Flashcards in Week 2 Deck (56)
List 4 functions of mucosal tissue
What is the dominant antibody in the gut?
IgA (usually IgG elsewhere)
Which antibody takes over if the patient can't make IgA?
What are intra-epithelial lymphocytes (IELs)?
CD8 +ve T cells which lie within the epithelial lining of the gut
Describe what is meant by intestinal failure
Where gut is no longer able to supply the hydration and nutritional needs of the body
Describe the 3 types/ levels of intestinal failure
1 - self-limiting, short term postoperative (most common) -(days to weeks)
2- Prolonged, associated with sepsis and metabolic complications, often related to abdominal surgery with complications
3 - long-term but stable
How would you treat Type 1 intestinal failure
- Fluids and electrolytes
- Parenteral nutrition if unable to tolerate foods and fluids
- Acid suppression (proton pump inhibitors/ ocreteotide)
- Alpha hyrdocycholecalciferol (to presevre magnesium)
What is a risk associated with insertion of lines for parenteral nutrition?
Due to the close proximity to the lungs, there is a risk of pneumothorax
Is bowel lengthening as a treatment of Type 3 intestinal failure used in adults or children?
Which other type of transplant is a small bowel transplant usually given in combination with?
Which vessel supplies the small bowel?
The superior mesenteric artery
Describe the outcomes of the three types of infarct to the small bowel
Mucosal infarct - There will be regeneration and mucosal integrity will be restored
Mural infarct - Repair and regeneration - fibrous stricture
Transmural - Gangrene and death if not sorted
What is 'Meckel's Diverticulum'
A slight bulge in the small intestine due to incomplete regression of the vitello-intestinal duct (an embryological remnant)
Secondary small bowel tumours are more common than primary tumours. Where do these secondary tumours commonly metastasise from?
What are the three types of primary tumour that can occur in the small bowel?
What are the symptoms of appendicitis
Epigastric pain initially, RIF pain later
List possible consequences of appendicitis
Which genes is coeliac disease associated with?
What component of gluten is the toxic agent?
What do serology tests to investigate for coeliac disease look for?
IgA (deficiency - 10X more likely to have coeliacs)
What can malabsorption of fats do to stool?
Cause STEATORRHOEA (fat in the stool)
List the negative possible effects of malabsorption
Failure to thrive
What are 'Peyer's Patches'
The lymph nodes of the gut
What is the function of M cells within payer's patches?
They provide maximum surface area for antigen absorption
What happens in the TH1 response to infection?
Macrophages and B cells are activated
What happens in the TH2 response to infection and which Interleukins are responsible?
- IgE production (IL 4)
- Recruitment and activation of eosinophils (IL-5)
- Recruitment of mast cells which produce histamine/ TNFa and MMCP (IL-3 and IL-9)
- Epithelial repair and production of mucus (IL- 13)
What are the two main receptors for the HIV virus?
CCR5 and CD4
List disorders associated with primary immunodeficieny
Selective IgA deficiency
Which mucosal disorder is associated with low IgG, IgA, IgM and IgE, causing recurrent sinopulmonary and GI infections?