Surgical Pathology at Universidad De San Pablo CEU | Flashcards & Summaries

Lernmaterialien für Surgical Pathology an der Universidad de San Pablo CEU

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Systemic response to injury - General concepts 

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The inflammatory response to injury and is designed to restore tissue function and eradicate invading microorganisms. 


When there is an injury, it is normal for the body to respond systemically with inflammation. 


Response to injury = Inflammation (local)


Generally, the more limited to injury, and its duration then the higher chance of complete functional restoration without the need of outside intervention. 

→ Most parts of the body resolve the injury on its own, but at times, intervention is needed. 

 

If there is major injury and no appropriate intervention is administered, then the patient is at risk of going into multiple organ failure (MOF).  

→ The rate of complications increases, and complete healing might not be possible.

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Definition - Injury 

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An injury can be defined as ‘rupture of the normal tissue structure’.

Stress is the physiologic manifestation of injury!


Injuries can be and be caused by many different things. Common injuries:

  • Burns
  • Fractures 
  • Surgery
  • Dental disease and treatment
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Nervous system regulation of inflammation

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The central nervous system (CNS), via autonomic signaling, has an integral role in the inflammatory response that is primarily involuntary.

 

Tissue injury and inflammation leads to impulses in the afferent pain fibers that reach the hypothalamus via the dorsal horn of the spinal cord under the lateral spinothalamic tracts, and further mediate the metabolic response in two important ways: 

  1. Activation of the sympathetic nervous system.
  2. Stimulation of pituitary hormone release.
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Components of systemic response to injury

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Components of systemic response to injury

  1. Nervous system regulation of inflammation.
  2. Hormonal response to injury.
  3. Mediators of inflammation and cytokine response to injury.
  4. Cell-mediated inflammatory response.
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Main hormones related to injury and stress - Insulin

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Insulin

Hormones and inflammatory mediators associated with stress response inhibit insulin release.

 

In a healthy individual insulin exerts a global anabolic effect by promoting hepatic glycogenesis and glycolysis, glucose transport into cells, adipose tissue lipogenesis and protein synthesis. 

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Nervous system regulation of inflammation - Stimulation of pituitary hormone release

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Stimulation of pituitary hormone release

Stimulation of the Vagus nerve reduces heart rate, increases got motility, dilates arterials, and causes pupil constriction as well as regulation of inflammation. 

 

Unlike the humoral anti-inflammatory mediators, signals discharged from the Vagus nerve are targeted at the site of injury or infection.

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Classification of hormones

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Classification of hormones

Hormones can be classified as: 

  • Polypeptides → Cytokines, Glucagon and insulin. 
  • Amino acids → Epinephrine, serotonin and histamine.
  • Fatty acids → Glucocorticoids, prostaglandins and leukotrienes.

 

The body has a hormonal way of responding which is through the hypothalamic pituitary adrenal axis

Releases hormones that influence the response to injury and stress – And some have a direct influence on the inflammatory response or immediate clinical impact.

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Hormonal response to injury - Hormone-signaling pathways

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Hormone-signaling pathways

Hormone receptors generate signals by one of the following pathways: 

  • Receptor kinases
    → Such as insulin and insulin-like growth factor.

  • G protein receptors (Guanine nucleotide binding)
    → Such as neurotransmitter and prostaglandin receptors.

  • Ligand-gated ion channels
    → Permit ion transport when activated.
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Main hormones related to injury and stress - ATCH

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ACTH – Adrenocorticotropic hormone 

CRH (corticotropin releasing hormone) is responsible for ACTH production and release. 

→ ACTH is produced and released by the anterior pituitary gland. 

 

Elevations in CRH (corticotropin-releasing hormone) and ACTH are typically proportional to the severity of the injury. 

→ ACTH promote cortisol production.

- Cortisol is the major glucocorticoid and is essential for survival during significant psychological stress. 


Following injury, the degree of cortisol elevation is dependent on the degree of systemic stress. 

It potentiates the actions of Glucagon and Epinephrine, that manifest as hyperglycemia.

Furthermore, it potentiates the release of free fatty acids, triglycerides and glycerol from fat providing additional energy sources.

 

Glucocorticoids have long been employed as immunosuppressive agents, due to depressed cell mediated immune response action.
*Note the importance of not stopping treatment with corticosteroids abruptly! Slowly reduction is needed to restore functions of hypothalamus, hypophysis and adrenal axis. 


Acute adrenal insufficiency secondary to exogenous administration is a life-threatening complication!

→ Patients with acute adrenal sufficiency typically presents with weakness, nausea, vomiting, fever and hypotension.


Objective findings include: 

  • Hypoglycemia – Caused by decreased gluconeogenesis. 
  • Hyponatremia 
  • Hyperkaliemia. 
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Main hormones related to injury and stress - Catecholamines 

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Catecholamines

The functions of catecholamines are activation of adrenergic system through the release of epinephrine and norepinephrine. 

→ It induces a hypermetabolic state after severe injury, due to the activation of the adrenergic system.

 

Furthermore, catecholamines reduce insulin release and increases glucagon secretion.

→ Which all results in stress-induced hyperglycemia.

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Sepsis

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Sepsis

The diagnosis of sepsis includes the presence of SIRS and an identifiable infection source

Two categories of sepsis can be identified:  

  1. Severe sepsis
    The presence of sepsis and some organ dysfunctionality. 

  2. Septic shock
    The presence of sepsis and cardiovascular collapse.
    At such point, vasopressors are required.
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Phases of systemic inflammatory response

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Phases of systemic inflammatory response 

The systemic inflammatory response has two phases:

  1. Proinflammatory response
     Activation of the cellular process designed to restore a tissue function and eradicate invading microorganisms.

  2. Anti-inflammatory response
    → It is counter-regulatory to prevent excessive pro-inflammation and restore homeostasis.
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Q:

Systemic response to injury - General concepts 

A:

The inflammatory response to injury and is designed to restore tissue function and eradicate invading microorganisms. 


When there is an injury, it is normal for the body to respond systemically with inflammation. 


Response to injury = Inflammation (local)


Generally, the more limited to injury, and its duration then the higher chance of complete functional restoration without the need of outside intervention. 

→ Most parts of the body resolve the injury on its own, but at times, intervention is needed. 

 

If there is major injury and no appropriate intervention is administered, then the patient is at risk of going into multiple organ failure (MOF).  

→ The rate of complications increases, and complete healing might not be possible.

Q:

Definition - Injury 

A:

An injury can be defined as ‘rupture of the normal tissue structure’.

Stress is the physiologic manifestation of injury!


Injuries can be and be caused by many different things. Common injuries:

  • Burns
  • Fractures 
  • Surgery
  • Dental disease and treatment
Q:

Nervous system regulation of inflammation

A:

The central nervous system (CNS), via autonomic signaling, has an integral role in the inflammatory response that is primarily involuntary.

 

Tissue injury and inflammation leads to impulses in the afferent pain fibers that reach the hypothalamus via the dorsal horn of the spinal cord under the lateral spinothalamic tracts, and further mediate the metabolic response in two important ways: 

  1. Activation of the sympathetic nervous system.
  2. Stimulation of pituitary hormone release.
Q:

Components of systemic response to injury

A:

Components of systemic response to injury

  1. Nervous system regulation of inflammation.
  2. Hormonal response to injury.
  3. Mediators of inflammation and cytokine response to injury.
  4. Cell-mediated inflammatory response.
Q:

Main hormones related to injury and stress - Insulin

A:

Insulin

Hormones and inflammatory mediators associated with stress response inhibit insulin release.

 

In a healthy individual insulin exerts a global anabolic effect by promoting hepatic glycogenesis and glycolysis, glucose transport into cells, adipose tissue lipogenesis and protein synthesis. 

Mehr Karteikarten anzeigen
Q:

Nervous system regulation of inflammation - Stimulation of pituitary hormone release

A:

Stimulation of pituitary hormone release

Stimulation of the Vagus nerve reduces heart rate, increases got motility, dilates arterials, and causes pupil constriction as well as regulation of inflammation. 

 

Unlike the humoral anti-inflammatory mediators, signals discharged from the Vagus nerve are targeted at the site of injury or infection.

Q:

Classification of hormones

A:

Classification of hormones

Hormones can be classified as: 

  • Polypeptides → Cytokines, Glucagon and insulin. 
  • Amino acids → Epinephrine, serotonin and histamine.
  • Fatty acids → Glucocorticoids, prostaglandins and leukotrienes.

 

The body has a hormonal way of responding which is through the hypothalamic pituitary adrenal axis

Releases hormones that influence the response to injury and stress – And some have a direct influence on the inflammatory response or immediate clinical impact.

Q:

Hormonal response to injury - Hormone-signaling pathways

A:

Hormone-signaling pathways

Hormone receptors generate signals by one of the following pathways: 

  • Receptor kinases
    → Such as insulin and insulin-like growth factor.

  • G protein receptors (Guanine nucleotide binding)
    → Such as neurotransmitter and prostaglandin receptors.

  • Ligand-gated ion channels
    → Permit ion transport when activated.
Q:

Main hormones related to injury and stress - ATCH

A:

ACTH – Adrenocorticotropic hormone 

CRH (corticotropin releasing hormone) is responsible for ACTH production and release. 

→ ACTH is produced and released by the anterior pituitary gland. 

 

Elevations in CRH (corticotropin-releasing hormone) and ACTH are typically proportional to the severity of the injury. 

→ ACTH promote cortisol production.

- Cortisol is the major glucocorticoid and is essential for survival during significant psychological stress. 


Following injury, the degree of cortisol elevation is dependent on the degree of systemic stress. 

It potentiates the actions of Glucagon and Epinephrine, that manifest as hyperglycemia.

Furthermore, it potentiates the release of free fatty acids, triglycerides and glycerol from fat providing additional energy sources.

 

Glucocorticoids have long been employed as immunosuppressive agents, due to depressed cell mediated immune response action.
*Note the importance of not stopping treatment with corticosteroids abruptly! Slowly reduction is needed to restore functions of hypothalamus, hypophysis and adrenal axis. 


Acute adrenal insufficiency secondary to exogenous administration is a life-threatening complication!

→ Patients with acute adrenal sufficiency typically presents with weakness, nausea, vomiting, fever and hypotension.


Objective findings include: 

  • Hypoglycemia – Caused by decreased gluconeogenesis. 
  • Hyponatremia 
  • Hyperkaliemia. 
Q:

Main hormones related to injury and stress - Catecholamines 

A:

Catecholamines

The functions of catecholamines are activation of adrenergic system through the release of epinephrine and norepinephrine. 

→ It induces a hypermetabolic state after severe injury, due to the activation of the adrenergic system.

 

Furthermore, catecholamines reduce insulin release and increases glucagon secretion.

→ Which all results in stress-induced hyperglycemia.

Q:

Sepsis

A:

Sepsis

The diagnosis of sepsis includes the presence of SIRS and an identifiable infection source

Two categories of sepsis can be identified:  

  1. Severe sepsis
    The presence of sepsis and some organ dysfunctionality. 

  2. Septic shock
    The presence of sepsis and cardiovascular collapse.
    At such point, vasopressors are required.
Q:

Phases of systemic inflammatory response

A:

Phases of systemic inflammatory response 

The systemic inflammatory response has two phases:

  1. Proinflammatory response
     Activation of the cellular process designed to restore a tissue function and eradicate invading microorganisms.

  2. Anti-inflammatory response
    → It is counter-regulatory to prevent excessive pro-inflammation and restore homeostasis.
Surgical Pathology

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