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Lymphatic System image (The Immune System image (Innate immunity (Think…

- - - - Fluid filling lymph capillaries called lymphatic fluid, or lymph
        
        Straw colored, clear fluid similar to blood plasma
        
        Primary component is water
        
        Contains digested nutrients (fats, gases like O2, proteins and WBC (lymphocytes and macrophages)
      - Lymph capillaries empty into lymphatic vessels, similar to veins including valves; body movement and contraction of smooth muscles propels lymph through system
        
        Large vessels empty into lymph nodes, ranging in size from olives to pin heads; many lymph vessels empty into each node, ensuring all lymph fluid passes through
        
        Can be thought of as filters
        
        Small, encapsulated bodies divided into sections
        
        Consist of sections of lymphatic tissue containing WBCs known as lymphocytes
        
        Lymphatic tissue surrounded by lymphatic sinuses filled with lymph fluid
        
        Filter and destroy pathogens using WBCs
        
        Are concentrated in several areas around the body and are identified according to their location: cervical, axillary, inguinal, pelvic, abdominal, thoracic, and supratrochlear (areas where pathogens are most likely to enter the body like the lungs, digestive system, and reproductive systems)
        
        Adenoids and tonsils, spleen, and thymus also part of lymph system
        
        Lymphatic trunks
        
        Lymphatic vessels exiting lymph nodes empty into one of several lymphatic trunks
        
        Trunks, named for location, include lumbar, intestinal, intercostal, bronchomediastinal, subclavian, and jugular trunks
        
        Collecting ducts
        
        Lymphatic trunks empty into one of two collecting ducts
        
        Lumbar, intestinal, and intercostal trunk empty into thoracic duct (large duct that runs from abdomen up through diaphragm and into left subclavian vein); more than 2/3 of lymphatic system drains into this duct
        
        Bronchomediastinal, subclavian, and jugular trunks empty into right lymphatic duct (smaller duct within right thorax which empties into right subclavian vein)
- - - - Sore throat
      - Difficulty swallowing
      - Swollen tonsils
      - Fever
      - Upper respiratory symptoms
      - Swollen lymph glands
      - Visible coating or spots on the tonsils
      - Sometimes upset stomach
    - - Based on presence of visible tonsil inflammation on physical exam
      - Throat culture can distinguish between bacterial and viral causes of tonsillitis
    - - Bacterial tonsillitis must be treated with antibiotics caused by streptococcus
      - Viral tonsillitis will resolve on its own
      - In both types symptoms managed with rest, fluids and analgesics like Tylenol
      - Tonsillectomy: used regularly as treatment in the past; today only used if tonsillitis becomes chronic, or if tonsils become enlarged to point of obstructing airway
  - - - Stages of cancer (based on degree of spread)
        
        Stage 1: no spread from origin
        
        Stage 2: spread to local tissues
        
        Stage 3: spread to lymph nodes
        
        Stage 4: spread to distant organs; often terminal
  - - - Myelogenous leukemia: cells that divide out of control are blood stem cells
      - Lymphocytic leukemia: cells that divide out of control are lymphocytes
      - Acute leukemias: have rapid onset of symptoms; overproduced WBCs are immature, non-functional cells
      - Chronic leukemias: have gradual onset; overproduced WBCs are mature, functional cells
    - - Some types of leukemia more common in children; others more common in adults
      - Chronic myelogenous leukemia associated with Philadelphia chromosome (chromosomal abnormality)
      - Down syndrome patients are higher risk for acute myelogenous leukemia
    - - Decreased function of immature WBCs (in types of leukemia with immature cells)
      - Decreased numbers of red blood cells and platelets (crowded out by excessive numbers of WBCs)
    - - Anemia; shortness of breath; fatigue; repeated infections; enlarged lymph nodes; weight loss; muscle aches; excessive bruising; bleeding
    - - Chronic lymphocytic leukemia has no cure, but symptoms can be managed for years
      - Acute lymphocytic leukemia common in childhood, and has very high rate of successful treatment
  - - - Too much inflammation, particularly in closed spaces (like brain, spinal cord, respiratory system or extremities), can cause more tissue damage than original injury or infection
        
        One of the reasons why you ice a sprained ankle
    - - Non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen and naproxyn
      - Steroids
      - Antihistamines (especially for allergic reactions)
    - - Causes widespread vasodilation, blood pressure plummets
      - Can be fatal if not treated immediately
        
        Many patients prone to anaphylaxis carry injectable epinephrine (adrenaline) to treat acute reactions
      - People allergic to insect stings, nuts, or shellfish may experience anaphylaxis
      - Should wear medical alert bracelets
  - - - Rheumatoid arthritis (attacks joint linings)
        
        Autoimmune disorder where synovial membranes of joints are attacked
        
        Leads to destruction of bone and cartilage in joints, weakening of soft tissue supporting joints
        
        Eventually can result in: joint collapse, fusion of bones, shortening of tendons, disfigurement (particularly of hands and feet)
        
        Symptoms (most patients have relapsing-remitting pattern of symptoms)
        
        Joint stiffness
        
        Symmetrical joint damage
        
        Fatigue
        
        Fever
        
        Systemic symptoms may include: anemia; dry eye; osteoporosis; lung, pericardial and blood vessel inflammation; increased risk of heart attack
        
        Epidemiology
        
        Juvenile and adult forms of disease
        
        Women 2-3 times more likely than men to have RA
        
        Although, pregnancy can improve RA symptoms
        
        Cause appears to be combination of genetics and some environmental trigger (such as virus, bacteria, or hormonal changes)
        
        Diagnosis typically consists of: medical history, physical exam, imaging, lab tests (leukocyte counts, erythrocyte sedimentation rate, test for presence of rheumatoid factor); no definitive test
        
        Treatment
        
        Drugs
        
        Disease modifying anti-rheumatic drugs (DMARDs): Injected gold, Methotrexate (cancer drug), Plaquinil (malaria drug)
        
        Biological Response Modifiers (BRMs): suppress immune system by decreasing immune enhancing chemicals
        
        Lifestyle changes: stress reduction, moderate exercise, eating healthy
        
        Assistive devices or surgery often necessary in severe cases
      - Multiple sclerosis (attacks myelin sheath in CNS)
      - Lupus erythematosus (attacks every tissue, perhaps DNA)
        
        Immune system attacks body’s connective tissue
        
        Symptoms include:
        
        ▪ Fatigue
        
        ▪ Depression or anxiety
        
        ▪ Joint pain and stiffness
        
        ▪Atherosclerosis
        
        ▪ Fever
        
        ▪ Heart problems
        
        ▪ Kidney disease
        
        ▪ Anemia
        
        ▪ Chest pain
        
        Swollen glands
        
        ▪ Hair loss
        
        ▪ Rashes (particularly butterfly shaped rashes on face)
        
        Course of disease may be chronic or show relapsing-remitting pattern
        
        Cause is unknown, but both genetics and environmental trigger probably necessary for onset
        
        Diagnosis (difficult because symptoms vary from patient to patient, no definitive test) typically includes:
        
        Medical history
        
        Imaging studies
        
        Tissue biopsies
        
        Lab tests: blood counts, urinalysis, erythrocyte sedimentation rate, complement levels, testing for anti-nuclear antibodies
        
        Treatment
        
        Drugs: NSAIDs, DMARDs, steroids, immunosuppressants
        
        BRM drugs also being investigated
      - Type 1 diabetes (attacks beta cells in pancreas)
      - Myasthenia gravis (attacks acetylcholine receptors in skeletal muscle)
      - Graves’ disease (attacks thyroid gland)
      - Addison’s disease (attacks adrenal gland)
  - - - Directly kills helper T cells
      - Destroys lymph nodes due to chronic infection
      - Decreases amount of immune enhancing chemicals in body
    - - Sexual contact
      - IV drug use
      - Consumption of breast milk from infected mothers
      - Development of fetuses in HIV-infected mothers
      - Accidental exposure to infected body fluids (rare)
      - Blood transfusions if donor was HIV infected (also rare in US today because of intense screening procedures)
      - From mother to fetus in utero and in breast milk
      - Accidental exposure to infected body fluids
      - * It cannot spread through casual contact, coughing, sneezing, shaking hands, or sharing eating utensils.
    - - May appear approximately 4 weeks after HIV infection, patients develop flu-like symptoms; occurs as body makes first attempts to fight off virus
      - Immune system may continue to fight off disease for next 10-12 years without any obvious symptoms
      - Eventually, disease progresses to full-blown AIDS or ARC Aids-related complex); symptoms may include
        
        Enlarged lymph nodes
        
        Fatigue
        
        Night sweats
        
        Weight loss
        
        diarrhea
        
        Opportunistic infections (kaposi’s sarcoma, Pneumosystis jiroveci (carinii) and toxoplasmosis
        
        CNS dysfunction
        
        Some forms of cancer
    - - Patients with HIV usually receive combination of antiviral drugs that block viral reproduction, keep virus from assembling new viruses, block entrance of virus into cells
      - Drug regimens are complicated, have severe side effects; are effective at postponing development of full-blown AIDS
      - Advancements have greatly improved over the last 10 years. Many pts have survived for years post infection. Education is the important method for preventing HIV/AIDS
- - - - White blood cells are second line of defense against pathogens that manage to get by barriers
        
        Finally, body processes kick in to help fight infection
        
        Cells
        
        If an invader gets in the body, white blood cells are where it is as!
        
        White blood cells (WBC or leukocytes) are cells responsible for defending body against invaders
        
        After being born in bone marrow, move to other parts of body to grow and mature until needed during invasion
        
        Not released into blood stream until needed such as an infection in the body
        
        Two types of leukocytes
        
        Polymorphonuclear granulocytes: cells with granules, or spots, in their cytoplasm
        
        Agranulocytes, or mononuclear cells: have no granules in their cytoplasm
        
        Four types of T cells
        
        Helper T cells
        
        Cytotoxic T cells
        
        Activity known as cell-mediated immunity because cells directly responsible for death of pathogens or pathogen-infected cells
        
        Release cytokine called perforin, which causes infected cells to develop holes in their membranes and die
        
        Release other cytokines that stimulate both innate and adaptive immunity, especially attracting macrophages to site of infection to dispose of cellular debris
        
        Response of cells is primary response of cell mediated immunity
        
        Regulatory T cells
        
        Are “off switch” for immune system, turn off response when threat over
        
        Not fully understood, have only been discovered in past 10 years
        
        Suggested they directly inhibit B cells and cytotoxic T cells, releasing cytokines that decrease immune and inflammatory response
        
        Malfunction of regulatory T cells implicated in some types of allergies, asthma, and autoimmune diseases
        
        Memory T cells
        
        Given rise from some T cells
        
        Like memory B cells, responsible for secondary response, adaptive immunity’s ability to improve with experience
    - - Barrier
        
        Anything that prevents invaders from getting inside your body prevents infection
        
        Physical barriers located in areas most likely to be invaded
        
        Skin and mucous membranes of eyes, digestive, respiratory, and rNot only are these surfaces difficult to penetrate, but are packed with WBCs and lymph capillaries to trap invaders
        
        Fluids associated with physical barriers, including tears, saliva, urine, mucous secretions, and sweat; all contain chemicals that act as barriers
        
        Barriers are part of innate immunity
        
        Reproductive systems act as barriers
    - - Chemicals
        
        It Is not just blood cells that fighting the invaders, chemical do too.
        
        Are found in body; assist in destroying and neutralizing invaders
        
        Cytokines:
        
        Proteins produced by damaged tissues and WBCs which stimulate immune response in variety of ways, including increasing inflammation, stimulating lymphocytes, and enhancing phagocytosis
        
        Involved in both innate and adaptive immunity; many are types of molecules called interleukins
        
        Interleukin
        
        There are at least 10 interleukins, and are involved in nearly every aspect of innate and adaptive immunity
        
        Interleukins have been used with moderate success to treat some forms of cancer
        
        Interferon
        
        A cytokine produced by cells that have been infected by virus
        
        Binds to neighboring, uninfected cells and stimulates them to produce chemicals that may protect these cells from viruses
        
        Has also had some success as anti-cancer drug, but still experimental
        
        Tumor Necrosis Factor
        
        A cytokine, produced by WBCs, that stimulates macrophages and also causes cell death in cancer cells
        
        New class of drugs that inhibit TNF have been successful in treating rheumatoid arthritis
        
        Complement cascade
        
        Complex series of reactions that activate 20 proteins usually inactive unless activated by pathogen invasion
        
        When activated, proteins have variety of effects including: lysis of bacterial cell membranes, stimulating phagocytosis, attraction of WBCs to site of infection, clumping of cells with foreign antigens, and alteration of structure of viruses
        
        Part of both innate and adaptive immunity
  - - - Positive selection: lymphocytes recognize and bind to antigens, allowing them to survive; some recognize and bind to own antigens and must be destroyed before they can destroy healthy cells
      - Negative selection: destruction of self-recognizing lymphocytes
  - - - Proliferation of helper T cells
      - Proliferation of all other types of lymphocytes
    - - This is why HIV is so devastating to the immune system. HIV targets helper T cells specifically
  - - - Inactivating antigen
      - Causing clumping of antigens
      - Activating complement cascade
      - Releasing chemicals to stimulate immune system and enhance phagocytosis
    - - This is called secondary response, is responsible for immune system’s ability to improve with experience