Chronic Inflammation Flashcards
(36 cards)
chronic inflammation is characterized by…
- accumulation of lymphocytes, plasma cells, and macrophages
- proliferating blood vessels
- formation of CT
- significant collateral damage
- repair processes occurring in parallel with persistent inflammation
what tends to cause acute inflammation
- infarction
- bacteria
- toxins
- trauma
what causes chronic inflammation
- viruses
- chronic infections
- persistent injury
- autoimmune disease
- genetic inability of the host to mount an appropriate response
the lack of resolution in chronic inflammation may be caused by…
- inability to get rid of the pathogen
- pathogen resistance to antimicrobials
- degradation resistant foreign body
chronic high levels of inflammatory cytokines cause
- increased rates of hepatic production of defense proteins
- increased hepcidin production
- increased growth factors for platelets and monocytes
what is the signature cell of chronic inflammation
M1 macrophages
what is hepcidin
it increases iron accumulation in macrophages and reducs iron absorption in the stomach so that there is less available iron for microbes to use but there is also less iron for pt so anemia is possible
M1s produce…
- ROS, NO, lysosomal enzyme for microbial actions and phagocytosis
- IL-1, IL-12, IL-23, and chemokines for inflammation
M2s produce…
- growth factors and TGF-B for tissue repair and fibrosis
- IL-10 and TGF-B for anti-inflammatory effects
what turns on M1s and turns off M2s?
microbes and IFN-y
What turns off M1s and turns on M2s?
IL-13 and IL-4
granulomatous inflammation
- associated with persistent T-cell activation
- common with persistent microbial intracellular infection
- common with macrophage uptake of poorly degradable foreign bodies
- found in sarcoidosis (granulomas without microbes), Inflammatory Bowel Disease, and Crohns
morphology of granuloma
- central portion is necrotic debris
- activated macrophages and multinucleated giant cells are in the periphery
- Cuff of T-cells, the vast majority of which are CD3+/CD4+
- the entire granuloma is rimmed by proliferating fibroblasts
what type of granulomas are seen in TB
caseous or necrotizing
what T cells are involved in granulomas
Th1- intracellular organisms
the Tcells in granulomas let out what cytokines?
IL-2 to promote more Th1 cells and INF-y to the APC
The APC lets out what cytokine in granulomas
IL-12 to the Th1 cell
frustrated macrophages in granulomas let out what cytokines
TNF-a, IL-1, IL-6, and IL-8
what is the logic of the granuloma
wall off the infecting organism- good but can cause collateral damage by progressive tissue necrosis and fibrosis
clinical differences in inlfammation are based solely upon _______ and _____
intensity and duration of the stimulus
biochemical changes in inflammation
- increased hepatic production of fibrinogen, ceruloplasmin, and complement components (C3)
- reciprocal decrease in albumin synthesis with duration of inflammation
- increased hepatic production of hepcidin
- growth factors stimulate marrow to increase production of leukocytes and platelets (can be shown clinically in blood counts)
C-Reactive Protein (CRP)
- production is stimulated by inflammation ad is tightly linked to IL-6 levels
- easily measured clinically— when it’s normal, it can exclude the presence of significant inflammation
- obesity can cause a false elevation of CRP
Erythrocyte sedimentation rate (ESR)
- chronic inflammation causes clinically detectable Ab sysnthesis of IgG
- IgG and fibrinogen coat RBCs which then fall more rapidly through a column of plasma (ESR)
- not a common because can be falsely elevated because of other reasons for higher IgG
What increases with chronic inflammation
- highest = CRP and ESR
- middle- platelets
- least- IgG
