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.

IMMUNITY
ABILITY TO RESIST INVASION BY
MICROORGANISM OR
ABILITY TO RESIST PARASITIC INFECTION.
IMMUNE SYSTEM ARE ALL THE
STRUCTURES THAT PROVIDE IMMUNITY.
IMMUNOLOGY IS THE STUDY OF IMMUNE
SYSTEM.

Structure/fxnal overview

Non
Host

specific/innate

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/
Eosinophils
Mast

cells
NK cells

monocytes

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

Anaesthesia

Initiates neutrophil leucocytosis except halothane

Trauma & surgical procedures

Burns, shock, radiotherapy & sepsis decrease immunity

depress all components of immune response

Blood transfusion
Splenectomy

Adversely affects immune status mostly to encapsulated

organisms

IMMUNODEFICIENCY STATES &

SURGERY
PRIMARY

IMMUNODEFICIENCY
--SCIDXterized by reticular dysgenesis
Selective T-cell deficiency DeGeorg synd
X-linked agamaglobulin
Agranulocytosis or poor phagocytic fxn
SECONDRY IMMUNODEFICIECY STATE
Malnutrition
InfectionHIV 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