Pathophysiology final- TTU- Dr. Gollahon

120 mm Hg

120 to 35

18-35 mm Hg

18 mm Hg

overall pressure from circulatory system

occurs when circulatory pressure is greater than cardiovascular pressure

about 100 mm Hg (from 18 - 120)

arteries have high elastic tissue composition because they rely on pressure rather than a series of valves like the veins

the systolic and diastolic pressure drop drastically and the velocity decreases

resistance pressure from the cardiovascular system

1. Vascular resistance

2. blood viscosity

3. turbulence

friction created by diameter of vessel

friction created by the thickness of the blood from the components and their interactions

friction created by eddies and swirls that cause high flow rates, irregular surfaces, and sudden changes in diameter that disrupt uniform flow

A. Intracellular fluid

B. extracellular fluid

1-interstitial fluid

2-intravascular fluid

3-lymph, synovial, intestinal, pleural, peritoneal, pericardial, intraocular fluids

4-CSF, sweat, urine

1) Heart (volume rate/velocity)

2) Kidneys (renin/vasoconstriction)

3) blood vessels (vasoconstriction)

meet OXYGEN requirements remove CO2 and WASTE

- primary ECF CATION (+)

- regulates OSMOTIC FORCES (water)

- roles in acid-base balance, chemical reactions, membrane transport

- primary ECF ANION (-)

- provides electroneutrality (neutral substance charge)

Renin- Aldosterone- Angiotensin System

aldosterone- sodium (and H2O) reabsorption angiotensin- promotes aldosterone secretion Renin- vasoconstriction

hormones that cause sodium excretion by kidneys

Atrial Natriuretic peptides- secreted by atria

Brain Natriuretic peptides- secreted by brain

response system to changes in the chemicals in blood or CSF

1) CO2

2) Oxygen

3) pH levels

in neck near carotid sinus

near Aortic Arch

response system to cardiovascular regulation, and cardiac output and peripheral resistance (how much blood is being pumped and at what pressure)

- carotid sinus

- aortic sinus

- wall of right atrium

Primarily High BP which can lead to:

1) Cardiovascular Disease (CVD)

2) Obesity

3) Arteriosclerosis

4) Stress

- Skeletal Muscle

- Heart

- Skin

- Total output

- Kidney

- Abdomen

- Misc.

Brain

consistently high BP

- systolic >140 or

- diastolic >90

• 70 million people UNdiagnosed

• must have high BP readings months apart (different doctor visits)

- Idiopathic

- may be genetic or environmental

- 92-95% all hypertension patients have primary

- Sympathetic Nervous System (SNS)

- RAAS

- Natriuretic Peptides

- RAAS-blocking

Drugs:

ACE, Renin, ARB, and Aldosterone inhibitors

Rapidly progressive Hypertension

• Diastolic > 140 causes organ damage due to high pressure tearing organs

-Chronic hypertensive damage to blood vessels and tissues - leads to target organ damage (heart, kidney, brain, and eyes)

-Myocardial hypertrophy

Genetic and Environmental vulnerabilities - cause neurohormonal dysfunction in SNS, RAAS, and Natriuretic peptides

- promotes inflammation

- creates insulin RESISTANCE

-caused by systemic disease (infects entire body)

-raises peripheral or

-resistance or cardiac output

could be renal vascular or parenchymal disease, tumors, or drugs

100%, all-or-none response

myelinated faster at transmitting signals

NOT myelinated slower at transmitting signals

space between synaptic pre and post-synaptic terminals

CNS

- cardiac muscle

- skeletal muscle

- smooth muscle

- glands

- Na OUTSIDE cell

- more positive outside cell

- K INSIDE cell

- less positive inside cell

membrane potential = -70mV

- action potential stimulus causes channels to open, Na IN, K OUT, inside cell becomes MORE POSITIVE, reaches point to send action potential to next cell

- made by schwann cell

- wrap around axon to keep electrical charges concentrated around axon

- makes for faster action potential

- Na initiates depolarization

- Ca stimulates neurotransmitter release

- imbalance in these chemicals messes up neural function

- drugs can either intervene on the Pre-synaptic or Post-synaptic terminals to work

neurotransmitters (ligands) bind to receptors

ex. dopamine, serotonin, norepinephrine

ion charges can encourage or inhibit activity down an axon

ex. Na/K activity in axon encourage

Cl inhibits activity

pressure on membranes or membrane distortion causes depolarization

1)chemical

2)electrical

3)mechanical

multiple places were neurons can go wrong and be modified

on the Postsynaptic Membrane

excitatory, when the ligand binds to receptor, it causes ions to enter and depolarize cell

ex. norepinephrine

ligand binds to receptor and keep membrane potential below -70mV, repressing impulse

ex. GABA

- Purely neural- problem in brain/cerebrum

- Somatosensory and somatomotor- faulty connection in nerves throughout body and signals

cerebrum is affected

1) Trauma- Traumatic Brain Injury (TBI)

affects memory and emotions

2) Aneurysms- Stroke

affects Broca (speech) Area 4 (motor) Wernicke (understanding speech)

3) Consciousness, Cognition, Awareness- trauma, medication, drugs

can be structural or non-structural

Physical damage to brain

ex. concussion, blunt force trauma to brain

neurotransmitter or neuron connection problems ex. drugs inhibit action potential reaching the the next postsynaptic terminal

faulty connection between Incoming Signals Outgoing signals or the ability to correctly interpret said signals

study the different areas and their functions

swelling on brain that is placing pressure on a certain section of brain, causing inflammation, cell damage, and/or loss of function in said area

how the brain is being compressed determines what brain functions are influenced/inhibited

some examples:

- drugs

- cerebral ischemia

- hyperglycemia

- hypoglycemia

- hypoxia

- seizure

- hypothyroidism

Purely Neural v. Somatosensory/motor

Degenerative changes:

only somatosensory/motor, mostly changes (irreversible damage) in myelin

metabolic imbalances

BOTH

structure changes

BOTH

cancers

BOTH

Inflammation

BOTH

can be hyperactive(seizure) or under active (post stroke)

functional disorders- what body/brain function affected is dependent upon which NEURAL NETWORK is affected

ALS- upper and lower motor

Parkinson-dopaminergic (dopamine release), motor system

Ischemic stroke- large areas of brain

Gaits- very different from each other, very informative

upper and lower motor neuron dysfunction

dopamine control and motor system dysfunction

large areas of brain stop function or die

arm and leg on one side of body are affected

both arms or both legs are affected, often spazzing

foot movement is weakened causing foot drop, looks like foot is pointing

described as waddling, weakness in pelvic muscles that would keep pelvis horizontal during walk, pelvis droops on one side

severe muscle rigidity, patient remains in hunched over posture, takes small steps, struggles to initiate steps

Parkinson posture- stooped head, small steps, tuck hands at sides, hunched over

irregular, jerky movements in all extremities

feet sensory fails to detect when foot has made contact with ground, patient slams foot into ground to sense it.

wide gait, clumsy movements, patients body swings from side-to-side as they walk

cerebellum and connections are affected

-ataxic gait

-truncal gait (needs arms for support)

-Dysmetria (no smooth coordination, cant do finger to nose touch)

-limb ataxia (uncoordinated limb tremor, slows movement down to compensate)

-vertigo (spinning dizziness)

-static and kinetic tremors (shaking when still or moving)

- cerebellar dysarthria (slurred speech)

-Nystagmus and ocular dysmetria (shaking eyes, eyes unable to focus)

dependent on:

1) human host

2) which infectious agent

3) exogenous or endogenous environmental factors

KEY FACTOR-

how susceptible the patient is to disease

leading causes of death GLOBALLY

- significant morbidity and mortality

- elderly

- very young

- immunocompromised

- disenfranchised

someone or something that carries the disease and can pass on to others

includes animals, people, objects, and food

animals carrying infectious agents and even amplifying it

ex. rats and the black plague, mosquitos and malaria

ability to spread from one individual to others

ability for pathogen to invade and multiply in host

ability of infectious agent to produce disease

capacity of pathogen to cause severe disease

microorganisms outcompete normal flora and multiply

ability of microbe to produce soluble toxins or endotoxins

microorganism in the body, don't cause harm, and can even prevent infection

an infection that shows obvious signs in patient

an infection that is not obvious in a patient, may be hard to diagnose

1) encounter host

2) enter host

3) multiply and spread at entry site

4) cause tissue injury in host

- directly (cytotoxin) indirectly (inflammation response from body)

Asymptomatic to Life-threatening

1) acute (rapid, onset)

2) subacute (in the middle)

3) Chronic (long, drawn out)

1) Resolve (recovery)

2) Chronic Infection

- active (parasitic)

- prolonged asymptomatic excretion of agent (agent is being produced in body for period without patient knowing)

- latency of agent within host (sleeps for a time then awakes)

3) Death of Host