stress and disease

Question 1

Definition of health

Answer 1

state of complete physical and mental and social well being; not just absence of disease and injury

Question 2

Determinants of health

Answer 2

Individual biology and behavior

Physical and social environments

Government policies and interventions

Access to quality health care

Question 3

Disease definition

Answer 3

Any deviation from the normal structure or function of a part, organ, or system of the body that is manifested by a characteristic set of signs and symptoms

Organic: no structural changes

Functional: no morphological changes

Question 4

2 types of presentation of disease

Answer 4

Asymptomatic:
Disease present but not associated with symptoms

Symptomatic:
Disease present with symptoms

Question 5

Pathophysiology definition

Answer 5

Patho and physiology: Study of structure and function of tissues and organs

Pathophysiology: the study of underlying disease which provides basis for preventative measures

Question 6

Etiology definition

Answer 6

describes what sets the disease process in motion

Question 7

Causes of disease

Answer 7

Cause of disease

Biologic agents (bacteria, viruses, fungi, archaea, parasites

Physical forces (trauma)

Chemical agents (recreation drugs and exposure)

Nutritional excesses or deficits

Question 8

important concepts regarding disease

Answer 8

A single disease agents can affect more than a single organ

A number of disease agents can affect the same organ
Most diseases have many causes

Question 9

Risk factors

Answer 9

Predisposing conditions for a particular disease
Congenital present at birth

Acquired
Caused by events after birth

Question 10

Disease risk factor categories

Answer 10

Genetic: (family history)

Disease associated:
Past illness that increase risk

Treatment associated:
surgical , transfusions, medications (side effects), allergies, immunizations

Environmental:
Exposures, occupational, travel

Lifestyle:
Substance use, sex, health habits

Question 11

Pathogenesis definition

Answer 11

Sequence of cellular and tissue events that take place from the time of initial contact with an agent until the expression of disease
Describes how the disease process evolves

Question 12

Morphology definition

Answer 12

structure / form of cells or tissues

Morphologic changes are connected with both the gross and microscopic changes that are characteristic of disease

Histology
Deals with the study of cells and extracellular matrix of body tissues

Lesion
Represents a pathologic or traumatic discontinuity of a body organ or tissue

Question 13

clinical manifestations of disease

Answer 13

signs: Objective manifestation of a illness or disorder
Can be seen, heard or measured or felt
Ex: fever , rash, wheezing

Symptom:
Subjective evidence of an illness or disorder
Changes in the body or its function that is perceived by the patient indicating disease
pain, itchiness, vison changes

Question 14

Syndrome definiton

Answer 14

a compilation of signs and symptoms characteristic of a certain disease state

Question 15

Complication

Answer 15

adverse extensions of a disease or treatment outcome

Question 16

Sequelae definition

Answer 16

lesions or impairments that follow or are caused by disease

Question 17

Diagnosis definition

Answer 17

Cause of a health problem

Question 18

what information is required for a diagnosis

Answer 18

Based on information obtained from:

health history: persons subjective account of symptoms, progression, contributing factors

Physical examination: checking for signs of altered body structure or function

Weighing all possible causes and selecting the most likely accounting for clinical presentation

Question 19

Deductive vs inductive reasoning

Answer 19

Deductive:
From general to specific
Concerned with the rules for determining when an argument is valid
General A to B, specific observation B to C, conclusion A to C

Inductive:
From specific to general
Concerned with the soundness of inferences for which the evidence is not conclusive
Probability theory

Question 20

Diagnostic tests and procedures

Answer 20

Assist in diagnosis to confirm or rule out
Invasive vs non invasive. Must weigh risk vs benefit

Ex: clinical lab tests, radioisotope, endoscopy, ultrasound, x-ray, magnetic resonance imaging, PET scans (Positron emission tomography), cytologic and histologic examination

Question 21

Categories of diagnostic tests and procedures

Answer 21

Chemical:Glucose, potassium, chemistry profiles

Toxicology: drug screens
Hematologic: CBC, ESR, PLT count

Urinalysis: routine and pregnancy testing

Microbiologic: Culture, antibiotic sensitivity.

Serologic: monospot, ASO

Therapeutic drug monitoring: dilantin, theophylline, digoxin

Transfusion service: ABO/Rh typing, compatibility testing

Question 22

Validity vs accuracy in clinical tests

Answer 22

Validity (accuracy): did the tool measure what it was intended to measure

Reliability (consistency): can that observation/ measurement result be repeated

Question 23

Clinical stages regarding course of disease

Answer 23

Acute: self limiting and relatively severe

Chronic: long term process. Continuous symptoms and severity of disease overtime. Exacerbation: varying degrees of aggravation of symptoms
Ex: having COPD and poll or dust makes it worse

Subacute: intermediate between acute and chronic

Preclinical: disease is not clinically evident but destined to progress

Subclinical: not apparently clinical and not destined to become clinically apparent

Clinical: characterized by signs and symptoms

Carrier: individual who harbors an organism but is without manifestations and can still infect others

Question 24

Classifications of disease:

Answer 24

Congenital and hereditary:
Genetic abnormality, intrauterine injury or interaction of genetic and environmental factors

Inflammatory:
Non specific reaction to injurious agent

Degenerative:
Deterioration of various parts of the body

Metabolic
Disruption of cellular energy processes

Neoplastic:
Benign or malignant (abnormal cell growth)

Question 25

Stress:

Answer 25

State of affairs arising when a person relates to situations in certain ways you can Successfully adapt or maladaptive resulting in disease People are not disturbed by situations per se but by the way they appraise and react to situations Stressor may be real or perceived Stressors that exceed a persons coping ability results in reactions of cognition, emotion, and behavior that can adversely affect well being

Question 26

HOMEOSTASIS definition

Answer 26

Purposeful maintenance of stable internal environment maintained by coordinated physiologic processes that oppose change

Question 27

negative feedback mechanism and the control systems that oppose change

Answer 27

Negative feedback: maintains stability A sensor: detects a change An integrator: that sums and compares the incoming data with a set point An effector: that returns the sensed function to within range

Question 28

general homeostasis features

Answer 28

Consistency require mechanisms that act to maintain it Steady state conditions which change is met with resistance Regulatory system which works together to maintain homeostasis It is the result of organized self governance

Question 29

What are control systems and What do control systems ultimately do?

Answer 29

collection of interconnected components that function to keep a physical or chemical parameter of the body relatively constant Regulate cellular function Control life processes Integrate function of different organ systems

Question 30

Positive feedback:

Answer 30

interject s instability in the system. Produces a cycle which produces more of the initiating stimulus.

Question 31

Endogenous vs exogenous stress

Answer 31

Endogenous = internal Exogenous =external stimulus stress is: a State manifested by specific syndrome of the body developed in response to stimuli

Question 32

General adaption syndrome/ deeper dive into Hans Selye's

Answer 32

General: Effect is a general systemic reaction Adaption: response is in reaction to a stressor Syndrome: the physical manifestations are coordinated and dependent on each other Alarm: central nervous system is aroused and body defenses are mobilized Epinephrine and norepinephrine released, which increases heart rate, force of contraction, oxygen intake, and mental activity Resistance or adaptation: Sympathetic nervous system response (fight or flight) / adrenaline rush Body responds to stressor in attempt to return to normal and coping mechanisms are used Exhaustion: Continuous stress causes progressive breakdown of compensatory mechanisms The body can no longer produce hormones and organ damage starts (onset of disease)

Question 33

Hans Selye's general adaptation syndrome

Answer 33

physical or psychological stressor→ alarm reaction → resistance → recovery or exhaustion

Question 34

What are the 2 factors determining stress response.

Answer 34

Stress properties Condition of the person being stressed

Question 35

What are the 3 properties of stress

Answer 35

type of stress: Eustress (mild, brief, controllable periods of stress perceived as positive stimuli to emotional, intellectual growth, and development Distress: severe, protracted, uncontrollable situations of psychological and physical stress which are disruptive to health Intensity: mild/ moderate/ severe Duration: acute/ chronic

Question 36

influences of adaptive capacity of a person to stress

Answer 36

Refers to the influence of the adaptive capacity of the person The relative risk for development of stress related pathologic process in part depends on these factors: internal : genetic predisposition, age, sex External: exposure to environmental agents, life experiences, dietary factors, level of social support physical , mental, emotional and social state is a function of: Age and genetics Diet and nutrition Rest Exercise/ physical condition Lifestyle Presence of other conditions Perception of social support Affects: susceptibility, adaptive capacity and response

Question 37

What two systems mediate the stress response

Answer 37

nervous and endocrine systems nervous: signals received along the neuron sensory pathways are integrated Endocrine: leads to the formation of circulating mediators in the bloodstream note: The immune system affects and is affected by the stress response

Question 38

what is the purpose of the stress response, why is a prolonged stress response significant, why is no stress response significant?

Answer 38

The stress response is meant to protect the person against acute threats to homeostasis and is normally time limited Neural responses and hormones that are released are usually not around long enough to cause tissue damage In situations where stress is hyperactive, psychological and behavioral changes can become a health threat If the stress is hypoactive a person may be more susceptible to diseases associated with overactivity of the immune response

Question 39

what are the two components of the neuroendocrine response? what chemical signals does each produce?

Answer 39

Hypothalamic pituitary-Adrenal cortex (HPA axis) Mediated by glucocorticoids secreted by the adrenal cortex generates Cortisol Sympathetic nervous system (SNS) Mediated by catecholamines secreted by the adrenal medulla mediates levels of Epinephrine and Norepinephrine

Question 40

Hypothalamic pituitary adrenal axis (HPA axis ) and its steps to create_?

Answer 40

Hypothalamus releases Corticotropin releasing factor (CRF). this stimulates the pituitary gland to release adrenocorticotropic hormone (ACTH) ACTH makes the adrenal cortex release corticosteroids (cortisol). Cortisol then increases blood glucose, depresses the immune system, and is broken down to cholesterol

Question 41

Glucocorticoids

Answer 41

Cortisol is the major glucocorticoid in the body Functions: Stimulates the breakdown of muscular protein into amino acids Help lipids break down into fatty acids and glycerol Promotes hepatic gluconeogenesis ( synthesis of glucose) from amino acids, glycerol, and fatty acids Inhibits tissues from utilizing glucose, thereby making more available to the brain during stress response (increasing insulin resistance) (sustained increased blood glucose) cortisol action is slow (minutes), its duration is (hours to days), sustained adaptive stress response

Question 42

what are the Permissive actions of cortisol

Answer 42

Allows small amount of glucose to be used for lipolysis and bronchodilation needed for stress response Cortisol decreases hormone production, reproductive function, bone formation, and red and white blood cell formation (inhibiting the immune response) more on cortisol effects: in the acute stress response cortisol actions to ensure the body has the energy means to survive the stressor thereby suppressing other systems that require energy but are not needed to immediately survive. i.e suppressing immune, reproductive, and digestion system etc. If the stressor is infectious the body uses other mediators like IL-1 and IL-6, so despite cortisol presence the inflammatory and WBC response can take place. however if cortisol stays high it will suppress this action to prevent the immune system from overshooting Cortisol release is self inhibitory usually, upon release its presence tells the hypothalamus and pituitary we have enough

Question 43

what are Adrenal catecholamines and what are their effects?

Answer 43

epinephrine and norepinephrine Almost all norepinephrine is converted to epinephrine Epinephrine and norepinephrine exert their effects in target organs as they travel through alpha and beta receptors. Alpha receptors are found in arteries in smooth muscle when stimulated by epinephrine and norepinephrine they cause the arteries to constrict and return blood to the heart. Beta 1 receptors are located in the heart and beta 2 receptors are located in the lungs. When beta 1 receptors are stimulated they cause the heart to beat faster and contract more forcefully to increase cardiac output. When beta 2 receptors are stimulated they cause bronchial dilation. Stimulates glycogenolysis (breakdown of liver glycogen) Stimulates gluconeogenesis Inhibits insulin secretion via α2 receptors (rapid blood glucose spike) epinephrines activity and release is rapid (seconds) and its duration short (minutes). Plays a role in immediate flight or flight

Question 44

Major hormonal induced metabolic changes in the stress response

Answer 44

as Epinephrine increases Fight or flight by: Mobilizing energy storages and increasing blood glucose and fatty acids as Cortisol increases: Mobilizes energy storages by increases blood glucose, amino acids, and fatty acids Glucagon increases thereby Increasesing blood glucose and fatty acids Insulin decreases: Allows glucose to stay in the blood

Question 45

Which systems mediate blood circulating volume and BP during stress

Answer 45

Renin-angiotensin -aldosterone system RAA Conservation of salt and water Increase in plasma volume Increase in arteriolar vasoconstriction to maintain/elevate blood pressure Antidiuretic hormone system (ADH or vasopressin) Increase plasma volume (controls water) Increase in arteriolar vasoconstriction to maintain/elevate blood pressure Note that epinephrine also stimulates the RAAs system by increasing the release of renin from the kidneys

Question 46

RAA system and its steps to increase vasoconstriction and BP

Answer 46

Renin → angiotensisn/ogen→ angiotensin + (ACE) → angiotensin II → adrenal cortex→ aldosterone → holds Na+ in the distal convoluted tubule; water follows na + gradient thus increases water retention Result: increased circulating volume (aldosterone) and vasoconstriction (angiotensin II)

Question 47

The Antidiuretic hormone system (ADH or vasopressin)

Answer 47

Antidiuretic hormone (ADH), also known as vasopressin, is produced in the hypothalamus and released from the posterior pituitary gland ADH primarily acts on the kidneys, specifically in the collecting ducts, to increase water reabsorption. leading to increased concentration of urine (yellow) increase in water reabsoprtion leads to increase in blood plasma volume. increase in blood pressue ADH also acts as a vasoconstrictor to maintain/ elevate blood pressure

Question 48

types of Stress and its effect on growth hormone, thyroid hormone and reproductive hormones

Answer 48

Acute stress: increased levels of thyroid hormones to generate energy chronic stress: decreased levels of growth and thyroid hormones (conserving energy)

Question 49

Stress effects on the immune system:

Answer 49

Stress suppresses the immune system, pathways are unclear

Question 50

The neuroendocrine control system: 6 systems

Answer 50

cerebral cortex: involved with cognition and attention limbic system: emotional response thalamus: relay center, receiving sorting and distributing sensory input hypothalamus: coordinates responses of the endocrine system and autonomic nervous system pituitary gland: releases hormones that govern vital processes reticular activating system: modulates mental alterness

Question 51

Stress summary

Answer 51

definition: State manifested by symptoms that arise from the coordinated activation of the neuroendocrine and immune systems Neurtotransmitters (catacholamines and corisol) function to: alert the individual enhance cardiovascular and metabolic processes focus the energy of the body suppressing other systems not needed

Question 52

Adaptation

Answer 52

ability to respond to changes in homeostasis affected by: coping strategies and appraisal of the stressor

Question 53

PTSD

Answer 53

characterized by flashbacks of occurrence. Avoidance: numbing and disruption of personal relationships. Hyper arousal i.e irritability or startle reflex Treatment: debriefing, crisis intervention, medications for anxiety and depressions In people with PTSD expect to find higher sensitivity to Cortisol (manifests as prolonged stress response), however this means that because cortisol is self inhibitory and the high sensitivity there will be LOW amounts in the blood after a Dexamethasone suppression test

Question 54

Stress and diseases

Answer 54

Heart disease: Heart attacks and high blood pressure Diabetes Insulin resistance, metabolic syndrome Pain Join pain, headaches Increased infection risk Immune disorders Cancer Digestion problems Eating problems Repductive failures Issues with memory and concentration Hair loss

Question 55

How to quantify stress

Answer 55

Methods: electrocardiographic recordings of heart rate blood pressure electrodermal measurement of skin resistance/ sweating test Biochemical assays for hormonal levels (Dexamethasone suppression test: testing cortisol levels, the result is an inference to sensitivity) urinairy samples of hormones (cortisol) WBC count

Question 56

symptoms/Effects of acute vs chronic stress:

Answer 56

Acute stress: Autonomic system: fight or flight Headache, cold skin, moist, stiff neck, arousal, alertness, cognition Diversion of clood to essential body systems Chronic stress: Neural and hormonal connections become dysfunctional Systems become overactive or underactive Linked to Cardiovascular issues, immune issues, and neurologic diseases Depression, alcoholism, drug abuse