Exam #1: Chronic Inflammation II Flashcards Preview

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Flashcards in Exam #1: Chronic Inflammation II Deck (42):
1

What is granulomatous inflammation?

Type of chronic inflammation that is seen in a limited number of infections & some non-infectious causes (e.g. a foreign body)

2

What are the characteristics of granulomatous inflammation?

- Aggregates of activated macrophages with an "epitheliod" appearance

*Purpose is to contain an offending agent that is indigestible and difficult to get rid of

3

When does granulomatous inflammation occur?

- Forms in the setting of persistent T-cell responses to microbes & fungi
- T-cell derived cytokines are responsible for persistent macrophage activation

*Recall that strong T-cell activation leads to macrophage activation-->injures normal tissue

4

What is the prototype of granuloma formation?

TB

5

What are the components of a graunloma?

Granulomas are a focal area of inflammation
- Consists of microscopic aggregates of macrophages i.e. epitheloid cells
- Macrophages are surrounded by mononuclear cells i.e. lymphocytes & occasionally plasma cells

6

Describe the histological appearance of a granuloma.

- Ring of epithelioid macrophages
- Langhan's "Giant cell"
- Peripheral rim of lymphocytes

7

What is the difference between granuloma & granulation tissue?

Granulation tissue= tissue repair i.e. histological appearance of "granulation tissue" characterized by fibroblasts, capillaries, and loose ECM

8

What is a Langhan's cell? How does the presentation of these cells differ in infectious & foreign body induced granulomas?

Multinucleated giant cells

*These are seen in a peripheral arrangement in infectious granulomas; haphazard arrangement in foreign body

9

What is a foreign body granuloma?

Granuloma formed in response to inert foreign body-->forms when material is too large to be phagocytosed by a single macrophage
- Splinter suture material
- Breast implant
- Piece of glass

*In surgery, be sure to completely cut the silk thread used for sutures; if you don't, can form granuloma at the incision

10

Describe the histological appearance of a granuloma formed in response to a foreign body.

Haphazard giant cells that do NOT form a ring like what is seen in an infectious granuloma

11

What can granuloma formation lead to in the lung?

Granulomatous inflammation with extensive tissue destruction i.e. caseous necrosis

12

What is lymphangitis?

Inflammation of the lymphatic channels

*Clinically, red streaks up the arm or leg are called "blood poisoning"-->this is actually an infected lymphatic vessel or "lymphangitis"

13

What is reactive lymphadenitis?

Inflammation of draining lymph nodes

14

What happens if an infection overwhelms lymph nodes?

The infection gains access to the blood, causing bacteremia

*Bacteremia is NOT sepsis, but bacteremia can lead to sepsis

15

What are the systemic effects of inflammation?

Acute phase response or SIRS (Systemic Inflammatory Response System)

16

Clinically, what are the effects of inflammation?

- Fever
- WBC
- Anorexia
- Altered sleep
-Increase in serum acute phase proteins

17

What cytokines lead to the systemic effects of inflammation?

IL-1 & TNF-a

18

How is a fever produced in the body?

Cytokines stimulate PG synthesis in hypothalamic thermoregulatory center

-->resets body thermometer

19

What happens to heart rate in the presence of fever?

Increase in HR by 10 bpm per every increase in fever by 1 degree C

20

What is the main exogenous pyogen that induces fever?

LPS

21

What is the effect of IL-1 & TNF in the acute phase response?

- Increased COX that convert AA into PG

Cyclooxygenases convert arachnadoinic acids into prostaglandins

22

What are the serum acute phase proteins?

Plasma proteins that are mostly synthesized in the liver (hepatocytes); concentrations increased 100-fold in the presence of inflammatory stimuli

Include:
- CRP (C-reactive proteins)
- Fibrinogen
- SSA (serum amyloid A protein)

23

What is the function of the serum acute phase proteins?

Proteins bind microbial cell walls & may act as opsonins & fix complement

24

What is leukocytosis?

Increase in total WBC count from the normal range 4,000- 10,000 to levels around 15,000- 20,000

25

What is a leukemoid reaction?

Extremely high white cell count

- 40,000- 100,000

26

What is a left shift?

- Increase in immature WBCs due to accelerated release from the bone marrow

I.e. band cells are being released from the bone marrow before maturing to full WBCs

27

What is neutrophilia?

An increase in the number of neutrophils seen in most bacterial infections

28

What is Lymphocytosis?

Increase the in absolute number of lymphs; seen in viral infection

29

What is eosinophilia?

Increase in absolute number of eosinophils; seen in asthma, hay fever, and parasitic infections

30

What is Leukopenia?

Decrease in absolute number of WBCs; seen in certain infections & in debilitated hosts/ overwhelming infection
- This can be an indication of a MORE SEVERE infection in the elderly or immunocompromised despite WBC numbers in the "normal" range

31

What are the autonomic manifestations of systemic inflammation?

- Increased pulse and blood pressure
- Decreased sweating secondary to redirection of blood flow from cutaneous to deep vascular beds

32

What are the behavioral manifestations of systemic infection?

- Shivering
- Chills
- Anorexia
- Somnolence
- Malaise

33

What happens in severe bacterial infections?

Large numbers of organisms & LPS lead to large quantities of cytokines, esp. TNF-a & IL-1
- Cardiovascular decompensatin
- DIC
- Liver injury--> hypoglycemia
- Overproduction of NO
- Heart failure
- Decreased blood pressure

34

What is the triad of septic shock?

- DIC
- Hypoglycemia
- CV failure

35

What is the difference between defective inflammation & excessive inflammation?

Defective= increased susceptibility to infections & delayed wound healing

Excessive= inflammation leading to tissue injury & contributing to athersclerosis, heart disease, neurodegenerative disease & cancer

36

What is the cancer associated with gastritis? What is the etiologic agent?

Gastric adenocarcinoma, MALT
- H. pylori

37

What is the cancer associated with Schistosomiasis? What is the etiologic agent?

Bladder, liver, & rectal carcinoma
- Schistosomes

*****Schistosomiasis is a disease caused by parasitic worms of the Schistosoma type. It may infect the urinary tract or intestines.

38

What is the cancer associated with Cholangitis? What is the etiologic agent?

Cholangiocarcinoma
- Colon carcinoma

*****Note that Cholangitis= inflammation of the common bile duct

39

What is the cancer associated with chronic cholecystitis? What is the etiologic agent?

Gallbladder cancer
- Bacteria
- Gallstones

40

What is the cancer associated with Hepatitis? What is the etiologic agent?

Hepatocellular carcinoma
- Hep B & Hep C

41

What is the cancer associated with PID? What is the etiologic agent?

Ovarian and cervical carcinoma
- Gonorrhea, chlamydia, or papillomavirus

42

What is the cancer associated with Osteomyelitis? What is the etiologic agent?

Skin carcinoma in draining sinuses
- Various bacterial infections