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PATHOPHYSIOLOGY > Stress and Adaptation > Flashcards

Stress and Adaptation Flashcards

1
Q

T/F: Stress is a normal physiological response?

A

True

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2
Q

What are the types of stress responses?

A

neuro-endocrine response or psycho- neuro immunological response

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3
Q

What does homeostasis resist to?

A

internal and external disturbances

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4
Q

What are the components of negative feedback mechanisms?

A
  • sensor detecting change
  • integrator and comparator that sums and compares
  • effector system that returns sensed function within that range point
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5
Q

General Adaptive syndrome

A

Response to stressors was a process that us to resist challenge by using the function of the system best able to respond to it

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6
Q

Three stages of GAS

A
  • alarm stage
  • resistance stage
  • exhaustion stage
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7
Q

Alarm stage

A

stimulation of sympathetic nervous system and the HPA axis

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8
Q

The alarm stage results in what being released?

A

catecholamines and cortisol

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9
Q

The resistance stage

A

body selects the most effective channels of defence

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10
Q

What drug has decreased levels during the resistance stage?

A

cortisol levels decrease after the first stage as they are not needed

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11
Q

Exhaustion stage

A

stressor is being prolonged and overwhelms the body to defend itself
- resources are depleated and wear and tear starts to begin

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12
Q

Where are stressors and do they always lead to stress?

A

they are everywhere and not always lead to stress

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13
Q

What leads to the stress repsonse?

A

stimuli and perception

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14
Q

Three components of stress

A
  • the stressors
  • the stress response
  • pathophysiological sequelae that occurs
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15
Q

Is a stress a response or something that happens to us?

A

a response

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16
Q

Different types of stressors and their names

A

positive (eustressors) and negative (distressors) or neutral

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17
Q

How do neutral stressors work?

A

dont lead to stress response until we change them to positive or negative

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18
Q

What effects do external demands trigger?

A

emotional, behavioural and physical reactions

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19
Q

How are external stimuli categorized?

A

By three categories

  1. quantity
  2. quality
  3. duration
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20
Q

External stimuli: quantity

A

identifies the negative consequence of stress resulting from an accumulation of stressors either positive or negative in too short of a period of time

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21
Q

External stimuli: quality

A

major changes affecting a large or small number of people; daily hassels which normal people complain of stress response

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22
Q

External stimuli: duration

A
  • can be acute or limited
  • can be sequential
  • can be chronic
  • can be chronic intermittent
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23
Q

Individual judgement

A

Stress is an individual’s conscious appraisal that a disturbance has occurred

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24
Q

What challenges a persons ability to cope?

A

individual judgement

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25
Q

Physiological Response to stress

A

responses to life events

  • depression
  • anxiety
  • excitement
  • anticipatory events
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26
Q

What are the primary hormones involved in stress response?

A
  • glucocorticoid
  • mineralocorticoids
  • cataecholamines
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27
Q

What is glucocorticoid mainly consist of?

A

cortisol

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28
Q

What is the effect of glucocorticoid?

A
  • maintains blood glucose levels by antagonizing effect of insulin
  • enhances effects of catecholamines on cv system
  • suppresses osteoblast activity
    protect against the effects of stressor and focus energy on regaining balance
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29
Q

What makes up mineralocorticoids?

A

primarily aldosterone

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30
Q

Catecholamines consist of?

A

epinephrine, norepinephrine and small amount of dopamine

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31
Q

What are the three main layers the compose a retroperitoneal gland?

A

outer capsule, adrenal cortex and adrenal medulla

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32
Q

Outer capsule

A
  • tough fibrous capsule enclosed in fat for protection
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33
Q

Adrenal cortex

A
  • forms bulk of the gland
  • accounts for 80-90%
  • 3 divisions
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34
Q

Adrenal medulla (inner most)

A
  • knot of nervous tissue
  • part of sympathetic nervous system
  • accounts for 10-20%
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35
Q

Adrenal cortex has how many layers?

A

3

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36
Q

What are they layers of adrenal cortex

A
  • zona glomerulosa
  • zona fasciculata
  • zona reticulata
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37
Q

What does the zona glomerulosa primary produce?

A

aldosterone

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38
Q

What does the zona fasciculata produce?

A

primarily cortisol

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39
Q

What are some examples of stressors?

A

Trauma

  • Surgery
  • Temperature extremes
  • Disasters
  • Medications (chemo/radiation)
  • Malnutrition
  • Prolonged exercise
  • Pain (acute + chronic)
  • New baby
  • New job
  • Grief
  • Bereavement
  • Aging
  • Obesity
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40
Q

Role of the Zona glomerulosa?

A
  • Produces aldosterone
  • Regulate Na+/K+ secretion and retention
  • Key role for volume and BP control
  • pH balance
41
Q

What occurs when there is too much aldosterone?

A

Increase in blood pressure

42
Q

What occurs when there is too little aldosterone?

A

Decrease in blood pressure

43
Q

What is the role of the Zona fasiculata?

A
  • Cortisol, cortisone, corticosterone

- Release with ACTH stimulation

44
Q

What is cortisol?

A

Major stress hormone, released during periods of stress

45
Q

What signs can be associated with increased cortisol levels?

A

Increases blood glucose, decreases peripheral intake and gluconeogenesis (which is why diabetes is better controlled when the patient is at home)
- Promotes lipolysis

46
Q

What are cushingoid signs?

A

Fat pads, buffalo hump

47
Q

What is another major role of cortisol?

A
  • Anti-inflammatory
  • Immunosupression
  • Cortisol impairs T-helper 1
48
Q

What disease state occurs when you don’t have sufficient cortisol?

A

Addison’s disease

49
Q

What happens when you have too much cortisol?

A

Cushing’s disease

50
Q

What are some signs/effects of steroid diabetes?

A

Edema, poor wound healing, buffalo hump, moon face

51
Q

What is the role of the Zona reticularis?

A
  • Gonadocorticoids
  • Good blood supply
    _ Epi/norepi
  • Linked to the autonomic nervous system
52
Q

What is the role of the thalamus?

A

Sensory perception and regulation of motor functions

53
Q

What is the role of the reticular activating system?

A

Responsible for regulating wakefulness and sleep/wake transitions and promoting motor control of posture

54
Q

What is the role of the hypothalamus?

A

Releases CRH, stimulates the CNS via the locus ceruleus, anterior pituitary and CRF, stimulates the p.p less. CRF release, stimulates the anterior pituitary to release ACTH, responsible for releasing cortisol from the adrenal glands

55
Q

What does epinephrine do to the body?

A
  • Increase available glucose via gluconeogenesis, glycogenolysis, limits peripheral uptake of glucose and pancreas production of insulin (causes transient hyperglycemia)
  • Bronchodilator
  • Promotes lipolysis
  • Promotes contractility and increases heart rate
56
Q

What does norepinephrine do to the body?

A
  • Promotes arousal
  • Increases vigilance
  • Increase anxiety
  • Increase activity of sweat glands i the palms and the axilla
  • Triggers pyloerection
  • Increase CV smooth muscle constriction
  • Increases blood pressure
57
Q

Acute stress feedback

A
  • Activate hypothalamus, negative feedback from cortisol. Allows the body to deal with stress as short and self limiting
58
Q

Chronic stress feedback

A
  • Negative feedback system desensitized no longer responds to increased levels of cortisol, allows hypothalamus to secrete more CRF and anterior pituitary to secrete more ACTH
  • Neural and hormonal connections become dysfunctional with prolonged activation, often leads to overactivation
59
Q

Short term stress: (what hormones are more predominant?)

A
  • Catecholamine effect more predominant
  • Increase HR and BP
    Liver converts glycogen to glucose and releases glucose into the blood
  • Bronchiole dilation
  • Change in blood flow, decreased GI activity and decreased urine output
  • Increased metabolic rate
60
Q

Long term stress: (effects)

A
  • Retention of sodium and H20 by kidneys
  • Increased blood pressure and increased blood volume (these top two controlled by mineralcorticoids)
  • Proteins converted and fats to glucose or broken down for energy
  • Increased blood glucose
  • Suppression of the immune system
61
Q

Positive consequences of stress

A

Hyper-metabolic state (lipolysis, gluconeogenesisglyocgenolysis) provides body with increased nutrients for energy and healing

62
Q

Negative consequences of stress

A
  • Loss of muscle mass
  • Nitrogen depletion (muscle catabolism, increased N output in the urine)
  • Immune system suppression
  • Hyperglycemia
  • Cardiovascular wear and tear
63
Q

How can you measure stress?

A
  • Biological (blood for hyperglycemia, adrenal function, aldosterone, cortisol and ACTH)
  • Cortisol measured by looking at metabolites in 24 hour collection
  • Suppression/stimulation test to measure HPA feedback system
  • Insulin tolerance test, assess HPA axis, hypoglycemia stress test, pts get insulin to lower blood glucose below 2.2 mmol/L, then serum cortisol + growth hormone response is measured
  • Serum catecholamines
  • Cardiovascular reactivity
  • Muscle tension
  • Urinary nitrogen
  • Psychosocial, any to assess anxiety, fear, mood, coping, support
  • Self reporting systems
64
Q

What effect does stress have on the brain?

A

High cortisol = decreased hippocampal function (verbal and contextual memory)

  • Neuronal atrophy and destruction
  • Decreased short term memory
  • Decreased accuracy of contextual memories, impaired reliability
  • Decreased ability to recognize threat
  • Repeated stress causes pathophysiology
65
Q

What are the clinical implications of stress

A
  • Rising blood pressure
  • Rapid HR, chest pain, SOB
  • Sweating hands and feet
  • Churning stomach
  • Aching neck and shoulders
  • Clenched teeth
  • Decreased sexual interest, loss of DHEA, reproductive issues
  • Insomnia
  • GI symptoms
  • Hives, ticks, itching, acne
66
Q

What are stress related diseases of the nervous system?

A
  • Fatigue
  • Anxiety
  • Depression
  • Insomnia
  • Addiction
67
Q

What are stress related diseases of the cardiovascular system?

A
  • Arrythmias
  • HTN
  • Heart failure
  • Stroke
  • Coronary artery disease
68
Q

What are the stress related diseases of the GI system?

A
  • Crohn’s disease
  • Heartburn/GERD
  • Gastritis
  • Ulcer
  • Malabsorption
69
Q

What are the stress related diseases of the MSK system?

A
  • Tension headache
  • Backache
  • Inflammatory disease of the tissue
  • Arthritis
  • Muscle wasting
  • Osteoporosis
70
Q

What are the stress related diseases of the integumentary system?

A
  • Eczema
  • Psoriasis
  • Dermatitis
  • Acne
  • Alopecia
  • Poor wound healing
71
Q

What are the stress related diseases of the endocrine system?

A
  • Hyperglycemia
  • Diabetes mellitus
  • Amenorrhea
  • Cushing’s disease
  • Addison’s disease
72
Q

What are the stress related diseases of the respiratory system?

A
  • Respiratory rate
  • Hypersensitivity reactions (asthma)
  • Exacerbation of COPD
73
Q

What are the stress related diseases of the immune system?

A
  • Immunodeficiency
  • Immunosuppression
  • Autoimmune disease
74
Q

What are the stress related diseases of the genitourinary system?

A
  • Diuresis
  • Irritable bladder
  • Renal failure
  • Impotence
  • Menstrual irregularities
75
Q

What are the emotional symptoms of stress:

A
  • Anxiety, phobia, depression, irritable, frustrated, overreaction, focus issues, memory problems, “out of control”, substance abuse
  • Translates to behaviour, conflict, isolation, violence, “difficult patient”
  • Health teaching is important but hard, these patients have issues with memory and dealing
76
Q

Clinical interventions for stress:

A
  • Eliminate stressors (ex. give antiobiotic, promote sleep to avoid sleep deprivation)
  • Manage stress response (positive vs negative coping)
  • Prevent/reduce stress response
  • Blocking stress response (distance, make light of situation)
77
Q

Non-Pharmacologic treatment for stress:

A
  • Relaxation (controlled breathing), meditation, yoga
  • Imagery
  • exercise (Decrease cortisol and increase endorphins)
  • Music therapy
  • Massage therapy
  • Biofeedback
78
Q

Factors affecting adaptation

A
  • Hardiness
  • Nutrition
  • Genetic endowment and age
  • Psychosocial factors
  • Sleep-wake cycles
  • Physiologic reserve
  • Rapidity for which needs for adaptations occur
  • Addresses ability of the individual to deal with stress
79
Q

What does elevated growth hormone do?

A

Counter the effects of insulin

80
Q

Where is the locus ceruleus found?

A

In the brain stem

81
Q

Function of the locus ceruleus?

A

Integrating centre for the autonomic nervous system

82
Q

What occurs when the SNS is activated?

A

Release catecholamines, epinephrine and norepinephrine

83
Q

Why do we give epi-pens for clinical attacks?

A

Epinephrine acts as a broncho-dilator

84
Q

What is the role of the parasympathetic nervous system?

A

Return the body to homeostasis/balance after the threat is no longer perceived

85
Q

Why is acute stress beneficial?

A

Allows us to prepare for threatening period (increased vigilance, attention, cognition, etc)

86
Q

Why might a person with a weak cardiovascular system experience negative effects from short term stress?

A

They do not have the capacity to handle the sure of catecholamines which are demanding on the heart

87
Q

What occurs when the cortisol is elevated? (Acute stress feedback)

A

Inhibits hypothalamus from producing more CRF and the anterior pituitary from producing more ACTH, allows body to deal with situation as an acute self limited response

88
Q

What is the difference between acute stress feedback and chronic stress feedback?

A

System is desensitized and does not respond to elevated cortisol. Hypothalamus produces more CRF and anterior pituitary produces more ACTH, neural and hormonal connections become dysfunctional.

89
Q

What type of hormones are more predominant in acute stress?

A

Catecholamines

90
Q

What type of hormones are more predominant in chronic stress?

A

Glucocorticoids

91
Q

How does stress impact healing?

A
  • Decreased immune response to vaccines
  • Increased susceptibility to infection (NK cells are suppressed because of cortisol)
  • Slow wound healing
  • Angiogenesis impaired
92
Q

Sustained stress levels can damage which part of the brain?

A

hippocampus

93
Q

Is the damage to the brain caused by cortisol reversible?

A

If the stress is acute, yes

94
Q

How can stress cause an ulcer?

A

Cortisol causes the stomach contents to become more acidic, if there is a break in the mucosa it can occur

95
Q

Why is teaching people with chronic stress difficult?

A

They can have issues with attention and memory, they may not be able to focus on/remember what you are saying

96
Q

How will stress show in blood work?

A
  • Increased glucose in the blood (because of cortisol and other factors that increase gluconeogenesis)
97
Q

How might stress show itself in the cardiovascular system

A
  • Increased HR
  • Increased BP
  • Palpitations
98
Q

How might stress show itself in the neurological system?

A
  • Short term memory problems
  • Emotional symptoms (agitation)
  • Physical symptoms (headache)
  • Behavioural symptoms (isolation)

PATHOPHYSIOLOGY (9 decks)

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