Sannu's Story Case Study Answers
Anita Strahm
A & P 1
Sannu’s Story
11/9/12
A: Long-term, untreated leprosy may cause people lose the use of their hands or feet due to repeated injury because they lack feeling in those areas of the body. Ultimately, all forms will cause nerve damage in the arms/hands and legs/feet, causing sensory loss in the skin and muscle weakness. This may cause the person with leprosy to lose an extremity affected by the disease.
B: Schwann cells are involved in many important aspects of peripheral nerve biology. The conduction of nervous impulses along axons, nerve development and regeneration, trophic support for neurons, production of the nerve extracellular matrix, modulation of neuromuscular synaptic activity, and presentation of antigens. The nerve impulses …show more content…
along the axons are most likely not functioning properly.
C: The Achilles reflex is tested by asking the patient to relax his/her leg while the doctor supports the foot so that the ankle is held at a 90 degree angle. The doctor then strikes the Achilles tendon with a reflex hammer and determines and feels the dorsiflexion of the foot with his other hand. The Babinski sign is elicited by stroking the bottom of the foot in a "J" shape (starting near the outside of the heel and progressing toward the great toe). If the Babinski sign is present, then the great toe will extend while the other toes will flex. Dianna evaluated somatic, visceral, and special sensing when she preformed these tests on Sannu.
D: The brain receives two types of sensations: (1) superficial sensations, including pain, temperature and crude touch, and (2) deep sensations, including sense of position, sense of movement, vibration sense, muscle sense and fine touch. Pathway of pain, temperature and crude touch sensations: (1) the first order neuron is present in the posterior root ganglion. Its dendrite passes to the periphery to act as a pain receptor, while its axon passes towards the spinal cord. (2) The second order neuron is present in the substantia gelatinosa of Rolandi. (3) The third order neuron is present in the thalamus. Pathway of deep sensations and fine touch: (1) the first order neuron is also present in the posterior root ganglion. (2) The second order neuron is present in the Gracil and Cuneate nuclei of the medulla. (3) The third order neuron is present in the thalamus. Its axon passes upwards in the internal capsule to end in the sensory area of the cerebral cortex.
E: I do not believe so, because the interoceptor is a sensory receptor that detects stimulus within the body. Examples of stimuli that would be detected by interoceptors include blood pressure and blood oxygen level.
F: Both fast and slow pain messages are transmitted to the brain by pain receptors, which are a network of nerve endings throughout the body. Fast-pain receptors are found beneath the surface of the skin. Slow-pain receptors are also located beneath the skin, but it also carries messages from the joints and large internal organs of the body. The burning and itching feeling that Sannu is feeling would be a form of slow pain.
G: The most common phantom sensations are localized to upper and lower extremities2. Phantom limb patients often experience perceptions of tactile sensation in the absence of outer stimulus on the phantom limb. This subset of perceptible hallucinations commonly involves sensory experiences of touch, pressure, temperature, vibration, and most prominently, pain. The source of phantom limb pain has been linked to maladaptive peripheral and central nervous system alterations in brain areas pertaining to perception and body awareness.
H: Many believe the frequency of phantom pain increases if the part of the limb that was amputated had a significant amount of pain for a long period of time before the amputation. Because of this, it is felt that traumatic amputees who experience pain for a brief time tend to have a lower incidence of phantom limb pain compared to patients with PVD or infections. It is therefore recommended that one way to avoid phantom limb pain from occurring is by treating pain adequately with a nerve block or epidural before the planned amputation as well as treating pain effectively.
I: It will eventually go away.
Once the body gets use to something not being present it will act as if it was never there.
J: Yes, not having that leg will set off the sensory nerves and not allow Sannu to stand and have proper equilibrium and sense of balance.
K: Leprosy bacillus can reproduce only at temperatures just a few degrees below core body temperature; CNS leprosy is rare if it exists at all. Leprosy produces a peripheral neuropathy, which is characterized by the involvement of nerves only in the cooler parts of the body. In persons with tuberculoid leprosy, nerve trunks are involved; the nerves situated immediately subcutaneously are affected. In lepromatous leprosy, terminal nerve endings are involved, producing a patchy sensory loss; the cooler areas of the skin (ears, back of the hands) are affected first. Leprosy is rare in the United States, but worldwide it is one of the most important causes of peripheral neuropathy (in the United States, peripheral neuropathy is diabetes mellitus). An invasion of new cases appeared in the U.S. when veterans who contracted the disease in Southeast Asia returned home. I would have to say that in Sannu’s case would have to sensory pathway
transmission.
L: Leprosy is caused by the bacteria Mycobacterium leprae, very slow-growing bacteria comparable to that which causes tuberculosis and is a chronic infectious illness that attacks the nervous system, above all the nerves of the hands, feet and face. In lepromatous leprosy, skin lesions typically develop in areas of nerve damage. These may be pale, having lost pigment, or may develop a reddish copper color. As the sensory nerves turn out to be damaged, sensation is lost to pin-prick or light touch. Sensation loss starts at the fingers and toes and may only affect a small patch of skin to begin with, but as time passes numerous skin lesions and nodules increase.
M: Pain receptors called nociceptors activate whenever there has been an injury, or even a potential injury, such as breaking the skin or causing a large indentation. Even if the rock does not break your skin, the tissues in your foot become compressed enough to cause the nociceptors to fire off a response. Now, an impulse is heading through the nerve into the spinal cord, and eventually all the way to your brain. This happens within fractions of a second.
N: Phantom limb is thought to be secondary to the brain plasticity and restructuring. The human brain has a vast capacity to modify its connections and role in response to everyday learning or to the setting of injury. These processes of reorganization may occur in retained nerves in the amputated limbs, the spinal cord, or various parts of the brain, including the thalamus and the cerebral cortex.
O: Recent research suggests that there is a defect in cell-mediated immunity that causes susceptibility to Leprosy. The region of DNA responsible for this variability is also involved in Parkinson disease, giving rise to current speculation that the two disorders may be linked in some way at the biochemical level.
A & P 1
Sannu’s Story
11/9/12
A: Long-term, untreated leprosy may cause people lose the use of their hands or feet due to repeated injury because they lack feeling in those areas of the body. Ultimately, all forms will cause nerve damage in the arms/hands and legs/feet, causing sensory loss in the skin and muscle weakness. This may cause the person with leprosy to lose an extremity affected by the disease.
B: Schwann cells are involved in many important aspects of peripheral nerve biology. The conduction of nervous impulses along axons, nerve development and regeneration, trophic support for neurons, production of the nerve extracellular matrix, modulation of neuromuscular synaptic activity, and presentation of antigens. The nerve impulses …show more content…
along the axons are most likely not functioning properly.
C: The Achilles reflex is tested by asking the patient to relax his/her leg while the doctor supports the foot so that the ankle is held at a 90 degree angle. The doctor then strikes the Achilles tendon with a reflex hammer and determines and feels the dorsiflexion of the foot with his other hand. The Babinski sign is elicited by stroking the bottom of the foot in a "J" shape (starting near the outside of the heel and progressing toward the great toe). If the Babinski sign is present, then the great toe will extend while the other toes will flex. Dianna evaluated somatic, visceral, and special sensing when she preformed these tests on Sannu.
D: The brain receives two types of sensations: (1) superficial sensations, including pain, temperature and crude touch, and (2) deep sensations, including sense of position, sense of movement, vibration sense, muscle sense and fine touch. Pathway of pain, temperature and crude touch sensations: (1) the first order neuron is present in the posterior root ganglion. Its dendrite passes to the periphery to act as a pain receptor, while its axon passes towards the spinal cord. (2) The second order neuron is present in the substantia gelatinosa of Rolandi. (3) The third order neuron is present in the thalamus. Pathway of deep sensations and fine touch: (1) the first order neuron is also present in the posterior root ganglion. (2) The second order neuron is present in the Gracil and Cuneate nuclei of the medulla. (3) The third order neuron is present in the thalamus. Its axon passes upwards in the internal capsule to end in the sensory area of the cerebral cortex.
E: I do not believe so, because the interoceptor is a sensory receptor that detects stimulus within the body. Examples of stimuli that would be detected by interoceptors include blood pressure and blood oxygen level.
F: Both fast and slow pain messages are transmitted to the brain by pain receptors, which are a network of nerve endings throughout the body. Fast-pain receptors are found beneath the surface of the skin. Slow-pain receptors are also located beneath the skin, but it also carries messages from the joints and large internal organs of the body. The burning and itching feeling that Sannu is feeling would be a form of slow pain.
G: The most common phantom sensations are localized to upper and lower extremities2. Phantom limb patients often experience perceptions of tactile sensation in the absence of outer stimulus on the phantom limb. This subset of perceptible hallucinations commonly involves sensory experiences of touch, pressure, temperature, vibration, and most prominently, pain. The source of phantom limb pain has been linked to maladaptive peripheral and central nervous system alterations in brain areas pertaining to perception and body awareness.
H: Many believe the frequency of phantom pain increases if the part of the limb that was amputated had a significant amount of pain for a long period of time before the amputation. Because of this, it is felt that traumatic amputees who experience pain for a brief time tend to have a lower incidence of phantom limb pain compared to patients with PVD or infections. It is therefore recommended that one way to avoid phantom limb pain from occurring is by treating pain adequately with a nerve block or epidural before the planned amputation as well as treating pain effectively.
I: It will eventually go away.
Once the body gets use to something not being present it will act as if it was never there.
J: Yes, not having that leg will set off the sensory nerves and not allow Sannu to stand and have proper equilibrium and sense of balance.
K: Leprosy bacillus can reproduce only at temperatures just a few degrees below core body temperature; CNS leprosy is rare if it exists at all. Leprosy produces a peripheral neuropathy, which is characterized by the involvement of nerves only in the cooler parts of the body. In persons with tuberculoid leprosy, nerve trunks are involved; the nerves situated immediately subcutaneously are affected. In lepromatous leprosy, terminal nerve endings are involved, producing a patchy sensory loss; the cooler areas of the skin (ears, back of the hands) are affected first. Leprosy is rare in the United States, but worldwide it is one of the most important causes of peripheral neuropathy (in the United States, peripheral neuropathy is diabetes mellitus). An invasion of new cases appeared in the U.S. when veterans who contracted the disease in Southeast Asia returned home. I would have to say that in Sannu’s case would have to sensory pathway
transmission.
L: Leprosy is caused by the bacteria Mycobacterium leprae, very slow-growing bacteria comparable to that which causes tuberculosis and is a chronic infectious illness that attacks the nervous system, above all the nerves of the hands, feet and face. In lepromatous leprosy, skin lesions typically develop in areas of nerve damage. These may be pale, having lost pigment, or may develop a reddish copper color. As the sensory nerves turn out to be damaged, sensation is lost to pin-prick or light touch. Sensation loss starts at the fingers and toes and may only affect a small patch of skin to begin with, but as time passes numerous skin lesions and nodules increase.
M: Pain receptors called nociceptors activate whenever there has been an injury, or even a potential injury, such as breaking the skin or causing a large indentation. Even if the rock does not break your skin, the tissues in your foot become compressed enough to cause the nociceptors to fire off a response. Now, an impulse is heading through the nerve into the spinal cord, and eventually all the way to your brain. This happens within fractions of a second.
N: Phantom limb is thought to be secondary to the brain plasticity and restructuring. The human brain has a vast capacity to modify its connections and role in response to everyday learning or to the setting of injury. These processes of reorganization may occur in retained nerves in the amputated limbs, the spinal cord, or various parts of the brain, including the thalamus and the cerebral cortex.
O: Recent research suggests that there is a defect in cell-mediated immunity that causes susceptibility to Leprosy. The region of DNA responsible for this variability is also involved in Parkinson disease, giving rise to current speculation that the two disorders may be linked in some way at the biochemical level.