Nursing 4 Lecture 2 Autoimmunity

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Nursing 4 Lecture 2 Autoimmunity
2012-01-25 12:47:00

Nursing 4 Lecture 2 Autoimmunity
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  1. Autoimmunity:
    A disease produced when the bodies own tolerance of the antigens (proteins) on its own cells become disrupted

    Autoantibodies produced by B-Lymphocytes or T-Lymphocytes attack normal cells whose surface contains self antigen or auto antigen destroying the tissues
  2. Important hints!
    -ViRaL: viral, right shift, increased lymphocytes

    -LBN: bacterial, left shift, increased neutrophils

    • Cyte- cell
    • Leuko- white
    • Erythro- red
    • Exo- outside
    • Emia- blood
    • Dys- difficult or painful

  3. Blood Cell Production:
    - A Pluripotent Stem Cell can turn into anything

    - When a pluripotent stem cell turns into a Myeloid Stem Cell it then turns into various precursor or blast cells then turning into neutrophils, eosinophils, basophils (mast cell), monocyte (macrophage), platelets, and erythrocytes (red blood cells).

    - When a Pluripotent Stem Cell turns into a Lymphoid Stem Cell then into Blast cells, finally turning into Lymphocytes.
  4. Hypersensitivity Reactions
    • - Altered immune response leading to disease or damage
    • -Allergy = exogenous antigens (outside the body)
    • -Alloimmune = immune response against tissues of another (transplant needs to be on an antirejection drug whole life)
    • -Autoimmune = disturbance in the immnologic tolerance of self-antigens
    • --Tissue injury from auto-antibodies or auto-reactive T cells

    • ***Muscle pain, diarrhea, n/v = NOT ALLERGIC REACTION
  5. Factors in Autoimmunity
    • - Genetic predisposition
    • - Insult or trigger- which alters immunologic hemeostasis
    • - The actual immunologic process that causes the disease symptoms
    • --IgE, tissue specific, immune complex related, or cell mediated
  6. Immune Tissues
    • - Appendix
    • - Spleen
    • - Thymus
    • - Skin
    • - Bone Marrow
    • - Thymus (kids)
    • - Lymph nodes
  7. Rheumatoid Arthritis
    • -One of the most common connective tissue diseases AND the most destructive to the joints
    • -More common in middle-aged women

    • *Chronic, progressive, systemic inflammatory autoimmune disease that affects primarily synovial joints
    • Early Manifestations:
    • Joint:
    • -Inflammation
    • Systemic:
    • -Low grade fever
    • -Fatigue
    • -Weakness
    • -Anorexia
    • -Paresthesias

    • Late Manifestations:
    • Joint:
    • -Deformities
    • -Moderate to severe pain and morning stiffness
    • Systemic:
    • -Osteoporosis
    • -Severe fatigue
    • -Anemia
    • -Weight loss
    • -Subcutaneous nodules
    • -Peripheral neruopathy
    • -Vasculitis
    • -Pericarditis
    • -Fibrotic lung disease
    • -SJOGRENS SYNDROME: most common associated syndrome; look for dry eyes(often feel "gritty" as if sand is in there eyes), dry mouth, or dry vagina.
    • -Renal disease
    • Labs:
    • -Decreased albumin (normal: 3.5-5)
    • -Positive rheumatoid factor
    • -Positive ANA
    • -Increased ESR (normal: up to 15 male, up to 20 female)
    • -Presence of HLA
  8. Lupus Erythematosus
    • -Chronic, multi-system inflammatory
    • -Generalized throughout the body


    -Most common systems to be affected: joint, kidney, skin, heart, brain, hematology


    • -Inflamed
    • -Butterfly rash (sometimes scarring from inflammation can develop)
    • -Nephritis
    • -Pericarditis
    • -Raynauds phenomenon
    • -Pleural effusions
    • -CNS lupus
    • -Abdominal pain
    • -Joint inflammation
    • -Myositis
    • -Fever
    • -Fatigue
    • -Anorexis
    • -Vasculitis

    • Labs:
    • -False positive VDRL for syphilis is common
    • -+ANA titre
    • -ESR (sed rate) will be increased

    • Diagnosis:
    • ATLEAST three of the following:
    • -facial or discoid rash, oral ulcers, photosensitivity, non-erosive arthritis of atleast 2 peripheral joints, proteinuria, neurologic(seizures, psychoses), hematologic disorders and immunologic (+LE cell prep, anti double stranded DNA, ASA, false + syphilis), +ANA titre
    • -Fever, fatigue
    • -Numerous inflammatory and immunologic tests
    • -Skin lesions of present
    • -CBC: commonly shows pancytopenia (decrease of all cell types)
    • -Electrolytes, renal, cardiac, elect, liver, and clotting

    • Collaborative Management:
    • -Symptomatic
    • -Exacerbations
    • -Hydroxychloroquine (Plaquenil): Main drug, FREQUENT EYE EXAMS
    • -Steroids
    • -Immunosuppressive agent: Methotrexate

    • *Monitor body temperature because it is the major sign of exacerbation
    • *Avoid sun exposure, and other forms or ultraviolet lighting
    • *Use mild soap to wash the skin and avoid harsh, perfumed substances
    • *Alopecia is common during exacerbations
  9. Progressive Systemic Sclerosis (Scleroderma)
    • -When systemic: similar to SLE
    • -Connective tissue: inflammation, fibrosis (tough like scar tissue, and sclerosis (hardening)
    • -Skin, calcium deposits, Raynauds, esophogeal dysmotility, spider like hemangiomas, internal organs
    • -Not as responsive to steroids and immunosuppressants
    • -Affects almost every oran in the body

    • Symptoms:
    • -Inflamed
    • -Fibrotic
    • -Sclerotic
    • -Edematous
    • -Renal failure: what will kill you with this disease
    • -Myocardia fibrosis
    • -Raynauds phenomenon
    • -Interstitial fibrosis
    • -Pulmonary hypertension
    • -Esophagitis
    • -Ulcers
    • -Joint inflammation
    • -Myositis
    • -Fever
    • -Fatigue
    • -Anorexia
    • -Vasculitis
    • -Shiny, taut digits, sausage like
    • -Initially swelling, then hard, tight, thickened: decreased ROM, ulcers
    • -Dysphagia, GERD
    • -Claw like appearance to fingers

    • CREST:
    • Calcinosis
    • Raynauds
    • Esophagus dysmotility
    • Sclerodactyly
    • Telangiecstasia (spider veins)

    Organ damago most commonly goes to GI tract, cardiovascular system, pulmonary system, and renal system

    *Large doses of immunosuppressants and streroids are used but are not as responsive
  10. Raynauds
    • -Vasospasm of the arterioles and arteries in the periphery
    • -Femals are more common than males
    • -Blanching followed by hyperemia (too much blood), pain, swelling
    • -Avoid the cold, DON'T smoke (because makes vasospasm worst)

    • Parashthesia: disturbed feeling
    • -Can develop necrosis
  11. Sjogrens Syndrome
    • -Inflammatory cells and immune complexes block of secretory ducts and glands
    • -Effects glandular of secretory ducts
    • -Dry eyes, dry mouth, dry vagina
    • -Associated with other autoimmune diseases (most often rheumatoid arthritis or fibromyalgia)
    • -Effects women ages 35-45 most frequently
    • -Local management
    • -Keep up with dental and eye appointments
    • -More prone to dental problems with dry mouth

    • *Treat symptomatically
    • -Methotrexate or cyclophosphamide (both of these have serious long term s/e especially on liver and bone marrow function)
    • -Corticosteroids, cyclosporine, and plaquenil
  12. Sarcoidosis
    • -Widespread granulomatous lesions
    • -90% in lungs
    • -Symptomatic
    • -End up with restrictive lung disease
    • -Diagnose by bronchoscopy with biopsy
    • -Steriods
    • -Manage like restrictive lung diseases
    • -Manage with steroids
  13. Vitiligo
    Loss of pigmentation

    • -Melanocytes of the skin are destroyed
    • -White patches on the skin of which is exposed to the sun
    • -Topical steroid therapy can be used to treat
  14. Ankylosing Spondylitis
    • -Fusion of inflamed vertebrae
    • -More common in males than females
    • -Late teens, early 20s
    • -Back pain and stiffness
    • -Systemic- lung, bowel, cardiac(aortic valve), other joint
    • -Treatment- physical therapy, NSAIDS
  15. Hypersensitivity
    Hypersensitivity or Allergy: increased or excessive response to the presence of an antigen(foreign protein or allergen) to which the patient has been previously exposed

    • These problems can range from:
    • -Uncomfortable: itchy, watery eyes, or sneezing
    • TO
    • -Life Threatening: allergic asthma, anaphylaxis, bronchorestriction, or circulatory collapse
  16. Type 1: Rapid Hypersensitivity Reactions
    • -Most common type of allergy
    • Results from the increased production of the immunoglobulin E antibody class

    Examples: anaphylaxis and allergic asthma

    When all blood vessels and bronchiolar smooth muscle causing widespread blood vessel dilation, decreased cardiac output, and bronchoconstriction= ANAPHYLAXIS
  17. Type 2: Cytotoxic Reactions
    • -The body makes special autoantibodies directed against self cells that have some form or foreign protein attatched to them
    • -the autoantibody then binds to the self cell and forms an immune complex
    • -The self cell is then destroyed along with the attatched protein by phagocytosis or lysis

    Examples: hemolytic anemia, thrombocytopenia prpura, hemolytic transfusion reactions (pt receiving wrong blood type during a transfusion), good-pastures syndrome, and drug-induced hemolytic anemia

    • Treatment:
    • -Discontinue the offending drug or blood product
    • -Plasmapheresis (filtration of the plasma to remove specific substances) to remove autoantibodies may be beneficial
    • -Otherwise treatment is symptomatic
    • -Complications such as hemolytic crisis and renal failure can be life threatening