Immunity Disorders

1. IMMUNOLOGICAL DISORDER
PREPARED BY:
AHMED GAMAL FAHMY
FATMA SAEED FAHMY
UNDER SUPERVISION OF
PROF DR AMIRAAHMED

2. OUTLINES
Immune System Basics and Components
Primary Organs (Bone Marrow and Thymus)
 Secondary Organs (Tonsils, Lymph nodes, Spleen, and Adenoid Appendix)
Disorders Related to Heigh Immunity
Ulcerative Colitis
Rheumatoid Colitis
Disorders Related to Low Immunity
Acquired Immune Deficiency Syndrome (AIDS)

3. GENERAL OBJECTIVES:
• At the end of this lecture the participants
should be able to acquired knowledge,
skills and attitude toward immunological
disorders.

4. INTRODUCTION
• Immune system is biological structures and
processes within an organism that protect
against disease by identifying and killing
pathogens and tumor cells.

5.  Primary organ:
 Bone marrow
 Thymus
 Secondary Organ:
 Tonsils
 Lymph nodes
 Spleen
 Adenoid
 Appendix

6. All the specialized cells of the immune system are formed in the bone
marrow.
The bone marrow is the production site of the WBCs involved in
Immunity. Lymphocytes are generated from stem cells, which are
undifferentiated cells. Descendants of stem cells become lymphocytes,
the B lymphocytes (B cells), and the T lymphocytes (T cells). B
lymphocytes mature in the bone marrow and then enter the circulation.
T lymphocytes move from the bone marrow to the thymus, where they
mature into several kinds of cells capable of different functions.
 Bone Marrow
 Primary Organs

8.  The thymus gland is found in the thorax in the anterior mediastinum
it gradually enlarges during childhood but after puberty it undergoes
a process of involution resulting in a reduction in the functioning
mass of the gland. (70g in infant -3g in adults).
 Thymus is responsible for maturation of precursors T lymphocytes
from the bone marrow.
 Thymus

9.  Lymphoid Tissues
 Lymphoid tissues include:
 The spleen
 The lymph nodes
 The tonsils
 Adenoids
 Appendix
 Secondary Organs

10.  The spleen, composed of red and white pulp, acts somewhat like a filter for
the blood. The red pulp is the site where old and injured red blood cells are
destroyed. The white pulp contains concentrations of lymphocytes.
 The lymph nodes are distributed throughout the Body (neck, axilla, femoral,
and popliteal area). They are connected by lymph channels and capillaries,
which remove foreign material from the lymph before it enters the
Bloodstream.
 Spleen
 Lymph Nodes:

11.  Defense against microbes (Viruses, Fungi, Bacteria, fungi)
 Defense against the growth of tumor cells
 kills the growth of tumor cells
 Homeostasis
– Destruction of abnormal or dead cells (e.g. dead red or
white bloodcells, antigen-antibody complex)
Role of the immune system:

12. RheumatoidArthritis

13. INTRODUCTION

14. RHEUMATOID ARTHRITIS
 is a systemic inflammatory autoimmune disease
that characterized by chronic inflammatory
arthritis with multiple extra-articular features.
 1:3 times greater incidence in women in the child
bearing age
 It is a result of immunologic abnormalities.
 Characterized by exacerbations and remissions.

15.  Chronic inflammation of synovial membrane
 Cellular proliferation and damage to the
microcirculation
 Synovial membrane becomes irregular
 Swelling, stiffness and pain
 Cartilage and bone destruction
 Ankylosis or fusing of joints
 Ligaments and tendons also affected

18. CAUSES OF RA
 Autoimmune disease
 Develops after an immune response
 Bacterium, mycoplasma or virus
 Original response is IgG mediated
 May destroy microorganism
 Other antibodies produced (IgM or IgG)
 Self-directed antibodies called rheumatoid factors (RF)
form against IgG.
 Genetic predisposition
 Women affected more
 Various cytokines contribute to the inflammation

19. PATHOPHYSIOLOGY - RA
 The autoimmune reaction primarily occurs in the synovial tissue.
 Phagocytes produces enzymes within joint.
 The enzymes break down collagen causing:
 Edema
 Proliferation of the synovial membrane
 Ultimately pannus formation
 Pannus (granulation tissue) covers synovium destroys cartilage
and erodes the bone.
 Spreads throughout joint
 The consequence is loss of articular surfaces and joint motion.
 RA is an erosive deforming arthritis

21. JOINTS INVOLVED IN RA

22. CLINICAL MANIFESTATION
 PRESENTATION:
 Joint pain
 Swelling
 Warmth
 Erythema
 Lack of function (limited ROM)
 Joint stiffness specially in the morning, lasting for
more than one hour. Difficult to flexsion

23.  Begins with small joints in the hands & feet, and wrists.
 As the disease progresses, the knees, shoulders, hips, elbows and
ankles are involved.
 Symptoms are bilateral and symmetric (same joint on both
sides of body).
 Palpation of the joints reveals spongy or boggy tissue.
 Limitation in function can occur when there is active inflammation
in the joints.
 Joints that are hot, swollen, and painful are not easily moved.
 The patient tends to protect these joints through
immobilization.

24.  Immobilization for extended periods in addition to erosion lead
to contractures and deformity
 Rheumatoid nodules may occur in patients with advanced RAand
these nodules are usually nontender and movable in the
subcutaneous tissue
 They usually appear over bony prominences such as the elbow,
are varied in size, and can disappear spontaneously

25.  Other extra-articular features include:
 Dry eyes
 Dry mouth
 Vasculitis
 Neuropathy
 Scleritis / episcleritis
 Pericarditis / pleurisy
 Splenomegaly/ hepatomegaly
 Lymphadenopathy
 Weight loss, anorexia ,fever, & fatigue

26. Class I: No Limitations
Class II: Adequate for Normal Activities Despite
Joint Discomfort & Limitation of Movement
Class III: Inadequate for Most Self-Care and
Occupational Activities
Class IV: Largely or Wholly Unable to Manage Self-

27. ASSESSMENT & DIAGNOSTIC FINDINGS
 Laboratory findings:
 Rheumatoid factor (RF) is positive in more than 80%
of patients.
 (ESR) The erythrocyte sedimentation rate
elevated
 C-reactive protein elevated.
 Anemia may also present.
 Arthrocentesis (joint aspiration) shows synovial fluid that is
cloudy, milky, or dark yellow and contains numerous
leukocytes.
 X-ray joints shows characteristic bony erosions
and narrowed joint spaces.

28. NURSING MANAGEMENT
 Nonpharmacologic pain management techniques:
 Relaxation techniques
 Heat and cold applications
 Focused on relieving pain and preventing
damage/disability
 Patient education about the disease is key
 Physical Therapy for stretching and range of motion exercises
 Occupational Therapy for splints and adaptive devices
 Surgery: arthroplasty (joint replacement), synovectomy, nerve
decompression, arthrodesis (the joint is fused)

29. MEDICAL MANAGEMENT
 (NSAID) Non-Steroidal Anti-inflammatory for quick control
of joint inflammation but cannot use for long term due to side
effects (Osteoporosis, cataracts, weight gain, insulin
resistance, dyslipidemias)
 Corticosteroids
 (DMARD) Disease Modifying Anti-Rheumatic Drugs
 Methotrexate is the gold standard in the treatment of RA
because of its success in improving disease parameters (ie,
pain, tender and swollen joints, quality of life).
 Hydroxychloroquine or Sulfasalazine -for mild disease, to
reduce inflammation
 Biologic therapies: such as tocilizumab (Actemra),
certolizumab (Cimzia)- target specific immune mediators of
RA such as tumor necrosis factor (TNF).

30. COMPLICATIONS - RA
 Extrasynovial rheumatoid nodules develop on:
 Cardiac valves
 Lungs
 Eyes (retinal degeneration)
 Spleen
 Rheumatoid Vasculitis thrombosis & infarction
 Ankylosis (joint fixation) leads to loss of ability to carry
out ADL
 Joints appear red, swollen, tender, with deformity (e.g.,
swan neck deformity of fingers)

31. PULMONARY NODULES