Week 2 Flashcards by Molly Richard

List 4 functions of mucosal tissue

Reproduction
Sensory activities
Food absorption
Gas exchange

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What is the dominant antibody in the gut?

IgA (usually IgG elsewhere)

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Which antibody takes over if the patient can’t make IgA?

IgM

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What are intra-epithelial lymphocytes (IELs)?

CD8 +ve T cells which lie within the epithelial lining of the gut

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Describe what is meant by intestinal failure

Where gut is no longer able to supply the hydration and nutritional needs of the body

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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

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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)

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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

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Is bowel lengthening as a treatment of Type 3 intestinal failure used in adults or children?

CHILDREN

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Which other type of transplant is a small bowel transplant usually given in combination with?

Liver transplant

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Which vessel supplies the small bowel?

The superior mesenteric artery

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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

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What is ‘Meckel’s Diverticulum’

A slight bulge in the small intestine due to incomplete regression of the vitello-intestinal duct (an embryological remnant)

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Secondary small bowel tumours are more common than primary tumours. Where do these secondary tumours commonly metastasise from?

Ovaries
Colon
Stomach

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What are the three types of primary tumour that can occur in the small bowel?

Lymphomas
Carcinoid tumours
Carcinomas

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What are the symptoms of appendicitis

Epigastric pain initially, RIF pain later
Vomiting
Fever possible

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List possible consequences of appendicitis

Rupture
Abscess
Sepsis
Peritonitis

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Which genes is coeliac disease associated with?

HLADQ2/HLADQ8

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What component of gluten is the toxic agent?

GLIADIN

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What do serology tests to investigate for coeliac disease look for?

IgA (deficiency - 10X more likely to have coeliacs)
Anti-TTG
Anti-gliadin antibodies
Anti-endomesial antibodies

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What can malabsorption of fats do to stool?

Cause STEATORRHOEA (fat in the stool)

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List the negative possible effects of malabsorption

Weight Loss 
Anaemia 
Abdominal Bloating 
Vitamin deficiencies 
Failure to thrive

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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

SCID CVID XLA Selective IgA deficiency

Which mucosal disorder is associated with low IgG, IgA, IgM and IgE, causing recurrent sinopulmonary and GI infections?

CVID

Which mucosal disorder is x-linked and involves agammaglobulinaemia (No B cells!)

XLA

Which areas of the GI tract does Crohn's disease most commonly affect?

terminal ileum and the proximal colon

What does Crohn's disease cause?

Inflammation and deep eroding fissures

What is the important gene to Crohn's disease?

NOD2

What area of the GI tract does ulcerative colitis affect?

The rectum and the colon

Would mucositis occurring post-chemotherapy be considered as acute or chronic intestinal failure?

Acute/ Short-term

Would short-gut syndrome be considered as acute or chronic intestinal failure?

Chronic/ Long-term

What length of bowel constitutes 'Short-Bowel Syndrome'

Less than 200cm

List some of causes and impacts of malnutrition

Causes; - Anorexia - Dysphagia - Infection - Malabsorption Impacts; - Infections and sepsis - Poor wound healing - GI dysfunction - Weight loss - Reduced muscle strength and fatigue - Reduced respiratory muscle strength causes an increase in the risk of chest infections

List some of the assessments for malnutrition

``` Mid arm circumference Biochemical assessments for; - Albumin - Transferrin - Vitamins E.t.c ```

What is meant by enteral tube feeding?

Delivery of feed via a tube into the stomach or duodenum or jejunum

What are the indications of use for enteral tube feeding?

Upper GI obstruction Unconscious patients Swallowing disorder

What is meant by parenteral nutrition?

Administration of nutrient solutions via a vein

What are the indications for use of parenteral nutrition?

``` Severe malabsorption e.g IBD Short bowel syndrome Motility disorders Severe malnutrition Intestinal fistulae ```

What is 'MUST' a screening tool for?

Malnutrition risk

List some specific diseases that can be associated with malabsorption

Coeliacs Disease Crohn's Disease Whipple's disease e.t.c

What is Tropical Sprue?

Colonisation of the intestines by an infective agent

Where does B- oxidation occur?

In the mitochondrial matrix

What are the products of B-oxidation?

1 Acetyl CoA 1 FADH2 1 NADH and H+ 1 Fatty Acyl CoA

Under what conditions would ketone bodies accumulate?

Starvation

Where does fatty acid synthesis occur?

In the liver

What substance is the major fatty acid synthesis precursor?

Malonyl CoA

What substances upregulate Acetyl CoA and which downregulate it?

``` Upregulate - Citrate - Insulin Downregulate - Glucagon - Adrenaline - AMP - Pamitoyl CoA ```

Where does the urea cycle occur?

In the liver

What is the catalyst which sits at the centre of the glycogen polymer and acts as the starting point for the glycogen polymer to be extended?

Glycogenin

Which interleukin is specifically involved in Crohn's disease?

IL 12

What is meant by mucous membrane pemphigoid?

A group of autoimmune disorders that involve blistering lesions affecting mucous membranes