Chronic Inflammation Flashcards Preview

ESA 2- Mechanisms of Disease > Chronic Inflammation > Flashcards

Flashcards in Chronic Inflammation Deck (171):
1

What is chronic inflammation?

A chronic response to injury with associated fibrosis

2

What is the timescale for chronic inflammation?

It is not rapid or immediate, and not short lived,

3

How does our knowledge of chronic inflammation differ from that of acute?

Less is known

4

Why is less known about chronic inflammation?

Because it’s so diverse

5

What does chronic inflammation overlap with?

Host immunity

6

How is the immune system different from chronic inflammation?

It’s very specific, and delivered by specific reactions with specific immunological reagents, whereas chronic inflammation is a generalised response to any injury

7

What is chronic inflammation usually associated with?

Some sort of the permanent tissue damage

8

What is the major difference between acute and chronic inflammation?

The long term outcomes are different

9

What are the long term outcomes of chronic inflammation?

No resolution, always leads to repair and scarring

10

Is function regained in chronic inflammation?

Sometimes

11

Can acute inflammation lead to chronic inflammation?

Yes, if the damage is not slight

12

When does chronic inflammation take over from acute?

If acute inflammatory processes don’t work immediately 
If damage is too severe to be resolved within a few days 
If infection arises

13

What is meant by chronic inflammation arising de novo?

When there is no acute phase- it goes straight to chronic

14

When may chronic infection arise de novo?

In some autoimmune conditions 
In some chronic infections 
Because of ‘chronic low level irritation’

15

Give an example of an autoimmune condition that can lead to chronic inflammation?

Rheumatoid arthritis

16

Why does chronic inflammation arise in some chronic infections?

Partly becomes of the bodies immunological response to them

17

What kind of inflammation does bacteria cause?

Acute

18

Give an example of an infection that causes chronic inflammation?

Vital hepatitis

19

What can chronic low level irritation be caused by?

A reaction to foreign material

20

How can  a bone replacement cause chronic inflammation?

If there is a joint replacement, a lot of compounds are inserted during the operation which can cause chronic inflammation, e.g. cement and bone fragments

21

What may chronic inflammation develop alongside?

Acute inflammation

22

When may chronic inflammation arise alongside acute inflammation?

In severe persistent or repeated infection

23

Can repeated attacks of acute inflammation which get better result in chronic inflammation?

Yes

24

How is chronic inflammation characterised?

It’s microscopic appearance

25

How does the microscopic appearance of chronic inflammation differ from that of acute?

It is much more variable

26

What is the microscopic appearance of chronic inflammation characterised by?

What the cellular infiltrate is

27

What is the most important characteristic of the cellular infiltrate?

What type of cell is present

28

What cells are involved in chronic inflammation?

Macrophages 
Lymphocytes 
Plasma cells 
Eosionphils 
Fibroblasts/myofibroblasts

29

Are macrophages used in acute inflammation?

They may be important in resolving it

30

What are macrophages more specifically associated with?

Chronic inflammatory reactions

31

What do macrophages have lots of?

Granular cytoplasm

32

Why do macrophages have a lot of granular cytoplasm?

Because they have lots of organelles to do with their phagocytic process

33

What are macrophages derived from?

Blood monocyte

34

What is a monocyte?

What we call a macrophage when it’s circulating in the blood

35

When is a monocyte called a macrophage?

When it gets into tissues

36

In what manner do macrophages get activated?

In various levels

37

Why are the various levels of activation of the macrophage important?

Because it would be bad if the monocyte performed it’s function in the circulation

38

When do blood monocytes get activated?

In chronic inflammation

39

What are the functions of macrophages?

Phagocytosis and destruction of debris and bacteria
Processing and presentation of antigen to immune system 
Synthesis of substances 
Control of other cells by cytokine release

40

What do macrophages synthesise?

Cytokines 
Complement components 
Blood clotting factors
Proteases

41

What do cytokines do?

Communicate with other cells

42

What are lymphocytes sometimes called?

Chronic inflammatory cells

43

Why may it be inappropriate for lymphocytes to be called chronic inflammatory cells?

They are a normal component of many tissues

44

What parts of the body are populated with lymphocytes?

Lymph nodes, gut, airway and lots of other places

45

What are the functions of lymphocytes?

Complex
Mainly immunological

46

What do B lymphocytes do?

Differentiate to produce antibodies

47

What do T lymphocytes do?

Involved in control and some cytotoxic functions 
Signal to other cells

48

What are plasma cells largely cells of?

Chronic inflammation reactions

49

Describe the structure of plasma cells?

Bilobed nucleus 
Bright pink eosinophilic cytoplasm

50

What are plasma cells?

Differentiated antibody producing B lymphocytes

51

What do plasma cells do?

They are a factor synthesising and secreting lots of antibodies

52

What do plasma cells usually imply?

Considerable chronicity

53

Why do plasma cells usually imply considerable chronicity?

Because it takes about 7 days for a plasma cell to develop an antibody response, and a chronic inflammatory response gives that duration

54

What are eosionphils involved in?

Allergic reactions 
Parasite infections 
Some tumours

55

How are eosionphils involved in allergic reactions?

IGE related processes

56

What tumours are eosionphils involved in?

Certain lymphomas

57

What are fibroblasts/myofibroblasts?

Connective tissue cells

58

What do (myo)fibroblasts do?

Produce collagen responsible for fibrosis

59

What recruits (myo)fibroblasts?

Macropages

60

What are giant cells?

Multinucleate cells made by the fusion of macrophages

61

When are giant cells made?

In frustrated phagocytosis

62

What is frustrated phagocytosis?

A situation where macrophages alone can’t phagocytose the target

63

Give 3 types of giant cells

Langerhans
Foreign body type 
Touton

64

What do Langerhans type giant cells look like?

Horseshoe of nuclei around the periphery 
Have very pale, foamy cytoplasm

65

When do Langerhans type giant cells occur?

Usually in the context of TB

66

Why does TB form Langerhans type giant cells?

Myobacterium TB is very resistant to phagocytosis and destruction, so can survive in the organelle/cytoplasm of a macrophage. The macrophage forms a giant cell to try and deal with them

67

When do foreign body type giant cells occur?

When cells engulf foreign bodies of any sort, e.g. calcium, bone fragments

68

Where do touton giant cells usually occur?

In areas of fat necrosis, e.g. in adipocytes

69

Why does fat necrosis cause Touton giant cells?

When you get fat necrosis in areas of high fat content, a lot of fat needs to be phagocytosed- can’t cope

70

Is the morphology of chronic inflammations specific or non-specific?

Non-specificin most

71

Give 3 example of conditions where the proportions of each cell in chronic inflammation vary?

Rheumatoid arthritis
Chronic gastritis 
Leishmaniasis

72

What cell types are present in chronic inflammation with rheumatoid arthritis?

Mainly plasma cells

73

What cell types are present in chronic inflammation with chronic gastritis?

Mainly lymphocytes

74

What cell types are present in chronic inflammation with Leishmaniasis?

Mainly macrophages

75

Why does Leishmaniasis produce chronic inflammation with mainly macrophages?

Protozoa parasites can survive in macrophages, so get lots of foamy macrophages reacting

76

How can the cell type present in chronic inflammation be helpful?

It can aid diagnosis

77

What are the effects of chronic inflammation?

Fibrosis
Impaired function 
Rarely, increased function 
Atrophy 
Stimulation of the immune response

78

Where may fibrosis be a problem?

In the gall bladder
Chronic peptic ulcers 
Cirrhosis

79

What is chronic cholecystitis?

A chronic inflammatory proces that leads to scarring of the gall bladder

80

Give an example of where chronic inflammation causes impaired function?

Chronic inflammatory bowel disease

81

Give two examples of where chronic inflammation can cause increased function

Mucus secretion
Thyrotoxicosis

82

Give an example of thyrotoxicosis?

Graves disease

83

What happens in Graves disease?

An antibody stimulates the TSH receptor, which leads to an excess of thyroxin

84

What is atrophy?

Loss of functional tissue mass

85

Give two examples of places that chronic inflammation can cause atrophy?

Gastric mucosa
Adrenal glands

86

How can chronic inflammation cause stimulation of the immune response?

Macrophage-lymphocyte interactions

87

Is the production of gall stones in the gall bladder a problem?

Not in itself

88

When is the production of gall stones a problem?

If they go into the cystic duct, they block bile flow. 
Gall stones move about, and might eventually pass down the billary tree

89

What is the problem with a blockage of bile flow?

Bile is highly toxic, so its blockage causes tissue injury, leading to inflammation and ulceration in the gall bladder mucosa

90

What happens if gall stones pass down the billary tree?

They cause inflammatory damage to the billary epithelium

91

What is the net effect in patients with gall stones?

They get multiple, repeated episodes of acute inflammation, which over time develops into chronic inflammation

92

What is the problem once the gall bladder is chronically inflamed?

It won’t resolve, and therefore can’t get better

93

What does chronic inflammation in the gall bladder lead to?

Fibrosis of the gall bladder wall

94

What is an ulcer?

A full thickness defect in the mucosa, which can be caused by necrosis

95

What can gastric ulceration be caused by?

Acute gastritis or chronic gastritis

96

What causes acute gastritis?

Alcohol and drugs

97

What causes chronic inflammation?

Helicobacter pylori

98

When does ulceration occur?

Because of an imbalance of acid production and mucosal defence

99

How does gastric ulceration appear?

As a rounded, discreet area of mucosal necrosis

100

What happens if gastric ulcers don’t get better quickly?

Can get a lot of tissue damage and scarring

101

Is tissue damage and scarring in the stomach a problem?

Not in most of the stomach, however if the antrum or pyloris are scarred, can get gastic outlet obstruction

102

What is the problem with a gastric outlet obstruction?

It can affect the perilstaltic function of the stomach

103

What is inflammatory bowel disease?

The specific term for a family of idiopathic inflammatory diseases

104

What is meant by idiopathic?

Unknown cause

105

What does inflammatory bowel disease look like?

Get cobblestone mucosa

106

What gives the cobblestone mucosa appearance?

Islands of surviving mucosa, inbetween which are ulcers

107

How does inflammatory bowel disease usually present?

Most patients have relaxing and remitting course

108

Why do most patients have a relaxing and remitting course of inflammatory bowel disease?

Because they get attacks of acute inflammation which will convert asymptomatic chronic disease into something symptomatic

109

What are the symptoms of inflammatory bowel disease?

Bleeding and diarrhoea

110

Why does inflammatory bowel disease cause bleeding?

It ulcerates any mucosal surface, and so the protective mucosa underneath damaged

111

Why does inflammatory bowel disease cause diarrhoea?

The function of the colon is compromised by the degree of inflammation

112

What is the prognosis for inflammatory bowel disease?

It pretty much stays- it can get better or worse. 
If treated, it can largely go away

113

What is the result of chronic inflammation to the bowel mucosa?

Chronic damage to the mucosa, leading to abnormal crypts and inflammation to the wall

114

What are the two types of inflammatory bowel disease?

Ulcerative colitis and Crohn’s disease

115

What is ulcerative colitis?

A superficial colonic disease, that leads to a lot of ulceration

116

What are the symptoms of ulcerative colitis?

Diarrhoea, bleeding

117

What is Crohn’s disease?

A transmural disease- inflammation through the full thickness of the bowel wall

118

What does Crohn’s disease lead to?

Strictures
Fistulae

119

What is a fistula?

An abnormal connection between two epithelium-lined organs

120

What is cirrhosis a consequence of?

Severe, chronic liver disease

121

What are the common causes of cirrhosis?

Alcohol
Infection with HBV, HCV
Immunological 
Fatty liver disease 
Drugs and toxins

122

How does a cirrotic liver usually appear?

Shrunken 
Diffuse process with bands of fibrous tissue and nodules of regenerating liver

123

When does cirrhosis cause complications?

When the normal liver architecture is destroyed

124

What leads to cirrhosis?

Chronic inflammation with fibrosis, disorganisation of architecture and attempted regeneration

125

What happens in Graves disease?

Get antibodies produced by plasma cells in chronic inflammatory infiltrate that stimulate the TSH receptor that causes thyroid epithelial cells to produce thyroxin

126

How does an atrophic gastric mucosa appear?

Lots of lamina propria, lots of lymphocytes

127

Why are there lots of lymphocytes with an atrophic gastric mucosa?

Because the epithelium has been destroyed by lymphocytes

128

How does atrophic gastric mucosa cause problems?

Get loss of acid producing cells, giving achlorhydria

129

What problems can gastric mucosa atrophy cause?

Gastric cancer

130

What kind of disease is rheumatoid arthritis?

Autoimmune

131

What causes rheumatoid arthritis?

Localised and systemic immune response

132

What problem does the localised immune response cause in rheumatoid arthritis?

Localised chronic inflammation leads to joint destruction

133

What problem does the systemic immune response cause in rheumatoid arthritis?

Can affect other organs and amyloidosis

134

What is amyloidosis?

A chemical process where proteins that can be laid down as ß pleated sheets can cause tissue problems

135

How does chronic inflammation lead to amyloidosis?

It can lead to an increase in plasma proteins, and therefore cause amyloidosis

136

How does rheumatoid arthritis present?

Classically symmetrical disease of small joints of hands and feet, leading to ulnar deviation of the hands and marked swelling of the joints

137

How do chronic inflammation and immune responses overlap?

Immune diseases cause pathology by chronic inflammation 
Chronic inflammatory processes can stimulate immune responses

138

What is granulomatous inflammation?

Chronic inflammation with granulomas

139

What is a granuloma?

A cohesive group of (usually) macrophages and other inflammatory cells

140

What do granulomas invariably have present?

Some other inflammatory cells, usually lymphocytes

141

Why do granulomas usually have lymphocytes present?

Because the role of T lymphocytes is in communicating with the macrophages with T helper cells, which is important in forming

142

What does a small granuloma consist of?

Epithelioid histiocytes on the inside
Lymphocytes on the outside

143

What are epithelioid histiocytes?

Modified, immobile macrophages

144

What do granulomas arise with?

Persistent, low-grade antigenic stimulation 
Hypersensitivity

145

What are hypersensitivity reactions?

Pathological immunological reactions

146

What are the main causes of granulomatous inflammation?

Mildly irritant ‘foreign’ material 
Infections 
Granulomatous diseases of unknown cause

147

What infections can cause granulomatous inflammation?

Tuberculosis
Leprosy 
Syphilis 
Chronic fungal infections 
Cat-scatch disease 
Xanthogranulomatous pyelonephritis and malakoplakia

148

What unknown causes can cause granulomatous inflammation?

Sarcoid
Wegener’s granulomatosis 
Crohn’s disease

149

What is Wegener’s granulomatosis?

Granulomatous vasculitis, usually affecting the lung and kidneys

150

What can happen if a patient gets a bowel perforation?

Often see little granulomas of feacel material

151

What causes tuberculosis?

Mycobacteria, especially M. tuberculosis

152

What is the problem with M. TB?

It is difficult and slow to culture, so to be sure of a negative result, have to give 6 weeks growth time

153

What wall lipids do TB have?

Mycosides

154

What is the result of TBs wall lipids?

They can be taken up by phagocytosis and survive

155

How does TB cause disease?

By persistence (leading to chronic inflammation) and induction of cell-mediated immunity

156

Does TB produce toxins or lytic enzymes?

No

157

What does a TB granuloma have in the middle?

Caseous necrosis

158

What are the outcomes of TB?

Arrest, fibrosis and scarring 
Erosion into bronchus 
Tuberculous empyema 
Erosion into blood stream

159

What is meant by arrest of TB?

The immune system controls it within granulomas

160

What can erosion of TB into the bronchus cause?

Bronchopneumonia 
TB in GIT

161

How can TB get into the GIT?

If coughed up and swallowed

162

What is empyema?

Formation of pus in pleural

163

What happens is TB erodes into the blood stream?

It circulates in the blood and spreads to multiple organs

164

What is it called when there are many TB bugs?

Miliary tuberculosis

165

What is it called when there are few TB bugs?

Single organ TB

166

How does sarcoidosis manifest clinically?

Variably

167

Who does sarcoidosis occur in?

Young adult women

168

What does sarcoidosis produce?

Non-caseating granulomas and giant cells

169

What does sarcoidosis involve?

Usually upper air and digestive tract
Usually bilateral hylar lymph node

170

What does the severity of sarcoidosis depend on?

Location

171

What is Crohn’s disease?

Region enteritis- patchy full thickness inflammation throughout the bowl