NURS 5315 ADVANCED PATHOPHYSIOLOGY|2023/24 UPDATE|GRADED A+

Ovarian cancer site of metastasis? Peritoneal surfaces, omentum (fold of peritoneum connecting the stomach with other abdominal organs), liver The increased NADH/NAD+ ratio in the liver from ethanol causes: 1. Pyruvate -- lactic acid, causing lactic acidosis 2. Oxaloacetate -- malate. This prevents gluconeogenesis and leads to hypoglycemia 3. Glyceraldehyde-3-phosphate -- glycerol 3- phosphate and combines with fatty acids to form triglycerides in the liver, known as hepatosteatosis 4. Decreases citric acid cycle production of NADH and leads to using Acetyl-CoA for ketogenesis and lipogenesis What can Reactive Oxygen Species cause? Heart disease, Alzheimers, Parkinsons, Amyotrophic Lateral Sclerosis (ALS), CV disease, HTN, HLD, DM, ischemic heart disease, HF, OSA. Lipid perioxidation, damage proteins, fragment DNA, less protein synthesis, chromatin destruction, damage mitochondria What is the body's defense against ROS? Antioxidants (Vitamin E, Vitamin C, cysteine, glutathione, albumin, ceruloplasmin, transferrin) How are free radicals produced? 1. Normal cellular respiration 2. Absorption of extreme energy sources (radiation, UV light) 3. Metabolism of exogenous chemicals, drugs, and pesticides 4. Transition of metals 5. Nitric oxide acting like a chemical mediator and a free radical action potential Process of conducting an impulse. Activates the neuron -- the neuron depolarizes -- then repolarizes Threshold potential Point at which depolarization must reach in order to initiate an action potential Hypokalemia and action potentials HYPERpolarized (more negative, ex. -100). Less excitable. Decreased neuromuscular excitability: weakness, smooth muscle atony, paresthesia, cardiac dysrhythmias Hyperkalemia and action potentials HYPOpolarized (more positive, ex: closer to 0). More excitable. Peaked T waves. When resting membrane potential=threshold potential, it is BAD = cardiac standstill, paresthesia, paralysis Hypocalcemia and action potentials Increased permeability to Na+. More excitable. Tetany, hyperreflexia, circumoral paresthesia, seizures, dysrhythmias. Hypercalcemia and action potentials Decreased permeability to Na+. Less excitable. Weakness, hyporeflexia, fatigue, lethargy, confusion, encephalopathy, depressed T waves Atrophy Occurs as a result of decrease in work load, pressure, use, blood supply, nutrition, hormonal stimulation, or nervous stimulation. Once the cell has decreased in size, it has now compensated for decreased blood supply, nerve supply, nutrient supply, hormonal supply, and has achieved new homeostasis. Cells are alive but have diminished function and may lead to cellular death. Atrophy examples Physiologic atrophy- shrinking of the thymus gland during childhood. Disuse atrophy- someone that ends up being paralyzed Hypertrophy Increase in SIZE of cells, which will lead to increase in size of organ. Caused by hormonal stimulation or increased functional demand. Hypertrophy examples physiologic hypertrophy- skeletal hypertrophy when a person does heavy work or weight lifting / when a kidney is surgically removed, the other kidney increases in size pathologic hypertrophy- cardiomegaly results from an increased workload in hypertensive patients / left ventricular hypertrophy Hyperplasia Increase in NUMBER of cells. Results from increased rate of mitosis. Can ONLY happen in cells that are capable of mitosis (cell division). Hyperplasia examples 1. Thickening of skin because of hyperplasia of epidermal cells. 2. Hormonal hyperplasia- occurs in estrogen dependent organs like uterus and breast. 3. Compensatory hyperplasia- liver regenerates, callus on skin 4. Pathologic hyperplasia- estrogen is unopposed by progesterone and the endometrial lining undergoes hyperplasia and increased risk for endometrial cancer Dysplasia abnormal changes in the size, shape, and organization of mature cells due to persistent, severe cell injury or irritation Dysplasia examples Pre cancer pap smears often show dysplastic cells of the cervix that must undergo treatment. Metaplasia Changed cell that is REVERSIBLE (one cell is replaced by another cell). Exposure to chronic stressors, injury or irritation, like smoking or hydrochloric acid from heart burn