1. Pathophys

• Physical Symptoms
• Cognitive Awareness
• Emotional Response
• Assumption of sick role
• Dependency
• Recovery or rehab.

• Permanent impairment of disability
• Residual physical or cognitive disability
• Need for special rehab or long term care

• D
• I
• F
• D
• diseaseimparimentfnctionallimitationsdisability

• 1.Physical activity
• 2. Overweight/obese
• 3. Tobacco use
• 4. Susbstance abuse
• 5. Sexual behavior
• 6. Mental health
• 7. Injury/violence
• 8. Environmental quality
• 9. Immunization
• 10. Access to health care. (this is the one we can help the most with)

• Wear and tear
• Antioxidant damage to DNA
• Genetically predetermined

Clot-ischemia-hypoxia-lessATP-accumulation of ions-swelling-rupture

• Bacteria-release endotoxins and exotoxins
• Virus- Directly: RNA viruses disrupt function of plasma membrane and ion transport and cause rupture of cell. Indirectly: They integrate themselves in the cellular genome, make copies of themselves and cause the host cell to be tagged and destroyed by T-cells

Antibodies attach to the tagged cell. There is activation of the complement system and the inflammatory cells.

By changing the genome, cell production would be altered. This would directly affect the cells function, and usually result in its destruction.

• Nutrition-if cells lack nutrition they will die.
• Chemical- injury to cells directly, pH and antioxidants
• Physical- Temperature, electricity, trauma, radiation

• Atrophy-decrease in size
• Hypertrophy-increase in size
• Hyperplasia-increase in number
• Metaplasia-change in cell
• Dysplasia-increase in different cells

Damage to the cell nucleus, mitochondria, lysosomes, and ruputre of the cell membrane.

The coordinated reaction of body tissue to cell injury and cell death that involves vascular, humeral, neurlogical, and cellular responses.

• If wall injury: small arteries contrict d/t neural reflex. Surrounding blood increases in pressure. Flow slows and you get clots.
• If no wall injury: Vasodialation occurs. Hydrostatic pressure rises. Transudate leaves vessels and enters the area.

• Margination: The binding of Leukocytes to the margins of the vessel do to the slowing of blood and increase in adhesive glycoprotiens.
• Diapedesis: Chemoactic agents cause migration from intravascular to extravascular locations.
• Leukocytes release enzymes and toxic substances to kill, they phagocytoses, and release growth factor to induce healing.

• Lymphadenopathy
• Lymphangitis

• Histamine: Endothelial contraction and vasodialation, bronchoconstriction
• Platelet activating factor: induces aggregation and infiltration of leukocytes
• Cytokines: local-stimulates margination, activates fibroblasts, chondrocytes, osteoclasts. Systemic-induces fever, increase metabolism, causes hypotension

• Blood coagulation system: Hageman-Prothrombin-thrombin-fibrinogen-fibrin
• Fibrinolytic systems: Hageman-Plasminogen-plasmin
• Kinin system: Hageman-bradykinin-pain and vasodilation
• Complement system: Chemical activation- Vasodilation,chemoactic agent, Opsonization, MAC

Opsonization-binding to leukocytes-invagination d/t calcium influx-incapsulation-digestion(pus/purulence)

• Accumulation of specific leukocytes (macrophages and lymphocytes) and plasma cells
• Granulation tissues, endothelial cells and fibroblasts

Fibronectin, proteoglycans and elastin, collagenh

• Regeneration: When the perenchymal cells experience regrowth
• Repair: Formation of scare tissue
• Keloids: hypertrophic deposition of collagen
• Brain: permanent, no regeneration, no fibroblast for scar tissue, so there are holes. no collagen. astrocytes form glail scars.

The innate immune system. Non-specific, non-adaptive. Skin and inflammatory response. Macrophages responding to any pathogens, not specific ones.

• Specific antigen = specific response
• Humeral and cell mediated components
• Active v. Passive

• NK cells -
• Neutrophils - PMN cells
• Monocytes - become macrophages

B-Cells bind with antigens. Very rapid. Can be passively transmitted.

Helper t-cells. 75% of t cells. Stimulate b cells to make more antibodies. The antibodies will bind with antigens to help the innate leukocytes, like the macrophages other T-cells and NK cells kill them.

Via the Autonomic nervous system and the neuroendocrine outflow via the pituitary. May explain how stress and emotion cna modify a person capacity to cope with infection or cancer and influence autoimmune disease.

• One that occurs from a physicians actions.
• Cytotoxic drugs, Corticosteroids, cyclosporine, Radiation Splenectomy

• Asymptomatic: CD4>500cells/mm3 (unresticted exercise)
• Early Symptomatic stage: CD4=200-500 cells/mm3 (Cytomegalovirus, Pneumocysti carinii pneumonia)
• HIV advances CD4<200 cells/mm3
• Normal=600-1200 cells/mm3
• 40,000 new infections/year
• 50%-drugs use, 41% MSM 20-49