Week 2 Notes
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This 13 page Class Notes was uploaded by Chalcedonia Neufeld on Friday September 30, 2016. The Class Notes belongs to PHE 363 at Portland State University taught by Claire Wheeler in Fall 2016. Since its upload, it has received 78 views.
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Date Created: 09/30/16
PHE 363- Communicable & Chronic Disease Prof. Claire Wheeler CRN# 13220 Date: Monday-September 26, 2016 Defining Disease Domains of Wellness & Illness: The base line or where a person feels healthy and can use in comparison if ill. o Physical Function o Physical Role (persons daily activities) o Pain o General Health & Vitality o Social Function o Emotional Function o Mental Health Bio-Psycho Paradigm: includes social, mental and work environments that make a person well or ill. Causes of Disease and Mortality *Epigenetics has become very relevant more recently in research and in health care. *Behavior and Mindfulness are a huge factor to wellness and illness also. (Referring to Causes of Disease and Mortality slide in Pathology Lecture) 30% Genetic 15% Social 5% Environment 10% Health Care 40% Behavior Biological Factors Include: Exposures Infections or Toxins (carcinogens) Injurycar accident, trauma Medical Treatment(Malpractice, etc) Pathology of Disease Cellular, Organ, System, Organism, Relationship, Social (listed smallest to largest) Cellular Physiology: Cell is the functional unit of all living things Cells Purpose Create structure/barriers, Reproduction, Metabolism, Perception, Defense and Mechanical. Multicellular Organisms=Animals Single Cells=Bacteria (oldest type of cell) Viruses are NOT cells, they are a virus and different because they hi- jack the cell/insert their own DNA, overtaking the cells original purpose. Example: Epithelial Cells Epi (on top of) thelial (layer) -High functioning areas of the body or specialized areas -Compartmentalize and create barriers to and for the body **2 Epithelial Cell Characteristics! 1. Basement Membrane- feature that is a sheet of proteins, organizes structures by creating separation and compartments for the body. 2. Tight Junctions- proteins + tight junctions create epithelial cells locked to each other. a. Lock out water, etc. b. Create a gradient (chemical) or difference across the barriers or in comparison to other compartments c. Tight junctions interlock the epithelial cells like people standing next to each other and interlocking arms with each other. Cell’s!!! Homeostasis: a system that makes adjustments to lessen internal impact of major external diisturbances. A constant state in a system. Example: Diabetes (Disease), the homeostatic mechanism of maintaining blood glucose is broken affecting the persons ability to uptake glucose. Cell Membrane Layer of fat between sugar and protein Water is kept from flowing in/out of the cell Dense with receptors for communication (varying) *Signs of cell membrane damage is called “blebbing”, around a membrane, appears like lesions, inability to maintain structure. Pathway to Disease: Risk Factors: Anything that increases the chances of you getting a disease/illness Personal Environmental Social Modifiable=can be changed through behaviors Unmodifiable=out of persons direct control Additional Terminology: Myocardial Infarction Myo(muscle)cardial(heart) Infarction(tissue death caused by loss of blood flow) Functional Medicine Fairly new practice Diagnostic issues are political issues as well, due to high health care expenses (labs, tests ordered by physicians). Key to Notes: ** symbol for what will be quizzed on in class. _________ definitions, with purpose or functions following. *symbol for important information. PHE 363-Communicable & Chronic Diseases Prof. Claire Wheeler, M.D. CRN#13220/9.28.16/Wednesday Pathogenesis Pathogenesis: development of morbid condition or disease, starting or developing stage at the cellular level. 1. Environmental-Asbestosis 2. Autoimmune-Lupus, Multiple Sclerosis (immune system attacks own body) 3. Inflammatory-Arthritis, heart Disease 4. Deficiency/Excess-Obesity or Malnutrition 5. Neoplastic-Cancers “The Lesion”: morphological change occurs as a result of pathogenesis. -metabolically active virus/disease. Heart attack=cardiac muscle death Herpes simplex=cold sore/lesion Alzheimers=neuro tangles and atrophy *PET scans commonly used for diagnosis. Functional Disease: chemical/mechanical disfunction (Ex. GI Tract isssues) No lesions seen Infarction: Sudden loss of blood flow to a localized area causing tissue/m. death -Lack of blood flow also is loss of glucose transports Fatty Infarction: fatty Liver! Fat is deposited in and around the livers cells Causes are alcoholism and high sugar/simple sugar diet Reversible via diet/exercise, preventive care Calcification: Calcium deposits & buildup in aging tissue (Ca ), crystallizes. Affects the following: Heart valves Blood vessels Arterial Plaque leading to heart attack Endocarditis Tricuspid valve cannot control blood flow +2 Breast tumors-Buildup of Ca , microcalcification & density Thyroid-microcalcification, cancer Types of Affects on Tissues Necrosis: Change in tissue via cell death. o Ischemia-Poor blood flow, chronic condition, gradual progression o Pressure-(Ischemic and pressure) Bedsores o Infarct-sudden cell death o Toxic-insect or snake bite o Gangrene- A)Dry: erosion of tissue caused by Diabetes or Hypothermia. B) Wet: Bacterial infection causing puss o Atrophy-No growth/Shrinkage Due to limited blood flow (Atherosclerosis) o Hyperplasia-Growth/Morphological size -Goider in Thyroid -Prostate Hyperplasia (Example-Necrotizing Enterocolitis- Infection affecting neonate/baby, kills the entire GI Tract) General Concepts: (Health Observations) Sign’s- A sign is ‘visible’ and ‘seen’. Objective finding/physical exam show the sign. o Ex Rash (chicken pox), tremor (Parkinson’s), Tenderness via pushing/palpating. Symptoms- Patient telling the symptoms, subjective experiences that cannot be observed by looking at the patient. o Ex Nauseated, Headache, Sharp pains Differential Diagnosis- List of possible outcomes/diagnosis’ from collected information. Complications-Negative outcome of the course of illness or treatment, may go wrong even when everything is done correctly (Ex. Drug interactions) Natural H xHistory of disease or condition. Prognosis-Personalized natural History to person. *Immunity-The bodies own defense mechanism/”army” o External Defense o Innate Defense o Adaptive Immunity External Barriers- Mechanical, chemical, microbiological skin, gut, lungs, eyes, nose (Ex. Skin is a “Torus”= enzymes on skin/sweat to kill bacteria’s Mechanical Barriers- 2 Major roles of invasion Microbiological fungus on skin, stap. Epiderdimis, creates mutual benefit as a protector. *Additional Important Concept: Health Literacy: Ability to read, understand and act on health information. -People with low health literacy affects all ages/race/cultures, and tend to require these people to skip preventive care and in need of hospitalization. Resources: UnityPoint Health “Ask Me Three” NIH Plain Language- Simple to understand language Key to Notes: ** symbol for what will be quizzed on in class. _________ definitions, with purpose or functions following. *symbol for important information. PHE 363- Communicable & Chronic Disease Prof. Claire Wheeler CRN# 13220 Date: Friday, September 30, 2016 Mechanical Defenses of the Respiratory System (Nonimmunological Defenses) Airway Protected by various specialized cells Specialized Columnar Epithelial cells, Cells in between are mucosal cells Cilia- Specialized cells that sweep things out of the airway. Overcoming Mechanical Defenses Respiratory System: Smoking-Cilia can no longer do sweeping movement, Paralyzes cilia of respiratory tree Cystic Fibrosis- Overly thick mucus, tends to be in children who do not grow to adulthood GI Tract: Sphincters help compartmentalize/open and close to facilitate movement Food/water contaminated with microbes Cooking/Filtering help but aren’t perfect Major cause of death in the U.S. Immune System **KNOW THESE & PRINT MAP/KNOW CHARACTERISTIC<CAUSE.. (STRUCTURE AND FUNCTION) Skin Mucosal Immunity Lysozyme Phagocytes Immunoglobulins Cell-imediated immunity Complement Interferon Organs of Immune System: Major purpose of Immune organs is to be the birth-place of the Immune Cells! Bone marrow (all blood cells come from bone marrow, stem cells) Thymus Where T Cells mature. Organ that shrinks/dissolves over time. Spleen Lymph Nodes swell/painful, inflamed when infection is present Afferent system(coming in/moving toward the center), draining from body and head in and towards the chest/converging at the Lymphatic duct) Found along lymph vessels-higher exposure rate of bacteria, expose bacteria and pathogens to T & B cells Facilitate the crossover b/w Innate & Adaptive immune response (from nonspecific to specific killing of pathogens) *Lymphocytes & Lymph return to the blood via the Lymphatics *Pathogens from site of infection reach lymph nodes via Lymphatics Tonsils & Adenoids Appendix (continued..) Mucosal Immunity-activity in transition form the outside to the inside of the body, contains more moisture and has less resistant epithelial cells in orifices (urethra, nose, rectum, mouth) these orifice epithelial cells are not as resistant and are much more likely to get disease such as HPV. Lymphatics Low pressure with thin walls Help facilitate fluid drainage Cells of the Immune System Kine (stimulatory chemical) **There is no OFF switch for the Immune System Each cell has a specific function As a system, the cells work together to create immunity Rapid, precise communication Communication: (especially in lymph cells) Formation of physical connections using nanotubes Formation of synapse like connections-communication b/w cell about what to do or how to kill Primary Mode*-Biochemically via Cytokines and Interleukens Interleukens-facilitate communication b/w WBC’s, stimulatory nature Cytokines- **Know what Cytokines and Interleukens do & How! Cytokines: tend to have 2 responses Cell detects Invader Release a cytokine in local area-eventually circulates through circulation Proliferation (creates clone/army) & Activation (release of cytokines) All immune cells with receptors to the cytokine will respond Response-Activation and increased division to increase numbers End/Deactivation-Remove the trigger that started the problem! (remove foreign material) Innate Immunity: activated/begin fight against infectious agents when foreign invader is present & ANY kind of tissue damage Purpose is to be active for a short period during “inflammation”, then to allow repair to occur while Adaptive Immunity repairs Cells in Innate Immunity are Phagocytes! Examples) Occurs with Sterile injury (surgery) Stubbing your toe High blood pressure damaging the epithelial lining cells of the artery (causing chronic inflammation leading to heart disease). *Important ConceptHow Cancer Spreads All lymphatic drainage gradually ends up at L.Subclavian vein, then enters blood stream Once it reaches a certain size it enters lymph nodes and spreads Metastatic Cnacer-Cancer that has spread, survival rate declines Metastis-cancer cells that are spreading *Liver, Brain, Lungs & Bone are high blood flow areas and are most likely to have Metastatic Cancer Terminology Phagocytosis: Cells eating other cells Phago (eating) cyt (cells) osis Aspiration: Needle in body which aspirates liquid (puss from abscess, bone marrow, or liquid that has been swallowed) Afferent: Entering, towards center-inward flow Efferent: Exiting, outward flow Sepsis Latent/Latency When a virus is dormant in a cell **** The Molecules of Emotion by Candace Pert The Receptor Revolution (1980’s) PHE 363- Communicable & Chronic Disease Prof. Claire Wheeler CRN# 13220 Date: Monday October 3, 2016 Innate Immune System (continued from previous lecture) -Fights antigens that are on viruses, fungi, bacteria -You are immune to antigenic particles -Only mediated by Phagocytes (cells that engulf/eat other cells) *Proliferation & Activation of cells Turning off an Immunological ResponseYou must remove the antigen that started the response in the first place. Mechanisms: Cell Membrane Chemical Communication ‘on cell membrane’ Cytokines & Cytokine Functions (proteins) ‘Amplify/Prolong immune response until antigen is removed from the body’. Bind to receptors- communication packets that go from one cell to the other. (Not specific for pathogens/Produce effects by binding to receptors) Machrophages spit out cyctochines, a general/local “high alert” for foreign invader. Immune Function: Defense against Viruses, Bacteria, Fungi, Parasites, Cancer, abnormal cells, worn out cells (recycle)-Maintaining environment of healthy body. Recognition: “Self vs. Non-Self” cells All cells have markers on the surface htat help identify them (HLA antigens) Receptors of immune cells are specific Recognition mainly occurs in the Thymus (T-Cells must be able to recognize self) Antigen: A particle that triggers an immune response Antigens are what you are immune to! (Immune to these and the structure of whatever virus a vaccine you get-Ex. Measles) If Antigens are stable-you can be protected for life! o *Main characteristicSize & Structural Complexity * Large molecules Complex structure (must have the exact structure of the antigen to fit) Protein/Carbohydrates (changing 1-2 protein amino acids coding can change an antigen into a virus creating a pandemic) Accessible to immune cells Foreign Influenza Constantly changes its DNA/RNA mutation which produces a new infection each year. More on Innate Immunity & Macrophages o -Specificity only goes as far as okay or not okay! (Good vs. bad cells) o -Rapid speed of Action- swelling/pain kicking in when you get a vaccine required to have a rapid/big response in order to create a good immunity o -No Memory! o Macrophage Carry bad cells to a lymph node in order to present the bad cells to T-Cells o *Focus on the Macrophage and other Phagocytes* PMN-Polymorphonuclear Leukocytes & NK Natural Killer Cells: Bacterial Infection present Glial Cells: Highly specialized for cleaning things like Alzheimers. But if they are not turned off, can lead to Alz. Macrophages (Big Eater) o Mature, tossue residing form of the monocyte o General scavenger of the bodys cells o Aggressive/powerful, Move like amoeba o Start as a ball-can extend arms to “grab” foreign/bad cells o Monocyte = inactive form of a Macrophage Steps of Immune Response **WATCH KHAN VIDEO** 1.Rolling, 2. Activation, 3.Adhesion, 4.Extravasation Epithelial Cells-Damage to the epithelial barrier/break through first line of defense Local infection-Foreign antigens present (dirt/bacteria/microbes and damaged tissue) Macrophage leaves capillary (side street roadway) and enters damaged tissue areacapillaries are high pressure and you only need some capillary ingredients/requires chemotaxis so that you don’t lose more blood than necessary. Macrophage Movement: *Chemotaxis* Macrophages can leave the blood stream to enter tissue Attracted by chemicals released by pathogens and damaged tissues Can squeeze into tiny spaces and b/w epithelial cells of the capillaries Does not enter capillary again, stays in the tissue due to hydrostatic pressure and eventually enters the Lymph fluid, swept into Lymphatic vessel, to Lymph Nodes Chemotaxis Extravasasion: Adhesin-signal Integrin-signal Macrophage Ingestion Lysosomes-to break something open, a package of Hydrogen Peroxide and Bleach used to kill via chemical warfare. As the macrophage engulfs the target/bad cell, the lysosomes line up along the microtubules surround the bad cell, drill holese into the cells target cell membrane and squirt in their chemical the bad cell then dissolves into ingestible pieces. *Required for deconstruction of target cells = Hydrogen Peroxide & Bleach Macrophage Disposal aka Endosomes: Endo(inside)some( _________) o Reuses some of the molecules o Puts some pieces on the surface to activate other cells- “Presentation of Antigen” o Packages debris for expulsion from the bodySputum & Feces o Endosomes doesn’t open up until the H.Peroxide is used up to prevent H.Peroxide from being spilled out into the body freely Inflammation Responses: IL-1, IL-6 & TNFalpha ***QUIZ QUESTION!!!! Fever!!! Higher temp. activates macrophages How your brain makes you have a fever Cutaneous vasoconstriction-Less blood going to the skin Reduce Sweating-sweating takes heat with it when it evaporates Increase Brown adipose tissue metabolism-takes immense sugar and E to burn brown fat
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