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Sa has the highest prevalance rate. Humans act as a reservoir for TB. Originates from mutation of Bovine TB, likely because of intro of milk. It is spread through droplets coughed, sneezed or spat by an infected person. The spread of TB is enhanced by environmental factors such as poverty, overcrowding, prevalence, poor ventilation and inadequate sunlight. People that are vulnerable to TB disease are people with HIV( those who are immunoppressed), people under 5, people between the ages 19 - 35, people aged over 65 years, people experiencing undernutrition, people with occupations that put them at risk of exposure (miners, healthworkers),smoking and alcohol.

70-90% experience TB infection after exposure to TB, thereafter 97% experience its latent form whereas 3% experience active TB. With reference to people with active TB that is left untreated: 50% die within 2yrs, 25% experience TB as a chronic disease and 25% recover.
upstream prevention: improving people's environments
downstream prevention: eg. vaccinations, educate trace contacts, treatment, sunlight minimizes TB

Case relation: Meriam have active TB. Nurse recognized it was TB because it is common. Meriam lives in overcrowed area increasing risk. Other environmental factors couldve played a role eg. lack of sunlight, stress. The older lady and husband she lives with is at risk. Meriam is within range of TB infection/disease. Meriam couldve spread the TB multiple people.

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Inspiration occurs due to the elevation of the rib cage caused by the contraction of the external intercostal muscles and the contraction plus flattening of the diaphragm, this increases the volume of thoracic cavity. Pressure within the lungs decreases and air flows into the lungs. Expiration occurs as the rib cage returns to its original position because of the relaxation of the intercostal muscles and the diaphragm relaxes; this causes the volume of the thoracic cavity to decrease. Pressure within the lungs increases and air moves out of the lungs. Quiet expiration occurs when the volume in the lungs decreases due to elastic recoil whereas forced expiration is assisted by accessory muscles (internal intercostal muscles, transversus thoracis and abdominal muscles) that contract. Applies to Boyles law. The lungs don't completely deflate due to pleural pressure.

Case relation: The muscle weakness could affect her breathing.

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Respiration is controlled by two factors, namely resistance and compliance. Resistance refers to the resistance to the respiratory tract to airflow through adjusted Bronchodilation and Bronchoconstriction. Compliance refers to a measure of the lungs' expandability. A lower compliance means that there is a greater force to fill the lungs. The factors that affect compliance are the connective tissue in the lungs, the level of surfactant production (reduces surface tension at the air/liquid interface) and mobility of the thoracic cage.
Neural control (physiology lecture)
Controlled by the brainstem (medulla oblongata)
first level: Respiratory rhythmicity centers which create a pace of respiration by adjusting pacemaker cells and coordinating other respiratory muscles. Subdivided into DRG and VRG
second level: Apneustic and Pneumotaxic centers, ventral respiratory group is involved in active respiration
third level : Higher centers

Case relation: Theres is more Sympathic activity than Parasympathic

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The symptoms of pulmonary TB include coughing up phlegm, coughing up blood, consistent fever, night sweats, chest pains, weight loss, fatigue, diarrhoea and clubbing. Dullness of due to fluid in the pleural cavity ( healthline article on pulmonary tuberculosis)

Case relation: She had bouts of coughing and fatigue. The doctor found abnormal breathing sounds and dullness at the left base. The increased respiratory rate is a sign of TB. The skin was not cyanosed which may be a sign of absence

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During glycolysis glucose undergoes a highly exergonic oxidation. In the cytoplasm. During the oxidation step some energy is used to drive ATP synthesis. During the energy investment stage of glycolysis the Phosphorylation of glucose to form glucose-6-phosphate traps the glucose in the cell for further metabolism (lacks the transport systems to leave). It is then split into 2 different triose phosphates that are interconvertible (at 1 and 6 Carbon)(this requires 2 ATP for 1 glucose molecule). IN the energy generation stage ATP is generated via substrate level phosphorylation; each phosphate is oxidised and undergoes a series of reactions to form two high energy compounds whose hydrolysis is exergonic( some of the energy is trapped absorbed by NAD+ ). The third step is regulated by PFK. Net number of ATP is 4. Final product is pyruvate.
NAD+ is made available for Glycolysis to continue.
Aerobic - Reducing pyruvate
Anarobic - NAD+ is reoxidised

Case relation: Meriam doesnt have an appetite, therefore she would not take in enough glucose. The sugar she added to her diet could be used in glycolysis

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IT is important for tissue that lack glucose. The production of glucose from non - carbohydrate sources occurs through gluconeogenesis (requires ATP) which occurs in the mitochondrion and in the cytosol. Glucogenic amino acids from muscle protein are metabolised to pyruvate through glycolytic pathways. As Citric acid cycle intermediates, amino acids also make oxaloacetate. Lactate from anaerobic glycolysis also makes oxaloacetate via the production of pyruvate.This oxaloacetate is ultimately then converted to glucose. Glycerol from the breakdown of fat or triacylglycerols converted to acetyl coA that cannot be converted to pyruvate and oxaloacetate. Reciprocal regualtion of gluconeogenesis prevents a futile cycle.

Case relation
The adipose tissue could have been used as seen in the weight lose. Glucogenic amino acids could also be used.

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ATP (Adenosine triphosphate) is the principal molecule for storing and transferring energy in cells. It is an organic compound. It can be used as direct form of energy. It transports energy necessary for metabolic process such as muscle contraction. Hydrolysis of ATP supplies for energy needs. It is the neurotransmitter responsible for taste.

case relation :
There was no sufficient glucose intake. Non carbohydrate sources were used to produce the ATP.

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Good ventilation decreases risk to TB infection as TB can remain in the air for several hours, natural light has UV light that kills off TB bacteria and good hygiene such as covering the mouth and nose when coughing or sneezing reduces the spread of TB bacteria. A vaccine against tuberculosis is also a form of prevention against infection. Wearing masks .Tb patients having seperate wards(health professionals) (TB alert.org). DOTS in terms of treatment.

case relation: The nurse asks her to wear a mask and teaches her how to cough. She also completes the necessary procedures

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O2 is carried in the blood by binding to haemoglobin. Each haemoglobin molecule binds four O2 atoms. During loading O2 from the alveoli binds to haemoglobin in the pulmonary capillaries and becomes fully saturated, this oxygen rich blood then travels to the left side of the heart and is pumped through systemic circulation. Haemoglobin then releases oxygen to the cells of the tissues. A small amount of O2 is dissolved in plasma. CO2 is transported in three ways: dissolved in plasma, bound to haemoglobin on its polypeptide chain forming carbaminohaemoglobin and as bicarbonate ions; the CO2 is converted to carbonic acid by the activity of carbonic anhydrase, the carbonic acid immediately dissociates into a hydrogen ion and a bicarbonate ion

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Two pleural cavities separated by the mediastinum. Each lung is surrounded by a single pleural cavity which is lined by serous membrane called pleura and it consists of two layers: the parietal and the visceral pleura.  Pleural fluid which is secreted by the pleura prevents lung from collapsing.

Case relation: there was a small amount of pleural fluid found in her left lung. There may be a case of infection. This may affect her breathing in terms of the functions of pleural fluid.

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The respiratory system is comprised of the lungs, the upper respiratory tract which consists of the nose and nasal cavity, the paranal sinuses and the pharynx and the lower respiratory tract which consists of the larynx, trachea, bronchi, bronchioles and alveoli. The conducting portion, which is meant for conditioning air, of the RS is from the nasal cavity up to the terminal of the bronchioles and the respiratory portion, which is meant for gaseous exchange and minimizing damage, is from the respiratory bronchioles to the alveoli. Primary bronchi branches into secondary bronchi. 10 pulmonary segments in the right lung and 8 pulmonary segments in the left lung. Oxygenated blood flow from the capillaries to the heart. The hilum is on the medial surface of the lungs and it provides access for entry to pulmonary vessels, nerves etc. The root attaches to the mediastium. The cartilage in the bronchi and bronchioles prevents them from collapsing.

Case relation : the infection is mostly occurring in the upper respiratory tract. Her left lungs is mostly affected as see by the dullness and abnormalities.