Acute and chronic inflammation

Question 1

Aetiology definition

Answer 1

cause of a disease/condition (pathology). Can be genetic +/ environmental

Question 2

Pathogenesis definition

Answer 2

progressive changes as the disease develops (morphological cellular changes and macroscopic)

Question 3

Sequalae definition

Answer 3

what happens next e.g. an intervention

Question 4

What is inflammation?

Answer 4

an immune response aimed at eliminating the inciting cause

Question 5

What are the possible inciting causes?

Answer 5

microorganisms, particulate materials (allergens or prostheses), altered self cells (disorders or injury) and transformed malignant cells (neoplasia)

Question 6

What are the stages of inflammation?

Answer 6

initiation (response to harmful agent), progression (containment), amplification (modulation of immune response), resolution (healing or failure to resolve)

Question 7

What is the resolution of acute inflammation?

Answer 7

healing (complete restoration of tissues)

Question 8

What is the resolution of chronic inflammation?

Answer 8

failure to resolve (leads to loss of function)

Question 9

Which parts of the immune system are involved in acute inflammation?

Answer 9

innate immune system only (e.g. neutrophils)

Question 10

Characteristics of acute inflammation

Answer 10

rapid onset, short-term, localised response

Question 11

In which type of inflammation may an abscess form?

Answer 11

acute inflammation

Question 12

What tends to precede chronic inflammation?

Answer 12

Acute inflammation

Question 13

How long can chronic inflammation last?

Answer 13

long-term, years, entire lifetime (persistent inflammation)

Question 14

Which parts of the immune system are involved in chronic inflammation?

Answer 14

Innate and adaptive immune system

Question 15

What is fibrosis?

Answer 15

formation of scar tissue

Question 16

In which type of inflammation may fibrosis occur?

Answer 16

chronic inflammation

Question 17

What are the 5 cardinal signs of inflammation?

Answer 17

redness (rubor), swelling (tumor), heat (calor), pain (dolor), loss of function (functio laesa)

Question 18

What causes redness (rubor) and heat (calor)?

Answer 18

dilation of small blood vessels adjacent to site of damage

Question 19

What happens to endothelial cells during inflammation?

Answer 19

endothelial cells swell and retract. Become activated to promote diapedesis (migration of immune cells to site of damage)

Question 20

Exudation definition

Answer 20

vessels become leaky and allow passage of fluids

Question 21

What substances drive dilation, exudation and endothelial activation?

Answer 21

soluble mediators

Question 22

What causes swelling (tumor)?

Answer 22

Exudation leads to oedema and there is an increased blood and lymph flow

Question 23

Oedema definition

Answer 23

excess of watery fluid collecting in tissues of body

Question 24

What does inflammatory exudate consist of?

Answer 24

fluids (lymph) and salts, glucose and oxygen (for immune cells), immune cells and soluble mediators, fibrin

Question 25

What causes pain (dolor) during inflammation?

Answer 25

stretching of tissues (due to excess fluid build up) and due to soluble mediators)

Question 26

What are the main types of soluble mediators?

Answer 26

AMPs, enzymes, cytokines and chemokines, complement proteins, prostaglandins and leukotrienes, immunoglobulins, growth factors, matrix metalloproteinases (MMPs)

Question 27

What are prostaglandins and leukotrienes?

Answer 27

chemical mediators

Question 28

Which cells produce prostaglandins and leukotrienes?

Answer 28

macrophages and neutrophils

Question 29

How are prostaglandins and leukotrienes produced?

Answer 29

By the metabolism of the fatty acid, arachidonic acid (found in neutrophils and macrophages)

Question 30

Which enzyme converts arachidonic acid into leukotrienes?

Answer 30

lipoxygenase

Question 31

Which enzyme converts arachidonic acid into prostaglandins?

Answer 31

cyclooxygenase

Question 32

How does ibuprofen work?

Answer 32

targets cyclooxygenase (enzyme) to inhibit prostaglandins production. This reduces inflammation

Question 33

What roles do prostaglandins and leukotrienes play in inflammation?

Answer 33

cause vascular dilation, act on nerve fibres (itching), involved in chemotaxis, tissue remodelling

Question 34

What is the largest component of human blood?

Answer 34

plasma (55%)

Question 35

What are the 4 plasma factor systems?

Answer 35

complement, kinins, coagulation factors, fibrinolytic system

Question 36

What is the name of the protein that can activate all 4 plasma factor systems?

Answer 36

Hageman factor (coagulation factor XII)

Question 37

What is the Hageman factor?

Answer 37

A serine protease (enzyme) that is circulating inactive in blood

Question 38

How is the Hageman factor activated?

Answer 38

When it circulates in inflamed tissue

Question 39

What is the complement system made up of?

Answer 39

A collection of soluble proteins present in circulation

Question 40

Where are complement proteins produced?

Answer 40

in the liver and by immune cells

Question 41

What 3 processes are driven by complement proteins?

Answer 41

opsonisation (tagging microorganisms for removal), forming membrane attack complexes (pores) and as pro-inflammatory proteins

Question 42

What are the 3 pathways of complement?

Answer 42

classical, lectin and alternative pathway

Question 43

Which complement pathway does the Hageman factor activate?

Answer 43

classical pathway

Question 44

What is the kinin system made up of?

Answer 44

collection of different inactivated proteins circulating in the blood waiting to be activated

Question 45

What does the kinin system ultimately lead to the production of?

Answer 45

bradykinins

Question 46

What is the main protein within the kinin system?

Answer 46

Kallikrein

Question 47

How is kallikrein activated?

Answer 47

Hageman factor cleaves the precursor of kallikrein (pre-kallikrein) to convert it into kallikrein (active). Neutrophils also can produce enzymes to convert pre-kallikrein into kallikrein.

Question 48

Function of kallikrein

Answer 48

kallikrein converts kininogens to kinins

Question 49

Example of kinin

Answer 49

bradykinin

Question 50

Function of kinins/bradykinin

Answer 50

has widespread effects (like complement proteins/anaphylatoxins) e.g. driving diapedesis, swell and retract endothelial cells making blood vessels leaky.

Question 51

Outline the kinin system pathway

Answer 51

pre-kallikrein is converted to kallikrein by Hageman factor/neutrophils. Kallikrein converts kininogens to kinins (e.g. bradykinins)

Question 52

Function of the coagulation system

Answer 52

form blood clots

Question 53

What are the 2 pathways that activate the coagulation system?

Answer 53

intrinsic and extrinsic pathway

Question 54

How is the intrinsic pathway of the coagulation system activated?

Answer 54

By internal vasculature injury (blood vessel rupture) which results in the Hageman factor (coagulation factor XII) becoming activated as it comes into contact with abnormal/activating surfaces

Question 55

How is the extrinsic pathway of the coagulation system activated?

Answer 55

External injury leading to bleeding (e.g. cut)

Question 56

What is common about the intrinsic and extrinsic pathways?

Answer 56

Both involve a cascade of clotting factors (plasma proteins) e.g. starting with the activation of the Hageman factor

Question 57

What do both the intrinsic and extrinsic pathways diverge into?

Answer 57

common pathway

Question 58

What does the common pathway of the coagulation system involve?

Answer 58

formation of a stable blood clot (fibrin) through the action of thrombin and the support of platelets

Question 59

What is a stable blood clot made up of?

Answer 59

fibrin and activated platelets (have projections)

Question 60

What happens to the blood vessel during the formation of a platelet plug?

Answer 60

vasoconstriction

Question 61

Which clotting factor converts fibrinogen into fibrin?

Answer 61

thrombin

Question 62

What is the name of inactivated thrombin?

Answer 62

prothrombin

Question 63

Which plasma factor systems can activate the complement system?

Answer 63

kinin system and fibrinolytic system

Question 64

What is the main protein in the kinin system?

Answer 64

kallikrein

Question 65

What is the main protein in the coagulation system?

Answer 65

fibrin

Question 66

What is the main protein in the fibrinolytic system?

Answer 66

plasmin

Question 67

Function of the fibrinolytic system

Answer 67

breaks down fibrin to prevent excess clotting and (plasmin) can activate the complement system

Question 68

What is the precursor to plasmin?

Answer 68

plasminogen

Question 69

How is plasminogen converted to plasmin in the fibrinolytic system?

Answer 69

By the Hageman factor or kallikrein

Question 70

Function of plasmin

Answer 70

breaks down fibrin and activates the complement system

Question 71

How does plasmin activate the complement system?

Answer 71

Plasmin can cleave the C3 complement protein (drives opsonisation, inflammation, membrane attack complex)

Question 72

Name of disease caused by excess blood clotting in circulatory system

Answer 72

thrombosis

Question 73

Name of disease caused by excessive bleeding into tissues

Answer 73

haemorrhage

Question 74

How may thrombosis or haemorrhage arise?

Answer 74

imbalance between the coagulation and fibrinolytic system

Question 75

What is maintaining the balance between the coagulation and fibrinolytic systems known as?

Answer 75

haemostasis

Question 76

Why is it important to maintain haemostasis?

Answer 76

to prevent thrombosis and haemorrhage

Question 77

How can haemostasis be maintained in people with disorders of the plasma factor system?

Answer 77

by sequalae (interventions)

Question 78

Examples of disorders of the plasma factor systems

Answer 78

Von Willebrand disease, Haemophilia A and B

Question 79

What causes Von Willebrand disease, Haemophilia A and Haemophilia B?

Answer 79

mutations in genes that code for clotting factor proteins (specifically in coagulation system)

Question 80

What medications inhibit blood clotting?

Answer 80

Warfarin and Heparin