Introduction To Immunologically Mediated Diseases Flashcards
Hashimotos disease MOA and symptoms and risk factors
MOA: igg auto abs against thyroid peroxidase(antimicrosomal) and thyroid globulin
Organ specific: thyroid gland
Symptoms:
Risk factors: genetic- HLA DR5 & DR3, environmental- smoking,drugs
Diffuse,non tender, moderate, thyromegaly
Hypothyroidism
Hashimoto’s thyroiditis diagnosis and treatment
Diagnosis :
Anti-TPO(microsomes) Abs in 90% ( non-specific)
Anti-TG Abs in 40%
Treatment:
If hypothyroid, levothyroxine
Pernicious anemia MOA and symptoms
MOA: IGg auto Abs against parietal cells or intrinsic factor
B12(cobalamin): deficiency
Organ specific: gastric parietal cells( cells excrete intrinsic factors to break down food)
Symptoms
Angular chelitis, glossitis (b12 deficiency)
Peripheral sensory neuropathy
Loss of proprioception(due to long standing b12 deficiency)
Pallor, weakness, fatigue ( due to anemia)
Pernicious anemia diagnosis and treatment
Diagnosis:
-CBC- low b12, macrocytic( megaloblastic) anemia
-inc homocysteine and methylmalonic acid
- acid secretion analysis
- endoscopy with biopsy
- historically: schilling test( used to determine how well patient can absorb b12 in intestinal tract)
Treatment:
- vitamin b12 IM ( IM because need to bypass stomach due to parietal cell damage)
Insulting dependent diabetes mellitus
MOA, and symptoms
MOA:
- T cell and microphages infiltration of beta cells-> decreased insulin
Organ specific: pancreatic, beta cells
Symptoms:
- genetic associations: HLA DR3 &4
- often asymptomatic ( initial symptoms diarrhea, vomiting, fruity breath, labored breathing)
- DKA common initial presentation
- acanthosis nigricans ( black skin rash)
- polyuria,polydipsia,glucosuria
Diabetes mellitus diagnosis and treatment
Dx:
- oral blood glucose testing ( fasting vs. non fasting )
- HbA1c greater than or equal to 6.5( can also be used for monitoring diabetes because looks at 3 months worth)
- anti glutamic acid decarboxylase antibodies
- islet cell cytoplasmic Abs
tx:
-exogenous insulin
- pancreas transplant
Poststreptococcal glomerulonephritis MOA and symptoms
MOA:
- IGg, IGm & C3 deposition on glomerular basement membrane and Mesangium ( hypersensitivity 3)
Nephritogenic group A streptococci pharyngitis or impetigo ( molecular mimicry)
- mostly happens to kids because group A seen most in children
Organ specific: renal GBM and mesangium
Symptoms :
- tea or cola colored urine
- HTN
- can range from asymptomatic to nephrotic syndrome
- periorbital and peripheral edema
Poststreptococcal glomerulonephritis diagnosis and treatment
dx:
- low c3 and or CH50
- ASO titers
- imminuoflurescence microscopy: GRANULAR
Treatment :
- anti hypertensives
- antibiotics
- diuretics/ NA+ restriction
- supportive
Good pastures syndrome MOA and symptoms
MOA:
- IGg auto abs against intrinsic Ag of glomerular basement membrane
- type 2 hypersensitivity
- mostly in adults
Organ specific- renal glomerular basement membrane
Symptoms :
- genetic associations: HLADR2
- rapidly progressing glomerulonephritis(he matures)
- pulmonary hemorrhage (hemoptysis)
- preceding URI
Goodpastures syndrome diagnosis and treatment
Dx:
- anti GBM abs>90%
- CXR: pulmonary infiltrate
- light microscopy
- Immunofluorescence miscroscopy: LINEAR
Treatment :
- plasmapheresis
- cyclophosphamide
Pemphigus vulgaris MOA and symptoms
MOA:
IGg auto abs against desmoglein 1 or 3 ( desmosome)
Organ- mucosal or cutaneous epithelial cell junctions
Symptoms :
- oral mucosal lesions initially
- painful Flaccid Bullard
Positive nikolsky sign
Pemphigus vulgaris diagnosis and treatment
Dx:
- anti desmoglein 1/3 Abs
- light miscroscopy; acantholysis
- immunofluorescence: reticular
Tx:
- corticosteroids
- rituximab
Immune thrombocytopenia purpura MOA and symptoms
MOA: auto abs against GpIIb/IIIa ( receptor on platelets)
Organ- blood, platelets
Symptoms: Children- self limiting, post viral Adults- chronic -purpura, mucucutaneous bleeding, splenomegly ( bleeding on nose ) - pallor, fatigue
Immune thrombocytopenia purpura diagnosis and treatment
DX:
- CBC: isolated thrombocytopenia
- Dx of exclusion
- blood smear
- bone marrow biopsy ( adults)
Tx:
Children- none
Adults- corticosteroids, rituximab, IVIB, and anti- IgD, splenectomy( last resort )
DIscontinue drugs inhibiting platelet count
Primary biliary cholangitis
MOA and symptoms
MOA:
- etiology unclear
-lymphocytic infiltrate+ granulomatous inflammation
Auto abs against mitochondria
Organ- medium sized intrahepatic bile ducts
Symptoms :
- obstructive jaundice
- cirrhosis, HSM, portal hypertension
- xanthomas, steatorrhea
- dark colored urine, light stool
- pruritis ( itching skin)
Bile made up of cholesterol so when there is an increase in bile body takes that as a sign not to convert cholesterol to bile -> inc in cholesterol resulting in xanthomas and steatorrhea
