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Mucosal Surfaces > B4- Allograft Injury > Flashcards

B4- Allograft Injury Flashcards

1
Q

What is clad

A

Chronic lung allograft dysfunction

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2
Q

What 2 types of injury to lung wre there after transplant

A

Alloimmune (eg response to hla) and non alloimmune injuries eg aspiration/infection

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3
Q

Why are transpalnt patients susceptible to infection

A

Immunosupressnts

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4
Q

What is decreased in clad shpwing airway obstruction

A

Fev1

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5
Q

What % of transpalnt pateints have clad sfter 3 years

A

50%

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6
Q

Ehat is a major type of clad

A

Bronchiolitis obliterans syndrome BOS

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7
Q

What is it

A

Airway obstruction ,epithelial damage and inflammation of the bronchioles

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8
Q

What are the 2 major allogrsft injuries causing clads

A

Aspirstion/reflux and infections

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9
Q

What do these cause

A

Epithelial damage, airway remodelling and obstruction

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10
Q

What is BAL measuring allgraft rejection

A

Bronchioalveolar lavage is where bronchoscope passed then washint using saline

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11
Q

What other things are used

A

Immunohistochemistrt and brush cultures

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12
Q

What to visualise

A

Viral titre, cutokines, infection

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13
Q

Why are allograft patients vulnerbale to ger and aspiration

A

Vagal damage during transplantation causes gastroparesis and changed emptying of stomach

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14
Q

Which muscles usually stop teflux

A

Oesophagwl sphincters

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15
Q

What measures teflux

A

Impedance messurements

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16
Q

What is measured when a pladtic catheter is inderted to measure reflux

A

Electrical resistance increase as fluid moves ip and also ph

17
Q

What surgery refuces BOS via tigthening sphincter muscles reducing reflux

A

Fundoplication

18
Q

Aspiration is usually hidden. What increases in alount in transplant patients which shoes aspiration

A

Pepsin increwses from gwetric juice

19
Q

Which infection is seen with cf

A

Pseudomonas aeruginosa

20
Q

Can this also lead to bos

A

Yes due to chronic infection lrading to inflammation and dmsage to walls etc

21
Q

What is the rgidence for it coming from aspiration

A

75% pf pa was identical in gastric juice and sputum

22
Q

Which artyicle links aspirstion to cf

A

Al momani et al 2016

23
Q

What was lowered in diversity in cf gj ans sputum in presence of p. Aeruginosa

A

Faecaelibacterium, lactobacillus and roseburia

Would all refuce inflammation

24
Q

What fungi was also present in all cf gj and sputum samples

A

Candida and aspergillus

25
Q

What phase does pa come ftom yo form biofilm

A

Planktonic phase

26
Q

How do they communicwte in biofilms and conform virulence

A

Quorum signalling

27
Q

Which article links Pa to inflammstion and potentiallt bos/clad

A

Malhotra 2019

28
Q

What does ros damage/ oxudative stress

A

Lung tissue

29
Q

Which amp would usually refuce pa infection

A

LL 37

30
Q

Why can pa thrive in inflammation compsred to commensas

A

Can use nitrate as aea to grow

31
Q

Why does pa when it attracts neutorphils still resistant

A

Can trap NETs in biofilm and also exotoxins kills/lyses neutrophils

32
Q

Which chemokine increases in clad / after transplantation

A

Il 8

33
Q

What article discusses bos in detail including the emt shift

A

2009 robertson et al

34
Q

What % does fev decrease for it to be considered a clad (robertson)

A

20%

35
Q

Why is there alck of coughing and mucociliary clearnace ib allograft causing furhter infection

A

Denervation

36
Q

What in reflux juices can induce neutrophils and il8,

A

Bile salts

37
Q

Why can bile dalts also cause pulmonary collapsing

A

Reduce surfactant

38
Q

Which mmps released after aspiration/infectikn cause emt transition- fibro proliferation seen in bos

A

Mmp2 and 9

39
Q

Other than il8 what is also present after aspiration/infection

A

Il17 caudint inflammation

Mucosal Surfaces (33 decks)

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