病理学课件.ppt

按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,STRESS AND STRESS-RELATED DISEASES,Pathophysiology Department,Tongji Medical College,HUST,Concepts:,general adaptation syndrome,stress,stressor,Mechanism-stress response,Neuroendocrine,:LC-NE/sympathetic,HPA,Humoral,and cellular:APP,HSP,Functional metabolic alteration,Stress-related diseases:,stress ulcer,Prevention and treatment principle,Case discussion,Contents,Hans Selye,(1907-1982),General Adaptation Syndrome(GAS),A serial of non-specific signs and symptoms caused by various strong stimulus.,Different diseases,Specific symptoms,Non-specific,symptoms,A,general adaptative response,in order to cope with the,altered homeostasis,.,Stimulus,Diseases or symptoms,Disturbance of homeostasis,Adaptative response,General Principle of Stress,Homeostasis,Alarm reaction,Stages of GAS,Adaptation,Exhaustion,Relaxation,Stimulus,Diseases,Stress Definition,Non-specific,response,of the body to,any demand,made upon it,.,Any stimuli,that elicit the stress response,External,Internal,Psycho-social,Physical,Psychological,Stressor,Short-term(acute),Long-term(chronic),Stressors:noise,danger,infection,on-going highly pressured work,long-term relationship problems,loneliness,and persistent financial worries.,Stress Responses,Neuroendocrine,Humeral,Cellular,Neuroendocrine Response,Locus,ceruleus-norepinephrine,(LC/NE)/sympathetic-adrenal medulla axis,Hypothalamic-pituitary-adrenal(HPA)axis,Dopamine,Norepinephrine,Epinephrine (adrenaline),Release of Catecholamines,Peripheral:,Central:Arousal,vigilance and memory,Role of Catecholamine,Heart,Blood redistribution,Respiratory rate,Gastrointestinal activity,Insulin,Glucagons,(Alarm stage),short-term memory,concentration,and rational thought,Catecholamines,amygdala,emotional response,hippocampus,long-term memory,the front of the brain,CNS Response,Diencephalons,Corticotrophin-releasing hormone(CRH),Adrenocorticotropic hormone(ACTH),Glucocorticoid hormones(cortisol and cortisone),Hormones Released,Others(growth hormones,thyroid hormone,reproductive hormones,(Large surgical operation,long term effect),Role of Glucocorticoid,Lysosome,Blood glucose,Immune system,Cardiovascular system,GC,Protection,Other hormones,Interaction of LC and HPA,Locus ceruleus,Paraventricular nucleus,Amygdala,Hippocampus,Spinal cord,Adrenal cortex,Acute phase protein,C-reactive protein,Serum amyloid A,Ceruloplasmin(chelating protein),Humoral Response,(Severe burn injury),APP,Complement activation,Bind phosphocholine,Cytokine secretion,Superoxide reduction,Heat shock protein,e.g.,HSP70,Chaperone protein,:folding,assembly,translocation,degradation,Cellular Response,Structure of HSP,Electron micrograph of HSP70 in scrapie infected cell,A,Endosome-lysosome related,multivesicular dense body;,B,HSP70 specific glod particles;,C,HSP70 specific particles in,the cytoplasm.,Regulation of HSP expression,Stimulus,Release of hormones,(e.g.,GC),or neurotransmitters,(e.g.,NA),Understanding Stress Mechanism at Cellular and Molecular levels,Intracellular protein,(e.g.,HSP),Neuroendocrine response,Functional and Metabolic Alteration,Memory,Concentration,and Learning,Effect of Acute Stress on Memory,.,Subjects taking,cortisone,performed significantly,worse on memorization,tests than those taking the placebo did.,Effect of Chronic Stress on Memory,.,Prolonged exposure to,cortisol,to,shrinkage in the hippocampus,the center of memory.,Heart rate and blood pressure increase;,Blood flow may increase 300%to 400%;,Breathing becomes rapid and takes in more oxygen;Dryness and difficulty in talking;,Spasms of the throat muscles,difficult to swallow;,Cool,clammy,sweaty skin;,Scalp tightens,hair stand up;,Digestive activity shuts down,(,appetite,ulcer,diarrhea);,Genito-urinary system,:disturbance of hormone.,Stress,Neuroendocrine system,Immune system,CRH,CRH-R1,b,-endorphine ACTH,TNF-,a,IL-1,IL-6,Stress and Disease,Mucosal damage or lesion of the stomach or duodenum in critical illness or severely stressed situation.,Stress Ulcer,Gastrointestinal mucosal ischemia,Counter-diffusion of gastric hydrogen ion,to mucosa,Psychological Effects of Stress,In one study,two-thirds of subjects who experienced a stressful situation had nearly six times the risk of,developing depression,within that month.Some evidence suggests that repeated release of stress hormone disrupts normal levels of,serotonin,which,is critical,for feelings of well-being.,Posttraumatic Stress Disorder is a,psychiatric disorder,that can occur following the,experience,or witnessing of,life-threatening events,such as military combat,natural disasters,terrorist incidents,serious accidents,or violent personal assaults like rape.People who suffer from PTSD often relive the experience through nightmares and flashbacks,have difficulty sleeping,and feel detached or estranged,and these symptoms can be severe enough and last long enough to significantly impair the persons daily life.,Post-Traumatic Stress Disorder Symptoms,Other Gastrointestinal Problems,(Irritable bowel syndrome,Crohns disease or ulcerative colitis),Immune Disorders,(Rheumatoid arthritis,multiple sclerosis),Heart Disease,(E,ssential hypertension,coronary artery disease,arrhythmias,),Sexual Function Premenstrual Syndrome Fertility,miscarriage,etc.,Sexual and Reproductive Dysfunction,a,Endoscopic examination revealed scattered erosions(2 mm in diameter)throughout the stomach.A bigger ulcer was oozing.,A 32-year-old man was severely burned(78%of skin surface,II degree)by gasoline.,On the second day,the patient vomited about 200 ml of coffer-colored bloody juice.,Bleeding was stopped by endoscopic hemostasis.,Case Presentation,Treating,stress is a very important component in a medical regimen.,Some evidence exists that stress management programs may reduce the risk of heart events(eg,heart attack)by up to 75%in people with heart disease.,Principle of Treatment and Prevention,Fight for your highest attainable aim;but never put up resistance in vain.,Fight for your highest attainable aim;but never put up resistance in vain.,Hans Selye,General Guidelines,Rule One-Find your own purpose in life,that fits,your own personal stress level.,Rule Two-Control your emotional level by,recognizing situations as being either life-,threatening or non-life-threatening.,Rule Three-Collect the goodwill and appreciation,of others.,Thank you,