- PATHOPHYSIOLOGIES - Flashcards

Question

Discuss the pathophysiology of Type II respiratory disrders

Answer 1

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A hyperglycaemic syndrome resulting in severe:

Acidosis
Dehydration
Electrolyte imbalance (Na+, K+, glucose)
Autoimmune attack on B cells in the pancreas causing a decrease in insulin production
Lack of insulin increases gluconeogenesis and glycogenolysis and a decrease in glycolosis
This all together results in an increased amount of glucose in the bloodstream (hyperglycaemia)
This results in Glucosuria, Polyuria, and polydipsia
Lack of insulin production also results in the breakdown of fats (lipolysis)
the fats are broken down from adipose tissue to form free fatty acids
These FFA go to the liver and undergo ketogenesis to make more ketone bodies
This is to obtain a second energy source as glucose is not working or not present in this case
This results in a high amount of ketones in the blood (hyperketonaemia) and thus ketones in the urine (ketonuria)
Ketones are acidic and reduce the pH of the blood and the urine

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ADH is made in the hypothalamus and stored in the pituitary gland
The stimuli for release of ADH are:
- low blood pressure (presence of angiotensin II, from RAAS pathway)
- high plasma osmolality (blood is hypertonic, low amount of water in the blood and high solutes)
osmoreceptors on the hypothalamus are stimulated by high plasmaosmolality, and there are also receptors for angiotensin II
This stimulates the release of ADH
ADH travels to the kidneys and acts on the cells in the collecting duct by binding to vasopressor receptors
This activates an intracellular cascade that results in the activation of Protein kinase A
PKA stimulates Aquaporin II protein channels to fuse with the cell membrane absorb water from the filtrate that otherwise would have been secreted
This water travels into the cell and into the blood stream via Aquaporin III and IV channels
This incease in water in the blood stream causes and increase the plasma volume and thus blood pressure and also decreases the osmolality of the blood
ADH can also bind onto the vasopressin receptors of the smooth muscle cells of the blood vessel
Stimulating the GQ mechanism resulting in high amounts of calcium, causing the cell to contract -> vasoconstriction -> increase in peripheral resistance -> increase in blood pressure

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(25 cards)