Flashcards in 2. Inflammation Deck (63):
It is fundamentally a protective response, designed to eliminate initial cause of cell injury and the consequences of such injury:
What are the 2 types of inflammation and differentiate?
1. Acute inflammation - rapid in onset with short duration lasting for minutes to several hours or few days.
2. Chronic inflammation - longer in duration.
Differentiate acute inflammation from chronic inflammation according to morphologic or histologic features:
1. Acute inflammation - main characteristics are the exudation of fluis and plasma proteins and emigration of leukocytes, predominantly NEUTROPHILS
2. Chronic inflammation - presence of lymphocytes and macrophages, proliferation of blood vessels, fibrosis, and tissue necrosis
What are the general features of inflammation? (5 R's)
1. Recognition of injurious events
2. Recruitment of leukocytes
3. Removal of the agent
4. Regulation of response
5. Resolution (repair)
What are the 5 cardinal signs of inflammation?
1. Rubor - redness
2. Calor - heat
3. Tumor - swelling
4. Dolor - pain
5. Functio laesa - loss of function
It is transient and early response to injury that involves release of chemical mediators, causing stereotypic vessel and leukocyte responses:
What is the hallmark of acute inflammation?
Increase vascular permeability
What are the 3 major components of acute inflammation?
1. Vascular dilatation and increase blood flow (causing erythema and warmth)
2. Extravasation and deposition of plasma fluid and proteins (edema)
3. Leukocyte emigration and accumulation in the site of injury
What are the stimuli for acute inflammation?
3. Physical and chemical agents
4. Tissue necrosis
5. Foreign bodies
6. Immune reactions (hypersensitivity rxns)
Transudate vs. exudate
Transudate- hypocellular, poor protein (albumin), SG of 1.012, causes increase hydrostatic pressure and decrease oncotic pressure
Exudate - highly cellular, rich in protein, SG of >1.012(1.020) and causes inflammation or infection
What are the vascular events in acute inflammation?
1. Vasoconstriction of arterioles
2. Vasodilation of arterioles
3. Increase permeability of venules
4. Swelling of tissue (edema)
5. Reduced blood flow
One of the earliest manifestation of acute inflammation:
What are the 2 main mediators that induces vasodilation?
2. Nitric oxide
What are the 4 cellular events involved in leukocyte extravasation with their corresponding mediatiors?
1. Rolling (vasculature/stroma: E-selectin, P-selectin) (leukocyte- sialyl lewis)
2. Tight bonding (ICAM) (LFA-1(integrin))
3. Diapedesis (PECAM-1) (PECAM-1)
4. Migration (bacterial products: CILK - C5a, IL-8, LT B4, Kallikren
What are the mediators for chemotaxis, leukocyte recruitment and activation?
What are the mediators for fever?
What are the mediators for pain?
What are the mediators for tissue damage?
1. Lysosomal enzymes
What are the 2 main acute phase reactants?
2 C-reactive protein
What conditions present with increased ESR?
What conditions present with decreased ESR?
1. Sickle cell anemia
What are the morphologic hallmarks of Acute inflammation?
1. Dilation of small vessels
2. Slowing of blood flow
3. Accumulation of leukocytes and fluid in the extravascular tissue
What are the morphologic patterns in acute inflammation?
A type of inflammation where there is Outpouring of a thin fluid (effusion) derived from the plasma or from the secretions of mesothelial cells:
Give some examples of serous infammation:
1. Pleural effusion
2. Pericardial effusion
3. Skin blisters
Which biochemical disorder in heme synthesis presents with skin blisters due to photosensitivity?
What is the most common variant of porphyria? What enzyme is deficient?
Porphyria cutanea tarda
Deficient enzyme: URO decarboxylase
What is the morphologic characteristic of Fibrinous inflammation:
Bread and butter appearance
Give an example of fibrinous inflammation:
Two weeks after sustaining a myocardial infarction, your patient presented with fever, pleuritic chest pain, and a pericardial effusion. What is most likely etiology?
Dressler's syndrome - fibrinous pericarditis post MI
Type of inflammation containing pus or abscess?
Consists of neutrophils, liquefactive necrosis and edema
Pus or purulent exudate
Localized collections of purulent inflammatory tissue:
Central region: necrotic wbc and tissue
Outer rim: neutrophils, connective tissue
Examples of suppurative inflammation:
1. Acute appendicitis
2. Skin abscess
It is a local defect, or excavation, of the surface of an organ; produced by sloughing of inflamed necrotic tissue:
Example of ulcerative inflammation:
Peptic ulcer disease
What are the most common complications of peptic ulcer disease?
What blood vessels will be injured with perforation of gastric ulcer?
Left gastric artery
What blood vessels will be injured with perforation of duodenal ulcer?
Type of inflammation with bacterial toxin-induced damage of mucosal lining:
Morphologic characteristic of pseudomembranous inflammation:
Shaggy membrane of necrotic tissue
Give 3 examples of pseudomembranous inflammmation:
2. Esophageal candidiasis
3. Pseudomembranous colitis
Which antibiotic is regarded as the most common cause of pseudomembranous colitis?
Clindamycin (ampicillin, 3rd gen cephalosporins)
What is the treatment of pseudomembranous colitis?
Stop offending antibiotic
Note: metronidazole (metallic taste and disulfiram like effect)
Vancomycin (red man syndrome)
Inflammation of prolonged duration (weeks or months) in which inflammation, tissue injury, and attempts at repair coexist, in varying combinations
What are the 3 main causes of chronic inflammation?
1. Persistent infections (evoked as delayed type hypersensitivity or granulomatous reaction)
3. Prolonged exposure to potentially toxic agents
What are the cytokines involved in chronic inflammation?
1. IL-12 (principal source: Dendritic cells and macrophages)
2. IFN-y (principal source: T lymphocytes and NK cells)
3. IL-17 (principal source: T lymphocytes)
What is the principal action of IL-12?
Increase production of IFN-y
What is the principal action of INF-y?
Activation of macrophages (increase ability to kill microbes and tumor cells)
What is the principal action of IL-17?
Recruitment of neutrophils and monocytes
Morphologic characteristic of chronic inflammation:
1. Infiltration with mononuclear cells
2. Tissue deatruction
3. Healing by connective tissue replacement of damaged tissue (angiogenesis and fibrosis)
What is the dominant cellular player in chronic inflammation?
A type of inflammation with a distinctive pattern of chronic inflammatory reaction characterized by focal accumulations of activated macrophages, which often develop an epithelial-like appearance.
A focus of chronic inflammation consisting of a microscopic aggregation of macrophages that are transformed into epithelial-like cells surrounded by a collar of mononuclear leukocytes, principally lymphocytes with occasional plasma cells:
Macrophages surrounded by a collar of mononuclear leukocytes:
Epitherloid cells fused to form giant cells:
1. Langhans-type: in the periphery
2. Foreign body-type : haphazardly
Which DMARD drug may cause reactivation of latent tuberculous infection?
What precautionary test should be done prior to starting treatment with Influximab?
PPD or tuberculin test
What are the two types of granuloma and differentiate each?
1. Foreign body granuloma -incited by relatively inert foreign bodies.
2. Immune granulomas - caused by insoluble particles, typically microbes, capable of inducing a cell mediated immine response
In TB, granuloma is referred to what? Classically characterized by the presence of central caseous necrosis:
Give 6 examples of infectious cause of granulomatous inflammation:
3. Systemic mycosis
4. Catscratch disease
5. Tertiary syphilis
Give examples of non-infectious causes of chronic granulomatous inflammation:
2. Crohn's disease