Paramedic Pathophysiology Iii

Pathophysiology III Paramedic Class 108

Disease in the Human Body Factors Genetics Environment Life-style Age Gender

Many Factors Combine To Cause Disease Inherited traits are determined by molecules of deoxyribonucleic acid (DNA). Each somatic cell contains 46 chromosomes. Sex cells contain 23 chromosomes.

Many Factors Combine To Cause Disease An offspring receives 23 chromosomes from the mother and 23 chromosomes from the father. One or more chromosomes may be abnormal and may cause a congenital disease or a propensity toward acquiring a disease later in life.

Genetic vs. Environmental Genes need an environment to work. Environmental factors vary with everyone. Environment the same – People have different genetic characteristics. Very Complex

Genetic Factors Heredity – Chromosomes Individual Genetic Factors Entire Chromosmal abnormalities

Genetic Factors EXAMPLES

Down’s Syndrome – Rearranged Chromosomes. Sickle Cell / Hemophilia – Single gene on chromosome passed on results in an abnormal protein.

Genetic Factors Polygenic Determined by many genes multi- factional CAD HTN CA

Environmental Factors Think Chronic Disease’s Microorganism & immunological exposure Personal Habits Chemical Substances Physical Environments Psychosocial Environments

Environment & Heredity More than one genetic defect CAD HTN CA > 40 yoa

AGE & GENDER Cumulative Effects Gender Specific Breast Cancer Testicular Cancer Ovarian Cancer Prostrate Cancer

AGE & GENDER Cumulative Effects

ENVIRONMENTAL Cigarette Smoking Lung Cancer CAD – Men

COMBINED EFFECTS

Familial Disease Tendencies

Aging and Age related Disorders

LINES OF DEFENSE

Characteristics

Body’s Self-Defense Mechanisms Defense against illness and injury – First-line external barriers include: Skin Mucous membranes of the respiratory, digestive, and genitourinary (GU) tract

– Second—Inflammatory response – Third—Immune response

Stages of Inflammatory Response Cellular response to injury – Energy depletion, autolysis

Vascular response to injury – Hyperemia, vessel dilation – Leukocyte migration

Phagocytosis – –

Leukocytes destroy pathogens Exudate (pus) forms

Cellular Response Metabolic Decreased Energy Stores (Aerobic Respiration) Sodium/Potassium Pump impaired Cell Swelling – Acidosis Membranes Leak Cellular Destruction Inflammatory Response

Vascular Response Dilation - arterial, venules, and capillaries. Increase permeability (Interstitial = Edema) Leukocytes – Attack injured Tissue

Phagocytosis Leukocytes – attack & Destroy Macrophages – Clean area of dead cells Occurs at site of invasion General Circulation – Systemic Leukocytes – Lyses Pus Forms – (Exudate) Pus= dead dying leukocytes, broken down tissue cells,pathogens,and tissue fluid.

MAST CELLS Connective Tissue Cytoplasm Histamine/serotonin – Allergies

– Vasoactive amines – Aminos – Allergies

– Chemotactic Factors – Random migration – Stimulated migration

– Attracts leukocytes

MAST DEGRANULATION Stimulated by physical Injury – Chemicals – Allergies IgE Histamine – Capillary Dilation Serotonin – Vasoconstriction or dilation Chemotaxis – Attract White Blood Cells Neutrophils – Most Prevalent Eosinphils – parasites - Worms

MAST CELL HELP

Mast Cell Degradation and Synthesis

Inflammatory Response Local  Vascular  Vasodilatation increased permeability  Formation of pus (Exudate)  Local Signs - ???  Heat, Redness, swelling, pain and tenderness

Inflammatory Response Systemic Fever ( Pyrogens) Leukocytes Increased Plasma Proteins

Inflammatory Response Acute inflammation – Local responses – Systemic responses

Chronic inflammation – Inflammation > 2 wks

Inflammatory Response Chronic Defined Lasting 2 weeks or longer Results From Unsuccessful acute inflammation Persistent –Ongoing antigen or infection

CHRONIC INFLAMMATION Characteristics Persistent – Acute Inflammation Response Neutrophil- Degranulation & Death Lymphocyte Activation – Clean up Fibroblast Activation - Healing Infiltration (pus) – Clean up Tissue Repair (Scar)

Types of Immunity Natural (native) Genetic or Innate – Present at Birth –

No prior exposure

Acquired Humoral immunity Cell-mediated immunity

Acquired Immunity Active- Immunizations or disease (Natural)

Passive – Mother –Child or Antibody administration.

Humoral vs. Cell Immunity Humoral – (Anti Body Mediated) Lymphocyte B cells Cell Mediated ( cellular immunity) Lymphocyte T cells Direct Attack – Best Defense

AGE & IMMUNE RESPONSE INFANTS Antibodies – Passive Immunity Older we get the less immunities we maintain. But Why?

Induction of Immune Response Triggers Antigen – Reacts with preformed components of immune system

Immunogen – Antigen that can also induce formation of antibodies

Induction of Immune Response To be immunogenic, the antigenic molecule must be – – – –

Sufficiently foreign to the host Sufficiently large Sufficiently complex Present in sufficient amounts

B lymphocytes - Antibodies T lymphocytes - Killers

IMMUNE RESPONSE

Summary of the Immune response

Immune vs. Inflammatory Immune

Inflammation

Develops slowly

Develops swiftly

Targets specific antigens

Non-specific

Long-lasting—has “memory”

Temporary—days to weeks

Involves one type of white blood cell

Involves many types of white blood cells and platelets One type of plasma protein— Several plasma proteins— antibodies complement, coagulation, kinin

Disease Deficiencies Nutritional Iatrogenic Trauma Stress Acquired Immunodeficiency (AIDS)

Immune - Primary Immunizations – Exposure Activate B Cells Memory Cell Develops (B) Secretion of Antibodies Pathogenic organism DEAD

Classes of Immunoglobulin's IgM—produced first. IgG—has “memory.” IgA—involved in secretory immune responses. IgE—involved in allergic reactions. IgD—present in very low concentrations.

Immunoglobulin's IgG (70 -75 %) – Secondary immune response

IgM (5-10 %) – ABO incompatibilities

IgA (15%) – Defends body surface against organisms

IgE (less than 1%) – Immediate hypersensitivity reactions

IgD (less than 1%) Function unknown

Hypersensitivity Altered immunologic reactivity to antigen Causes pathologic immune response after reexposure Abnormal responses include: – Allergy – Autoimmunity – Host own cells – Isoimmunity – Beneficial foreign tissue

Mechanisms of Hypersensitivity Immediate hypersensitivity reactions – Itching, hives – Anaphylaxis

Delayed hypersensitivity reactions – Take several hours to 1 to 2 days to appear – At maximum several days after antigen reexposure

IMMEDIATE

Antigen – Anti Body Reaction – Mild- Itching Hives Severe – Life Threatening Anaphylaxis

DELAYED Cell Immunity Hypersensitivity Hours – Days Maximum Severity days later Poison Ivy – Skin Grafts

Homeostasis

QUAN

Stress & Disease Think Sympathetic Adrenal Gland – Epi, Norepi, Dopamine Alpha & Beta Effects

Stress & Disease Hypothalamus – pituitary gland Growth Blood pressure Some aspects of pregnancy and childbirth including stimulation of uterine contractions during childbirth Breast milk production Sex organ functions in both women and men Thyroid gland function The conversion of food into energy (metabolism) Water and osmolarity regulation in the body

Stress & Disease Cortisol Secreted by the adrenal glands and involved in the following functions and more: Proper glucose metabolism – Regulation of blood pressure – Insulin release for blood sugar maintenance Immune function Inflammatory response

Cortisol (Hydrocortisone) Circulates in the plasma Mobilizes substances needed for cellular metabolism Stimulates gluconeogenesis – Decreases glucose utilization

Immunosuppressant Decreases migration of macrophages – Decreases phagocytosis

Catecholamines Stimulate: – Alpha-adrenergic receptors Alpha-1 and alpha-2

– Beta-adrenergic receptors Beta-1 and beta-2

Alpha Receptors Alpha-1 receptors – Postsynaptic – On the effector organs – Stimulate contraction of smooth muscle

Alpha-2 receptors – Presynaptic nerve endings – Stimulate alpha-2 receptors – Inhibit release of norepinephrine

Beta Receptors Beta-1 receptors – Primarily in heart

Beta-2 receptors – Bronchiolar and arterial smooth muscle

Beta receptors – – –

Stimulate the heart Dilate bronchioles Dilate blood vessels in the skeletal muscle, brain, and heart – Aid in glycogenolysis

STRESS Nature Intensity Duration Perception Coping Skills

STRESS

Stress: The confusion created when one's mind overrides the ”

“Stress is when you wake up screaming and you realize you haven't fallen asleep yet”

The Stress Response: Effects on the Sympathetic Nervous, Endocrine, and Immune Systems.

QUESTIONS