lecture 5

Question 1

what is linked to BOS?

Answer 1

acute rejection

Question 2

what is BOS?

Answer 2

bronchiolitis obliterates syndrome

Question 3

what is a marker for gastric aspiration?

Answer 3

pepsin

Question 4

what can be used to measure pepsin?

Answer 4

slot/blot elisa

Question 5

what antibodies are used in the slot/blot Elisa?

Answer 5

primary antibody and a secondary sheep/goat antibody which is conjugated with hydrogen peroxidase

Question 6

what is added to the substrate?

Answer 6

DAB with hydrogen peroxidase = a colour development

Question 7

is there pepsin in people who have a chronic cough?

Answer 7

NO

Question 8

is there pepsin in people who have had a lung transplant?

Answer 8

YES

Question 9

why is pepsin not found as much in patient with BOS?

Answer 9

because BOS makes the lungs leaky, therefore any gastric juice that gets in the lungs escapes from the lungs

Question 10

why is there little amounts of pepsin in people that have chronic cough?

Answer 10

because they are aspirating buts its not getting into the lungs as the patients are coughing up the sputum instead

Question 11

what conditions after lung transplantation has the most pepsin?

Answer 11

acute rejection

Question 12

what response happens in acute rejection?

Answer 12

inflammatory response, CD8 lymphocytes

Question 13

what happens if you limit aspiration?

Answer 13

lots of T lymphocytes present

Question 14

what are the effects of gastric juice with a pH of 2.5?

Answer 14

acid of pH2.5 damages the lungs, causing destruction and fibrosis of the alveoli and interstitial spaces narrowing the airways

Question 15

what is needed to improve long term survival of the lung allografts?

Answer 15

a more aggressive anti-reflux approach is needed early on to help reduce the development of BOS

Question 16

what can help prevent the deterioration of allografts?

Answer 16

an antibiotic called azithromycin

Question 17

what does azithromycin do?

Answer 17

prevents reflux by increasing gastric emptying, reducing stomach contents to reflux less easily

Question 18

what can reduce azithromycoin from working?

Answer 18

if you have bile acids - it reduces the the survival long term and you will still get allograft deterioration

Question 19

when is acid damaging?

Answer 19

at a pH below 3.5

Question 20

how can pepsin be reactivated?

Answer 20

if it is trapped in the tissue, it can be reactivated by a second exposure to acid

Question 21

how comes there is less pepsin in the lungs for patients who have chronic cough?

Answer 21

as it is coughed up before it can be let into the lungs

Question 22

what is a non acid reflux event?

Answer 22

pH tract doesn’t not go below ph7

Question 23

what can measure a non-acid reflux?

Answer 23

impedance

Question 24

what happens every time reflux passes the rings of the pH channel?

Answer 24

there is a reduction in impedance, there is no drop in pH

Question 25

how can you measure bile salts?

Answer 25

by oxidising them with the 3 alpha HSD which removes an OH group so it is oxidised and also generating NADH

Question 26

how is a link assay carried out?

Answer 26

during oxidation you will get NADH produced and H+, then reacted with a dye to form formazan which produced a colour.

Question 27

what does the amount of colour indicate?

Answer 27

relates to how much bile acid is present