predictive health notes

predictive health notes - The alcoholic lung-David guided...

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The alcoholic lung-David guided 3/31/11 1. Illustrative Cases: a. 57 year old man with long history of alcohol abuse a.i. exploratory parotomy shows small bowel ischema/infaration (unhealthy tissue cut out and active peritonitis a.ii. post-op develops sepsis syndrome and ards (lung injury due to infection a.iii. prolonged sickness. After 7 months in icu he is released and can later go back to work b. 53 year old man-type 2 diabetes/hypertension/ab pain/fever b.i. has ecoli in blood, septic, other infections, perforated appendix b.ii. quick recovery goes home quickly after 1 week c. both men have very similar issues, very sick c.i. but #1 has unhealthy lungs and # 2 has relatively normal lungs 2. ARDS a. Severe form of lung injury. Acute respiratory distress syndrome b. If you are admitted into hospital with sever alcohol abuse vs. non-alcohol abuse they are two to four times more likely at risk for ARDs (and other negative outcomes) c. Avg age of alcohol abuse who gets ards is 30 3. History of alcohol abuse a. Fermentation of fruits contains ethanol b. Beer, wine recipes have existed since ancient times c. Ubiquitous in human culture d. Alcohol is most commonly used drug in world d.i. Has role in defining human culture and ceremonies and religion e. Assoc betwe alcohol abuse and pneumonia has been recognized for centuries 4. Epidemiology-> pathophysiology a. Epidemiology a.i. Observation # alcohol is a risk factor (defining history of disease) b. Pathophysiology b.i. Why/how is it a risk factor b.ii. How can we figure out what it is doing to us (underlying reason we have it) 5. Animal model for mechanistic studies a. Chronic ethanol injection in rats render the lung susceptibility to injury b. Sepsis-mediate lung injury in vivo (in life) 6. The glutathione story a. Gsh is a critical antioxidant b. When you breath in 02, is very toxic, reactive in the airway c. Gsh in the lungs (alreolar space) concerts things like h202 r-ooh to h20 r-oh water d. Ethanol lowered gsh levels in rats airways in less than 6 weeks thus lowering defense in animals e. alcoholism humans many are healthy otherwise, but have a much lower level of gsh in their lungs
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f. gsh replacement can make lungs healthy again and decrease lung injury f.i. but may not help alcoholics when they are very sick g. gsh supplement in sick people is like putting on a seatbelt after a crash h. gsh is a way to measure damage to lungs, but is only an element of sickness in alcoholics i. chronic ethanol ingestion alters components of the dynamic aleover epithelial barrier i.i. lungs become leaky, seeps out of lungs into body i.ii. homeostasis is altered, body has to compensate i.iii. the alcoholic lung cannot weather a storm (another stress0 aka sepsis 7. the alcoholic lung a. glutathione is very bad b. epithelial protection 8. defining alcohol abuse a. not defined by quantity but by behavioral and or consequented effects/magnitude
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This note was uploaded on 02/15/2012 for the course ANTHRO 231 taught by Professor Dr.lampl during the Spring '11 term at Emory.

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predictive health notes - The alcoholic lung-David guided...

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