Immunology of gut Flashcards

1
Q

what is the surface area of the gi tract

A

200m^2

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2
Q

what is the antigen load in gi tract

A

resident microbiota 10^14 bacteria
dietary antigens
exposure to pathogens

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3
Q

what is meant by state of ‘restrained activation’ in gi tract

A

has to balance tolerance with active immune response
tolerate: food antigens and commensal bacteria
immunoreactivity against: pathogens

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4
Q

what is the gut microbiota

A

considered a virtual organ
4 major phyla of bacteria - bacteroidetes, firmicutes, actinobacteria, proteobacteria, also viruses and fungi
provide traits we have not had to evolve on our own

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5
Q

what is dysbiosis

A

altered microbiota composition

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6
Q

what are some causes of dysbiosis

A
infection and inflammation
diet
xenobiotics
hygiene
genetics
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7
Q

what are the physical barriers against pathogens

mucosal defence

A

anatomical - epithelial barriers and peristalsis

chemical - enzymes and ph

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8
Q

how does the epithelial barrier defend against pathogens

A

mucus layer - goblet cells
epithelial monolayer - tight junctions
paneth cell(small intestine) in bases of crypts of lieberkuhn
- secrete antimicrobial peptides and lysozyme

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9
Q

what is commensal bacteria

A

occupy ecological niche and act as barrier itself

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10
Q

what are some immunological defenses following invasion

A

malt - mucosa associated lymphoid tissue

galt - gut associated lymphoid tissue

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11
Q

what is malt

A
  • found in submucosa below epithelium as lymphoid mass containing lymphoid follicles
  • follicles are surrounded by HEV postcapillary venules - allowing easy passage of lymphocytes
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12
Q

what is galt

A

responsible for both adaptive and innate immune response through generations of lymphoid cells and antibodies

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13
Q

what are some examples of non organised galt

A

intra epithelial lymphocytes

lamina propria lymphocytes

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14
Q

what are some examples of organised galt

A

peyers patches(si)
caecal patches(li)
isolated lymphoid tissues
mesenteric lymph nodes - encapsulated

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15
Q

what are peyers patches

‘immune sensors’

A

found in submucosa of small intestine - mainly distal ileum
- aggregated lymphoid follicles covered with follicle associated epithelium
fae - no goblet cells, no secretory igA and lack microvilli

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16
Q

what is found in peyers patches

A

collection of naive t cells and b cells

  • development requires exposure to bacterial microbiota
  • 50 in last trimester foetus and 250 by teens
17
Q

how does antigen uptake via peyers patches take place

A

via microfold cells within FAE

M cells express igA receptors - facilitating transfer of igA bacteria complex into peyers patches

18
Q

what is the b cell adaptive response

A

mature naive b cell expresses igM in PPs
on antigen presentation class switches to igA
- t cells and epithelial cells influence b cell maturation via cytokine production
b cells further mature to become igA secreting plasma cells
populate lamina propria

19
Q

what immunoglobulin do upto 90% of gut b cells secrete

A

igA

secretory IgA binds luminal antigen - preventing its adhesion and consequent invasion

20
Q

why do enterocytes and goblet cells have short life span

A

can be directly affected by toxic substances in diet

- lesions will be short lived as responded to

21
Q

what is the mechanism of cholera

A

acute bacterial disease caused by vibrio cholerae serogroups o1 and o139
- bacteria reaches small intestine - contact with epithelium and releases cholera enterotoxin

22
Q

how is cholera transmitted

A

through faecal oral route

spreads via contaminated water and food

23
Q

what are the main symptoms of cholera

A

severe dehydration and watery diarrhoea

other symptoms: vomitting, nausea and abdo pain

24
Q

what is the diagnosis for cholera

A

bacterial culture from stool sample on selective agar is gold standard, rapid dipstick tests also available

25
what is the treatment for cholera
oral rehydration is main management - upto 80% cases can be successfully treated vaccine - dukoral, oral and inactivated globally : 1.3 - 4 mill cases
26
what are some viral causes of diarrhoea
rotavirus | norovirus - winter vomiting bug
27
what are some bacterial causes of diarrhoea
``` campylobacter jejuni escherichia coli salmonella shigella c. diff ```
28
what are some protozoal parasitic casues of diarrhoea
giardia lamlia | entamoeba histolytica
29
what are rota viruses
rna virus - replicates in enterocytes | 5 types: A is most common in human infections
30
what is the treatment for rotaviruses
oral rehydration therapy still causes ~ 200000 deaths/yr vaccine - live attentuated oral vaccine against ype a
31
what is the norovirus
rna virus | incubation period 24-48 hrs
32
how is norovirus transmitted
faecal oral transmission individuals may shed infectious virus for upto 2 wks outbreaks often occur in closed communties
33
what are the symptoms of norovirus
acute gastroenteritis
34
how to diagnose norovirus
sample pcr
35
what are the most common species of campylobacter
c. jejuni and c. coli
36
how is campylobacter spread
undercooked meat esp pultry untreated water unpasteurised milk low infective dose
37
what is treatment for camylobacter
non required usually azithromycin resitance to fluoroquinolones is problematic
38
what is e coli
diverse group of gram neg intestinal bacteria most harmles 6 pathotypes associated with diarrhoea
39
what is the management for c diff
isolate patient stop current antibiotics give metronidazole and vancomycin recurrence rate 15-35%, increasingly hard to treat faecal microbiota transplantation - 98% cure rate