vitamin and factors
    • Vitamin K deficiency
    • dependent factors: 2, 7, 9, 10

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