Friday, October 22, 1999

Structure and Function of the Human Body week 10

Answer each of the questions below using information gathered from your readings, lectures, and outside research. You should provide at least a paragraph response for each of the questions.
1. Describe the role of the following organs within the digestive system: stomach, liver, salivary glands, small intestine and gallbladder. Also, describe what complications could occur within the functions of the digestive system if each listed organ was damaged or dysfunctional.

Our digestive system provides the body a means to transfer nutrition from the external environment into the cellular level in order to sustain life.

Salivary glands, controlled by the autonomic nervous system, is located in the oral cavity. It's main role is to secrete saliva in the oral cavity. There are three pairs of salivary glands. Parotoid savary gland lies under the skin on each side of the mandible. These glands secrete amylase, an enzyme that breaks down starches. The parotoid duct implies empties into the vestibile at the level of the second upper molar. The sublingual duct is (located under the tongue) between the mucus membrane of the floor of the mouth and the submandibular duct is located in the floor of the mouth. Both the sublingual and submandibular glands secrete saliva that contains more buffers and mucus. (p. 539-40)

Saliva (mucus) consists of 99.4% water, mucins and an assortments ions, buffers, and waste products and enzymes. The mucines absorbs water and form the mucus. During meal time, the saliva lubricates the mouth along with dissolved chemicals that stimulates the taste buds. The mucus coats the food, and reduces friction making swallowing easier. The continuous flow of saliva also flushes and cleans the oral surfaces while controlling oral bacteria through salivary antibodies (IgA and lysozyme). The pH of saliva during meal time raises from slightly acidic (pH 6.7) to more alkaline (pH 7.5).

Radiation and emotional distress can cause a reduction of salivary secretions. This then can create an unhealthy oral cavity environment due to increased bacteria population. Over time, the complications caused by the decreased salivary secretions are infection and erosion of the teeth and gums. (p.540)

The stomach is another component of the digestive system which is located within the left upper quadrant of the abdominal cavity. It is a muscular J-shaped organ that is positioned inferior of the esophagus and superior to the small intestines. There are four primary functions the stomach has to offer. First, it becomes a temporary storage for ingested food. Food is stored in the stomach while it is physically broken down for chemical digestion. Second, it provides a mechanical means to break down ingested food. The stomach is an area where there is a lot of mixing of the food, so added strength to the muscularis external layer is needed. Instead of two layers in the muscular external, the stomach's has three layers, a longitudinal layer, a circular layer, and an inner oblique layer. Thirdly, it provides an acidic environment that causes a break down of the chemical bonds in food through the actions of acids and enzymes. The pH of 2.0 in the stomach makes the environment acidic. The ingested foods, mixed with stomach's secretion, produces an acidic soupy mixture of partially digested food called chyme. Lastly, the stomach is responsible for the production of the intrinsic factor, a compound necessary for the absorption of vitamin B-12. (p.544)

Gastric ulcers is one complication that can occur in the stomach. Ulcers are caused either bacterium Helicobacter pylori or by medication such as aspirin that irritates the mucus membrane. This irritation causes erosion of the mucus membrane; which either creates an excessive production of acid or an inadequate production of alkaline mucus that defends the epithelium against the acid. Treatment can lean toward a medication such as cimetidine, a drug that inhibits acidity in the stomach, or it can be treated with antibiotics for bacterial infection depending on the cause. Meal time still would include a complete diet, but staying away from high fat, high acidic foods like tomatoes, and spicy foods. In atropic gastritis, there is chronic inflammation in the stomach which produces a lower acid production capability. When this happens, the intrinsic factor is affected , trapping vitamin B12 within the food. People in this case would need to take a vitamin B12 supplement.

The small intestines main function is in the digestion and absorption of nutrients. Ninety percent of nutrient absorption occurs in the small intestine. The duodenum is the segment in the small intestine that receives chyme from the stomach and digestion secretions from the pancreas. It also contains duodenal glands which secrete alkaline mucus that helps buffer acids in the chyme. The bulk of chemical digestion and nutrient absorption occurs in the jejunum. The small intestines receives and raises the pH of the materials arriving from the stomach. Most of the important digestive processes are completed in the small intestine where the final products of digestion (simple sugars, fatty acids, amino acids) are absorb along with most of the water contents. (p. 548)

Crohn's disease is one complication found in the small intestine. It is a chronic auto-immune inflammatory disorder that occurs in intervals active (flares) disease altering in periods of remission . Treatment varies from special diets, medication like Cortisone and surgery (possible ileostomy). Crohn's disease is not curable. Treatment only covers the symptoms caused by the disease progression. Over time, the inflammation of the small intestine can result in scaring and thickening of the walls of the affected structure. With this disease, absorption of nutrition can lead to difficulties. The inflammation causes damages to the lining of the intestine so that it cannot absorb nutrients, water, and fats from the food eatened. This can result in malnutrition, dehydration, vitamin and mineral deficiencies. (emedicinehealth, 2011)

The liver is an essential part to the digestive process. The liver has three functional roles: metabolic regulation, hematological, and bile production. The basic functional unit of the liver is its 100,00 lobules. Within each lobule there are liver cells called hepatocytes .
In metabolic regulation, the liver's main goal is to regulate the composition of the circulating blood. It does this through the hepatocytes. The hepatocytes extract and absorbed nutrients or toxins from the blood prior to reaching the general circulation. Hepatocytes also monitors/adjusts the circulating levels of organic nutrients. Excesses are removed and stored; while deficiencies are corrected by utilizing stored reserves or synthesizing the necessary compounds. Toxin and metabolic wastes are removes for later inactivation and excretion. Fat-cell vitamins such as A,D,K, and E are absorbed and stored. ( p.555-6)

With hematological regulation, the liver becomes the blood reservoir. As the blood passes through the liver, phagocytes (kupffer ) cells remove spent/or damaged RBCs, debris, and pathogens from the circulation. The hepatocytes synthesizes plasma proteins ( which determines blood's osmotic concentration), transports nutrients, and makeup the clotting and complement systems. ( p.556)

The bile production is derived from the hepatocyte secretions. Bile may either flow into the common bile duct, which empties into the duodenum, or enters into the cystic duct, which leads into the gallbladder. Bile consist of water, ions, bilirubin (pigment from hemoglobin), cholesterol, and bile salts (an assortment of lipids). The bile's water and ions dilute and buffer acids in chyme as it enter the small intestine. The bile salts (synthesized from cholesterol) are required for normal digestion and absorption of fats. Bile breaks down large lipid droplets into smaller lipid particles in order for the digestive enzymes to become more effective. ( p.556)

After revealing the main functions the liver provides, any condition that can damage or make the liver dysfunctional can be life threating to the body. One example is hepatitis which is an inflammation of the liver producing swelling in the liver. There are many virus that can cause hepatitis depending in how it is transmitted, but the main ones are A, B, and C. If left untreated, in some cases hepatitis can lead to cirrhosis which is a progressive degenerate disease that results in the loss of organ/tissue function due to scar tissue. Further progression of the disease could eventually lead to liver failure. Unlike a healthy liver, the liver would not be able fight infection, clean the blood and help digest food and store energy; thus, leaving the body, toxic.

The gallbladder is a hollow pear-shape organ that stores and concentrates bile made in the liver. Bile is secreted continuously (approx1 liter/day); however, it is only release into the common duct to the duodenum when fatty foods enters the digestive tract and through the stimulation of a duodenum's hormone CCK (cholecystokinin). The CCK stimulates contractions in the walls of the gallbladder, releasing the bile into the small intestine. In the absence of CCK, bile leaving the liver through the common duct is redirected into the cystic duct delivering bile into the gallbladder for storage.
The concentration of bile changes its composition while in the gallbladder's storage. Water is absorbed and the bile salts along with other bile components become increasing concentrated. Sometimes bile salts become too concentrated through stasis (due to no-fat diet) or infection which alters the ratio of bile salts and water content, forming gallstones. ( pg.550, 556-7)

Gallstones can be a complication of the gallbladder. Gallstones can develop when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not completely empty or emptied enough. Most people are unaware they have a problem. If a person is asymptomatic, no treatment necessary. Only those with sever discomfort or repeated attacks from gallstones receive treatment. This usually requires surgery for removal of the gallbladder (cholecystectomy). People can live without their gallbladder because bile is made continuously and the gallbladder is just a reservoir for bile. If any change in life style it would be in diet (low-fat) and frequently of meals. (, ) ( p.557)

Explain how the small intestine’s anatomy is geared to increase surface area. Why is increased surface area important in the small intestine?

The length of the small intestine is approximately 20 feet long. The intestinal lining consist of transverse folds (plicae circulares) composed of multitude of finger like projections called villi.
These structures are covered with simple columnar epithelium that are covered with microvilli, in other words the epithelium looks like bristles on a hair brush. If the small intestine was smooth and simple , the total absorption area would be about 3.6 feet long. Instead, the small intestine is composed of multiple arrangement of the intestinal wall, which consist of plicae circulares layered with villi; villi is layered with epithelium; epithelium that is layered with microvilli; thus makes the total increase absorption area approximately 2,200 feet.

3. Describe the role of each of the four layers in the stomach including the mucus cells and parietal cells of the mucosa layer.

The four layers of the stomach are the mucosa layer, submucosa layer, muscularis externa, and serosa layer.
The mucosa layer of the stomach is the inner lining consisting of mucosal (glandular secreted) membrane that is composed of simple columnar epithelium dominated by mucus cells. The role of these mucus cells this is to secrete alkaline mucus that covers and protects epithelial cells from acids, enzymes, and abrasive material. Gastric pits are shallow depressions open onto the gastric surface. The mucus cells at the base of each gastric pit divide and replace the superficial cells of the mucus epithelium which is then shed into the chyme. The gastric pit corresponds with the gastric glands which secrete the gastric juice. The cells that produce the components of the gastric juice as the parietal cells. The parietal cells secrete the intrinsic factor and hydrochloric acid. The intrinsic factor is needed to facilitate the absorption of Vitamin B-12 across the intestinal lining. The hydrochloric acid lowers the pH of the gastric juices which keeps the stomach pH contents at approximately 2. The acidity of the stomach kills micro organisms, helps break down plant cell walls, and connective tissues in meat and also activates the enzyme secretions of the chief cells. The main purpose of chief cells is the production of the enzyme pepin (a protein digesting enzyme) Within both the mucosa and sub-mucus are distinct ridges or folds called rugae. The folds increase the surface area for absorption and permits expansion (flattens out) for food. Ducts between the rugae opens onto the epithelial surface and carries the gastric glands that secrete digestive juices.

The sub-mucosa layer is the second layer that is composed loose connecting tissue which contain large blood vessels, lymphatic vessels, and nerve fibers( sensory neurons and parasympathetic motor neurons). Its main role is in controlling and coordinating contraction of the smooth muscle layers and in regulating secretion.
Muscularis externa makes up the third layer of the stomach. This layer consist of bands of smooth muscle cells which contains a longitudinal layer, a circular layer, and an inner oblique layer. These three portions of the muscularis externa provides strength and assists in the mixing and churning essential to forming chyme.

The serosa layer (visceral peritoneum) covers the outer surface of the stomach. It has no role except to stabilize the stomach in the peritoneal cavity.

4. We discussed the endocrine role of the pancreas when we studied the endocrine system but it has an exocrine role within the digestive system. Please explain what type of dysfunction would occur if the pancreas didn’t secrete its pancreatic juices. What type of dysfunction would occur if someone had to have their gallbladder removed?

The pancreas is primary an exocrine organ that produces digestive buffers and enzymes. The four enzymes: carbohydrases (digest surgars and starches), lipases (break down lipids), nucleases (break down nucleic acids), and proteases (break protein apart). Specific enzymes are the pancreatic amylase (breaks down carbohydrates), pancreatic lipase (group of nucleases and several proteases), and trypsin and chymotrypsin are all part of the proteases enzymes Proteases accounts for 70% of the enzyme production. The main buffer is sodium bicarbonate which increases the pH of the chyme. (pg 552-553)

If the pancreas becomes dysfunctional, these pancreatic and enzymes would be missing in the duodemum. Inadequate digestion would take place. Your sugars, starches, fats, and proteins would be incompletely digested, because of the missing enzymes. In pancreatitis, inflammation occurs from blockage of excretory ducts, bacterial infection, or drug reaction (alcohol), This can cause injury in the exocrine cells. The lysosomes within the damaged cells then activated the pancreatic enzyme which attack the normal pancreatic cells and there is a chain reaction which produces destruction. In most cases, with treatment, this can be reversed/stopped. However, there are a few cases where this auto-digestion continues and destroys the organ. In that case, two conditions result: diabetes mellitus that requires insulin and nutrient malabsorption where oral pancreatic enzymes need to be taken. (pg 563)

In the case of the gallbladder, people can live without their gallbladder, because the only function of the gallbladder is a reservoir for bile from the liver. Bile will continue the flow into the small intestines without a problem. It might be a little more or less depending on the food quantity and substance.

5. What is the importance of adenosine triphosphate (ATP)? Carbohydrate metabolism is our body’s main source of ATP production. Explain where carbohydrate metabolism occurs in the cell, what additional “ingredient” is needed and what waste product is produced in this process.
The primary function of ATP is the transfer energy from one location to another, not the long term storage of energy. The energy a cell produces in the form of ATP supports cell growth division, contraction, secretion, and all functions that vary from cell to cell and tissue to tissue. Cells in the body generate most ATP through aerobic (oxygen-required) metabolism in the mitochondria ;however,the initial steps occur through glycolysis (anaerobic -with out oxygen) in the cystosol of the cytoplasm. Oxygen is the key ingredient needed in mitochondria energy production. Aerobic (oxygen) metabolism in the mitochondria provide most (95%) of the energy needed to keep cells alive. Most of the energy deriving from carbohydrates are produced in the mitochondria. Energy is stored and transferred in a high energy bond of ATP in order to move from place to place. The by-product of areobic metabolism is carbon dioxide. Glycolysis involves enzymatic steps that breakdown glucose to pyruvic acid molecules. These molecules are then absorbed by the mitochondria. Glycolysis (anarobic) can also continue to provide ATP when the oxygen availability is limited for mitochondrial production. This usually occurs during the body's peak activity, such in the case of a long distance runner. The body cannot provide enough O2 to maintain the metabolism in the metochondria. This the time where glycolysis becomes the prime source for ATP. (p.77, 210, 577)

Thursday, August 19, 1999

Structure and Function of the Human Body week 5

Explain how adaptation relates to our thermoreceptors and touch receptors. What is referred pain and how could it be dangerous?
Thermoreceptors and touch receptors are both nerves. The thermoreceptors Referred pain is when the perception of pain coming from parts of the body that aren't actually stimulated. It's dangerous, because you don't know where the real dangerious areas really point too. If you didn't have touch receptors, you wouldn't know what information like location, shape, size, texture and movement. (pg 309)
Explain why olfaction and gustastion are considered “chemical” special senses (think of how these two senses work). Explain the importance of hair cells with the sense of hearing and equilibrium. Lastly, compare and contrast rod and cone cells' location, function, and overall amount.
Both olfaction and gustastion occurs as dissolved chemicals stimulate olfactory receptors. The hiding of an odorant changes the permeability of the receptor membrane, producing action potentials. The gustatory are actually chemically based tasted receptors of the tongue which tastes chemicals. Taste buds have gustatory cells which tends to slither microvilli to the taste poor. The poors are more sensitive to acids. (pg 313- 315)
Hair cells are simple mechanoreceptors which are complex structure of the inner ear and the different arrangements of accessory structures of the inner ear and the different arrangements of accessory structures. (pg 329)
Rod cells do not discriminate among colors of light. They help us see in dim light. Cone c ells provide color vision. Cones give humans sharper colors. Rod cells are found on the side while cones are found on the bottom (pg 320)
Explain how the body maintains homeostasis of serum (blood calcium) levels through the use of the thyroid and parathyroid glands.
Fibrin is large insoluble strands. The fibrin fibers interact and provide framework for blood clots. The steps not taken to prevent clotting in a plasma sample, fibrinogen will convert to fibrin. The fluid left over is called serum. The liver synthesizes more than 90% of the plasma proteins including albumins and fibrinogen and globulins. Antibodies are produced by the plasma cells and fibrinogen and plasma proteins clot the blood preserving homeostasis of serum (pg 384)
Explain the role the hypothalamus and pituitary gland have in the regulation of the endocrine system. What would happen if there were no negative feedback control on growth hormone and thyroid hormone?
The hormonal secretion is controlled by negative feedback mechanisms. The stimulus triggers the production of hormone worse direct or indirect effects that reduce the intensity of the stimulus. The simplest case, endocrine activity may be controlled by humoral stimuli - changes in the composition of the exetracelluar fluid. The control of blood calcium levels are controlled by two hormones, parathyroid hormone and calcitinin. The calcium levels are the blood decline, parathyroid hormone is released and the response of target cells elevate blood calcium levels. The blood rise, calcitonin is released and the response of target cells lower blood calcium levels. The endocrine activity is also controlled by hormonal stimuli or changes in the levels of circulating stimuli. The hypothalamus provides the highest level of endocrine control by acting as an important link between the nervous and endocrine systems. (pg 350).
The control of the calcitonin secretion is independent of the hypothalamus gland and pituitary gland. C cells produce hormone calcitonin. Physiologic effects of growth hormone are direct effects and indirect effects. The glands within the endocrine system simulate release of a hormone from thyroid glands are shut off. If too much negative feedback occurred there would be hormone imbalance , because too much of the hormone would be. The hypothalamus secretes TRH. This causes the tituitary to release THS. THS will cause the thyroid hormone to secrete T4. In many parts of the world, inadequate dietary iodine intake leads to the inability to synthesize thyroid hormones. The calcitonin inhabits osteoclasts and stimulates calcium excretion in at the kidneys. C-cells are endocrine cells sandwiched between the follicle cells and their basement membrane. If there was too much negative feedback, the kidneys would fail. If negative feedback occurs, there could be a loss of bone mass. Calcitonin is most important during childhood in controlling muscle cells and nerve cell activities. Thyroid hormones are stored in the colloid of follicle. There would be too much energy utilization, oxygen consumption, growth and development for most cells. There would be more calcium concentration in body fluids in the bones and kidneys.
Explain how the nervous system, general senses, and endocrine system work together to maintain homeostasis. Remember the 3 steps of the nervous system function: afferent (input/sensory) information, analysis, and efferent (output/motor) information. This will be helpful along with remembering what homeostasis is.
The nervous system regulates the breathing, urinary, and digestive systems. The heart rate and breathing are controlled by the nervous system. Hormones are less energetically expensive, the lymphatic system ability to fight infection. Second, the respiratory system maintains oxygen and pH levels. The exposure to drugs, alcohol and toxins kick the excretory functions and test these substances to accumulate damage of the body's cells. A body that lacks nutrients will induce the body to compensate or become sick.
Make sure you provide citations and references for your answers!

Read chapters 9 - 10 ys/endocrine/hypopit/gh.html

Tuesday, August 17, 1999

Structure and Function of the Human Body week 3

Bone is a very active tissue. Please explain the pathway of how the bone cells get nutrients and oxygen from the blood vessels using the following terms: Periosteum, endosteum, lacunae, lamellae, canaliculi, perforating canals, osteon, Haversian canal (central canal) and trabeculae.
There are two types of bone tissue, compact bone (solid dense) and spongy bone (bone separated by spaces). Example, the humerus bone consists of compact bone (diaphysis and spongy bone) at each end or epiphysis. The periosteum is the outer layer of the bone where tendons and ligaments are attached; whereby, attaching muscle to bone and bone another. The main function of periosteum isolates bones to surrounding tissues provides a route to circulatory and nervous supply. It has an influence of growth and repair of the bone. The endosteum is found in the inner surface of the bone. The function of the endosteum is growth and repair of the bone. In compact bones, the functional unit is the osteon. Within the osteon, the bone cells (osteocytes) are layered around a central canal called haversian that contains some blood vessels. The bone cells are found in small pockets called lacunae which are found between calcifid matrix which is called lamellae which are cylindrical. The inter-connections inside the matrix have small channels called canaliculi that connect the lacunae with the nearby blood vessels. Nutrient and waste products are exchanged from the osteocytes through diffusion in the extracelluar fluid that surround the cells. Perforating canals provide a highway and linkage from the central canal to the periosteum and the marrow cavity.
In the spongy bone, has no osteons. Instead, the spongy bone consists of trabeculae which are lamellae that are shaped as thin rods that create an open network. Nutrients and waste are diffused between marrow and ostreocytes through small channels (canaliculi) that extend from the lacunae of the spongy bone end, where the triabeculea is exposed.

There are three main types of canals including canaliculi, Haversian canals and Volkmann's canals.

The canaliculi would join osteocytes. Second, the thicker canals are Haversian canals. In the center of the osteone are longitudinal directly through the bone. Third, the transverse tunnels are Volkmann canals. The Volkmann canals will go into the bone from the exterior; therefore, allowing vascularization to go into the osseous tissue.

Bone tissue being hard, it requires canals or tunnels to get the osteocytes nutrients to the cells. Osteocytes have long protrusions of their cytoplasm within the tunnels that contact other osteocytes. The Osteocytes are connected at these unions which can transport nutrient.
In general compare and contrast the three functional classifications of joints according to movement. What are two characteristics that make synovial joints unique and different from other joints? Which joint is stronger-the shoulder or hip joint and why is it?

Two characteristics that make synovial joints unique is they are found at the end of long bones. They are also unique in that they have fibrous joint capsule surrounding it. The hip joint is stronger, because the femur is the largest bone in the body and the hip joint was made for strength and stability. In comparison the shoulder has a higher range of movement; therefore, is weaker at the joint. (pg 174)

Please explain how the muscle cell’s anatomy of the cytoplasm is unique from other cells.
Cytoplasm has cytosol, which is dissolved in nutrients, ions, soluble, and insoluble proteins. Cytosol would contain higher concentration of potasiums ions and lower sodium ions. Likewise, extracellular fluid contains lower potassium-ion concentration. Cytosol contains high concentration of dissolved proteins like enzymes which regulate metabolic operations. It gives the cytosol it's consistency. Organelles directly connect to Cytosol. pg 72.
With your knowledge of how a muscle cell contracts please describe three mechanisms (problems) that could inhibit or disrupt the process of muscle contraction. Think about the process and the steps involved in muscle contraction.
The three mechanism are Concentric Contractions, Eccentric Contractions, Isometric Contraction. Muscle fiber generates tension through the action of actin and myosin cross-bridge cycling. While under tension, the muscle may lengthen, shorten or remain the same. Although the term contraction implies shortening, when referring to the muscular system, it means muscle fibers generating tension with the help of motor neurons.
Many sarcomeres work serially and in parallel to achieve the full contraction ability of the muscle. The sarcomere includes Actin and Myosin. Actin and Myosin are protein based filaments from opposite sides of the sarcomere. Once the muscle is at rest, both the Actin and myosin filaments overlap. When the muscle contracts, the filaments from the opposing sides slide so the pulling both walls of the sarcomere. When the muscle is fully contacted, the filaments overlap each other the most. The sliding motion is activated by calcium that floods the sarcomeres (at the end of a process that is triggered by a command from a motor nerve). The calcium reveals sites on the Actin filaments at which molecular 'whips' extending from the Myosin filaments, can throw themselves, attach, pull, and leave, using the muscle's energy reserves in the process. Each molecular whip works at its own time (much like cylinders in an internal combustion engine), so that in any given time, contact between the filaments is being made by some of the whips.
What is the difference between osteoarthritis and osteoporosis?
Osteoarthritis is a noninflammatory condition that occurs in obese people or people who have trauma joints. They are both over the age of 65. It has lost of cartilage and adjacent bone overgrowth. Osteoporosis is a metabolic condition with loss of trabecular bone. Osteoporosis normally happens in women over 65, because she had steroids, smoking, caffeine, thyroid replacement. The hip and vertebral fracture are at risk for women. (Krant, J, Healthcentral, 2006)

Friday, July 23, 1999

Pathophysogy week 2b

Not Me!

All cells have a outer plasma membrane that separate the cell's contents from the extracellular fluid. It provides a physical barrier that separates the inside of the cell from its surrounding environment. It regulates with the environment such as nutrients, waste, and release of secretions. It contains a variety of receptors that helps the cell recognize specific molecules. It provides the cell a stable structure. Cytoplasm consists of material inside the cell from the plasma membrane to the nucleus. Cytoplasm contains all the ingredients for cellular metabolism such as proteins, glucose, electrolytes, and many more depending on the cell's function. The nucleus contains the DNA and enzymes essential for controlling cellular activities. Differentiation is a specialized process that occurs as an embryo. Each cell has all its genetic information intact; however, as the embryo grows, the body dictates what cells need to be produced such as neurons, muscle cells; every cell has their own specialized function and are organized in collections called tissues. Every cell has its own cell cycle and production (mitosis) and the DNA has control over growth and production. If the DNA is altered in the parent cell, the daughter cells contain the same altered cells. All cells need an adequate blood supply, oxygen and nutrition in order to prosper. Hormones stimulates cell growth and reproduction or it may be inhibited by nearby cells. Altered DNA can either mutate in other structures and functions, or cause the cell to die. (Gould, B. E.., pg 96-97, 2011)
The difference between a cancer cell and a normal cell is its growth patterns. Unlike a normal cell, when its time is up, it dies. Cancer cells continue to grow and prosper into mutated cells. Cancer cells can also invade other cells which normal cells cannot. Some cancer cells become neoplasm (tumor). Benign tumors consist of differentiated cells, mitosis is fairly normal, growth is slow, can expand in a mass, most times it is encapsulated and it usually remains localized. Malignant tumors vary in size and are undifferentiated, has an increased mitosis and atypical, has a rapid growth, capable of infiltrating tissues, has no capsule, capable of metastasizing, and become life threating. (Gould, B. E.. , pg 97- 98, 2011)(BreastCancerOverview, pdf, 2011)
Mary is a 35 y.o. Female, 5 foot 3 inches tall, 110 pounds, who has been on oral birth control pills for 5 years, She does regular breast self exams. Her aunt on her mother's side is the only other family member known to have breast cancer. Mary found a lump in her right breast while doing a self exam. She immediately made an appointment with her physician. Other the next few days, she had a physical examination and a mammogram. The mammogram showed a growth and a biopsy was recommended. The biopsy showed cancer and surgery was scheduled.
In Mary's situation, two obvious risk factors were noted, in family history on her mother's side, her aunt had breast cancer. Secondly, Mary was on birth control pills for 5 years and according to the cancer society, 3+ more years on birth control pills can increases the cancer risk for those women; however, if a women stopped taking birth control pills and it has been over 10 years since taking the birth cintrol pills, the risk goes down. Other statistics that were not enclosed in the story are the following: Women who have early menstrual periods before age 12 and went through menopause after 55 have a slight increase of breast cancer due to longer exposure to hormones estrogen and progesterone. The same could be said for women who do not breast feed vs. breast feed their children, there is a decrease risk due to decrease hormonal effects from cessation of the menstrual cycle while breast feeding . Lack of exercise can increase the risk of breast cancer because exercise lowers the hormonal levels, alters metabolism and boosts the immune system. Lastly, woman with dense breast tissue contains more gland tissue and less fatty tissue causing potential problems in mammogram interpretations . (, 2012)

During surgery, a few surrounding lymph nodes were sent to the lab and since some showed cancer cells, a mastectomy was done. Per Mary's wishes, a mastectomy was done on the healthy left breast. After surgery, the breast tissues of both breasts was examined. The lab test found the following: on her right breast, invasive ductal carcinoma; stage 2; Estrogen receptor positive. On her left breast; ductal carcinoma in situ; also ER positive.
Mary's left breast did not show any lumps in her mammogram or on her physical, she still requested if a mastectomy was done on a right, that it would be also be done on her left. Like Mary, other women also choose to have a bilateral (both) mastectomy, especially if one breast contains cancer and the other is healthy in order to decrease their risk for future cancer in the unaffected side. (, 2012)
Per cancer society, the term 'in situ' is used in “early stages of cancer, when it is still confined to the layer of cells where it began”. This preinvasive stage cancer may be present for months or years.
In Mary's case, she elected to have both (bilateral) mastectomy for preventive care. Even with women who option for the bilateral mastectomy, some breast tissue still remains and the risk is greatly decreased; however, cancer can regenerate in the breast tissue that remains. Mary had a biopsy prior to her surgery, I am sure the method of treatment was discussed thoroughly between her and her doctor prior to surgery due to the results of the biopsy. From the biopsy lab test, breast cancer grade are given from one to three. Lower number means slowing growing cancer, and higher number means faster growing cancer. This is also used as a prognosis. Staging of cancer indicates how wide spread the cancer is by the time it is found. It portrays if the cancer is invasive or non-invasive, it also indicates the size of the tumor and if lymph nodes are involved and whether it has metastasize. (Gould, B. E.., pg 99, 2011) (, 2012) (, 2012)
Post-op lab results showed that Mary had stage II, invasive ductal (cells lining the milk ducts ) carcinoma with estrogen receptor (ER) positive. This type of cancer had spread out side the duct into the surrounding tissue with no lobe invasion. In order to grow, this type of cancer depends on the hormone estrogen. The lab result on her left breast showed ductal carcinoma in situ (DCIS) with positive ER. This type of cancer is a noninvasive cancer, but if not removed, it could develop into an invasive cancer. It also means that this cancer was only found in the breast ducts and has not spread past the layer of tissue where they began. This type of cancer also relies on the hormone estrogen in order to grow. According to Mary's post-op lab results her left breast cancer would be a stage 0. (, 2012) (, 2012)
For Mary, treatment was tailored to her individual cancer. Bilateral mastectomy was performed to removed the cancer that is visible. The next step taken was to lower the risk of recurrence and get rid of any remaining unseen cancer cells that have been left behind (adjuvant therapy). Radiation and hormonal therapy where chosen for her treatment. Radiation therapy is the use of high energy x-rays to kill cancer cells. A radiation regimen consist of a specific number of treatment over a set period of time. Mary was also prescribed tamoxifen for her hormonal therapy. Her type of cancer fuels its growth by the estrogen hormone. Tamoxifen is a drug that blocks estrogen from binding to the cancer cell. It is effective in lowering the risk of recurrence to the breast that had cancer and risk of future recurrence. Tamoxifen can be classified as an antiestrogen or selective estrogen receptor modulators. (Gould, B. E.., pp. 99, 107-110, 11, 2011) (, 2012) (medcinenet, 2012)


Gould, B. E.. (2011) Chapter 5
(pp. 101-102), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.
Gould, B. E.. (2011) Chapter 5
(pp. 96-97), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.
Gould, B. E.. (2011) Chapter 5
(pp. 99), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.
Gould, B. E.. (2011) Chapter 5
(pp. 107-108), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.

Gould, B. E.. (2011) Chapter 5
(pp. 111), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.

Anonymous. (2011). Breast Cancer Risk Factors
Retrieved January 15, 2011, from website
Anonymous. (2011). Tamoxifen
Retrieved January 15, 2011, from NIH website
Anonymous. (2011). Tamoxifen
Retrieved January 15, 2012, from website
Anonymous. (2011). Breast cancer treatment by stage
Retrieved January 15, 2012, from website

Saturday, July 17, 1999

Pathophysiology week 3b

Caution: Fragile!

When we are young and sprite, we believe we are invincible. When we become older, we are programmed to think young regardless of the physical wear and tear changes that occur, it just takes a little longer (life cycle). In the following scenario, Bill is enjoying his retiring life style in ways he enjoys; however back pain may involve some changes.
Bill is a 70 y.o. male who held a desk job until his retirement 5 years ago. Since then, he has spent most of his time working on his stamp collection. Bill has never been very active due to his asthma. He also is a picky eater and does not like dairy products. Bill and his wife do take a daily walk around the neighborhood. One day while on their walk, Bill begins to complain of back pain. The next day, the pain is worse and Bill's wife insists that he see the doctor.
Bill suffers from asthma. Asthma is an chronic allergic lung disorder that inflames, creates swelling and narrows the airways. Because the airways are already inflamed, certain factors promote episodes of breathing difficulties called asthmatic attacks. The factors that can trigger an asthmatic attack include allergens, environmental agents, exercise, or infection. When asthmatic attack occurs narrowing of the airway occurs the same way regardless of the stimuli factor as the following: The inflamed mucosa causes edema (swelling), broncho constriction of the smooth muscle occurs, and increase thick stick mucus. According to the National Heart Lung and Blood Institute inhaled corticosteroids are the preferred medicines for long-term control for asthma. It helps reduced inflammation and helps prevents symptoms caused by asthma. Corticosteroid pills and liquids are only used short term in order to control severe cases of asthma. Prolong use of pill/liquid corticosteroid can raise the risk of cataracts and osteoporosis. (nih, 2012)
The doctor does an x-ray which shows a compression fracture in Bill's L1 vertebrae. As a follow-up, the doctor also orders a Bone Mineral Density Test. This test comes back with a T score of -2.8. The doctor prescribes a pain reliever for Bill's back pain and a course of treatment for the diagnosed disease.
Our skeletal system has many primary functions such as body's structural support, storage for calcium, contributes to blood cell production, protection of the soft tissues in the body, and gives our body leverage in order to assist our muscles in movement. When we are younger, our bones are in a frequent manufacturing mode throughout the year building bone mass ( bone density) by absorbing calcium and removing protein and mineral components. After 30s the body starts to reabsorb calcium faster than the bones can rebuild leading to a net loss in bone mass as we age. This net loss of bone mass (bone density) cause the bones to become more fragile and a candidate for fractures especially in the spine, hip and wrist.
Osteoporosis occurs when there is a marked loss of bone density and a increase in bone porosity. This condition is frequently seen the aging. There is usually no symptoms until the damage has already occurred such as back pain, loss of height and fractures of vertebrae, hips, wrist and other bones. Unlike hip fractures, fractures in the spine do not need an incident like a fall to occur. The spine may have become so weakened that it just starts to compress. There is many risk factors that can make a person prone to osteoporosis. Some of these factors are the following: You are an older person; You are a woman; Decrease estrogen levels especially after menopause; For men, low testosterone levels; Have a sedentary life style; Decreased intake of vitamin D, C, and calcium; Heredity; and Take corticosteroid drugs. (
Men have more bone mass than women; whereas men in their 50s are loosing bone mass at a very slow rate compared to women after menopause. By the time men reach their mid sixties – 70, men and women lose bone density at the same rate. This is a possible reason why men are not diagnose with osteoporosis until a fracture actually happens because women are having bone density tests earlier in life. (about, 2012)

Diagnosis of osteoporosis can be done by simply having a bone mineral density test called DXA or DEXA ( Dual-energy X-ray absorptiometry) that measures bone loss. DXA is the standard for measuring bone mineral density. A Lateral Vertebral Assessment (LVA) is a low -dose x-ray examination of the spine to screen for vertebral fractures is also performed on the DXA, especially if a person has lost in height, or have an unexplained back pain, or if the DXA scan gives a borderline reading. Radiation from the DXA is lower than a chest x-ray. The DXA works by sending out a low-dose x-rays with two distinct energy peaks through the bones being examine. One peak is absorbed by soft tissue and other is absorbed by bone. The bone density measurement results is by subtracting the soft tissue amount from the total. The test results are in two forms. The 'T' score is the amount of a person's bone compared to a young adult of the same gender, which are the following: A score above
[ -1 ] is considered normal. A score between [ -1 ] and [ -2.5 ] is classified as low bone mass (osteopenia). A score below [ -2.5 ] is defined as osteoporosis. T score estimates your risk of developing fractures. A 'Z' score reflects the amount of bone a person's has compared others in the same age group. Score is usually high or low, indicating a need for further testing. Bills T score was
[-2.8]. Bill T score is classified as osteoporosis accordingly to the DXA test results. (radiologyinfo, 2012)
Bills history, supports his risks for osteoporosis. His use of asthma medications which could be either glucocorticoids or corticosteroid puts him at risk for bone loss. The gluccorticoid is an anti-infla mmatory drug decreases calcium absorption from food, decreases bone formation, and increases calcium excretion in the kidneys. The corticosteroid drug can interfere with sex hormone production, promote muscle and bone loss. Most of Bills activity is mostly sedentary due to his asthma, although he does take daily walks which is a plus. He also does not eat well and does not take in dairy products. Lastly his age makes him an obvious risk. His increasing back pain after a walk was the only symptom that made him go to a physician. The x-ray report showing a compressed (collapse) fracture the L1of the vertebrae which probably cause his pain. The vertebrae (lumbar region) is a region that bears most of the body weight. The Bone Mineral Density Test (DXA) T results was scored [-2.8]. Both x-ray and DXA medical findings support Bill's diagnosis.
Bill's treatment management will possibly require a increase calcium and vitamin D diet intake, with the emphasis in a calcium supplement of 1200-1500 mg daily and a vitamin D of 600 -800 units a day. Continue to encourage a more active life style along with his daily weight bearing exercise to prevent bone loss, which he already does by walking. Bill's physician will probably manage both asthma and osteoporosis by balancing medication that will benefit Bill with least side effects. For his asthma, the physician may put Bill on a glucocorticoid ( hydrocortisone or prednisone) inhaler instead of oral, at a lower dose and encourage shorter time of use. For osteoporosis, treatment would consist of anti-resorptive agents which inhibit bone reabsorption. Bisphosphonates is a class of drugs that inhibits breaking down of bone, decreasing the risk for hip, wrist, and spinal fracture. One example of this drug would be Fosamax ( bisphosphonate anti-resorptive medication) which has shown to increase bone density in men. Another example, Actonel (bisphosphonate anti-resorptive ) is a better medication for those people who have osteoporosis caused by cortisone related medication, which may be indicated in Bill's case. This medication is more potent in resorption of bone than Fosamax and is less irritating to the esophagus.

Anonymous. (2012). How Is Asthma Treated and Controlled?
Retrieved January 20, 2012, from website
Anonymous. (2012). What is Asthma?
Retrieved January 20, 2012, from website
Anonymous. (2011, January). What People With Asthma Need to Know About Osteoporosis
Retrieved January 20, 2012, from website
Anonymous. (2012). Bone Density Scan
Retrieved January 20, 2012, from Radiologyinfo website
Bihari, M. MD. (2008, November 25). Osteoporos for men
Retrieved January 20, 2012, from About website
Anonymous. (2012). Osteoporosis medications
Retrieved January 20, 2012, from ACAAI website

Gould, B. E.. (2011) Chapter 10
(pp. 180), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.

Thursday, July 15, 1999

Pathophysiology week 3

I'm Just Tired
You have to love the our immune system. “ You must remember this. A kiss is not just a kiss..., ” is a partial lyrics in a song sung in the classic movie “Casablanca”. The above lyrics is a clue how infectious mononucleosis can be spread. Unknown to any one person, the saliva in the mouth may harbor the Epstein-Barr ( EBV) virus. In part, this may be what happened in the following scenario.
Karen is a 17 y.o. Female basketball player who has been suffering from fatigue. It is beginning to interfere with her playing, and her team is expected to go to the playoffs this year. She also has a sore throat. Karen believes she is just not getting enough sleep due to games and being out with her boyfriend. However, her mother insists she visit the doctor.
Infectious mononucleosis is a common illness caused by Epstein-Barr virus(EBV). EBV is categorize in the herpes virus group. The primary transmission source of EBV is a person-to-person contact with saliva; however in a few cases transmission may occur through air ( droplet in sneezing or coughing) or blood. The EBV exposure eventually leads to the infection of the B lymphocytes in the epithelial cells of the nasopharynx and oropharynx In the United States, 95 % of adults between the ages of 30-45 years of age have already been exposed to the EBV and have antibodies (immunity) that can target the virus. Thus, sometime during their life span, these people have been infected with EBV. Thanks to the immune system, the antibodies that targets the EBV cells, produces a life long immunity. However, the EBV can become dormant and remain in a few epithelial cells in the throat and blood. In some healthy people, this stealth-like nature of the EBV reactivates in the person's saliva, causes no symptoms and , the person then becomes a carrier, shedding the EBV without his/hers knowledge of its existence. According to the Center of Disease and Control (CDC), this may be one reason why EBV is world wide and difficult to prevent. These same people can secrete the EBV through out their life time due to the periods of reactivation. Most children who have been exposed to EBV do not have any symptoms or are treated for having other mild childhood illnesses. In teenagers and young adults, symptomatic conditions and signs of mononucleosis, usually occurs in 35-50% of the cases per National Center of Infectious Disease. Incubation period (time from the initial infection to the appearance of symptoms) for mononucleosis is approximately 4 -8 weeks. Contagious period is usually
during the infection period and weeks after ward. (pg 164-165)(, 2011)(aafp, 2004)
The physician finds Karen has swollen lymph nodes; an enlarged spleen; and tonsillitis. The lab test come back with the following findings: CBC: Increased WBC; normal RBC. Liver Function Test: Increase liver enzymes. Heterophil antibody test : positive.
Clinical symptoms and signs of mononucleosis involve sore throat (80-90%), fever, headache, malaise (lack of energy), fatigue, temporary rash on trunk, enlarged (swollen) lymph nodes/glands (lymphadenopathy), enlarged spleen (splenomegly) and the age factor. Diagnostic measures are also taken to confirm or rule out other illnesses/causes. Lab test that narrow in on certain symptoms or signs such as culture for sore throat or fever, blood chemistry test to reveal infection or abnormal liver functions, and a heterophil antibody test (Monospot test), which is sensitive to specific antibodies made in the immune system. An elevated white count( increase in lymphacytes and monocytes ), an increase or presence of atypical T-lymphacytes, and a positive heterophil test confirms the diagnosis. (, 2012)( Gould, B. E, pg 165, 2011)(aafp, 2004)(labtestonline, 2012)
Karen's physician likely suspected Karen's diagnosis as mononucleosis due to Karen's symptoms, signs and physical exam. Karen was in the right age group, suffered fatigue, malaise, and had a sore throat. Her exposure to saliva could have come from any one she was close to. Number one, it could have come from her boy friend. Number two, one or more of her family members or friends, where she may shared a bite of cake or another food item where the utensil or food may have saliva on it. It could be any number of situations where saliva maybe exchanged.
Karen's physical exam noted swollen lymph nodes, an enlarge spleen, and tonsillitis. Karen's lab results showed an increase in WBCs and normal RBCs, an increase liver enzymes obtained from the liver function test, and a positive Heterophil Antibody Test. The increase liver enzymes only indicates that there is some liver inflammation, with mono the liver enzymes usually return to normal without treatment. The lab results along with the Heterophil Antibody Test confirmed Karen's diagnosis. Karen had to have mono for a period of time in order to obtain an acceptable amount antibodies made by the immune system for the Heterophil Antibody Test to become positive, approximately 1-4 weeks. ( immunity cycle).
Karen's doctors prescribes a treatment regimen and tells her she may not play basketball for at least one month and she needs an exam before she resumes playing. Karen is disappointed she cannot play basketball, but is happy that the doctor says she will never get this disease again.
Since mononucleosis is viral, Karen's physician more than likely prescribed comfort and supportive measures that would help in relieving her symptoms, such as plenty of rest, or an over-the-counter analgesic like tylenol or motrin for temporary relief from discomfort (no aspirin in her age group due to Reyes syndrome), and fluid hydration. It also might be possible that Karen's tonsillitis is a bacterial infection, secondary affect of mono. An antibacterial drug would be prescribed ( ampicillin and amoxicillin should be avoided due body rash potential in people with mono, thus mistaken as an allergy) . If not, gargling with salt water is one home-made treatment that could be used to soothe the soreness in her throat along with others temporary remedies , such sucking on a Popsicle or warm drinks etc. (medicinenet, 2010)
The spleen is fragile and important part of the immune system. It filters blood, stores iron from recycle RBCs, removes abnormal blood cells, and initiates response of B cells and T cells in the blood. Splenomegaly (enlarged spleen) caused by mono, makes it vulnerable to injury. Karen's physician requested no basketball for a month most likely due to the spleen's vulnerability to injury. A follow up clinic visit was needed in order to evaluate the spleen before Karen resumes basketball. (webmd,
As mentioned earlier, Karen does not have to worry about getting the disease again; she has life time immunity. At the present, she only needs to concern herself in getting better with lots of hugs with no kisses from her family, friends, and boyfriend.

Anonymous. (2012). Epstein-Barr Virus and Infectious Mononucleosis
Retrieved January 20, 2012, from website
Ebell, M.H.. (2004, October, 1). Epstein-Barr Virus Infectious Mononucleosis
Retrieved January 20, 2012, from website
Anonymous. (2012). Epstein-Barr Virus Antibodies
Retrieved January 20, 2012, from website
Anonymous. (2010, April 19). Spleen
Retrieved January 20, 2012, from website
Stöppler, M.C. (2012). Infectious Mononucleosis
Retrieved January 20, 2012, from medicinenet website

Gould, B. E.. (2011) Chapter 10
(pp. 165), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.

Structure and Function of the Human Body week 7

1. Compare and contrast non-specific and specific immunity. What is the difference between innate immunity, acquired immunity, active immunity, and passive immunity?

The immunity system works two ways. Non-specifically and specifically. The main difference between non-specific immunity and specific immunity have to do with the following: the response time, non-antigen specific vs. antigen specific and no memory vs. memory after exposure from the pathogen, foreign matter or abnormal cell.
In non-specific immunity (present at birth ) defense barriers are always present, capable of targeting non-specific antigens, has no immunological memory (immediate action only), and responds more immediate to invading organisms. In other words, the main function of non-specific immunity is preventing microbes from entering into the body by targeting antigens before hand or isolating them if microbes does enter the body, as in an inflammatory response (temporary repair, slows the spread of pathogen, and helps with tissue regeneration). An intact skin is the first line of defense for non-specific immunity. The skin prevents invasion of microbes. Other body defense surfaces includes mechanical and tactile protection the hair provides on the scalp and other parts of the body, sweat and sebaceous glands found in the epidermal (that flushes and washes away microbes and chemical agents), and epithelium lining in the digestive, respiratory, and urinary tract where acidity, enzymes, and mucus are secreted. Microbes are caught in the mucous found in the nose and respiratory. The stomach's acidity produces an environment that can hinder microbe growth or can destroy the microbe. Mucous in the urinary track attract microbes and flushes them out of the body. (pg 480)

Also included in non-specific immunity is phagocytes, the first line of cellular defense. There are two classes of phagocytes, microphages and macrophages. These 'Pac-Man' cells circulate in the blood system and enter the peripheral tissue, looking for microbes and pathogens to surround, and destroy. They are usually the first to encounter infection. (pg 479-480)

In the immunological surveillance, our body's immune system is surveying for abnormal cells to attack and destroy. This involves lymphocyte,NK (natural killer)cells. The NK cells pick up antigens on abnormal cells membranes. (pg 480)

The interferons are small proteins released by activated lymphocytes, macrophages, and tissue cells that have been exposed to a virus. In essence, cellular exposure with interferons produces anti-viral proteins; thereby, prevents viral replication inside the cell and slows the spread of the virus.

The complement system (complements antibodies' action) attacks and breaks down. Complement activation attracts phagocytes, stimulates phagocytosis, destroys plasma membranes (breaks down cellular walls), and stimulates inflammation. (pg 480-481)

In the inflammation process, mast cells play an important role. Mast cells are found in connective tissue and their main duty is to release chemicals that activates the body's defenses after an injury or infection. Once the mast cell is activated, blood flow increases, phagocytes are activated, capillary permeability increases the inflammation response, clotting reaction walls off region, regional temperature is increased, and specific defenses are activated. (pg 480)

In specific immunity, there is a lag time between exposure to the antigen and maximum response (antibodies). T-cells and B cells are naturally programmed in the bone marrow and thymus to attack only specific (nonself) antigens and not normal (self)body antigens found on normal cells. T-cells provide defense against abnormal cells and pathogens inside living cells (cell mediated immunity). B-cells provide defense against antigens and pathogens in body fluid (antibody-mediated immunity). Exposure to the pathogen or foreign cell results in immunological memory.

There are also two types of specific immunity, innate and acquired. Innate immunity is the genetically determined at birth and has no prior exposure to the antigen involved. The acquired immunity occurs when prior exposure and antibody production exist. Active and passive immunity are subdivision of acquired immunity. Active immunity is produced when specific antibodies develop in response to specific antigens. Active immunity can either occur through natural ( environmental) means or induced ( administration of antigens) means. Passive immunity is produced by transfer of antibodies from another person. Passive immunity can also occur through natural means such as in maternal breast milk or transferred of maternal antibodies across the placenta. (pg 482-483)

2. Explain the pathway of lymph once it enters into the lymphatic vessels to being “dumped” back into the blood stream. What materials or items could be found in the lymph? What happens to the lymph when it goes through the lymph node?

Unlike our circulatory system, where the blood stream is pumped by the heart, the lymphatic system is only a one way system that flows upward from the extremities (feet and hands), through the body towards the neck. This is accomplished through the normal movement of the respiratory and skeletal muscles and the overlapping arrangement of the endothelial cells found in the lymphatic vessels that promotes forward movement and prevents backflow. (pg 473)

Since the lymphatic vessels run parallel to the venous system, the start of the lymphatic system begins with the lymphatic capillaries which begins as a blind pockets in the peripheral tissue. These capillaries are lined with simple squamous epithelium and lack a basement membrane. This permits permeability of fluids, solids, and waste to flow into the lymphatic capillaries. (pg 473)

Lymphatic capillaries eventually flows into larger lymphatic vessels that eventually leads toward the trunk of the body. Like the venous system, valves are needed in the larger lymphatic vessels to prevent back flow due to the pressure in the vessel is low. The larger lymphatic vessels empty into two large lymphatic ducts, thoracic duct and right lymphatic duct. The thoracic duct collects lymph from the lower abdomen, pelvis, lower limbs and from the left half of the head, neck, and chest. It finally empties into the venous system near the junction between the left jugular vein and the left subclavian vein. The right lymphatic duct covers a smaller area. The right lymphatic duct collects lymph from the upper right quadrant of the body, the right arm, and the right side of the head and neck. It empties into the right subclavian vein (which is blood) that eventually goes into the right atrium of the heart back into the circulatory. I can imagine anything that leaks out from the tissue into the interstitial fluid leaks into the lymphatic capillaries; therefore, the thin epithelium found in the lymphatic capillaries permits water, protein molecules and other molecules, virus, bacteria, fungi and other pathogens are carried in the lymph. (pg 473)

When the lymph is processed through the lymph node, a filtration process is taking place removing waste products, some excess fluids, and purifying lymph fluid before it reaches the venous system. Afferent lymphatic vessels carry unfiltered lymph fluid through the nose. When the lymph flows through the sinuses of the lymph node, 99% of antigens are removed by macrophages (white blood cells). As the antigens are spotted and removed, this stimulates the T-cells and B-cells to activate which initiates the immune response. After the purification of the lymph fluid, the fluid is returned to the venous circulatory system through the efferent lymphatic vessels.

3. Compare and contrast T-lymphocytes and B-lymphocytes specific immunity mechanisms. In specific immunity, why does exposure (1st exposure compared to 2nd and subsequent exposures) matter?

Cells recognize antigens when those antigens are bound to membrane receptors of other cells. The structure of these antigen-binding membrane receptors is generally determine. Membrane receptors are called major histocompatibility complier (MHC) proteins. There are tow classes of MHC. Class I MHC protein are found in the plasma membrane of all nucleated cells. Class II MHC proteins are found in the membranes of lymphocytes of antigen – presenting cells (APC)
Class I MCH is MCH bend of display small peplicales molecules (chain of amino acid that are activated either by recognition such as in organ donation or by contact as in viral or bacterial which results in destruction of the abnormal cell. Class II MCH activate 7 cells to attack foreign cells, including bacteria and foreign proteins such as microglia in the CNS and macrophages in the liver (keep their cells) After the ACC breakdown the foreign antigens / pathogens – fragments of the foreign antigens are imprinted on their cell surfaces bound to class II MHC protein. T Cells that come in contract are APC membrane become activated initiating an immune response activating of T cell only occurs when MHC protein contains the specific antigen the T cell is program to detect T cells divide and differentiate into cells specific function in the immune response. These types are cytotoxic T cells, helper T cells, memory T cells and suppressor T Cells. (pg 486-488)

Cytotoxen T cells (killer t-cells) responsible for all medicated immunity they are activated by exposure to antigens bound to class I MHC proteins. They destroy their target by the following specific secretions: lymphotorein disrupt the cell metabolism, cytocrine tell the cell genes to die and perform which destructs the plasma membrane. T cells are activated by exposure to antigen bound to Class II MHC helper T Cells are activated by exposure to antigen bound to class II MHC proteins on antigen presenting cells through activation they divide to produce memory cells and more helper T cells. (pg 486-488)

Cytotoxin T cells and helper T cells developing into memory T cells these cell remain in reserve until the same antigen appears a second time around in which case they will become either cytotoxic T cells or helper T cells and enhance in speed and effectiveness of the immune response. Suppressor T cells have their major job which is to put the brakes on the response of other T cells and B cells by secreting cytolysis called suppression factors – suppression cells act after the initial immune system. (pg 486-488)

Initial response to antigen exposure is called primary response. Primary response takes approximately one-two weeks to develop peak antibody levels after exposure then recline. ICM modules are the first to appear in the blood stream followed by a slow rise in IGC. Secondly, in the primary response, antigens must activate specific B cells and B cells must then respond by differentiating into plasma cells. Memory B cells do not differentiate into plasma until cells are exposed to the same antigen a second time. After the 2nd exposure occurs, memory B cells respond quickly by dividing and differentiating into plasma cells that then secrete massive amount of antibodies. (pg 486-488)

During the second response, the body is ready with antibodies. The response is faster and stronger. The memory cells are already equipped to attack even with low levels of antigens. Immunization looks as a secondary response. because it stimulates the production of memory B cells under controlled condition. (pg 486-488)

B cells launch a chemical attack on antigens by going through a series of events that result in production of specific antibodies. Each B cells carries its own antibody molecule in its cell membrane. When a corresponding antigen appears in the interstitial luid gets well bound by B cells antibodies. The antigen enters the b cell by endocytosis and become displayed on class II MHC protein surface this is called sensitized activated help T cells encounting the antigen on the sensitizing B cell then release cytogens that trigger the activation of the B cell. The B cell then divides producing memory B cells and plasma cells that secrete antibodies.
Memory B cells like memory T cells remain on reserve to respond until second exposure of the same centigen at which time they respond by differenting into antibodies and secreting plasma cells. (pg 486-488)

Antigen antibody binding occurs between antigen binding sets on the antibody and antigenric determinant sites on the antigen. When an antibody molecule binds to its specific antigen an antigen antibody complex is formed. This is where they bind to certain positions of its exposed surface called antigenic determinate sites. (pg 486-488)

4. Immune responses are consistently occurring within our body and involve many complex steps. For the most part these mechanisms perform very well but there are 3 categories of complications and/or dysfunction that can occur within the immune system. List and describe each category and the cause of the dysfunction.

There are three classes of disorders that can result from a malfunctioning immune system. Autoimmune system is one class that targets normal (self) cells' antigens and tissues as foreign invaders. This causes the B-cells to produce specific antibodies to attack normal cells and tissues. These antibodies are called autoantibodies. Examples of autoimmune deficiency disorder is a situation that occurs in IDDM (insulin-dependent diabetes mellitus) where the auto-antibodies attack cells in the pancreatic islets. Another situation that can occur under autoimmune disorder is when antibodies start to associate normal protein amino acids sequencing with those of several viruses. Many viruses' proteins contain amino acids that closely resembles the amino acid sequence found in the nervous system protein. Complications caused by a viral infection or vaccination can result in a decease such as multiple sclerosis. Lastly, autoimmune disorder can be found in people who have an unusual genetic MHC (major histocompatibility complex) protein. People with this defect may sub-comb to such diseases as rheumatoid arthritis, grave's disease, psoriasis or pernicious anemia.

Immune deficiency disease is another class. In this case, there is an abnormal development of the immune system or the immune response is blocked. Children with SCIDC (severe combined immunodeficiency deceases) get to developed cell on immune response, total protected infected. Aids is another immunodeficiency decease caused by viral infection that targets helper T-cells which eventually causes an immune response to malfunctionencies.

Allergies is a third classes of the immune diffidences caused by antigens called allergens. In this case, the immune responds inappropriately excessively to the allergies. Immune hypersensitivity is a rapid form response to an antigen. The initial exposure does not trigger a response allergic reaction, but only lets the stage for a prone aggressive response second time around. The initial response only starts the process for IGE antibodies production and attach themselves to the cell membrane of the aphelia and mast cells. Later with the second exposure, these cells are activated and release histamine, heparin, several cytoganis, prostoglancilins, and other chemical into the surrounding tissues. The severity depends on the person's sensitively on areas envalve such as the body surface. - inflammation is restricted to that area, blood stream could be devastating in area prophylaxis is where the allergen affects the mast cells producing a severe reaction or even lethal reaction. The affects can produce cells-producing capillaries in the smooth muscle causing difficult breathing and of severe vasodilation causing circulatory collapse in the airway (Cana-phylactic shock)

5. Why can fevers be a good mechanism for the body? Why can they be a bad mechanism?
Fever is any temperature higher than 99°Fahrenheit. Fever is also your body's reaction to infection and illness. It helps the body to fight infections. Fever is only a symptom – along with other symptoms helps one determine your illness.
Fever as high as 103°for short time is helpful, because it helps the body fight infection by increasing the rate of metabolism, which enhances the phagocytosis, and increase enzymatic reaction. Fever occurs when the body's immune response is triggered by a protein called pyrogen (fever producing) . Pyrogens usually come from an outside source of the body and can stimulate production the inside of the body. Pyrogens causes the hypothalamus to increase the temperature set point (higher than 98.6° as an example). Examples of outside pyrogens are viruses, bacteria, fungi, and toxins.
High fevers over a long duration can cause problems for the body such as dehydration, and CNS problems which over the long run can be lethal to the body's homeostasis.

Friday, July 09, 1999

Pathophysogy week 2a

The inflammation process is our body's attempt to zero-in, confine, and repair damaged tissue cells cause by a pathogenic invasion that can occur when the body's first line of defense, the skin, has been broken. In other words, it is the body's natural means in restoring its homeostasis status after a tissue has been injured.
When an injury occurs, the insult stimulates the connective tissue cells (mast cells) and platelets to release chemical mediators such as histamine and heparin. This action causes the injured area blood vessels to dilate and become more permeable. The increase blood flow (hyperemia) to the injured region makes the area warm and reddened, while at the same time, diffusion (protein and fluid shift) of the blood plasma creates swelling in the injured region. The increase pressure from fluid and the chemicals released by the mast cells also activates the nerve endings, causing pain. In some cases, depending on injured area, a loss of function can occur because of the swelling and lack of nutrition to the area's cells. Leukocytes are rapidly attracted to the injured site by mears of chemotaxis,a chemical signal released by the injured cells. Phagocytes become the first line of cellular defense, moving out of the blood stream and interring the injured tissue by squeezing between adjacent cells in the capillary wall (diapedesis). Macrophages remove the cause and the debris (phagocytosis) in order for healing to take place. If the causative agent is not removed, inflammatory response will continue until it is. (Gould, B.E., pp 19 – 21, 22 – 23, 2011)
Richard, a 50 y/o father, fishing with his family in the bounty waters, started out his day with the joy in catching northern pike and days later, ended receiving antibiotics. The events that place cascade from one small mishap, a fish bite. Factors that allow the infection to spread prior to Richard's emergency visit will be pointed out the following narrative along with the answers to the remaining questions.

Richard's son caught a large northern pike. As the fish was brought in, it came off the hook and landed on the bottom of the canoe. Richard manage to subdue the fish and put it on the stringer, but in the process, the fish bit his finger. This caused a puncture and some bleeding at the base of the finger nail on the right ring finger. The wound was washed with boiled water and a Band-Aid applied which he wore for only one day until the bleeding stopped.
The moment the protective skin barrier was broken, the punctured wound ( fish bite) at the base of his finger nail provided a direct avenue for microorganism. Unknown to Richard, a tooth ( foreign body) from the northern pike was embedded in the puncture wound. The embedded tooth was full of germs, thus infection was inevitable. No antibacterial ointment was ever applied and the puncture wound was only Band Aided for one day (no mention of if Band-Aid was changed). The inflammation response was initiated when Richard was bitten by the fish.
Four days later, while at work, Richard noticed that he kept bumping the injured finger and that it was very sore. That evening, he ask his wife (an allied heath professional) about the soreness and she recommended washing it out again and applying a Band-Aid to protect it. The next night , 5 days after the injury, Richard came home and showed his wife his hand and arm. His wound was swollen and white with pus, and his arm now had red streaks to the shoulder. They immediately went to the emergency room and he was put on IV antibiotics. After two days of treatment, Richard was changing the bandage when he noticed a northern fish tooth had come out of the wound with the pus.
Even though the injured finger did not have protected covering from the environment, which it probably should have, the site was never iced, elevated, rested nor monitored for infection since day one and prior to evening on day four, when Richard ask his wife about the soreness. Richard's complaint of soreness in the the injured finger indicated that the inflammation was still in progress and infection had already begun due to the embedded northern pike's tooth (foreign body). Even if the northern pike's tooth was discovered a day or two earlier, contamination had already occurred with the fish's bite. The only possible advantage could be that the infection would be less evasive and Richard possibly only needed to be on oral antibiotics. Secondly, the wound was unprotected when Richard was at work, which may have provided more exposure to more microorganism, especially in his line of work.
Instead, on day five after the injury, Richard's wound was swollen and white with pus and his arm had red streaks to the shoulder. Pus is a purulent exudate that consist of collection of interstitial fluid formed in the inflamed area. Pus is usually thick in consistency, yellow-green in color, and contains leukocytes, cell debris, and microorganisms. Formation of pus found on Richards was a marker for a bacterial infection. The swollen and white wound indicated edema caused by the fluid shift in the interstitial space due to inflammation process. The red streaks found on Richard's arm indicated that the infection had begun to spread . Red streaks do not necessary mean sepsis however, it could eventually occult if immediate treatment was not taken. In Richard's case, the red streaking in the skin may possibly mean that the bacteria had spread into the lymphatic channels, causing lymphangitis; therefore, a excellent reason why Richard was put on IV antibacterial drug, a possible broad spectrum drug,in order to deliver a immediate loading dose and achieve an adequate blood level to effectively treat the infection. Along with help of IV antibacterial drug and the northern pike's tooth (causative agent) being expelled, Richard's injured finger can now start the healing process through skin regeneration. (Gould, B.E , pg 20,26,86, 2011)
The IV treatments were given on an outpatient basis. Richard spent 3 hours, twice a day for 3 days receiving antibiotics. An IV port was left in his arm and wrapped to protect it at work. However, when it was discovered he worked in the sewer system, he was instructed not to return to work until the infection was gone.
Richard already had one encounter with infection from the fish's bite, returning to work with the IV port, would have advance his risk for another infection. Working in a sewer system has to be a microorganism minefield.

Gould, B. E.. (2011) Chapter 2
(pp. 19-23), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.
Gould, B. E.. (2011) Chapter 2
(pp. 26), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.
Gould, B. E.. (2011) Chapter 4
(pp. 86), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.

Tuesday, June 15, 1999

1999 Caribbean cruise

This is the second vacation I took in June. This was first class.

I remember there was an arcade with Soul Calibur, Area 51, Daytona USA, X-men vs. Capcom on the ship. There was a casino and strip bar.





Monday, June 07, 1999

Pathophysiology week 6b

Blood Pressure Woes

In the following scenario, two diseases are exposed, both are silent in progression in early stages, and both can cause insult to the body's homeostasis. In George's case, he has been battling with partially controlled hypertension for the past five years. What he did not realized that his partially controlled hypertension was not preventing damage to his kidneys.
George is a 55 y.o. male who has had hypertension (HTN) for the last 5 years. His HTN is only partially controlled. He is trying to watch his diet, but does not exercise like he should due to his high-stress job. He is also on HTN medication. He monitors his blood pressure at home on a regular basis. For the past month he has noticed his blood pressure seems to be higher than usual and even harder to control, but figured it was due to the stress of a big project at work. In the past 2 weeks, however, he has noticed he does not feel like eating much; he is fatigued; he seems to be urinating more often; and he has been losing weight. He decides to go in to see the doctor.
Total peripheral blood flow should be equal to cardiac output. Adequate blood pressure (B/P) is needed to overcome friction and elastic forces and to maintain blood flow. If blood pressure is too low, vessels collapse; likewise, if blood pressure is too high, vessels stiffen. A normal B/P is <120 140="" and="" arterial="" b="" cardiac="" contraction="" diastolic="" high="" hypertension="" minimum="" peak="" phase="" pressure="" relaxation="" systolic="">) is when high pressure (tension / vasoconstriction / increase peripheral resistance) is created in the arteries. Pressure and resistance can effect blood flow. When pressure increases, blood flow increases, however, if vascular resistance increases, systemic blood flow decreases. The variance causes the heart to produce enough pressure to compensate for any resistance in order to maintain adequate blood flow. Chronic hypertension can cause complications in the cardiovascular system. According to the National Kidney Foundation, hypertension is the leading cause of heart attacks, strokes, and chronic kidney disease. p.308-311
George's doctor decides to run several tests with the following results: Blood Test Results: RBC: 3.8 million cells/mcL; WBC: 10,000 cells/mcL; Hgb: 11.0 gm/ dL. Urine Test Results: GFR: 45ml/min/1.73m; Creatinine: 3g/ 24hr; Protein: 3g/ 24hr. The diagnosis George received was Chronic Renal Failure.
The kidneys are the body's primary excretory organ along with the skin and respiratory systems. It regulates the internal environment of the body by selectively excreting foreign material (drugs, toxins etc.) and metabolic waste while retaining valuable water, organic nutrients, and electrolytes in order to maintain adequate blood volume and composition. Urine is the end product of metabolism. Urine formation begins in the glomerular capillaries and ends in the collecting ducts ranging between dilute to concentrate composition (pH 4.5 – 8), depending on the body's physiological needs. Handy Tables, (Gould, B. E. , pg 440, 444-445, 2011)
Each kidney consist approximately one million of nephrons. The nephron is the basic functional unit in the kidney. The nephron consist of a renal corpuscle (filtering system known as a glomerulus )and a tubule. The glomerulus (site of filtration) is composed of a capillary network surrounded by a round structure called Bowman's capsule. Between twenty and twenty-five percent of cardiac output per minute flows into the renal artery. The route of blood flow into the kidney starts at the renal artery then proceeds into interlobar artery, then arches into arcuate artery, then flows into interlobar artery, meeting its final destination in the afferent arteriole which is the entrance into the glomerulus At the distal end of the glomerus, the capillaries rejoin to form the efferent arteriole through which blood eventually winds itself back to the renal vein. The dual arterioles controls the pressure (passive) in the glomerular capillaries and the glomerular filtration pressure. The glomerular capillaries restrict only large molecules (protein) resulting into filtrate that consist of plasma minus the large molecules. (Gould, B. E., pg 440- 442, 2011)

Filtrates leaves the glomerulus and enters the renal tubule which reabsorbs all useful organic molecules from the filtrate, reabsorbs > 90% water (osmotic), and secretes into the tubular fluid any waste products that were missed by the filtration process. In the collecting duct, additional reabsorption of water and absorption or active secretion of sodium, potassium, hydrogen, and bicarbonate ions before urine is released. Both secretion and absorption are controlled by selective permeability in different areas of the renal tubule and the response of hormones such as aldosterone ( responds to low sodium or high potassium concentrate), antidiuretic hormone ( >ADH >water permeability making urine more concentrated), and kidney hormones calcitriol, erythropoiten, and renin. (Gould, B. E., pg.440-443, 2011)
As previously mentioned, one of the kidney's main function is to regulate blood volume and blood pressure. Renin an enzyme/ hormone is release in response to low glomerular pressure due to declining blood volume ( low salt and water retention), declining blood pressure or both and triggers the renin-angiotensin system ( leads to formation of angiotensin II). The response triggers the sympathetic nervous system (SNS) to cause a notable peripheral vasoconstriction of the capillaries, elevating B/P in the renal arteries. It also causes constriction of the efferent arterioles, elevating glomerular pressure and filtration rates. In turn the release of ADH promotes water and sodium absorption, increasing the thirst feeling. To maintain homeostasis, a hormone called atrial natriuretic peptide ( released by the atrial cardiac muscle cells), becomes involved to reverse high blood volume and blood pressure leading to an increase sodium excreted in the urine and inhibits renin. (Gould, B. E., pg.442, 2011)
Two other hormones release by the kidneys are calcitriol and erythropoitin. Calcitriol is an hormone released by the kidneys in order to stimulate absorption of calcium and phosphate in the small intestine.
Calcitriol is a converted form of vitamin D3 that has been absorbed from sun light into the skin, modified and released from the liver and converted in the kidneys. It is use to promote bone health.
Erythropoiten is a hormone release by the kidneys when there is low oxygen levels in the kidney tissue. Erythropoitin stimulates the bone marrow to produce more red blood cells, increasing the blood volume and improves oxygen delivery to the tissues. (Gould, B. E., pg .244, 2011) (medicinenet, 2012)
When kidney function becomes comprised by hypertension, as in George's case, the process of glomerular filtration and renal tubular absorption and secretion become affected. Chronic renal failure is where the kidney function deteriorates gradually. The condition can not be reversed, only prolonged, and symptoms of acute renal failure can eventually developed because of scar tissue and loss of functional organization. George initially may not have known he had his chronic kidney failure since gradual loss of nephrons usually occurs without symptoms until it becomes well advanced. The kidneys are highly adaptable and are able to compensate for loss function with the surviving nephrons. In George's case, hypertension may have cause of the chronic renal failure. George's labile B/P status in the past month may have resulted from the progression of his chronic kidney disease, thereby , creating an inadequate blood flow into the glomeruli and causing the kidney's release of the hormone renin. George's job stress, diet,and limited exercise may have initially predispose him to hypertension or it could be genetic or another cause. In the past 2 weeks, George experienced a decrease in appetite, weight loss, fatigue, and had frequency in urination are early signs of chronic renal failure. George's blood test results showed RBC: 3.8 million cells/mcL ( norm. 4.2-5.9) and Hgb: 11.0 gm/dL (norm. for men 13.5). Both hemoglobin and RBC is low and these results indicate anemia, a sign that the kidneys are not adequately producing erythropoiten causing a decrease RBC production, resulting in anemia. George's urine test results exhibit impaired kidney function. Glomerular filtration rate (GFR) is a measure in how well the kidneys are filtrating wastes from the blood. George's glomerular filtration rate (GFR) is 45 mL/min/1.73m ( norm. > 90-130), Creatinine is an end product of muscle metabolism. It is normally excreted in urine. George's creatinine is 3g/24hr (norm.1-2g/24hr). Protein is not normally excreted in the urine. If the filtration membrane is damaged, blood protein will leak out and end up in the urine. George's protein is 3g/24hr ( norm. trace-0-150mg/24hr). No blood creatinine test was noted. Accordingly to the National Kidney Foundation (NKA), George is in stage 3 kidney failure with moderate decrease kidney function ( a greater loss of nephrons than stage 2). Increase urine creatinine and protein in the urine signifies damage to kidney's filtration units. (kidney)(stress) (Gould, B. E. , pg 196-197, 2011)
If George was in second stage of chronic renal failure, approximately 75% of the kidneys' nephrons would be lost. The GFR would decrease to approximately 20% of normal. A significant retention of nitrogen wastes would be found in his blood. Tubular function would be decreased resulting in a less concentrate urine and control secretion and exchange of acids and electrolytes. His urine would become diluted and would excreted in large amounts. If the progression of George's chronic renal failure became end-stage (uremia) renal failure, more than 90% of the nephrons would be lost. His GFR would be negligible. Blood would become toxic due to fluid, electrolytes and wastes are retained causing an impact on all body systems. Marked oliguria (scant) to none (anuria) would develop. His kidneys have failed; without intervention ( regular dialysis or transplant), George's life would be in jeopardy. (Gould, B. E., pg. 460, 2011)
George did not have acute renal failure. Acute means 'rapid'. With acute renal failure, most times the situation can be reversed when the cause is immediately corrected or properly treated in order to minimize the insult to the kidneys. The main goal is reduce the risk for necrosis and permanent kidney damage. The cause of acute kidney failure is directly due to the reduction of blood flow into the kidneys or inflammation and necrosis of the tubules causing obstruction leading to a decrease in GFR and reduction in urine. Problems of reduction of blood flow before it reaches the kidneys can be cause by dehydration, sepsis, or surgery (>blood loss), or heart attack, or severe injury and or burns. Problems of obstruction (movement of urine) could be cancer of the urinary tract, or kidney stone, or enlarged prostate, or nephrotoxins ( drugs, chemicals, toxins). Lastly, problems with the kidney itself that reduces blood filtration or production of urine such as glomerulonephritis (possible due to strep infrection), or acute interstitial nephritis (aspirin, ibuprofen, penicillen). (Gould, B. E. pg. 458-460, 2011)
The major goal of George's treatment would most likely consist in lowering his blood pressure, decreasing risk for cardiovascular disease, and slowing the progression of his chronic renal failure. His treatment would most likely include antihypertensive medications Ace inhibitor and/or ARB in order to reduce and stabilize his B/P ( < 130/80 per NKF). Life style changes that would include diet (low sodium, low fat, low protein, with increase intake of fruits and foods rich in iron, vitamin B12 and folic acid. Additional vitamins with B12, folic acid, and iron (for anemia) may also have to be taken. Weight control or maintenance would be encourage along with an exercise plan. George may have to receive erythropoiesis (ESA) stimulating agents injections to help his body make RBCs. Additional iron supplement may also be needed; without iron, ESA is wasted and is needed to reach target hemoglobin. Lastly, if it has not been approach before now, educate George on the effects of prolonged stress and how it is impacting his cardiovascular and kidney systems. Along with a healthy diet and exercise already mentioned, George's physician may also encourage other means in developing coping mechanism that are appropriate for George, which may include engaging in some 'time-out' during his job for better assessment, or using relaxation techniques etc. (National kidney foundation)
(mayoclinic)(NKF kidney,) ((Gould, B. E., pg. 196-197, 2011)


Anonymous. (2012). KDOQI™ Guidelines and Commentaries
Retrieved February 12, 2012, from Kidney website

Workeneh, B.T., Batuman, V.. (2012, February 9). Acute Renal Failure
Retrieved February 12, 2012, from Emedicine website

Anonymous. (2012). Hypertension
Retrieved February 12, 2012, from Stress website
Anonymous. (2012). How Your Kidneys Work
Retrieved February 12, 2012, from Kidney website

Anonymous. (2012). Erythropoietin (cont.)
Retrieved February 12, 2012, from Medicinenet website

Anonymous. (2011, August 02). Chronic kidney failure
Retrieved February 12, 2012, from Mayoclinic website

Gould, B. E. (2011) Chapter 12
(pp. 196-197), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.
Gould, B. E. (2011) Chapter 15
(pp. 244), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.
Gould, B. E. (2011) Chapter 18
(pp. 308-311), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.
Gould, B. E. (2011) Chapter 21
(pp. 460), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.
Gould, B. E. (2011) Chapter 21
(pp. 458-460), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.