HUMAN ANATOMY AND PHYSIOLOGY

Transcription

1 LECTURE #5 1

2 HUMAN ANATOMY AND PHYSIOLOGY The Nervous System The Endocrine Glands The Hemopoietic System The Circulatory System The Respiratory Tract The Digestive Tract The Urinary Tract The Reproductory System The Locomotor System The Skin E. MORAN

3 THE BLOOD-FORMING ORGANS (THE HEMOPOIETIC SYSTEM) 3

4 Blood E. MORAN

5 BLOOD COMPONENTS Plasma Cells: Red blood cells (RBC or erythrocytes) White blood cells (WBC): Granulocytes: neutrophils, eosinophils, basophils Lymphocytes: T- and B-lymphocytes Monocytes - macrphages Platelets E. MORAN

6 CELLULAR BLOOD COMPONENTS RBC - carry Oxygen and CO 2 WBC Various functions Neutrophils Fight infections Lymphocytes Active in immune responses Monocytes Promote neutrophils Eosinophils Active in allergy Platelets - essential in initiating blood clotting E. MORAN

7 Blood film (smear) to show: Red blood cells, white blood cells (neutrophils), and a platelet E. MORAN

8 DEVELOPMENT OF THE GRANULOCYTES E. MORAN

9 LIFETIME OF BLOOD CELLS RBC 120 days WBC days Platelets ~ one week E. MORAN

10 LACK OF RED BLOOD CELLS (ANEMIA) Bone marrow failure: Leukemia, lymphoma Nutritional deficiencies: Iron, Folate, Vitamin B 12 Destruction of RBC s: Inherited abnormal hemoglobin (hemoglobinopathy) (Sickle cell anemia) Auto-immune hemolytic anemia E. MORAN

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12 SICKLE CELLS E. MORAN

13 SICKLE CELLS PLUGGING BLOOD VESSEL E. MORAN

14 BLOOD CLOTTING 14

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16 THE COAGULATION CASCADE 16

17 BLOOD COAGULATION (CLOTTING) Blood changing from liquid to a gel state in 7-8 min. The gel is the clot (thrombus) and the liquid is called serum. 1. Damaged endothelial surface of vessels or slow blood movement (stasis) activation, adhesion, and aggregation of platelets (platelet plug) 2. Prothrombin in plasma changes to thrombin 3. Thrombin changes fibrinogen (soluble in blood) into fibrin 4. Fibrin + RBC s form a clot (thrombus) 5. Thrombus will be digested by fibrinolysis. E. MORAN

18 ANTICOAGULATION Anti-platelets medications: aspirin, clopidogrel (Plavix) interfere with platelets function and impede their agglutination Anticoagulants: Warfarin, coumadin affect the vitamin K-dependent clotting factors (II, VII, IX, X) Heparin action of antithrombin and factor Xa. Newer drugs interfere with the enzymatic action of coagulation factors E. MORAN

19 BLOOD GROUPS AND TRANSFUSION 19

20 BLOOD TYPES (GROUPS) Classification of inherited antigenic substances on the surface of RBC s. Contributions from both parents Some of these antigens may be present on the surface of other cells. >600 Ag s in 33 blood groups. Some types are related to resistance to diseases (absence of Duffy Ag. resistance to malaria) E. MORAN

21 BLOOD TYPES ABO System (C. Landsteiner, 1901) A Anti-B antibody. B Anti-A antibody. AB No antibody. Universal recipient. O Anti-A and Anti-B antibody. Universal donor Rh System (A. Wiener, 1937) Positive (+) Anti Rh factor antibody present Negative (-) Anti-Rh factor antibody absent E. MORAN

22 RED BLOOD CELL COMPATIBILITY 22

23 BLOOD TRANSFUSION Blood banks Blood products: Packed RBC s Plasma Platelets Cryoprecipitate Fresh frozen plasma (factors V and VIII) Cross matching for compatible RBC s E. MORAN

24 BLOOD TRANSFUSIONS Cross-matching No agglutination of RBC s Transfusion of incompatible blood causes destruction of the recipient s RBC, (hemolysis), renal failure, shock, and possible death If an Rh (-) woman receives Rh (+) blood she gets sensitized to the Rh factor (develops anti-rh antibodies). If later she is pregnant with an Rh (+) baby, she may risk to cause massive destruction of baby s RBC (hemolytic disease of the newborn) E. MORAN

25 ORGAN TRANSPLANTATION Definition: Moving tissues/organs from one site of a person to another person (allografts) or tissues/organs from one body to another site of the same (autografts). Autografts: Blood, vessels, skin Isografts: Identical twins - Genetically identical, cannot trigger an immune response Allografts: Between two non-identical persons Xenografts: Porcine heart valve E. MORAN

26 ALLOGRAFTS - SOURCES Living persons: Single kidney, partial liver, lung lobe, intestine Brain death or circulatory death: Kidney, liver, heart, lungs, intestine, thymus. Cornea, bone marrow, bones, tendons Recovery of tissues/organs up to 24 hrs. after last heart beat Best outcomes when using brain death sources Tissues may be banked for up to 5 years Bioethical issues: Definition of death, Consent, Pay Organ sales are illegal E. MORAN

27 ALLOGRAFTS (CONT D) Dr. P. Medawar: Tissue rejection, Graft vs. Host reaction. Immunosuppressive therapy Non-identical require ABO and tissue antigens compatibility Cyclosporine treatment USA, United Network for Organ Sharing (UNOS) Organ Procurement and Transplantation Network (OPTN) - Identification and allocation of organs from deceased persons E. MORAN

28 PATHOLOGY OF BLOOD CELLS Decreased production: Diseases of the bone marrow Increased destruction: Usually in the blood. Congenital or acquired E. MORAN

29 CHANGES IN THE NUMBER OF BLOOD CELLS Decreased number of cells: Red cells Anemia White cells Infections Platelets Bleeding Increased number of cells: Red cells Erythrocytosis Polycythemia White cells Leukocytosis in infections Leukemia Platelets Thrombocytosis - Thrombocythemia E. MORAN

30 LACK OF RED BLOOD CELLS (ANEMIA) Bone marrow failure: Leukemia, lymphoma Nutritional deficiencies: Iron, Folate, Vitamin B 12 Destruction of RBC s: Inherited abnormal hemoglobin (hemoglobinopathy) (Sickle cell anemia) Auto-immune hemolytic anemia Symptoms: Weakness, dizziness E. MORAN

31 BLOOD CLOTTING 31

32 32

33 THE COAGULATION CASCADE 33

34 BLOOD COAGULATION (CLOTTING) Blood changing from liquid to a gel state in 7-8 min. The gel is the clot (thrombus) and the liquid is called serum. 1. Damaged endothelial surface of vessels or slow blood movement (stasis) activation, adhesion, and aggregation of platelets (platelet plug) 2. Prothrombin in plasma changes to thrombin 3. Thrombin changes fibrinogen (soluble in blood) into fibrin 4. Fibrin + RBC s form a clot (thrombus) 5. Thrombus will be digested by fibrinolysis. E. MORAN

35 ANTICOAGULATION Anti-platelets medications: aspirin, clopidogrel (Plavix) interfere with platelets function and impede their agglutination Anticoagulants: Warfarin, coumadin affect the vitamin K-dependent clotting factors (II, VII, IX, X) Heparin action of antithrombin and factor Xa. Newer drugs interfere with the enzymatic action of coagulation factors E. MORAN

36 INTERMISSION 36

37 Infectious Mononucleosis 37

38 38

39 Infectious Mononucleosis 39

40 Clinically: ACUTE VS. CHRONIC LEUKEMIA Acute leukemia: Acute course, with bleeding, infections Chronic leukemia: Course is chronic - years Microscopically: Acute: Primitive bone marrow cells with poor differentiation in the bone marrow and in the blood Chronic: Relatively differentiated bone marrow cells in the blood E. MORAN

41 ACUTE LEUKEMIA 41

42 42

43 HOMEOSTASIS OF THE BLOOD 43

44 Genetic factors Viral infection ACUTE LEUKEMIA ETIOLOGY Radiation exposure Chemicals exposure E. MORAN

45 ACUTE LEUKEMIA ETIOLOGY GENETIC FACTORS Chromosome imbalance: Down s syndrome Other aneuploidies Chromosome breakage: Bloom s syndrome Fanconi s syndrome Ataxia telangiectasia Genetic susceptibility : Familial (?) Coexistent neoplasm (?) E. MORAN

46 ACUTE LEUKEMIA ETIOLOGY VIRAL LEUKEMOGENESIS In animals: Experimental evidence In humans: Viruses and virus-like particles in leukemic cells and plasma of patients Are viruses bystanders? Are viruses co-carcinogens? Koch s postulate not fulfilled E. MORAN

47 ACUTE LEUKEMIA ETIOLOGY RADIATION EXPOSURE In the general population: Survivors of the atomic bomb explosions (Japan, 1945) Radiologists exposed to ionizing radiation In patients treated for other diseases: Ankylosing spondylitis Thymus radiation in childhood Diagnostic tests: Unknown dose threshold E. MORAN

48 LEUKEMIA BURDEN OF SUFFERING US 2015 Est. new cases 54,270 Acute lymphocytic leukemia 6,250 Chronic lymphocytic leukemia 14,620 Acute myeloid leukemia 20,830 Chronic myeloid leukemia 6,660 Other leukemias 5,910 E. MORAN

49 LEUKEMIA - SYMPTOMS Weakness, fatigue Recurrent infections Bleeding, gum bleeding Bone pain Anorexia E. MORAN

50 A child with bleeding in the mouth mucosa had low platelets E. MORAN

51 E. MORAN

52 BLEEDING INTO THE BRAIN IN LEUKEMIA B/O LOW PLATELETS E. MORAN

53 CHRONIC LEUKEMIAS Polycythemia rubra vera (P. vera) Chronic myeloid leukemia (CML or CGL) Chronic lymphatic leukemia E. MORAN

54 E. MORAN

55 CLOTTED BLOOD THE WHITE CELL COUNT WAS 1,000,000/CCM E. MORAN

56 TREATMENT OF LEUKEMIA Acute leukemia (lymphatic and myeloid): Chemotherapy Bone marrow transplantation Chronic lymphatic leukemia: Chemotherapy Chronic myeloid leukemia: Chemotherapy BMT (?) Polycythemia rubra vera: Phlebotomies Chemotherapy E. MORAN

57 THE LYMPHATIC SYSTEM 57

58 THE LYMPHATIC SYSTEM Intercellular spaces Lymphatic capillaries Lymphatic vessels (afferent and efferent) Lymph nodes, spleen (see the Immune System) Thoracic duct Blood Spleen Thymus E. MORAN

59 E. MORAN

60 LYMPH NODE STRUCTURE - SCHEMA E. MORAN

61 The Spleen E. MORAN

62 mmm muscles The Female Breast E. MORAN

63 DISEASES OF THE LYMPHATIC SYSTEM Obstruction to the lymph flow Edema Draining infected areas Lymphadenitis Cancer: Lymphomas, Hodgkin s disease, Leukemia E. MORAN

64 ENLARGED GLANDS (LYMPHADENOPATHY) Subjective: tender or painless Objective: Acute or chronic Local or general Isolated or matted glands Differential diagnosis: Chronic infections Cancer Diagnosis: Biopsy and pathologic examination No needle biopsy E. MORAN

65 Left cervical lymphadenopathy (Enlarged lymph nodes) 65

66 Hodgkin s disease of the mediastinum with metastases to the right cervical area 66

67 CONSTITUTIONAL SYMPTOMS Weakness, fatigue Unexplained fever Night sweats Lack of appetite, weight loss Alcohol-induced pain at the site of the cancer E. MORAN

68 E. MORAN

69 EVALUATION OF HODGKIN S DISEASE AND LYMPHOMA Physical examination Laboratory profile CT or PET CT scan Other tests as indicated by the presentation E. MORAN

70 E. MORAN

71 E. MORAN

72 E. MORAN

73 LYMPHOMAS OTHER THAN HODGKIN S DISEASE Classified by their rate of proliferation: Low-grade Intermediate grade Hi-grade E. MORAN

74 ABDOMINAL CT SCAN IN A PATIENT WITH LYMPHOMA E. MORAN

75 LARGE CELL LYMPHOMA E. MORAN

76 High-grade lymphoma involving the floor of the mouth 76

77 HIGH-GRADE LYMPHOMA OF THE LT. TONSIL 77

78 TREATMENT OF LYMPHOMAS Low-grade (Indolent) lymphomas: Observation Chemotherapy at time of progression +/- Radiation High-grade (aggressive) lymphomas: Chemotherapy Bone marrow transplantation Multiple myeloma: Chemotherapy + BMT E. MORAN

79 BURKITT s LYMPHOMA 79

80 MYCOSIS FUNGOIDES PLAQUE and TUMOR STAGE 80

81 MYCOSIS FUNGOIDES TUMOR STAGE E. MORAN

82 MULTIPLE MYELOMA C = Serum calcium elevated R = Renal (kidney) failure A = Anemia B = Bone lesions E. MORAN

83 KAPOSI s SARCOMA (KS) 83

84 E. MORAN

85 HUMAN ANATOMY AND PHYSIOLOGY The Nervous System The Endocrine Glands The Hemopoietic System The Circulatory System The Respiratory Tract The Digestive Tract The Urinary Tract The Reproductory System The Locomotor System The Skin E. MORAN

86 THE CIRCULATORY SYSTEM 1. Heart 2. Arteries 3. Capillaries 4. Veins E. MORAN

87 87

88 The Coronary Arteries Lt. coronary artery Lt. circumflex art. Lt. anterior descending Rt. coronary artery 88

89 The Heart Chambers - schema 89

90 Heart autonomous conduction system 90

91 Heart s conduction system 91

92 THE HEART CHAMBERS, VALVES, AND CIRCULATION 92

93 Blood Circulation 93

94 RESPIRATION BLOOD-GAS EXCHANGES Heart Lung Heart Rt. Atrium Rt. Ventricle Pulmonary artery Release oxygen Get carbon dioxide Lt. atrium Lt. ventricle Systemic circulation E. MORAN

95 Schema of an artery wall Endothelium Tunica media Tunica externa Tunica intima 95

96 Artery and Vein structures 96

97 Schema of an artery and vein wall 97

98 ATHEROSCLEOSIS 98

99 ATHEROMA PLAQUE 99

100 ATHEROMA AND THROMBUS 100

101 VASCULAR ISCHEMIC EVENTS (I) Acute - d/t closure of blood supply by a blood clot (thrombus) or by a circulating clot, tumor, gas, fat (embolus) Chronic - d/t narrowing of arteries by: Arteriosclerosis = hardening of arteries Atheroma plaque E. MORAN

102 VASCULAR ISCHEMIC EVENTS (II) Brain Transient ischemic attack (TIA) or Cerebral vascular accident (CVA, Stroke) Heart Angina, or Heart attack (Myocardial infarct or MI) Limbs Claudication, Peripheral vascular insufficiency (PVI) Lung Pulmonary infarct Kidney, Spleen - Infarcts E. MORAN

103 Tissue plasminogen activator (tpa) Angioplasty Intracoronary stent placement Antiplatelets: aspirin, clopidogrel (Plavix) Physical exercise Lifestyle Diet Weight reduction CORONARY THROMBOSIS TREATMENT E. MORAN

104 Stent with balloon angioplasty 104

105 Tissue plasminogen activator (tpa) Angioplasty Intracoronary stent placement Antiplatelets: aspirin, clopidogrel (Plavix) Physical exercise Lifestyle Diet Weight reduction CORONARY THROMBOSIS TREATMENT E. MORAN

106 AORTIC STENOSIS 106

107 AORTIC STENOSIS 107

108 AORTIC STENOSIS SYMPTOMS Usually present in the advanced stage: 1. Syncope (loss of consciousness) 2. Anginal chest pain 3. Shortness of breath with effort Later, dyspnea at rest (PND, edema) E. MORAN

109 MITRAL VALVE MECHANISMS 109

110 MITRAL VALVE DISEASES 110

111 MITRAL VALVE STENOSIS (NARROWING) 111

112 Shortness of breath (dyspnea) Fast breathing (tachypnea) Sleeping with more than one pillow (orthopnea) Weakness or dizziness Panic attack Swelling of ankles and feet (edema) Rapid weight gain Rapid pulse VALVULAR HEART DISEASE SYMPTOMS Cough of frothy sputum E. MORAN

113 CARDIAC MEDICATIONS Water pills (diuretics) remove fluid accumulated in tissues Beta-blockers Slow the heart rate - Lower the blood pressure ACE inhibitors Treat hypertension Vasodilators Reduce the heart work Anti-arrhythmic medications Blood thinners Anticoagulants Digitalis Oldest heart medication E. MORAN

114 Vein thrombus and embolus 114

115 Vein blood clot (thrombus) 115

116 DVT PREVENTION 1. Active lifestyle 2. Manage your weight 3. No smoking 4. Check BP 5. (?) Family hx. of blood clotting 6. Alternatives to birth control pills 7. Walk/leg stretches on long airplane trips E. MORAN

117 END OF LECTURE #5 117