Chronic Inflammation (7)

Question 1

Inflammation

Answer 1

A protective response involving host cells, blood vessels and proteins

Question 2

Purpose of inflammation is

Answer 2

Remove the cause of injury, remove necrosis and initiate repair

Question 3

Problem with inflammation

Answer 3

Can be inappropriate and damage nearby tissues and be destructive

Question 4

Onset of acute inflammation

Answer 4

Fast onset - mins-hours

Question 5

Onset of chronic inflammation

Answer 5

Slow onset - days

Question 6

Which cells primarily involved in acute inflammation?

Answer 6

Neutrophils

Question 7

Which cells primarily involved in chronic inflammation?

Answer 7

Macrophages, plasma cells and lymphocytes

Question 8

Are the signs of acute or chronic inflammation more prominent?

Answer 8

Acute

Question 9

How severe is acute inflammation?

Answer 9

Mild, self-limiting tissue injury

Question 10

How severe is chronic inflammation?

Answer 10

Severe, progressive

Question 11

Infections that cause chronic inflammation

Answer 11

TB and leprosy

Question 12

Endogenous materials that cause chronic inflammation

Answer 12

Have an internal original e.g. necrotic adipose tissue, uric acid crystals

Question 13

Exogenous materials that cause chronic inflammation

Answer 13

External origin e.g. asbestos fibres, sutures, implanted prostheses

Question 14

Autoimmune disease that cause chronic inflammation

Answer 14

RA, SLE, pernicious anaemia

Question 15

Primary granulomatous diseases that cause chronic inflammation

Answer 15

Crohns, sarcoidosis

Question 16

Acute > Chronic

Answer 16

Most common in supportive (pus forming) acute inflammation, if deep enough walls thicken, granulation and fibrous tissue and recurrent acute

Question 17

Cholecystitis

Answer 17

Gall bladder inflammation - due to stones

Question 18

Morphological features

Answer 18

Infiltration with mononuclear cells (macrophages, lymphocytes, plasma cells), tissue destruction, healing by fibrosis

Question 19

Macroscopical features - chronic peptic ulcer

Answer 19

Mucosal breach, granulation tissue base, fibrous tissue extends through wall

Question 20

Macroscopical features

Answer 20

Chronic abscess cavity, granulomatous, fibrosis

Question 21

When is fibrosis prominent?

Answer 21

Once inflammatory infiltrate has stopped

Question 22

Crohns

Answer 22

Chronic inflammation with non-caseating granulomas, Diarrhoea, mucus, blood, weight loss, pain

Question 23

What does caseating mean?

Answer 23

Necrosis with conversion of damaged tissue into a soft substance

Question 24

Microscopically

Answer 24

Cellular infiltrate of lymphocytes, plasma cells and macrophages, production of new fibrous tissue from granulation, exudation of fluid not prominent

Question 25

Mast cells

Answer 25

Release histamine - increases permeability of blood vessels to WBCs and proteins

Question 26

Polymorphonuclear leukocytes/granulocytes

Answer 26

(Neutrophils, Basophils, Eosinophils, Mast cells) Eliminate microbes and dead tissues (acute)

Question 27

Neutrophils

Answer 27

Found in blood stream, most abundant phagocyte

Question 28

Eosinophils

Answer 28

Don't phagocytose, good antigen presenting cells

Question 29

Basophils

Answer 29

Produce histamine

Question 30

Injured basophils

Answer 30

Release prostaglandins - increase blood flow to infection site

Question 31

Macrophages/histiocytes

Answer 31

Increase inflammation, already at site of damage release cytokines signal to monocytes, monocytes enter damaged tissue from endothelium of blood vessel (leukocyte extravasion), proliferate locally in damaged tissue, immobilisation

Question 32

What is released from phagocytosis?

Answer 32

Proteases

Question 33

What are proteases stimulated by?

Answer 33

Low oxygen content > induce angiogenesis and cells to re-epitheliase the wound and create granulation tissue

Question 34

Granulation tissue

Answer 34

New connective tissue and blood vessels that form on surface of wound during healing, grows from base up (light red/pink due to capillaries)

Question 35

Wound healing

Answer 35

Repair by replacement of injured tissues by fibrous tissues - granulation tissue, angiogenesis, fibroblasts deposit collagen and inflammatory cells

Question 36

Fibrosis

Answer 36

Formation of excess fibrous connective during repair, scarring, macrophage induced laying down of connective tissue (collagen)

Question 37

Fibroma

Answer 37

If fibrous tissue arises from 1 cell line

Question 38

Granuloma

Answer 38

Aggregate/nodule of epithelioid histiocytes, lymphocytes, histolytic giant cells

Question 39

Epitheliod histiocytes

Answer 39

Large vesicular nuclei and eosinophilic cytoplasm, in clusters, secrete angiotensin converting enzyme

Question 40

Histiocytic giant cells

Answer 40

Form where material is indigestible to macrophages, multinucleate (>100) giant cells, not phagocytic

Question 41

Example of when histolytic giant cells form

Answer 41

Tubercle bacilli - cell walls resistant to macrophages

Question 42

Granuloma

Answer 42

Can be considered collection of macrophages

Question 43

Langhans giant cells

Answer 43

Horseshoe arrangement of peripheral nuclei (TB)

Question 44

Foreign body giant cells

Answer 44

Large cells, randomly scattered nuclei

Question 45

Examples of granulomatous inflammation

Answer 45

``` Bacterial - TB, leprosy Parasitic - Schistosomiasis Fungal - Cryptococcus Synthetic materials - Silicosis Sarcoidosis, Crohn's ```

Question 46

TB

Answer 46

Night sweats, weight loss, haemoptysis, cough, caseous (cheese-like) necrosis, TNFa and INF-y important information and function of granuloma

Question 47

Leprosy

Answer 47

Granulomas of nerve, respiratory tract, skin and eyes > loss of pain sensation, weakness, poor eyesight

Question 48

Silicosis

Answer 48

Occupational lung disease from inhailing silica dust, forms scarring and granulomas in upper lobes of lungs

Question 49

Sarcoidosis

Answer 49

Granulomas form in multiple organs (lungs and lymph nodes), fatigue, weight loss, joint aches and pains, cough, bilateral hilar lymphadenopathy

Question 50

Inflammation in common diseases

Answer 50

MI, atheroma formation, MS (plasma cells and T seen in white matter where macrophages break down myelin)

Question 51

Clinical outcomes of chronic inflammation

Answer 51

Persistence of infection, prolonged exposure to toxic agents, autoimmune disease