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Molecular Physiology And Pathophysiology > Lecture 4 > Flashcards

Lecture 4 Flashcards

1
Q

how do you measure tissue damage?

A

can measure a fluorescent assay for DNA, look at DNA release

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2
Q

at what pH is there more DNA release?

A

pH2 and there is even more DNA release with pepsin + pH2

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3
Q

what are the 5 tissues in the larynx?

A

supra glottic, posterior commissure, ventricle, vocal fold and sub glottic

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4
Q

what tissue type is the sub glottic?

A

columnar epithelium

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5
Q

what tissue type is supra glottic?

A

squamous epithelium

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6
Q

what is the tissue type in the vocal chords?

A

there is a mixture of types

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7
Q

what is the highest level of pepsin in gastric juice?

A

1mg/ml

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8
Q

what tissue in the larynx is the most damaged by pepsin?

A

sub glottis

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9
Q

what tissue in the larynx is the least damaged by pepsin?

A

the posterior commissure

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10
Q

what in the stomach gives you pH gradient across the mucus layer?

A

a bicarbonate secretion with the mucus layer

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11
Q

what tissue type is the oesophagus?

A

squamous epithelium

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12
Q

how does the oesophagus protect itself from gastric juice If it doesn’t contain a mucus layer?

A

it sheds dead cells

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13
Q

what organ is more sensitive the oesophagus or the larynx?

A

the larynx, as the oesophagus is more protected

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14
Q

what symptoms can you get from LPR?

A

hoarseness and globus pharyngeanus, chronic cough

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15
Q

what is LPR?

A

larynx-pharyngeal reflux

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16
Q

what is globus pharyngeus?

A

a lump in your throat which is related to reflux

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17
Q

why isn’t heart burn common in LPR?

A

because generally stays in the oesophagus, heart burn doesn’t happen in the larynx

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18
Q

how many isoforms are there of carbonic anhydrase?

A

11

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19
Q

what does carbonic anhydrase do?

A

it generates bicarbonate, to protect the tissue from acid reflux - bicarbonate neutralises it

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20
Q

what type of carbonic anhydrase is increased in GORD?

A

carbonic anhydrase 3

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21
Q

what does carbonic anhydrase do when its expression is increased?

A

moves the expression away from the surface of the cells down into the mucosa to form a barrier

22
Q

what can be seen in LPR patients regarding carbonic anhydrase 3?

A

there is none - it is completely lost

23
Q

in different pHs in in the oesophagus is the expression of carbonic anhydrase 3 affected by acid exposure?

A

No, in the oesophagus acid does not affect the expression of carbonic anhydrase at any pH

24
Q

does acid exposure affect the larynx at different pHs?

A

yes, there is high expression of carbonic anhydrase at ph7.4, then a reduction at ph4, and an even bigger reduction at pH2

25
Q

can the tissue recover in the larynx from pH2 with acid exposure?

A

yes if you incubate the tissue at pH7.4 for 4 hours

26
Q

what happens to the expression of carbonic anhydrase when acid and pepsin exposure occurs in the oesophagus?

A

at ph4 there is a reduction and an even bigger Reduction at ph2

27
Q

can the oesophagus recover after its been exposed to acid and pepsin?

A

yes if it is incubated for 4 hours at a pH of 7.4

28
Q

what happens to the expression of carbonic anhydrase when acid and pepsin exposure occurs in the larynx?

A

there is little or no expression of carbonic anhydrase at pH4 and Ph2

29
Q

is the larynx able to recover after exposure of acid and pepsin?

A

no, it becomes irreversible

30
Q

what is the normal expression of mucus in the larynx?

A

MUC4 and MUC5AC

31
Q

what is MUC4?

A

it is a membrane bound mucin

32
Q

what is MUC5AC?

A

it is a gel forming surface mucin

33
Q

what happens to MUC5AC in LPR?

A

the expression of MUC5AC is lost - the surface mucus has a role in protection and now it is gone

34
Q

what is the treatment for OME (glue ear)?

A

Pierce the eardrum and suck out the mucus effusion and fit the grommet which helps the pressure

35
Q

what is the hearing loss for people that have glue ear?

A

20 decibel loss

36
Q

what can pepsin damage?

A

can damage tissues at high pH

37
Q

what can be associated with supra-oesophageal disease?

A

pepsin can be found which means reflux has happened

38
Q

what are lung transplants called?

A

allografts

39
Q

what are allografts?

A

they are not perfectly matched

40
Q

what are isografts?

A

they are a perfect match

41
Q

what happens if after 5 years of a lung transplant there is epithelial damage or scarring?

A

could be linked to gastroesophageal reflux

42
Q

what happens as a result from fibrosis in lung transplant rejection?

A

FEV1 is lost over time, no air can go through and lungs lose the ability for gas exchange =

43
Q

what syndrome can result from fibrosis?

A

Bronchiolitis obliterates syndrome (BOS)

44
Q

what happens if you develop BOS early in time after a transplant?

A

higher bile acids

45
Q

what happens to bile acids during liver failure?

A

bile acids increase

46
Q

what is a test that measures bile acids in liver failure?

A

colorimetric test

47
Q

what does it mean if you have acid in the lungs?

A

must have come from a double reflux event, acid would have come from the duodenum in the stomach and up into the oesophagus and then aspirated into the lungs

48
Q

what event is reflux?

A

it is a transient event

49
Q

what could reflux play a role in?

A

lung allograft rejection

50
Q

describe the paradigm for chronic allograft rejection?

A

alloreactivity and response to injury (acute rejection), then get a cytokine response (killer T lymphocytes) with a transition of the epithelia to myofibroblasts, matrix changes and collagen scarring which leads to an allograft loss and death

51
Q

what must of happened if you are developing BOS?

A

must have had an acute rejection event

52
Q

what do clinicians provide to patients that develop BOS?

A

steroids to dampen down the inflammatory response

Molecular Physiology And Pathophysiology (14 decks)

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