Chronic Inflammation

Question 1

What is chronic inflammation?

Answer 1

prolonged inflammation with associated repair

Question 2

Features of chronic inflammation

Answer 2

delayed
variable duration
variable appearance
limits damage, initiate repair
cause debilitating symptoms

Question 3

when can chronic inflammation arise?

Answer 3

After acute (if resolution not possible)
Alongside acute (persistent irritiation)
De novo (by itself, eg. autoimmune conditions)

Question 4

cells present in chronic inflammation

Answer 4

macrophage
lymphocyte (B and T)
plasma cells
Eosinophils
fibroblasts/myofibroblasts 
giant cells

Question 5

macrophage name change

Answer 5

in blood - monocyte

in tissue - macrophage

Question 6

macrophage appearance

Answer 6

large
lots of foamy cytoplasm
slipper shaped nucleus? (indented)

Question 7

macrophage function

Answer 7

phagocytosis (remove pathogen/debris)
produce inflammatory mediators
antigen presentation

Question 8

Lymphocyte appearance

Answer 8

small (similar little larger than RBC)
spherical nucleus
thin cytoplasm

Question 9

T cell function

Answer 9

helper - assists other inflammatory cells

cytotoxic - destroy pathogens

Question 10

B cell function

Answer 10

mature into plasma cells

produce antibodies

Question 11

plasma cell appearance

Answer 11

eccentric nucleus (to one side)
nucleus: clock face clumped chromatin (around outside)
peri nuclear clearing (lighter patch around nucleus = golgi for antibodies)

Question 12

plasma cell function

Answer 12

produce antibodies - its a mature B cell

Question 13

Eosinophil appearance

Answer 13

bilobed nucleus
granular pink staining cytoplasm

tomato with sunglasses

Question 14

eosinophil function

Answer 14

release mediators (granular cytoplasm)
Hypersensitivity reactions (allergies and asthma)
Parasitic (worm) infections

Question 15

giant cells

Answer 15

fused macrophage

same cytoplasm, multinucleated

Question 16

why do giant cells form?

Answer 16

when one macrophage cannot destroy pathogen alone

Question 17

3 types of giant cells

Answer 17

foreign body
Langhan
Touton

Question 18

foreign body giant cells

Answer 18

random nuclei distribution

surround foreign body

Question 19

Langhans giant cell

Answer 19

usually tuberculosis
Nuclei is arranged around periphery
horse shoe nuclei pattern

Question 20

Touton giant cell

Answer 20

Central organised nuclei

fat necrosis

Question 21

What can cells in chronic inflammation indicate?

Answer 21

proportion of cells can indicate diagnosis

Question 22

diagnosis for lots of plasma cells

Answer 22

Rheumatoid arthritis

Question 23

Diagnosis for lots of lymphocytes

Answer 23

chronic gastritis

Question 24

Diagnosis for lots of macrophages

Answer 24

Protozoal infection (Leishmaniasis)

Question 25

effects of chronic inflammation

Answer 25

Fibrosis (collagen deposition) Impaired function (rarely increased eg Graves) Atrophy Stimulation of immune response

Question 26

Cholelithiasis

Answer 26

Repeated obstruction of bile duct from gall stones Fibrosis (thickened and pale wall of gall bladder) Repeated bouts of acute inflammation then becomes chronic

Question 27

how does fibrosis appear H&E?

Answer 27

pale pin linear strands

Question 28

Idiopathic inflammatory bowel disease effects and names

Answer 28

``` Crohns disease or Ulcerative colitis red and inflamed abdominal pain altered bowel motion weight loss rectal bleeding ```

Question 29

Crohns disease features

Answer 29

Can affect all of GI Discontinuous inflammation (skip lesions) Inflammation affects full thickness (transmural) - can cause strictures (narrowing) or fistulae (connect to other tissues) Granulomata Less likely rectal bleeding

Question 30

Ulcerative Colitis features

Answer 30

``` Only affects large bowel Continuous inflammation Only affects superficial bowel (mucosa and submucosa) No granulomata More likely rectal bleeding ```

Question 31

Cirrhosis

Answer 31

End stage liver damage | Fibrosis (pale areas) with attempted regeneration (nodules)

Question 32

causes of cirrhosis

Answer 32

alcohol hepatitis drugs/toxins fatty liver disease

Question 33

what is granulomatous inflammation?

Answer 33

Chronic inflammation with granuloma

Question 34

what is a granuloma?

Answer 34

collection of epithelioid histiocytes | with surrounding lymphocytes

Question 35

what is a epithelioid histiocyte?

Answer 35

Macrophages that looks like an epithelial cell | light pink and packed

Question 36

types of granuloma

Answer 36

Foreign body | Immune mediated

Question 37

Foreign body granuloma

Answer 37

destruction and removal of foreign material (surgical thread, implant, shrapnel) few lymphocytes

Question 38

Immune mediated granuloma

Answer 38

Destruction and removal of pathogens (bacteria/fungi) Central necrosis can occur can be idiopathic MANY lymphocytes

Question 39

Infections that often cause granuloma and why

Answer 39

Mycobacterium (mycobacterium tuberculosis, mycobacterium leprae) Difficult destroy due to thick cell wall and mycolic acids (proteins on surface)

Question 40

Specific features of mycobacterium granuloma

Answer 40

Epithelioid histiocytes Central caseous necrosis Many lymphocytes

Question 41

Causes of granulomatous inflammation

Answer 41

Crohns (non caseating) Sarcoidosis (non caseating) - lungs, skin and lymph can cause nodules on skin, enlarged lymph nodes and breathlessness