Discussion: Alterations in Cellular Processes
At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.
Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.
For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.
To prepare:
• Use the scenario below for this Discussion.
Scenario: A 16-year-old boy comes to clinic with chief complaint of sore throat for 3 days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections or pneumonias. NKDA or food allergies. Physical exam reveals temp of 99.6 F, pulse 78 and regular with respirations of 18. HEENT normal with exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy. Rapid strep test performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg po q 12 hours x 10 days disp #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips, difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction. Alterations in Cellular Processes Essay
Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:
• The role genetics plays in the disease.
• Why the patient is presenting with the specific symptoms described.
• The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
• The cells that are involved in this process.
• How another characteristic (e.g., gender, genetics) would change your response.
RESOURCES/READING
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
• Chapter 1: Cellular Biology; Summary Review
• Chapter 2: Altered Cellular and Tissue Biology: Environmental Agents (pp. 46-61; begin again with Manifestations of Cellular Injury pp. 83-97); Summary Review
• Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids, and Bases
• Chapter 4: Genes and Genetic Diseases (stop at Elements of formal genetics); Summary Review
• Chapter 5: Genes, Environment-Lifestyle, and Common Diseases (stop at Genetics of common diseases); Summary Review
• Chapter 7: Innate Immunity: Inflammation and Wound Healing
• Chapter 8: Adaptive Immunity (stop at Generation of clonal diversity); Summary Review
• Chapter 9: Alterations in Immunity and Inflammation (stop at Deficiencies in immunity); Summary Review
• Chapter 10: Infection (pp. 289–303; stop at Infectious parasites and protozoans); (start at HIV); Summary Review
• Chapter 11: Stress and Disease (stop at Stress, illness & coping); Summary Review
• Chapter 12: Cancer Biology (stop at Resistance to destruction); Summary Review
• Chapter 13: Cancer Epidemiology (stop at Environmental-Lifestyle factors); Summary Review
Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/
Credit Line: Immediate Hypersensitivity Reactions – StatPearls – NCBI Bookshelf. (2019, June 18). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/. Used with permission of Stat Pearls
Immunity and Inflammation
Khan Academy (2010, February 24). Inflammatory response | Human anatomy and physiology | Health & medicine [Video file]. Retrieved from https://www.youtube.com/watch?v=FXSuEIMrPQk
Note: The approximate length of the media program is 14 minutes.
Soo, P. (2018, July 28). Pathophysiology Ch 10 alterations in immune function [Video file]. Retrieved from https://www.youtube.com/watch?v=Jz0wx1-jTds
Note: The approximate length of the media program is 37 minutes.
Acid-Base Balance #1
MedCram. (2012, April 28). Medical acid base balance, disorders & ABGs explained clearly [Video file]. Retrieved from https://www.youtube.com/watch?v=4wMEMhvrQxE
Note: The approximate length of the media program is 13 minutes.
Acid-Base Balance #2
MedCram. (2012, April 29). Medical acid base balance, disorders & ABGs explained clearly | 2 of 8 [Video file]. Retrieved from https://www.youtube.com/watch?v=GmEeKVTpOKI
Note: The approximate length of the media program is 15 minutes.
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Hyponatremia
MedCram. (2017, December 23). Hyponatremia explained clearly (remastered) – Electrolyte imbalances [Video file]. Retrieved from https://www.youtube.com/watch?v=bLajK5Vy55M
Note: The approximate length of the media program is 15 minutes. Alterations in Cellular Processes Essay
Alterations in Cellular Processes
Introduction
Allergic reactions in the pediatric population, after taking amoxicillin are common. Allergic reactions after taking amoxicillin are different and among the most common allergic reaction is an igE-mediated hypersensitivity reaction (Blumenthal et al., 2019). This reaction normally occurs immediately after being exposed to the allergen. Type I hypersensitivity reactions normally take place in an hour’s time after exposure to the medication. The client in this case study experienced an allergic reaction immediately after taking the amoxicillin capsule and thus had a type I hypersensitivity reaction.
Regarding genetics, genotypes of major histocompatibility complex (MHC) are attributed to drug hypersensitivity. According to Blumenthal et al (2019), MHC delivers antigen to immune T-cell, leading to an immune reaction. In addition, there are genes allied to drug hypersensitivity. For example, the type I hypersensitivity occurring in the patient in the case study is allied to FcεR1β gene’s E237G variant (Trubiano et al., 2017). This gene has a very high affinity for IgE receptor β chain and thus triggers an immune reaction. Polymorphisms of IL-4RαQ576R and IL-4 Il-13-SNP are also associated with type I hypersensitivity as evidence in the patient in this case study. These genes are common among different races depending on the genetic makeup.
The patient had an immediate reaction as indicated by immediate symptoms like swelling of the tongue and lips as well as breathing difficulties with audible wheezing, this is most likely Type I hypersensitivity. The BL molecules reacted with proteins leading to the formation of the hapten-carrier conjugate. The dendritic cells present the complex (hapten-carrier conjugate) to the B and T cells, and hence specific igE antibodies are formed against the complex (Lteif & Eiland, 2019). A re-exposure to the complex leads to the specific igE antibodies identifying the complex and hence a cascade of action is initiated. As a result, inflammatory mediators like histamine, tryptase, prostaglandin, and other cytokines are released and this leads to an immediate reaction and then symptoms manifest (Lteif & Eiland, 2019).
The types of cells involved in type I hypersensitivity include B-cells that are normally triggered by CD4+TH2 cells to release IgE antibodies that are specific to an antigen. In addition, blood basophils and mast cells are also involved. Biding of the IgE antibodies normally occurs on FcεRI receptors on the surface of mast cells and blood basophils on the tissue (Trubiano et al., 2017).
Allergic reactions against drugs like amoxicillin can also be caused by other factors such as age, genetic factors, immunity status, as well as medication administration factors like how the drug is administered, dosage, and previous exposure to the penicillin in the amoxicillin. For instance, allergic reactions against penicillin are more common in children when compared to adults (Norton et al., 2018). Therefore, age could be a major contributing factor to the evident allergic reaction in this patient. Alterations in Cellular Processes Essay
Conclusion
Allergic reactions in children after being administered with penicillin are very common. Genotypes of major histocompatibility complex (MHC) are attributed to drug hypersensitivity. The patient’s allergic reaction occurred immediately after taking the amoxicillin capsule and hence this is Type I hypersensitivity. B-cells, basophils, and mast cells are involved in Type I hypersensitivity. Other factors associated with allergic reactions in amoxicillin include age, immunity condition, and how the medication is administered.
References
Blumenthal, K. G., Peter, J. G., Trubiano, J. A., & Phillips, E. J. (2019). Antibiotic allergy. Lancet (London, England), 393(10167), 183–198. https://doi.org/10.1016/S0140-6736(18)32218-9.
Norton, A. E., Konvinse, K., Phillips, E. J., & Broyles, A. D. (2018). Antibiotic Allergy in Pediatrics. Pediatrics, 141(5), e20172497. https://doi.org/10.1542/peds.2017-2497.
Trubiano, J. A., Stone, C. A., Grayson, M. L., Urbancic, K., Slavin, M. A., Thursky, K. A., & Phillips, E. J. (2017). The 3 Cs of Antibiotic Allergy-Classification, Cross-Reactivity, and Collaboration. The journal of allergy and clinical immunology. In practice, 5(6), 1532–1542. https://doi.org/10.1016/j.jaip.2017.06.017.
Lteif, L., & Eiland, L. S. (2019). The Basics of Penicillin Allergy: What A Clinician Should Know. Pharmacy (Basel, Switzerland), 7(3), 94. https://doi.org/10.3390/pharmacy7030094. Alterations in Cellular Processes Essay