Immune System Dysfunction Flashcards
Molecule capable of inducing an immune response in host organism
Antigen
Existing from brith immune system; evolutionarily conserved system acting as a first line defense against invading microbial pathogens and other potential threats to host; mechanism include physical barriers (skin, chemicals in blood, cells that attack foreign cells in body)
Innate immune system
Come into play immediately or within hours of antigen’s appearance in body
Innate immune system
Antigen specific immunize response; triggered when pathogen evades innate immune system; mor complex
Adaptive immunity
Requires days to active with unfamiliar antigen; develops memory that make future response quicker and more effective
Adaptive immunity
Major functions of acquired immune system
Recognition of specific “non self” antigens in the presence of “self”, during process of antigen presentation
Immune system that enhances ability of antibodies and phagocytic cells to clear microbes and damages cells, promote inflammation, and attach pathogens plasma membrane
Complement system
Proteins that act to inhibit the complement system (C1-inhibitor) and can lead to what kind of response, causing hereditary angioedema
Overactive
Proteins that act to activate the complement system (C3) that can lead to what response, causing greater susceptibility to infections
Under active
Measure of number of neutrophil granulocytes
Absolute neutrophil count (ANC)
Abnormal ANC
> 7,700 cells/cubic mm
Excessive innate response leads to what?
Higher neutrophilia count
Angioedema can be treated with what? (3)
C1inhibitor (25U/kg) or FFP (2-4units)
- Cinryze
- Ruconest
- Berinert
What is NOT useful for angioedema (4)
- Androgens
- Catecholamines
- Antihistamines
- Anti fibrolytics
Defects of antibody production and how is it treated?
X-linked treated with IV immunoglobulin /3-4 months
Defects in T lymphocytes
DiGeorge syndrome (characteristics facies, congenital heart disease, hypocalcemia)
Combined immunodeficiency (SCID), unable to fight off most types of infections, including bacterial, viral and fungal infections
Adenosine deaminase (ADA) deficiency
Excessive adaptive immunity with allergic reaction types?
1, 2, 3, 4
Life threatening antigen antibody reaction, occurs within 5-10min, up to 50% IV fluid leaks out through capillaries
Antiphylaxis, type 1
Most common intraop drug allergies?
Muscle relaxant
Intraop drug allergies (4)
- Muscle relaxant
- Latex
- Antibiotics
- Hypnotics, opioids, X-ray contrast, protamine
What are the least cause of anaphylaxis with drug allergies (2)
- Ketamine
2. Benzodiazepines
What is a good consideration with anaphylaxis?
Abrupt drop in BP
What can anaphylaxis mimic (4)
PE, acute MI, aspiration, vasovagal
Treatment with anaphylaxis? (4)
- Epi 10-100mcg every 1-2min
- Benadryl
- Albuterol inhaler
- Corticosteroids
Misdirected adaptive immunity
Autoimmune disease
Who gets autoimmune disease? (4)
- Women of childbearing age
- Family history (lupus and MS)
- Environment triggers (sunlight, solvents, viral and bacteria)
- Race or ethnicity (DM1=whites, lupus=African&hispanic)
Enlargement of thyroid due to lymphocytic infiltration and fibrosis rather than tissue hypertrophy; hypothyroidism with bouts of hyperthyroidism, leading to muscle failure and HF
Hashimoto’s thyroiditis
Anesthesia and Hashimoto’s thyroiditis? (5)
Airway compromise (edema and deviation), hypothermia, anemia, hypoglycemia, hyponatremia
Leading cause of hyperthyroidism?
Graves’ disease
Treatment of Graves’ disease
Propylthiouracil (PTU) or methimazole
Anesthesia and Graves’ disease (2)
- Use anything that DOES NOT simulate SNS
2. Run DEEP
How to handle thyroid storm (5)
- Cooling pt
- IV fluids
- Control BP and HR (propranolol, esmolol, labetalol, NTG)
- Decadron (2mg/6hr) or cortisol (100-200mg/8hr)
- PTU (200-400/8hr)
Destruction of gastric parietal cells decreases absorption of Vit B12 leading to anemia
Pernicious (Addison’s) anemia
Treatment of pernicious (addison’s) anemia
B12 supplements
Immune system begins to attack liver cells leading to cirrhosis and even liver failure
Autoimmune hepatitis
Treatment for autoimmune hepatitis?
Corticosteroids (if not treated can lead to DM, HTN, psychosis, infxn, osteoporosis)
Hyperglycemia (>250), hyperosmolar, dehydration, ketosis, acidosis (<7.25), low K Na Mg PO4
Diabetic ketoacidosis (DKA)
Fluid bolus for DKA
Peds: 10ml/kg
Adult: 1L
Add K if below 5.3
Insulin bolus for DKA
Lower glucose to 250-300mg/dL slowly
.1unit/kg/hr or .1 unit/kg bolus
No bicarb unless pH below 7.0
What is used for cerebral edema for DKA (2)
Mannitol Hypertonic saline (3%)
Chronic disease resulting form inability of pancreas to maintain production of insulin necessary to regulate blood sugar levels leading to DKA, HTN, CAD, PVD, CHF, MI, CVA, CRF, infxn, neuropathy
Type 1 DM
Stress of surgery can lead to what in DM1?
Hyperglycemia, ketoacidosis, insulin resistance
Gluten intolerance, consumption of gluten products and some other proteins in foods like wheat or rye cause damage to small intestines lining
Celiac disease
Progressive disease that affects CNS; causes damage to nerves, slowing down or completely disrupting nerve impulses
Multiple sclerosis
MS and anesthesia (5)
- Spinal exacerbate symptoms
- Caudal, epidural doesn’t
- Sux may increase k+
- NDMR may prolong or resistant
- Steroids
Causes hair loss anywhere on body but is most common on scalp
Alopecia areata
Characterized by inflammation of GI tract; can afflict any part of GI tract right from the mouth to anus
Crohn’s disease
What should you be careful with for pt on Crohn’s disease
OG
