patho_exam1

• 1. A decrease of insulin, which normally pumps K+ from ECF into cells.
• 2. Polyuria due to osmotic effect of glucose in the urine leads to volume depletion & oliguria.
• 3. Oliguria decreases potassium excretion, which leads to hyperkalemia.

• 1. Poor dietary intake of Mg
• 2. Decreased Mg absorption from GI tract
• 3. Increased Mg excretion in urine due to (repeated) rising blood alcohol.

• - Potassium
• - Magnesium
• *NOT calcium - vitamin D activation does not occur effectively, which leads to low plasma calcium.

• - ECV excess
• - hyperkalemia
• - hypermagnesemia
• - hyperphosphalemia
• - hypocalcemia

• - Hyponatremia
• - Sometimes hypevolemia
• Why? ADH acts in the distal portion of the renal tubule and the collecting duct and causes the retention of water, but NOT solute. Hence, ADH activity effectively dilutes the blood (decreasing the concentrations of solutes such as sodium).

With chronic inflammation, there is evidence of tissue repair & damage happening at the same time, so the inflammation persists (ie, cirrhosis).

The type of cells involved.

• 1. Coagulative (heart, kidney, most other tissues)
• 2. Liquefactive (brain, areas of bacterial infection with pus)
• 3. Fat (adipose tissue)
• 4. Caseous (pulmonary)

• 1. Dry
• 2. Wet
• 3. Gaseous

• Chronic oliguric renal disease.
• Note: Before giving extra potassium (ie, in IV solution), check that urine output is normal.

Abnormal retention of fatty substances within a cell.

• - Near drowning (intake)
• - Excessive use of antacids (ie, Milk of Magnesia)
• - Chronic oliguric renal disease (excretion)
• - Adrenal insufficiency (excretion)

• A wound breaks open along surgical suture.
• Risk factors are age, diabetes, obesity, poor knotting or grabbing of stitches, and trauma to the wound after surgery.

ECV excess. Many contain extremely high amounts of sodium, which leads to water retention.

• Infarction = tissue death (necrosis) that is caused by a local lack of oxygen due to obstruction of the tissue's blood supply.
• Ischemia = restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue

• Inflammation
• Proliferation/reconstruction
• Maturation/Remodeling

• Hemostatic phase: blood clotting occurs
• Vascular phase: blood vessels dilate
• Cellular phase: chemotaxis causes phagocytes move to area via margination and diapedesis; Phagocytic cells release cytokines that promote tissue healing.

Bradykinins and pressure

Cytokines circulate to the hypothalmus.

• Necrotic tissues are replaced by tissues of the same type.
• Note: This restores tissue function, if the supporting framework has not been destroyed.

It makes it harder for nourishment to reach cells.

Allow WBCs to stick to the sides of the capillaries and small venules, which is necessary to enable them to squeeze through the vessel walls and enter tissue to fight microorganisms

Macrophages secrete growth factors and cytokines that stimulate fibroblasts to produce collagen.

Cause vasodilation and increased vascular permeability.

Arrive first and clean up debris

Aldosterone

Aldosterone causes reabsorption of sodium and water, and excretion of potassium at the distal convoluted tubules.

The kidneys are unable to conserve water, though they do retain sodium. This results in hypernatremia.

Aldosterone, cortisol.

Salt restriction. This will reduce the amount of serum sodium, and the reduced sodium concentration will allow water to be lost as well.

ADH. ADH causes water to be retained by the kidneys, but NOT salt. More water is retained for a given volume of salt, leading to sodium dilution.

Increase ECF volume. It's like giving water, but with enough solutes to not cause RBCs to lyse.

Lethargy, confusion. Too high sodium concentration in ECF causes water to leave cells, causing them to shrivel. In the CNS, this leads to "nonspecific signs of cerebral dysfunction".

ADH. It can lead to hyponatremia (low serum sodium).

• Sudden weight loss (unless 3rd space accumulation)
• Postural BP decrease substantially with postural tachycardia
• Prolonged capillary & small vein rill time
• Flat neck veins when supine
• Sunken fontanel (infants)
• General dryness (mucous membranes, skin, eyes,
• Dizziness/fainting
• Oliguria

ECV deficit from loss of sodium-containing fluid due to lack of cortisol/aldosterone.

• - Gain of relatively more water than salt. (Too much D5W, tap water enemas, too much water, irrigating with distilled water, excessive ADH (SIADH), NSAIDs)
• - Loss of relatively more salt than water. (diuretic use; sweating/vomiting/diarrhea while replacing water but not electrolytes).

• Salt (to help hold water in the blood)
• Water (to offset fluid deficit)

• - Gain of relatively more salt than water. (Decreased thirst sensation in elderly; unable to swallow, unable to access water, tube feedings with more solute than water)
• - Loss of relatively more water than salt. (diabetes insipidus due to insufficient ADH, diarrhea without fluid replacement, urine water excretion due to particulates in tube feedings).

Hypotonic without sodium

• 1/3 extracellular (1/3 of that vascular, 2/3 interstitial)
• 2/3 intercellular

To get water into cells. It's a cell-friendly way to infuse the equivalent of "plain water".

• - hypokalemia
• - hyperkalemia

- Electrolyte deficit in serum

They may both result from loss of gastrointestinal fluids.

Hypocalcemia.

Hyperparathyroidism, which would pull lots of calcium from bones.

Trousseau sign

• Urine output.
• You want to.make sure kidneys are working before giving ANY extra solute (KCl, Magnesium sulfate, etc.)

• Potassium
• Calcium
• Magnesium
• Note: This would necessitate a variety of foods.

• - hypocalcemia (due to citrated blood)
• - hypomagnesemia (due to citrated blood)
• - hyperkalemia (K leaks out of stored blood cells into plasma)
• Tests:
• - Apply cardiac monitor
• - Test Chvosktek sign
• - Tell pt to watch for tingling in fingers/around mouth

• Hypokalemia.
• Insulin causes K+ to move from plasma into cells.
• Note: Alkalosis and Beta-andrenergic stimulation also moves K+ from plasma into cells.

Venous congestion increases capillary hydrostatic pressure and causes increased movement of fluid into the tissues.

• Distended neck vein when upright (due to extra fluid)
• Rapid weight gain (due to retention of extra fluid)
• Edema (due to extra fluid leaking out)
• Crackles/rails (due to fluid in lungs)
• Dyspnea/Orthopnea (due to increased fluid volume making it hard to breathe)
• Bulging fontanels (infants)
• Note: You would not expect to see abnormal sodium levels. The concentration would be normal.

Hypokalemia (low serum potassium), because insulin moves it into cells.

• Dark/Brown Foods
• Cocoa
• Coffee
• Dark green veggies
• Legumes
• Meat
• Milk
• Nuts
• Whole-grains

• Constipation
• Lethargy
• Muscle weakness
• Fatigue
• Nausea
• Vomiting
• Polyuria
• Personality/mood changes

• Hypokalemia (acute or chronic: people with diarrhea excrete more potassium in feces)
• ECV deficit (loss of sodium-containing fluid)
• Hypernatremia (diarrhea WITHOUT fluid replacement = clinical dehydration)
• Hyponatremia (diarrhea with water replacement but NO salt replacement)
• Hypocalcemia (chronic diarrhea)
• Hypomagnesemia (chronic diarrhea)

• 1. Algor mortis (body cools off to environmental temp)
• 2. Livor mortis: Blood starts to pool & settle
• 3. Rigor mortis starts (2-6 hrs after death)
• 4. Putrefication (with the help of bacteria)

Where body temperature equals environmental temperature.

Tissue degradation after death.

• Capsases are "executioner enzymes" in apoptosis.
• Cells have "PROCASPASES" inside the cell. "Pro-" = inactive; "-ase" = enzyme. If a trigger happens, the procaspases become activated caspases.

• 1. Hematoma formation
• 2. Fibrocartilage formation
• 3. Callus formation
• 4. Ossification
• 5. Consolidation and remodeling.