CRS 2 Flashcards
Describe the anatomy and innervation of the diaphragm.
- Diaphragm extends into thoracic cavity
- Major muscle of inspiration
- Striated muscle
- Motor and sensory innervation through phrenic nerve (left and right)
- From cervical segments of spinal cord
- separates thorax from abdominal cavity
- Muscular part is peripheral, tendinous part is central
- Muscle attached to xiphoid process, to inside of lower costal cartilages and ribs by digitations
- Crura attach to lumbar vertebrae
- 3 openings: aortic hiatus, oesophageal hiatus, caval foramen
What are the borders of the thoracic cavity?
The first and last ribs and cranially and caudally, and laterally the rib cage.
What is the main difference between the left and right thoracic cavity?
More arteries visible on the left, more veins visible on teh right
What divides the left and right thoracic cavities?
The mediastinum
List what is present in the left pleural cavity.
Sympathetic trunk, aorta, brachiocephalic trunk, oesophagus, vagal nerve, laryngeal recurrens, trachea, vena cava, lymph nodes and thoracic duct, pericardium with the heart
List what is present in the right pleural cavity.
Sympathetic trunk, aorta, brachiocephalic trunk, oesophagus, vagal nerve, laryngeus recurrens, trachea, vena cava, azygous vein, lymph nodes, thoracic duct, pericardium with heart.
- Fold for vena cava is called plicae venae cavae
Mediastinal recess for accessory lobe of right lung
Describre the structure of the pleural membranes including the mediastinum.
- Each lung surrounded by pleura (serous membrane)
- 2 pleural membranes arranged as closed sacs around the lung
- Same between left and right sac - mediastinum is space between these
- Surface of lung covered by visceral (pulmonary) pleura (derived from splanchnic mesoderm), reflected around root of lug to become continuous with mediastinal pleura
- Mediastinal pleura also continuous with diaphragmatic and costal pleura = parietal pleura and line the cavity (derived from somatic mesoderm)
- Space between parietal and visceral pleura is pleural cavity
- Contains small amount of serous fluid spread over surface = adhesion + smooth movement
- Lung not attached to thoracic wall
Describe the function of the pleural membranes including the mediastinum.
- Lung not attached to the thoracic wall
- Follows movement of pleural membranes
- Serous fluid allows for adhesion between the pleura
Identify the structures contained within the mediastinum.
- Heart with pericardium
- Vena cava
- Trachea
- Thoracic oesophagus
- Lymoh nodes
- Right phrenic nerve
- Filled with connective tissue
Outline how pathogens have evolved mechanisms for interacting with their hosts.
- Different methods of adhesion, different virulence factors, resistance to immune response
- Contact between host and pathogen either leads to recognition by the host (internal and external receptors) or production of virulence factors by pathogen
- Triggers immune response - immunopathology
- Pathogen detaches, invade and produces toxins which lead to damage
- Collateral damage caused by immune response
- Leads to morbidity or mortality
Explain how the signs of infection may be caused bythe pathogen or by the host’s responses.
- Swelling, redness and fever are responses of the host to fight infection
- Swelling caused by invasion of neutrophils
- Redness caused by increased blood flow to site of infection (supply more WBCs)
- Fever is mechanism used to kill pathogens - cannot survive above certain temperatures
Outline the role of virulence genes in bacterial pathogens.
- Genes that code virulence factors
- Virulence genes can be passed on through plasmid trasfer and phage transduction
- Hoizontal transfer
- Virulence factors are what allows the bacteria to survive
- Without virulence genes, no virulence factors, bacteria will die
Describe virulence factors and explain how they work.
- Virulence factorsare molecules that allow bacteria to adhere, invade, evade host defence, cause tissue damage and replicate or persist in the host
- Adhesion can be to cells, secretory products, structual components (teeth) or other bacteria (biofilms)
- Bacterial structures involved may be fimbrae, pili or adhesive macromolecules imbedded in membrane
- Other structures with adhesive properties: capsules, flagella, proteinaceous fibrils
- Will usually bind to surface proteins, carbohydrates, host glycolipids/glycoproteins
Explain the process by which tissue invasion occurs.
- Can be opportunistic (injury, procedures, catheters), vector mediated (arthropods)
- Pathogen produces virulence factors and damaged is caused by toxins
- Paracytosis = passage through cell layers without penetrating individual cells
Explain the phagocytic process by which bacteria enter host cells.
- Host uptake mechanism (M-cells in gut) or invasion into cells (actin rearrangement, microtubule rearrangement -> forced phagocytosis)
- Zipper mechanism
Explain the Zipper mechanism by which bacteria enter host cells.
- Bacteria bind to host transmembrane adhesion proteins (integrins, cadeherins)
- Host attempts to form cell junction
- Spreads over adhesive surface of bacterium => phagocytosis
- e.g. Listeria
Explain the trigger mechanisms by which bacteria enter host cells.
- Bacteria inject TTSS effector proteins into host cell
- Bacterial effector proteins interfere with host cytoskeleton
- Stimulate actin polymerisation
- Leads to localised membrane ruffling
- Shigella and Salmonella are examples
Explain how host bacteria exploit host cell cytoskeletal and metaboic pathways.
- Cytoskeleton used for Zipper and Trigger mechanisms, extracellular attachment and movement within/between cells
- Cytoplasm viscous and inhibits diffusion
- Some bacteria use nucleation and assembly of host actin filaments at one pole of bacterium
- Growing filament generates force
- Bacteria move 1mm/s
- Depolymerisation factors in cytosol depolymerise actin again which leads to appearace of an actin tail
- Some pathogens use monocytes to “hitch a ride”
- Spread to other tissues
Explain the intracellular movement of bacteria contained in vacuoles
- Salmonella containing vesicles (SCVs) localised along microtubules using molecular moors
- Both motors (dynein and kinesin) associated with SCVs
- Position along microtubules is controlled
- Effector proteins constantly recruiting kinesin
- Production of Sifa down modulates amount of kinesin on vacuole surface
- Commonly used by viruses, not well understood in intracellular bacteria
Describe the concept of PAMPs
- Pathogen Associated Molecular patterns
- Expression of specific components that are then recognised as danger signals
- Gram -ve: LPS recognised
- Gram +ve: peptidoglycan
- Binding of PAMP leads to signalling cascade
- Activation of host response factors that have already been produced
- OR activation of transcription factors and then ecpression of host response
- Both lead to host response
Describe the concept of PRRs
- Pathogen recognition receptors
- host expression specific receptors that recognise the PAMPs
- 6 different types of receptors: Toll-like, transmembrane, Nod-like cytoplasmic, C-type lectin, Mannose and Scavenger
Describe the concept of TLRs
- Toll-like receptors
- Membrane spanning receptors
- Structure allows signal to go from outside to inside
- Extracellular section (leucine rich repeats - LRRs)
- Transmembrane domain that sits in the cell membrane
- Intracellular section - Toll/IL-1 receptor (TIR) domain that is used for signalling
Outline the types of PAMPs that can elicit an inflammatory response
- Microbial nucleic acids
- Microbial lipoproteins
- Microbial carbohydrates
- Damage associated molecular patterns released from injured cells
- All cause increase in leukocyte recruitment
Outline the roles of TLR1-TLR9 as pathogen recognition receptors.
- TLRs 1, 2, 3, 4, 5 and 6 localised on cell surface and recognise molecular structures unique to bacteria
- TLRs 3, 7, 8 and 9 are localised on intracellular compartments (including lysosomes and endosomes) and recognise viral and bacterial nucleic acids
- TLR2 and 9 are stimulated during asthma
Explain the role of TLR4.
- Recognises LPS, requires LBP, CD14 and MD2
- LPS binds to LBP, then passed onto CD14
- CD14 cannot pass through membrane so is passed onto MD-2, then TLR4 so LPS can pass through
- Signalling through TLR4 requires 4 adapter proteins
- Essential for host response to gram -ve bacteria
- Absence leads to resistance to endotoxic shock, but infection by gram -ve bacteria cannot be controlled
Explain the role of TLR2.
- Heterodimer
- Responds to lipoproteins and lipopeptides from wide range of pathogens
- Interacts with TLR1, TLR6 or dectin1 to increase specificity
- Deficiency in TLR2 = increased susceptibility to infection with gram +ve bacteria
Explain the role of TLR5.
Recognises bacterial flagellin from gram +ve and -ve bacteria
Explain the role of TLR9.
- Recognises bacterial CpG DNA motives
- CpG motif consisting of unmethylated CpG dinucleotide generally flanked by 2 5’ purines (A or G) and 2 3’ pyrimidines (T or C)
- Different for differen species
- Activation of immune system by bacterial DNA motifs may be utilised in development of adjuvants for vaccines
Explain the role of TLR3.
- Responds to double stranded RNA
- Only other TLR that requires adapter molecule (Trif)
Explain the role of TLR7 and 8.
Interacct with single stranded RNAs
How do TLR receptors contribute to hoemostasis on muscosal surfaces populated by commensal bacteria?
- TLR receptor expression on basal surface of epithelial cell
- Not on apical surface that is in contact with gut lumen and commensal bacteria
- Prevents reaction to commensals
List clincial syndromes associated with systemic inflammation.
Bacteremia/septicaemia, SIRS, shock, sepsis, severe sepsis, MODS
Define bacteremia/septicaemia
Presence of viable bacteria in the blood stream
Define SIRS
Systemic inflammatory response syndrome
Systemic response to an array of severe clinical insults
Define shock
SIRS induced hypotension refractory to fluid resuscitation in association with hypoperfusion
Define sepsis and severe sepsis
SIRS due to infection
Severe sepsis is sepsis associated with organ dysfunction, hypoperfusion or hypotension
Define MODS
Multi organ dysfunction syndrome
Altered organ function in an acutely ill patient requiring intervention to maintain homeostasis
Explain the processes leading to sepsis, especially pathogen recognition by the host.
- Localised infection becoming systemic
- Sepsis as complication due to commensal bacteria after breakdown of barrier (often in neonates, some colic cases in horses, long operations, oxygen supply to gut epithelial layer reduced so epitehlial layer breaks down and larger number of bacteria enter blood stream)
- If a localised infection becomes systemic, will be high systemic levels of mediators which will cause sepsis
Discuss the progession of inflammatory processes and associated pathophysiological damage and how sepsis, SIRs and MODS lead to high mortality
- SIRS and sepsis lead to MODS
- Infection carried through system by blood
- Leads to high mortality as organs are destroyed and blood flow is altered
Outline potential therapeutic intervention strategies.
- Early diagnosis
- Treatment of primary disease process
- Supportive care
- Balance to prevent detrimental effects without suppressing beneficial effects
- Removal or circulation LPS using antibodies or poly myxin B prevents activation of receptors
- preventing actin of pro-inflammatory cytokines (target TNF alpha, anti TNF alpha antibody, soluble TNF alpha receptor)
- Targeting IL-1beta (soluble so not likely to be beneficial to all patients)
- NSAIDS (widely used but no controlled studies to analyse efficacy)