HD exam 5
parasites (protozoa, helminths, and arthropods)
members of the animal kingdom that infect or colonize other animals, which then transmit them to humans
hypoxemia dyspnea tachypnea cyanosis
restrictive lung disorders reduce the diffusing capacity of the lung, producing ...
pleural pain
results fro somatic pain fibers that innervate the parietal pleura; unilateral and abrupt in onset made worse by chest movements such as deep breathing and coughing
GERD
weak or incompetent lower esophageal sphincter that allows refuels to occur, the irritant effects of the reflux ate and decreased clearance of refluxed acid from the esophagus (heart burn and mucosal injury)
graft versus host disease
when immunologically competent cells or precursors are transplanted into recipients who are immunologically compromised; T cells recognize foreign cells; CD4 and CD8 cells generate type IV cell mediated reactions
embryonic pseudo glandular canalicular saccular alveolar
0-6 weeks 6-16 weeks 16-26 weeks 24 weeks -birth 32 weeks - 8 years old
They think it started in the 1920 in the kongo region they think its a SIV virus that originated in the primate species. It was mutated and then transmitted to humans. 1982 It was highly seen among the 4 h's: hemophiliacs, homosexuals, heroin users, and patients. 1984 HIV virus causes AIDS 1985 It was the peak leading cause of death 2004 mortality rates have declined due to drug therapy
Briefly trace the history of the AIDS epidemic.
Inflammatory Diarrhea: Characterized by the presence of fever, abdominal pain, and smaller amounts blood diarrhea. It is caused by bacterial invasion of the intestinal cells or toxins associated with C. Diff or E. coli infection. Non-inflammatory Diarrhea: Characterized by large amounts of watery diarrhea and non-bloody stools, periumbilical cramps, bloating, and N/V. It is commonly caused by toxin-producing bacteria (e. Coli, s. aureus) or other agents that disrupt the normal absorption or secretory process in the small bowel.
Compare the causes and manifestations of inflammatory and noninflammatory diarrhea
Crohn's Disease is a recurrent inflammatory response that can affect any area of the GI tract. Ulcerative Colitis is a nonspecific inflammatory condition of the colon only.
Compare the characteristic of Crohn disease and ulcerative colitis
emphysema and chronic obstructive bronchitis
COPD encompasses 2 diseases:
Early phase: Usually 10-20 minutes after exposure and are caused by the release of chemical mediators from presensitized IgE-coated mast cells. Reactions occur when antigens bind to the sensitized mast cells. Bronchospasms are present, caused by stimulation of the parasympathetic receptors, mucosal edema caused by increased vascular permeability, and increased mucus secretions.This phase can usually b inhibited by bronchodilators but not corticosteroids. Late phase: Develops 4-8 hours after exposure, involves inflammation and increased airway responsiveness that prolong the asthma attack and set into motion a vicious cycle of exacerbations. Maximum is reached within a few hours and may persist for 12-24 hours or longer. The initial trigger in the late phase response causes the release of inflammatory mediators from mast cells, macrophages and epithelial cells. These substances then produce epithelial injury and edema, changes in mucociliary function, reduced clearance of respiratory tract secretions, and increased airway responsiveness.
Characterize the early-phase and late-phase responses in the pathogenesis of bronchial asthma
The liver takes the unconjugated bilirubin and absorbs it and turns it into conjugated bilirubin which is secreted as a constituent of bile. About ½ of the bilirubin is converted into urobilinogen in the intestine. It is then reabsorbed into hepatic circulation or excreted in feces. Unconjugated hyperbilirubinemia is caused by preventing the absorption of bilirubin Conjugated hyperbilirubinemia is caused by a blockage of bile from entering the intestines. Unconjugated is caused before entering the liver, and conjugated is after the liver.
Characterize the function of the liver in terms of bilirubin elimination and describe the difference between unconjugated and conjugated hyperbilirubinemia
Cirrhosis is the replacement of hepatocytes with fibrous tissue. Cells become surrounded by fibrous tissue(nodules) which limits the flow of material like bile and blood within the liver.
Characterize the liver changes that occur with cirrhosis
Helicobacter pylori produces enzymes and toxins that have the capacity to interfere with the local protection of the gastric mucosa against acid and produce a continuous inflammatory response. Noninvasive testing for the presence of H. pylori includes the urea breath test or fecal antigen test. Blood tests to obtain serologic titers of H. pylori antibodies can also be done.
Characterize the proposed role of Helicobacter pylori in the development of chronic gastritis and peptic ulcer and cite the methods for diagnosis the infection
They have a failure to thrive, CNS abnormalities and developmental delays. Children born infected generally weigh less, and are shorter than non-infected infants. They are at great risk of infection and P. jiroveci is a major cause of early mortality around 3-6 months of age.
Cite problems with diagnosis of HIV infection in the infant.
Age over 65, Cigarette smoking, chronic bronchitis, exposure to asbestos and dusts containing arsenic, chromium, nickel, and vinyl chloride
Cite risk factors associated with lung cancer
In persons with Zollinger- Ellison's syndrome, gastric acid secretion reaches such levels that ulceration becomes inevitable. The increased gastric secretions cause symptoms related to peptic ulcer. People at high risk for developing stress ulcer includes individuals with large surface area burns, trauma, sepsis, acute respiratory distress syndrome, severe liver failure, and major surgical procedures. They are thought to result from ischemia, tissue acidosis, and bile salts entering the stomach in a critically ill patient with decreased gastrointestinal tract motility.
Cite the etiologic in ulcer formation related to Zollinger-Ellison syndrome and stress ulcer
Atopic Asthma: Is typically initiated by a type I hypersensitivity reaction induced by exposure to an extrinsic antigen or allergen. It usually has an onset in childhood or adolescence and is seen in persons with a family history of atopic allergy. Nonatopic Asthma:Occurs without an allergic component triggers include respiratory tract infections, exercise, hyperventilation, cold air, drugs, and chemicals, hormonal changes and emotional upset, airborne pollutants and GERD.
Compare and contrast extrinsic (atopic) asthma and intrinsic (non atopic) asthma
B Cell: Defect in humoral immunity, increasing the risk of recurrent pyogenic infections, and affected antibody production. A well-defined series of differentiation steps ultimately leads to the production of immunoglobulins. T Cell: Consists of distinct subpopulations with diverse immunologic assignments. Have infections or other clinical problems that are more severe. responsible for coordinating the overall immune response.
Compare and contrast immunodeficiency disorders caused by B-cells and T-cells disorders.
The liver converts drugs into lipid soluble molecules through oxidation, reduction hydroxylation. Then it has to convert those to water soluble molecules. Some of these drugs can cause hepatotoxicity and damage liver cells. Alcohol causes fatty liver disease, which is the accumulation of fat in hepatocytes. This is reversible with the discontinuation of alcohol consumption. With extended alcohol consumption damage to hepatocytes results and the liver can become inflamed leading to cirrhosis.
Compare the metabolism of drugs and alcohol by the liver and state metabolic mechanisms that can be used to explain liver injury
Obligate intracellular organisms are unable to live outside of the host cells and cannot be grown outside of a host like in a lab setting. Extracellular organisms don't usually enter the cells, but they can adhere to the cell and secrete toxins, causing disease.
Compare the obligate intracellular organism with extracellular organisms.
Chronic Hepatitis is a chronic inflammatory reaction to the liver. Viral can be treated. Autoimmune is genetic and environmental with no treatment except liver transplant.
Define chronic hepatitis and compare the pathogenesis of chronic autoimmune hepatitis and chronic viral hepatitis
Paraneoplastic: incompletely understood patterns of organ dysfunction related to immune-mediated or secretory effects neoplasia. 1. Hypercalcemia from secretion of parathyroid-like peptide 2. Cushing syndrome from ACTH secretion 3. Neuromuscular syndromes
Define the term paraneoplastic and cite 3 paraneoplastic manifestations of lung cancer
Host: An organism capable of supporting the nutritional and physical growth requirement of a microorganism. Infectious disease: When the host sustains injury or damage from a parasitic infection Colonization: The act of establishing a presence in a host Microflora: Harmless bacteria to the internal and external exposed surfaces Virulence: The disease producing potential of a microorganism Pathogen: Microorganisms that are extremely virulent and most commonly associated with disease Saprophyte: A fungus living on dead or decaying organic matter
Define the terms of host, infectious disease, colonization, microflora, virulence, pathogen, and saprophyte.
It is an immune-mediated disorder triggered by ingestion of gluten-containing grains. It results from the inappropriate T-cell mediated immune response against the gliadin fraction of the gluten. Manifestations: Diarrhea, abdominal distention, anemia, constipation, osteoporosis Diagnosis: Clinical manifestations, and serologic tests, and intestinal biopsy
Describe celiac disease in regard to etiology, pathophysiology, manifestations, and diagnosis
A classification system that emphasized the clinical importance of the CD4+ T-cell count along with a list of AIDS-defining conditions. The revision highlights the central importance of the CD4+ T-cell count and percentages, which are objective measures of immunosuppression routinely used in the care of HIV infected persons. It distinguishes three stages of HIV infection based on CD4+ T-cell counts and T-cell percentages: stage one >500 cells/uL (29%); stage two 200-499 cells/uL (14-28%); stage three <200 cells/uL (<14%)
Describe the CDC HIV/AIDS classification system.
Acute: May last from 5-7 days, or up to 4 weeks depending on the type: viral, bacterial, or viral-bacterial. Symptoms include facial pain, headache, nasal discharge, decreased sense of smell, fever, pain on bending, unilateral maxillary pain, and tooth pain. Chronic: The pathogens causing these are usually a mixture of aerobic and anaerobic bacteria like: Staphylococcus aureus, coagulase-negative Staphylococcus, and anaerobic gram-negative bacilli. Allergies, mucociliary dysfunction, mucostasis, hypoxia, and release of microbial products are thought to contribute to getting the chronic type. Symptoms include nasal obstruction, a sense of fullness in the ears, post nasal drip, hoarseness, chronic cough, headache, and loss of taste and smell.
Describe the causes and manifestation of acute and chronic rhinosinusitis
One factor is that the peritoneum is large Second: It's large surface also permits rapid absorption of bacterial toxins into the blood. It is well adapted for production an inflammatory response as a means of controlling infection. I tal is able to seal off sections by exuding a thick sticky fibrinous substance and omentum to seal off perforations to localize the process
Describe the characteristics of peritoneum that increase its vulnerability to and protect it against the effects of peritonitis.
Infectious enterocolitis can be caused by a number of bacteria through ingestion of preformed toxins that are present in contaminated food, infection by toxigenic organisms that proliferate in the gut lumen and produce an enterotoxin, and infection by enteroinvasive organisms that proliferate in the lumen and invade and destroy mucosal epithelial cells. It can also be caused by viral infections, especially the norovirus and enteric adenoviruses.
Describe the common causes of infectious enterocolitis
Someone infected with an exotic disease anywhere in the world can be into major city within hours causing widespread infection. Foods from other countries are imported into the United States routinely. Vectors hitchhiking on imported products.
Describe the effect of international travel on the spread of infection.
Step 1: Viral genome and reverse transcriptase enter the cell Step 2: DNA copy synthesized by reverse transcriptase , this is the site of action of AZT and other reverse transcriptase inhibitors. Step 3: RNA degraded; second DNA strand synthesized Step 4: DNA circularize or integrase functions to incorporate DNA into host cell genome, this is the site of action of antiretroviral drugs under development Step 5: With host cell activation, viral DNA is transcribed, yielding messenger RNAs and viral genome RNA Step 6: Viral RNAs are translated, yielding viral enzymes and structural proteins, this is the site of action of protease inhibitor. Step 7: Viral membrane proteins are transported to host cell membrane Step 8: Final viral assembly and budding takes place
Describe the eight steps of HIV replication.
Stomach lining is impermeable Secretion of hydrogen and bicarbonate ions
Describe the factors that contribute to the gastricmucosal barrier.
stores excess glucose as glycogen and releases it into circulation when blood glucose falls. synthesizes glucose from amino acids, glycerol, and lactic acid during fasting or need, converts excess carb to triglycerides for fat storage Carbs → Stores glycogen and synthesizes glucose from amino acids, lactic acid, and glycerol Lipids → Forms lipoproteins; converts carbs and proteins to fat; synthesis, recycling, and elimination of cholesterol; formation of ketones from fatty acid Proteins → Deamination of proteins; formation of urea from ammonia synthesis of plasma proteins
Describe the function of the liver in terms of carbohydrates, protein, and lipid metabolism
Type I: (IgE cells) Reactions like hay fever, food allergies, bronchial asthma and anaphylaxis. Allergy to proteins, foods, plant pollens, insects products, drugs and mold spores, animal hair and dander and Latex. Vasodilation and low blood pressure can occur within minutes Type II: (IgM and IgG cells) Transfusion reactions, hemolytic disease of newborn, goodpasture syndrome, pemphigus, drug induced hemolytic anemia, and certain types of glomerulonephritis Reactions: that's when the immune complexes are lodged in the vessel walls. The injury that is caused by the anti-tissue antibody. Type III: (Immune complex) Infectious diseases that could cause autoimmune infections like strep, some types of meningitis, hepatitis, mononucleosis, and malaria. Type IV: (T cells) When you have contact sensitivity to chemicals/poison ivy, tissue injury to microbes Contact Dermatitis: When there are activated T cells, after 48-72 hours it can lead to Eczema, lymphocytes and macrophages
Describe the immune mechanisms involved in a type I, type II, type III and type IV hypersensitivity reactions.
Heredity, alterations in the immune response and environmental agents can all lead to bronchial asthma. Atopic asthma is seen in persons with a family history of atopic allergy. It is a hypersensitivity type I reaction induced by exposure to an antigen or allergen. Whereas nonatopic asthma is induced by environmental agents.
Describe the interaction between heredity,alterations in the immune response and environmental agents in the pathogenesis of bronchial asthma
Manifestations vary depending on the type of cancer. Can include anorexia, weight loss, metastases of the brain, bone, and liver, chronic cough, shortness of breath, wheezing, hemoptysis, dull intermittent poorly localized retrosternal pain, hoarseness, superior vena cava syndromes. Symptoms include hoarseness, difficulty in swallowing because of compression of the esophagus.
Describe the manifestations of lung cancer and list two symptoms of lung cancer that are related to the invasion of mediastinum
Transferred through the exchange of blood or body fluids that contain the virus. Typically through sexual contact, blood contaminated objects, needles, syringes, and the passage of mother to newborn.
Describe the mechanism of HIV transmission and relate them to the need for public awareness and concern regarding the spread of AIDS.
Allergic Rhinitis: An allergic response causing itchy, watery eyes, sneezing, and other similar symptoms. Food allergy: An unpleasant or dangerous immune system reaction after a certain food is eaten. Serum Sickness: Reaction that is similar to an allergy. The immune system reacts to medicines that contain proteins used to treat immune conditions. Or it can react to antiserum, the liquid part of blood that contains antibodies given to a person to help protect them against germs or poisonous substances. Arthus Reaction: Are rarely reported after vaccination and can occur after tetanus toxoid-containing or diphtheria toxoid-containing vaccines. An Arthus reaction is a local vasculitis associated with deposition of immune complexes and activation of complement. Contact Dermatitis: A skin rash caused by contact with a certain substance.The substance might irritate the skin or trigger an allergic reaction. Some common culprits include soap, cosmetics, fragrances, jewelry, and poison ivy. Hypersensitivity pneumonitis: is an inflammation of the alveoli within the lung caused by hypersensitivity to inhaled organic dusts. Sufferers are commonly exposed to the dust by their occupation or hobbies.
Describe the pathogenesis of allergic rhinitis, food allergy, serum sickness, Arthus reaction, contact dermatitis, and hypersensitivity pneumonitis.
Obstructive airway disorders due to bronchial smooth muscle hyperactivity or changes in bronchial wall structure, injury to the mucosal lining of the airways, or excess respiratory tract secretions are characterized by limitation in movement of atmospheric air into and out of the gas exchange portion of the lung
Describe the physiology of bronchial smooth muscle as it relates to airway disease
Risk factors include, infection with the bacteria H. pylori and the use of aspirin or other NSAIDS. Three complications include: hemorrhage, perforation, and gastric outlet obstruction
Describe the predisposing factors in the development of peptic ulcer and cite the three complications of peptic ulcer
The pain is caused by stretching of the appendix during the early inflammatory process. There may also be accompanying bouts of nausea or vomiting. When the inflammatory process has extended to involve the serosal layer of the appendix and the peritoneum, the pain becomes localized to the lower right quadrant. Fever or temperature elevation may be present and can be related to the immune response of the body.
Describe the rationale for the symptoms associated with appendicitis
Prions: Are protein particles with no genome. Replication methods are unclear but the prion is thought to bind to the normal host protein. They spread within the axons of the nerve cells and cause progressive damage of nerve cells. Viruses: Are the smallest pathogen that has no cellular structure. Has either DNA or RNA, never both. It cannot replicate outside living cells. It invades the host and causes the host to replicate. Bacteria: A unicellular prokaryote that lacks an organized nucleus, they are small and strictly structures. It contains both RNA and DNA and are extremely adaptable. Most reproduce asexually by simple cellular division. Rickettsiaceae: An intracellular pathogen containing DNA with no defined nucleus. It depends on the host for vital nutrients. They infect arthropods which do not produce the disease until transmitted to humans. Anaplasmataceae: The target host are the leukocytes and multiply in the cytoplasm. They do not have a defined life cycle and do not need the host for energy requirements. Chlamydiaceae: Is transmitted between vertebrae without an arthropod. They have a defined life cycle and when they become infectious they transform into a larger body. They multiply in the leukocytic cytoplasm. Structurally similar to rickettsiaceae but slightly smaller. Coxiella: Contains only 1 species. It is a gram-negative intracellular organism. It is a gram-negative organism that produces a highly resistant spore-like stage when in contact with humans.h Fungi: Are free living, eukaryotic saprophytes living everywhere. Some are microflora but others are capable of causing disease. Most are incidental and self-limited. Serious infections are rare.The two types are yeast and mold. Uses both sexual and asexual reproduction. Parasites: Members of the animal kingdom. Majority of them are single cells. An IDA pathogen that benefits from the host. Can reproduce sexually or asexually depending on species.
Describe the structural characteristics and mechanism of reproduction for prions, viruses, and bacteria, Rickettsiaceae, Anaplasmataceae, Chlamydiaceae, Coxiella, fungi, and parasites.
Malabsorption is characterized by defective absorption of fats, carbs, proteins, vitamins, minerals and water from the intestine. Symptoms may include: diarrhea, dehydration, weight loss, cramps, edema, flatulence, abdominal discomfort, loss of muscle mass, tetany, iron-def. Anemia, dry eyes, easy bruising.
Describe the symptoms that may indicate malabsorption syndrome.
Children are the main source of infection often acquiring a new strain from others in daycare or school. Fingers are the greatest source of spread and the nasal mucosa and conjunctival surface are the most common portals of entry. The first 3 days after the onset of symptoms are the most contagious. Washing hands is the best way to prevent.
Describe the transmission of the common cold from one person to another
Breakdown of T-Cell Anergy: Infections of particular tissues may induce local innate immune responses that attract leukocytes into the tissue and result in the activation of antigen-presenting cells. Molecular Mimicry: A microbe shares an immunologic epitaph with the host. Classic case of mistaken identity, causing inflammation of the heart or kidney Superantigens: A family of related substances, the can short-circuit the normal sequence of events in an immune response, leading to inappropriate activation of CD4 helper t cells.
Describe three or more postulated mechanisms for underlying autoimmune disease.
Community-acquired pneumonia: An infection that begins outside the hospital or is diagnosed within 48 hours after admission to the hospital in a person who has not resided in a long term care facility for more than 14 days or more before admission. Can be viral or bacterial with S. pneumoniae being the most common cause. Hospital-acquired pneumonia: Lower respiratory tract infection that was not present upon admission. Most are bacterial. Gram negative rods and S. aureus are the most common isolates. Pneumonia in immunocompromised: Can be caused by bacteria, viruses, fungi, myobacterial, and protozoa. People undergoing chemotherapy are predisposed to infections caused by S. aureus, Aspergillus, gram negative bacilli, and Candida.
Differentiate among the community-acquired pneumonia, hospital-acquired pneumonia, and pneumonia in immunocompromised persons in terms of pathogens, manifestations, and prognosis
Mechanical obstruction occurs from a number of conditions that encroach on the patency of the bowel lumen like hernia and postoperative adhesions, tumors, and foreign bodies. Paralytic obstruction occurs from a neurogenic or muscular impairment of peristalsis. Occurs from abdominal surgery or intestinal ischemia, pelvic fractures and back injuries.
Differentiate between mechanical and paralytic intestinal obstruction in terms of cause and manifestations
Primary: Typically is initiated as a result of inhaling droplet nuclei that contain the TB bacillus. Most people are asymptomatic and go on to develop latent TB infection. The disease is not active in latent and cannot be transmitted to others. Reactivated: Either reinfection from inhaled droplet nuclei or reactivation of a previously healed primary lesion. Often occurs in situations of impaired body defense mechanisms. Hypersensitivity and cavities may occur in the lungs. Pleuritic pain, low grade fevers, night sweats, easy fatigability, anorexia, and weight loss can occur. Nonproductive cough turns productive and dyspnea/orthopnea develops.
Differentiate between primary tuberculosis and reactivated tuberculosis on the basis of pathophysiology
Small cell lung cancer: Small round to oval cells about the size of a lymphocyte. Cells grow in clusters that exhibit neither glandular or squamous organization. It is highly malignant, tends to infiltrate widely, disseminate early and is rarely resectable. Non-small cell lung cancer: Include squamous cell carcinomas, adenocarcinomas, and large cell carcinomas. --> Squamous cell carcinoma is most common in men, usually originates in the central bronchi as an intraluminal growth and is more amenable to early detection through cytologic examination of the sputum, it also tends to spread centrally into major bronchi and lymph nodes. --> Adenocarcinoma is the most common type of cancer in women and nonsmokers. It is a malignant epithelial cell tumor with glandular differentiation or mucin production by the tumor cells. Adenocarcinomas have a poorer stage for stage prognosis than squamous cell carcinomas. --> Large cell carcinomas have large, polygonal cells. They are highly anaplastic and tend to occur in the periphery of the lung.
Differentiate between small cell lung cancer and non-small cell lung cancer in terms of histopathology and prognosis
Gastritis refers to inflammation of the gastric mucosa. Acute Gastritis: Causes: Local irritants such as bacterial endotoxins, caffeine, alcohol, and aspirin; corticosteroid drugs, serious illness or trauma, uremia, treatment with cancer chemotherapy drugs and gastric radiation. Manifestations: Persons can be totally unaware they have this, or may only complain of sour stomach or heartburn. In more severe cases, it causes vomiting, bleeding, hematemesis, and gastric distress. Chronic Gastritis: Causes: H. pylori, antibodies, or chronic injury from reflux of alkaline duodenal contents, pancreatic secretions, and bile into the stomach. Manifestations: atrophy of glandular epithelium, nausea, abdominal pain, chronic mucosal inflammation; may be related to anemia and vit. B12 deficiency: atrophic glossitis, tongue becomes smooth and beefy red, malabsorptive diarrhea, neuropathies.
Differentiate between the causes and manifestations of acute and chronic gastritis
Measuring the CD4+ T-cell count as well as following conditions that are known to be associated with AIDS
Discuss methods of diagnosis of HIV infections.
Respiratory infections- These include bacterial pneumonia, Pneumocystis jiroveci pneumonia, and pulmonary tuberculosis. GI infections- most frequent complications of HIV infection and AIDS. In people with HIV, esophageal candidiasis, CMV infection, and herpes simplex virus infection commonly cause esophagitis. Aphthous ulcers, diarrhea, and gastroenteritis are common in people with HIV as well. Nervous system infections- These include neurocognitive disorders, toxoplasmosis, and progressive multifocal leukoencephalopathy.
Discuss respiratory tract infection, gastrointestinal infections, and nervous system infections and their connection to the term opportunistic infections.
The recovery of a probable pathogen or evidence of its presence from the infected sites of a diseased host and accurate documentation of clinical signs and symptoms compatible with an infectious process.
Discuss two criteria used in the diagnosis of an infectious disease.
If the mother is infected with HIV, the child can get it in utero, during the birth process, or from breastfeeding
Discuss vertical transmission of HIV infection from mother to child.
Virulence factors are substances or products generated by infectious agents that enhance their ability to cause disease. They include: toxins (endotoxins & exotoxins), adhesion factors, evasive factors, and invasive factors. --> Toxins: Are substances that alter or destroy the normal function of the host or host's cells. Bacterial toxins can be divided into two main types: endotoxins and exotoxins. * Endotoxins are lipopolysaccharides (LPS) found in the cell wall of gram-negative bacteria. At high levels, LPS can precipitate septic shock, disseminated intravascular coagulation, and acute respiratory distress syndrome. * Exotoxins are proteins released from the bacterial cell during growth. Bacterial exotoxins enzymatically inactive or modify key aspects of host cell structure or function, leading to cell death or dysfunction. --> Adhesion factors: No interaction between microorganisms and humans can progress to infection or disease if the the pathogen cannot attach to and colonize the host. After the initial attachment, some bacterial agents become embedded in a gelatinous matrix called a slime layer. The slime layer serves two purposes: it anchors the agent firmly to the host tissue surfaces and it protects the agent from the immunological defenses of the host. --> Evasion factors: A number of factors produced by microorganisms enhance virulence by evading various components of the host's immune system. Extracellular polysaccharides discourage engulfment and killing of pathogens by the host's phagocytic white blood cells. Some pathogens avoid phagocytosis by excreting leukocidin C toxins, which cause specific and lethal damage to the cell membrane of host neutrophils and macrophages. Other pathogens are adapted to survive and reproduce within phagocytic WBC's after ingestion, avoiding or neutralizing the usually lethal products contained within the lysosomes of the cell. Other unique strategies used by pathogenic microbes to evade immunologic surveillance have evolved solely to avoid recognition by host antibodies. Strains of S. Aureus produce a surface protein that immobilized immunoglobulin G, holding the antigen-binding region harmlessly away from the organisms. This pathogen also secretes a unique enzyme called catalase, which converts soluble human coagulation factors into a solid clot, which envelops and protects the organism from phagocytic host cells and antibodies. --> Invasion factors: Infectious agents also produce invasive factors that facilitate the penetration of anatomic barriers and host tissues. Most invasive factors are enzymes capable of destroying cell membranes, connective tissue, intercellular matrices, and structural protein complexes.
Discuss virulence factors and their mechanisms for enhancing their ability to cause disease.
Forced expiratory volume in 1 second; measures the volume of air expired in the first second of FVC- forced vital capacity (max amount of air that can be exhaled forcefully after lung inspiration) Residual volume volume of air remaining in the lungs after max expiration Total Lung Capacity total amount of air the lungs can hold.
Explain the changes in pulmonary function studies that occur with airway disease
Culture refers to the propagation of a microorganism outside of the body, usually on or in artificial growth media. Culture is placed in a controlled environment until the growth of organisms becomes detectable. Appearance, gram stain reaction, texture, shape, and color are taken into consideration. Serology is an indirect means of identifying infectious agents by measuring serum antibodies in the diseased host. DNA and RNA sequencing can use a portion of the genetic code to determine the contents leading to diagnosis.
Explain the differences between culture, serology, and DNA/RNA sequencing as methods for diagnosis of infectious disease.
Chronic Bronchitis: Represents airway obstruction of the major and small airways. Most common in middle-aged men and is associated with chronic irritation from smoking/recurrent infection. History of chronic persistent cough for 3 consecutive months in at least 2 years. Earliest feature is hypersecretion of mucus in the large airways associated with hypertrophy of submucosal glands in trachea/bronchi. Increase in goblet cells and excess mucus production with plugging of the airway lumen, inflammatory infiltration, and fibrosis of bronchial wall. Symptoms: blue bloaters→ cyanosis and fluid retention r/t right sided heart failure. Emphysema: Loss of lung elasticity and abnormal enlargement of the air spaces distal to the terminal bronchioles, with destruction of the alveolar wall and capillary beds. Enlargement of the air spaces leads to hyperinflation of the lungs and produces an increase in TLC. Caused by smoking, inherited deficiency of antiprotease enzyme and genetic factors. Thought to result from breakdown of elastin and other alveolar wall components by enzymes. Two types: centriacinar or centrilobular and panacinar. Symptoms: pink puffers→ lack of cyanosis, use of accessory muscles, and pursed lip breathing, barrel chest.
Explain the distinction between chronic bronchitis and emphysema in terms of pathology and clinical manifestations.
The cerebral cortex normally controls the defecation reflex so that defecation can occur at acceptable times and places. Voluntary control inhibits the external anal sphincter to allow defecation or contracts the sphincter to prevent defecation. When the external sphincter remains contracted, the defecation reflex dissipates, and the urge to defecate usually does not recur until additional stool enters the rectum or several hours later. In people who often inhibit the defecation reflex or fail to respond to the urge to defecate, constipation develops as the reflex weakens.
Explain why a failure to respond to the defecation urge may result in constipation
Serum enzyme Alanine Aminotransferase (ALT) Aspartate Aminotransferase (AST) --You should see a rise in ALT and AST in the event of hepatocellular injury as in viral hepatitis, autoimmune hepatitis, hypoxic or ischemic injury, acute toxic injury, or Reye syndrome - Albumin-measures the liver's synthetic capacity. - Alkaline phosphatase- released when there are disorders affecting the bile duct - serum bilirubin- measures liver excretory function
List 4 laboratory tests used to assess liver function and relate them to impaired liver function
Risk factors : Low socioeconomics, male, genetic predisposition, carcinogenic factors in diet like in smoking and preserved foods, and chronic gastritis.
List risk factors associated with gastric cancer
Anthrax (Bacillus anthracis) Botulism (Clostridium botulinum toxin) Plague (Yersinia pestis) Smallpox (variola major) Tularemia (Francisella tularensis) Viral hemorrhagic fevers, including Filoviruses (Ebola, Marburg) and Arenaviruses (Lassa, Machupo)
List the infectious agents considered to be in the highest level of bioterrorism threat.
Risk factors for colorectal cancer include family history, crohn's or ulcerative colitis, high fat/sugar and low fiber diets, and increased age. Screening: digital rectal exams, fecal occult blood, x-rays using barium, sigmoidoscopy, and colonoscopy.
List the risk factors associated with colorectal cancer and cite the screening methods for detection
croup
Mainly parainfluenza viruses 3 months to 5 years Usually follow symptoms of a cold Stridor and a wet, barking cough Usually occurs at night Relieved by exposure to cold or moist air Mist tent or vaporizer and administration of oxygen
bronchiolitis
Respiratory syncytial virus <2 years Preceded by stuffy nose and other signs Breathlessness, rapid shallow breathing, wheezing, cough, retraction of lower ribs and sternum during inspiration Supportive treatment, administration of oxygen and hydration
Symptoms include an abrupt onset of fever and chills, malaise, muscle aching, headache, weakness, profuse and watery nasal discharge, nonproductive cough, and sore throat. Influenza is very contagious and the effectiveness of a flu shot is based on the age and immunocompetence of the recipient and the match between virus strains and those circulating during flu season.
Relate the characteristics of the influenza virus to its contagious properties and the need for a yearly "flu shot"
Bile is formed in the liver, it then moves to the gallbladder and enters into the small intestine. If there is a blockage of flow the bile collects. It leads to an accumulation of bilirubin, cholesterol, and bile acids in the blood. Which is cholestasis- the condition of impaired bile formation and bile flow.
Relate the mechanism of bile formation and elimination to the development of cholestasis
Tolerance refers to the specific immunological non-reactivity to an antigen resulting from a previous exposure to the same antigen. The most important form of tolerance is non-reactivity to self antigens, it is possible to induce tolerance to non-self antigens. Disruption of self tolerance: Maintained through central bone marrow and thymus. We detect the cells that starts to kill our own and we kill it and peripheral mechanisms and we make some that decide to attack or not Autoimmunity can be defined as breakdown of mechanisms responsible for self tolerance and induction of an immune response against components of the self. Such an immune response may not always be harmful.However, in numerous autoimmune diseases it is well recognized that products of the immune system cause damage to the self.
Relate the mechanism of self-tolerance to the possible explanations for development of autoimmune disorder.
Usual treatment is to prevent symptoms and complications. Increasing bulk in the diet helps to promote regular defecation and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure.
Relate the use of high-fiber diet in the treatment of diverticular disease to the etiologic factors for the condition
Evidence of autoimmune reaction, determination of immunological are not due to secondary condition, and no other identifiable causes for the disorders. Diagnosis: Current diagnosis is based on clinical findings and logical testing, testing antibodies, and take blood serum mix it will antibodies.
State the criteria for establishing an autoimmune basis for a disease.
A commonly used set of diagnostic criteria requires continuous or recurrent symptoms of at least 12 weeks duration of abdominal discomfort or pain in the preceding 12 months, with two or three accompanying features: relief with defecation, onset association with a change in form of stool. Other symptoms that support the diagnosis of IBS include abnormal stool frequency more than 3 times per day, abnormal stool passage, passage of mucus, and bloating or feeling of abdominal discomfort.
State the diagnostic criteria for irritable bowel syndrome.
Immunodeficiency Disorders are associated with or predispose affected patients to various complications, including infections, autoimmune disorders, and lymphomas and other cancers. Primary immunodeficiencies are hereditary Secondary immunodeficiencies are acquired and are much more common.
State the difference between primary and secondary immunodeficiency states
Virulent fungi that live freely typically in soil or decaying organic matter and frequently in specific geographic regions
State the mechanism of the transmission of fungal infections of the lung
Ammonia is formed from oxidative deamination. It is the removal of the amino group and a hydrogen atom from an amino acid. The ammonia is rapidly removed from the blood and combined with CO2 to form urea which is then excreted by the kidneys in urine.
State the origin of ammonia and describe the function of the liver in terms of its detoxification
HIV is a Human Immunodeficiency virus. It comes in two forms HIV-1 and HIV-2. It is different from other viruses because it carries its genetic material as RNA instead of DNA. HIV is a retrovirus that selectively attacks CD4 T lymphocytes.
State the virus responsible for AIDS and explain how it differs from other viruses.
Fatty liver disease→ alcohol causes fat to build up in hepatocytes. Alcoholic hepatitis→ inflammation and necrosis of liver cells Alcoholic cirrhosis→ hepatocytes become necrotic and are replaced by fibrous cellular tissue which hardens the liver. Fatty liver disease is the initial phase it is reversible, but with continued alcohol consumption leads to damage and inflammation of the liver(hepatitis) and continued use leads to cirrhosis.
Summarize the three patterns of injury that occur with alcohol-induced liver disease
pleuritis
inflammation of the pleura; unilateral pain that is abrupt in onset and exaggerated by respiratory movements
Portal of Entry: Is the process by which a pathogen enters the body or gain access to susceptible tissues and causes disease. Includes penetration, ingestion, direct contact, and inhalation. Source of infection: The location, the host, the object, or substance from which the infectious agent was acquired. Symptomatology: A collection of signs and symptoms expressed by the host during the course of the disease. Disease course: --> Incubation period: The pathogen begins active replication without producing recognizable symptoms in the host, can be short like in salmonellosis(6-24 hrs) or prolonged like in Hep B(50-80 days) or months to years like in HIV. --> Prodromal stage: The initial appearance of symptoms in the host, although the clinical presentation during this time may only be a vague sense of malaise. Host can experience: mild fever, myalgia, headache, and fatigue. Duration of this stage varies. --> Acute stage: The period during which the host experiences the maximum impact of the infectious process corresponding to rapid proliferation and dissemination of the pathogen. Toxic products combine to produce tissue damage and inflammation. Symptoms are pronounced and usually identify the pathogen and site(s) of involvement. --> Convalescent period: Characterized by the containment of infection, progressive elimination of the pathogen, repair of damaged tissue, and resolution of associated symptoms. Time required time to complete this may be days, weeks, or months depending on the pathogen. Site of infection: Is determined by the type of pathogen, the portal of entry, and the immune competence of the host defense system. Virulence factors: Affect how well the pathogen can get into the body
Use the concepts of portal of entry, portal of entry, source of infection, symptomatology, disease course, site of infection, agent, and host characteristics to explain the mechanisms of infectious disease.
cancer
___ of the lung is a leading cause of death worldwide, with cigarette smoking being implicated in the majority of cases; environmental hazards increase the risk; poor prognosis due to disease developing insidiously
hypoxemia hypoxemia and hypotension
___ usually develops after a large pneumothorax, followed by vasoconstriction of the blood vessels in the affected lung causing the BF to shift to the unaffected lung without immediate intervention, the increased thoracic pressure will further impair both cardiac and pulmonary function resulting in severe ___ and ___
a close match graft versus host disease
a _____ between donor and patient HLA markers are essential for a successful transplant; promotes the growth and development of new healthy blood cells (engraftment) and reduces the risk of a post transplant complication called ____
hypoxemia
a decrease in blood oxygen levels
tension pneuthorax
a life threatening event in which air accumulates int he thorax, collapsing the lung on the inured side and progressively shifting the mediastinum to the opposite side of the thorax, producing severe cardiac and respiratory impairment
pulmonary circulation
a low pressure system that links the right heart and systemic venous system with the left heart and the systemic arterial system and functions as a conduit for exchange of the dissolved gases in the blood with the ventilated air in the alveoli
peritonitis
inflammatory response of the serous membrane that lines the abdominal cavity and covers the visceral organs
pleural effusion
abnormal accumulation of fluid in the pleural cavity (transudate, exudate, chyle, or blood)
pleural effusion
abnormal collections of fluid in the pleural cavity; can be transudate, exudate, purulent, or sanguineous
exogenous
acquired from sources in the external environment such as the water, food, soil, or air
endogenous
acquired from the host's own microbial flora, as would be the case in an opportunistic infection
atelectasis
airway obstruction, lung compression, and increased recoil can cause ___
small cell
alost all ____ lung cancers have metastasized at the time of diagnosis and are not amenable to surgical resection
25 weeks 24 weeks 26-30
although body systems are ready for life as early as ___ weeks, the lungs take longer; type II alveolar cells produce surfactant and begin to develop at ___ weeks; by the ___ to ___ weeks the baby produces sufficient amounts of surfactant to prevent alveolar collapse
immunodeficiency
an absolute or partial loss of the normal immune response, which places a person at increased risk for development of infections or malignant complications; it can be classified as primary (congenital) or secondary (due to another condition)
pneumothorax
an accumulation of air in the pleural cavity that cause partial or complete collapse of the lung; result from rupture of an air filled bled on the lung surface or from penetrating or non penetrating injuries
grunting
an audible noise emitted during expiration (tries to raise the end expiratory pressure to maintain airway patency and prolong the period of oxygen and carbon dioxide exchange across the alveolar capillary membrane
cystic fibrosis
an autosomal recessive genetic disorder manifested by chronic lung disease, pancreatic exocrine deficiency, and elevation of sodium chloride in the sweat; causes exocrine gland secretions to become exceedingly viscid, and promotes colonization of the respiratory tract with P. aeruginosa and other organisms such as S. aureus; accumulation of viscid mucus in the bronchi, impaired mucociliary function and infection contribute to the development of chronic lung disease and a decreased life expectancy
atelectasis
an incomplete expansion of the lung
diverticulum
an outputting of the esophageal wall caused by a weakness of the muscular layer
type II
antibody-mediated cell destruction (transfusion reactions, hemolytic disease of newborn, and drug reactions), complement and antibody mediate inflammation, and antibody mediated cell dysfunction (graves disease and myasthenia gravis)
self identical twins share similar HLA types recognized as foreign
autologous = syngeneic = allogeneic = alloantigens =
bacteria
autonomously replicating unicellular organisms known as prokaryotes because they lack an organized nucleus; produce a cell wall that is produced only by prokaryotes and is therefore an attractive target for antibacterial therapy
25 weeks conducting airways gas exchange 25-28 weeks 28 weeks 24 weeks 26-30 weeks 1/6 ; 8 years
babies are physiologically ready for life as early as ___ weeks but the lungs take much longer to develop immaturity of the ___ is the major cause of death in preemies the first three stages (embryonic, pseudoglandular, and canalicular) are devoted to developing the ___ the last two stages (saccular and alveolar) develop the ___ portion of the lungs by __ to __ weeks sufficient terminal sacs are present to permit survival, before this time premature lungs are incapable of adequate gas exchange by __ weeks the terminal sacs are lined with squamous epithelial cells type II alveolar cells develop at __ weeks by __ to __ weeks, sufficient amounts of surfactant are available to prevent alveolar collapse when breathing begins __ of the adult number of alveoli are present in a full term baby and by __ years the adult complement of alveoli is present
prokaryotes
bacteria; organisms in which the nucleus is not separated
organisms
both prokaryotes and eukaryotes are ____ because they contain al the biologic equipment necessary for replication and metabolism
microbes
can enter the host by direct contact, ingestion, and inhalation
precipitation of substances contained in bile (cholesterol and bilirubin) abnormalities in the composition of bile, stasis of bile, and inflammation of the gallbladder
causes of gallstones (cholelithiasis)
hypoventilation diffusion impairment shunt ventilation-perfusion abnormalities increased respirations cyanosis impaired sensory and neuro function increase ventilation pulmonary vasoconstriction increased production of RBCs
causes of hypoxemia manifestations how does the body compensate
hypoventilation diffusion impairment shunt ventilation-perfusion abnormalities
causes of hypoxemia:
COPD sleep apnea heart failure
causes of secondary pulmonary HTN:
Hypertrophy and eventual failure of the R ventricle Venous congestion, peripheral edema, SOB, and productive cough, redness, cyanosis, and warm moist skin may result, drowsiness and altered LOC may occur due to CO2 retention
characteristics of cor pulmonate
AIDS phase
characterized by a marked decrease in CD4 cells and the development of opportunistic infections, malignancies, wasting syndrome, and metabolic disorders
faster shallow grunting nasal flaring inspiratory retractions increased turbulence stridor
children with respiratory distress breathe ___ and their excursions are ___ ___ is an audible noise emitted during expiration and is common as the child tries to raise the end-expiratory pressure to maintain airway patency and prolong the period of oxygen and carbon dioxide exchange across the alveolar capillary membrane ___ helps reduce the nasal resistance and maintain airway potency and can be a sign of increased work of breathing ___ are often observed with airway obstruction in infants and small children ___ of air moving through the obstructed airways produces an audible crowing sound called ___ during inspiration
inflammatory bowel disease
chrohn's disease (small and large bowel) & ulcerative colitis (colon and rectum)
bronchial asthma
chronic disorder of the airways that causes reversible episodes of airway obstruction due to bronchial smooth muscle hyperactivity and airway inflammation
bronchopulmonary dysplasia
chronic lung disease in preterm infants treated with mechanical ventilation or prolonged oxygen supplementation ; interferes with normal lung maturation with may prevent subsequent lung growth and development ; mechanical ventilation and oxygen produce lung injury through their effect on alveolar and vascular development ; oxygen induces injury by producing free radicals that cannot be metabolized by the immature antioxidant systems the preterm infant
bronchiectasis
chronic productive cough, foul smelling purulent sputum, hemoptysis, dyspnea, wheezing, weight loss, anemia, clubbing of the fingers, hypoxemia
tuberculosis
chronic respiratory infection caused by the bacterium M tuberculosis; cell mediated hypersensitivity response that the bacillus evokes rather than its inherent destructive capabilities; treatment consists of eliminating the TB using multiple medications due to resistant forms of the disease
acute respiratory failure
condition in which the lungs fail to oxygenate the blood adequately or present undue retention of CO2
hypercapnia
decrease in pH due to hypoventilation (respiratory acidosis)
hypoxia
deprived of oxygen supply
chronic rejection
develops over months and years; arterial occlusion resulting from the proliferation of vascular smooth muscle cells, with graft failure resulting from ischemic damage; release of cytokines that stimulate proliferation of vascular endothelial and muscle cells; repair with fibrosis after repeated bouts of acute antibody-mediated or cellular rejection; toxic effects of immunosuppressive drugs
pulmonary embolism
develops when a blood borne substance lodges in a branch of the pulmonary artery and obstructs blood flow; embolus can consist of a thrombus, air, fat, or amniotic fluid
radiography, contrast media, esophagoscope, ambulatory esophageal pH monitoring
diagnosis of GERD
dysphagia
difficulty swallowing
Addison's disease is an uncommon autoimmune disease, characterized by chronic and insufficient functioning of the outer layer of the adrenal gland.Because of this chronic under-functioning of the adrenal glands, persons with Addison's disease have a deficiency in the production of glucocorticoid hormones. Lupus is a chronic inflammatory autoimmune disease. Behcet's disease is a chronic, multisystem autoimmune disease involving inflammation of blood vessels, called vasculitis, throughout the body. Psoriasis is a skin disease that causes itchy or sore patches of thick, red skin with silvery scales. Crohn's disease, Rheumatoid arthritis, Graves' disease, and Ulcerative Colitis.
diseases attributed to autoimmunity
autoimmune disease
disruption in self tolerance that results in damage to body tissues by the immune system
interstitial lung diseases
diverse group of lung disorders that produce similar inflammatory and fibrotic changes in interstitial or alveolar septa of the lung; the lungs become stiff and difficult to inflate, increasing the work of breathing and causing dyspnea and decreased exercise tolerance due to hypoxemia, without evidence of wheezing or signs of airway obstruction
emphysema
enlargement of air spaces and destruction of lung tissue
sac that stores and concentrated bile sphincter regulates the flow of bile into the duodenum bile flows from the two lobes of the liver into the hepatic and common bile ducts if food is present, the bile will continue into the duodenum to aid in the digestion of fats; if no food is present, the sphincter will be closed, and bile will be forced back up the tube until it reaches the open cystic duct
explain the function of the gallbladder
achalasia
failure to relax
esophagus
fixed muscular tube through which swallowed food and liquids move as they pass from the pharynx t the stomach
hepatitis C
flaviviridae virus 2-26 week incubation Bleeding Bruising Fatigue Poor appetite Jaundice Dark urine Ascites Lower extremity edema Chronic: Cirrhosis Liver cancer Liver failure
latency phase
may last for years
fungi
free living, eukaryotic saprophytes, some of which are members of the normal human microflora
eukaryotes
fungi and parasites; contain a membrane-bound nucleus
diffusion
gases move between the alveoli and pulmonary capillaries
interstitial lung diseases
group of lung disorders that produce inflammatory and fibrotic changes in the interstitial or inter alveolar septa of the lung; results in a stiff and noncompliant lung and are commonly classified as restrictive lung disorders
COPD
group of respiratory disorders characterized by chronic and recurrent obstruction of airflow in the pulmonary airways
epiglottitis
haemophilus influenza type B bacterium 2 to 7 years Sudden onset Child appears very sick and toxic Sits with mouth open and chin thrust forward, low pitched stridor, difficulty swallowing, fever, drooling, anxiety; danger of airway obstruction and anaphylaxis Hospitalization, intubation or trach, treatment with antibiotics
hepatitis B
hepadnavirus >4 week incubation Fever Malaise Nausea Anorexia Abdominal discomfort Dark urine jaundice Chronic: Cirrhosis Liver cancer Liver failure Kidney disease Inflammation of blood vessels
increased ventilation pulmonary vasoconstriction increased red blood cells
how does the body compensate for chronic hypoxemia
treat underlying disease, maintain adequate gas exchange and tissue oxygenation, and general supportive care; mechanical ventilation may be required
how to treat respiratory failure:
type 1
mediated by IgE and include anaphylactic shock, hay fever, and bronchial asthma
hyper acute rejection
immediately after transplantation; often seen at the time of surgery; as soon as blood flow begins, it gets cyanotic and mottled; can take hours to days; produced by existing recipient antibodies to graft antigens that initiate a type III hypersensitivity reaction in the blood vessels
hypersensitivity disorders
immune responses to environmental, food, or drug antigens that would not affect most of the population
culture serology DNA/RNA sequencing
in the lab, the diagnosis of an infections agent is accomplished through...
chlamydial diseases
include sexually transmitted genital infections, neonatal and adult conjunctivitis, and infant pneumonia
hypercapnia
increase in carbon dioxide
hypercapnia
increase in the carbon dioxide content of the arterial blood
chronic obstructive bronchitis
increased mucus production, obstruction of small airways, and chronic productive cough
acute hypoxemia
increased respiratory effort, cyanosis and impaired sensory and neuro function
pulmonary
infections caused by the fungi H, capsulatum, C. immitis, and B. dermatitidis produce ___ manifestations that resemble TB; they are common but seldom serious unless they produce progressive destruction of lung tissue or the infection disseminates to organs and tissues outside the lungs
diverticulitis
inflammation and gross or microscopic perforation of the diverticulum
cholangitis
inflammation of the common bile duct
cholecystitis
inflammation of the gallbladder due to obstruction of the outlet
gastritis
inflammation of the gastric mucosa
cystic fibrosis
inherited disorder involving fluid secretion by the exocrine glands in the epithelial lining of the respiratory, GI, and reproductive tracts ; it is an autosomal recessive trait ; mutations on a single gene which function as a chloride channel in epithelial cell membranes
tension pneumothorax
intrapleural pressure exceeds atmospheric pressure; allows air to enter but not leave; decreased venous return to the heart and decreased CO; complication of mechanical ventilation manifestations: trachea deviates toward the opposite side of the chest along with structures in the mediastinal space; decreased CO; distension of neck veins, subcutaneous emphysema, clinical signs of shock due to impaired cardiac function
type IV
involve direct cell cytotoxicity, in which sensitized CD8 T cells kill antigen-bearing target cells, and delayed type hypersensitivity reactions, in which presensitized CD4 T cells release cytokines that damage and kill antigen containing cells
type III
involve the formation and deposition of insoluble antigen-antibody complexes and are responsible for vasculitis (SLE), systemic immune complex disease (serum sickness) and local immune complex disease
acute pancreatitis
irreversible inflammatory process of the pancreatic acini brought about by premature activation of pancreatic enzymes Autodigestion of pancreatic tissue by inappropriately activated pancreatic enzymes; trypsin activated digestive enzymes that cause pancreatic injury Caused by alcohol abuse and gallstones
Originate suddenly Epiglottitis, lung infection, bronchiolitis Rapid breathing Exaggerated use of accessory muscles Retractions Nasal flaring Grunting during expiration Cyanosis Heart rate >150 Depressed breathing Fatigue Decreased LOC
list signs of impending respiratory failure in small children
nonsmall cell and small cell
lung CA is divided into two categories:
acquired atelectasis
mainly adults and is caused by a mucus plug in the airway or by external compression by fluid, tumor mass, exudate, or other matter in the area surrounding the airway
self tolerance
maintained through central and peripheral mechanisms that delete auto reactive B or T cells or otherwise suppress or inactivate immune responses that would be destructive to hose tissues
abdominal pain in the epigastric or LUQ and radiate to back, chest or flank; serum amylase or lipase >3 times the upper limit of normal; signs on abdominal imaging Fever, tachycardia, hypotension, severe abdominal tenderness, respiratory distress, and abdominal distension
manifestations of acute pancreatitis
tachypnea tachycardia dyspnea cyanosis hypoxemia diminished chest expansion absence of breath sounds intercostal retractions intercostal retraction signs of respiratory distress
manifestations of atelectasis:
Episodes of epigastric and ULQ pain with anorexia, nausea, vomiting, constipation and flatulence; eventually signs of diabetes and malabsorption occur
manifestations of chronic pancreatitis
pruritic maculopapular rash on the palms and soles and extends over the entire body with subsequent squamatization; skin and liver involvement; nausea, bloody diarrhea, and abdominal pain; painless jaundice, hyperbilirubinemia, and abnormal liver tests
manifestations of graft versus host disease:
decreased pH vasodilation depression of CNS
manifestations of hypercapnia
decrease in lung expansion, dullness to percussion and diminished breath sounds hypoxemia, dyspnea, pleuritic pain, increased effort or rate of breathing
manifestations of pleural effusion
breathlessness, pleuritic pain, apprehension, slight fear, cough productive of blood, tachycardia, rapid and shallow breaths, sudden collapse, crushing substernal chest pain, shock, loss of consciousness, rapid and weak pulse, low BP, neck veins distended and skin cyanotic and diaphoretic
manifestations of pulmonary embolism:
rapid onset, respiratory distress, increase in respiratory rate, and signs of respiratory failure
manifestations of respiratory distress syndrome:
primary atelectasis
most often in premature and high risk infants
ventilation
moves air into and out of the lungs
diverticular disease
mucosa of the colon herniate through the muscular layer
limitation in movement of atmospheric air into and out of the gas exchange portion of the lung
obstructive airway disorders due to bronchial smooth muscle hyperactivity or changes in bronchial wall structure, injury to the mucosal lining of the airways, or excess respiratory tract secretions are characterized by ...
hyper acute rejection
occurs almost immediately after transplantation an dis caused by existing recipient antibodies to graft antigens that initiate a type III reaction in the blood vessels of the graft
secondary pneumothorax
occurs in persons with underlying lung disease; trapping of gases and destruction of lung tissue; emphysema
graft versus host disease
occurs most often following bone marrow transplant, develops when immunologically competent cells or precursors are transplanted into recipients who are immunologically compromised 1) the transplant must have a functional cellular immune component 2) the recipient tissue must bear antigens foreign to the donor tissue 3) recipient immunity must be compromised to the point that it cannot destroy the transplanted cells
chronic rejection
occurs over a prolonged period and is caused by T cell generated cytokines that damage blood vessels, causing ischemic damage to graft tissue
primary phase
occurs shortly after infection and is usually manifested by mononucleosis like symptoms
acute rejection
occurs within first few days to weeks after; suddenly months to years when immunosuppression is discontinued; recipient's immune system generates T cells and antibodies against the graft; involves both cell mediated and humoral mechanisms; T cells cause direct lysis of graft cells and recruit and activate inflammatory cells that injure the graft
acute rejection
occurs within the first few weeks or months after transplant and occurs when graft tissues or blood vessels are damaged by alloreactive T cells or antibodies
human leukocyte antigens
on the cell surface that determine whether the tissue of transplant organs is recognized as foreign
respiratory distress syndrome
one of the most common causes of respiratory disease in premature infants; pulmonary immaturity and surfactant deficiency lead to alveolar collapse
diffusion ventilation
oxygenation depends on ___ and removal of CO2 depends on ___
diffuse epithelial cell injury with increased permeability of the alveolar-capillary membrane; permits fluid, plasma proteins, and blood cells to move into the interstitium and alveoli of the lung; accumulation of fluid, surfactant inactivation, and formation of hyaline membrane that is fibrous and impervious to gas exchange
pathologic lung changes that occur in acute lung injury or acute respiratory distress syndrome
traumatic pneumothorax
penetrating or non penetrating chest injuries; fractured or dislocated ribs; CPR manifestation: hemothorax
pulmonary arterial hypertension
persistent elevation in pulmonary artery pressure that occurs in the absence of identified cardiopulmonary or other secondary causes; abnormal proliferation and contraction of vascular smooth muscle, coagulation abnormalities, and marked intimal fibrosis leading to obliteration or obstruction of the pulmonary arteries and arterioles; increase in pulmonary pressure, R heart failure, low CO, and death if untreated
hepatitis A
piconavirus 25-30 day incubation Fever Malaise Nausea Anorexia Abdominal discomfort Dark urine jaundice no chronic development
remove CO2 from the blood entering the pulmonary circulation and provide adequate amount of oxygen to blood leaving the pulmonary circulation
primary functions of the respiratory system
hiatal hernia
protrusion of the stomach throughout the esophageal hiatus of the diaphragm
respiratory distress syndrome
pulmonary immaturity with surfactant deficiency that causes alveolar collapse ; poorly functioning type II alveolar cells
hypoxemia
reduction of the PO2 of the arterial blood
chronic cholecystitis
repeated episodes of gallstones, pancreatitis, carcinoma, intolerance of fatty foods, belching, and discomfort, colicky pain, obstruction of biliary flow
pneumonias
respiratory disorders involving inflammation of the lung structures, such as the alveoli and bronchioles; caused by infectious agents such as bacteria and viruses; classified according to the type of organisms causing the infection, location of the infection and setting in which it occurs
respiratory failure
respiratory system fails in one or both of its gas exchange functions -- oxygenation of mixed venous blood and removal of CO2
croup bronchiolitis epiglottitis supraglottic infection
respiratory tract infections that affect small children:
obligate intracellular pathogens
rickettsiaceae, anaplasmataceae, chlamydiaceae, and coxiella are ___ ___ ___, like viruses, but produce a rigid peptidoglycan cell wall, reproduce asexually by cellular division, and contain RNA and DNA, similar to bacteria
cor pulmonale
right heart failure caused by pulmonary disease and long standing pulmonary HTN
cor pulmonate
right heart failure from primary lung disease or pulmonary HTN
spontaneous pneumothorax
rupture of an air filled bleb or blister on the surface of the lungs allowing air to enter the pleural cavity causing the lungs to collapse; smoking can also be a cause
blood borne substance lodges in a branch of the pulmonary artery and obstructs blood flow (DVT), thrombus, air injected into the IV, fat from bone marrow, or amniotic fluid
state causes of a pulmonary embolism:
impaired chloride transport causes increased absorption of chloride and lower water content in the mucous layer causing it to become more viscid allowing accumulation of secretions that obstruct airways
state cystic fibrosis' effect on lung function
disease metastasizes before the diagnosis is made
state the reason for the poor prognosis associated with esophageal cancer
it has metastasized by the time of diagnosis
state the reason for the poor prognosis in pancreatic cancer
choledocholithiasis
stones in the common bile duct; acute biliary colic, right upper quadratic pain, chills, fever, and jaundice; acute suppurative cholangitis accompanies by pus in the common duct
virulence factors
substances or products generated by infectious agents the enhance their ability to cause diseases; these include toxins, adhesion factors, evasive factors, and invasive factors
acute cholecystitis
sudden onset of upper right quadrant or epigastric pain, mild fever, anorexia, nausea, vomiting, biliary pain, elevated WBC count and elevations in AST, ALT, ALP and bilirubin
fingers nasal mucosa or conjunctiva of the eye
the ___ are the most common portals of transmission and the most common portal of entry is the ___ or ___
colonization
the act of establishing a presence, a strep required in the multifaceted process of infection
retractions
the diaphragm must generate more negative pressure, as a result, the chest wall is sucked inward, producing abnormal inward movements of the chest wall during inspiration
AIDS
the most common type of secondary immunodeficiency, caused by HIV, a retrovirus that infects the body's CD4 cells and macrophages; destruction leads to an attack on the entire immune system because this subset of lymphocyte exerts critical regulatory and effector functions that involve both humoral and cellular immunity
viruses
the most frequent cause of respiratory tract infections including the common cold and infection of influenza
incubation period (activation without symptoms) prodromal (appearance of symptoms) acute (maximum impact) convalescent (containment, elimination and repair) resolution (total elimination)
the natural history of an infectious disease includes: (5)
ability of microbes to breach host barriers and colonize and damage host tissues
the outcomes of infections depend on ....
infection
the presence and injurious multiplication of an infectious agent within a human host
viruses
the smallest pathogens, have no organized cellular structure, and consist of a protein coat surrounding a nucleic acid core of DNA or RNA; unlike prokaryotes and eukaryotes, these are incapable of replication outside of a living cell
epidemiology
the study of factors, events, and circumstances that influence the transmission of disease
bronchiectasis
uncommon form of COPD that is characterized by an abnormal dilation of the large bronchi associated with infection and destruction of the bronchial walls
uncomplicated rhinotracheitis (viral infection) bacterial infection viral pneumonia
three syndromes:
blood enters the liver through the hepatic artery and the portal vein, venous outflow is carried by the valve-less hepatic veins into the vena cava
trace the movement of blood flow into, through, and out of the liver
antimicrobial agents surgical intervention (drain abscess, debridement, remove infected organ)
treatment methods include...
avoidance, eat sitting up, avoid laying down, sleep with HOB elevated, antacids, H2 inhibitors, and PPI's
treatment of GERD
pain relief, gastric suction, IV fluids and electrolytes, IV colloid solutions
treatment of acute pancreatitis
intrinsic asthma
triggered by respiratory tract infections, exercise, drugs and chemicals, airborne pollutants, and GERD
mucosal and cutaneous barriers and normal immune function
two defense mechanisms of the host
extrinsic asthma
type I hypersensitivity reaction triggered by an allergen
small airway
why are respiratory infections more serious in infants?