CVS 11 Flashcards
types of inflammatory bowel disease HLA classification
Crohns and UC
HLA b27
other HLAB27
PAIR
which one of the IBD has granuloma formation
and which type of T helper response
Crohns
TH1
cytokines needed for granuloma
IL2 and IFN gamma
MHC classes and IBD
Crohns MHC I
UC MHCII
MHC I is present on which types of cells
all nucleated cells including platelets and virally infected cells EXCEPT RBC
MHCI antigen presentation
Endogenous pathway
large endogenous peptide is broken down to a proteosome—- transported to ER by TAP (molecular channel) —- loaded on the MHC I—- shuttled through golgi to the cell membrane
structure of MHC I and MHC II
MHCI —- heavy alpha 1 2 3 and small B2 globulin
MHC II — alpha 1 alpha 2 beta 1 beta 2 and INVARIANT chain
MHC II is present on
macrophages
dendritic cells
B lymphocytes
antigen processing of MHC II
EXOgenous
antigen is brought inside from extracellular site by phagocytosis (crush antigen) (phagolysosome)——- MHC II binds with phagolysosome —– the acidic ph in lysosome destroys the INVARIANT CHAIN—— free peptide binding groove exposed and antigen binds here
HLA A1
SLE
HLA A3
hemochromatosis
HLA B8
addison/ graves/ myasthenia gravis
HLA B27
PAIR
what does seronegative spondyloarthropathies mean?
negative for rheumatoid factor
which is igM against Fc of IgG
HLA C
psoriasis
HLA DQ2 DQ8
celiac disease
HLA DR2
multiple sclerosis/ SLE / hay fever/ Good pasture
HLA DR 3
Diabetes/ addison/ graves/ MGravis/ HASHIMOTO
HLA DR4
Diabetes/ addison
HLA DR5
HASHIMOTO/ RA/ Pernicious anemia
crohn disease mannifestation
SISTER Skip lesions Ileum affected m/c site Sacharomyces cerevisae antibody Transmural Extra fibrosis and FISTULA Radiology string sign
Rectum is SPARED!!
Ulcerative colitis mannifestation
Ulcers in mucosa submucosa (not muscularis) Continuous retrograde Originates rectum Lead pipe Increased cancer risk Toxic megacolon Increased growth from mucosa (pseudo polyps) Severe symptoms
types of fistulas in crohsn
entero enteric
entero vesicular
entero cutaneous (abd wall)
perianal
enterovesicular fistula characteristic finding
pneumoturia
other symptoms of crohns
fever fatigue
cobble stone mucosa (wavy appearance)
CREEPING fat — mesenteric fat wraps around bowel)
edematous and fibrosis of bowel (thickening)
other symptoms of crohns
EYE – uveitis (iris, cilliary, choroid)
MOUTH — apthous ulcers
JOINT — arthritis
RASH — pyoderma gangrenosum, erythema nodosum
INCREASE RISK OF CALCIUM OXALATE STONES
how does crohns increase risk of calcium oxalate stonse
normally calcium + oxalate —- forms salts in gut and is excreted
due to malabp calcium undergoes saponification with fat — oxalate has no calcium to bind to — it gets absp in the gut — filtered to the kidney and forms calcium oxalate stones here
risk of calcium oxalate stones is also increased in?
increased ascorbic acid VIT C
most stones are formed in acidic conditions except
1. calcium PHosPHate
2. ammonium mg PHosPHate
mnemonic for acidic vs alkaline stones
most stones form at low PH except
- calcium PHosPHate
- ammonium mg PHosPHate
blood bag has these components
Acid — to shift O2 curve to right … o2 unloading
Citrate —– binds calcium — no coagulation
Dextrose —- RBC nutrition — increases 2,3 BPG
radioopaque stones
almost all are radio opaque except radioLUcent
uric acid stones
shape of calcium oxalate stones
envelope/dumbells
shape of calcium phosphate stones
wedge shape
shape of uric acid stones
rhomboid rossettes
shape of ammonium magnesium phosphate stones
coffin lid
shape of cysteine stones
hexagonal
treatment of calcium phosphate stones
haydrate low sodium thiazide diuretics citrate remmber phosphate stones precipitate in alkaline media so giving citrate can help
who has risk of uric acid stones
lesch nyhan tumor lysis syndrome uricosuric drugs (probenacid, sulfinpyrazon) HIGH dose aspirin von gierke disease (hepatic glucose 6 psptase) thiazide niacin male diabetes HTN obesity alcohol red meat
what kind of crystals are seen in gout under polarized light
negatively birefringent crystals
yeLLow when paraLLel light
blue wen perpendicular light
tophus can be seen in
olecranon bursa
external ear
achiles tendon
pseudogout what kind of crystal?
calcium phosphate in the joint
Positive birefingent
risk factors for pseudogout
hemochromatosis
trauma
hyperpartahyroidism
what can be seen on imaging in pseudo gout
chondrocalcinosis
blue when parallel to light
what happens in tumor lysis syndrome
hyperkalemia postassium leaves damaged celsl
hyperphosphatemia
hyperuricemia due to nucleic acids broken down
free calcium decrease (ca + phosphate) — tetany
struvite staghorn calculus in adults and children
Adults —- Ammonium magnesium phosphate
Children —- cysteine
causes for ammonium magnesium phosphate stones
urease producing bacteria PUNCHKISS Proteus Ureaplasma urealyticum Nocardia Cryptococcus H pylori KI klebsiella S. epidermis ( NO sensitive) S. saprophyticus (NO resistant)
cysteine stones are linked to which condition
AR COLA Cysteine Ornithine Lysine Arginine
normally it is abspd in PCT
how to diagnose cystinuria
sodium cyanide nitropruside —- turns blue
what can be seen on histology in crohns disease
paneth cells metaplasia
abcess —- perforation —– peritonitis
treatment for crohns
steroids
azathioprine ( PRPP amidotransferase -)
TNF alpha (infliximab / adalimumab)
cipro/ metronidazole
does UC have granulomas?
NO
perinuclear anti neutrophil cytoplasmic antbodies seen in P ANCA
primary sclerosing cholangitis
microscopic polyangitis
churg straus
what can be seen in UC
haustras are lost
toxic megacolon
crypt abcess
primary sclerosing cholangitis
treatment for ulcerative colitis
5 amino salicylic acid (mesalamine)
6mp/ azathioprine
colectomy
sulfasalazine breaks down into
- sulfapyridine (RA)
2. 5 amino salicylic acid (UC)
