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GI 2 > Immunology > Flashcards

Immunology Flashcards

1
Q

Which presentation of IBD presents with fistulae but rare bleeding?

A

Crohn’s

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2
Q

Which presentation of IBD goes with pANCA? Which goes with ASCA?

A 
pANCA = UC
ASCA = Crohn's
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3
Q

Which presentation of IBD has skip lesions?

A

Crohn’s

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4
Q

What is the overall accepted etiology for IBD?

A

Primary increase in permeability –> exaggerated immune response to normal microflora

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5
Q

How does diet contribute to IBD?

A

Eating a low-fiber diet can negatively influence the balance of good-bad microflora

Alternatively, food particles may directly stimulate TLR’s (MAMPs, PAMPs)

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6
Q

By which mechanism does eating a high-carb diet lead to inflammation?

A

Carbs –> fermentation –> acetate production –> IL-10

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7
Q

How much of IBD is believed to be environmental?

A

10-50%

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8
Q

Which type of IBD is made worse by smoking?

A

Crohns

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9
Q

How does smoking damage the immune system?

A 
1- alters numbers of Tregs
2- inhibits t cell proliferation 
3- modulates apoptosis
4- decreases serum and mucosal Ig's
5- promotes leukocyte adhesion
6- enhances bowel permeability
7- increases colonic mucus production
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10
Q

Evidence of the effect of which thing is LEAST SUPPORTED in IBD?

A

Diet

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11
Q

Which type of iBD may be related to sugar intake and not being breastfed?

A

Crohn’s

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12
Q

Which type of IBD may be related to a high fat diet?

A

UC

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13
Q

Which type of IBD may be related to lactose intolerance?

A

BOTH

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14
Q

Which 2 broad classes of drugs may increase the risk of IBD?

A

OC’s, NSAID’s

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15
Q

IBD is very uncommon in anyone other than white people. Which type is especially uncommon?

A

Crohns

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16
Q

IBD1/CARD15/NOD2 is specifically implicated in which form of IBD?

A

Crohns (20% of cases)

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17
Q

What is the function of IBD1/CARD15/NOD2? Where does it act?

A

Location: Paneth cell macrophages (SI)

Action:
CARD15 is a PPR (pathogen receptor)
CARD15 binds to MDP (muramyl dipeptide) and activates NF-kB

18
Q

What is the 3-hit genetic hypothesis of IBD? How does CARD15 fit into it?

A

1 - mutation in innate immune response (NF-kB)
2 - mutation in CARD15 (constitutive activation)
3- disruption of mucosal homeostasis

19
Q

Why does IBD typically appear in the terminal ileum and colon?

A

Those are the areas with the highest bacterial count

Studies have shown that if the stool doesn’t pass through those areas, IBD goes away

20
Q

Some studies have shown that Abx (as well as probiotics) can improve IBD. Which class, on the other hand, always makes it worse?

A

FQ’s

21
Q

Name the 3 organisms that have been implicated in some cases of IBD.

A

1- M. paratuberculosis
2- Paramyxovirus (measles)
3- Listeria

22
Q

Which type of IBD is associated with Anaerobes? With Aerobes?

A

Anaerobes - Crohns

Aerobes - UC

23
Q

How does bacteroides act to decrease the auto-immune response to gut flora?

A

Activates PPAR (peroxisome proliferation activated receptor) –> carries NF-kB out of the cell

24
Q

Which cell types should you recognize as causing NF-kB activation and auto-inflammation in response salmonella?

A

TLR-5

IKK

25
Q

Which CK activates Th17 cells to secrete IL-17?

A

IL-23 (also activates macrophages directly)

26
Q

IL-12

A

Stimulates Th1 cells to secrete TNF, IFN-y

27
Q

Which type of T cell predominates in UC vs Crohns?

A

Crohns - Th1, Th17 (IL10, TGFB)

UC - Th2 & NKT (IL10, IFN, IL11)

28
Q

Appendectomy may be associated with decreased risk of which form of IBD?

A

UC

29
Q

IL-4, IL-5, IL-13

A

Th2 (UC)

30
Q

What happens if you have no IL-23?

A

No Th17 –> No delayed type hypersensitivity

31
Q

IL-10, TGF-B

A

From Tregs (Crohns) or B cells (UC)

32
Q

IL-13

A

stimulates NKC’s (UC)

secreted by both NKC’s and Th2

33
Q

IL-11

A

Comes from bone marrow to regulate B cells

CAUSES UC

34
Q

CCL25 with receptor CCR9

A

expressed in SI of IBD pt’s; mediates lymphocyte recruitment; possible drug target?

35
Q

Tbet

A

TF for Th1

36
Q

GATA-3

A

TF for Th2

37
Q

ROR-gamma-t

A

TF for Th17

38
Q

Foxp3

A

TF for Treg

39
Q

Effect of Tregs on all other types of T cells

A

Decrease

They may turn them off directly or indirectly (CK’s)

40
Q

How many gut T cells in GALT are Tregs in a healthy person?

A

> 10%

41
Q

Which random drug type may be used to treat IBD?

A

Anti-thrombotics

42
Q

Which CK’s activate Tregs? Which cell types?

A

IL-2, TGF-B (APC’s)

GI 2 (4 decks)

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