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Semester 3 > General Pathology 300 (Shock, & intro to infectious diseases) > Flashcards

General Pathology 300 (Shock, & intro to infectious diseases) Flashcards

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1
Q

define shock

A

state of hypoperfusion to tissues (blood)

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2
Q

what are 3 possible mechanisms of shock

A
  1. Pump failure of heart
  2. Loss of circulating fluid
  3. Loss of peripheral vascular tone
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3
Q

features

A

collapse of circulation

disproportion of circulating blood volume & vascular space

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4
Q

result?

A

Tissue anoxia

multi-organ failure

cardiorespiratory failure

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5
Q

categories of shock (not including

A
  1. Cardiogenic shock = pump failure of heart
  2. Hypovolemic shock = not enough volume (blood)
  3. Hypotonic shock = not enough tone
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6
Q

how do categories of shock correspond to mechanisms of shock?

A
  1. # Pump failure of heartCARDIOGENIC SHOCK
  2. # Loss of circulating fluidHYPOVOLEMIC SHOCK
  3. # Loss of peripheral vascular toneHYPOTONIC SHOCK
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7
Q

what 3 categories of shock are sub-categories instead of main categories (in contrast to AP300 notes)

A

Obstructive shock
(categorized under cardiogenic shock?)

Septic shock
(under Hypotonic shock?)

Neurogenic shock
(hypotonic or cardiogenic??)

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8
Q

note about septic shock

A

“Septic shock is a mixed form of a variety of pathologies (hypovolemia, vasodilation, impaired cardiac function, and mitochondrial dysfunction)”

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9
Q
  1. Cardiogenic shock
A

via heart pump failure

via infarction (MI)

via destruction of large portion of myocardium

=
loss of contractile tissue
—> inability to pump

may also be via
—> myocarditis
—> valve disease
—> Arrythmias
—> conduction block (Obstructive shock?)

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10
Q
  1. Hypovolemic shock
A

Loss of circulatory volume

via
—> massive hemorrahge

via fluid loss
—> burns
—> vomiting
—> diarrhea

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11
Q
  1. Hypotonic shock
A

loss of vascular tone

blood pooling in peripheral vessels (note varicose veins?)

via
—> anaphylactic shock (allergy)

—> neurogenic
(trauma, pain, spinal cord injury)

—> bacterial infection (SEPTIC SHOCK)

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12
Q

anaphylaxis vs sepsis (anaphylactic shock vs septic shock)

A

Septic shock (from a bacterial infection).
Example: A serious infection complication called sepsis that gets so bad it leads to septic shock.

Anaphylactic shock (from an allergic reaction or asthma attack).
Example: An allergic reaction to peanuts that leads to anaphylactic shock.

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13
Q

Events of shock

A

series of events – act synergistically

cause viscious cycles

result in death if not treated

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14
Q

early vs late stages of shock

A

early stages are treatable and reversible

late stage
—> serious organ failure
—> @ this stage shock can be irreversible
(nervous tissue, myocardium = no regeneration

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15
Q

what can shock (late?) lead to

A

Acute Respiratory Distress Syndrome (ARDS)

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16
Q

Acute Respiratory Distress Syndrome

A

AKA “Shock Lung”

result of shock

lungs cannot function properly

pump failure, vasodilation —-> LOW BP
(cardiogenic/hypotonic)

LEADS TO
—> STAGNATION OF BLOOD IN PULMONARY CIRCUIT
—-> PULMONARY EDEMA

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17
Q

What can ARDS lead to?

A

COR PULMONALE

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18
Q

recall cor pulmonale

A

The definition of cor pulmonale (pulmonary heart) is when a lung issue causes your right ventricle (heart chamber) to get so big that your heart starts to fail.

It’s a type of right-sided heart failure. Normally, your right ventricle sends blood to your pulmonary artery to get oxygen from your lungs.

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19
Q

ARDS facts

A

break-down of alveolar-capillary units of lungs

loss of lung function

hypoxia/anoxia
dyspnea/tachypnea

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20
Q

what can anoxia lead to in tissues

A

anoxia of tissues can lead to release of cytokines
E.g.
—> TNF
—> IL-1

Leads to
—> increase permeability of vessels
—> vasodilation (hypotonic)

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21
Q

why hypoxia/anoxia lead to cytokine release (?)

(Hypoxia induced factor)

A

Hypoxia leads to the activation of HIF-1α, which is involved in several cellular processes (such as apoptosis, vasomotor control, energy metabolism and angiogenesis).

Additionally, hypoxia leads to the activation of HIF-2α, which is involved in the activation of pro-inflammatory cytokines.

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22
Q

Clinical correlations of shock (THREE STAGES)

A
  1. Early, or compensated shock
  2. Decompensated but reversible shock
  3. Irreversible shock
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23
Q
  1. Compensated (early) shock
A

adaptive characteristics to compensate for changes in homeostasis

E.g.
—> Tachycardia

—> Peripheral artery casoconstriction
(send blood to vital organs?)
-NOTE PALLOR (“paleness or a loss of color from your normal skin tone. Pallor affects your skin and mucous membranes”

—> reduced urine production to preserve volume of circulating blood

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24
Q

Compensated shock symptoms

A

BP is normal

no serious signs of organ ischemia

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25
2. Decompensated shock
compensatory mechanisms failing Hypotension ---> BP & CO drop Tachypnea ---> shortness of breath, increased respiratory rate
26
Decompensated shock symptoms
Oliguria (renal fluid output decreases) Acidosis (build up of metabolic wastes, CO2) ---> renal excretory failure / retention of metabolites ---> note also possible congestion in lungs = CO2 build-up
27
3. Irreversible shock
circulatory collapse hypoperfusion of vital organs loss of vital functions great distress, unconsciousness, death NOTE ALSO ---> DISSEMINATED INTRAVASCULAR COAGULATION
28
disseminated intravascular coagulation (irreversible shock)
"Disseminated intravascular coagulation, or DIC, is a complicated condition that can occur when someone has severe sepsis or septic shock." widespread clot formation / in small blood vessels (?) via ---> hypercoagulability of blood ---> fluid loss ---> hemoconcentration
29
Infectious diseases
..
30
infection
disease caused by microorganisms (including viruses) ---> esp microorganisms that release toxins or invade body tissues
31
infection is
process where organism establishes parasitic relationship with host can cause cellular damage ---> producing toxins ---> intracellular multiplication ---> competing with host metabolism
32
INFECTION vs COLONIZATION
colonization: micro-organisms reside harmlessly on/in body, & Perform useful functions ---> gut bacteria/digestive health ---> adaptation of immune system ---> reproductive health Microbes on/in body outnumber cells by 10-1 *** Colonies not harmful, but can become harmful if become infections
33
Colonies
do not cause detectable Sx /infection However, they can be transmitted to others CAN CAUSE INFECTION IF IMMUNE SYSTEM WEAKENED/COMPRIMISED --- or if circumstances like going from one place to another (cut/break in skin) ---> some bacteria may thrive in some parts of body, but not in others
34
Normal flora
mix of organisms typically found @ a particular anatomical site I.e. In that part of the body, it would be typical to find a particular set of micro-organisms
35
what are benefits for normal flora
nutrients stable environment proection/transport from host
36
what are benefits for host
nutrition/digestion benefits stimulation/development of immune system protection against colonization/infection of pathogenic microbes
37
relatively, what is the proportion of micro-organisms that can cause infection?
only small proportion are capable of causing infection/disease
38
Clinical manifestations (infection)
vary based on pathogen type (etiology) also vary based on system involved
39
clinical manifestations (SYSTEMIC Sx)
fever, chills, malaise, enlarged lymph nodes (lymphadenopathy) consitutional symptoms (?)
40
Integumentary system Sx
pus, open wound, rash, red streaks, bleeding
41
CV system Sx
tachycardia, hypotension (RECALL cytokines ---> vasodilation/hypotension E.g. TNF, IL-1) also increased pulse rate (?)
42
CNS Sx
altered consciousness, confusion, seizures, headache, memory loss photophobia Stiff neck (MENINGITIS) I.e. NUCHAL RIGIDITY
43
GI Sx
nausea, vomiting, diarrhea
44
Genitourinary Sx
dysuria, flank pain (kidneys?) hematuria oluguria urgency, frequency, nocturia
45
URT Sx
tachypnea, dyspnea cough, hoarseness, sore throat nasal drainage, sputum production decreased exercise tolerance
46
TYPE OF (MICRO)ORGANISMS
Viruses BACTERIA MYCROPLASMAS RICKETTSIAE CHLAMYDIAE PROTOZOA FUNGI PRIONS
47
viruses
pathogen made of nucleic acid (DNA/RNA) inside protein shell smallest known organism (only visibly through electron microscope) depends on host cells for replication
48
how many virus types that infect humans
estimated 400 viruses that infect humans
49
how are viruses classified
Nucleic Material Size Shape Means of transmission
50
BACTERIA
single-celled microorganism without true nucleus without membrane bound-organelles have CELL WALLS can grow INDEPENDENTLY without other cells
51
bacteria classified via
shape: ---> SPHERICAL (cocci) ---> ROD (bacilli) ---> SPIRAL (spirochetes) response to staining: ---> gram positive ---> gram negative ---> acid fast motility capsulation spore forming
52
MYCOPLASMAS
"mykes (fungus) and πλάσμα, plasma (formed)" self-replicating, very small bacteria LACK CELL WALL (cell membrane =/= cell wall) unique/different from other bacteria in lacking cell wall
53
mycoplasmas usually associated with which diseases/systems
diseases of repiratory system diseases of urinary system E.g. PNEUMONIA
54
RICKETTSIAE
"Obligate" Intracellular Bacteria ---> I.e. require host for replication (LIKE VIRUS) "animal reservoire" arthropod vector (insects?)
55
Obligate define
Capable of existing only in a particular environment or by assuming a particular role. E.g. An obligate aerobe, such as certain bacteria, can live only in the presence of oxygen. An obligate parasite cannot survive independently of its host.
56
vector
BIOLOGY an organism, typically a biting insect or tick, that transmits a pathogen, disease, or parasite from one animal or plant to another.
57
Example of conditions via RICKETTSIAE
ROCK MOUNTAIN SPOTTED FEVER TYPHUS
58
CHLAMYDIAE
small "OBLIGATE" intracellular bacteria "Obligate" ---> requires host cell for replicaiton associated with ---> STDs ---> Respiratory infections
59
PROTOZOA
single-celled organisms classification ---> INTRAINTESTINAL parasites ---> EXTRAINTESTINAL parasites
60
E.g. conditions (intraintestinal protozoa)
Amebiasis Giardiasis
61
E.g. conditions (extraintestinal protozoa)
Malaria Toxoplasmosis
62
FUNGI
unicellular / filamentous organisms have hyphae have CELL WALL have NUCLEUS Can occur as YEASTS (single-cell, oval shaped organisms) Can occur as MOLDS (organisms with branching filaments) Can be systemic or local E.g. Fungal skin infections (ringworm, athlete's foot), fungal mucosal infections (candida vaginitis)
63
hyphae
each of the branching filaments that make up the mycelium of a fungus.
64
mycelium
A mycelium is a network of fungal threads or hyphae. Mycelia often grow underground but can also thrive in other places such as rotting tree trunks. A single spore can develop into a mycelium. The function of the mycelium is to provide a transportation network to pass nutrients along the fungal body.
65
presence of fungus or yeast in the blood
Fungemia
66
Fungal diseases in humans called
mycoses "Fungal infections, or mycosis, are diseases caused by a fungus (yeast or mold)." "most common on your skin or nails, but fungi can also cause infections in your mouth, throat, lungs, urinary tract and many other parts of your body."
67
PRIONS
infectious particles consist of proteins, WITHOUT NUCLEUS ACIDS transmitted from animals to humans E.g. Creutzfeldt-Jakob disease Bovine spongiform encephalopathy (Mad Cow disease)
68
Classification
endogenous (from within) ---> microorganism that was previously not pathogenic, but now pathogenic E.g. Yeast exogenous (not from within) ---> from source outside body E.g. Influenza virus Nosocomial ---> acquired in health care setting E.g. staphylococcus
69
nosokomos
from Greek nosokomos ‘person who tends the sick’
70
Tranmission
invading organism must be transported from the infected source to susceptible host
71
portals of exit from host
feces, urine, vomit, tears, semen, open lesions, blood
72
transmission routes
via several possible routes contact airborne droplet vehicle vector
73
contact
direct or indirect
74
airborne
float air currents remain suspended small particles
75
droplet
"fall out within 3 ft of source" (??) large particles
76
vehicle
E.g. food, water
77
vector
intermediate source E.g. insect (usually)
78
pathogen may enter new host via
ingestion inhalation bites contact with mucosa transplacentally injections
79
other
skin to skin contact contact with blood/fluids contact with contaminated articles
80
variation (requirement for infection to take place)
number of organisms required to start infection duration of exposure required to start infection (RECALL LYME) pathogenecity: "the property of causing disease."
81
Susceptibility -- depends on
vary from person to person ---> Age? Nutrition hormonal balance concurrent disease (immmune comprimised?) drug use? hygiene
82
chain of transmission
pathogen or agent: virus, mycobacteria, bacteria, fungi, prions reservoire: humans portal of exit: GU, GI, oral cavity, open lesion, semen, tears, blood, feces, urine Transmission: contact (direct/indirect), airborne, droplet, vehicle, vector modes of entry: ingestion, inhalation, injeciton, transplacental susceptible host
83
portal of exit
The Portal of Exit refers to any route that the pathogen can leave the reservoir
84
chain of transmission define
This describes how microorganisms are transmitted from one person or place to another. This could be via someone's hands, on an object, through the air or bodily fluid contact. portal of entry. This is how the infection enters another individual.
85
chain of transmission is
mode of transmission portal of entry susceptible host? infectious agent reservoir portal of exit
86
defense
first, second, third line of defense first = mechanical barriers second = inflammation, nonspecific/innate immune response third = acquired imune response
87
first line of defense e.g.
intact skin, mucous membranes oil, perspiration cilia (resp tract) gag/cough peristalsis (GI) flushing of tears, saliva, mucus normal flora
88
2nd/3rd line of defense
2 inflammatory process NK cells, eosinophils, neutrophils, macrophage, basophil 3 lymphatic system leukocytes/lymphocytes (B/T cells) cehmical, proteins, enzymes
89

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