10.09 Chronic inflammation

Question 1

chronic inflammation

Answer 1

inflammation of prolonged duration in which active inflammation, tissue destruction and attempts at repair are proceeding simultaneously.

may begin spontaneously or as a result of smoldering acute inflammation

Question 2

cells involved in chronic inflammation

Answer 2

mononuclear cells: lymphocytes (B and T), macrophages (monocytes specialized in tissue), plasma cells (specialized B cells in tissue; never found in circulation)

Question 3

granulation and fibrosis

Answer 3

granulation tissue: ingrowth of new capillaries (to supply cells involved in inflammation)

fibrosis: scarring

Question 4

macrophage activation

Answer 4

circulating monocyte is drawn to inflammation site

tissue macrophage is activated by non-immune activation (endotoxin, fibronectin, etc) and/or activated T-cells

Question 5

activated macrophages: tissue injury

Answer 5

• tissue injury: phagocytosis, proeases, neutrophil chemotactic factors, coagulation factors, aa metabolites, NO, ROS

Question 6

activated microphages: fibrosis

Answer 6

fibrosis: growth factors (PDGF, FGF, TGF-beta)
fribrogenic cytokines.
.angiogenesis (FGF, VEGF),
“remodeling” collagenesis

Question 7

activated macrophages: mediators

Answer 7

cytokines: interferon-gamma (activates macrophages)

lymphokines, monokines (attract leukocytes)

C5a

angiogenesis factors (VEGF)

Question 8

granulomatous inflammation: definition

Answer 8

nodular collection of specialized macrophages that are a part of chronic inflammation

infectious and non-infectious or immune and foreign body

represent a cellular attempts to contain an offending agent that is difficult to eradicate

Question 9

granulomatous inflammation: macrophages

Answer 9

macrophages and recruited to the site, divide then aggregate to form a granuloma

**macrophages and leukocytes are not terminally differentiated and can divide in tissue

**neutrophils are terminally differentiated and cannot divide (for short-term use)

Question 10

granulomatous: types

Answer 10

• morphology
  
  • non-necrotizing: foreign body, sarcoid (unknown etiology), fungi
  • necrotizing: TB, fungi, rhematoid arthritis
  • **TB: caseating granulomas (“chessy” look)
  • suppurative (puss; active inflamm): chalazion, CSD

Question 11

granulomatous inflammation: multi-nucleated giant cells

Answer 11

not a marker: also seen in tumors

seen in some but not all granulomas

syncitial (fused) macrophages: if offending agent is too big or difficult to digest for one cell

enhanced phagocytic activity but with limited life-span (incapable of dividing) >> one way of inhibiting macrophages from dividing forever

foreign body (suture) giant: random nuclei organization

Langhans giant cell: nuclei organized around the edges

Question 12

systemic effects of chronic inflammation

Answer 12

• low grade fever
• malaise, weight loss, anemia
• mild leukocytosis: usually lymphocytosis not neutrophils