Exam 3 pathophysiology Cancer growth types: Adenocarcinomas - Glandular tissue Sarcomas - Connective, muscle, and bone tissue Gliomas

- Supportive tissue of the brain and spinal cord Melanomas - Pigmented cells Lymphomas - Lymphatic tissue Leukemia - Leukocytes Erythroleukemia - erythrocytes Characteristics: benign tumor one lacking the properties of invasion and metastasis and showing a lesser degree of anaplasia (regressive change) than do malignant tumors; it is usually surrounded by a fibrous capsule. malignant tumor one having the properties of invasion and metastasis and showing a high degree of anaplasia Breast cancer is classified by the tissue type of origin and location of lesion: Adenocarcinomas - most common form of breast cancer, arises from epithelial tissue. Types of tumor tissue in breast: Carcinomas - cancer of epithelial tissue Intraductal - Cancer develops within the ducks. Infiltrating - Cancer arises in the parenchyma tissue. Inflammatory - Cancer (rare) grows rapidly and causes the overlying skin to become edematous, inflamed, and indurated. Lobular - Cancer involves the lobes of glandular tissue. Medullary or Circumscribed - Cancer is a tumor that grows rapidly. Stages of Cancer: Stage 1 - Cancer confined to organ of origin. Stage 2 - Cancer that is locally invasive. Stage 3 - Cancer that has spread to regional structures such as lymph nodes. Stage 4 - Cancer that has spread to distant sites, (liverlungs or prostatebone).

Tumor Markers: Are substances (hormones, enzymes, genes, antigens, antibodies) found in blood, spinal fluid, or urine. Markers are used to; Screen and identify risk for cancer. Diagnose specific types of tumors. Follow clinical course of cancer. Cervical Cancer Causes - human papilloma virus (HPV). Environmental causes of cancer - substances in the environment that damage DNA in cells. Carcinogens and related cancers; Tobacco (lung, pancreatic,, kidney, bladder, esophageal cancer) Asbestos and airborne aromatic hydrocarbons (lungs cancer) Alkylating agents (leukemia) Skin head and neck cancer is called Risk factors that increase cancer - smoking, radiation, obesity, viruses, UV sunlight, diet, family history, alcoholism. Most frequent complaint of patients with cancer - Fatigue Side effects of chemotherapy; Cachexa (loss of appetite, weakness, inability to maintain weight, taste alteration, altered metabolism. Anemia occurs because malnutrition, long term bleeding and BBC suppression resulting iron deficiency. Leukopenia caused by toxic effect of chemo to bone marrow, Thrombocytopenia (platelet count below 50,000 per micro liter) Atherosclerosis - fatty, fibrous plaques, possibly calcium deposits, progressively narrow the coronary arteries lumens, which reduces the volume of blood that can flow through them. Can lead to myocardial ischemia (heart death). Primary/Essential/ Idiopathic Hypertension no definite cause, usually attributed to atherosclerosis. Secondary Hypertension - Secondary Hypertension usually derived from

diseases such as renal disease. Drugs act on what? Distal tubules of kidneys (diuretic), blood vessels (vasodilators), Heart (cardio-inhibitory), and nervous system (sympathetic adrenergic) Orthostatic Hypertension - A decrees in systolic and diastolic arterial BP on standing. Pericarditiswhere/what is it - is an inflammation of the sac of the pericardium. Acute form can be fibrinous or effusive, with serous, purulent, or hemorrhagic exudate. Chronic form, called constrictive pericarditis is characterized by fibrous pericardial thickening.. Thrombus(Blood) --- Is a solid mass of platelets and/or fibrin (and other components of blood) that forms locally in a vessel. Pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches by a substance that has traveled from elsewhere in the body through the bloodstream (embolism). Usually this is due to embolism of a thrombus (blood clot) from the deep veins in the legs. Thrombus of the leg (DVT)Causes; Blood clot that remains attached to vessel wall. Causes: Venous stasis - immobility, age, congestive heart failure Venous epithelial damage - trauma, medications Hypercoagulable states - inherited disorders, malignancy, pregnancy, oral contraceptives, hormone replacement Orthopedic trauma, surgery, spinal cord injury, obstetric/gynecologic conditions.

Angina - chest pain Angina Pectoris - substantial chest discomfort, ranging from a sensation of heavyness or pressure to moderately severe pain. Stable Angina (predictable) - If the pain is predictable and relived by rest of nitrates.

Unstable (unpredictable) - left untreated may progress to MI. Unstable Angina is a result of reversible MI and is a harbinger of impeding infractions. Myocardial infraction (MI) result when there is a prolonged ischemia >20min, causing irreversible damage to the heart muscle. MI ischemia -Myocardial infarction occurs when myocardial ischemia, a diminished blood supply to the heart, exceeds a critical threshold (>20 min). Cell in heart when you have MI? Myocardial hypoxic injury cellular death and tissue necrosis. What impaired function? Decreased contractility, stroke volume and blood pressure. Diagnosis - Electrocardiography, stress test, electrocardiogram (ECG), single photonemission computerized tomography (SPECT), echocardiogram computed tomography, (CT) Interventions -Pharmacologic manipulation of BP, HR, contractibility and left side volume, reduce vasospasms, cholesterol, prevent clotting. Drugs include Nitrates, -adrenergic blocking agents, calcium channel blockers, ACE inhibitors, statins (lipid lowering), and antipathetic agents (aspirin) Modifiable (controllable) risk factors of CAD - Systolic BP >160nnHg or Diastolic BP > 95 mmHg,LDL, HDL, Cigarette smoking (risk dramatically drops within 1yr of quitting), stress or being type A personality (aggressiveness, competitiveness, addicted to work, chronically impaired), Obesity which increases risk of (Diabetes mellitus, Hypertension, and cholesterol), Diabetes mellitus (especially in women), oral contraceptives, Physical inactivity, Kidney disease, , Alcohol consumption, Nonmotifiable risks (controllable) risk factors of CAD - age (>40), being male, being white, and having a family history. Things you can do (controlling risk) - Maintain healthy weight, limit salt, fats and cholesterol, stop smoking, exercise, control hypertension.

Renal Disease - Diabetes insipid us is a disorder of water metabolism cased by deficiency in ADH. The absence of ADH allows filtered water to be excreted instead of reabsorbed. Endocrines Function - Regulates and integrates the bodys metabolic activities and maintain homeostasis.

Endocrine work with - Central Nervous System (CNS) T3, T4 - Thyroid-stimulating hormone (TSH) is inhibited by thyroxin (T4) and to a lesser extent triiodothyronine (T3). Thyroid-stimulating hormone (THS) stimulates the synthesis and secretion of thyroid hormones. (THS) is regulated by thyroxin-releasing hormone primarily in the hypothalamus and by negative feedback inhibition from thyroid hormones. Water soluble - mediate short acting responses, The protein (peptide) hormones, circulate freely, short life of sec. Fat Soluble - mediate both rapid and long-acting responses, transported bound to a carrier or transport proteins, long lasting remain in blood for hours to days Steroid Hormones activate - lipid-soluble synthesized in liver, have direct effect on gene expression (DNA) Release and inhibit hormones -the hypothalamus excretes hormonal control at the anterior pituitary gland by releasing or inhibiting hormones. hypothalamic hormones stimulate the posterior pituitary gland to release tropic (gland-stimulating) hormones Anterior pituitary - Secrets tropic hormones that affect the physiologic function of specific target organs. Carried to anterior by? Neurosecretory cells (Axons), through the pituitary stalk. Posterior and anterior hormone go where? Anterior hormones - ADH and Oxytocin Posterior pituitary - derived from hypothalamus gland secret two effecter hormones: Oxytocin (which stimulates uterine contractions during labor and causes milk let-down reflex in lactating women). Antidiuretic hormone (ADH) - which controls the concentration of body fluids by altering the permeability of the distal renal tubules and collecting ducts in the kidneys, thereby conserving water. What permeability of renal hormones? ADH controls serum osmlarity, increases permeability of the renal tubules to water, and causes vasoconstriction when administered pharmacologically in high doses Pancreas cells - alpha beta, delta and F cells. What they do? ( islets of Langerhans) Alpha cells - produce glucagon, initiates a rise in blood sugar levels by stimulating the breakdown of glycogen by the liver.

Delta cells - secrete somatostatin (inhibitory hormone), which inhibits glucagon and insulin secretion. Beta cells - secret preproinsulin (precursor of proinsulin), which is ultimately converted to insulin. F Cells - secret pancreatic polypeptide a hormone released from the D cells of the islets of Langerhans of the pancreas in response to protein in the small intestine. Its actions are to inhibit pancreatic bicarbonate and protein enzyme secretion and to relax the gall bladder. Glucocorticoid - Cortisol carries out the following four important functions: 1. Stimulation of gluconeogenesis (formation of glycogen from no carbohydrate sources), which occurs in the liver in response to low carbohydrate intake or starvation. 2. Increased protein breakdown and free fatty acid mobilization. 3. Suppression of immune response 4. Assistance with stress response. Mineralocorticoid - Aldosterone regulates the reabsorption of sodium and the excretion of potassium by the kidneys. Mono s/s -

Lymphadenopathy - is characterized by enlarged lymph nodes, lymph node enlargement is caused by an increase in size and number of its germinal centers caused by proliferation of lymphocytes and monocytes (immature phagocytes) or invasion by malignant cells. Results from four types of conditions; 1) neoplastic disease, 2) immunologic or inflammatory disease, 3) endocrine disorders, 4) lipid storage disease. Hodgkins lymphoma (HL) - characterized by its progression from one group of lymph nodes to another, the development of systemic symptoms, and the presents of Reed-Sternberg (RS) cells. (RS) cell represents the malignant transformation of lymph cells. Non Hodgkins lymphoma - B-cell neoplasm and T-cell and NK-cell neoplasms. Blood cascade with clots start and stop - Positive feedback between Circulating thrombin activates both coagulation and fibrinolysis leading to a

paradoxical bleeding and clotting.------thrombin triggers excess fibrin causing clots tissue damage (necrosis)fibrinolysis (clot destructionhemorrhageconsumption of platelets and coagulation factors hemorrhage Liver coagulation disorders - Vitamin K deficiency, liver disease DIC - how do you get it, s/s, pathology; Clotting and hemorrhage occur in the vascular system at the same time. Circulating thrombin activates both coagulation and fibrinolysis leading to a paradoxical bleeding and clotting. DIC develops in association with infectious disease particularly involving sepsis. 1) damage to endothelium, 2) release of tissue thromboplastin, 3) activation of X factor. S/S - Abnormal bleeding without a history of serious hemorrhagic disorder. Thrombosis cause, s/s - unregulated thrombi, s/s change in levels of consciousness, behavior, confusion, seizure activity, Liguria, hematuria, hypoxia, hypotension, hemoptysis, chest pain, tachycardia,, symmetric cyanosis of fingers and toes.