Chronic Inflammation

Question 1

What is chronic inflammation?

Answer 1

Chronic response to injury with associated fibrosis

Question 2

How does chronic inflammation arise?

Answer 2

1) It may ‘take over’ from acute inflammation if damage is too severe to be resolved within a few days
2) May arise de novo
3) May develop alongside acute inflammation in severe persistent/repeated irritation

Question 3

In which situations can chronic inflammation arise de novo?

Answer 3

Some autoimmune conditions (such as rheumatoid arthritis)

Some chronic infections (eg viral hepatitis)

‘Chronic low-level irritation’

Question 4

What is the most important characteristic of how chronic inflammation looks?

Answer 4

The type of cell present

Question 5

What are the cells of chronic inflammation?

Answer 5

Macrophages, lymphocytes, plasma cells, eosinophils, fibroblasts

Question 6

What are macrophages derived from?

Answer 6

Blood monocytes

Question 7

What are the functions of macrophages?

Answer 7

1) Phagocytosis
2) Antigen presentation
3) Synthesis of cytokines, complement, blood clotting factors and proteases
4) Control of other cells by cytokines release

Question 8

Which are the two types of lymphocytes?

Answer 8

B lymphocytes and T lymphocytes

Question 9

What is the difference between T and B lymphocytes?

Answer 9

T = involved in control and some cytotoxic functions

Cell mediated

B = Differentiate to produce antibodies

Humoral

Question 10

What is a feature of the appearance of plasma cells?

Answer 10

Open nucleus - can see cytoplasm, visible golgi

Question 11

What is a feature of the appearance of eosinophils?

Answer 11

Stain pink, bilobe nucleus

Question 12

What are plasma cells?

Answer 12

Differentiated antibody-producing B lymphocytes

Question 13

What does the presence of plasma cells usually imply?

Answer 13

Considerable chronicity - usually lasted a while

Question 14

In which situations are eosinophils usually involved?

Answer 14

Allergic reactions, parasite infestations, some tumours

Question 15

How are fibroblasts involved in the chronic inflammatory response?

Answer 15

Recruited by macrophages, make collagen

Question 16

What are giant cells?

Answer 16

Multinucleate cells made by fusion of macrophages

Question 17

When are giant cells usually present?

Answer 17

Frustrated phagocytosis

Question 18

What are 3 types of giant cells?

Answer 18

Langhans (TB)
Foreign Body Type
Touton (fat necrosis)

Question 19

What is a feature of the appearance of langhans type giant cells?

Answer 19

Horseshoe nuclei

Question 20

What is a feature of the appearance of foreign body type giant cells?

Answer 20

Multiple irregular aggregates of nuclei

Question 21

Which cell type is usually present in rheumatoid arthritis?

Answer 21

Mainly plasma cells

Question 22

Which cell type is usually present in chronic gastritis?

Answer 22

Mainly lymphocytes

Question 23

Which cell type is usually present in leishmaniasis (a protozoan infection)?

Answer 23

Mainly macrophages

Question 24

What are some effects of chronic inflammation?

Answer 24

Fibrosis, impaired function, atrophy, stimulation of immune response

Question 25

What is an example of a condition where fibrosis is the effect of chronic inflammation?

Answer 25

Cirrhosis

Question 26

What is an example of a condition in which impaired function is the effect of chronic inflammation?

Answer 26

Chronic inflammatory bowel disease

Question 27

What is an example of a condition in which increased function is the effect of chronic inflammation?

Answer 27

Thyrotoxicosis

Question 28

What is cholecystitis?

Answer 28

Inflammation of the gallbladder

Question 29

What is one cause of fibrosis of gall bladder wall?

Answer 29

``` Chronic cholecystitis (Repeated obstruction by gall stones, repeated acute inflammation leading to chronic inflammation) ```

Question 30

What is inflammatory bowel disease?

Answer 30

Idiopathic inflammatory disease affecting large and small bowel

Question 31

What do patients with inflammatory bowel disease present with?

Answer 31

Diarrhoea, rectal bleeding (due to damaged mucosa, ulcers)

Question 32

What is ulcerative colitis?

Answer 32

Ulcerative colitis is a long-term condition, where the colon and rectum become inflamed.

Question 33

What is a fistula?

Answer 33

Abnormal connection between two epithelium-lined organs

Question 34

True or False: Ulcerative colitis is superficial thus causing diarrhoea and bleeding

Answer 34

True

Question 35

True or False: Crohn's disease is transmural thus causing strictures and fistulae

Answer 35

True

Question 36

What are some common causes of cirrhosis?

Answer 36

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

Question 37

What is thyrotoxicosis?

Answer 37

Hyperthyroidism - thyroid produces too much thyroid hormone

Question 38

How do immune diseases cause pathology?

Answer 38

Chronic inflammation

Question 39

What is granulomatous inflammation?

Answer 39

Chronic inflammation with granulomas

Question 40

What is a granuloma?

Answer 40

A mass of granulation tissue, typically produced in response to infection, inflammation, or the presence of a foreign substance.

Question 41

What do granulomas arise with?

Answer 41

Persistent, low grade antigenic stimulation and hypersensitivity

Question 42

What are the main causes of granulomatous inflammation?

Answer 42

1) Mildly irritant foreign material 2) Infections (eg TB) 3) Sarcoid 4) Crohn's disease 5) Wegener's granulomatosis

Question 43

Why are Myobacteria tuberculosis hard to phagocytose?

Answer 43

Contain wall lipids (mycosides) that are difficult for phagocytes to digest

Question 44

How do Mycobacteria tuberculosis cause disease?

Answer 44

By persistence and induction of cell-mediated immunity (use body's reaction to cause disease) So produce no toxins or lytic enzymes

Question 45

What is sarcoidosis?

Answer 45

Sarcoidosis is a rare condition that causes small patches of red and swollen tissue, called granulomas, to develop in the organs of the body. It usually affects the lungs and skin.