All cells are in contact with extracellular macromolecules that make up the _______ (think of this as a big grid that holds the cells in place)
extracellular matrix
_____ are chemicals made by cells that affect other cells growth and activity.
cytokines
Migration of cells: Cells may travel in the body to ____ locations.
different
_____ is when cells travel to a site due to the effects of cytokines.
chemotaxis
Cytokines are chemicals produced by other cells at the ______ of injury.
target site
i.e. lymphocytes migrate due to the effects of lymphokines
Cells must communicate and recognize both undifferentiated and specialized cell as as being ______ status (self-host)
same-organism
Receptor proteins on cell surfaces serve as recognition _______.
identifiers
There are many types of ____ junctions.
cell
______ are cell junction bodies between cells.
Desmosomes
Tight junctions are cell junctions that prevent _____.
diffusion
____ junctions are types of cell junctions that enhance communication.
Gap
Cells are specialized, but lose ability to perform some functions, including _____ in the more highly differentiated.
replication
_____ yields the different types of tissues that make up the different organ systems.
differentiation
Specialized tissues arise out of the three _______.
embryonic tissue types
______ tissue develops into nerves, eyes, and skin.
ectoderm
_____ tissue develops into mesenchymal - muscle and GU)
mesoderm
_____ tissue develops into visceral organs.
endoderm
Epithelial tissue may be smooth, or have microvilli and/or ____.
cilia
______ tissue is organized into simple, stratified, or psuedostratified.
epithelial
Simple epithelial tissue is ____ layer.
one
Stratified epithelial tissue is ____ layer (s)
two
Pseudostratified epithelial tissue looks stratified but is ____ layer.
one
The three basic shapes of epithelial tissue are squamous, cuboidal, and _____.
columnar
Connective tissue (CT) makes up the body’s _____.
framework
Connective tissue is made up of ground substance (fluid/gel) with _______.
fibroblasts (produce fibers)
The three basic types of fibers found in connective tissue include collagenous, _____, and _____.
elastic
reticular
Collagenous fibers are not elastic, but ____.
protein
Elastic fibers are made of ____ protein and memranes.
elastin
Reticular fibers form the stroma or parenchyma (acutal tissue) of visceral organs and ______.
bone marrow
There are three types of _____ tissue that deal with all specialized movement (contraction/relaxation)
muscle tissue
The three types of muscle tissue.
skeletal
cardiac
smooth
Neural tissue is made up of neurons specialized for conduction and initiation of the ______ information processing and transmission.
electrical impulses
Neurons are made of cell body, the soma, axon(s), and _____.
multiple dendrites
Cells in tissues are usually _____ and have a specific cytoplasmic to nuclear ratio.
organized
Changes in tissues that result from cell changes include ______ with increased cell size and increased organelles to support the cell, but there is no increase in actual _____.
hypertrophy
cell number
____ is the reduction in cell size and organelles, but again, no change in cell number.
atrophy
_____ involves an increase in cell number.
hyperplasia
____ is the reversible replacement of one cell type with another and can lead over time to dysplasia (abnormal cells and organization), which in turn can lead to neoplasia (cancer).
metaplasia
Tissues undergo hyperplasia for _____ reasons.
various
Hormonal hyperplasia (female breast tissue response to female hormones of puberty and pregnancy) is a ____ form of hyperplsia.
physiologic
_______ hyperplasia (liver regenerates to replace lost tissue after surgical removal of a lobe of the liver) and is a form of physiologic hyperplasia.
compensatory
______ hyperplasia involves hyperplasia that can led to the continuum towardss dysplasia and neoplasia (cancer)
pathologic
One type of dysplasia is “carcinoma in situ” and is ____.
non invasive
Metaplsia may occur in some types of _____.
cancer development
One theory of cancer development is that the effects of _____ that damage DNA and the DNA is not repaired.
carcinogens
One theory of cancer development is that the effects of carcinogens that mutate prot-oncogenes, covert them to _____.
onccogenes (i.e. p53)
Cancer can also be endogenously produced substances (hormones) that promote the growth of ____.
tumors
In post Menopausal women, since the ovaries have stopped producing estrogen, the main source of estrogen is from body fat. THus, overweight PM women have more estrogen production. And, obese women are at higher risk of developing ______, a cancer that can be stimulated by estrogen.
breast cancer
There is a balance between protective (anti-cancer) factors and _____ factors in our environment and diet.
carcinogenic
Things that _____ carcinogenic activation include vitamin A, C, and E, selenium, cruciferous vegetables, geneistein (soy), and epigallocatechin gallate (green tea)
inhibit
_____ agents block activated carcinogens from accessing DNA target. Dietary initiators of detoxification enzymes: Plant phenols (ellogic acid, fruits, vegetables), Epigallocatechin gallate (green tea), Isothiocyanantes, flavones, and coumarins (all parts of plants)
inhibiting
Agents that inhibit _____ and progression include retinols, carotenids, protease inhibitors, phenols and polyphenols (fruits and vegetables).
promotion
Most theories of cancer consider the development to be a ______ from previous abnormal cell changes.
continuum
Hyperplasia to dysplasia to _____; metaplasia develps in some cancers.
neoplasia
Development of cancer as a continuum is the basis of ______ for abnormal cell types to intervene with therapeutics before outright cancer develops.
screening
With metastasis there are three ways to travel: direct invasion, hematologic, or _____.
lymphatic
Carcinoma in situ (CIS) is not invasive and remains in the place where it started, some people call it _____.
precancer
Most cancers travel to other parts of the body, this is called _____.
metastasis
Metastasis can be LOCAL (very close to the original cancer) or _____ (far away in the body)
distant
Metastasis can be locally invasive - traveling to adjacent tissues by ______.
direct invasion
The cancer cells can also travel further via _____ spread (in the bloodstream). Or they can travel via ____ spread (using lymph channels)
hematologic
lymphatic
There are common sites of distant metastasis and these cause ____ symptoms.
specific
Different types of cancer have ______methods of metastasis and also specific locations for metastasis. (i.e. ovarian cancer often goes to lung and _____)
preferred
bone
Cancer in the brain can cause symptoms such as headaches, seizures, and ______.
vertigo
Cancer in the _____ can result in lymphadenopathy.
lymph nodes
Cancer in the respiratory system can result in cough, hemoptysis, and _____.
dyspnea
Cancer in the liver can result in hepatomegaly and ______.
jaundice
Skeletal cancer can cause pain and ____.
fractures
_____ by healthy living and avoidance of cancer-inducing environmental factors (i.e. ionizing radiation)
prevention
If cancer is diagnosed, then the focus changes to prevent metastasis and _____.
recurrence
____ to determine histologic type of cancer and degree of invasiveness.
biopsy
____ to determine the histological type and spread of the cancer and is usually linked to choice of treatment and also prognosis.
staging
Staging of ovarian caner video
?
_____ node biopsy to determine spread to lymph nodes. The _____ is the watcher of the initial spread beyond the cancer site.
sentinel
sentinel
_____ of cancer means the cancer has reappeared in the body after completion of treatment or previous determination of no evidence of disease (____)
recurrence
NED
During general assessment of well-being and ability to perform activities of daily life (ADL) in the cancer patient. Various scoring systems exist, one commonly used is the ________ score.
WHO/ECOG/Zubrod
Karnofsky Scale
refer to notes pg 8
Zubrod Scale
refer to notes pg 8
Hypoxia (anoxia) are sometimes used ______.
interchangeably
Hypoxia means reduced ____.
O2
Anoxia means _____ of O2.
complete lack
Loss of oxygen means that aerobic respiration _____ (less ATP produced), than no ATP at all is produced when glycogen stores are depleted from using anaerobic respiration. Na/K pump and Ca pumps can’t work (require ATP) & cell swells with Na/Water; then Ca+2 enters cell and poisons mitochondria –> ____. Reversible until mitochondria is poisoned.
ceases
cell death
Conditions resulting from oxygen dysregulation such as _________ causing angina or infarct, coronary thrombosis causing infarct.
coronary ischemia
Conditions resulting from oxygen dysregulation such as cerebral ischemia (TIA) and cerebral infarct (_____)
thrombosis, CVA
A _____ is an uncharged atom or molecule that has a free unpaired electron; can be formed by ionizing radiation or _____ - these tend to want to combine with other chemicals and thus cause damage; in humans, secondary inflammation results due to release of toxic intracellular chemcials.
radical
chemicals
Free Radicals - oxidatin - sort of too much oxygen?
? pg 10
Oxidation can result in ____ of lipids which destroy cell membranes, lose selective permeability, cell swells and bursts.
peroxidation
Oxidation can result in ____ poisoning when carbon tet is converted by the liver enzyme to free radical CCI3.
CCI4
Some evidence suggests that vitamin C and E stabilizes free radicals and are therefore called _____ (found in fruits and vegetables in cancer-reducing diets)
anti-oxidants
Poisons act in ____.
different ways
____ is a poison that affects almost all organs.
Lead (Pb)
_____ is a poison displaces O2 from hemoglobin.
Carbon Monoxide (CO)
_____ is a poison that results as a toxic buildup of acetaldehyde affecting liver, stomach, brain and heart.
ethanol
______ effect cell structure and enzymes, enzymatic pathways.
Abnormal genes
Genetic factors cause ______ with possible cell/organ/organism death (i.e.e sickle cell anemia)
cell malfunction
Macrophases, lymphokins, ______, antibodies bind receptor sites and interferes with cell function/regulation.
proteases
________ alters cell membranes, affecting cell volume with swelling and death due to Na/K pump.
Complement
This interaction is designed to fight infection and deal with tissue damage but if our response is too _____, we cause damage to our own tissues with the response.
excessive
Thermal injury includes freezing and ____.
burning.
The changes seen in this burned (scalded) foot from a thermal burn from hot water include firs-degree (redness) and second-degree (______) changes.
blistering
The blister (bullae) includes fluid accumulation _____. This is the result of the breakdown of normal skin layers and increased permeability of the small blood vessels (capillaries) due to the effects of ____.
under the skin
inflammation
Nutritional imbalances result in _____ of essential nutrients.
insufficiency
Macronutrients provide ____ (protein, fat, carbohydrate)
energy
Micronutrient include substances necessary for life, usually coenzymes or cofactors - help your enzymes work in ______.
biochemical pathways
Vita means ____.
vital
Min means ____.
minimum for life
_____ are often enzyme co-factors that affect all levels of metabolism.
vitamins
Vitamin A can affect _____.
visual pigments
Vitamin B6 can affect _____.
amino acid reactions
Vitamin C can affect connective and ____ tissue repair.
epithelial
Anemias can occur due to B12 and ______ deficiencies.
folic acid
Vitamin D deficiency causes rickets and poor _____.
fracture healing
Pressure changes include _______, low-pressure injuries, pressure ulcers (decubitus ulcers).
blast injuries
Due to pressure changes decompression sickness with nitrogen bubbling out of blood and _____ and forming emboli.
blocking capillaries
Due to pressure changes ______ (low oxygen causes compensatory blood flow to the viscera and lungs).
high-altitude pulmonary edema
____ degeneration can result from injury that leads to changes in water balance.
hydropic degeneration
Water imbalance causes cellular swelling and damage to the internal ______.
cell structures
DNA damaged in mitosis/meiosis when chromosomes are vulnerable, usually be _____.
free radical attack
Ionizing radiation leads to transformation of cell into ______.
abnormal tissues
_____ are caused by bacteria, viruses, and parasites invade and destroy, produce toxins, or cause damaging hypersensitivity immune reactions.
infections
HIV attacks the ____ cell, which is a type of T-lymphocyte (the T helper cell white blood cell). In turn the decreased activity of the CD4 cell results in reduced activity of other immune and inflammatory _____. Overall effect makes individuals more susceptible to infection. In the meantime, more virions (virus particles) are being manufactured and released to the body, worsening the infection.
CD4
cell action
Apoptosis vs Necrosis ?
?
Different tissues have different patterns of necrotic ____.
change
____ necrosis occurs in the kidneys, heart and lungs.
coagulative
_____ necrosis occurs in neurons and glial cells; and due to inflammation from bacterial infection.
liquefactive
____ necrosis occurs from TB and has a cheesy appearance.
caseous
____ necrosis occurs in the breast, pancreas, other abdominal organs (lipases form fatty acids = soaps)
Fat
_____ necrosis is seen in hypoxia and subsequent bacterial infection (dry = coagulative necrosis, wet = neutrophil invasion and liquefactive necrosis)
gangrenous
___ gangrene is an anaerobic byproduct of Clostridium infection produces gas bubbles in tissues
gas
______ seems to be limited to 80-100 years (cross-cultural, multi-ethnic)
Lifespan
Life expectancy among genders and races (& socio-economic groups) varies due to standard of living, _______ (diet risk taking, etc)
cultural behaviors
Women have a ____ life expectancy than men, possibly due to cardiovascular disease developing later in life.
higher
Somatic mutation theory states cells are programmed to mutate and die after a _______ of divisions (ceiling to possible number of cell divisions of all human cells:; possibly due to accumulated defects in mitochnodria over time (can’t extract energy from foodstuffs) This is often referred to as the _______ (cells can can only replicate 40-60 times, then processes break down and “programmed cell death” (apoptosis) occurs.
limited number
Hayflick Limit
______ theory also called the complexity theory (really a chaos theory) of _______ in DNA transcription and translation & the inability of the cells and organs to function together in response to the normal stresses of the environment. This results in adaptive dysfunction and organ derangements leading to organism disease as well as the normal process of aging and death. Helps explain associated neurological changes.
Catastrophic
accumulated mistakes
Neuroendocrine theory states that the brain is ______ to stop producing needed hormonal factors.
programmed
Extracellular degenerative theory states the accumulation of disease over time is due to ________
environmental factors.
_____ factors of aging include diet, physical activity, and environmental pollutants.
modifiable
Medical somatic (entire organism) death is defined in the medical field as permanent cessation of _______ as certified by healthcare provider (states have varying laws - some require secondary confirmation)
vital functions
_________ somatic (entire organism) death is when the would has left the body.
Ecclesiastical
_______ somatic death is presumed dead/disappearance for proven period.
legal
The legal definition of the timing of death is when someone was last ____ alive.
seen
_______ about the timing of death includes state of digestion, body heat, rigor, lividity, PM changes.
Ancillary evidence
When somatic (entire organism) death occurs multiple changes take place and it is obvious there is no breathing or _____.
circulation
_____ mortis is when the temperature drops 1-1.5 degrees F per hour, is 1/2 normal in 12 hours, then at 24 hours equals temp of the environment.
Algor
____ mortis is when blood drains to dependent parts gives purple color, starts in 3 hours, gradual rise over the next 36 hours
Livor
____ mortis involves muscle stiffening occurs within a few hours. Lack of ATP causes muscle stiffening since muscle relaxation is dependent on ATP. THen, muscle relaxation by 12-14 hours due to tissue liquefaction. As liquefaction progresses (postmortem autolysis) there is discoloration (hemoglobin degradation) & bloating/swelling (gases form due to bacterial anaerobic metabolism). Starts in 6 hours, peaks 12-24 hours, gone in 36 hours.
Rigor
Tests of death are used to disprove catalepsy, sock, _____, etc.
overdose
_____ tests include loss of movement, loss of reflexes (cornmeal, motor, pain), drying of cornea, softening of eyeballs, cessation of heart beat, no BP, no bleeding from arteries, cessation of respiratin, loss of body heat, PM lividity, rigor mortis, flat EEG, “railroad tracks” on retina.
clinical
________ is when decomposition of vital part occurs, aka mummification.
absolute indication
____ death is certified by health care provider, 80% of deaths. May be slow and expected (i.e. cancer), or sudden and unexpected (i.e. drowning, drug hypersensitivity anaphylaxis.
Natural
_____ death is certified by ME or coroner. Includes homicide (murder, manslaughter, criminal negligence), trauma & injury (hidden or obvious).
Unnatural
Death certification ascribes an immediate ____ of death as a consequence of disease.
cause
State health departments keep and develop summary data, and compiled nationally by the ______.
National Center for Health Statistics (NCHS)
Leading causes of death have changed since 1900 (_____ were #1 then). Now noninfectious chronic disease leader is (CVD & _____)
infectious diseases
cancer
Underlying cause of death is the _______, without which life would have been prolonged the longest.
disease entity
The ______ to an organism or individual cell’s response to injury or invasion.
immune response
The three types of immune response
innate
acquired
passive
_____ immunity is not directed at specific diseases, comprise general defenses.
innate
Phagocytosis by WBC and tissue macrophases is an example of ____ immunity.
innate
Stomach acid and digestive enzymes are an example of ____ immunity.
innate
Skin barrier with low pH is an example of ____ immunity.
innate
Blood chemicals that destroy toxins and bacteria are an example of ______ immunity.
innate
Lysozyme: mucolytic polysaccharide that attacks and dissolves bacteria is an example of ____ immunity.
innate
Basic polypeptides that inactivate some gram-positive bacteria are an example of ____ immunity.
innate
Complement system that destroys bacteria is an example of ____ immunity.
innate
Natural killer lymphocytes: recognize and destroy foreign cells, tumor cell, infected cells are an example of ____ immunity.
innate
Eosinophils kill parasites by punching holes in their cell membrane are an example of ____ immunity.
innate
innate immunity video
?
______ immunity is a specific targeted immune response to antigens.
Acquired
_______ are usually large molecules that share certain characteristics
antigens
Bacterial cell walls and some toxins share certain characteristics and are examples of ______.
antigens
Some smaller molecules combine with larger antigenic molecules can become antigenic with _______ exposure.
repeated
Dust, animal dander and urushiol (poison ivy) are examples of smaller molecules that combined with larger antigenic molecules and become _____ after repeated exposure.
antigens
______ are a specific type of white blood cell that originate from the “lymphoid” stem cell line - they are the basis of acquired immunity.
lymphocytes
Primary lymphoid tissue is where the cells ______ and are differentiated to mature cells (bone marrow, thymus)
originate
Secondary lymphoid tissue is where the activated cells reside for _____.
months to years
____ immunity is made up of immune globulins (immunoglobulins, antibodies) given to you preformed by someone else.
passive
A mother giving fetus immunoglobulins serves as immune system for first few months of infant life (maternal-fetal) is an example of ______.
passive immunity
Injecting immunoglobulin (gamma globulin) to prophylaxis against viral infection after exposure is an example of _____ immunity.
passive
The MPS ( Monocyte-Phagocyte) macrophage system is part of the ____ system. (phagocytosis by macrophages)
innate
The MPS or Monocyte-Phagocyte (macrophage) system also interacts with teh system responsible for ______ immunity.
acquired
White blood cells (WBC) called _____ migrate to tissues, take up residence there and become macrophages. It is the same cell, it just changed its name depending on where you find it. Monocytes are found in ______. Macrophages in _____.
monocytes
blood
tissues
Most invading organisms are first phagocytized by tissue ______.
macrophages
Interaction with lymphocytes involves processing the antigen and presenting it to the lymphocytes, which can then mount an _____ immune response.
acquired
Macrophages also secrete activating substances (i.e. interleukin - 1) that promotes growth and reproduction of ______. Therefore, the lymphocytes are extemely dependent on these WBC.
lymphocytes
The two types of acquired immunity
humoral (secretory) system
Cell mediated response
The Humoral (Secretory) system has two parts
antibodies(imunoglobulins, Ig)
complement system
In acquired immunity, in the ____ system, antibodies (immunoglobulins, Ig) are made by activated B-lymphocytes in response to a particular antigen.
humoral (secretory)
In acquired immunity, in the humoral system, in the complement system a series of chemicals that respond to injury by creating an ______ response. They are found in blood and tissues, made by the _____.
inflammatory response
liver ???
Another type of acquired immunity called cell mediated response is the cellular action of ____ in tissues. The action of other types of WBC (basophils, esoinophils, polymophonucelear cells and t-lymphocytes occur as well.
macrophages
Lymphocytes are a type of ____.
white blood cell
Two types of lymphocytes
B cells
T cells
Primary lymphoid tissue is found in the bone marrow and the _____.
thymus
The bone marrow is where the lymphocytes _______.
originate
The thymus is where lymphocytes are processed to _____.
maturity
The secondary lymphoid tissue is found in the spleen, lymph nodes, tonsils, and Peyer’s patches (_______). Location of “memory” lymphocytes (B cells and T cells) that are committed to acting against a specific antigen.
small intestine
______ are small “foreign” environmental proteins that are capable of stimulating an immune response.
antigens
The liver and bone marrow process lymphocytes into B-cells (the B comes from the Bursa of Fabricius, in birds); this processing commits these cells to respond to certain ______. They then migrate to the __________ and are clone populations that can react to antigen that may be presented to them. The activation of B-cells into plasma cells means they are now making _______(Ab((immunoglobulin, Ig) proteins as a host response to foreign antigen.
antigens
secondary lymphoid tissue
antibody
In the ____ immune response they manufacture immunoglobulins (Ig) (antibodies)(gammaglobulins).
primary
In the primary immune response macrophage (WBC monocyte that has taken up residence in the tissues) engulfs antigen by phagocytosis and presents it to the B-cell (antigenic stimulus).______ become activated, turning into a plasma cell, which can now manufacture proteins called antibodies (immunoglobulins, gamma globulins) + primary response. All of the above activities (macrophage presentation of antigen, B-cell activation to plasma cell) require the presence of the t-lymphocete called ______.
B-cell
T helper cells (CD4 cells)
There are ___ types of immunoglobulins
5
The 5 types of immunoglobulins
IgM IgG IgA IgE IgD
The primary immunoglobulin response is ____, which is the acute phase serum that is drawn when patient first presents with symptoms.
IgM
The secondary immunoglobulin response is ____.
IgG
Convalescent phase serum that is drawn when a patient has recovered also indicates immunity, such as testing for _____ after vaccination.
immunity
Allergic response triggers ______ immunoglobulins.
IgE
Local (mucosal, secretory): immunoglobulin response is _____ in the tonsils & upper airways.
IgA
Agglutination is when Ig molecules bind with antigen and cause _____ of bacterial organisms.
clumping
Precipitation is when toxin drops out of solution ???
????
______ is when the active site of the antigen is rendered harmless because it is covered up. (i.e. with viral infections
Neutralization
Directly rupture cell membranes of invading organisms is referred to as _____.
lysis
The antigen-antibody complex activation of inflammatory and complement systems: Ag-Ig complex activates the complement and ________ .
inflammatory systems
Opsonization is the coating of antigen helps macrophages to phagocytize bacteria and antigens (note that for this reason, immunoglobulins are also called ______
opsonins
Degranulation of mast cell by _____ occurs when there is a release of histamine (triggers inflammatory response) Every time you have an immune response you also trigger an _____.
IgE
inflammatory