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Transcript of Chapter009
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Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 9
Stress and Adaptation
Chapter 9
Stress and Adaptation
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HomeostasisHomeostasis• The body requires that a level of homeostasis or
constancy be maintained during changes in internal and external environments.
• Give an example in which your body kept some aspect of its internal environment stable. Aspects you might consider include:
– Water balance
– Weight
– Blood glucose
– Temperature
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Negative Feedback Control MechanismsNegative Feedback Control Mechanisms
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AllostasisAllostasis
• A difference between the perceived situation and desired situation causes the person to take action
• Cognitive activation theory of stress
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General Adaptation SyndromeGeneral Adaptation Syndrome
• Also called generalized stress response
– Corticotropin-releasing hormone (CRH) production
– Antidiuretic hormone release
– Sympathetic nervous system (SNS) activation
– Renin-angiotensin-aldosterone pathway activation
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stressorschange the internal
environment of part of the body
general adaptation response helps maintain normal function in spite
of the stressor
signs and symptoms
of the change
signs and symptoms of the
general adaptation response
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Cortisol—The “Stress Hormone”Cortisol—The “Stress Hormone”
• Helps regulate the stress response
• Diverts metabolism from building tissues to supplying energy for dealing with the stress
• Causes signs and symptoms of chronic stress
CRH
ACTH
Hypothalamus
Anterior pituitary
Adrenal cortex
Cortisol
Alters glucose, fat, and protein
metabolism
Suppresses inflammatory and immune responses
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Cortisol ReleaseCortisol Release
• Increases blood glucose
• Stronger sympathetic system effect on heart rate
• Decreases nonessential energy-using activities like:
– Hormone production
º Metabolic rate and reproductive functions decrease
– Bone formation
– Red and white blood cell production
º Immune system becomes depressed
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Question Question
Why does cortisol production result in increased blood glucose levels?
a. Glucose leads to a strong sympathetic nervous system response.
b. Glucose stimulates RBC production.
c. Glucose stimulates release of adrenaline.
d. Glucose provides energy.
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Answer Answer
d. Glucose provides energy.
The body’s energy requirements increase during periods of stress. Cortisol is the “stress hormone” – one of the effects of cortisol release is increased blood glucose levels. Glucose helps to meet the body’s increased demand for energy.
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Antidiuretic Hormone (ADH)Antidiuretic Hormone (ADH)
• Also called vasopressin
• Causes vasoconstriction
• Makes kidneys reabsorb water from urine to blood
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Sympathetic System—“Fight-or-Flight”Response
Sympathetic System—“Fight-or-Flight”Response
• Rapid response to trauma and emergency
• Epinephrine (adrenalin) and norepinephrine (noradrenalin) both released
• Both attach to adrenergic receptors on cells
hypothalamus
SNS neurons
adrenal medulla
Pain, fear, low BP
SNS activated
Norepinephrine
Epinephrine released into blood
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Sympathetic System—“Fight-or-Flight”Response (cont.)
Sympathetic System—“Fight-or-Flight”Response (cont.)• Blood pressure
restored
• Blood flow to skin, guts, and kidneys reduced
• Skin becomes pale
• Urine production decreases
• GI activity decreases
epinephrine and norepinephrine
heart
increased HRincreased heart
strength
increased BP
blood vessels
vasoconstriction in skin, guts,
kidneys
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Renin-Angiotensin-Aldosterone PathwayRenin-Angiotensin-Aldosterone Pathway
• Activated by:
– Sympathetic system
– Decreased blood flow to kidneys
• Angiotensin I: weak vasoconstriction
• Angiotensin-converting enzyme (ACE)
• Angiotensin II: stronger vasoconstriction
ACE
Kidneys release renin
Angiotensin I
Angiotensin II
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Renin-Angiotensin-Aldosterone Pathway (cont.)Renin-Angiotensin-Aldosterone Pathway (cont.)
• Angiotensin II: stronger vasoconstriction
• Also stimulates the adrenal cortex
• Aldosterone released
adrenal cortex
Angiotensin II
Aldosterone
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Question Question
Tell whether the following statement is true or false:
Angiotensin-converting enzyme must be present in order for aldosterone to be released by the adrenal gland.
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Answer Answer
True
Without angiotensin-converting enzyme, angiotensin II would not be created. Angiotensin II stimulates the adrenal cortex to produce aldosterone.
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Renin-Angiotensin-Aldosterone Pathway
(cont.)
Renin-Angiotensin-Aldosterone Pathway
(cont.)• Aldosterone released
• Na+/K+ ATPase in nephrons activated
– Kidneys reabsorb Na+ and water
– Kidneys secrete K+
kidneys
aldosterone
reabsorb Na+ and water
increased blood volumeoliguria
secrete K+
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stressorschange the internal
environment of part of the body
general adaptation response helps maintain normal function in spite
of the stressor
signs and symptoms
of the change
signs and symptoms of the
general adaptation response
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Scenario:Scenario:
After an accident, a patient has the following:
• Increased heart rate
• No urine production
• No bowel sounds
• Pale, sweaty skin
• Low blood pressure
• Dilated pupils
• Elevated blood glucose
Question:
• What should be fixed first? Why?
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releases
which affect
release
which affect
Central Nervous System
hormones and neurotransmitters
immune cells
inflammatory mediators
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Effects of Stress on the Immune SystemEffects of Stress on the Immune System
• Decreased immune cell production
• Decreased thymus activity
• Changes in the kind of immune cells produced
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Question Question
How does stress affect your immune system?
a. The thymus atrophies.
b. Fewer lymphocytes are produced.
c. Inflammatory mediators are released.
d. All of the above
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Answer Answer
d. All of the above
Stress causes the immune system to be suppressed. The thymus gland atrophies (shrinks), so that fewer T-lymphocytes are produced. Monocytes and lymphocytes cross the blood-brain barrier and release inflammatory mediators and cytokines.
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Physiologic StressPhysiologic Stress
• Stress-induced changes in body functions
• Detected by body’s normal regulatory sensors
• The body alters function to restore normal balance
• When normal balance is restored, negative feedback stops the reaction
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Psychosocial StressPsychosocial Stress
• Directly affects the central nervous system
• Turns on the stress responses, even when the body’s internal sensors have not detected an imbalance
Question:
• Do the stress responses solve the person’s problem?
• Will negative feedback tell them when to turn off?
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Acute StressAcute Stress
Question:
• Which organs of the body would you expect to see damaged by acute stress? Why?
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Results of Long-Term StressResults of Long-Term Stress
• Chronic stress
– Sympathetic activity and cortisol are elevated
– Complications result from the reduced immune response
• Posttraumatic stress disorder
– Sympathetic system is activated
– Cortisol levels are decreased
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Scenario:Scenario:
Mr. P saw violent combat in the army but he dealt with it and has become a successful air traffic controller.
• He is 50 and overweight:– With increased blood pressure and occasional
tachycardia– Insomnia– GI discomfort– He has had several colds already this year, and
wants a flu shotQuestion:What about his case might be stress-related?
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Scenario (cont.):Scenario (cont.):
The doctor has recommended relaxation therapy
• Mr. P is furious about this “new age gobbledygook”
Question:
• How will you explain its physiologic basis to him?