Diabetes

1. Normal physiology/Anatomy

In human pancreas, specifically in the islet of Langerhans you will able to

find Alpha cells and Beta cells. The pancreatic alpha cells are the one
responsible for releasing glucagon while the beta cells are the one responsible for
the release of insulin.

If someone consumes carbohydrates chemicals in the small intestine

break those down into single sugar molecules called glucose. Then the cells
lining of small intestine absorb the glucose which passes into the bloodstream.
When the blood reaches the pancreas, beta cells inside the pancreas detect the
rising glucose levels. The beta cells release insulin into your bloodstream to
reduce glucose levels and to keep blood glucose in a healthy range. Most cells of
the body have certain receptors on their surface that bind to the circulating
insulin. Insulin acts like a key in a lock to open up the cell so that circulating
glucose can get inside the cell. Now the body cells can use the glucose to
produce the energy it needs to function properly.

Also inside the Beta cells, glucose will undergoes glycolysis and increase
the production of ATP inside the beta cells. An increase level of ATP inside the
cell causes the potassium channel to close. Normally, the potassium channel in
the beta cells, pumps potassium from inside the cell out to the extracellular
compartment. Because an increase in ATP closes the potassium pump,
potassium will build up inside the cell. And the build up of positive charge
potassium causes the membrane to depolarize (become less negative). This
depolarization opens up the voltage-gated calcium channel. And once the
voltage-gated calcium channel opens, Calcium rushes into the beta cell. Increase
intracellular calcium serves as a second messenger to stimulate the release of
insulin from the beta cell.
 In pancreatic alpha cells when the glucose level gets too low it releases
glucagon that stimulate the liver to produce glucose, then again the body cells
can use the glucose to produce energy they needed to function properly.

2. Regulation

The INSULIN helps reduce blood glucose levels and to keep blood glucose in
a healthy range. Insulin acts like a key in a lock to open up the cell so that
circulating glucose can get inside the cell. Once glucose enters cells it used in
production of energy that they needed to function properly. If the body has
sufficient glucose, insulin helps store glucose in the liver and releases it when
your blood glucose become low or if the body cells need more glucose.

The work of GLUCAGON is to stimulate the liver to produce glucose from the
stored glycogen when there is too low blood glucose level. The glucose that
breaks down from the glycogen is then passes into the bloodstream so the
other cells can use it for energy.

3. Pathology

In type 1 diabetes the pancreatic beta cells loses their ability to produce
insulin. Because the immune system, specifically the WBC mistake the
pancreatic Beta cells for foreign invaders, the autoimmune response of WBC is to
secrete autoantibodies to destroy the beta cells. Since the beta cells in the
pancreas are the responsible for the production of Insulin because it is destroyed
there will be little or no insulin. Without insulin the glucose cannot get into the cell
and the cell won’t have any glucose to be used as fuel for energy. The glucose
will build up in the bloodstream causing hyperglycemia.
 Insulin acts like a key in a lock to open cell so that the circulating glucose
can get inside the cell. In type 2 diabetes the pancreatic beta cells produces
enough insulin but the insulin itself cannot unlock the cells to let the glucose in
because the receptors are abnormal or missing. To compensate, the beta cells
will produce insulin to keep up with the demand but gradually loses their ability to
produce enough insulin. The glucose will build up in the bloodstream causing
hyperglycemia.

In response, the kidney filters excess glucose out of the blood into urine,
along with large amount of water. When large water is consumed the kidney
cannot keep up the demand of removing excess glucose from the bloodstream
and diluting it sufficiently in urine. As a result blood becomes more concentrated.

4. A) Signs and symptoms/ clinical manifestation (give 5)

-Polyphagia
-Polydipsia
-Polyuria
-Fatigue
-Blurred vision

 Choose two Signs and symptoms/clinical manifestation, then

explain:
-Polyphagia – this happens when the body cells can’t have the enough
energy they need to function properly, as a result the body demand more
source of glucose in able to produce energy. The reason why this happens
is because in uncontrolled diabetes the blood cannot enter the cells - due
to either a lack of insulin or insulin resistance - so the body can’t convert the
food you eat into energy.

-Fatigue–since there is only little or no glucose enter the cells - due to

either a lack of insulin or insulin resistance the body are unable to produce
energy, which can cause a feeling of extreme exhaustion or fatigue.
 B) Laboratory test/Diagnosis

o Hb1ac- a test measures the amount of blood sugar attached to haemoglobin, the
oxygen-carrying protein in the red blood cells. Hb1ac levels are a reflective of
how well diabetes is controlled.
 Hb1ac - can be a sign for diabetes
 Hb1ac - Haemolytic anemia

o Fasting Blood Glucose- A test use to determine how much glucose is in a blood
that requires an overnight fasting.
 FBG - Hyperglycemia

 FBG - Hypoglycemia

5. Pharmacologic treatment

 SULFONYLUREAS
Function similar to an increase in ATP within the pancreatic beta cells in
results the potassium channel close increase positive charge ions inside
the membrane leads to the opening of voltage-gated calcium channel.
Calcium then acts as a second messenger that will stimulate the release
of insulin from the pancreatic beta cells.

 BIGUANIDES (Metformin)
The action of Biguanides is to lower or decrease the uptake of glucose
from the small intestine and improves receptor sensitivity to insulin so that
glucose may enter body cells.
 ALPHA GLUCOSIDASE INHIBITOR
Alpha glucosidase is one of the enzymes involvedvin breaking down
carbohydrates. The action of this drug is to inhibit the enzyme alpha
glucosidase to decrease the glucose absorption from the small intestine by
slowing or delaying the breakdown of carbohydrates to glucose.

 INSULIN
The action of insulin is like a key to unlock receptor for glucose to enter
body cells.
ASTHMA

1. Normal physiology/Anatomy
In a human anatomy we have trachea which is divides into 2 main bronchi and
these bronchi are further divided into bronchioles which also be divided into alveoli. When
we take a breath either in nose or mouth, the air will travels into the pharynx, and then to
larynx and it enters the trachea, which carries the air to the left and right bronchus and
through the bronchioles. The bronchi and bronchioles are dead space that moistens and
warm air as it goes to alveoli, which is surrounded by capillaries where oxygen enters and
carbon dioxide leaves the blood.

From the lungs the carbon dioxide is expelled via the trachea and into the air. When we
breaths in, normally air goes in through the lungs and as we breaths out, air exit the body
in the opposite direction easily because there are thin airway walls.

2. Regulation

Airways in the lungs are expand when the air is warm, moist and free of allergen.
While in opposite, it contracts when the air is cold, dry and contains irritants. Asthma is a
syndrome of lung dysfunction characterized by airflow obstruction, reversibility to
bronchodilators, and airways hyper-responsiveness and also it is a chronic dx with an
underlying inflammatory pathophysiology. Asthma exacerbations are caused by
precipitating factors such as allergens, exposure to irritants, environmental exposures and
certain drugs.

The lungs are innervated by both sympathetic and parasympathetic nervous

systems which entail activation of adrenergic and muscarinic receptors respectively. Both
the adrenergic and muscarinic receptors are G-protein-coupled receptors, and they share
many similar signal transduction molecules. These receptors are widely expressed in the
lung and the specific receptor expression can vary among the species.
 The location and the subtype of receptor expressed are important in regulation of
normal function. Acetylcholine released from parasympathetic fibers activates muscarinic
receptors located on the airway smooth muscle causing constriction. B2 receptors are also
expressed on the airway smooth muscle where its activation causes dilation.

The major inflammatory cells involved in asthma are mast cells and eosinophils.
Eosinophil are cells can be found in various parts of lungs and its activation causes the
release of inflammatory mediators. Mast cells have long been considered to play a
significant role in the pathophysiology of asthma through their ability to mediate
inflammatory response that is triggered by IgE. The mast cell secretes autacoid mediators’
histamine, prostaglandin, and leukotriene, which are capable of inducing
bronchoconstriction and all other that may features asthma.

3. Pathology

The pathogenesis of asthma. Antigen presentation by the dendritic cell with the
lymphocyte and cytokine response leading to airway inflammation and asthma
symptoms. The release of mediators such as histamine, prostaglandin, and leukotriene,
will cause activities such as excessive mucus production, smooth muscle constriction,
mucosal edema, and epithelial damage which can cause to pathological changes of the
airways.

4. Signs and symptoms/ clinical manifestation (give 5)

-Chest tightness
-SOB
-Wheezing
-Coughing
-Difficulty of breathing
.
  Choose two Signs and symptoms/clinical manifestation, then
explain:
-Coughing- this may start after people are exposed to allergens or when
breathing in cold air. Cold air is often dry air and dry air can often irritate the
airways of people with asthma.

-Wheezing- this occurs when the small airways of the lungs become
narrow or constricted. That makes it difficult to breathe, and can cause a whistling
sound when breathing out. Wheezing is a symptom of asthma where a
combination of swelling, mucus and muscles tightening can cause narrowing of
the airways.

 Laboratory test/ diagnosis

- Spirometry measures amount of air youre able to breath in and breath

out and its rates of flow.

- Chest X-ray small increase in lungs( hyperinflation)

5. Pharmacologic treatment

 Leukotriene antagonist.
The action of this drug is to block the 5-lipoxygenase activity and prevents
the formation of leukotrienes that may cause inflammation,
bronchoconstriction and mucus production.

 Sympathomimetic agents.
This agents promotes relaxation of the bronchial smooth muscle because it
inhibits the release of bronchoconstricting mediators. Therefore it causes
bronchodilation.
 Muscarinic antagonist.
The action of this drug is to increase airflow in asthma by blocking reflex
bronchroconstriction mediated by the vagus nerves. They may also inhibit
the secretion and clearance of mucus.

 Mast cell stabilizer.

The action of these drug is to prevent mast cells from releasing the
substances that causes inflammation. This may help in reducing asthma
symptoms.
.
ANEMIA

1. Normal Physiology/ Anatomy

In human blood, normally it is contains of 55% Plasma (protein, water &

other solutes); 45% Erythrocytes (RBCs); and 1% Leukocytes (WBCs) and
Thrombocytes (Platelets). WBC is larger than than RBC but RBC is greater in
number than WBC with the ratio of 1000 RBC: 1 WBC.

Normally, the primary function of the blood is to supply oxygen and

nutrients as well as constitutional elements to tissues and to remove waste
products. Also Blood enables hormones and other substances to be transported
between tissues and organs. And blood also involves in maintaining homeostasis
by acting as a medium for transferring heat to the skin and by acting as a buffer
system for the bodily pH.

2. Regulation

 Hematopoiesis is the production of all of the cellular components of blood

and blood plasma. This occur within the hematopoietic system, w/c
includes organs and tissues such as bone marrow, liver, and spleen.
Simply, hematopoeisis is the process through which the body
manufactures blood cells.

 Erythropoiesis is the process by which red blood cells are produced. It is

stimulated by decrease O2 in circulation, which is detected by the kidneys,
which then secrete the hormone erythropoietin. EPO will stimulate the red
bone marrow and then new RBCs are produced. When the blood oxygen
level is increased and homeostasis is reached, kidney and liver will stop
releasing EPO for a while.
  Leukopoiesis is the process of formation of leukocytes from the stem
cells in hematopoietic organs. Cytokines are being stimulated for the
production of leukocytes and are responsible for the development of
different types of WBC.

 Thrombopoiesis is the process in platelet generation or production.

Megakaryocytes are large cells that will break off into small fragments with
the help of thrombopoietin w/c give rise for platelet production. And these
platelets will enter the blood for preventing blood loss

3. Pathology

Anemia develops when there is a decrease in the number of RBC

transporting oxygen and carbon dioxide which impairs the body ability for gas
exchange. The decrease may result from blood loss, increased destruction of
RBC’s, or decrease production of RBC’s. Even if there is healthy RBCs and good
quantities being released into the blood but RBCs are being destroyed or
ruptured it will cause destruction anemia. When RBC destruction takes place, the
bone marrow and kidneys will work extra hard to compensate the lost. They will
try to pump more and more RBCs therefore immature RBCs will be released into
the blood and those young RBCs will be greater in number.
.

4. Signs and Symptoms/ clinical manifestation (give 5)

-SOB
-Headache
-Pallor
-Palpations
-Fatigue
  Choose two Signs and symptoms/clinical manifestation, then
explain:

Shortness of breath- this occurs when there is low level of haemoglobin,

because when haemoglobin is low the oxygen level will also be low. As a result,
breathing rate will increase as the body tries to get more oxygen.

Fatigue – this happens when there is enough oxygen reaching body

tissue therefore ATP production will be low. When there is less production of
ATP, energy provided in the body will be low.

B. Lab Tests/ Diagnostics

o Mean Cell Volume (MCV) is the ratio of the Hematocrit to the RBC count.

 ↓ MCV indicates MICROCYTIC RBC’s (Iron deficiency

anemia)

 ↑ MCV indicates MACROCYTIC RBC’s (Vitamin

B12 or Folic Acid deficiency)

o Mean Cell Hemoglobin (MCH) assesses the amount of Hemoglobin in an

average RBC.

 ↓ MCH indicates HYPOCHROMIA (blood cells have less color

or pale color than normal)

 ↑ MCH indicates HYPERCHROMIA (blood have an excessive

pigmentation or increase in color)
5. Pharmacologic Treatment

 Epoietin alfa
This drug is use to supply EPO and is given especially for patients w/ kidney
failure because their kidney cannot produce enough EPO for RBC production.

 Iron salt
This drug is useful in iron deficiency because Iron is an enzymatic mineral that is
an essential component in the formation of hemoglobin and promotes effective
erythropoiesis and utilization of oxygen transport; therefore iron deficiency
anemia will be prevented/corrected.

 Folic Acid (Vitamin B9)

This drug is needed RBC maturation and it is essential for body to produce and
maintain normal erythropoiesis therefore immature RBCs will be developed and
Megaloblastic anemia is prevented.

 Cyanocobalamin (Vitamin B12)

This drug is also needed RBC maturation and it is essential for body to produce
and maintain normal erythropoiesis therefore immature RBCs will be developed
and Megaloblastic anemia is prevented.