Pathophysiological Changes Discussion

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Pathophysiological changes refer to functional changes associated with disease infection, inflammation, aging, disease condition, or injury, and changes can occur in any system of the body. Disease conditions such as osteoarthritis, osteoporosis, and rheumatoid arthritis are among the most common musculoskeletal system disorders. These progressive, degenerative conditions lead to pain, joint deformities, and limitations in mobility. Arthritis is a gradual breakdown of cartilage and underlying bone; osteoporosis is a gradual degeneration of bone. These pathophysiological changes in the musculoskeletal system lead to pain, swelling, and fracture. Diabetes is one of the most common metabolic disorder where we can see the pathophysiological changes such as diabetic ketoacidosis (DKA). DKA is a condition in which blood glucose is more than 250mg/dl, Arterial pH <7.3, Serum bicarbonate <15mEq/l. Symptoms of DKA include nausea, vomiting, abdominal pain, dehydration, polyuria, and polydipsia. Severe DKA may lead to Kussmaul respiration hypotension, coma, and death. Sepsis is one of the common and serious disease conditions which affect multiple systems of the body. Symptoms are various based on stages including SIRS, sepsis, severe sepsis, and septic shock. Fever, tachycardia, tachypnea, changes in WBC count, increased platelets, changes in LOC, decrease in blood pressure are the symptoms of sepsis.

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Traumatic brain injury (TBI) is characterized by both the primary damage resulting from physical disruption of neural and vascular structures and the early emergence of secondary pathogenic events, which collectively contribute to neurologic deficits (Andriessen et al., 2010; Dash et al., 2010; Marklund et al., 2006). The identification of nutrients, dietary supplements, or specific diets that may

provide resilience or treat TBI requires an understanding of the key pathophysiological events that govern both injury and reparative processes. A detailed description of those events for the various types of TBI can be found in the published literature and will not be repeated in this document. The reader is referred to recent reviews addressing the pathophysiology of focal and diffuse TBI including diffuse axonal injury, a common consequence of TBI (Andriessen et al., 2010; Farkas and Povlishock, 2007); moderate, severe, and penetrating TBI (Dash et al., 2010; Maas et al., 2008); blast TBI (Cernak and Noble-Haeusslein, 2010; Desmoulin and Dionne, 2009; Elder and Cristian, 2009; Hicks et al., 2010; Ling et al., 2009; Taber et al., 2006); and mild or concussion TBI, including recurrent injuries (Dash et al., 2010; Elder and Cristian, 2009; Mazzeo et al., 2009; McKee et al., 2009b; Weber, 2007). As background for the report, this chapter includes a brief review of the literature on the pathophysiological changes that accompany TBI. The sequence of events following TBI has been the subject of different classifications. The committee relies on a recent working definition that describes the onset of secondary pathogenic processes after TBI (Margulies et al., 2009).

This chapter will refer to primary or acute effects as those effects that begin within the first minutes after injury, secondary or subacute effects as those that arise over the next 24 hours after injury, and long-term or chronic effects as those that are associated with the insult but occur at a later time. The committee recognizes that, as Margulies and colleagues (2009) observe, these definitions are estimates of the emergence of pathogenic events whose duration is likely to be variable and possibly overlapping. Both the cascade of secondary effects and the long-term effects are consequences of the primary insult and are susceptible to interventions to improve resilience or to treat TBI. The chapter also includes a brief review of the animal models and biomarkers used for TBI. Although the information in this chapter is provided as background to this report, the committee acknowledges the importance of developing good animal models and identifying biomarkers of the disease progression and outcomes, and therefore recommendations are made for improving these areas of research.

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Pathophysiological Changes Discussion