Applied Anatomy and Physiology - Essay Example

? Applied Anatomy and Physiology (Case Study) Applied Anatomy and Physiology (Case Study) The term physiology can be defined as the dynamic study of life and basically describes the vital functions of living beings inclusive of organs, cells and molecules. This discipline for a couple of centuries has been closely linked to medicine. In contrast to the fields of anatomy, structural biology and anatomy which primarily focus on morphology, physiology is tightly related to these fields. This is because morphology and functions of the organ systems and cells function in tandem interchangeably. Physiology can be grouped into several categories depending on what the physiologists are studying (Marieb and Hoehn 2009, p.317). In this particular approach, physiology is viewed in terms of medical aspect. This particular category focuses on human body functioning dependent on individual organ systems. These organ systems are in turn dependent on component functioning of the various cells in the system. The underlying cellular components are further studied at sub cellular levels so as to ascertain the interactions at cellular and molecular levels. As a result, medical physiology gains an integrated outlook of the human body. This is done with a view of understanding events at the cellular, molecular and organ levels. It is in this perspective that physiology has been attributed as the mother of several biological sciences including neuroscience, biochemistry and biophysics. This suggests that physiology has limited boundaries to other disciplines hence can be termed as multidisciplinary. In this case study, we find the correlation between biochemistry and clinical medicine extremely important in the case o a patient having tonsillectomy (Marieb and Hoehn 2009, p.298) Anatomy is the branch of medicine that deals with the morphology of body organs. In this case study, the organ system that comes into play is the lymphatic system which plays a crucial role in immunity. Cells within the lymphatic system are organized into tissues and organs and can be grouped into three main categories. This classification is done on the basis of their levels of arrangement or encapsulation of the tissues to the connective tissue. The first category comprises of dispersed bundles of lymphatic cells that are without a capsule. This form of lymphatic tissue is exemplified by macrophages and lymphocytes. They are linked to fiber network. This group of lymphatic tissues occurs within the middle layer of the mucus membranes termed lamina propria. This covering plays a role in lining respiratory and gastrointestinal regions (Shier, Butler and Lewis 2012, p.212). The second group comprises the organs that contain circulative lymphatic cells and lymph nodules which are capsulated and connected to the dense connective tissue. The third group which forms the focus of the case study consists of distinct bundles of lymphatic cells referred to as lymphatic nodules. A distinctive feature of this group of cells is the lack of capsules within their membranes. Additionally, these packs of cells possess clear demarcations which separate them from adjacent cells. They have a wide range of distribution within the human body and this explains their importance in immune responses. They are found within the lamina propria of mucus secreting coverings and line respiratory, urinary, gastrointestinal and reproductive tracts. Generally they are called mucosa-associated lymphoid tissue abbreviated as MALT. Lymphatic nodules or follicles secrete macrophages and lymphocytes which are protective towards pathogens which interfere with passages of urine, air and gut. Lymph nodes can occur as solitary nodules or they can be clustered into aggregates. Some of the most common clusters of lymph nodes include Peyer’s patches which are basically aggregates of the mucosa which lines the small intestines (Van Putte, Regan and Russo 2012, p.372). The second group of clustered lymph nodes is tonsils which basically occur within the mucosa that covers the pharynx or throat. A total of seven clustered tonsils occur within the lymphoid tissues and are named according to the regions where they are located. The adenoid or pharyngeal, which is solitary cluster that occurs in the back wall of the nasopharynx. Others are the double palatine aggregates of the tonsils occurring on either orientation of oral cavity. Additionally, there exist two lingual tonsils on either side of the bottom of the tongue. Finally, the last two sets of tonsils known as tubal tonsils are found within the pharynx at the entry of auditory tubes in the ear. The last cluster of lymph nodules is the appendix which forms a minute finger shaped attachment within the large intestines. The major organ under which this condition of tonsillectomy is performed falls under category of the lymph nodes. These are basically are small bean structured bodies occurring within the lymphatic vessels. These organs are more frequent in regions where the lymphatic vessels combine leading to formation of trunks. Such areas include the groin, mammary gland and armpits. The lymph fluid streams into the node via the afferent vessels and goes into the convex portion of the node. The fluid the exits the node through the efferent vessel through the hilus located on the opposite side. These exit tubules possess valves which confine the movement of the fluid in only one direction. Additionally, the number of efferent streams within the node is fewer than afferent vessels thus regulating the flow of lymph fluid through the organ (Barrett, Barman, Boitano and Brooks 2010, p.124). Lymph nodes undertake the role of sieving lymph hence preventing the circulation of toxins and other pathogens which find way into the intestines. These nodes also aid in the destruction of pathogenic content through phagocytosis via the macrophages. Finally, lymph nodes are critical powerhouses of production of antibodies via B-cell activity. At the vicinity of lymph nodes are the lymph glands whose swelling at any given time may be suggestive that an infection or inflammation is eminent. This paper looks at the areas of physiology and the endocrine system particularly the lymphoid tissues as fundamental aspects in tonsillectomy (Barrett, Barman, Boitano and Brooks 2010, p.214). Patient’s social, physiological and pathological details. The case study involves tonsillectomy as the preferred strategy for treatment and management of chronic tonsillitis. The study involved a patient (Miss X) with chronic tonsils. This patient is in her late teenage hood and attends school but started complaining of neck pains in her early teenage hood. The following parameters are studied: sex, age, throat swab test, white blood cells count, histological. Other tests involved immunohistochemical expression, CD4, CD8 and the determination of EBV cytokeratines. Another clinical approach employed was the use of fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the neck and head region. The uptake of the FDG was done as a comparison studies to the Histopathological findings. In this particular case, the patient was a teenage woman of 19 years. Upon analysis, there was an increased case of damages to the respiratory tract. Her duration of symptoms upon diagnosis was between 6 to 36 months and the patient followed an antibiotic treatment for the disease in history. However, upon treatment via tonsillectomy, the patient stopped the antibiotic treatment. The patient’s symptoms history included fever with body temperature of higher than 37.5?C, pain in the neck especially in cold periods. Other symptoms included dryness in the throat, halitosis, dry coughs, snoring and anorexia. Upon diagnosis, the patient had sore throat, dysphagia and high C-reactive protein that was 4.5 mg/dl. Clinical assessment of the patient disclosed the incidence of tonsillar lodge volume as well as color changes of the tonsils. A pre-assessment of the patient showed a heart rate of 72 beats per minute which was within the normal heart beat rate in normal conditions. Pre-assessment observation of the blood pressure revealed a systolic reading of 125 millimeters in mercury. The diastolic blood pressure showed 78 millimeters in mercury. On arrival at the anesthetic room, the patient seemed very nervous and showed signs of fatigue. A non-invasive cuff blood pressure cuff was used to ascertain the patient’s blood pressure. Clinical results showed systolic pressure of 139 mm Hg, while diastolic pressure recorded at 83mm Hg. Her heart beta rate was recorded as 98 beats per minute. There were disparities in both the blood pressure and heart beat rate in clinical and pre-assessments. Higher figures were recorded just before anesthesia due to a stress response in an instantaneous reaction where the body is prepared for flight or fight due to adrenaline. Symmetrical fluorine-18-fluorodeoxyglucose uptake by the tonsils indicated blood sugar level of 54mg/dl compared to the normal levels o 0.4 mg/dl. Regions of interest placed on the tonsils and mean standardized values (SUVs) showed 6.4 on the right and 7.4 on the left. After paraclinical examination, results identified from cultures from the pharyngeal biopsy included cases in hemolytic streptococcus and staphylococcus Aureus. The blood count of the patient indicated leukocytosis evident with lymphocytosis. Disorders of the lymphocytes were observed. Histopathological examination was conducted while the immunochemical assessment was done using markers of the B lymphocytes, CD20 and for T lymphocytes included CD4, CD8 and CD3. An additional marker included the pan antileucocitar antigen, CLA. Squamous epithelium was employed as a marker for the wide spectrum citokeratin-AE1/AE3. Immunochemistry analysis revealed intense positive response for the B lymphocyte marker, CD20 as well as the CLA antigen in lymphocytes derived from the crypt and surface epithelium. Additionally, the results were positive for lymphocytes obtained from the tonsillar lymphoid tissue. The B lymphocyte marker, CD20 was present in germ centers and numerous with signs of interfolicular nature. The distribution of the T lymphocytes markers such as CD3 was large in the tonsillar tissue as well as in the germ centers where they appeared as interfolllicular germinates. CD4 T lymphocytes were also another strong membrane marker with distribution occurring as single or in groups. They were located mostly as interfolicular germinates but also appeared at germinal centers. Palatine tonsils are mainly located within the alimentary and respiratory tracts. In such locations, these tonsils are directly and constantly exposed to antigens. Within the tonsils antigens are frequently found on the crypt epithelium leading to the activation of lymphocytes. Within a certain threshold, the inflammation can become physiological. Chronic tonsillitis has been shown to be one of the common diseases within the oral region of younger children and adults. The condition is attributed to chronic inflammation within the tonsils. Clinically, the condition of chronic tonsillitis has been reported to be characterized by recurrence of infections. Tonsillectomy which is closely related to adenoidectomy is a surgical operation performed on patients who show repeated infections in tonsils. These conditions may have severe effects on the dental system, alimentary canal and may also lead to sleep problems. When a patient complains of constant pain in the ears, neck or repeated ear infections and sinusitis, the best treatment option is surgery. Tonsillectomy is recommended in patients who display or suffer from serious complications such as streptococcal infections, rheumatoid disease. Patients who also exhibit neck pains and peritonsillar abscesses are advised to undergo the operation. Additionally, the clinical data have shown that chronic tonsillitis can be defined by obstruction of the upper airway thereby suppressing respiratory system functioning (McDowell and Windelspecht 2004, p.371). When the condition becomes complicated, it may portray endless systematic consequences. These repercussions may be exemplified by difficulty in swallowing, odynophagia, recurrent fever, halitosis and submandibular lymphadenopathy. The clinical expression of chronic tonsillitis is highly variable as indicated by cases of repeated infections coupled with recurrence in fever and pain. Also, in this condition is the variability in the number and intensity of episodes, with extremity lasting throughout the life of an infected patient. The immunological deficit of chronic tonsillitis has not been fully reviewed. This has prompted many researchers to allude with the hypothesis that the condition may have a local congenital immunodeficiency especially among children. However, in this case, the inheritance aspect of the condition cannot be demonstrated because of the patient’s history being inconclusive (Elling, Kirsten and Rothenberg 2005, p.279). The microbial study of chronic tonsillitis in this case showed that bacterial infection was a causative agent. However, it is imperative to note that other pathogens including viruses are also responsible for this condition. Bacterial infection as exemplified by cultures in ?-hemolytic Streptococcus and Staphylococcus aureus. The cultures of samples obtained from the throat swab on tonsillar surfaces were diagnosed via the group a beta hemolytic streptococcus. With a sensitivity of 95% in the detection of beta hemolytic streptococcus, this microbiology procedure indicated the presence of streptococcal infection in the patient. Viral infections such as the Epstein-Barr virus (EBV) are prevalent in a majority of adults throughout the world. The etiology of this infection can be attributed to oral contact with infected person’s saliva. It has been postulated that the infection initially occurs via the oral epithelial cells or tonsillar B cells followed by a short proliferation in the B lymphocytes. In certain circumstances, there have been reported cases of the absence of EBV infection from infectious mononucleosis (Hudnall, Ge, Wei, Yang, Wang and Chen 2005, p.523). This suggests that EBV infection within the tonsillar epithelia is a rare case. However, B cells may encounter salivary Epstein Barr Virus directly via the epithelial crypts hence bypassing the transmission of the virus via epithelial cell to B lymphocytes. Newly infected B cells move to germinal centers where they accumulate under the activity of complementation of underlying viral proteins (Thibodeau and Patton 2010, p.239). In a patients’ life, the tonsils undergo multiple morphological changes such as increased size due to hyperplasia of lymphocyte follicles or germ centers. Changes within the histological perspective may be due to recurrence in infections hence a strong indication of tonsillectomy. Histological modifications in parts of resection are the most prevalent in lymphoid hyperplasia. Histopathological studies indicate the existence of macroscopic palatine tonsils which can be broadly categorized as large and small tonsils. The large tonsils exhibit low consistency and small whitish areas. Smaller tonsils are characterized by fibrous network and hard whitish flesh. Within the surface of infected tonsils were areas of hemorrhage (Sherwood 2010, p.254). The line of treatment for chronic tonsillitis on this patient according to the history was antibiotics. These antibiotics were directed as the line of defense against beta-lactamase producing bacteria and anaerobes. However, these antibiotics majorly penicillin was unable to eradicate the condition due to the fact that they cannot penetrate the tonsillar tissues. This was targeted to be an eliminative step towards surgical procedure of tonsillectomy. Moreover, research has showed that symbiotic bacteria inhabiting the surrounding together with pathogenic streptococci release beta lactamase enzymes. This has the ultimate effect of inhibiting the efficacy of the antibiotics. Indicative signs for tonsillectomy for the patient were dependent on a number of factors including the number of episodes per year, halitosis. Unresponsiveness to antibiotic administration and suspicion of malignancy were also factors considered (Schimmel 1997, p.184). The standardized uptake values for FDG as well as the C-reactive protein were high indicative of the inflammation activity. Follicular hyperplasia in the patient was observed with increased sizes. Furthermore, histopathological examination indicated many neutrophils within the periphery of the epithelium of tonsils. This was also an indication of the level of activity in inflammation in this particular patient. Inflammatory cells such as lymphocytes are highly concentrate fluorine-18-fluorodeoxyglucose for their increased rates in glucose metabolism. This is an indicative sign of the level of active inflammation within tonsils in such patients (Bailey, Johnson and Newlands 2006, p.421). The tonsils form a major portion of the lymphoid ring of the pharynx which is situated along the access path of inhaled or ingested foreign antigens. It has been shown that all the immunoglobulins are secreted at the site of synthesis. Specifically the immunoglobulin IgG leads to hypertrophy and tenderness of the lymphoid tissue. IgG is the largest group of immunoglobulins among the five classes of immunoglobulins which provides specific immunity against bacteria and other toxins. This is due to a response to infection in the relevant area leading to inflammation (Martini, Nath and Bartholomew 2012, p.301). Inflammation may represent a coordinated non-specific response towards an injured tissue. This response is initiated by release of histamines and other chemical components which are stimulated by mast cells. This is followed by permeability and increase in the flow of blood, increased body temperatures, phagocytosis as well as the activation of specific defenses. Specific immunity can be attributed to the activities of lymphocytes. Basically, there are two components in specific immunity and include humoral and cell-mediated immunity. Humoral immune response results from the presence of antibodies within the fluids entering the body. The etiology of B cells which form an integral part in specific immunity result from the differentiation of activated B cells. On the other hand, cell mediated immunity requires the activation of T cells which bind to the specific targets via antigenic ligands (Martini, Nath and Bartholomew 2012, p.338). In the phase of maximum tonsillar hyperplasia, which is characterized by the proliferation of lymphoid elements there is a rapid increase in the volume of the tonsils. There is also compression and distal dilation of the crypts with amassing of squamous epithelial tissue. As such tonsillectomy is the typical time tested treatment for symptomatic tonsillar bulging and recurrent infections. This surgical procedure reduces the rate of occurrence of pharyngitis for several years following the surgery. This procedure also leads to low incidence of recurrence of tonsil re-growth (Marieb, 2011, p.186). Practically, this operation involves the resection of the tonsil growth, variable amounts of the peripheral mucosa and pillar muscle. Tonsils do not possess afferent lymphatics like lymph nodes. However, the epithelial tissue which covers the crypts has dendritic cells which aid in the transportation of exogenous antigens to extra follicular T cell areas and also in B-cell nodules. This synergistic relationship between the epithelial lining of the crypt and components of the lymphoid continues through life after birth (Montague, Watson and Herbert 2005, p.312). Following birth, the stimulation of the immune system is activated by exogenous antigens. Differential expression of the effector B cells to plasma cells proceeds after two weeks. The result is that there is an increase in the development of germinal centers from secondary follicles. The multiplication of these germinal centers is the striking event during the first ten years in the rapid growth of tonsil. This proliferation leads to expansion of the tonsils hence pushing the nearby soft tissues within the oropharyngeal space. In the second decade of life, the humoral component of specific immunity towards the tonsils begins to involute. The germinal centers decrease in size and there is an accumulation of fibrous within the capsules (McCance and Heuther 2010, p.267). T lymphocytes can be classified into three categories namely cytotoxic T cells, memory T cells and helper T cells. There exist two subtypes of helper T cells including T helper 1 and T helper 2 cells. T helper 1 cells release interleukin 2 and gamma interferon which are vital cytokines involved in cell mediated immunity. On the other hand, T helper 2 cells secrete interleukins 4 and 5 that mediate in humoral immunity of immune response. Cytotoxic T lymphocytes play a vital role in the destruction of foreign pathogens (Elgert 2009, p.234). Cell membrane markers also appear on the T lymphocytes. These are assigned cluster differentiation (CD) numbers on the basis of reactions towards a pool of monoclonal antibodies. A majority of cytotoxic T cells possess the glycoprotein CD8. Helper T cells have CD4 on their cell membranes. CD4 T cells provide a critical assistance to B cells for the induction of antibody responses. CD4 T cells coupled with dendritic cells ligated to antigens interact with the antigen-primed B cells at the extra follicular regions. This linking leads to the differentiation of naive B cells to assume two distinct paths namely extra follicular plasma cells and cells leading to germinal centers formation (Jenkins and Tortora 2012, p.194). References Barrett, K. E., Barman, S. M., Boitano, S. and Brooks, H. L. (2010) Ganong's Review of Medical Physiology 23rd ed. London: McGraw Hill Lange. Clancy, J. and McVicar, A. (2009) Physiology & Anatomy: A Homeostatic Approach. 3rd ed. London: Hodder Arnold. Fox, S. I. (2010) Human Physiology 12th ed. London: McGraw Hill Higher Education Jenkins, G. W. and Tortora, G. J. (2012) Anatomy and Physiology from Science to Life 3rd ed. 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