Pathophysiology III

Paramedic Class 108

Disease in the Human Body
Factors

Genetics
Environment
Life-style
Age
Gender
Many Factors Combine To Cause
Disease
Inherited traits are determined by molecules
of deoxyribonucleic acid (DNA).

Each somatic cell contains 46

chromosomes.

Sex cells contain 23 chromosomes.

 Many Factors Combine To Cause
Disease

An offspring receives 23 chromosomes from the

mother and 23 chromosomes from the father.

One or more chromosomes may be abnormal

and may cause a congenital disease or a
propensity toward acquiring a disease later in
life.
 Genetic vs. Environmental
Genes need an environment to work.

Environmental factors vary with everyone.

Environment the same – People have

different genetic characteristics.

Very Complex
 Genetic Factors
Heredity – Chromosomes

Individual Genetic Factors

Entire Chromosmal abnormalities

 Genetic Factors
EXAMPLES

Down’s Syndrome – Rearranged

Chromosomes.

Sickle Cell / Hemophilia – Single gene on

chromosome passed on results in an
abnormal protein.
 Genetic Factors
Polygenic
Determined by many genes
multi- factional

CAD
HTN
CA
 Environmental Factors
Think Chronic Disease’s

Microorganism & immunological exposure

Personal Habits
Chemical Substances
Physical Environments
Psychosocial Environments
Environment & Heredity
More than one genetic defect

CAD
HTN
CA > 40 yoa
 AGE & GENDER
Cumulative Effects

Gender Specific

Breast Cancer
Testicular Cancer

Ovarian Cancer
Prostrate Cancer
 AGE & GENDER
Cumulative Effects

ENVIRONMENTAL

Cigarette Smoking

Lung Cancer

CAD – Men
 COMBINED EFFECTS

Familial Disease Tendencies

Aging and Age related Disorders

LINES OF DEFENSE
Characteristics
Body’s Self-Defense Mechanisms
Defense against illness and injury
– First-line external barriers include:
Skin
Mucous membranes of the respiratory, digestive,
and genitourinary (GU) tract
– Second—Inflammatory response
– Third—Immune response
Stages of Inflammatory Response
Cellular response to injury
– Energy depletion, autolysis

Vascular response to injury

– Hyperemia, vessel dilation
– Leukocyte migration

Phagocytosis
– Leukocytes destroy pathogens
– Exudate (pus) forms
 Cellular Response
Metabolic
Decreased Energy Stores (Aerobic Respiration)
Sodium/Potassium Pump impaired

Cell Swelling – Acidosis

Membranes Leak

Cellular Destruction

Inflammatory Response
 Vascular Response

Dilation - arterial, venules, and capillaries.

Increase permeability (Interstitial = Edema)

Leukocytes – Attack injured Tissue

 Phagocytosis

Leukocytes – attack & Destroy

Macrophages – Clean area of dead cells
Occurs at site of invasion
General Circulation – Systemic
Leukocytes – Lyses
Pus Forms – (Exudate)
Pus= dead dying leukocytes, broken down
tissue cells,pathogens,and tissue fluid.
 MAST CELLS
Connective Tissue
Cytoplasm
Histamine/serotonin
– Allergies
– Vasoactive amines
– Aminos
– Allergies
– Chemotactic Factors
– Random migration
– Stimulated migration
– Attracts leukocytes
 MAST DEGRANULATION
Stimulated by physical Injury – Chemicals – Allergies IgE

Histamine – Capillary Dilation

Serotonin – Vasoconstriction or dilation

Chemotaxis – Attract White Blood Cells

Neutrophils – Most Prevalent

Eosinphils – parasites - Worms

MAST CELL HELP
Mast Cell Degradation and Synthesis
 Inflammatory Response
Local
 Vascular

 Vasodilatation increased permeability

 Formation of pus (Exudate)

 Local Signs - ???

 Heat, Redness, swelling, pain and tenderness

Inflammatory Response
Systemic

Fever ( Pyrogens)

Leukocytes

Increased Plasma Proteins

 Inflammatory Response

Acute inflammation
– Local responses
– Systemic responses

Chronic inflammation
– Inflammation > 2 wks
Inflammatory Response
Chronic
Defined

Lasting 2 weeks or longer

Results From
Unsuccessful acute inflammation
Persistent –Ongoing antigen or infection
 CHRONIC INFLAMMATION
Characteristics
Persistent – Acute Inflammation Response
Neutrophil- Degranulation & Death
Lymphocyte Activation – Clean up
Fibroblast Activation - Healing
Infiltration (pus) – Clean up
Tissue Repair (Scar)
 Types of Immunity

Natural (native) Genetic or Innate

– Present at Birth
– No prior exposure

Acquired
Humoral immunity
Cell-mediated immunity
 Acquired Immunity

Active- Immunizations or disease (Natural)

Passive – Mother –Child or Antibody

administration.
Humoral vs. Cell Immunity

Humoral – (Anti Body Mediated)

Lymphocyte B cells

Cell Mediated ( cellular immunity)

Lymphocyte T cells
Direct Attack – Best Defense
 AGE & IMMUNE
RESPONSE

INFANTS
Antibodies – Passive Immunity

Older we get the less immunities

we maintain.

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

Immunogen
– Antigen that can also induce formation of
antibodies
Induction of Immune Response
To be immunogenic, the antigenic molecule
must be
– Sufficiently foreign to the host
– Sufficiently large
– Sufficiently complex
– Present in sufficient amounts

B lymphocytes - Antibodies

T lymphocytes - Killers
IMMUNE RESPONSE

Summary
of the
Immune
response
 Immune vs. Inflammatory

Immune Inflammation
Develops slowly Develops swiftly
Targets specific antigens Non-specific
Long-lasting—has “memory” Temporary—days to weeks

Involves one type of white Involves many types of

blood cell white blood cells and
platelets
One type of plasma protein— Several plasma proteins—
antibodies complement, coagulation,
kinin
 Disease Deficiencies

Nutritional
Iatrogenic
Trauma
Stress
Acquired Immunodeficiency (AIDS)
 Immune - Primary
Immunizations – Exposure
Activate B Cells
Memory Cell Develops (B)
Secretion of Antibodies
Pathogenic organism DEAD
 Classes of Immunoglobulin's
IgM—produced first.
IgG—has “memory.”
IgA—involved in secretory immune
responses.
IgE—involved in allergic reactions.
IgD—present in very low
concentrations.
 Immunoglobulin's
IgG (70 -75 %) IgE (less than 1%)
– Secondary immune – Immediate
response hypersensitivity
reactions
IgM (5-10 %)
– ABO incompatibilities IgD (less than 1%)
Function unknown
IgA (15%)
– Defends body surface
against organisms
 Hypersensitivity
Altered immunologic reactivity to antigen

Causes pathologic immune response after

reexposure

Abnormal responses include:

– Allergy
– Autoimmunity – Host own cells
– Isoimmunity – Beneficial foreign tissue
Mechanisms of Hypersensitivity
Immediate hypersensitivity reactions
– Itching, hives
– Anaphylaxis

Delayed hypersensitivity reactions

– Take several hours to 1 to 2 days to appear
– At maximum several days after antigen
reexposure
 IMMEDIATE

Antigen – Anti Body Reaction

– Mild- Itching Hives
Severe – Life Threatening
Anaphylaxis
 DELAYED
Cell Immunity Hypersensitivity

Hours – Days

Maximum Severity days later

Poison Ivy – Skin Grafts

Homeostasis

QUAN
 Stress & Disease
Think Sympathetic
Adrenal Gland
– Epi, Norepi, Dopamine
Alpha & Beta Effects
 Stress & Disease
Hypothalamus – pituitary gland
Growth
Blood pressure
Some aspects of pregnancy and childbirth including
stimulation of uterine contractions during childbirth
Breast milk production
Sex organ functions in both women and men
Thyroid gland function
The conversion of food into energy (metabolism)
Water and osmolarity regulation in the body
 Stress & Disease
Cortisol
Secreted by the adrenal glands and involved
in the following functions and more:
Proper glucose metabolism
– Regulation of blood pressure
– Insulin release for blood sugar maintenance
Immune function
Inflammatory response
 Cortisol (Hydrocortisone)
Circulates in the plasma

Mobilizes substances needed for cellular metabolism

Stimulates gluconeogenesis
– Decreases glucose utilization

Immunosuppressant

Decreases migration of macrophages

– Decreases phagocytosis
 Catecholamines
Stimulate:
– Alpha-adrenergic receptors
Alpha-1 and alpha-2
– Beta-adrenergic receptors
Beta-1 and beta-2
 Alpha Receptors
Alpha-1 receptors
– Postsynaptic
– On the effector organs
– Stimulate contraction of smooth muscle

Alpha-2 receptors
– Presynaptic nerve endings
– Stimulate alpha-2 receptors
– Inhibit release of norepinephrine
 Beta Receptors
Beta-1 receptors Beta receptors
– Primarily in heart – Stimulate the heart
– Dilate bronchioles
– Dilate blood vessels in
Beta-2 receptors
the skeletal muscle,
– Bronchiolar and
brain, and heart
arterial smooth muscle
– Aid in glycogenolysis
STRESS
Nature

Intensity

Duration

Perception

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

“Stress is when you wake up screaming and

you realize you haven't fallen asleep yet”
 The Stress Response:

Effects on the Sympathetic Nervous, Endocrine,

and Immune Systems.
QUESTIONS