paramedic pathophysiology iii
DESCRIPTION
Patho for dirt doctors.TRANSCRIPT
Pathophysiology IIIPathophysiology III
Paramedic Class 108Paramedic Class 108
Disease in the Human BodyDisease in the Human BodyFactorsFactors
Disease in the Human BodyDisease in the Human BodyFactorsFactors
GeneticsGenetics
EnvironmentEnvironment
Life-styleLife-style
AgeAge
GenderGender
GeneticsGenetics
EnvironmentEnvironment
Life-styleLife-style
AgeAge
GenderGender
Many Factors Combine To Cause Many Factors Combine To Cause DiseaseDisease
Inherited traits are determined by molecules Inherited traits are determined by molecules
of deoxyribonucleic acid (DNA).of deoxyribonucleic acid (DNA).
Each somatic cell contains 46 Each somatic cell contains 46
chromosomes.chromosomes.
Sex cells contain 23 chromosomes.Sex cells contain 23 chromosomes.
Many Factors Combine To Cause Many Factors Combine To Cause DiseaseDisease
An offspring receives 23 chromosomes from the An offspring receives 23 chromosomes from the mother and 23 chromosomes from the father.mother and 23 chromosomes from the father.
One or more chromosomes may be abnormal One or more chromosomes may be abnormal and may cause a congenital disease or a and may cause a congenital disease or a propensity toward acquiring a disease later in propensity toward acquiring a disease later in life.life.
Genetic vs. EnvironmentalGenetic vs. Environmental
Genes need an environment to work.Genes need an environment to work.
Environmental factors vary with everyone.Environmental factors vary with everyone.
Environment the same – People have Environment the same – People have different genetic characteristics.different genetic characteristics.
Very ComplexVery Complex
Genetic FactorsGenetic Factors
Heredity – Chromosomes Heredity – Chromosomes
Individual Genetic FactorsIndividual Genetic Factors
Entire Chromosmal abnormalitiesEntire Chromosmal abnormalities
Genetic FactorsGenetic Factors
EXAMPLESEXAMPLES
Down’s Syndrome – Rearranged Down’s Syndrome – Rearranged Chromosomes.Chromosomes.
Sickle Cell / Hemophilia – Single gene on Sickle Cell / Hemophilia – Single gene on chromosome passed on results in an chromosome passed on results in an abnormal protein.abnormal protein.
EXAMPLESEXAMPLES
Down’s Syndrome – Rearranged Down’s Syndrome – Rearranged Chromosomes.Chromosomes.
Sickle Cell / Hemophilia – Single gene on Sickle Cell / Hemophilia – Single gene on chromosome passed on results in an chromosome passed on results in an abnormal protein.abnormal protein.
Genetic FactorsGenetic Factors
PolygenicPolygenic
Determined by many genes Determined by many genes
multi- factionalmulti- factional
CADCAD
HTNHTN
CA CA
PolygenicPolygenic
Determined by many genes Determined by many genes
multi- factionalmulti- factional
CADCAD
HTNHTN
CA CA
Environmental FactorsEnvironmental FactorsEnvironmental FactorsEnvironmental Factors
Think Chronic Disease’sThink Chronic Disease’s
Microorganism & immunological exposureMicroorganism & immunological exposure
Personal HabitsPersonal Habits
Chemical SubstancesChemical Substances
Physical EnvironmentsPhysical Environments
Psychosocial EnvironmentsPsychosocial Environments
Environment & HeredityEnvironment & Heredity
More than one genetic defectMore than one genetic defect
CADCAD
HTNHTN
CA > 40 yoaCA > 40 yoa
AGE & GENDERAGE & GENDERCumulative EffectsCumulative Effects
Gender SpecificGender Specific
Breast CancerBreast Cancer
Testicular CancerTesticular Cancer
Ovarian CancerOvarian Cancer
Prostrate CancerProstrate Cancer
Gender SpecificGender Specific
Breast CancerBreast Cancer
Testicular CancerTesticular Cancer
Ovarian CancerOvarian Cancer
Prostrate CancerProstrate Cancer
AGE & GENDERAGE & GENDERCumulative EffectsCumulative EffectsAGE & GENDERAGE & GENDER
Cumulative EffectsCumulative Effects
ENVIRONMENTAL ENVIRONMENTAL
Cigarette SmokingCigarette Smoking
Lung CancerLung Cancer
CAD – MenCAD – Men
ENVIRONMENTAL ENVIRONMENTAL
Cigarette SmokingCigarette Smoking
Lung CancerLung Cancer
CAD – MenCAD – Men
COMBINED EFFECTSCOMBINED EFFECTS
Familial Disease TendenciesFamilial Disease Tendencies
Aging and Age related DisordersAging and Age related Disorders
Familial Disease TendenciesFamilial Disease Tendencies
Aging and Age related DisordersAging and Age related Disorders
LINES OF DEFENSELINES OF DEFENSE
CharacteristicsCharacteristics
Body’s Self-Defense MechanismsBody’s Self-Defense Mechanisms
Defense against illness and injuryDefense against illness and injury– First-line external barriers include:First-line external barriers include:
SkinSkin
Mucous membranes of the respiratory, digestive, Mucous membranes of the respiratory, digestive, and genitourinary (GU) tractand genitourinary (GU) tract
– Second—Inflammatory responseSecond—Inflammatory response– Third—Immune responseThird—Immune response
Stages of Inflammatory ResponseStages of Inflammatory Response
Cellular response to injuryCellular response to injury– Energy depletion, autolysisEnergy depletion, autolysis
Vascular response to injuryVascular response to injury– Hyperemia, vessel dilationHyperemia, vessel dilation– Leukocyte migrationLeukocyte migration
PhagocytosisPhagocytosis– Leukocytes destroy pathogensLeukocytes destroy pathogens– Exudate (pus) formsExudate (pus) forms
Cellular ResponseCellular ResponseMetabolicMetabolic
Decreased Energy Stores (Aerobic Respiration) Decreased Energy Stores (Aerobic Respiration)
Sodium/Potassium Pump impairedSodium/Potassium Pump impaired
Cell Swelling – AcidosisCell Swelling – Acidosis
Membranes LeakMembranes Leak
Cellular DestructionCellular Destruction
Inflammatory ResponseInflammatory Response
Vascular ResponseVascular Response
Dilation - arterial, venules, and capillaries.Dilation - arterial, venules, and capillaries.
Increase permeability (Interstitial = Increase permeability (Interstitial = Edema)Edema)
Leukocytes –Leukocytes – Attack injured TissueAttack injured Tissue
PhagocytosisPhagocytosis
Leukocytes – attack & DestroyLeukocytes – attack & DestroyMacrophages – Clean area of dead cellsMacrophages – Clean area of dead cellsOccurs at site of invasionOccurs at site of invasionGeneral Circulation – SystemicGeneral Circulation – SystemicLeukocytes – LysesLeukocytes – LysesPus Forms – (Exudate)Pus Forms – (Exudate)Pus= dead dying leukocytes, broken down Pus= dead dying leukocytes, broken down tissue cells,pathogens,and tissue fluid.tissue cells,pathogens,and tissue fluid.
MAST CELLSMAST CELLSConnective TissueConnective Tissue
CytoplasmCytoplasm Histamine/serotoninHistamine/serotonin
– AllergiesAllergies
– Vasoactive aminesVasoactive amines– Aminos Aminos – AllergiesAllergies
– Chemotactic FactorsChemotactic Factors– Random migrationRandom migration
– Stimulated migrationStimulated migration
– Attracts leukocytes Attracts leukocytes
MAST DEGRANULATIONMAST DEGRANULATION
Stimulated by physical Injury – Chemicals – Allergies IgEStimulated by physical Injury – Chemicals – Allergies IgE
Histamine – Capillary DilationHistamine – Capillary Dilation
Serotonin – Vasoconstriction or dilationSerotonin – Vasoconstriction or dilation
Chemotaxis – Attract White Blood CellsChemotaxis – Attract White Blood Cells
Neutrophils – Most PrevalentNeutrophils – Most Prevalent
Eosinphils – parasites - Worms Eosinphils – parasites - Worms
MAST CELL HELPMAST CELL HELP
Mast Cell Degradation and Synthesis
Inflammatory ResponseInflammatory ResponseLocalLocal
1.1. VascularVascular
2.2. Vasodilatation increased permeabilityVasodilatation increased permeability
3.3. Formation of pus (Exudate)Formation of pus (Exudate)
4.4. Local Signs - ???Local Signs - ???
5.5. Heat, Redness, swelling, pain and tenderness Heat, Redness, swelling, pain and tenderness
Inflammatory ResponseInflammatory ResponseSystemicSystemic
Fever ( Pyrogens)Fever ( Pyrogens)
LeukocytesLeukocytes
Increased Plasma ProteinsIncreased Plasma Proteins
Fever ( Pyrogens)Fever ( Pyrogens)
LeukocytesLeukocytes
Increased Plasma ProteinsIncreased Plasma Proteins
Inflammatory ResponseInflammatory ResponseInflammatory ResponseInflammatory Response
Acute inflammationAcute inflammation– Local responsesLocal responses– Systemic responsesSystemic responses
Chronic inflammationChronic inflammation– Inflammation Inflammation >> 2 wks 2 wks
Inflammatory ResponseInflammatory ResponseChronicChronicDefinedDefined
Lasting 2 weeks or longerLasting 2 weeks or longer
Results FromResults From Unsuccessful acute inflammationUnsuccessful acute inflammation
Persistent –Ongoing antigen or infectionPersistent –Ongoing antigen or infection
DefinedDefined
Lasting 2 weeks or longerLasting 2 weeks or longer
Results FromResults From Unsuccessful acute inflammationUnsuccessful acute inflammation
Persistent –Ongoing antigen or infectionPersistent –Ongoing antigen or infection
CHRONIC INFLAMMATIONCHRONIC INFLAMMATIONCharacteristicsCharacteristics
Persistent – Acute Inflammation Response
Neutrophil- Degranulation & Death
Lymphocyte Activation – Clean up
Fibroblast Activation - Healing
Infiltration (pus) – Clean up
Tissue Repair (Scar)
Types of ImmunityTypes of ImmunityTypes of ImmunityTypes of Immunity
Natural (native) Genetic or InnateNatural (native) Genetic or Innate– Present at BirthPresent at Birth
– No prior exposureNo prior exposure
AcquiredAcquiredHumoral immunityHumoral immunity
Cell-mediated immunityCell-mediated immunity
Acquired ImmunityAcquired Immunity
Active-Active- Immunizations or disease (Natural) Immunizations or disease (Natural)
Passive –Passive – Mother –Child or Antibody Mother –Child or Antibody
administration. administration.
Humoral vs. Cell ImmunityHumoral vs. Cell Immunity
Humoral – (Anti Body Mediated)Humoral – (Anti Body Mediated)
Lymphocyte B cellsLymphocyte B cells
Cell Mediated ( cellular immunity)Cell Mediated ( cellular immunity)
Lymphocyte T cellsLymphocyte T cells
Direct Attack – Best DefenseDirect Attack – Best Defense
AGE & IMMUNE AGE & IMMUNE RESPONSERESPONSE
INFANTSINFANTSAntibodies – Passive ImmunityAntibodies – Passive Immunity
Older we get the less immunities Older we get the less immunities we maintain.we maintain.
But Why? But Why?
Induction of Immune Response Induction of Immune Response TriggersTriggers
AntigenAntigen– Reacts with preformed components of Reacts with preformed components of
immune system immune system
ImmunogenImmunogen– Antigen that can also induce formation of Antigen that can also induce formation of
antibodiesantibodies
Induction of Immune ResponseInduction of Immune Response
To be immunogenic, the antigenic molecule To be immunogenic, the antigenic molecule must bemust be– Sufficiently foreign to the hostSufficiently foreign to the host– Sufficiently largeSufficiently large– Sufficiently complexSufficiently complex– Present in sufficient amountsPresent in sufficient amounts
B lymphocytes - AntibodiesB lymphocytes - Antibodies
T lymphocytes - KillersT lymphocytes - Killers
IMMUNE RESPONSEIMMUNE RESPONSE
Summary of the
Immune response
Immune Immune vs.vs. Inflammatory Inflammatory
ImmuneImmune InflammationInflammation
Develops slowlyDevelops slowly Develops swiftlyDevelops swiftly
Targets specific antigensTargets specific antigens Non-specificNon-specific
Long-lasting—has “memory”Long-lasting—has “memory” Temporary—days to weeksTemporary—days to weeks
Involves one type of white Involves one type of white blood cellblood cell
Involves many types of Involves many types of white blood cells and white blood cells and plateletsplatelets
One type of plasma protein—One type of plasma protein—antibodiesantibodies
Several plasma proteins—Several plasma proteins—complement, coagulation, complement, coagulation, kininkinin
Disease DeficienciesDisease Deficiencies
NutritionalNutritional
IatrogenicIatrogenic
TraumaTrauma
StressStress
Acquired Immunodeficiency (AIDS)Acquired Immunodeficiency (AIDS)
Immune - PrimaryImmune - Primary
Immunizations – ExposureImmunizations – Exposure
Activate B CellsActivate B Cells
Memory Cell Develops (B)Memory Cell Develops (B)
Secretion of AntibodiesSecretion of Antibodies
Pathogenic organism DEADPathogenic organism DEAD
Classes of Immunoglobulin'sClasses of Immunoglobulin's
IgM—produced first.IgM—produced first.
IgG—has “memory.”IgG—has “memory.”
IgA—involved in secretory immuneIgA—involved in secretory immune responses. responses.
IgE—involved in allergic reactions.IgE—involved in allergic reactions.
IgD—present in very lowIgD—present in very low concentrations. concentrations.
Immunoglobulin'sImmunoglobulin's
IgG (70 -75 %)IgG (70 -75 %)– Secondary immune Secondary immune
responseresponse
IgM (5-10 %)IgM (5-10 %)– ABO incompatibilitiesABO incompatibilities
IgA (15%) IgA (15%) – Defends body surface Defends body surface
against organismsagainst organisms
IgE IgE (less than 1%)(less than 1%)
– Immediate Immediate hypersensitivity hypersensitivity reactionsreactions
IgD IgD (less than 1%)(less than 1%)
Function unknownFunction unknown
HypersensitivityHypersensitivity
Altered immunologic reactivity to antigen Altered immunologic reactivity to antigen
Causes pathologic immune response after Causes pathologic immune response after reexposurereexposure
Abnormal responses include:Abnormal responses include:– AllergyAllergy– Autoimmunity – Host own cellsAutoimmunity – Host own cells– Isoimmunity – Beneficial foreign tissueIsoimmunity – Beneficial foreign tissue
Mechanisms of HypersensitivityMechanisms of Hypersensitivity
Immediate hypersensitivity reactionsImmediate hypersensitivity reactions– Itching, hivesItching, hives– AnaphylaxisAnaphylaxis
Delayed hypersensitivity reactionsDelayed hypersensitivity reactions– Take several hours to 1 to 2 days to appearTake several hours to 1 to 2 days to appear– At maximum several days after antigen At maximum several days after antigen
reexposure reexposure
IMMEDIATEIMMEDIATE
Antigen – Anti Body ReactionAntigen – Anti Body Reaction
– Mild- Itching HivesMild- Itching Hives
Severe – Life Threatening Severe – Life Threatening AnaphylaxisAnaphylaxis
DELAYEDDELAYED
Cell Immunity Hypersensitivity Cell Immunity Hypersensitivity
Hours – DaysHours – Days
Maximum Severity days laterMaximum Severity days later
Poison Ivy – Skin GraftsPoison Ivy – Skin Grafts
HomeostasisHomeostasis
QUAN QUAN QUAN QUAN
Stress & DiseaseStress & Disease
Think SympatheticThink SympatheticAdrenal GlandAdrenal Gland– Epi, Norepi, DopamineEpi, Norepi, Dopamine
Alpha & Beta EffectsAlpha & Beta Effects
Stress & DiseaseStress & Disease
Hypothalamus – pituitary glandHypothalamus – pituitary glandGrowthGrowth Blood pressureBlood pressure Some aspects of Some aspects of pregnancypregnancy and and childbirthchildbirth including including stimulation of uterine contractions during childbirth stimulation of uterine contractions during childbirth Breast milkBreast milk production production Sex organSex organ functions in both women and men functions in both women and men Thyroid glandThyroid gland function function The conversion of food into The conversion of food into energyenergy ( (metabolismmetabolism) ) WaterWater and and osmolarityosmolarity regulation in the body regulation in the body
Stress & DiseaseStress & Disease
CortisolCortisolSecreted by the adrenal glands and involved Secreted by the adrenal glands and involved
in the following functions and more: in the following functions and more:
Proper glucose metabolism Proper glucose metabolism – Regulation of blood pressure Regulation of blood pressure
– Insulin release for blood sugar maintenance Insulin release for blood sugar maintenance
Immune function Immune function
Inflammatory response Inflammatory response
Cortisol (Hydrocortisone)Cortisol (Hydrocortisone)
Circulates in the plasmaCirculates in the plasma
Mobilizes substances needed for cellular metabolismMobilizes substances needed for cellular metabolism
Stimulates gluconeogenesisStimulates gluconeogenesis– Decreases glucose utilizationDecreases glucose utilization
ImmunosuppressantImmunosuppressant
Decreases migration of macrophages Decreases migration of macrophages – Decreases phagocytosisDecreases phagocytosis
CatecholaminesCatecholamines
Stimulate:Stimulate:– Alpha-adrenergic receptorsAlpha-adrenergic receptors
Alpha-1 and alpha-2 Alpha-1 and alpha-2
– Beta-adrenergic receptorsBeta-adrenergic receptorsBeta-1 and beta-2Beta-1 and beta-2
Alpha ReceptorsAlpha Receptors
Alpha-1 receptorsAlpha-1 receptors– PostsynapticPostsynaptic– On the effector organsOn the effector organs– Stimulate contraction of smooth muscleStimulate contraction of smooth muscle
Alpha-2 receptorsAlpha-2 receptors– Presynaptic nerve endingsPresynaptic nerve endings– Stimulate alpha-2 receptors Stimulate alpha-2 receptors – Inhibit release of norepinephrine Inhibit release of norepinephrine
Beta ReceptorsBeta Receptors
Beta-1 receptorsBeta-1 receptors– Primarily in heartPrimarily in heart
Beta-2 receptorsBeta-2 receptors– Bronchiolar and Bronchiolar and
arterial smooth musclearterial smooth muscle
Beta receptorsBeta receptors– Stimulate the heartStimulate the heart– Dilate bronchiolesDilate bronchioles– Dilate blood vessels in Dilate blood vessels in
the skeletal muscle, the skeletal muscle, brain, and heartbrain, and heart
– Aid in glycogenolysisAid in glycogenolysis
STRESSSTRESS
NatureNature
IntensityIntensity
DurationDuration
PerceptionPerception
Coping SkillsCoping Skills
STRESSSTRESSSTRESSSTRESS
Stress: The confusion created when one's mind overrideStress: The confusion created when one's mind overrides the body's basic desire to choke the living daylights outs the body's basic desire to choke the living daylights out of some jerk who desperately deserves it of some jerk who desperately deserves it” ”
““Stress is when you wake up screaming and Stress is when you wake up screaming and you realize you haven't fallen asleep yet”you realize you haven't fallen asleep yet”
The Stress Response:The Stress Response:
Effects on the Sympathetic Nervous, Endocrine, Effects on the Sympathetic Nervous, Endocrine, and Immune Systems.and Immune Systems.
Effects on the Sympathetic Nervous, Endocrine, Effects on the Sympathetic Nervous, Endocrine, and Immune Systems.and Immune Systems.
QUESTIONSQUESTIONS QUESTIONSQUESTIONS