Chronic Inflammation Flashcards
(171 cards)
1
Q
What is chronic inflammation?
A
A chronic response to injury with associated fibrosis
2
Q
What is the timescale for chronic inflammation?
A
It is not rapid or immediate, and not short lived,
3
Q
How does our knowledge of chronic inflammation differ from that of acute?
A
Less is known
4
Q
Why is less known about chronic inflammation?
A
Because it’s so diverse
5
Q
What does chronic inflammation overlap with?
A
Host immunity
6
Q
How is the immune system different from chronic inflammation?
A
It’s very specific, and delivered by specific reactions with specific immunological reagents, whereas chronic inflammation is a generalised response to any injury
7
Q
What is chronic inflammation usually associated with?
A
Some sort of the permanent tissue damage
8
Q
What is the major difference between acute and chronic inflammation?
A
The long term outcomes are different
9
Q
What are the long term outcomes of chronic inflammation?
A
No resolution, always leads to repair and scarring
10
Q
Is function regained in chronic inflammation?
A
Sometimes
11
Q
Can acute inflammation lead to chronic inflammation?
A
Yes, if the damage is not slight
12
Q
When does chronic inflammation take over from acute?
A
If acute inflammatory processes don’t work immediately
If damage is too severe to be resolved within a few days
If infection arises
13
Q
What is meant by chronic inflammation arising de novo?
A
When there is no acute phase- it goes straight to chronic
14
Q
When may chronic infection arise de novo?
A
In some autoimmune conditions
In some chronic infections
Because of ‘chronic low level irritation’
15
Q
Give an example of an autoimmune condition that can lead to chronic inflammation?
A
Rheumatoid arthritis
16
Q
Why does chronic inflammation arise in some chronic infections?
A
Partly becomes of the bodies immunological response to them
17
Q
What kind of inflammation does bacteria cause?
A
Acute
18
Q
Give an example of an infection that causes chronic inflammation?
A
Vital hepatitis
19
Q
What can chronic low level irritation be caused by?
A
A reaction to foreign material
20
Q
How can a bone replacement cause chronic inflammation?
A
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
Q
What may chronic inflammation develop alongside?
A
Acute inflammation
22
Q
When may chronic inflammation arise alongside acute inflammation?
A
In severe persistent or repeated infection
23
Q
Can repeated attacks of acute inflammation which get better result in chronic inflammation?
A
Yes
24
Q
How is chronic inflammation characterised?
A
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
