Inflammation 1 (acute) Flashcards Preview

Pathology block 1 > Inflammation 1 (acute) > Flashcards

Flashcards in Inflammation 1 (acute) Deck (113)

Define Inflammation

 a nonspecific bodily response to a variety of injurious agents


name the Four cardinal manifestations of acute inflammation: 

redness, swelling, heat and pain


Define Exudate: i

inflammatory extracellular fluid with high protein content, cells and cellular debris 


Define Transudate: 

thin acellular serous edema fluid


Define Pus:

 purulent exudate important to recognize and important to culture because it usually represents infection


Define Leukocytosis: 

increased number of white blood cells counted in the blood


Define Acute phase reactants: 

proteins produced in abundance with inflammation, including fibrinogen and complement


Define Sepsis: 

the systemic inflammatory response syndrome (SIRS) due to an infection (proven or suspected)  


Describe inflammation in a general sense

  • Inflammation is a reaction to injurious agents. 
  • It is not a disease. 
  • It is not specific. 
  • It is a nonspecific host response to something injurious.  The something may be a bacterial infection, a fungal infection, a viral infection, a toxic substance or material from dead necrotic cells. 
  • The response, inflammation itself, can become injurious in, for instance, the acute respiratory distress syndrome.


What are the 6 common causes of inflammation?

  • (1) infection,
  • (2) tissue necrosis,
  • (3) immune reaction,
  • (4) trauma,
  • (5) foreign bodies
  • (6) physical and chemical agents.


What is the difference bw sign and symptom?

A symptom is a subjective experience of an aspect of a disease,

sign is an objective physical manifestation of a disease.


What type of inflammation has a rapid onset (seconds to minutes) and short duration (minutes to a few days)?

acute inflammation


Other than redness, heat, swelling and pain, what is another cardinal symptom/sign of acute inflammation?

loss of function, is sometimes added.


There are five distinctive forms of inflammation: name them. Do they have to happen together?

(1) purulent (suppurative), (2) abscessing (necrotizing), (3) fibrinous, (4) serous and (5) granulomatous. 

They are not mutually exclusive.


Inflammation is a complex response.  There are 3 components of inflammation: name them

  1. a vascular response,
  2. a leukocyte (white blood cell) response 
  3. a systemic (total body) response.  


The vascular component consists of what?

What does the vascular component allow?

dilatation and increased permeability. 

 This vascular response permits an outpouring of fluid, plasma proteins and leukocytes (primarily neutrophils) from the blood into the extracellular space.


The fluid which pours out in acute inflammation can evident of what it contains. Name 3 common manifestations

thin (“serous”),

thick with abundant protein (“fibrinous”)

thick like pea soup with protein and inflammatory cells (“purulent”).


What is the liquid portion of blood that has clotted and been centrifuged to separate the clotted cells and proteins?



Why is serum thin?

Serum is thin because it has a low protein content (and no cells).


Define Plasma. How is fibrin related?

is the liquid portion of blood that has been anticoagulated and centrifuged, leaving a protein-rich liquid portion including the blood clotting factors.

Fibrin is one of those clotting factors.


Describe Serous inflammation. give example

 a form of usually acute inflammation marked by an outpouring of a thin fluid from blood vessels or mesothelium

[the lining of the chest or abdominal cavities] (effusion) or a skin blister (effusion into space created between the epidermis and dermis by burn or virus).


describe Fibrinous inflammation

 a form of usually acute inflammation featuring deposition of fibrin-rich exudate, on pleura, pericardium, peritoneum or meninges, or in the interstitium of any tissue.


Define edema

Edema is tissue swelling due to accumulation of water.


Purulent inflammation is also called suppurative, although some call it suppurative only when it is also necrotizing. What type of inflammation? produces what? caused by what?

 It is usually acute and features production of abundant pus (neutrophils, necrotic cellular debris and edema fluid).  It is commonly caused by infection with pyogenic (pus-producing) bacteria.


Describe pus in general

It is thick, opaque and variably colored (light green, yellow, tan, crème, off-white). 

Pus usually represents infection, so the usual thing to do with it is send a sample to the microbiology laboratory for them to isolate and identify the infecting organism (“culture” it).


Describe pus wrt mucous and blood

Pus can be mixed with mucus.  Mucus is grey, slimy, and stringy.  Mucopurulent exudate has a spectrum from mostly pus to mostly mucus. 

Pus can also be mixed with blood.  Blood has a spectrum from red to blue and can solidify (clot).  The mixture of blood and pus is commonly pink.


Defects in leukocyte function predispose patients to what?

patients to infections.


 leukocyte adhesion deficiency-1 and -2, chronic granulomatous disease, myeloperoxidase deficiency, Chediak-Higashi syndrome, and cryopyrin-associated periodic fever syndromes, which are all rare conditions, cause what?

Congenital leukocyte defects


diabetes mellitus, hemodialysis, malnutrition, and leukemia, which are common, especially diabetes mellitus cause type of defects?

Acquired leukocyte defects are caused by 


T/F Inflammation, acute or chronic, has systemic effects on the patient as a whole person



The four most important of the systemic effects of acute inflammation (the acute phase response) are: 

(1) fever (or hypothermia),

(2) tachycardia (rapid heart rate),

(3) hyperventilation (tachypnea [rapid respiratory rate])

(4) leukocytosis (more white blood cells in circulation in the blood)


The acute phase response is largely mediated what? give specifics

 by cytokines

especially IL-1, TNF-a and IL-6


The acute phase response includes changes in what?

plasma protein levels, with increased C-reactive protein, amyloid A, fibrinogen and other proteins.


What is the effect on albumin wrt acute inflammation?

  • acute phase response includes changes in plasma protein levels.
  • To make more acute phase reactants, the liver has to make less of other proteins, whose level falls as a result. 
  • Chief among these negative acute phase reactants is albumin.


Other than a decrease in albumin production, what else is altered as a result of acute phase response?

  •  causes changes in lipid metabolism,
  • a negative nitrogen balance,
  • changes in hormone synthesis,
  • decreased serum iron and zinc,
  • elevated white blood cell and platelet counts 
  • decreased red blood cell production.


What effect does inflammation have on metabolism?

Inflammation switches the body from anabolism to catabolism, and, initially, a hypermetabolic state. 


Because the acute phase response switches to hypermetabolic and from anabolism to catabolism, what is the effect toward the catabolic molecules? What does this ultimately cause?

The levels of epinephrine, norepinephrine, cortisol and glucagon go up, and skeletal muscle is broken down.  

Hepatic synthesis of protein goes up, but skeletal muscle is broken down faster than the amino acids are utilized for protein synthesis, so nitrogen is lost in the urine and the patient goes into a negative nitrogen balance.


***The most important systemic effects of inflammation are alterations what?***

***alterations of body temperature, heart rate, respiratory rate and white blood cell count, usually increases of them. ***


Define the most common form of leukocytosis

Leukocytosis consisting of neutrophils is called neutrophilia and is associated with bacterial infections as the cause.  


Leukocytosis consisting of lymphocytes is associated with  what type of infections?

Viral infections


leukocytosis consisting of eosinophils is associated with what type of infection?

allergies and parasitic infestations


What are  Dohle bodies?

 patches of dilated endoplasmic reticulum, which appear as “sky-blue peripheral cytoplasmic puddles”


Define and Describe toxic granulations. What do they look like and commonly found?

immature primary cytoplasmic granules characteristic of less mature granulocytes

Toxic granulations are dark blue or purple granules, bigger and coarser than the small, faintly stained neutral granules characteristic of segmented neutrophils. 

Predictably, toxic granulations are more common in immature neutrophils.


Severe acute inflammation can cause neutrophils to have  what?

(1) Dohle bodies  

(2) toxic granulations 


What are Acute phase reactants?

proteins produced in abundance with inflammation


What are common acute phase reactants?

  • fibrinogen and other clotting factors,
  • the complement proteins,
  • amyloid A,
  • C-reactive protein,
  • alpha-1-antitrypsin and other antiproteases,
  • hepcidin and ferritin.


T/F Acute phase reactants generally have harmful effects in inflammation

Acute phase reactants generally have beneficial roles in inflammation


What is Serum amyloid A role in inflammation?

seems to play a role in recycling and reusing cholesterol from destroyed and damaged cells

does this by replacing apolipoprotein A in high density lipoprotein and targeting delivery of HDL to macrophages,

suppressing ACAT and enhancing neutral cholesterol esterase and ABC transporters in macrophages.  


What is the role of fibrinogen in acute inflammation?

Fibrinogen causes sticky erythrocytes and an increased erythrocyte sedimentation rate (ESR, “sed rate”);

the cells sediment faster when they are stuck together. 


Describe the correllations of the ESR to inflammation, age, gender and what it is influenced by

ESR increases with inflammation,

Increases with age;

it is higher in women, and it is influenced by the size, shape and concentration of the erythrocytes. 


Why is ESR not a good diagnosis of inflammation? What is it used to screen for?

 ESR has low sensitivity and specificity for the diagnosis of inflammation, but it is simple, fast and cheap; it is still used to screen for temporal arteritis and osteomyelitis.


What is CRP? 

  • C-reactive protein (CRP) is an acute phase reactant composed of 5 identical 206-amino-acid subunits arranged in cyclic symmetry.  


What complement cascade is associated with CRP? How is this done?

CRP binds to phosphocholine residues uniquely found on bacteria and, once bound, becomes a ligand for complement C1 binding, initiating the classical complement cascade. 


Synthesis of CRP is induced by what?

Synthesis of CRP is induced by cytokines, chiefly IL-6.  


Describe the levels of CRP wrt age, ranges, types of infection

The levels of CRP change rapidly (up and down), do not increase with age and have a broad range. 

The average normal level of CRP is 1 mg/L, but it increases up to 300 mg/L with acute inflammation. 

The level of CRP goes up with bacterial, but not viral infection;

80-85% of patient with CRP >100 mg/L have bacterial infection.


What are Other systemic effects of inflammation?

  • anorexia (loss of appetite),
  • lethargy,
  • somnolence,
  • malaise (feeling sick),
  • chills,
  • rigors (shivering),
  • decreased sweating,
  • increased blood pressure.


Severely injurious agents cause a syndrome of signs and symptoms attributable to the systemic inflammatory reaction.  There are official consensus criteria for this systemic inflammatory response syndrome (SIRS): name them (4)

1. Temperature >38 (100.4) degrees or <36 (96.8) degrees
2. Heart rate >90/minute
3. Respiratory rate > 20/minute or pCO2 <32 mmHg
4. White blood cell count >12,000/cu mm or <4,000/cu mm or >10% bands


T/F Sepsis is not a positive blood culture.



The majority of patients with sepsis have what type of blood culture?

NEGATIVE blood cultures.


What is a protective response intended to eliminate the initial cause of cell injury as well as the necrotic cells and tissues resulting from the original insult?



What are Acute phase reaction characteristics?

  • Fever:  IL-1 and TNF
  • Somnolence, malaise, anorexia
  • Hypotension
  • Increased hepatic synthesis of proteins:  complement and clotting factors:  IL-6
  • Leukocytosis, “left shift”
  • Elevated ESR (erythrocyte sedimentation rate)


What are the participants in inflammation?

  • Circulating cells
  • Plasma proteins
  • Vascular wall cells
  • Connective tissue cells and extracellular matrix


What is this cell?



Name these. Cell on Left is 

Cell on right is

eosinophil on left

basophil on right


Name cells




Name these

plasma cells


Name the 3 cells in slide

Macrophage left

mast cell top right

basophil bottom left of right picture


Differentiate between the chronic and acute responses of inflammation


Describe the timing, components, and cellular events of acute inflammation

  • Immediate and early response to injury

Components => Vascular changes (Vasodilation and Increased vascular permeability)

Cellular events=> cellular recruitment and activation
(Emigration of leukocytes from the microcirculation to the site of injury)


What are the 3 main vascular changes in acute inflammation? What do they result in?

1) Vascular dilation causes erythema and warmth:  rubor and calor

2) Extravasation of plasma fluid and proteins causes edema:  tumor
3)  Emigration of leukocytes to site of injury:  tumor


Describe the Sequence of Vascular Changes in Acute Inflammation

Transient vasoconstriction (seconds)

Increased vascular permeability

  • Protein rich fluid leaks into extravascular tissues:  transudate first, then exudate; edema
  • Concentration of red blood cells:  increased blood viscosity and stasis


Differentiate between exudate and transundate


Increased vascular permeability causes what?

  1.  immediate transient response
  2. endothelial cell retraction
  3. direct endothelial injury/
immediate sustained response
  4. leukocyte dependent 
endothelial injury
  5.   increased transcytosis
  6. leakage induced by chemical mediators


Describe the immediate transient response


Describe endothelial cell retraction


Describe direct endothelial injury/
immediate sustained response


Describe leukocyte dependent 
endothelial injury


Describe  increased transcytosis


What does leakage induced by chemical mediators look like?


Describe this cell



  • first cell to arrive at the site of acute inflammation/abscesses
  • Very short life span:  about a day
  • Phagocytic—especially for pyogenic cocci
  • Contain lots of lysosomes (look like cytoplasmic granules); suppuration and liquefaction of tissue


What are the 3 functions of the neutrophil?

  1. phagocytosis
  2. H2O2, activated O2 species
  3. exocytosis


What does this cell represent?

acute inflammation


What is the sequence of events in leukocyte emigration?

List the steps for the leukocyte emigration to fight the stimulus

margination => rolling => adhesion => transmigration  toward the site of the injury
  1. endothelial activation
  2. leukocyte activation
  3. diapedesis
  4. chemotaxis


What is margination wrt Sequence of events in leukocyte emigration?

leukocyte accumulation at the periphery of blood vessels


What is rolling wrt Sequence of events in leukocyte emigration?

leukocytes are pushed out of the central axial column by flowing blood;

mediated by selectins


What is pavementing wrt Sequence of events in leukocyte emigration?

leukocytes line up along the blood vessel wall


What is a family of surface receptors that bind to selected sugar domains (lectins)? What is their role?


Account for the relatively loose and transient adhesions involved in rolling


E-selectin is associated with what?
P-selectin is associated with what?
L-selectin is associated with what?

E-selectin:  endothelium

P-selectin:  endothelium and platelets

L-selectin:  most leukocytes


leukocytes firmly stick to endothelial surfaces via what mechanisms?



leukocytes move between endothelial cells and through the basement membrane into the extravascular spaces via what mechanism?



What is mediated by molecules of the immunoglobulin superfamily on endothelial cells that interact with integrins expressed on leukocyte cell surfaces?

adhesion and transmigration


Ig superfamily:  Endothelial adhesion molecules are what? What induces them? What integrins are associated and what do they bind to?

ICAM-1 (intercellular adhesion molecule 1)
VCAM-1 (vascular adhesion molecule 1)

Induced by cytokines such as TNF and IL-1

integrins are LFA-1, Mac-1, and VLA-1

LFA-1 and Mac-1:  bind to ICAM-1
VLA-1:  binds to VCAM-1



Define Chemotaxis

movement of cells or organisms in response to chemicals


Describe the migration of leukocytes toward sites of injury along a chemical gradient

Soluble bacterial products

Complement:  C5a

Leukotriene B4 (LTB4)

Cytokines:  chemokine family, IL-8


Describe how chemotaxis results in the assembly of pseudopods

  1. Chemotactic molecules bind to cell surface receptors
  2. G protein-mediated activation of phospholipase C
  3. Membrane PIP2 is hydrolyzed into DAG and IP3
  4. IP3 increases intracellular calcium resulting in the assembly of pseudopods


What is the result of Activation of protein kinase C?

  • degranulation and secretion of lysosomal enzymes
  • generation of the oxidative burst


What is the result of Activation of phospholipase A2?

arachidonic acid metabolites


What is the process of phagocytosis consist of?

  1. Recognition and attachment
  2. Engulfment
  3. Killing and degradation


Describe the Recognition and attachment mechanisms involved in Phagocytosis

Opsonins:  Ig Fc, C3b and collectins
Bind to FcR; CR 1,2 and 3; and C1q respectively


Describe the process of engulfment wrt phagocytosis

  • Triggered by binding of opsonized particles
  • Pseudopods extend to form phagocytic vacuole
  • Membrane of vacuole fuses with  the membrane  of a lysosomal granule to form phagolysosome


Describe how killing and degradation is done in phagocytosis

  • Oxidative burst forms reactive oxygen metabolites:  H202
  • Azurophilic granules contain MPO:  HOCl
  • Dead microorganisms are degraded by lysosomal acid hydrolases


What is this an example of?

Skin blister from chickenpox with
effusion of thin serous fluid


What are the arrows indicating?

Shaggy fibrinous pericarditis 


What is the arrow pointing to?

Yellow purulent exudate on peritoneum


Describe this slide

Microscopic purulent exudate in pulmonary alveoli


What is this an example of?

Purulent green exudate on bowel serosa


What is this an example of?

Bronchial mucus plug in a patient who
died of asthma (actually mucopurulent)


What is this an example of?

Mucopurulent, mostly purulent exudate
mixed with a little blood (arrow) in a
bronchus with inflamed mucosa


Define a left shift

release of immature neutrophils from bone marrow,
especially adolescents (bands)


Describe the slide on the left and the right wrt granules. name them

Left is Dohle bodies

Right is toxic granulations


Define Somnolence

maybe just about to sneeze


Describe when the Acute phase reactants are produced with inflammation