Pathophysiology Final Outline
Genetic Influence in Disease
Alterations in Fluids, Electrolytes, and Intracellular Funcion
Altered Tissue and CEllular Proliferation
Mechanisms of Defense: Alterations in Inflammation and Immunity
Mechanisms of Defense: Infection
Disorders of Hematologic System
Disorders of Cardiovascular & Peripheral Vascular Systems
Arterial
● Healthy arteries
○ Normal muscle tone = flexible, compliant, patent→normal state of resistance
○ Good arteries = good perfusion (delivery of O2 & nutrients to tissues) = no
ischemia
■ Good perfusion
● Cap refill <2 sec
● Skin pink, warm
● Pulse normal
● Good UO, mentation, CO
● Bad arteries→ischemia
○ Arteriosclerosis
■ Stiffen, thicken → elasticity and compliance decrease → abnormal tone
and resistance
■ Damage from HTN, diabetes, hyperlipidemia
○ Atherosclerosis
■ Fatty deposit settle in micro injuries in arteriosclerotic vessels→
inflame→ combo of fat, collagen, clots = plague → build up in lumen
■ Higher risk and severity w/ high LDLs and low HDLs
● LDLs high in cholesterol and primary in plaque
● HDLs high in protein; find extra LDLs and take them to liver to be
broken down
○ Want to be high >40 and total ratio of cholesterol to HDL
to be <4
○ Narrowing, hardening, plague can block flow to tissues → bad perfusion =
ischemia
■ Sequela/ S&S
● Ischemic pain: worse with exertion, eases w/ rest
○ Leg arteries: intermittent claudication
○ Heart: angina
● Poor perfusion in peripheral arteries
● Heart
○ Hypoxic cardiomyocytes→decreased contractility→
decreased CO
● Brain: altered mentation
● Kidneys: decrease UO
● Specific arterial diseases r/t atherosclerosis
○ Peripheral arterial disease (PAD)
■ Peripheral arterial insufficiency outside heart
● S&S
○ Pain: intermittent claudication
○ Pallor: pale
○ Paresthesia: numbness and tingling in feet
○ Pulselessness: cap refill >2
○ Poikilothermia: Cold to touch
○ Ischemic skin ulcer
○ No leg hair
○ Arterial thromboembolic problems
■ Clots that form where sluggish arterial flow and/or arterial injury
● Atrial fibrillation→blood in atria flow inappropriately→platelets,
fibrin collect→ thrombus on atrial wall
○ In LA→emboli→flow to brain or other arterial system
○ In RA→emboli→flow to lungs
○ Femoral artery→ischemia to distal tissue
○ Aneurysm
■ Atherosclerosis & HTN→localized dilation or bulge of arterial vessel
wall→increase size of aneurysm→ increase risk of rupture
■ Brain→stroke
● Weakness to one side of body, headache, change in level of
consciousness
■ Aorta
● Gradual development
● Abdominal Aortic Aneurysm (AAA): pulsatile mass palpated,
abdominal and/or back pain; found by routine physical exam
● Thoracic Aortic Aneurysm (TAA): resemble MI (chest and back
pain); found by accident on xray
■ S&S: diminished pulse and ischemia to distal tissue
○ HTN
■ BP > 130’s/80’s
■ Primary HTN is due to = genetic predisposition + SNS and/or RAAS
in a constant state of “overdrive” + the simultaneous effect of
atherosclerosis = pathologic increase in CO and arterial
vasoconstriction→ increase BP
● SNS overdrive
○ Epinephrine levels elevated→tachycardia and/or
contractility to heart→greater ejected pressure→
sustained BP
● RAAS overdrive
○ RAAS normally vasoconstrict and retain Na+ and H2O
(low BP and blood volume)→RAAS always on→
sustained vasoconstriction and larger blood volume→
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higher BP
Secondary HTN: adrenal tumor, renal problems
Risk factors: high LDLs, low HDLs, high sodium intake, water retention
S&S
● Neuro: Stroke, ischemia/infarct of vision
● Renal: hematuria, proteinuria, renal failure
● Circulatory: MI, HF, PAD
Tx
● ACE inhibitors, diuretics, beta-blockers
Venous
● Venous insufficiency
○ Old people, preg women, standing up for long time, genetics
○ Problems with venous backflow/ congestion → peripheral edema
○ Increase hydrostatic pressure→venous stasis ulcer and thrombi
● Venous thrombi and emboli
○ Venous thromboembolism (VTS): DVT and PE
■ Virchow’s triad
● Venous stasis (i.e venous insufficiency, immobility
● Injury to living of vein (i.e surgery)
● Hypercoagulability (i.e dehydration)
■ DVT
● S&S
○ Thrombophlebitis→local inflammatory state→ pai,
erythema, warm
■ PE
● Venous thrombi gets loose→venous emboli→lungs→ SOB, chest
pain, hemoptysis
○ Tx
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Encourage mobility, hydration
Put up feet
Wach for skin problems r/t tightness from edema
Anticoagulants to prevent thrombus: coumadin, heparin, aspirin
Cardiovascular disorders
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If HR + NSR not normal affects CO
HR norm = 60-100
Irregular rhythm = atrial fibrillation and ventricular fib
Neurohormonal influences
○ SNS: epinephrine and norepinephrine increase HR and contractility
○ PNS: acetylcholine via vagus nerve decrease HR
● Electrolyte disturbances
○ hypokalemia→hyperpolarization→bradycardia, decreased contractility,
weakness
○ hyperkalemia→hyperpolarization→irritable myocardium till later patient
picture looks like hypokalemia
● Contractility - how toned, how well heart eject blood
○ Diminished contractility→low SV→low CO→diminished perfusion
○ Negative inotropic effect- anything that decreases contractility
○ Positive inotropic effect- anything that increases contractility (i.e digoxin)
● Preload - blood coming back to heart = volume-related issues
○ Low preload→fluid volume deficit→S&S dehydration
■ Low amount of blood sent to heart = low SV→CO
○ High preload→fluid volume overload→ S&S fluid overload
■ High amount of blood sent to heart→ too much workload on left
ventricle
● Afterload
○ Normal resistance, low, or high → affects SV, CO, perfusion
○ Left ventricle alterations
■ High afterload = high SVR = high resistance to eject blood
● Cause: brittle arteries, high blood volume, chronic HTN, systemic
arterial vasoconstriction
● S&S: decreased perfusion, cap refill, pulses, cold, low BP
■ Low afterload = arterial vasodilation
● Heat, meds, endotoxins, inflammatory mediators
● S&S: CO is high, blood pooling in periphery→ less blood back
to heart→ low CO →low BP
○ Right ventricle alterations
■ High afterload = PVR
● Increase pulmonary arterial vasoconstriction and/or lung problems
(chronic bronchitis)
Coronary Artery Disease (CAD)
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Disorders of Pulmonary System
Disorders of Renal & GU Systems
Disorders of Neurologic Systems
Disorders of Endocrine System
Disorders of GI System