Term
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Definition
| Data indicates the importance of epigenetic processes, especially those with resultant gene silencing of key regulatory genes. Epigenetic changes collaborate with genetic changes and environmental-lifestyle factors to cause the development of cancer. These changes are inheritable.Importantly, epigenetic processes can be modified by lifestyle, particularly diet and environment, pharmacologic interventions, or both. Environmental-lifestyle factors act on individuals throughout life, changing gene expression through epigenetic mechanisms with subsequent implications for health. |
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Term
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Definition
A fetus may develop a predisposition to CA, cancer itself, or other diseased in utero due to exposures during intrauterine time.
Ex: DES(used to prevent preterm birth) cuased poor development of reproductive organs and development of clear cell carcinoma in daughters and raised risk of getting breast CA before 40yo.
Pima Indians have increased risk of getting DMII due to famine.
Dutch Famine lead to increased DM, heart disease, and Syndrome X (metabolic syndrome) in adult life. |
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Term
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Definition
Large exposures lead to acute leukemias in adults and children and increase frequencies of thyroid and breast carcinomas. There are other health risk involved with high doses of therapeutic medicine and low doses in the A-bomb survivors. They included cardiovascular disease and stroke, and the late effects of radiation showed persistent elevations of inflammatory markers.. Other risk included somatic mutations that may contribute to other diseases such as birth defects and eye maladies. Heritable mutations are a particular concern for women because the number of oocytes (eggs) are presumably fixed at birth and if there are mutations that cannot be repaired they become cumulative. Also because of the high fetal radio sensitivity at different points in the gestational stages ionizing radiation can have adverse effects. The main adverse effects to the embryo and fetus include malformations, mental retardation, induced cancer, hereditary effects, and death.
MD's should limit excessive and unnecessary testing (CT/x-ray) because radiation of any kind can cause breaks in DNA cause RNA silencing, gene mutations, aneuploidy, late cell death, and genetic instability. Radiation can induce or increase genomic instability by creating new mutations in later generations. |
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Term
| 3 Categories of carcinogens |
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Definition
| Nutritional, Environmental, Radiation |
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Term
| Leading cause of preventable death in US |
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Definition
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Term
| 3 cancers caused by UV radiation |
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Definition
Squamous cell- caused by genetic mutation and induces the release of tumor necrosis factor. – usually found on the head, neck, and exposed areas of the upper extremities. It is commonly found in men who work outdoors and are exposed to greater hours of sunlight.
Basal cell- caused by genetic mutation and induces the release of tumor necrosis factor. Usually appear on the areas of the body that received the greatest some exposure, like head and neck, but they can appear other places. Most common in people with light complexions, light color eyes, and fair hair. These people tend to sunburn rather than tan and live in areas that have high sunlight exposure.
Melanoma- development is related to episodes of intense exposure. It is usually measured by the amount of times you have had extreme sunburn. It usually occurs on areas of the body that are less continually exposed to sunlight. Ex: trunk in man and back of legs in women. |
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Term
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Definition
| for colorectal, breast, esophageal, pharynx, hypopharynx, larynx, oral, liver. |
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Term
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Definition
| Colorectal, breast, endometrial, prostate, stomach, esophageal, pancreatic, kidney, liver |
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Term
| Oncogenic Viruses and Bacteria |
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Definition
Virus- Hep B&C, Epstein-Barr, Kaposi assoc. herpes, HPV 16, 18, 31, 45 (HPV= cervical CA).
Bacterial= Heliobactor pylori = stomach ca. |
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Term
| Chronic inflammation and CA |
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Definition
Chronic inflammation can lead to increased risk of ca. Ex: chronic asthma, inc. risk of lung ca; Ulcerative colitis, inc risk of colon ca.
** ASA & NSAIDs protect against colon ca.** |
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Term
| Breast and Endometrial Cancer risk due to obesity |
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Definition
| Estrogen and progesterone play a central role in these two cancers. An increase in estrogen is directly relate to BMI. Breast Cancer is strongly related to postmenopausal women who have never received HRT. Low estrogen levels causes an increase in adiposity, which increases the risk of breast cancer. Mortality rate is higher in women who are heavier versus women who are leaner. |
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Term
| Patho behind obesity and CA |
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Definition
| Viceral adipocytes are lipolytic and release free fatty acids and decrease release of adiponectin leading to insulin resistance, hyperinsulinemia, and increased insulin-like growth factors. Chronic Hyperinsulinemia (caused by excess weight gain, increased plasma triglyceride levels, low levels of physical activity, and poor dietary choices)is correlated with development of colon, pancreatic, and endometrial CA. |
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Term
| Dietary factors with the highest risk for the different forms of cancer |
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Definition
*obesity is the highest risk for major cancers: colorectal, breast, stomach, esophageal, pancreatic, kidney, endometrial
*animal fat consumption: prostrate and endometrial cancers
*red or processed meat: colorectal and prostate cancers
*grilled meat: colorectal and breast cancers
*western diet plate: colorectal cancer
*salt preserved foods: stomach cancer
*hot beverages: esophageal and oral cancers
IN A NUTSHELL: obesity biggest risk factor for major cancers, animal protein diet causes cancer. Plant based diet preventative measure against cancers! |
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Term
| Benefits of physical activity in decreasing risk of breast and colon CA |
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Definition
Decreased insulin and insulin growth factor levels.
Dec exposure of breast to ovarian hormones.
Dec obesity.
Dec free redicals
Improved immune function
Increases peristalsis and reduces transit time of mutagens in gut. |
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Term
| Occupational hazards and air pollutants that have been linked to cancer |
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Definition
asbestos increases the risk of mesothelioma and lung cancer.
benzol inhalation is linked to leukemia in shoemakers and in works in the rubber cement, explosives, and dyeing industries.
dyes, rubber, paint and aromatic amines have been linked to carcinoma of the bladder.
*radon: radioactive gas-safe until trapped indoors.
heavy metals: bladder, lung, breast, skin, soft tissue sarcoma, nasal & nasopharynx
*environmental tobacco smoke: lung, breast cancers
*diesel exhaust indicates increased risk for lung cancer. |
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Term
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Definition
Incidence is low in comparison to adults.
Most arises from mesodermal germ layer of embryo.
Caucasian more often and boys more succeptible. Kids with down syndrome more likely to develop leukemia.
Most common child CA is leukemia(accounts for 1/3 of all). you also see sarcoma & brain. |
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Term
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Definition
aka: Nephroblastoma
most common solid tumor in children. It is an embryonal tumor (from mesodermal layer) of the kidney arising from epigenetic and genetic changes that lead to an abnormal proliferation of renal stem cells. |
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Term
| Acquired factors for childhood CA |
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Definition
Kids with organ transplant more likely ot develop leukemia or lymphoma.
Immunosupressive agents used for transplants increase risk for lymphoma (bukett lymphoma). |
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Term
| Exposures for childhood CA |
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Definition
Teens who use anabolic androgenic steroids to boost muscle and performance are at an icreased risk for hepatocelular carcinoma.
Cytotoxins used in some cancer treatments for children may increase risk for leukemia. |
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Term
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Definition
| Epstein Barr is linked to Barkett lymphoma and hodgkins lymphoma. |
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Term
| 3 types of Alzheimer's Disease (AD) |
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Definition
Late-onset familial Alzheimer disease (FAD) and Non-hereditary (sporadic) late-onset AD (Collectively known as senile dementia of the Alzheimer type (SDAT) & account for 70-90%).
Early-onset FAD (10%) |
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Term
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Definition
Early-onset FAD includes at least 3 gene defects
o Late-onset FAD is linked to a defect in the apolipoprotein E (apoE4) gene on chromosome 19 (a marker of increased susceptibility). |
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Term
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Definition
| Greatest are age & family history; also atherosclerosis, low education level, head injury, cardiovascular disease, elevated serum homocysteine & cholesterol levels, environmental triggers, toxins, oxidative stress & damage, inflammation, and female gender estrogen deficit. |
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Term
| Protective factors for AD |
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Definition
| Lifelong activity, apoE2 gene, antioxidant substances, estrogen replacement, low caloric diet, nonsteroidal anti-inflammatory agents, and statins. |
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Term
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Definition
| Altered production and failure of clearance of amyloid-beta peptide from the brain result in initial accumulation of fine diffuse plaques (senile plaques). The abnormal AB is neurotoxic. |
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Term
| Clinical manifestations of AD |
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Definition
Becomes progressively forgetful over time, particular in relation to recent events; memory loss increase as the disorder advances.
Becomes disoriented and confused. Mental status changes induce behavioral changes including irritability, agitation, and restlessness.
o Mood changes result from cognitive deterioration. These may include anxiety, depression, hostility, emotional lability, and frequent mood swings.
Experiences decline/deterioration in the ability to concentrate, abstraction, problem solving, and judgment.
Experiences a failure in mathematic calculation ability, language, and visuospatial orientation.
May experience dyspraxia- loss of ability to plan a movement and therefore loss of coordination.
If posterior frontal lobe affected pt will have motor changes similar to parkinsons (rigidity,flexion posturing) |
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Term
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Definition
Only by ruling out other causes.
Experimental: presenilin 1&2, amyloid precursor of protein, and apolipoprotein E- used to screen for AD. |
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Term
| Degenerative Disk Disease (DDD) |
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Definition
| Term for several age-related diagnoses describing back pain, weakness and loss of flexibility resulting from biochemical and mechanical changes in intervertebral disks. After the age of 30, the gelatinous material in the nucleus pulposus is slowly replaced with fibrocartilage causing nerve impingement. Subsequent discomfort may be caused by disk herniation and protrusions, slippage, or narrowing of the spinal canal/intervertebral openings by calcifications or osteophytes. |
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Term
| Most common herniated disk locations |
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Definition
C-spine- C5-C6, C7-C7
L-spine- L5-S1, L4-L5 *most common location is lumbar accounting for 1/3 of all back pain*
T-spine- very rare d/t stabilization of spine by ribcage. |
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Term
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Definition
| structural defect of spine involving degeneration of the lamina or neural arch and associated soft tissue of vertebra. Related to repeated micro-fractures on the vertebral -articular facets as a result of mechanical stress. Hereditarily influenced. |
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Term
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Definition
| Most commonly occurring at L5-S1, when stress factors permit a superior vertebra to slip anteriorly over its inferior neighbor. |
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Term
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Definition
| Narrowing of the spinal canal resulting in single or multiple nerve compression or entrapment. |
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Term
| Herniated Intervertebral Disk |
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Definition
Discus pulposis or annulus fibrosis become displaced and protrude through a tear in the fibrous capsule that contains the disk, causing nerve compression and pain.
Men twice as likely to have than women. |
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Term
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Definition
| HTN, AA race, male, smoking, DM, insulin resistance, polycythemia, presence of lipoprotein A, impaired cardiac function, elevated cholesterol, a-fib. |
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Term
| Thrombotic strokes (cerebral thrombosis) |
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Definition
| arise from arterial occlusions caused by thrombi formed in the arteries supplying the brain or in the intracranial vessels. Most frequently attributed atherosclerosis and inflammatory disease processes (arteritis) that damage arterial walls. Conditions causing inadequate cerebral perfusion (dehydration, hypotension, prolonged vasoconstriction from malignant hypertension) increase the risk of thrombosis. |
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Term
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Definition
involves fragments that break from a thrombus formed outside the brain or in the heart, aorta, common carotid, or thorax. High risk sources for emboli include A-fib, MI, endocarditis, rheumatic heart disease, heart valve prosthesis, air, fat, amniotic fluid, tumor particles.
In persons who experience an embolic stroke, a second stroke usually follows at some point because the source of emboli continues to exist. |
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Term
| Hemorrhagic strokes (intracranial hemorrhage ICH) |
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Definition
the third most common cause of CVA and accounts for 10-15% whites, 30% blacks and Asians. The most common cause of spontaneous primary hemorrhagic strokes are hytertension, ruptured aneurysms, arteriovenous malformation and fistula, amyloid angiopathy, and cavernous angioma. Most common sites of bleed are basal ganglion, thalamus cortex and sub cortex, pons, and cerebellar hemisphere.
Risk factors for hemorrhagic stroke include HTN, previous cerebral infarct, coronary artery disease, and DM. |
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Term
| Lacunar strokes (lacunar infarct) |
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Definition
| microinfarct smaller than 1cm in diameter and involves small perforating arteries, predominantly in the basal ganglia, internal capsules and pons. Associated with smoking, HTN, and DM. |
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Term
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Definition
| Temporary decrease in blood flow to brain. Actually a stroke with very small amt of damage. All neuro deficits resolve spontaneously within 24 hrs. 80% people with TIA will have another within 1yr which may be mre severe than the first. |
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Term
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Definition
infection of the meninges which may be caused by bacteria, viruses, fungi, parasites, or other toxins.
Bacterial- Meningococcus and pneumococcus are the most common causes after the neonatal period. Pneumococcus and gram-negative enteric bacilli are the most common neonatal agents. |
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Term
| Bacterial meningitis and reservoirs |
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Definition
| Can come from systemic infection or from a reservoir (ex: sinus, ear, or lung). Bacteria leaves reservoir and travels via blood to the Chroid Plexus (portal of entry) where CSF is made. Once it reaches meninges, the bacteria causes inflammation and infection of CSF and ventricles. |
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Term
| Clinical manifestation of meningitis |
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Definition
| Fever, chills, petechial rash (menengiococcao), HA, photophobia, nucal rigidity, positive Kernig's sign (hip flexed to 90degrees, leg can not be straightened d/t hamstring tightness) and Brudzinski's sign (severe neck stiffness= flexion of neck causes flexio of hips). |
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Term
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Definition
| Inflammation of the brain; an acute febrile illness, usually of viral origin, with nervous system involvement |
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Term
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Definition
Incubation 3-14d
Found in lower 48 states
Increased in summer and fall
Affects elderly and very young
May range from mild infectious disease to life-threatening.
Clinical manifestations: Fever, delirium or confusion progressing to unconsciousness, seizure activity, cranial nerve palsies, paresis & paralysis, involuntary movement, abnormal reflexes, and signs of marked ICP. |
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Term
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Definition
A relatively common progressive autoimmune disorder involving degeneration of CNS myelin and loss of axons; a primary demyelinating disorder that affects white and gray matter.
Acquired condition, age of onset 20-50yo. More females than males, all races however slighty more caucasian. About 15% MS pts. have an affected relative. |
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Term
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Definition
| o Occurs when a previous viral insult to the nervous system has occurred in a genetically susceptible individual with a subsequent abnormal immune response in the CNS. Gene for Syncytin is activated, produced, & released with inflammatory proteins (Glutamate- cytokine) and free radicals. Demylination of nerve (demylinating lesions or plaque formations) in white matter of brain result. Periods of exacerbation and remission eventually lead to gliosis and scaring of the axon (d/t chronic demylination/plaque formation). Causes progressive loss of function that is eventually permenant. |
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Term
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Definition
May be caused by infection, trauma, or pregnancy.
With pregnancy, usually shows up 3 months pp. This is because it is related to the stres of labor and increased fatigue in first months. |
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Term
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Definition
a chronic autoimmune disease of the neuromuscular junction causing muscular weakness and fatigue-ability.
Females: typically pathologic changes in thymus gland.
Males: more likely a tumor of thymus gland. |
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Term
| Patho of Myastenia Gravis |
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Definition
| Post synaptic acetylcholine receptors not recognized as self. Autoantibodies bind to and block them so that receptor sites are eventually destroyed. Causes decreased nerve impulse transmission across the neuromuscular junction. |
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Term
| Clinical manifestations of Myasthenia Gravis |
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Definition
| Muscular fatigue & progressive weakness; weakness of the muscles of the eyes (ptosis), face, mouth, neck & throat affected first. May involve the muscles of the diaphragm & chest wall. May first appear during pregnancy or post partum period. Watch for ptosis in our patients. |
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Term
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Definition
| Pituitary tumors that secrete prolactin are called prolactinomas and are the most common of the hormonally active pituitary tumors. Tumor size correlates to the degree of prolactin elevation. Tumor also causes increased pressure and therefore size of tumor depends on severity of accompanying HA. |
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Term
| Clinical Manifestation of prolactinoma |
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Definition
Women: amenorrhea, nonpuerperal milk production (galactorrhea), hirsutism (excessive body hair in masculine distribution pattern, and osteopenia caused by estrogen deficiency.
Men:hypogonadism, erectile dysfunction, impaired libido, oligospermia, and diminished ejaculate volume.
Size of adenoma (pituitary tumor) may cause HA and visual disturbance.
Due to menstural abnormalities women usually present sooner than men so their tumors are smaller when found. Men have larger tumors. |
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Term
| Causes of increased prolactin |
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Definition
prolactinoma, renal failure, PCOS, primary hypothyroidism, breast stimulation, stress.
Meds: Antipsychotics (thorazine, risperdone), tricyclic antidepressants (elavil), Antihypertensives (methyldopa), estrogen. |
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Term
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Definition
Increasesd prolactin = supression of gonadotropin releasing hormone (GnRH)from hypothalamus.
Impaired gonadotropin release (FSH/LH) blunts gonad responsiveness to gonadotropin, and estrogen/progesterone primed breasts will produce milk. |
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Term
| Examples of Hyperthyroidism |
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Definition
| Grves disease (most common cause), toxic multinodular goiter, and solitary toxic adenoma. |
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Term
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Definition
An autoimmune disease that results in stimulation of the thyroid gland. Causes 50 – 80% of cases of hyperthyroidism. More common in women.
Triad: Hyperthyroidism, goiter, exophthalmus. |
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Term
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Definition
| B cells produce immunoglobulin G (IgG) antibodies that bind to TSH receptors in the thyroid gland and stimulate the synthesis and secretion of excess T4 (TypeII/5 hypersensitivity. cell not destroyed but made to malfunction). The hyperfunction (increased T4) of the thyroid gland leads to suppression of TSH. |
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Term
| Clinical manifesttion of Graves disease |
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Definition
Excess T4= increased metabolic rate and O2 consumption= tachycardia, nervousness, tremor, increased bp
Functional abnormalities= lid lag. |
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Term
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Definition
The thyroid gland normally enlarges in response to an increased secretion of TSH that may occur in puberty, pregnancy, or iodine deficiency. When condition resolves thyroid gland returns to normal, however some folicles may become nodules which function autonomously and produce excessive amounts of T4.
Multiple hyperfunctionong nodules= toxic multinodular goiter
Only one nodule hyerfunctioning is called toxic adenoma. |
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Term
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Definition
The most common thyroid disorder, caused by deficient production of T4.
types: primary and secondary. |
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Term
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Definition
causes include (1) defective hormone synthesis resulting from autoimmune thyroiditis, endemic iodine deficiency, or iatrogenic loss of thyroid tissue after surgical or radioactive tx for hyperthyroidism, and (2) congenital defects.
loss of functional thyroid tissue leads to decreased production of T4. Without the negative feedback of T4 on the pituitary, there is increased secretion of TSH that may lead to goiter.
EX: Autoimmune thyroiditis (hashimoto's), acute and subacute thyroiditis, painless thyroiditis, pp thyroiditis. |
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Term
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Definition
much less common, include conditions that cause either pituitary or hypothalamic failure to stimulate thyroid functionlike pituitary tumor or treatment of tumor .
caused most commonly by failure of the pituitary to synthesize adequate amounts of TSH . It is characterized by low TH levels with low TSH or TRH (thyroid releasing hormone) levels. |
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Term
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Definition
aka: autoimmune thyroiditis. Most common form of primary hypothyroidism in US.
gradual inflammatory destruction of thyroid tissue by infiltration of lymphocytes and circulating thyroid autoantibodies.
occurs in genetically predisposed individuals and is associated with high iodine intake, selenium deficiency, smoking, and chronic hepatitis C. |
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Term
| Clinical manifestation of Primary hypothyroidism |
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Definition
| Low metabolism, low heat production, cold intolerance, lethargy, goiter, myxedema (swelling around eyes, with long standing or severe hypothyroidism) |
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Term
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Definition
| occurs within 6 months of delivery. Spontaneous recovery is normal but may be permanent. |
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Term
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Definition
Most common endocrine malignancy, still relatively rare.
Typically found as a small thyroid nodule or metastatic tumor in the regional lymph nodes, lungs, brain, or bone.
Risk factor is exposure to ionizing radiation, esp. during childhood or puberty.
Most individuals have normal T3 and T4 levels and are euthyroid.
Clinical manifestations: changes in voice, difficulty swallowing, difficulty breathing. |
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Term
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Definition
Group of disorders with glucose intolerance in common.
Type I- absolute insulin deficiency.
Type II- insulin resistance with insulin secretory deficit. Pancreas does not secrete enough insulin.
Gestational DM- Diabetes during pregnancy. |
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Term
| Maturity-Onset Diabetes of Youth (MODY) |
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Definition
Genetic autosomal dominant disorder.
Subset of type II dm.
pts are usually normal weight, diagnosed before age 25, with strong family history of diabetes mellitus.
They may have hyperlipidemia, non-specific pruitis (itching), recurrent infection, visual changes, parathesias. |
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Term
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Definition
The most common pediatric chronic disease. Is thought to be the result of genetic-environmental interaction. People are born susceptible due to a change on chromosome 6 (risk marker is HLA on chrom 6). A virus or other environmental unsult occurs and autoantibodies to insulin and glutameic acid decarboxylase are produced and cause damage to iselt cells. This results in hyperglycemia from total absence of insulin and excessive glucagon.
clinical manifestations: polydipsia, polyphagia,polyuria, weight loss. |
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Term
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Definition
Acute complication of type I DM.
Most common precipitating factor- recurrent illness.
Increased metabolism of proteins and fats when cells can not get glucose due to lack of insulin.
Increasesd ketones, pH drops (metabolic acidosis), acetone (fruity) breath is blown off to compensate with kusmals respiration (very deep), and CNS depression. If not resolved= coma. |
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Term
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Definition
More common than type I and incidence continues to rise.
Most common in black women. Increased susceptibility in Native indians (esp. pima), hispaic, and AA. Mostly in adults >40yo however may be seen in obese children.
Risk factors: obesity, physical inactivity, family history, member of ethnic minority, female (women with PCOS 8x greater risk) |
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Term
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Definition
Genes influence insulin resistance (60-80% all cases) or beta cell function (deficiency), or both. May also see abnormal glucagon secretion.
Beta cell function lost d/t amyloid deposits, fatty deposits in liver and pancreas, or pancreatic fibrosis or cytokine toxicity. |
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Term
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Definition
Pregnancy is a diabetogenic state.
Glucose intolerance appears in pregnancy.
Risk factors: >25yo, family history (particularly first degree relationship), history of GDM or PCOS, obesity, membership in certain ethnic or racial group, and history of poor OB outcomes(including fetal demise), infant weighing > 9 pounds. |
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Term
| Acute complications of DM |
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Definition
Hypoglycemia: from too much insulin. tachycardia, palpitations, diaphoresis, tremors, pallor, and anxiety, hunger, HA, confusion, seizure, coma.
Ketoacidosis
Hyperosmolar hyperglycemic nonketotic syndrome (HHNK)- assoc with type II, primarily in elderly people. Inc glu (>600) and serum osmotic pressure lead to severe dehydration, low blood volume, low bp, and possibly renal failure and death.
Somogyi Effect- hypoglycemia followed by rebound hyperglycemia. D/t counter regulatory hormones that are stimulated by hypoglycemia. Uusally triggered by an excessive carb intake. More common in type 1 diabetes and in children. |
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Term
| Chronic complications of DM |
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Definition
Strict glycemic control reduces complications.
Non-enzymatic glycosylation- Persistent hyperglycemia causes glucose to become irreversibly bound to collagen and other proteins in red blood cells, blood vessel walls, and interstitial tissue.
Advanced glycosylatoion end products (AGEs)- develop and cause the tissue damage associated with DM.
Polyol Pathway- an alternative metabolic pathway for glucose metabolism for tissues that do not require insulin for glucose transport such as RBC’s, blood vessels, eye lenses, nerves. In hyperglycemia glucose is shunted to this pathway and converted to sorbitol which increases intracellular osmotic pressure and attract water, leading to cell injury. explains swelling of lense and increased cateracts in DM as well as kidney and nerve changes.
Protein Kinase C- an intracellular signaling protein inappropriately activated by hyperglycemia. Some consequences are insulin resistance, production of cytokines, vascular cell proliferation, and increased permeability. contributes to micro and macro vascular changes and neruo complications of DM.
Neuropathies- common result of AGE's and polyols that cause nerve degeneration and delayed conduction and polyneuropathies. Sensory, not motor. |
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Term
| Microvascular disease caused by DM |
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Definition
Casued by thickening of the capillary basement membrane, endothelial hyperplasia, thrombosis, and pericyte degeneration.
Ex: visual changes, neuropathy, |
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Term
| Macrovascular disease caused by DM |
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Definition
More prevelant in type II, but seen in both.
Will lead to athrosclerotic disease unrelated to severity of DM.
Ex: CAD (DM pts have an increase of CAD even without HTN and high cholesterol however most do have.), Stroke, Peripherial vascular disease (aka: peripherial artery disease). |
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Term
|
Definition
Increased risk d/t:
impaired vision and touch (neuropathy)
hypoxia related to glycoselated Hg and a decreased release of O2 to tissues.
Pathogens like glucose rich environment.
Blood supply is compromised d/t vascular changes, athrosclerotic changes.
WBC function impaired d/t decrease in # of WBC ablt to migrate (via chemotaxis) to site of infection and defective phagocytosis. |
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