Patho 2

Organs of Immune system

Tonsils and adenoids, thymus, lymph nodes, lymphatic vessels, spleen, bone marrow, appendix

Natural immunity/Innate

Found in

•Skin

•Mucous membranes

Acquired immunity

Develops in response to exposure to an antigen

Acquired immunity

-Antibodies

•proteins specific to an antigen

•formed to destroy the antigen now and in future exposures.

•Reduced in babies or immune-compromised individuals

T lymphocytes (WBCs)

-Bone marrow → thymus

-Local effect on tissue

Helper T cells

•Assist B lymphocytes

•Stimulate Microphages

Cytotoxic T cells (tumors & viruses)

•T suppressor cells

•Natural killer (NK) cells- (first line of defense)

B lymphocytes

Bone marrow or liver (fetus)

-Produce traveling antibodies

-Produce immunoglobulins known as antibodies

IgE

Active in allergic reactions

IgG and IgM

Activated after immunization

Hypersensitivity Type 1

Allergy

-Immediate, or anaphylactic

-Examples:

•Bronchial asthma

•Allergic rhinitis (hay fever)

•Anaphylactic shock (anaphylaxis)

Hypersensitivity Type 2

Cytotoxic

-Antibodies reacting with antigens

-extrinsic or intrinsic

-Examples

•Rheumatoid arthritis (RA)

•Systemic lupus erythematosus (SLE)

•Diabetes mellitus (DM)

•Multiple sclerosis (MS)

Hypersensitivity Type 3

Immune Complex

-Antigen & antibody complex embeds in tissue → inflammation

-Examples:

•Glomerulonephritis

•SLE

•RA

Hypersensitivity Type 4

Delayed

-PPD test for tuberculosis (TB)

-Organ transplant rejection

-Allergic reaction to direct contact with

•Chemicals

•Metals

•Plant toxins

•Latex

Anaphylactic shock (anaphylaxis)

-Histamine is released causing vasodilation and blood pressure to drop

Vaccination/immunization

•Causes the body to create antibodies to the antigen responsible for a disease

-CDC recommends blood titer to confirm antibodies

Effects of exercise on immune response

Stimulates production of

•White blood cells

•Endorphins for pain relief

-Intense exercise stimulates an increase in natural killer T cells.

Nosocomial infections

-Endogenous (in the body) or

•Exogenous (outside the body

•Infectious/contagious

Mode of transmission of infections

-Air

-Directly onto open wounds

-Contact with body fluids

-Ingestion

-Direct contact with pathogenic organism

-Vector

Bacterial

•Unicellular

•Bacilli (rod-shaped)

•Cocci (spherically shaped)

Spirilla (curved w

Viral

•RNA or DNA

•Mutate rapidly

Fungal

•Molds and yeasts

•Moisture & warmth

Viruses

•Smaller than bacteria

•Encased DNA/RNA

•Need a Host

•Specific Target (i.e., liver, resp, blood. Can even target bacteria)

•Viral meningitis- most common

Bacteria

•Do have RNA and DNA, but not membrane bound

•Can survive without host

•Bacterial meningitis- most serious form can → paralysis, CVA, Sz, sepsis

Fungal diseaes

•Athletes Foot

•RingWorm

•Vaginal yeast infection

•Tinea cruris

Signs and symptoms of infection

-General body fatigue

-Headaches

-Diarrhea or constipation

-Skin rash

-Severe pain in specific area

-Abscesses with purulent drainage

Treatment of infections

-Prevention

-Suitable antimicrobial medication

-Antiviral

-Antifungal

-Antibiotics/antibacterials

Factors affecting increasing resistance

-Overprescription

-Incorrect prescription

-Non specific prescription

-Failure to follow dosage

-Taking without prescription (mail order)

-Antibiotics in food

-Antibiotic sprays on food

Antibiotic Resistant Bacteria

-MRSA(methicillin-resistant Staphylococcus aureus)

-VRE (vancomycin-resistant Enterococcus)

-VISA (vancomycin-intermediate S. aureus)

-MDR-TB (multi-drug resistant TB)

-DRSP (drug-resistant Streptococcus pneumoniae)

Neoplasia

-New + formation

Oncology

study of neoplasia

Carcinogenesis

CA + beginning

Angiogenesis

blood supply

Benign

-"oma"

-Self limiting

-Well defined borders

Malignant

-"sarcoma" or "carcinoma"

-Metastatic cascade

-Metastasize

-Grade I through IV

Metastasize

•Traveling of cells via blood, lymph, or seeding

•Still name from original location

Characteristics of Benign and Malignant Tumors

-Appearance of cells

-Growth Rate

-Metastases

-Appearance of tumor surface

-Vascularity

-Recurrence

Carcinogens: causes of cancer

Exogenous or endogenous

Risk factors for developing malignant tumors

•Controllable vs. uncontrollable

-Hereditary

-Age

-Smoking

-Sun overexposure

-Promiscuity

-High levels of fat in diet

Warning Signs of Cancer

-Skin lesion or sore that does not heal

-Mole or wart that alters size or shape

•Unusual bleeding (cervix or rectum)

Rhabdomyoma

Benign tumor of skeletal muscle cells

Rhabdomyosarcoma

Malignant tumor of skeletal muscle cells

Rhabdomyolysis

•the breakdown of damaged skeletal muscle

•Muscle breakdown causes the release of myoglobin into the bloodstream

Physical therapy interventions

-Mobility

-Strengthening

-Endurance

-Aerobic exercise

Autosomal dominant

a pattern of inheritance where a single copy of an altered gene from only one parent is enough to cause a genetic trait or disorder

•Marfan's, HD, OI

Autosomal recessive

a specific pattern of genetic inheritance where an individual must inherit two copies of a mutated gene—one from each biological parent—to express a particular trait, condition, or disorder

•sickle cell anemia, CF

-X-Linked

•Males (DMD, BMD, fragile X, hemophila A & B)

Teratogens

•Toxoplasma, Other, Rubella, CMV, and Herpes virus (TORCH)

Most common chromosome abnormality conditions seen in physical therapy

-Down syndrome (trisomy 21)

-Fragile X syndrome

-Klinefelter syndrome (47 X-X-Y syndrome)

-Patau syndrome

-Turner syndrome

•Etiology

-Trisomy 21

-↑ risk with age

Down Syndrome

•Signs & Symptoms

-Low tone,

MR,

flattened facial features

Hip Dysplasia,

atlantoaxial subluxation

heart defects

hearing deficits

Down Syndrome

Prognosis

-Live into 50s

-Jobs, marry, MR varies

-Multiple medical problems (e.g. leukemia, dementia)

Down Syndrome

Medical Intervention

Counseling, folic acid while pregnant (SB), infections

Down Syndrome

•PT Intervention

-DDH (developmental dysplasia of the hip)

•No compromised hip positions

Down Syndrome

Low tone

•Tone increasing techniques

-Tapping, bouncing, ice, stimulation

Down Syndrome

AA instability

•AVOID tumble salts,

•Any position that would compromise the neck

Down Syndrome

Developmental Diseases/Birth Injuries

-Cerebral palsy

-Erb's palsy

-Prematurity

-*Fetal Alcohol syndrome

-Rhesus disease/hemolytic disease of the newborn

-Scoliosis

Spina bifid

Brain injury in or around birth

Cerebral Palsy

Classification

-Tone (hypo, hyper/spastic, athetoid, ataxic)

-Location (mono, bi, tri, quad, hemi) -plegic

Cerebral Palsy

Signs and Symptoms

-Scoliosis, Orthotics, Weakness, Arthritis...

Cerebral Palsy

Treatment

-Tone management, strength, orthotics, mobility

Cerebral Palsy

Arm and Leg on one side (Hemiplegic)

Hemiplegic

Cerebral Palsy

Both Legs only

Paraplegic

Cerebral Palsy

slight involvement elsewhere

Diaplegic

Cerebral Palsy

Both arms and both legs

Quadrplegic

Cerebral Palsy

Paralysis of the upper limb typically resulting from a traction injury to the brachial plexus

Brachial Plexus Injury

affecting the C5 to C6 nerve roots (95-99% of all cases)

Upper Plexus

•Birth injury when shoulder stretched down

•Winging of scapula

Erb-Duchenne palsy

affecting C5-T1

Whole- arm palsy

affecting the C8 and T1 (lower plexus) nerve roots

•Birth injury when arm overhead and cervical rib compresses

Klumpke's palsy

C7- Rare

Middle Plexus

•Birth

•Associated w/ Horner's Syndrome in 1/3 those affected

Complete or Total Plexus

Damage to sympathetic nerves on that side of the neck

Horner's syndrome

•contracted pupil

•drooping upper eyelid

•local inability to sweat on one side of the face

Horner's Syndrome

PT interventions for brachial plexus injuries

-Soft tissue techniques

-E-stim

-Aquatherapy

-Splinting

-AROM & AAROM

Healing time of Brachial Plexus Injury

6-8 months

-Preeclampsia, substance abuse, materal diabetes, heart dz, poor nutrition

•Before 37 week of pregnancy or < 2,500g

Prematurity

•S & S

-Neonatal respiratory distress syndrome- surfactant

-Atresia (esophagus undeveloped, not connected)

Prematurity

PT Intervention

-Positioning

•Supine →limbs retracted or extended

•Lack of physiological flexion

-Chest percussion (airway clearance) possibly

-ROM

-Developmental motor milestones

Prematurity

Refers to growth, mental, and physical problems that may occur in a baby when a mother drinks alcohol during pregnancy.

Fetal Alcohol Syndrome

Signs & Symptoms

-Poor growth while the baby is in the womb and after birth

-↓ muscle tone and poor coordination

-Delayed development & significant functional problems in 3 or more major areas: thinking, speech, movement, or social skills (as expected for the baby's age)

Fetal Alcohol Syndrome

•Mother with (Rh-) blood

•Baby with (Rh+)

•Mother develops antibodies if blood mixes after first birth

•Problems if second baby is (Rh+).

Rhesus disease/hemolytic disease of the newborn

Prevention:

RhoGAM shot to mother 12 hours after first born which prevents antibody formation.

Rhesus disease/hemolytic disease of the newborn

S & S

-Rib hump, shoulder height, pelvic, rotation

Scoliosis

permanent, does not change with movement

Structural Scoliosis

Caused by pain or poor posture, does not affect the structure of the spine

Funtional Scoliosis

•Prognosis

-Varies. Alters lung capacity.

Scoliosis

•Medical Intervention

• body brace

• surgery. Fusion or Harrington rod

Scoliosis

>20% Scoliosis

Body Brace

>40-45% Scoliosis

-surgery. Fusion or Harrington rod

•PT Intervention

-Posture education & training

-Restoring alignment

-Cardiovascular

-Brace re-eval every 6 months while growing

-E-stim under review

Scoliosis

•Therapeutic Ex for Scoliosis

•Stretch

•Strengthen

•Kinesthetic

•Etiology

-Genetic, yet 95% have no family history

-Risk: Folic acid, DM, Obesity, high temps 1st trimester, antisezure meds, father (Agent Orange)

Spina Bifida

•S & S

-Hydrocephalus (possible MR)

-Chiari II malformation

-Hypotonia or hypertonia

B & B dysfunction

Spina Bifida

spina bifida occulta

hidden

spina bifida cystica

visilbe

Hydrocephalus

Ventricles fill with fluid, pushing the brain outward

Brain herniates through foramen magnum

Chiari II malformation

-S & S

•Difficulty swallowing & breathing

•UE weakness due to cervical peripheral nerve compression

•Flaccid or spastic paralysis of LE

•Hypotonia

•Slowed postural reflexes

Chiari II malformation

•Prognosis

-Varies. Treat as SCI; many normal life expectancy

•Medical Intervention

-Surgery within 72 hrs of birth, shunt, hydroceph.

Spina Bifida

•Medical Intervention

Surgery within 72 hrs of birth, shunt, hydroceph

Spina Bifida