Chronic Inflammation Flashcards
(26 cards)
What is chronic inflammation?
Long term response to injury with associated fibrosis
Causes of chronic inflammation?
Autoimmune e.g. Rheumatoid arthiritis, crohns
Chronic infections- viral hepatitis
Chronic low level irritation- H. pylori
Alongside acute- Chronic cholecystitis
Which cells are present in chronic inflammation?
Macrophages Lymphocytes Plasma cells Eosinophils Fibroblasts/myofibroblasts Giant cells
What do macrophages do?
And where are they derived from?
They: phagocytose, Antigen present, synthesise-cytokines blood clotting factors and proteases.
They are derived from monocytes in bone marrow
What are lymphocytes?
‘Chronic inflammatory cells’
B lymph: produce antibodies
T lymph: involved in control and cytotoxic functions
What are plasma cells?
Differentiated antibody producing B lymphocytes
Clear sign of chronic inflammation
What are eosinophils?
Allergic reactions, parasite infections and tumours
What do fibroblasts do?
Recruited by macrophages to make collagen
What are Giant cells?
What do they do?
Giant cells are multinucleate cells made by the fusion of macrophages. More effective as larger aggregate Langhans- TB Foreign body type Touton- fat necrosis
List the effects of chronic inflammation
Fibrosis: e.g. cirrhosis, chronic cholecystitis
Impaired function: e.g. chronic IBD- crohns & UC
Atrophy: gastric mucosa/adrenal glands
Stimulated immune response: macrophage/lymphocyte interactions.
How does fibrosis occur?
Repeated attacks of acute inflammation
Thickened muscle leading to lymphocytes and scarring
Give two examples of fibrosis?
Chronic cholecystitis- gallstones causes acute inflammation and irritation to the gallbladder wall. This occurs repeatedly and over time causes scarring and fibrosis.
Gastric ulceration- acute gastritis or chronic gastritis
Ulceration due to imbalance of acid production
Defect in the mucosa leaving the submucosa open to acid.
Describe typical presentation of Ulcerative colitils?
Typically younger female.
Abdomen pain, weight loss, rectal bleeding, diarrhoea.
No skip lesions, continous affecting the colon and cecal patch.
How does crohns differ from U.C?
Crohns is transmural therefore fistula and strictures
Crohns is mouth to anus with skip lesions. Cobbles stone appearance.
No rectal involvement
How can Rectal sparing occur in U.C?
UC patients are often given suppository this can heal the rectum.
How can scarring affect the liver?
Fibrosis = cirrhosis
Caused by alcohol, infection, immunological, Fatty liver disease, drugs and toxins
Fibrosed nodular green appearance due to impairment of bilirubin conjugation.
High collagen content.
Give an example of how chronic inflammation causes increased function
Thyrotoxicosis - Graves disease
Hyperthyroidism- caused by TSH antibodies acting on TSH receptors causing increased T3 + T4 release.
What are the localised and systemic responses in Rheumatoid arthritis?
Localised: chronic inflammation of the joints, synovium covered in lymphoid tissue
Systemic: Skin, lungs and pleura affected- amyloidosis
What is a granuloma?
Aggregate of activated macrophages
Immune system attempts to wall off a foreign substance which it cannot break down.
State the main causes of granulomatous inflammation
Foreign material Mycobacterium TB- casseous necrosis Sarcoidosis Wegeners granulomatosis- lesions in Resp tract and kidneys Crohns disease
Why does TB cause granulomas?
TB is a mycobacterium with mycolic acid wall.
Therefore cannot be broken down via phagocytosis
List the 4 outcomes of TB
1) Arrest, fibrosis, scarring.
2) Ersion into the bronchus - bronchopneumonia or TB in GIT
3) Tuberculous empyema- infection of the pleural space
4) Erosion into the blood stream = Miliary TB which is systemic and fatal.
List 5 Granulomatous infections apart from TB
Leprosy Syphilis Chronic fungal infections Cat scratch disease Xanthogranulomatous pyelonephritis
Describe the symptoms and causes of sarcoidosis
Normally presents in young adult women
With cough and high Calcium blood levels
Non-caseating granulomas, giant cells present involving the lymph nodes and lungs
