Week 10 Study Guide Flashcards
Innate Immune Response
FIRST LINE
- Physical barriers: skin, mucosal linings at bodies opening
- Mechanical barriers: coughing, sneezing, vomiting, urination
- Biochemical barriers: saliva, tears, earwax, perspiration
SECOND LINE - Inflammatory response
- Generalized response: infectious agent, trauma, exposure to toxins, burns, etc. (Scorched earth policy, kill everything in the area)
- Tissue damage -> pathogenic invasion -> vasodilation and increased capillary permeability -> invading organisms EATEN ALIVE & fibrinogen clot formation -> LOCALIZED RESPONSE: signs of inflammation (erythema, warmth, edema, pain) -> SYSTEMIC RESPONSE: Fever, malaise, chills, increased WBCs, (figure 18.7)
Acquired Immune Response
Natural vs. artificial
- B & T cells mediated
- Actively adapts to new and interesting virus and bacteria exposure
*Reactive and specific (SLOW) response compared to innate immunity
- Passive adaptive immunity: immunizations, newborn from mom through placenta/breastmilk, transfusion of antibodies
- Active adaptive immunity: “normal” method of acquiring immunity. Body experiences illness or an invading pathogen, learns to recognize and fight it for next time
Lymphatic System
- Filtration system for the blood
- Lymph Nodes: grain of rice sized nodes with ton of macrophages, lymphocytes, monocytes within filtering out and destroying invaders (police check points watching for bad guys)
- Spleen: the main filter point, filters out old and broken RBCs and also has WBCs, like the lymph nodes, for capture and destruction of invaders
Thymus
- Trains the WBCs for adaptive immunity
- Teaching T-cells what invaders look like so thy can go out and kill them
Bone Marrow
- Builds lymphocytes and then separates them into B-cells and T-cells
- T-cells go to finishing school at the thymus
- B-cells mature at home in the bone marrow
Tonsils, Adenoids, Peyer’s Patches
- Tonsils and adenoids are traps inhaled viruses and bacteria
- Peyer’s patches are in the intestine- intestinal lymph nodes
B Cells
- Apart of the bodies adaptive immunity
- B cells mature in the (B)ones,
-Attack external invaders (bacteria, viruses)
*Have memory cells and antibodies
*Memory to mount a more effective attack next time
*Antibodies to ‘mark’ cells for destruction
T Cells
- Part of the adaptive immunity
- T Cells matured in the (T)hymus
- T Cells attack infected cells and cancerous cells
Immunoglobulins (IG)
- Specific antibodies that the B cells produce
- Antibodies attach to invaders, marking them for destruction
- Like a bright neon sign to T-cells saying “Please come and destroy these”
- Types of IGs (Table 18.2)
Risk Factors for Decreased Immune Response
- Lifestyle factors: smoking, ETOH, drug use, nutritional status
- Past medical history: HIV/AIDs, cancer, Splenectomy, immune disorders, TB
- Medications: chemo/radiation, immunosuppressive medications like DMARDs and corticosteroids, anti-inflammatories
- Allergies
Age-related changes - TLDR: immune system weakens with age in a variety of ways
- Pg. 353, Table 18.6 and Figure 18.9
- Death from viruses such as pneumonia, influenza, ect. increase with age
* Vaccinations even more important in the elderly
Hernia
Risk Factors
Signs and Symptoms
- Protrusion of abdominal contents (bowel/organ) through a weakening of the muscle in the abdominal area
- Reducible: goes back through the muscle and into its proper spot easily.
- Incarcerated: trapped beyond the muscle, unable to go back in. Can be strangulated (pressure from muscles is squeezing off the blood supply)
- Both incarcerated and strangulated hernias are a medical emergency requiring surgical intervention
- Risk factors: age, straining with the abdominal muscles (such as for a BM or urination), lifting heavy objects, twisting movements, obesity, chronic cough
- S&S: bulge or visible swelling, dull achy pain in area of the hernia
- Strangulated hernia S&S: severe pain, N/V, abdominal pain, abdominal distention, fever, tachycardia
Types of Hernias
- Indirect inguinal: congenital muscle weakness that potentially leads to hernia in the inguinal canal (groin area)
- Direct inguinal: only in men. Weakening of the connective tissue and muscles eventually leads to hernia
- Femoral: more often in women in a weak spot called the femoral canal. 40% present as incarcerated or strangulated
- Umbilical: more common in women. R/T increased abdominal pressure like obesity/pregnancy
- Ventral (Incisional): forms at the site of a previous surgery that has weakened the muscle.Typically related to poor wound healing (poor nutrition, smoking, immunosuppressive meds, obesity)
Diagnosis and Treatment of a Hernia
- Diagnosis: seen with the eye but if questionable, a U/S, CT, or MRI
- Treatment: surgically repair. Un-incarcerate the hernia, push it back through the abdominal muscle, suture up the muscle so it doesn’t re-herniate
*Can use mesh to reinforce a weakened area
*May need significant surgery for severe cases up to and including ostomy formation
*Post-op care exactly like any other abdominal surgery, EXCEPT NO COUGHING
Hemorrhoids
Risk Factors
Signs and Symptoms
- Swollen and dilated veins in the anorectal area (Varicose veins of the rectum)
- Risk Factors: prolonged constipation, straining during BM, heavy lifting, prolonged standing or sitting, increased intra-abdominal pressure, obesity heart failure
*Affects both men and women approximately equally, more women report it - S&S: painless bleeding during BM, itching, irritation, pain. *40% are completely asymptomatic
Hemorrhoids Treatment
Conservative management
- Topical medications like local anesthetics, protectants astringents, corticosteroids (Table 58.1)
- Symptom relief with cold packs, Sitz baths, increase of fluids, increased in fiber intake
Surgical management
- Removal of hemorrhoids in a variety of different ways (Pg. 1335)
Irritable Bowel Syndrome
- Causes are unknown. Patient experience symptoms but little (if any change) to structure of the bowel.
*In contract to IBD and Celiac - Functional disorder of the bowel
- Twice as often in women
- Mostly diagnosed between 30-50 years
- IBS-C(onstipation), IBS-D(iarrhea), or IBS-M(ixed)
- S&S: can have abdominal pain, abdominal distention, constipation, diarrhea, both, bloating, flatulence
IBS Treatment & Complications
- Treatment: Manage symptoms
*Variety of medications that must be individualized between doctor and patient (Table 58.2)
*Track foods that cause symptoms, elimination diet and slowly add back in foods
*Avoid caffeine, ETOH - Complications: fluid & electrolyte imbalances, issues related to chronic constipation
Inflammatory Bowels Disease
- Crohn’s disease and ulcerative colitis
- Key Term = Inflammatory
* Inflammation-based changes to the GI tract
* Crohn’s disease: patchy inflammation all throughout GI tract from mouth to anus
* Ulcerative colitis: continuous, diffuse inflammation starting at the rectum and working upwards
*TABLE 58.4 for comparison of two disorders - S&S: chronic conditions with remissions and exacerbations
* persistent diarrhea, abdominal pain, cramping, fever, weight loss, anemia, GI bleeding
IBD Treatment
- Medication management
- Psychosocial management
* Exacerbations seem to occur R/T emotional or physical stress - Nutrition
* Long-term IBD leads to malabsorption of nutrients and/or fluid - Surgical management
* Only in severe cases, can have an ostomy
Celiac Disease
- Autoimmune disease that damages small intestine R/T eating gluten-containing foods
- Body has an immune response to the gluten, creating inflammation in the intestine. Inflammation damages the intestine and can, eventually, cause enough damage that absorption is affected
- There is a difference between a Celiac disease, gluten allergy, and gluten intolerance
- S&S: diarrhea that is light-colored and frothy, steatorrhea, flatulence, weight loss, signs and symptoms of malabsorption/nutrition
- Diagnosis can be complicated by symptoms similar to that of the previous diseases we’ve talked about
Celiac Disease Treatment
- AVOID GLUTEN
- 70% of patients see a reduction in symptoms within 2 weeks of going gluten free, but can take months to heal previous damage
Things that contain gluten - wheat, rye, barley, Semolina, spelt, bulgur, Farro
- Malt: beer, malt vinegar, milkshakes with malted milk
- Brewer’s yeast
Things that are okay to eat - Rice, corn, buckwheat, quinoa, potatoes, soybean flour, tapioca flour,
- Distilled alcoholic beverages, vinegar, wine
(C)onsult a dietitian
(E)ducation about the disease
(L)ifelong adherence to a gluten-free diet
(I)dentify and treat malabsorption and malnutrition
(A)ccess support groups
(C)ontinue management with an interdisciplinary team
Diverticulitis
- Inflammation (-itis) of diverticula in the GI tract
- Diverticula are small, pouch-like protrusions in the GI tract (tiny little hernias on the intestines and colon)
- Having diverticula is called diverticulosis (-osis meaning abnormal condition)
- When those diverticula becoming inflamed or infected, thats when it is called diverticulitis
- Diverticula becomes increasingly common as people age
*30%-50% of people over 60 have diverticula
*65% of all people by age 85 - Risk factors for the development of diverticula: age, heredity, NSAIDS, acetaminophen, corticosteroids, opioids, high red meat diet, high fat diets, lack of fiber, obesity, sedentary lifestyle
Signs & Symptoms/ Treatment and Complications of Diverticulitis
- S&S: abdominal pain over involved area. May have fever, elevated WBC, palpable mass over involved area, anorexia, abdominal distention, diarrhea/constipation, bleeding, mucus in stool
- Treatment: ABX & period of bowel rest followed by gentle, slow resumption of diet *Patient mat need hospitalization for fluid/ electrolyte monitoring and replacement
- Complications: perforation, abscess, fistula, bowel obstruction
Appendicitis
- Acute inflammation of the appendix, which is the weird-looking little tail that projects off the cecum
- Appendix is made of lymphatic tissue but purpose is unknown
- Affects more men than women
- Affects ages 10-19
- When the elderly are effected, there is a higher risk for rupture and mortality
Appendicitis S&S/Management/Complications
S&S
- Early: peri-umbilical pain, anorexia, nausea, vomiting
- Later: pain shifts to RLQ and becomes more severe and constant
- Also: may show S&S of infection - fever, tachycardia, elevated WBC, etc
- Clinical signs: McBurney’s point (tenderness on site), Rovsing’s sign (tenderness opposite of site)
Management
- cut the appendix out with a simple post-op recovery
Complications
- rupture which can lead to peritonitis, which can further lead to sepsis
Colorectal Cancer
- Any cancer of the rectum or large intestine
- Risk Factors: family history of colorectal CA, IBD, obesity, sedentary lifestyle, high fat diets, consumption of a lot of red meats, inadequate fruit and veggie intake
- 3rd and most common form of cancer, 2nd leading cause of death
- Incidence and death rates have been declining for nearly 2 decades (better detection. when caught early enough, it is the most curable of all cancer types
*Stage I colon cancer 5 year survival rate = 74%
*Stage IV colon cancer 5 year survival rate = 6%
S&S of Colorectal Cancer
- Colonoscopy to detect: the entire area is visualized, and polyps and questionable areas removed and/or biopsied
- Stay up to date on recommendations for you and your patients (BOX 58.3)
- S&S: early -> none or just vague symptoms like weight loss, fatigue, anorexia. Late -> blood in stool, pain, abdominal distention, etc
- If cancer is found, treatment is typical for CA. Surgery to remove tumor, chemo/radiation to destroy what is left. *Metastasis is a bad sign
Abdominal Trauma
- Blunt or penetrating trauma to the abdomen
Biggest concerns - Bleeding= liver is highly vascularized, aorta runs through abdomen, lots of opportunity for lots of bleeding
- Hollow organ penetration= spills undigested food, feces, or urine into abdominal cavity leading to peritonitis and possibly sepsis
- Airway, Breathing, Circulation
- Obvious injuries
- Signs of internal bleeding like Cullen’s sign or Grey Turner’s sign
Abdominal Trauma
- Start 2 large- bore (18 G. or bigger) IVs, start administering fluids
- VS monitoring
- Labs and diagnostic tests
*Focused abdominal sonography for trauma (FAST) - quick bedside U/S is performed by physician to look for free fluid in abdomen (FREE FLUID= abdominal contents or blood) - Prep patient for surgery
- If there is a knife in the wound it stays there until the patient goes back to surgery and wrap cloth or gauze around it to stabilize until surgery
