PATHOPHYSIOLOGICAL BASIS OF DISEASES

 PATHOPHYSIOLOGICAL BASIS OF DISEASES

INFLAMMATORY CONDITIONS AND THE HUMAN BODY

OBJECTIVES:  By the end of the discussion, the reader/medical student will be able to;

1.  Describe the process of inflammation in relation to the functioning of the human body

2.  Explain the consequences caused by inflammation into the human body

3.  Outline the medical management of inflammation

NEW TERMS

1.  Analgesia:  This term means alleviating pain and subsequent drugs that accomplish that are known as analgesics

2.  Pyrexia:  This term means fever and drugs that arrest fever are called antipyretics

INFLAMMATORY CONDITIONS AND THE HUMAN BODY:  The inflammatory process is a response by the human body to invaders.  It is a process that aims at not only fighting, but also elimination of any new antigens that happen to enter the body.  Whether microbes, chemicals, foreign particles or incompatible food stuffs, the body will always try to make sure it does not affect the body in any way.  Inflammation is the body's second line of defense.  If you have not been following me, click here to read more about the body's lines of defense.  In our series of discussion here, we are going to look at some of the most common inflammatory conditions that can affect the human body.  We have already looked at the inflammatory process earlier involving redness of the affected tissue, swelling, increased temperature and loss of function as detailed in the link below.

The process of inflammation

THE EXTENT OF DAMAGE MADE BY INFLAMMATION:  Inflammation can be seen in many dimensions including the time it can be taking affecting a given part of the human body, and in that respect we shall be looking at acute versus chronic inflammation.  I just discussed chronic inflammation recently and you can click here to read about it.  On the other hand, it can be localized where a specific area or organ is involved, or generalized, where the entire body is involved.

When addressing issues concerning inflammation, we normally end with the suffix itis on the organ or tissue associated for examples; If the inflammation happens in the liver cells and because medically the liver cells are known as hepatocytes, the condition will be termed hepatitis.  In other words when an organ is involved, we tend to add the suffix itis to the name of the organ for example if the pancreas is involved, the condition is known as "Pancreatitis".

MANAGEMENT OF INFLAMMATION:  Inflammation is a deadly body response that require immediate attention.  Whether local or systemic, the process produces inflammatory mediators that can cause various effects on the body like we saw earlier.  When inflammation is systemic, the resultant inflammatory effects include development of fever.  Because inflammation is always accompanied by pain and swelling as we saw under the cardinal signs of inflammation, the drugs that are used in management of the condition will have some property of arresting pain as well and alleviate swelling and loss of function if possible.  In that respect, we shall be refering such types of drugs as anti-inflammatory, but to be more specific, a precise ant-inflammatory drug will posses 3 properties namely; 

1)  Analgesic or pain killing, 

2)  Antipyretic or anti-fever because pyrexia means fever in medical language and 

3) Anti-inflammatory for arresting the whole process of inflammation.  I have discussed more about analgesics in some of my previous discussions and you can follow the embedded link to read more about them.

RELATED;

1.  BODY'S LINES OF DEFENSE 

2.  THE PROCESS OF INFLAMMATION

3.  CHRONIC INFLAMMATION

4.  HEPATITIS

5.  PANCREATITIS

6.  FEVER

7.  ANALGESICS

NUTRITIONAL CONSIDERATIONS OF THE NEWBORN

Growth and development:  Newborn infants are at special nutritional risk due to their body makeup versus nutritional requirements. In the first place, this is a period of very rapid growth, and needs for many nutrients are higher compared to an adult human being. Some micronutrients such as vitamins E and K, do not cross the placental membrane well and therefore, the tissue stores are low in the newborn infant. I have discussed a lot about vitamins E and K and if you have not been following me, you can click on the link below to read about them.  Vitamins

The gastrointestinal actecture:  The gastrointestinal tract may not be fully developed, leading to malabsorption problems  and especially true for fat-soluble vitamins. The gastrointestinal tract is also sterile at birth and the intestinal flora that normally provide significant amounts of certain vitamins especially vitamin K, take several days to become established. If the infant is born prematurely, the nutritional risk is slightly greater, since the gastrointestinal tract will be less well developed and the tissue stores will be less.  I have already talked about the human intestinal flora and their development from birth and if you have not been following me, you can read about normal flora and the human microbiome from the link below.  Normal flora of the human body

Hematological concerns:  The most serious nutritional complications of newborns appear to be hemorrhagic disease. Newborn infants, especially premature infants, have low tissue stores of vitamin K and lack the intestinal flora necessary to synthesize the vitamin. Breast milk is also a relatively poor source of vitamin K. 

It is estimated that, approximately 1 out of 400 live births shows some signs of hemorrhagic disease and in that case, one milligram of the vitamin at birth is usually sufficient to prevent hemorrhagic disease.

The burden of iron in the newborn:  Most newborn infants are born with sufficient reserves of iron to last 3–4 months. Since iron is present in low amounts in both cow's milk and breast milk, iron supplementation is usually begun at a relatively early age by the introduction of ironfortified cereal.

The issue with vitamin D and other minerals:  Vitamin D levels are also somewhat low in breast milk and supplementation with vitamin D is usually recommended.  Other vitamins and minerals appear to be present in adequate amounts in breast milk as long as the mother is getting a good diet.

RELATED;

1.  BODY METABOLISM AND HOMEOSTASIS

2.  VITAMINS

3.  DIGESTION AND ABSORPTION OF MINERALS

4. NORMAL FLORA OF THE HUMAN BODY

REFERENCES

CONCURRENT USE OF OVER THE COUNTER (OTC) DRUGS

CONCURRENT USE OF OVER THE COUNTER (OTC) DRUGS:  In drug use, we have two broad categories namely; Over the counter drugs (OTC) and Prescription only Medications (POM).  The first category looks at drugs and medications that clients can easily buy from drug shops and any type of retail shop without official consultation from a trained and authorized medical personnel.  The last one, describes those drugs that can only be given and only allowed to be given following a medical prescription and directions from a trained medical personnel.  The medical prescription.  Whether a pharmaceutical product bought from a recognised pharmacy, a traditional medication from traditional healers and drug shops selling traditional and complimentary medications or drugs of abuse such as alcohol and caffeinated drinks, the brief pharmacological intervention of all chemicals bought relieve some sort of disorder qualifies to be OTC.  In our discussion here, we are going to look at the OTC drugs and their types, and then the consequences of their use in humans.

COMMON OTC DRUGS:  Some of the most common drugs used as the "Over the Counter medications" include but not limited to analgesics or literally known as pain killers.  These drugs are bought and used by clients after having extraneous activities, following toothache and for others, after sensation of fever. Here we have some common drugs including but not limited to; Paracetamol (Panadol), Indomethacin (Indocid), Diclofenac and Ibuprufen among others.  We also commonly have clients buy antibiotics of different types and among some of the most common include but not limited to; Metronidazole, Amoxicillin, Artemisinin combination Therapies and others.  There is also misuse of peptic ulcer medications such as Omeprazole and antiacids containing magnesium and aluminum and antihistamine.

Such drugs have ever been prescribed to the patient and or, they have been used by the patient for a long period of time.  The so called pain killers are used by many people in our communities day to day.  These are the likes of Indomethacin, Dicrofenac, Paracetamol or Acetaminophene among others.  But the use of these drugs comes at a cost, that they are not the safest chemical to use frequently.

Despite the fact that they may not be the perfect medications to be used for whatever condition the patient may be using them for, there is no thorough evaluation of the patients' condition before their use, and they are normally used in either under or overdose for Un predetermined time.

CONSEQUENCES OF USING OTC:  Some of the most common consequences of using on the counter drugs comes as a result of ether underdose and or overdose, irrational prescription, or drug resistance.  Let us look at each drug manufactured and marketed to have a predetermined dosage regimen where, you are required to take some amount of the drug in  a given time t.  Sometimes you notice that depending on the patient's status, the dosage can be adjusted at various degrees making let's say a drug being available in 20mg, 40mg and 45 mg per Kg body weight.  It will not be easy for a non medical personnel buying such a drug to notice the different strength, subjecting them to less or more than the actual dose they need.  I have discussed a lot about therapeutic window and therapeutic index in the past as you can read about the details from here.

When it comes to irrational prescription, there is a tendency of patients to buy drugs that because their presenting signs and symptom are similar to those that a friend had, and they saw the drug they were given.  When it comes to Drug resistance, this is one of the major topics of concern when it come to antimicrobial drug use especially the so called antibiotics.  Without a proper laboratory investigation and consultation from a trained medical personnel, there would be no need to take any antibiotic for any anticipated medical condition.

RELATED;

1.  DYNAMICS OF DRUGS AND THE HUMAN BODY

2.  DRUG USE AND CLINICAL TRIALS

3.  DRUG USE IN RELATION TO PREGNANCY

4.  CLASSIFICATION OF DRUGS

5.  ANALGESICS

6.  ANTIBIOTICS

ALCOHOL AND THE HUMAN BODY

Introduction:  In our day to day life we tend to take in many stuff in our bodies some of which are helpful and others are harmful.  Whether intentional or accidentally taken, every chemical that we consume in our bodies has limits with in which it will be either useful or harmful and today, let us look at the comings and goings of alcohol in the human body and the effects both short term and long term of it's consumption.

Ethyl alcohol or simply alcohol has few clinical uses when given systemically, but is of great medical importance because of its pathological and psychological effects when used as a beverage in beers, wines, vodkas and other local and international alcoholic beverages.  Seasonal consumers of alcohol have some benefit from it and these are some of the few here; It is a sedative but not a perfect sedative-hypnotic.  I have discussed much about sedation and hypnosis and if you would like to read more about Sedative-hypnotics click here.  Alcohol in small quantities is capable of causing depressant states but it is not a perfect depressant.  So for that respect, many people tend to take it when they feel hyperactive to gain some feeling of depression especially following extraneous activities that require mental hassling.  Following ingestion of alcohol, there may be some feeling of pain killing or relief in some painful situations but it is not a perfect analgesic or what people literally call "pain killer" and it is never in any way intended for that purpose.  

Alcohol is one of the most important drug of dependence and abuse, and in many countries, the incidence of alcoholism is about 10% among the adult population.

Pharmacokinetics:  Ethyl alcohol is absorbed from the buccal, oesophageal, gastric and intestinal mucosae, and approximately 80% is absorbed from the small intestines.  In fact this makes it one of the most easily absorbable compounds when taken orally, and one of the drugs that can achieve maximum bioavailability in a short period of time.  I have discussed about the term bioavailability in relation to drug absorption and distribution recently and if you would like to read about that, you can click here. 

Alcohol delays gastric emptying and in high doses delays its own absorption. Following oral administration, alcohol can usually be detected in the blood within five minutes.  Alcohol is capable of crossing the placenta and the fetus can be exposed to it following drinking for pregnant mothers.  The effects of alcohol is so intense in pregnancy that when a mother drinks, the fetus will have almost the same concentration of alcohol in it's blood as that of the mother's blood per in mg/dl.  This is indicative of the degree with which it crosses the placenta compared to other compounds, and an alert on the possible initiation and development of teratogens or fetal malformations.

Peak concentrations occur between 30 minutes and two hours and during this period, the quantity taken and the amount reaching the body systems will be following a first order kinetics fashion. It should be noted that, Fats and carbohydrates delay absorption and therefore may affect. Alcohol is distributed throughout the body water. About 95% is metabolized mainly in the liver and the remainder is excreted unchanged in the breath, urine and sweat.

Effects of alcohol:  Alcohol has several effects on the different body systems as follows;

Nervous system: Alcohol decreases concentration, judgement, discrimination, and reasoning and increases self-confidence. Progressively increasing plasma concentrations are associated with sensations of relaxation followed by mild euphoria, incoordination, ataxia and loss of consciousness. 

At high blood concentrations, the gag reflex is impaired, vomiting may occur and death may result from aspiration of gastric contents. The importance of alcohol as a factor in road traffic accidents is well known. 

The central depressant actions of alcohol greatly enhance the effects of other central depressant drugs. In patients with organic brain damage, alcohol may induce unusual aggression and destructiveness, known as pathological intoxication.

Medical uses of alcohol:  Alcohol may seem to be a universal poison because of it's hazardous effects on the human body when consumed in large quantities and for a long time however, there times when it can be used as a medicine.  Alcohol is used topically as an antiseptic and many antiseptic solutions have some alcoholic component in them. In fact the smell of alcohol can be detected by exposed individual on use of sanitizing solutions.  Systemic alcohol is used in poisoning by methanol or ethylene glycol, since it competes with these for oxidation by alcohol dehydrogenase, slowing the production of toxic metabolites such as formaldehyde, oxalic acid.  We shall late be discussing the toxicities that result form alcohols including methanol in a separate discussion.

Conclusion:  Health experts say that is good to have some sort of alcoholic beverage in a day with a daily recommendation of 2 bottles of bear for men and 1 bottle for women.  The recommendation however may be different depending on the region and someone's health status.  Small quantities of alcohol are shown to increase the efficiency and normal functioning of the cardiovascular system and Gastrointestinal tract.  The problem however comes that once taken, alcohol tends to make an individual develop tolerance and dependance to it.  Increasing intake of large quantities of alcohol is associated with Nervous system, Cardiovascular and GIT related medical conditions as seen above. 

RELATED;

1.  ADDICTION, TOLERANCE AND DEPENDENCY

2.  ALCOHOL BREAKDOWN BY THE LIVER

3.  FUNCTIONS OF THE LIVER

4.  ALCOHOL LIVER FAILURE

5.  ALTERED LEVEL OF CONSCIOUSNESS

6.  SEDATIVES AND HYPNOTICS

7.  CENTRALLY ACTING DRUGS

8.  BIOAVAILABILITY

REFERENCES

PATHOPHYSIOLOGY OF DIABETES MELLITUS

OBJECTIVES OF THE DISCUSSION:  By the end of this discussion, the learner/Medical student/reader will be able to;

1.  Explain the roles of glucose as a universal fuel for the human body.

2.  Explain the role of insulin in the human body

3.  Explain the alterations in glucose metabolism that later lead to development of diabetes mellitus

INTRODUCTION:  Glucose is the universal fuel molecule for the human body.  For when it is metabolised in cells it generates Adenosine Triphosphate (ATP) and the cell will then be able to run it's activities that require energy.  The entry of glucose into the cells is facilitated by the hormone insulin as we are going to see it in details.  By binding to cell surface receptors, insulin activates entry of glucose molecules into the cells so that they can be utilised for energy production.  This means the human body will require to produce not just enough insulin alone, but also be responsive to it.

In diabetes mellitus, there is impaired uptake of glucose by the cells in the body and glucose will remain in blood circulation, reaching extreme concentrations that are disastrous to the walls of the blood vessels but also, leaving the body cells starving from enough energy source.  In our discussion here, we are going to look at the pathophysiology of this monster disease known as Diabetes Mellitus (DM) but before we continue, let us briefly look at what happen with metabolism of glucose.

METABOLISM OF GLUCOSE:  Glucose also commonly known as blood sugar, is a monomer of polysaccharides, many disaccharides and oligosaccharides, and is a constituent of many carbohydrate food stuffs.  When taken in the body especially in form of food, carbohydrates yield this precious source of fuel in the body as part of digestion in the gastrointestinal tract.  Digestion of carbohydrates

The glucose produced as a result of food breakdown in the Gastro-intestinal Tract (GIT) is then absorbed into the lumen of the intestines, to blood circulation and in the next few minutes following a heavy meal, the glucose levels in blood will be higher than normal.  The excess of it will then be converted to glycogen and stored for later use in the liver and skeletal muscles, and the rest of it will remain in circulation ready to be taken up by cells.  The liver carries out the role of converting this extra glucose into glycogen for later use, and the rest of glucose is absorbed into the cells to provide energy.  For glucose to enter the cells, the goal is accomplished by the endocrine system via a hormone known as insulin, produced by the endocrine pancreas.

DEVELPMENT OF DIABETES MELLITUS: Development of diabetes follows the body's inability to absorb glucose from the blood circulation either as a result of insufficient production of insulin from the pancreas, cellular resistance to circulating insulin or both and therefore increasing load of glucose in circulation.

TYPES OF DIABETS:  Now that we have seen the issue is insulin and glucose, there are two aspects; The insulin produced in the pancreas is not enough or it is not produced at all, and this will be termed Diabetes mellitus type 1 or Insulin dependent diabetes mellitus.

The other aspect will be, the pancreas is normal and producing enough insulin but the body cells are not sensitive to the produced insulin and therefore the produced insulin noes not work despite it's presence.  This is termed Diabetes mellitus type 2 or Non Insulin dependent diabetes mellitus.

SUMMERY:  That describes the out goings of glucose metabolism, insulin production, and development of diabetes.  To read about the detailed description for the types of diabetes, possible causes of pancreatic failure and management of diabetes click here.

RELATED;

1.  POLYSACCHARIDES

2.  DISACCHARIDES

3.  CARBOHYDRATES

4.  DIGESTION OF CARBOHYDRATES

5.  THE ENDOCRINE PANCREAS

6.  MEDICAL MANAGEMENT OF DIABETES MELLITUS

7.  PANCREATITIS