immune system Flashcards
when does the rudimentary system develop
begins at approx 6 weeks
what is phagocytosis
destruction of foreign toxins that are harmful
what do T cells do
destroy many virus-infected cells
antibodies (activated T cells) transfused to provide protection are a form of
passive immunity
acquired (adaptive) immunity
destruction of organisms and toxins by antibodies and specific lymphocytes
humoral branch of acquired immunity includes which cells
B lymphocytes (20-50% circulating)
cell mediated branch of acquired immunity includes which cells
T lymphocytes (20-50% circulating)
what are the 3 kinds of granulocytes
neutrophils, basophils, eosinophils
neutrophils
most numerous WBCs, 6h half life, fight bacteria and fungal infection
basophils
least common. involved in hypersensitivity. release histamine, leukotrienes, cytokines, and prostaglandins. stimulate smooth muscle contraction (bronchospasm)
eosinophils
heavy in GI (parasites), respiratory, and urinary mucosa
agranulocytes consist of
monocytes, lymphocytes
monocytes
phagocytosis, release cytokines, present pieces of pathogens to T-lymphocytes
b-lymphocytes is a type of ____ immunity
humoral immunity (produce antibodies)
T-lymphocytes is a type of ___ immunity
cell mediated immunity (does not produce antibodies)
characteristics of inflammation
localized vasodilation, increased blood flow, increased capillary permeability, extravasation of plasma proteins, chemotactic movement of leukocytes to site of injury
histamine is released by which two cells
basophils mast
stimulation of gastric secretion is by h
2
contraction of most smooth muscle other than that of blood vessels is H
1
cardiac stimulation is h
2
vasodilation is h
1
increased vascular permeability is h
1
type 1 hypersensitivity =
anaphylaxis
type 2 hypersensitivity =
antibodies specific to antigens attach to cell surface. cytotoxic (autoimmune hemolytic anemia)
type 3
immune complex disease. antibodies bind antigens and release enzymes that cause tissue damage (SLE, rheumatoid, glomerulonephritis)
type 4
delayed sensitivity (contact dermatitis, graft rejection)
symptoms of anaphylaxis
pruritus, urticarial, angioedema, hypotension, wheezing, bronchospasm, nausea, vomiting, abd pain, diarrhea, uterine contractions, cardiac effects, arrhythmias
what causes hypotension d/t anaphylaxis
increased capillary permeability. 50% fluid shift
which reaction can occur with first exposure
anaphylactoid
muscle relaxants percentage %
60 %
latex percentage %
15 %
antibiotics %
5-10%
opioids %
less than 5%
non-life threatening tx 3 drugs
epi, benadryl, corticosteriod
non-life threatening tx epi dose adult
100-500 mcg sub-q or IM repeat q10-15min
non-life threatening tx epi dose child
10mcg/kg - 500 mcg max q15 min x2 then q4h
non life threatening benadryl dose
1-2mg/lg or 25-50mg IV
life threatening (anaphylaxis) treatment
airway, 100% O2, epi, bronchodilators, H1 antihistamine and H2 receptor agonist, corticosteroid
life threatening epi dose
50-100mcg IV or more
what dose epi do?
increases cAMP which restores normal capillary permeability and relaxes smooth muscle
which type of patient might you see a poor response from epi
beta-blocked
what are some bronchodilators you can give during anaphylaxis
albuterol, terbutaline, and or anticholinergic agents (atropine, scop, glyco)
whats the chance of a mild transfusion reaction
1:500
whats the chance of a fetal hemolytic reaction
1;250,000-600,000
What is a fetal hemolytic reaction caused by
ABO incompatibility - antibodies destroy donor cells - DIC, renal failure
fetal hemolytic reaction is masked with anesthesia but you may see
CV instability, hypotension, fever, hemoglobinuria, bleeding diathesis
who’s at high risk for a latex allergy
health care workers, neural tube defects, multiple surgeries, spina bifida, GU tract defects, banana, kiwi, mango allergy
latex Type 4 reaction is ___ while type 1 is ___
dermatitis, anaphylaxis
how does latex allergy present in the awake patient
itchy eyes, generalized pruritus, SOB, feeling of faintness, impending doom, n/v, abd cramping, diarrhea, wheezing
how does latex allergy present in the anesthetized patient
tachycardia, htn, wheezing, bronchospasm, cardiorespiratory arrest, flushing, facial edema, laryngeal edema, urticaria
autoimmune disease pathology
insufficient or limited response to antigens superseded by a self-reactive state that is inadequate and dysfunction;
which 3 groups of people are commonly affected by autoimmune dz
female, child bearing years, working age
how does anesthesia interact with the immune system
anesthesia and surgery depress non-specific host resistance mechanisms
how do epidurals affect immune system
significant but transient alteration of lymphocyte and killer T activity
how do hypnotics affect immune system
decrease ciliary action
HIV/AIDS pathology
retrovirus invades cell-mediated branch of immune system
what kind of drugs do HIV patients take and whats the significance
non-nucleoside reverse transcriptase inhibitor (NNRTIs), induce CYP 450 system
common CV comorbidities HIV/AIDS
abnormal EKG in 50%, pericardial effusions in 25%
common comordibities
wasting syndrome, demential , peripheral neuropathies, autonomic abnormalities, platelet stability and function impairment, non-hodgkins lymphoma, kaposi’s sarcoma
most common opportunistic pathogen with HIV/AIDS
pneumocystis carinii (pneumonia responsible for most deaths)
highest risk of exposure to a blood borne pathogen is with
open bore needle
risk % after percutaneous exposure
0.3%
risk % after mucous membrane exposure
0.09%
non intact skin to infected fluid other than blood %
0.0%
what to do after exposure med tx
empirical treatment with 2 or more antiretrovirals within 1-2h, 1-2 weeks. periodic testing for 6mo.
SLE patho
chronic inflammatory dz, production of antinuclear antibodies
SLE presentation
polyarthritis and dermatitis, molar rash in 1/3 of patients, renal dz in >50%.
most common cause of death with SLE
renal disease. 10-20% will require dialysis
which patient is at a higher risk for sz, stroke, dementia, neuropathy, psychosis
SLE
pericardial effusion occurs in >___% of SLE patients
50
tx of SLE
corticosteroids, antimalarial, immunosuppresants
SLE is exacerbated by
infection, pregnancy, surgical stress, drugs
which drugs exacerbate SLE
procainamide, hydralazine, captoprol, enalapril, isoniazid, methyldopa, d-penicillamine
during anesthesia SLE patients are prone to
PE, pneumonitis, alveolar hemorrhage, pulm RN, restrictive lung dz
1/3 of SLE patients exhibit
cricoarytendoid arthritis, RLN palsy
cyclophosphamine, used to treat SLE & RA does what
inhibits plasma cholinesterase, so LA and succs have prolonged effects
scleroderma is what kind of disease , characterized by
collagen vascular disease. inflammation, vascular sclerosis, fibrosis of skin and organs.
how does scleroderma progress
- injury to vascular endothelium. 2. vascular obliteration and leakage of proteins into the interstitial space. 3 tissue edema and lymphatic obstruction due to the protein leakage. 4 tissue fibrosis
scleroderma anesthetic implications
may require fiberoptic intubation, bleeding with airway manipulation, chronic htn (contracted vascular volume) , GERD (hypotonis of lower esophageal sphincter), corneal abrasion (prone to dry eyes), pulm htn (avoid acidosis and hypoxemia)
what are advantages of regional anesthesia
offers advantage of peripheral vasodilation and post op pain control
Rheumatoid Arthritis patho
cellular hyperplasia in synovium (infiltration by lymphocytes, plasma cells, and fibroblasts)
articular cartilage is eventually destroyed in which dz
RA
Tx of RA
corticosteroids, methotrexate, immunosuppressants, NSAIDs
airway considerations for RA - cervical joints
neck extension restricted, atlantoaxial subluxation
airway considerations for RA - temporomandibular joint
small mouth opening
airway considerations for RA - laryngeal joints
generalized edema, laryngeal swelling
5 moments of hand hygiene
before patient contact, before aeseptic tase, after patient contact, after contact with patient surroundings
