DISCUSS THE ROLE OF IMMUNOLOGY

IN SURGICAL PRACTICE BY DR D.C ONWU.N.O.H DALA

OUTLINE INTRODUCTION STRUCTURE/FUNCTION IMMUNE RXN SURGICAL DXS WITH IMMUNOLOGICAL

BASIS. ROLE OF IMMUNOLOGY IN SURGERY RECENT ADVANCES CONCLUSION.

IMMUNITYABILITY TO RESIST INVASION BY MICROORGANISM ORABILITY TO RESIST PARASITIC INFECTION.IMMUNE SYSTEM ARE ALL THESTRUCTURES THAT PROVIDE IMMUNITY.IMMUNOLOGY IS THE STUDY OF IMMUNE SYSTEM.

Structure/fxnal overview

Non specific/innate

Host defences Local superficial/barrier,--prevents entrance

of infective agents. [skin]—fatty acid, increased salt

conc. ,dryness, normal flora

[Urinary tract]

Flushing, dilution [resp.] cilli, mucus trapping cough reflex [female genitalia] –lactobacilli decreases pH GIT has highly specialised immune fxn

– Gastric acid, bile acid,mucous secretion & flora

HUMORAL DEFENCES

Immunoglobulins– Non specific antibodies e.g. IgA in the gut wall

Complements Trace elements Vitamins Nutritional factors interferons

CELLULAR DEFENCES

Nutrophils Macrophages/ monocytes Eosinophils Mast cells NK cells

SPECIFIC IMMUNITY

Humoral– Antibodies by B-lymphocytes & plasma cells

Cell mediated– Activated T-lymphocytes

SURGICAL DISEASES OF IMMUNOLOGICAL RXN

Rheumatoid arthritis Rheumatic valvular dx Goitrous conditions Graft Vs Host disease Graft rejections Transfusion rxns Septic shock HIV

USES OF IMMUNOLOGY IN SURGERY

DIAGNOSIS– Cancer, Tumor markers eg OC125 antibody for

CA125 antigens– Immunohistochemistry –shows biochemical

xteristics of tumors– Infections like pneumococcal antigen by

immunofluorescent technique, rapid identification of slow growing & fastidious organisms

– Others– DVT, MI, Tuberculin test

USES OF IMMUNOLOGY IN SURGERY

THERAPEUTIC– Monoclonal antibodies– alone or with radioisotopes– Serotherapy– Immunoconjugate therapy

Radionucleide conjugate Toxin (immunotoxins) Drug conjugate/ADEPT

– Sepsis/ MOF treatment using monoclonal/polyclonaln antibodies against endotoxins

Research is still going on devt of antiTNF antibody

USES OF IMMUNOLOGY IN SURGERY

MONITORING– Progress of treatment– Recurrence

EFFECTS OF SURGERY ON IMMUNOLOGY

Pre op conditions– Burns, shock, radiotherapy & sepsis decrease immunity

Anaesthesia– Initiates neutrophil leucocytosis except halothane

Trauma & surgical procedures – depress all components of immune response

Blood transfusion Splenectomy

– Adversely affects immune status mostly to encapsulated organisms

IMMUNODEFICIENCY STATES & SURGERY

PRIMARY IMMUNODEFICIENCY --SCID—Xterized by reticular dysgenesis Selective T-cell deficiency –DeGeorg synd X-linked agamaglobulin Agranulocytosis or poor phagocytic fxn SECONDRY IMMUNODEFICIECY STATE Malnutrition Infection—HIV TB SACOIDOSIS

RECENT ADVANCES

Anti I-L antibody TNF antibody research are on going

In our own environment not much is going on aspect of research.

CONCLUSION

A TWO EDGE SWORD=IMMUNE SYSTEM