Ageing and disease- Learning objectives

Male:

Cardiovascular disease

Alzheimer's disease

Respiratory disease

Females:

Cardiovascular disease

Alzheimer's disease

Influenza and pneumonia

Environment,

Genetics

Behaviour

Age

Socio-economic

Occupational 

Nutritional

General motivation

Primary prevention:

Education and immunisation

Secondary prevention:

Early detection (screening)

Tertiary prevention:

Slow and prevent spread.

T- helper cell clones into B cells (humoral immunity) or more T cells (cell-mediated immunity) in response to and antigen.

Humoral immunity:

• Plasma cells grow and they release specific antibodies into the blood stream to target antigen.

Cell mediated immunity:

• T cells produce helper cells that produce more B cells and help to promote growth of plasma cells and the release of antibodies into the blood stream.
• Supressor cells kill of antibodies after a period of time (when not used the get bashed against vessels and become mishapen and will provide immunity against something not necessary.)
• Produce Killer T cells that kill antigen directly.
• Produce memory cells for subsequent infections that produce T cells.

Allergen

IgE synthesis (Bcell)

Attaches to Mast cell or Basophils

Cross-linking by allergen

Calcium influx into the cell

Releases histamine and serotonin

Increase vascular permeability 

causing oedema

Bronhial constriction

Acute inflammation:

• Vasodilation and increased vascular permeability
• Neutrophils and monocytes
• Resolution within days (fluid drained by lymph channels)

Chronic Inflammation:

• Persistant inflammatory stimulus
• Recurrent bouts of inflammation
• Macrophages, Lymphocytes and plasma cells ( no neutrophils)
• Tissue destruction, fibroblasts and collagen.

Oedema:

• Increased pressure created by excess fluid
• Restricts blood flow
• Ischaemia 
• Avascular necrosis

Increased pressure on brain -Loss of differentiation and loss of gyri and sulci.

Bone bruising 

Water flows to higher concentrations of solute

Pulmonary oedema when fluid is in the alveoli. - Reduced by diuretics

Atrophy- Reduced size and number of cells

Hypertrophy- Increase in size

Hyperplasia- Increase in number

Metaplasia- The cells change thir function

Dysplasia-  Deranged cell growth cells, various cell size, shape, and function (pre cursor)

Neoplasia- Complete loss of control, Abnormal replication

Loss of apoptosis. (Cell death)

Systemic Lupus Erythematosus-

• Oral ulcers
• skin rash
• anaemia
• myalgia
• arthritis
• osteroporosis
• Cerebral lupus
• Lupus nephritis

Sclerosis:

Oesophageal stricture

Pulmonary fibrosis

Vascular renal damage

Raynaud's phenomenon

Sclerosis of subcutis

Acrosclersosis Calcinosis cutis

Sarcoidosis- Disease involving abnormal collections of inflamatory cells that form lumps known as granulomas.

• Lacrimal and salivary infiltration
• Lung infiltration
• Lymphadenopathy
• Neuropathy
• Meningitis
• Iritisi and uveitis
• Lupus pernio
• Mild splenomegaly
• Myostis
• Erthema nodosum

Rheumatoid Disease

• Dry eyes
• Scleritis
• Lymphadenopathy
• Pulmonary fibrosis
• Rheumatoid nodules
• Anaemia
• Hypersplenism
• Drug related renal damage
• Arthritis
• Osteoporosis
• Drug related ulcers of the stomach
• Skin rash

Diabetes mellitus:

• Cerebrovascular
• Diabetic retinopathy
• Ischarmic heart disease
• Diabetic nephropathy
• Severe athersclerosis
• Peripheral neuropathy/ w/ trophic ulcerations
• Skin infections
• Necrobiosis lipoidica
• Ischaemia of lower limbs (gangrene)

Affect of aging on cardiovascular system:

• Decreased cardiac output
• Blood vessels become less elastic - Increased systolic BP
• Venous blood returned slower- thrombus formation
• Fascia supporting veins are weakened - variose veins
• Cardiac muscles weaken 
• Valvular thickening -disrupt blood flow
• Loss of responsiveness of nerve cells - Arrythmias
• Systolic hypertension- due to rigid aorta
• Orthostatic hypotension- due to lack of autonomic Nervous System control

Affects on respiratory system:

• Weakening of respiratory muscles
• Increased workload- less desire to breathe deeply
• Decreased tidal volume
• Increased residual volume
• Decreased vital capacity
• Reduced perfusionat alveolus
• Increased risk of infections:
• Calcification off tissues in the cartilage wall

Affects on Nervous system:

• Loss of- Cortical thickness, Neurotransmitter, synapses, cerebral blood flow, Metabolic rate.
• Increase in neurofribillary tangels and neuritis plaques of amyloid deposits.

Pathologies:

• Acute brain failure
• Chronic brain failure
• Parkinson's
• Motor neuron disease
• Herpes zoster
• Malignant disease
• Peripheral polyneuropathy

Affect of ageing on Gastrointestinal tract

Oesophagus:

Depressed motility,

Inadequate relaxation of cardiac sphincter.

Colon:

Diverticula,

Constipation,

Haemorrhoids

Affects of ageing on the urinary system:

Renal function:

Reduced number of functional glomeruli

Reduced renal blood flow- Sclerosis of renal arteries, Loss of homeostatic control

Easier predisposition to dehydration

Urinary bladder:

Weakened and stiffened walls, less elastic

Males enlarged prostate

Sign- Objective evidence of a disease, Can be observed or measured. i.e skin rash or lump.

Symptom- Subjective to the patient.

Health- A state of physical mental and social well-being. Not merely the abscence of disease. Capacity of the body to perform "normal" functions efficiently.

Disease- Failure to adapt; A dysfunction- failure of homestasis mechanism.

Autoimmune diseases often originate from a perversion of a survival mechanism; failures in adaptation tend to be self-reinforcing and proressive.

• There needs to be a recognised need for it.
• Objectives must be definied
• There must be a target population
• Scientific evidence must support effectiveness of screening programme
• Benefits of screening must outweigh the risk.

Lymphocytes produce antibodies, regulation of inflammatory responses.

Endothelium- Produce prostoglandin.

Prostoglandin causes pain- Aspirin surpresses prostoglandin

Histamine and serotonin are secreted by mast cells and basophils. They increase vasodilation and vascular permeabiity allowing fluid to leave more freely from the vessels causing oedema.

Oedema Increase the hydrostatic pressure reducing blood supply to areas of the body.

Redness- Dilation of blood vessels- increased blood flow

Heat- Increased blood flow

Swelling- Accumulation of fluid leaving the vessel

Pain- Increased pressure on endothelium and cellular reactions

Loss of function due to pain and swelling.

IgA- Secretions

IgD- Lymphocyte membrane protein

IgE- Activated basophils and mast cells in allergic reactions

IgG- Major whole body reactions

IgM- Largest First to appear after infection.