Pathophysiology Exam 2 Ch. 6-13

Local Spread of Cancer

-Cells multiply faster then they die -Mechanical pressure -Release of lytic enzymes -Decreased cell to cell adhesion - cancer cells do not anchor to anything -Increased motility

Types of mutation

-Secretion of growth factor - cells will trigger other cells to grow/mutate to make more cancer cells. -Increased growth factor affects receptors -Signal from cell-surface receptor is mutated in the "on" positions -Mutation in the intracellular signaling protein (called RAS) -Inactivation of Rb tumor suppressor -Activation of protein kinases that drive the cell cycle -Apoptosis in the p53 gene - signals cell to continue to proliferate, will not allow it to self destruct.

Biology of Cancer

-Some called transport cells which are created from normal cells. These cells -have decreased need for growth factors to multiply -lack contact inhibition - they get out of control and don't respect boundaries -Anchorage independence - they don't need to adhere like normal cells do -immortality - normal cells have a shelf life, cancer cells do not, they never die.

Three-Step Theory of Invasion

-Tumor cell attachment - fibronectin and laminin -Degradation or dissolution of the matrix - enzymes -Locomotion into the matrix - invadopodia

Tumor Spread

-direct invasion of contiguous (touching) organs - local spread. -Metastases to distant organs - spread of cancer cell from original site to different location -Metastases by way of implantation -Requires great efficiency - every step has to be perfect -Usually occurs late

Steps of Metastasis

-direct or continuous extension -penetration into lymphatic, blood vessels, or body cavities -transport into lymph or blood -transport to secondary sites -entry and growth in secondary sites

Portions of Nervous System responsible for Pain

1. The Afferent Pathways which begin in the peripheral nerves. 2. The interpretive centers located in the brain stem (Medbrain, diencephalon, and cerebral cortex). 3. The Efferent Pathways that descend from the CNS back to the dorsal horn of the spinal cord.

Tumor marker can be used in three ways

1. They screen and identify individuals at high risk for cancer. 2. Diagnose specific types of tumors 3. Observe clinical course of cancer - is it growing or shrinking. *A problem - false positives and negatives which can be caused by electrolytes and medications.

Criteria that influence the degree to which an antigen is immunogenic.

1. foreigness to the host, 2. adequate size, 3. being present in a sufficient quantity.

Environmental/Lifestyle Factors and Cancer Risk

2/3 of all cancers are caused by environmental/lifestyle factors interacting with genes such as skin cancer and cancers caused by smoking.

Cerebrospinal fluid ***

A clear, colorless fluid similar to blood plasma and interstitial fluid. Intracranial and spinal cord structures float in CSF and are thereby protected from jolts and blows. Between 125-150 ml is circulating within ventricles (small cavities)

Reticular Formation

A collection of nerve cell bodies within the brain stem and controls vital reflexes such as those controlling cardiovascular function and respiration.

Anemia from Cancer

A decrease in hemoglobin in the blood due to chronic bleeding resulting from iron deficiency, severe malnutrition (due to inability to eat, chemotherapy, cancer taking nutrients), medical therapies, and malignancy in blood forming organisms.

Leukopenia and Thrombocytopenia

A disease of white blood cells and decreased platelets. Caused by direct tumor invasion to the bone marrow. Chemotherapy drugs are toxic to the bone marrow. Infection risks increase when the absolute neutrophil and lymphocyte counts fall. Can die from infection while fighting cancer and undergoing chemo.

Superantigens (SAGs)

A group of molecules that certain diseases are produced by. Results in an excessive amount of inflammatory cytokine production which results in symptoms of fever, low blood pressure, and potentially fatal shock. Some examples of SAGs are Staphylococcus aureus and streptococcus pyogenes.

Chromosome translocation

A piece on one chromosomes is transferred to another chromosome. Takes 1 or 2 generations before full mutation occurs.

B Lymphocyte Deficiencies

A primary deficiency resulting from defects in antibody production.

T Lymphocyte Deficiencies

A primary deficiency resulting from defects in the development and function of cell mediated immunity.

Acute Pain

A protective mechanism that alerts the individual to a condition or experience that is immediately harmful to the body and mobilizes the individual to take prompt action to relieve.

Secondary Immune Response

A second challenge by the same antigen. This response is characterized by the more rapid production of a larger amount of antibody than the primary response. The rapidity is a result of memory cells that do not require further differentiation.

Immunoglobulin (Ig)

A serum glycoprotein produced by plasma cells that mature from lymphocytes called B lymphocytes in response to an antigen

Fever

A temporary "resetting of the hypothalamic thermostat" in reponse to endogenous or exogenous pyrogens. The thermoregulatory mechanisms adjust heat production, conservation, and loss to maintain body core temp at a normal level. The response is mediated in part by cytokines associated with the inflammatory response.

Immunoglobulin

A term generally used for all antibodies

Astrocytes

A type of Neuroglia, Fill the spaces between neurons and surround blood vessels in the CNS.

Acquired Immunodeficiency Syndrome

AIDS - is a secondary immune deficiency that develops in response to viral infections. The major immunologic finding in AIDS is the striking decrease in the number of CD4+ Th Cells. Depletion of CD4+has a profound effect on the immune system. New cases of AIDS are diagnosed by decreased CD4+ T cell numbers, if less then 200/mm3 then have AIDS.

Pathogenicity

Ability of an agent to produce disease - success depends on communicability, infectivity, extent of tissue damage, and virulence.

Immunigenicity

Ability of pathogens to induce an immune response.

Infectivity

Ability of the pathogen to invade and multiply in the host. Is facilitated by the ability of pathogens to attach to cell surfaces, release enxymes that dissolve protective barriers, and escape the action of phagocytes. They then multiply and cause disease.

Toxigenicity

Ability to produce soluble toxins or endotoxins, factors that greatly influence the pathogen's degree of virulence.

Communicability

Ability to spread from one individual to others and cause disease.

Human Thermoregulation

Acheived through precise balancing of heat production, heat conservation, and heat loss. Body temperature is maintained in a range around 37 C (98.6 F) Internal Temp varies in response to activity, environmental temp, and daily fluctuations.

Pia Mater

Adheres to the contours of the brain and spinal cords and provides support for blood vessels serving brain tissue.

Primary Immune Responses

After a single initial exposure to most antigens, there is a latent period or lag period during which antigen processing and B cell differentiation and proliferation occur. After 5-7 days IgM antibody is detected in the circulation. The lag phase is the time necessary for the process of clonal selection. This response is characterized by initial production if IgM followed by IgG against the same antigen.

Mutation of tumor-suppressing gene

Allows unregulated cellular growth which causes loss of heterozygosity (the loss of one copy)- both chromosome copies of a gene are inactivated.

Exogenous pyrogens

Also known as endotoxins, are produced by pathogens and stimulate the release of endogenous pyrogens.

Hypersensitivity

An altered immunologic response to an antigen

Impulse Transmission

An impulse is originated in a presynaptic neuron (the nerve that conducts the nerve impulse) and moves to postsynaptic neurons (the neuron that receives the impulse)

Influenza Virus

And example of a virus binding to a receptor in order to reproduce. Attaches to respiratory epithelial cells and causes upper respiratory tract infection.

Two components of Immune Response

Antibodies and T cells, both of which protect against infection.

Testing for AIDS

Antibodies usually appear rather rapidly after infection through blood products, usually within 4-7 weeks. After sexual transmission, the individual can be infected yet seronegative for 6-14 months or longer.

Differences between Antigens and Immunogens

Antigens can bind with antibodies or antigen receptors on B and T cells. Immunogen will induce an immune response. All immunogens are antigens. Not all antigens are immongens.

T Cells

Are a subset of lymphocytes. They attack and kill targets directly. Targets include cells infected by a virus as well as those that have become cancerous. These cells have memory.

Brachial Plexus

Are formed by the last 4 cervical nerves (C5-C8) and the first thoracic nerve (T1)

Nocireceptors

Are free nerve endings in the afferent peripheral nervous system located throughout the body

Type IV: Cell-Mediated Hypersensitivity Reactions

Are mediated by T lymphocytes and do not involve antibody. Reactions include graft rejection, the skin test for TB, and allergic reactions resulting from contact with such substances as poison ivy and metals.

Plexuses

Are networks of nerve fibers

Parasitic infection

Are rarely transmitted from human to human. The predominant means of transmission is through vectors such as Mosquitos. Contamination from food and water is another way of transmission.

T Cytotoxic cells (T Cells)

Are responsible for the cell mediated destruction of tumor cells or cells infected with viruses.

Clonal proliferation or expansion

As a result of mutation, a cell acquires characteristics that allow it to have selective advantage over its neighbors. It can increase growth rate or decrease apoptosis, allowing cells to be modified and change into cancer.

Examples of Primary Immune Deficiencies

B Lymphocyte, T Lymphocyte

Pyrogenic Bacteria

Bacteria that produce endotoxins

Pain Transduction

Begins when tissue is damaged by exposure to chemical, mechanical, or thermal noxious stimuli. The causes activiation of nocireceptors.

Intervertebral Disk

Between the interspace of the vertebrae. They absorb shocks, preventing damage and are also a common source of back problems.

Blood Supply to the Spinal Cord

Blood is derived from branches off the vertebral arteries and from branches from various regions of the aorta.

Forebrain

Called the Telencephalon consists of the cerebrum and the limbic system. Consists of the frontal, parietal, occiptal, and temporal lobes.

Fungal Diagnosis

Can be diagnosed by microscopic observation. Specimen can also be cultured. No vaccines are available to prevent fungal infections and many antifungal drugs are toxic to the host cell.

Alloimmunity

Can be observed during immunologic reactions against transfusion, transplanted tissue, or the fetus during pregnancy.

Skin Colonizing Fungi

Can digest Keratin

Angiogenesis

Cancer cells that secrete Angiogenic factors (VEGF) that stimulate new blood vessel growth. They do this in order to find their own nutrition source allowing the cancer cells to enlarge and grow. This makes cancer very difficult to remove because it connects to the body's blood vessels and removing it can cause patient to bleed out.

Cancer-Causing Mutations

Cancer is predominantly a disease of aging due to the amount of times cells have divided. The more a cell divides the more it is susceptible to mutate. Multiple mutations are required before cancer develops.

Cancer Stem Cells

Cancer stem cells self renew and cell divisions can create new stem cells. Stem cells are pluripotent which means they have the ability to differentiate into multiple different cell types (can adjust to environtment it has moved too). Current cancer chemotherapy does not kill cancer stem cells.

Pain

Cannot be adequately defined, identified, or measured by an observer. It is completely subjective.

Sexual reproductive behavior

Carcinogenic types of human papillomavirus - 99.7% of women with cervical cancer are positive for HPV, a sexually transmitted disease.

Sensory Neurons

Carry impulses from peripheral sensory receptors to the CNS

Secondary (acquired) Immune Deficiency

Caused by another condition, such as cancer, infection, or normal physiologic changes, such as aging. These are farm more common the primary deficiencies. Some are extremely severe (AIDS) and may result in recurrent life-threatening infections.

Primary (congenital) Immune Deficiency

Caused by genetic defects, usually single gene.

DiGeorge Syndrome

Caused by the lack or partial lack of the thymus, resulting in greatly decreased T cell numbers and function.

Cell wall structure of Fungus

Cell walls are rigid and multilayered. Combosed of polysaccharides instead of peptidoglycans (like bacteria). Lack of petidoglycans allow fungus to resist the action of bacterial cell wall inhibitors such as penicillen .

Memory Cells

Cells capable of remembering the specific antigen and responding more rapidly and efficiently against future infection (Both Humoral and Cell-Mediated Immunity)

CD8

Cells designed to become Tc cells that have a different cell surface protein.

Cell-Mediated Immunity

Cells that target and kill bacteria and viruses without the use of antibodies. (T-Cells)

CD molecules

Cellular cooperation to produce an immune response requires a large array of accessory molecules which are called CD (cluster or differentiation) molecules.

Cellular effects of viruses

Cellular destruction results from large quantities of virus being released from the cell's plasma membrane. Once inside the cell has many harmful effects 1. cessation of DNA, RNA and protein synthesis 2. Disruption of lysosomal membranes 3. Alteration of identity of the infected cell causing individuals immune system to attach the cell as if it were foreign.

Contralateral Control

Cerebral impulses control function on the opposite side of the body.

Point mutations

Changes in one or a few nucleotide base pairs due to alterations during cell divisions.

Inflammation and Cancer

Chronic inflammation can cause cancer. Constant stimulation can lead to mutation of cells and eventually to cancer. Examples of chronic inflammation are ulcerative colitis, chronic viral hepatitis.

Factors that influence pathogens capacity to cause disease

Communicability, Immunogenicity, Infectivity, Pathogenicity, Portal of Entry, and Toxigenicity.

Upper motor neurons

Completely contained within the CNS. They form synapses with interneurons, which then form synapses with lower motor neurons.

The Autonomic Nervous System

Components are located in the CNS and PNS and consists of the sympathetic and parasympathetic nervous systems.

Vertebral Column

Composed of 33 Vertebrae: 7 cervical, 12 thorasic, 5 lumbar, 5 fused sacral, and 4 fused coccygeal

Cranium

Composed of eight bones and protects the brain and its associated structures.

Dura Mater

Composed of two layers, with the venous sinuses formed between them.

Parasympathetic Nervous System

Conserves and restores energy. The nerve cells are located in the cranial nerve nuclei and in the sacral region of the spinal cord and therefor constitute the craniosacral division.

Brain Stem

Consists of the Midbrain, the medulla, and the pons, which connects the hemispheres of the brain, cerebellum, and spinal cord.

Central Nervous System

Consists of the brain and spinal cord, enclosed within the protective cranial vault and vertebrae

Wernicke Area

Constitute a sensory speech area

Cytosol of Fungus

Contain organelles: mitochondria, ribosomes, Golgi apparatus, microtubules, microvessicles, ER, and nuclei

Endotoxins

Contained in the cell walls of GRAM NEGATIVE bacteria (Lipopolysaccharides). May be released from membrane of bacteria during bacterial growth or during treatment with antibiotics.

The Hindbrain

Contains the Cerebellum, pons, and medulla oblongata.

Cerebral cortex

Contains the cell bodies of neurons (gray matter) and covers the forebrain

Parietal Lobe

Contains the major area for somatic sensory input

Obesity

Correlates with BMI, related to increased incidence of several cancers: Esophagus, gastric, breast, ovarian, kidney. Insulin resistance may influence cancer. The causal relationship is unclear. Difference in obesity related cancers in men/women.

Myelin Sheath

Covers the axon with an insulating lipid material called myelin. They are interrupted at regular intervals by nodes of Ranvier

Cancer

Derived from Greek word for crab - karkinoma, pertains to malignant tumors and not benign growths

Blood-Brain Barrier ***

Describes cellular structures that selectively inhibit certain potentially harmful substances in the blood from entering the interstitial spaces of the brain or CFS. Certain metabolites, electrolytes, and chemicals can cross into the brain in varying degrees. This has substantial implications for drug therapy because many cannot cross the barrier.

Brodmann's Areas

Different areas of the brain where various activities are correlated

Lower motor neurons

Directly influence muscles

Mycoses

Diseases caused by fungi. Can be superficial (on or near the skin or mucus membranes), deep (enter through inhalation or open wounds), or opportunistic.

Gene amplification

Duplication of a small piece of chromosome over and over. This results in an increase expression of an oncogene.

The Brain

Enables people to reason, function intellectually, express personality and mood, and interact with the environment. Is pinkish gray and about 3 lbs, and receives 15-20% of the total cardiac output. There are three major devisions: The forebrain (formed by the two cerebral hemisphers), the midbrain, and the hindbrain (includes the cerebellum, pons, and medulla).

Caretaker genes

Encode for proteins that are involved in repairing damaged DNA. The make sure everything is correct with the DNA sequence and repair any damage. They are the Guardians of the Genome

Tumor-Suppressor genes

Encode proteins, which normally negatively regulate (slow down) proliferation (anti-oncogenes).

Epigenetics

Epigenetics are changes in genetic expression (phenotype) without DNA mutation and usually involve factors that silence genes that should be active or activate genes that should be silent. It can be influenced by environment and lifestyle. Example: Genetics plus smoking = increased risk

Parasitic Disease

Establish symbiosis with another species in which the parasite benefits at the expense of the other species. They range from unicellular to large worms.

Dendrites

Extensions of the neuron that carry nerve impulses toward the cell body.

Foods that increase cancer risk

Fat, high glycemic index, carbs, lots of preservatives, alcohol, grilled blackened food, high levels of calcium, refined grain products.

Referred Pain

Felt in an area removed or distant from its point of origin.

Benefits of Fever

Fever helps the body respond to infectious processes through several mechanisms: 1. Raising body temperature to kill MO and effect their growth 2. Higher body temps decrease levels of iron, zinc, and copper which bacteria need to replicate 3. Increased temp causes lysosomal breakdown preventing viral replication in infected cells 4. Heat increases lymphocytic transformation, facilitating the immune response 5. Phagocytosis is enhanced.

Reflex Arc

Forms the basic unit that respond to stimuli and provide protective circuitry for motor output. Structures needed are an afferent (sensory) neuron, and efferent (motor) neuron, and an effector muscle or gland.

Immunoglobulin IgD

Found in low concentrations in the blood. Its primary function is as an antigen receptor on the surface of early B cells.

Neuromodulation of Pain

Found in the pathways that mediate information about painful stimuli throughout the nervous system. Triggering mechanisms that initiate release of neromodulators include tissue injury (prostaglandins, bradykinin) and chronic inflammatory lesions.

Ionizing Radiation

From x-rays, CT scan. Exposure causes cell death gene mutations, and chromosome abberations. Effects the DNA by causing damage and breaks the strands. Mutations in germ cells are heritable. CT scan provide 50 times more radiation to stomach then x-ray.

Foods that decrease cancer risk

Fruits/vegetables, fiber, vitamin A, B6, D, E, whole grains, legumes/nuts

Hypothalamus

Functions to 1. maintain a constant internal environment 2. implement behavioral patterns. It exerts its influence through the endocrine system.

Fungal Disease

Fungal are relatively large MO with thick walls that have two basic structures: Single celled yeasts (pheres) or multicelled molds.

Dermatophytes

Fungi that invade the skin, hair, or nails and produce the disease tineas (ringworm). They grow in ringlike, erythematous patch with a raised border. Itching is often intense and cracking of tissue can occur and lead to secondary bacterial infection.

Dimorphic Fungi

Fungus that can that can exist in either single celled yeast or multicelled molds.

Pathogenic Fungi

Fungus that cause disease by adapting to the host environment.

Type II: Tissue-specific Hypersensitivity Reactions

Generally reactions against a specific cell or tissue. Cells express a variety of antigens on their surfaces. The symptoms of Type II diseases are determined by which tissue or organ express the particular antigen. The cell my be destroyed by antibody and compliment. The antibody IgM or IgG react with an antigen on the surface of the cell.

What are the two phases of immune response?

Generation of clonal diversity and clonal selection.

Malignant Tumors

Grow Rapidly, are not encapsulated, are invasive, poorly differentiated (hard to see), high mitotic index, and can spread distantly.

Benign Tumors

Grow slowly, well-defined capsule - stay in specific area, not invasive, well differentiated (easy to see), low mitotic index, and do not metastasize (spread)

Septicemia

Growth of bacteria in the blood and is caused by a failure of the body's defense mechanisms. The usual cause is proliferation of gram negative bacteria.

Human Immunodeficiency Virus

HIV - infects and destroys the Th cells which are necessary for the development of both plasma cells and cytotoxic T cells. HIV suppresses the immune response against itself and suppresses development of immune response against other pathogens leading to the development of AIDS.

Epidemiology of AIDS

HIV is a blood borne pathogen acquired by transmission of blood or blood products, intravenous drug abuse, sexual activity, and maternal-child transmission before or during birth.

Pathogenesis of AIDS

HIV is a member of a family of viruses called retroviruses which carry genetic information in the form of RNA rather then DNA.

Bacterial causes of cancer

Helicobacter pylori - which can cause chronic infections such as peptic ulcer disease (the leading cause of cancer death world wide as a result of bacteria), stomach carcinoma, and mucosa-associated lymphoid tissue lymphomas. If not treated, chronic exposure can lead to cancer.

Parasitic Worms

Helminths - include tissue nemotodes (hookwork), flukes (liver fluke), and tapeworm.

Examples of Viruses

Herpes, Measels, Mumps, RSV, HIV, and Heb B

Urticaria

Hives, is a dermal manifestation of allergic reactions.

Genetics of Cancer

If the mutation occurs in somatic cells, it is not passed to progeny (the next generation), if the mutation occurs in germline cells (egg and sperm), a germline mutant cell it can be passed to future generations. It can be transferred in tumor suppressor gene, retinoblastoma gene, wilms tumor, neurofibromatosis, colon cancer, and breast cancer.

Type III: Immune Complex-mediated hypersensitivity

IgG. Most are caused by antigen-antibody (immune) complexes that are formed in the circulation and deposited later in vessel walls or other tissues.

Hyperacute rejection

Immediate and Rare rejection of transplant.

Broca Speech Area

In the frontal lobe, injury causes inability or difficulty in forming words.

Fever and Infection

Infections many not cause fever directly, but induce the production of endogenous pyrogens during inflammation. It is generally accepted that fever has beneficial effects against infection.

Body's initial response to presence of bacteria

Inflammation

Arteries supplying blood to the brain

Internal Carotid and Vertebral

Autonomic Nervous System

Involved with regulation of the body's internal environment through involuntary control of organ systems. The ANS is further divided into sympathetic and parasympathetic.

The Midbrain

Involved with voluntary and involuntary visual motor movements (the ability of the eyes to track moving objects in visual field), and movements in the auditory system (positioning the head to improve hearing)

Fatigue associated with Cancer

Is a major definitive sign of cancer. Tired, weakness, lack of energy, exhaustion, lethargy, inability to concentrate, depression, sleepiness, boredom, and lack of motivation. These are subjective clinical manifestations.

Acute Rejection

Is cell-mediated immune response that occurs withing days to months after transplantation.

Chromosome instability

Is increased in malignant cells which results in chromosome loss, loss of heterozygosity, and chromosome amplification.

White Matter

Lies beneath the cerebral cortex and is composed of myelinated nerve fibers.

Subarachnoid Space

Lies between the arachnoid and the pia mater and contains cerebrospinal fluid.

Subdural Space

Lies between the dura and arachnoid. Many small bridging veins that have little support traverse the subdural space. Their disruption causes subdural hematoma.

Spinal Cord

Lies within the vertebral canal and is surrounded and protected by the vertebral column. It has many function such as somatic and autonomic reflexes, and motor pattern control centers. Originates at Medula.

Gray Matter of Spinal Cord

Located in the middle of the spinal cord, has three sections the posterior horn, lateral horn, and ventral horn.

Axons

Long conductive projections from the cell body that carry nerve impulses away from the cell

Cancer Diagnosis

Manifestations based on site, tumor size Diagnostic testing - mamorgrams. Main way to diagnos is with signs and symptoms. Patients are often treated for other diseases as symptoms are similar. Once cancer is discovered, a biopsy is done.

Temperature needs of Fungi

Many fungi can grow with a wide variety of temperatures in low oxygen environments.

Diet - Risk factors

May account for 30% of overall risk factors for cancer. Toxic, mutagenic, and carcinogenic chemicals in food such as cooking of meat proteins, certain oils in foods.. Research ongoing regarding vitamin influence.

Temperature Regulation

Mediated primarily by the hypothalamus. The Hypothalamus triggers heat production and heat conservation or heat loss mechanisms.

Myelencephalon

Medula Oblongata - forms the lowest portion of the brain stem. Controls reflex activities, such as heart rate, repsiration, blood pressure, coughing, sneezing, swallowing, and vomiting.

Distant Metastases

Metastases often occurs in the first capillary bed encountered by circulating cells - it follows the path of blood or lymphatic system. Organ tropism - preferential growth of cancerous cells in certain organs

Opportunistic Microorgansims

Microorganisms that normally would not cause disease but seize the opportunity provided by the person's decreased immune or inflammatory responses.

Electromagnetic radiation

Microwaves, cell phones, power lines, cell towers, fluorescent lights, computers, and other electrical equipment.

Sympathetic Nervous System

Mobilizes energy stores in times of need (fight or flight response). Epinephrine and norepinephrine are mediators of the fight or flight response.

Oxygen needs of Fungus

Molds are aerobic and Yeasts are facultative anerobies which mean they adapt to, but do not require, anaerobic conditions.

How many neurotransmitters are there?

More then 30, one of them being acetylcholine.

Allergies

Most are a hypersensitviity desease with type 1 reactions that lead to annoying symptoms such as rhinitis, sneezing, and other relatively mild reactions. Some individuals have excessive life-threatening reactions (anaphylaxis) to things such as peanuts, bee stings, shellfish, fish, milk, eggs, and some medications. Use of epipen!

Type I: IgE Mediated Hypersensitivity

Most occur against environmental antigens and are therefor allergic. Most potent is histamine. Some allergic responses can be controlled by blocking histamine receptors with antihistamines.

Oncogenes

Mutant genes that in there normal non-mutant state direct synthesis of proteins that positively regulate (accelerate) proliferation. The mutant genes prevent the tumor-suppressor genes from suppressing proliferation. Cells continue to divide and do not stop.

Nomenclature of Malignant tumors

Named according to the tissue from which they arise OR by the name of the person who discovered it.

Nerve Impulses

Neurons generate and conduct electrical and chemical impulses by selectively changing the electrical potential of the plasma membrane and influencing other nearby neurons by releasing chemicals (neurotransmitters).

Acetylocholine

Neurotransmitter released by somatic efferent nerves

Age related factors affecting mechanisms of self defense in Newborns and the Elderly

Newborns cannot produce all classes of antibodies. Elderly immune function decreases with age.

Proto-oncogenes

Normal genes that direct protein synthesis and cellular growth

Immune system and Cancer

Normal immune system protects against cancer, but immunosupression fosters cancers such as non-hodgkin lymphoma and kaposi sarcoma. In some cases, cancer promotes secretion of cytokines that foster cancer. Damage to immune system does not mean you will get cancer though.

Immunoglobulin IgE

Normally at low concentrations in the circulation. It is a mediator of many common allergic responses (hay fever, dust allergies, bee stings). It protects the individual from infection with large parasites.

Alloimmune Disease

Occur when the immune system of one individual produces an immunologic reaction against tissue of another individual.

Chronic Rejection

Occurs after a period of months or years of normal function of transplant.

Passive Immunity

Occurs when preformed antibodies or T cells are transferred from a donor to the recipient. This can occur naturally, as during pregnancy, or artificially, when antibodies are injected to fight against specific disease.

Air pollution

Outdoor - Heavy metal and aromatic hydrocarbon emissions from industry (cars). Increased risk in bigger cities. Indoor - Environmental tobacco smoke, radon gas, heating and cooking combustion sources, asbestos, and inorganic arsenic.

Chronic or persistent pain

Pain lasting more then 3 to 6 months.

Cancer Metabolism

Parasitic extraction of nutrients from blood. Divide even in hypoxic (less oxygen) or acidic states - can grow in these states when most things cannot. Use aerobic glycolysis so subsequent metabolites can be used for growth.

T Lymphocytes

Part of cell-mediated immunity. Attack antigens directly and destroy cells that bear foreign antigens. Cells are particularly important in protection against viruses, tumors, and pathogens.

Secretory (mucosal) immune system.

Part of the Humaral system. A partially independent immune system that protects external surfaces of the body. Antibodies in bodily secretions such as tears, sweat, saliva, mucus, and breast milk provide local protection against infection.

Systemic Immune System

Part of the Humoral system. Protects the entire body.

Controlling Fungi

Phagocytes and T lymphocytes are important in controlling fungus. Low white blood cell counts promote fungal infection and infection control is particularly important for individuals who are immonosuppressed.

Immunoglobulin IgA

Predominant class found in body secretions. It is the dominant secretory immunoglobulin.

Efferent Pathways

Primarily relay information from the cerebrum to the brain stem or spinal cord.

What are the two phases (responses) of the immune response to antigens?

Primary and Secondary Responses.

Endorphins

Produce the greatest sense of exhilaration as well as substantial natural pain relief.

Active Immunity

Produced by an individual either after natural exposure to antigens or after immunization.

Telomeres

Protective caps on each chromosome that are held in place by telomerase, they block cell division and prevent immortality. They become smaller and smaller with each cell division, the smaller they are the less likely they are to divide. Cancer cells can activate telomerase and tell them not to get smaller so cells will continue to divide.

Exotoxins

Proteins released during bacterial growth. They are usually enzymes and have highly specific effects on host cells. They include cytotoxins, neurotoxins, pneumotoxins, enterotoxins, and hemolysins.

Antibodies

Proteins that are produces by B cells, circulate in the blood, and bind to antigens on infectious agents. They are responsible for protection against many bacteria and viruses. These cells have memory.

Circle of Willis

Provides an alternative route for blood flow to the brain when one of the contributing arteries is obstructed.

Examples of Gram Negative Bacterial Infections

Pseudomonas Euroginosa, Rickettsia, Escherichia Coli

Conditions associated with Secondary immune deficiencies

Psychological stress, and dietary insufficiency.

Toxoids

Purified toxins that have been chemically detoxified without loss of immunogenicity - used in vaccinations against system toxins (Diphthera, tetanus)

Brachytheropy

Radiation is placed in a capsule near the cancer cells

Endogenous pyrogens

Raise the set point by inducing the hypothalamic in response, there is an increase of heat.

Delayed hypersensitivity

Reactions take several hours to appear and are at maximal severity days after re-exposure to the antigen.

Immediate hypersensitivity

Reactions that occur within minutes to a few hours after exposure to antigen

Physical Activity

Reduces cancer risk (breast, colon, other). Decreases insulin growth factors, decreases obesity, decreases inflammatory mediators and free radicals, increases gut motility.

Classification of cancers of blood-forming cells

Referred to as Leukemias

Classification of lymphatic tissue cancer

Referred to as Lymphomas

Classification of Malignant Connective tissue tumors

Referred to as Sarcomas (Rhabdomyosarcomas)

Tumor

Referred to as a neoplasm - new growth

Classification of Malignant epithelial tumors

Referred to as carcinomas (adenocarcinoma)

Carcinoma in situ (CIS)

Referring to epithelial cells which are abnormal in cell of origin. The cells are in their normal location but are abnormal in quantity and shape. These cells have not moved into the surrounding area and are not yet malignant. These cells can do three things 1. Do nothing, 2. be digested by the body, 3. turn cancerous and spread.

Allergy

Refers to a hypersensitivity to environmental antigens that include medicines, natural products (pollen, bee stings), infectious agents, and other antigens not naturally found in individual.

Visceral Pain

Refers to pain in internal organs and lining of body cavities

Nerve Regeneration factors

Regeneration depends on location of the injury, the type of injury, the presence of inflammatory responses, and the process of scaring.

Norepinephrine

Releases most postganglionic sympathetic fibers (adrenaline). The primary response causes vasoconstriction.

Opiate Drugs and Pain

Relieve pain by attaching to the opiate receptors.

Frontal Lobe

Responsible for goal-oriented behavior (ability to concentrate), short term or recall memory, programming motor movement, controlling eye movement, primary motor area.

Cerebellum

Responsible for reflexive, involuntary fine tuning of motor control and for maintaining balance and posture.

Alcohol Consumption

Risk factors for oral, cavity, esophagus, and liver cancers. Substantial alcohol consumption has been associated with head and neck cancers. Cigarette/alcohol combination increases risk even more. Genetic factors involved.

Portal of Entry

Route by which a pathogenic MO infects the hose: Direct contact, inhalation, ingestion, or bites of an animal or insect.

Products of the adaptive immune response

Serum proteins Immunoglobulins or antibodies and blood cell lymphocytes

Types of Chemotherapy

Single agent - some cancers respond to one kind Combination Principle of dose intensity Administration schedule very important

Causes of Fatigue associated with Cancer

Sleep disturbances, biochemical changes, psychosocial factors, level of activity, nutritional status, and environmental factors.

Types of Acute Pain (3)

Somatic, visceral or referred

Dermatomes

Specific areas of cutaneous innervation at spinal cord segments.

Metastasis

Spread of cancer from a primary site of origin to a distant site. This is a major cause of death in cancer and a defining characteristic of cancer.

Staging - a way to annotate cancer in chart

Stage 1 - No metastasis State 2 - Local Invasion State 3 - Spread to regional structures State 4 - Distant metastasis TNM system T - for tumor spread (T 0-3) N - for node involvement (N 0-2) M - for presents of distant metastasis (M 0-2)

Choroid Plexuses

Structures that produce CSF.

Pain Threshold

Subjective phenomena that influence an individuals perception of pain

Nonself

Substances that are foreign to the body. This is something the Immune Response is capable of doing.

Antigens **

Substances that react with molecules of the immune system. They are often infectious agents (viruses, bacteria) on noninfectious substances from the environment (pollens, foods, or bee venom).

Somatic Pain

Superficial, arising from the skin. Sharp, dull, aching, or throbbing.

Meninges

Surround the brain and spinal cord and have three protective membranes: The dura mater, the arachnoid, and the pia mater.

CD4

T cells that are destined to become Th (t-helper) cells emerge from the thymus with characteristic cell surface proteins.

Types of lymphocytes

T lymphocytes (T cells) and B lymphocytes (B cells), they have the capacity to recognize almost any foreign antigen. Each T and B cell recognizes only one particular antigen.

Ultraviolet Radiation

Tanning Beds, sunlight. Causes basal cell carcinoma, squamous cell carcinoma, and melanoma. Promotes skin inflammation and release of free radicals. Released TNF in epidermis, produces ROS.

Diencephalon

The Interbrain. Is surrounded by the cerebrum and has four divisions: epithalamus, thalamus, hypothalamus, and subthalamus.

Humoral Immunity ***

The arm of immune response responsible for protection against many bacteria and viruses (antibodies)

Blood Supply of the CNS

The brain receives 20% of the cardiac output or 800-1000 ml of blood flow per minute. Carbon Dioxide is a primary regulator for blood flow within the CNS, it is a potential vasodilator.

Epidemiology

The branch of medicine that deals with the incidence, distribution, and possible control of diseases and other factors relating to health.

Syndrome of Cachexia

The cancer east all the nutritional reserves in the body. It is the most severe form of malnutrition and is present in 80% of cancer patients at death. It includes anorexia, weight loss, anemia, asthenia, taste alterations, and altered protein, lipid, and carb metabolism.

Tobacco - Risk factors

The chemicals and nicotine, linked to cancers in the lung, lower urinary tract, upper aerodigestive tract, liver, kidney, pancreas, cervix, and uterus. Linked to myeloid leukemia. Second hand smoke, cigars, and pipe smoking are just as toxic.

Function of Antibodies

The chief function is to protect against infection. It is possible to measure the amount of immunoglobulins in the blood.

Pain Perception

The conscious awareness of pain which occurs primarily in the reticular and limbic systems and the cerebral cortex.

Autoimmunity

The disturbance in the immunologic tolerance of self-intigens.

Immune Deficiency

The failure of the immune or inflammatory response to function normally resulting in increased susceptibility to infection. The most common presenting symptom of immune deficiencies is recurrent severe infections.

Generation of clonal diversity

The first phase of immune response. This process mostly occurs in specialized lymphoid organs. (primary lymphoid organs)

Neuroglia

The general classification of cells that support the neurons of the CNS.

Surgery Treatment

The goal is to prevent cancer. Biopsy for diagnosis and staging. Lymph node sampling to see if the cancer has spread. Debulking surgery - to remove as much as possible, common before chemo. Palliative surgery.

Ionizing radiation treatment

The goals are to eradicate cancer without excessive toxicity and avoid damage to normal structure. Can only be exposed for a limited time. Radiation damages the cancer cell's DNA.

Specific Immunity

The immune response is able to identify a specific pathogen among many pathogens and eliminate it by using memory

Inducible Immunity

The immune response must recognize the pathogen as foreign or "nonself"

Immunoglobulin IgM

The largest Immunoglobulin. It is the first antibody produced during the initial, or primary response to antigens.

Immunoglobulin IgG

The most abundant Immunoglobulin constituting 80% to 85% of the immunoglobulins in the blood and account for most of the protective activity against infection.

Viral Disease

The most common affliction of humans and include a wide variety of disease ranging from common cold and "cold sores" of herpes to several types of cancers and AIDS. Viruses are simple MO consisting of nucleic acid, has a layer of proteins that protect it from environment, and are sensitive to many environmental factors and have a short life span outside the cell.

Systemic Lupus Erythematosus (SLE)

The most common, complex, and serious of the autoimmune disorders. Is characterized by the production of a large variety of antibodies (autoantibodies) against self-antigens. It occurs most often in women. Clinical manifestations include arthritis (90%), renal disease (40-50%) and cardiovascular disease (30-50%). Has frequent remission and exacerbation.

Anaphylaxis

The most rapid and severe immediate hypersensitivity reaction and occurs within minutes of re-exposure to the antigen. Can be fatal.

Bacteremia

The presence of bacteria in the blood

Temporal Lobe

The primary auditory cortex

Neuron

The primary cell of the nervous system

Development of T Lymphocytes

The primary lymphoid organ for T cell development is in the Thymus. Lymphoid stem cells journey through the thymus and eventually exit the thymus through the body vessels and lymphatics mature.

Occipital Lobe

The primary visual cortex

Nociception

The process of potentially harmful (noxious) stimuli through a normally functioning nervous system

Induction Chemotherapy

The purpose is to shrink the tumor or cause it to disappear completely

Neoadjuvant Chemotherapy

The purpose is to treat cancer before surgery to shrink it to make surgery more successful.

Adjuvant Chemotherapy

The purpose is to use after surgical removal of tumor/cancer calls.

Transplantation

The recipient of a transplant can mount an immune response against the foreign MHC (major histocompatibility complex) antigens on the donor tissue, resulting in rejection.

Synapse

The region between adjacent neurons

Clonal Selection

The second phase of immune response initiated by antigens.

Bacterial Disease

The thick capsules of carbohydrates or protein on encapsulated bacteria prevent phagocytosis.

Adaptive Immunity or Immune response

The third line of defense in the human body. It is called into action once external barriers have been compromised. It serves two purposes: Destroying infections MOs and providing long-term highly effective protection against future exposure against the same MO. It can be either active or passive.

Spinal Nerves

There are 31 pairs, they derive their names from the vertebral level from which the exit. (There are 12 pairs of cranial nerves)

Synaptic Cleft

There area that neurotransmitters diffuse across once the impulse is released from the vesicles. Neurotransmitters are normally stored on one side of the cleft and the receptors on the other.

Pain associated with Cancer

There is little to no pain associated with early states of malignancy. Most is influenced by fear, anxiety, sleep loss, fatigue, and overall physical deterioration. Some things that may cause pain: Pressure, obstructions, invasion of sensitive structures, stretching of visceral surfaces (brain), Tissue destruction, and inflammation

Viruses and Cancer

These viruses can lead to cancer: Hepatitis B and C, Epstein-Barr, Kaposi sarcoma herpesvirus, Human papillomavirus Human T cell leukemia - lymphoma virus

Hypersensitivity reactions

They are immediate or delayed depending on the time required to elicit clinical symptoms after re-exposure to the antigen. There are 4 types of reactions Type I - IV

Nomenclature of Benign Tumors

They are named according to tissues from which they arise and include the suffix "oma", Lipoma, glioma, leiomyoma, Chondroma

Motor Neurons

Transmit impulses away from CNS to an effector (skeletal muscles or organs).

Afferent Pathways

Transmit information from peripheral receptors and eventually terminate in the cerebral or cerebellar cortex, or both.

Pons

Transmits information from the cerebellum to the brain stem. The nuclei of the fifth through eight cranial nerves are located in this structure.

Paraneoplastic Syndromes

Triggered by cancer but not caused by cancer. These are symptoms that cannot be explained by the local or distant spread of the tumor or by the effects of hormones released by the tissue from which the tumor arose.

Tumor markers

Tumor cell markers (biologic markers) are substances produced by cancer cells or that are found on plasma cell membranes, in the blood, CSF, or urine. Some tumors can be detected before they appear as cancer. Are found in hormones, enzymes, genes, antigens, and antibodies

Histology and Gentics of Tumors

Tumors are classified based on immunohistochemical analysis of genetic alterations for improved treatment. - Determine specific genetic mutation - Identify multiple subdivisions Looking at a specific cancer gene you can find a specific treatment to kill that cancer cell. (breast cancer)

Chemicals and Occupational Hazards

Upper respiratory passages, lung, bladder cancers caused by Asbestos, dyes, rubber, paint (huffing), explosives, rubber cement, air pollution

What is Chemotherapy

Use of nonselective cytotoxic (kills cells both good and bad) drugs that target vital cellular machinery or metabolic pathways critical to both malignant and normal cell growth. The goal is to eliminate enough tumor cells so the body's defense can eliminate the rest.

Hormone therapy treatment

Used mostly with cervical and breast cancer. Interferes with cellular growth and signaling.

Virus's are self limiting

Viral pathogens bypass many defense mechanisms by developing intracellularly, they can hide within the cell and away from normal inflammatory or immune responses. In many cases though, because virsus must spread from cell to cell, immunity eventually cures the infection.

Viral Replication

Viruses have no metabolism and are incapable of independent reproduction (unlike bacteria). Replication relies on their ability to infect a host cell that cannot resist viral invasion and replication. After infection, viruses make multiple copies of their genetic material in order to replicate.

Latent Viruses

Viruses that are not initially productive but instead initiate a latency phase. Stimuli produced by stress, hormonal changes, or disease can cause viruses to enter productive cycle.

RNA Viruses

Viruses that replicate their genetic material in the cytoplasm of the infected cell.

DNA Viruses

Viruses that require the DNA to enter the nucleus and use the cell's DNA polymerases to replicate.

Septic Shock

When gram negative bacteria enter the blood, endotoxins cause the release of vasoactive peptides that reduce blood pressure, cause decreased oxygen delivery, and produces subsequent cardiovascular shock.

Normal Flora fungal infections

When the immune system is compromised, normal flora can grow and translocate such as with Candida Albicans. This causes changes in pH and use of antibiotics can destroy bacteria that normally inhibit Candida growth. This can lead to superficial or deep infection.

Secondary Lymphoid Organs

Where Clonal selection occurs. Where antigens selectively react with B or T cells. These organs include the spleen, lymph nodes, adenoids, and tonsils.

Synaptic bouton

Where chemical (neurotransmitters) are stored when an impulse is originated from a presynaptic neuron, and the impulse reaches the vesicles (where the chemicals are stored)

Gene Silencing

Whole regions of chromosomes are shut off while the same region in other cells remain active. The cell is no longer productive and cannot fulfill it's function.