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Pathophysiology: Chapters 8, 9, and 10

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Pathophysiology: Chapters 8, 9, and 10 HLTHST 300

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These are notes taken in the third week of class. Topics include disorders of fluid, electrolyte, and acid-base balance, stress and adaptation, and disorders of nutritional status
Jennifer Legget
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This 13 page Class Notes was uploaded by Notetaker on Monday September 12, 2016. The Class Notes belongs to HLTHST 300 at Boise State University taught by Jennifer Legget in Fall 2016. Since its upload, it has received 11 views. For similar materials see Pathophysiology in Biology at Boise State University.

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Date Created: 09/12/16
Pathophysiology: Chapter 8 – Disorders of Fluid, Electrolyte, and Acid-Base Balance  Fluid Distribution o Intracellular Fluid Compartment (ICF)  Fluid inside the cells  2/3 of total water volume  Lots of potassium o Extracellular Fluid Compartment (ECF)  All fluids outside the cells  1/3 of total water volume  Lots of sodium and chloride  1. Interstitial/Tissue Space  Fluid between the cells and blood vessels  2. Plasma/Vascular Space  Fluid in the blood vessels  3. Transcellular Space  “Third space” o This fluid is not available for the body to use  Fluid in hollow body cavities (peritoneal, pericardial, pleural, joints)  Movement of Fluids o Osmosis  Movement of water across a membrane  Moves down the concentration gradient (high to low)  Osmotic Pressure: pressure needed to oppose water movement across the membrane  Osmolarity: osmoles per liter  Osmolality: osmoles per kilogram  High osmolarity causes  Thirst = increased water intake  ADH (antidiuretic) release = water reabsorbed from urine  Low osmolarity causes  Lack of thirst = decreased water intake  Decreased ADH (antidiuretic) release = water lost in urine o Tonicity  Isotonic  RBCs will not change  Hypertonic  Fluid has a higher osmolality (more solutes) than ICF  Water moves out of the cell  RBCs will shrink  Hypotonic  Fluid has a lower osmolality (less solutes) than ICF  Water moves into the cell  RBCs will swell o Capillary and Interstitial Fluid Exchange  Movement of water between the vascular and interstitial spaces  Forces  Capillary Filtration Pressure o Pushes water out of the capillary  Capillary Colloid Osmotic Pressure o Pulls water back into the capillary  Interstitial Hydrostatic Pressure o Opposes movement out of the capillary  Interstitial Colloid Osmotic Pressure o Pulls water out of the capillary  Edema: palpable swelling produced by an increase in interstitial fluid volume  Affected by o Increase in capillary filtration pressure  More water out of the capillary o Decrease in capillary colloid osmotic pressure  Less water pulled into the capillary o Increase in capillary permeability  More substances out of the capillary o Obstruction of lymph flow  Lymph accumulates in interstitial space  Manifestations o Severity is based on location  Life-Threatening = brain, larynx, lungs  Non-Life-Threatening = joints o Compresses blood vessels o Interferes with movement o Pitting Edema: accumulation of interstitial fluid exceeds absorptive capacity  Tissue is squishing, pushing causes indentations o Nonpitting Edema: plasma proteins have accumulated in tissue spaces and coagulated  Localized infection or trauma  Tissue is firm and discolored  Treatment o Preventing tissue injury and death o Elevation of lower extremities o Diuretics o Albumin to increase capillary colloid osmotic pressure o Tight stockings/sleeves increase interstitial hydrostatic pressure  Third Spacing  Trapping of fluid in the transcellular space o Pericardial sac, pleural cavity, peritoneal cavity  Ascites: extra fluid in peritoneal cavity  Caused by obstruction of lymph flow  Causes pressure on the organs in the cavity  Water and Sodium Balance o Sodium concentrated in ECF o Positive Water Balance: intake greater than output  Decrease in body fluid osmolality  Decrease in ECF sodium concentration (water dilutes) o Negative Water Balance: output greater than intake  Increase in body fluid osmolality  Increase in ECF sodium concentration o Sympathetic Nervous System  Monitors arterial pressure and blood volume  Adjusts glomerular filtration rate and Na filtration from blood  Regulates renal reabsorption of sodium o Also monitored by thirst and ADH o Disorders  Diabetes Insipidus (DI)  Caused by insufficient ADH  Extremely large volumes of urine and extreme thirst o ADH is not able to keep water in the body  Causes dehydration  Neurogenic o Problem with the synthesis or release of ADH o Caused by inflammation, autoimmune disease, vascular disease, head injury  Nephrogenic o Kidneys do not respond to ADH o Can be congenital or acquired  Syndrome of Inappropriate ADH (SIADH)  Too much ADH released  Extreme water retention  Decreased urine output  Hyponatremia  Symptoms similar to water intoxication  Caused by surgery, pain, stress, temperature changes, certain drugs  Treated with fluid restriction, diuretics, or hypertonic solutions  Isotonic Fluid Volume Deficit  Decrease in extracellular fluid  Caused by loss of body fluids and decreased fluid intake o Vomiting, diarrhea, excessive sweating or urination  Manifested as decrease in body weight  Symptoms: thirst, sunken eyes, decreased urine output, tissue turgor o Tissue turgor: skin doesn’t return to normal after being pinched  Treated with fluid replacement  Isotonic Fluid Volume Excess  Increased interstitial and vascular fluid volumes  Caused by excessive sodium intake, renal, liver, and heart failure o Water follows sodium  Causes circulatory overload, edema  Manifested by weight gain  Hyponatremia  Sodium deficiency < 135  Increases intracellular water o ECF becomes hypotonic o RBCs swell  Caused by loss of sodium  Happens when water (rather than electrolytes) is used to replace sweat  Symptoms: muscle cramps, weakness, nausea, vomiting, diarrhea o Brain cells swell – headache, disorientation, seizures  Treatment: limit fluid intake, administration of sodium, diuretic  Hypernatremia  Excess of sodium > 145  Cellular dehydration o ECF becomes hypertonic o RBCs shrink  Treated with sodium administration  Prevented by thirst o Babies and the elderly (who cannot get their own water) are more susceptible  Caused by renal failure, and loss of water o Kidneys cannot conserve water  Symptoms: thirst, decreased urine output, increased temperature, dry mouth and skin, headache  Treatment: fluid replacement  Potassium Balance o Concentrated in ICF (skeletal muscles) o Controls resting membrane potential o Disorders  Hypokalemia  Decrease in potassium  Caused by inadequate intake, excessive GI, renal, and skin losses, and shift between ICF and ECF  Manifested by changes in neuromuscular, GI, renal, and cardiovascular functions  Symptoms: thirst, constipation, abdominal distention, muscle cramps, confusion, depression, cardiac arrhythmias o Changes are gradual – may go untreated for a while  Causes a decrease in resting membrane potential o Affects cardiac muscle  Treated by the intake of potassium  Hyperkalemia  Increase in potassium  Does not usually occur in healthy people  Caused by decreased renal elimination, shift from ICF to ECF, and excessive administration  Always associated with kidney disease  Manifested by decrease in neuromuscular excitability  Symptoms: paresthesia, paralysis, cardiac arrest  Treated with calcium and sodium bicarbonate administration  Calcium Balance o Mostly in bone and ICF o Necessary for muscle contraction o Hypocalcemia  Calcium deficiency  Caused by renal failure  Parathyroid hormone mobilizes calcium from bones  Problems with PTH can cause hypocalcemia  Only ionized calcium can leave capillaries and participate in body functions  Causes increased neuromuscular excitability and cardiovascular effects  Ionized calcium makes nerve cells less sensitive to stimuli  Chvostek Sign: tapping the face over the facial nerve causes spasms of lip, nose, or face in a positive test  Trousseau Sign: blood pressure cuff is inflated for 3 minutes, contraction of the fingers and hands indicates tetany  Treated with calcium administration  Magnesium o Ingested from the diet, absorbed from the intestine, and excreted by the kidneys o Required for  Cellular metabolism  NA/K pump  Membrane stabilization  Nerve conduction  Ion transport  Generation of ATP from ADP  All reactions that require ATP  Every step related to replication and transcription of DNA  Preventing cardiac arrhythmias  Relaxing smooth muscle  Acid-Base Balance o Normal pH = 7.35 to 7.45  Too much of a deviation is not compatible with life  Needed to determine Arterial Blood Gas (ABG) levels o Acid  releases H+  H2CO3 o Base  accepts H+  HCO3 o Respiratory Role  CO2 is exhaled by the lungs  Chemoreceptors in the brain stem monitor the amounts of CO2 in the blood and increase or decrease the rate of ventilation o Kidney’s Role  Reabsorb HCO3  Secrete excess H+ o Acidosis  Metabolic Acidosis  Decreased bicarbonate  Increased ketoacids, lactic acid  Increased H+ = low pH  Heavier breathing causes decreased CO2  Respiratory Acidosis  Holding your breath or not breathing fast enough – not enough O2  Increased CO2 combines with water to produce H2CO3  Increased carbonic acid (H2CO3)  Increased H+ = low pH  Increased bicarbonate  Fixed with Metabolic Alkalosis o “partially compensated respiratory acidosis” o Alkalosis  Metabolic Alkalosis  Increased bicarbonate  Decreased H+ = high pH  Lighter breathing causes increased CO2  Respiratory Alkalosis  Hyperventilating – too much O2  Decreased CO2  Decreased carbonic acid  Decreased H+ = high pH  Decreased bicarbonate  Fixed with Metabolic Acidosis o “partially compensated respiratory alkalosis” Pathophysiology: Chapter 10 – Disorders of Nutritional Status  Metabolism o The process of macronutrients being broken down and converted into energy o Sum total of the body’s anabolic and catabolic processes  Anabolism: builds proteins and amino acids from the nutrients we take in  Catabolism: breaks down nutrients to use for energy o Energy Storage  Energy sources come from nutrients in food  Energy utilization = energy expenditure  When food intake > energy expenditure, excess is stored as fat  When food intake < energy expenditure, fat stores are broken down  90% of energy stored as triglycerides in fat cells (adipocytes)  Adipose Tissue  Endocrine organ o Produces leptin and adiponectin  Associated with chronic inflammation  White (unilocular) o Predominant type o Functions  Energy storage, endocrine/adipocytokine secretion, insulation, cushioning  Brown (multilocular) o Lots of mitochondria – and iron o Produces uncoupling protein -1  Releases energy generated from metabolism as heat o Found mainly in newborn babies  Macronutrients o Proteins  Functions  Growth, maintain body tissues, enzyme/antibody formation, fluid/electrolyte balance, nutrient transport  Composed of amino acids  Complete Proteins  Supply all 9 essential amino acids in adequate amounts  Milk, eggs, meat, fish, poultry  Contain nitrogen  Positive balance = more taken in than excreted  Negative balance = more excreted than taken in o Indicates tissue breakdown o Fats  25% to 35% of daily calories  Functions  Energy, carry lipid-soluble vitamins, precursors for prostaglandins, source of essential fatty acids  Composed of triglycerides  Saturated Fats  No double bonds between carbons, saturated with hydrogen  Elevates cholesterol  Solid at room temperature  Come from animal fats  Unsaturated Fats  One or more double bonds between carbons  Lower cholesterol  Liquid at room temperature  Come from plant oils o Carbohydrates  45% to 65% of daily calories  Functions  Energy  Simple sugars and starches  Need 50 to 100 grams per day to prevent ketosis  Made of saccharides  Body Mass Index (BMI) 2 o Body Mass Index = weight (kg)/height (meters ) o Less than 18.5 = underweight o 18.5 to 25 = normal weight o 25 to 30 = overweight o Greater than 30 = obese  Obesity o Health Risks  Hypertension  Hyperlipidemia  Type 2 diabetes  Coronary heart disease  Stroke  Osteoarthritis  Cancer o Causes  Genetics/hereditary  Diet  Lack of physical activity o Types  Determined by waist circumference/hip circumference  Upper Body Obesity = apple shaped  Aka central, abdominal, or visceral obesity  Men waist to hip ratio <1.0  Women waist to hip ratio <0.8  High risk for cardiometabolic diseases  Lower Body Obesity = pear shaped  Aka peripheral, or gluteal-femoral obesity  Not as risky o Prevention and Treatment  Diet  Exercise  Behavior Modifications  Social Support  Surgery  Malnutrition o Marasmus  Too few calories and Too little protein  Depression in all body systems  Wasted appearance, diarrhea, wrinkled skin, low heart rate, blood pressure, and body temperature  Stunted growth o Kwashiorkor  Adequate calories and Too little protein  More severe  Edema, discolored skin/hair, apathy, distended belly, decreased cardiac output, and tachycardia o Trauma and Illness  Burns, sepsis, COPD, heart failure, cancer, HIV, cancer  Protein breakdown is accelerated, protein synthesis is interrupted  Slows healing o Effects  Muscle mass  muscle broken down for energy once fat is gone  Respiratory function  breathing muscles are weak  Immune function  less immune cells and more immunologic malfunctions  Wound healing  body cannot fight off infections  Eating Disorders o Come from psychological issues o Anorexia Nervosa  Extremely underweight  Disturbed body image, fear of gaining weight, obsession with restricted calorie intake and appearance  Effects  Amenorrhea, decreased estrogen, osteoporosis, loss of brain tissue  Symptoms  Constipation, cold intolerance, cardiac issues, blood/electrolyte imbalances  Usually cannot recognize that there is a problem o Bulimia Nervosa  Can have normal weight  Cycle of binging and purging  Done by vomiting, fasting, exercise, laxatives, diuretics, enemas  Characterized by dental issues (from vomiting) o Binge Eating  More common in men  Eating too much in a short period of time, eating too fast, eating when not hungry  People are overweight or obese Pathophysiology: Chapter 9 – Stress and Adaptation  Homeostasis o Stable equilibrium maintained by the body with internal and external changes o Allostasis: the changes in body systems in response to challenges to homeostasis o Controlled by Negative Feedback Mechanisms  When a value gets too low, feedback mechanisms bring it back up  When a value gets too high, feedback mechanisms lower it back down  Ex: blood glucose and insulin  The Stress Response o Selye’s definition of stress: a state manifested by a specific syndrome of the body developed in response to any stimuli that made an intense systemic demand on it o General Adaptation Syndrome (GAS)  Creates a system that is best able to respond to any stressor  Mobilization of energy  Sharpened focus and awareness  Increased glucose utilization  Enhanced cardiovascular and respiratory function  Redistribution of blood flow to the brain and muscles  Inhibition of reproductive function  Inhibition of immune system  Decrease in appetite  Stages  1. Alarm o Stimulation of sympathetic nervous system o Release of cortisol  2. Resistance o Body selects most effective and economic channels of defense o Cortisol levels drop if the stressor goes away o If the stressor remains, the body enters the exhaustion stage  3. Exhaustion o Depletion of resources o Systemic damage o Neuroendocrine Response  Central Nervous System  Cerebral cortex  vigilance, cognition, focused attention  Limbic system  emotional components  Thalamus  receives, sorts, and distributes sensory information  Hypothalamus  coordinates hormones and autonomic nervous system  Pituitary gland  releases hormones  Reticular activating system  mental alertness and skeletal muscle tone  Locus Ceruleus  produces norepinephrine  Hormones  Corticotropin Releasing Factor  causes secretion of ACTH  Adrenocorticotropic Hormone (ACTH)  causes secretion of cortisol  Cortisol  maintains BG, suppresses osteoblasts and immune system  Antidiuretic Hormone  signals for water retention in kidneys o Immune Response  Monocytes & lymphocytes penetrate blood-brain barrier and release cytokines  Hormones influence lymphocyte function o Adaptation to Stress  Purpose of adaptation is to survive in our changing environment  Factors that influence a person’s adaptive capacity  1. Physiologic and Anatomic Reserve o Physiologic  The ability of body systems to increase level of function, given the need to adapt  Extra O2 in RBCs, stores of fat, extra calcium in bones o Anatomic  Paired organs in case one fails  Lungs, eyes, kidneys  2. Time  3. Genetics  4. Age  5. Gender  6. Health Status  7. Nutrition  8. Sleep-wake cycles  9. Hardiness  10. Psychosocial Factors o Acute Stress  Stress response is meant to be acute and resolved quickly  Can be damaging  Directs energy away from body processes that promote health  Can be caused by severe trauma, infection, or surgery  Increases blood sugar o Makes recovery difficult after septic shock, hemorrhagic shock, and stroke o Chronic Stress  Contributes to the development of long-term health problems  Linked to diseases of cardiovascular, GI, immune, neurologic systems  Can cause depression, alcoholism, drug abuse, eating disorders, suicide  Diminished immune system can’t defend against communicable diseases o Posttraumatic Stress Disorder  Types of symptoms  Intrusion o Flashbacks and nightmares  Avoidance o Avoiding situations and people that bring distressing memories  Negative alterations in cognition and mood o Inability to remember important aspects of the event  Marked alterations in arousal and reactivity o Inability to experience positive emotions o Treatment for Stress  Progressive Muscle Relaxation  Systematic contraction and relaxation of major muscle groups  Guided Imagery  Patient creates a mental image designed to bring positive physical and emotional effects  All 5 senses are involved to make the experience real  Music Therapy  Music reduces anxiety, stress, pain, loneliness, and facilitates expression of emotion  Massage Therapy  Manipulating the soft tissues of the body to relieve muscle tension  Biofeedback  Patient learns to control physiologic functions  Patient watches the electrical monitoring and learns to control it


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