Inflammation

Question 1

Acute

Answer 1

minutes to a few days

Question 2

Main causes of acute inflammation

Answer 2

Allergic reaction/ hypersensitivity.
Infections
Physical injury
Chemical injury

Question 3

What happens in the vascular phase of acute inflammation ?

Answer 3

Small vessels dilate, Vascular endothelium cells contract thus making spaces between them

Question 4

What happens in the exudative phase of inflammation ?

Answer 4

Fluid and protein leaking through capillary walls and cells through venules.

Question 5

Exudate meaning

Answer 5

Leaky/dilated blood vessels so protein and cells in fluid.

Question 6

Transudate meaning

Answer 6

Passive outflow of fluid when balance of osmotic and hydrostatic pressure change.

Question 7

Transudate vs Exudate

Answer 7

Transudate has low protein content, few cells.
Exudate has high protein content, may contain some white & red blood cells.

Question 8

Chemokines and IL-1

Answer 8

Stimulate adhesion molecules on endothelium and white cells

Question 9

Tumour necrosis factor

Answer 9

Stimulates vascular permeability

Question 10

Macrophages role

Answer 10

Have the role of clearing debris and dead cells

Question 11

What is the role of neutrophils during inflammation ?

Answer 11

Migration into tissues

Recognise bacteria by
- formylmethionine at end of surface protein chains
-coating of antibody or complement (C3b)

Phagocytosis is carried out.

Kill bacteria via lysozyme destroying cell wall and via hydrogen peroxide production

Apoptosis

Question 12

What is the lifespan of neutrophils ?

Answer 12

8-12 hours (short lifespan)

Question 13

How are basophils/mast cells activated ?

Answer 13

By tissue damage
Or antigens interacting with surface IgE

Question 14

What do mast cells produce ?

Answer 14

Histamine
Leukotrienes
Prostaglandins

Question 15

Histamines role

Answer 15

Vascular dilation and permeability

Question 16

Leukotrienes role

Answer 16

Act as a chemoattractant for other white blood cells

Question 17

Prostaglandins function

Answer 17

Vascular dilation and pain

Question 18

What does the coagulation pathway result in ?

Answer 18

Fibrin production to contain infection in a ‘mesh’.

When coagulation factor 12 is activated, bradykinin is produced - vasodilation and sensitises pain receptors.

Question 19

Abscess

Answer 19

Pus enclosed by fibrin and connective tissue

Question 20

Pus

Answer 20

Inflammatory exudate rich in neutrophils, organisms and dead tissue

Question 21

Empyema

Answer 21

Pus enclosed in an existing body cavity eg gall bladder, pleura etc.

Question 22

What are some beneficial effects of acute inflammation ?

Answer 22

Dilution of toxins

Effector cells and antibodies (and antibiotics) get to the area

Fibrin helps to “wall-off” further spread of infection
Antigens get carried to local and regional lymph nodes- prevents systemic spread and allows antibodies to be made

Question 23

What are some harmful effects of acute inflammation ?

Answer 23

Destruction of normal tissues eg colo-vesical fistula.

Swelling within a confined space eg brain.

SEPSIS

Cytokine storm

Question 24

Systemic effects of acute inflammation

Answer 24

Monocyte/macrophage derived TNF and IL-1 cause re-setting of temperature control at hypothalamus

Question 25

Results of systemic effects of acute inflammation

Answer 25

Production of Granulocyte colony stimulating factor (G-CSF)- increase production and release of neutrophils from marrow Rise in “acute phase proteins” eg C-reactive protein (CRP)- assists complement binding to microbes Rise in immunoglobulins (later in acute inflammation)

Question 26

Chronic

Answer 26

Goes on for a long time. e.g. months, years

Question 27

What happens in chronic inflammation ?

Answer 27

Tissue damage, inflammation, healing going on at same time

Question 28

What types of cells are involved in chronic inflammation ?

Answer 28

macrophages, lymphocytes, plasma cells rather than neutrophils

Question 29

Chronic vs Acute inflammation

Answer 29

Chronic inflammation goes on for a long time, whereas acute inflammation is resolved quickly.

Question 30

Factors promoting resolution of acute inflammation

Answer 30

Minimal cell death and tissue loss An organ with good regenerative capacity Rapid destruction of the causative agent Rapid removal of fluid and debris by good blood supply Good nutrition and immune function

Question 31

As part of resolution of acute inflammation, what is the damaged/dead tissue organised into ?

Answer 31

Granulation Tissue

Question 32

Role of macrophages

Answer 32

Digests debris

Question 33

What does granulation tissue contain ?

Answer 33

Macrophages Fibroblasts New blood vessels

Question 34

Role of fibroblasts

Answer 34

Provide scaffolding for repair

Question 35

Role of new blood vessels

Answer 35

Allow nutrients for regeneration of tissues

Question 36

What is the end result of using granulation tissue ?

Answer 36

Healing, often with some scarring.

Question 37

Primary chronic inflammation examples

Answer 37

Leprosy TB Asbestosis Inflammatory Bowel disease Rheumatoid arthritis

Question 38

Examples of progression from acute to chronic

Answer 38

Osteomyelitis, foreign body

Question 39

Causes of chronic inflammation processing from acute inflammation - osteomyelitis

Answer 39

Poor blood supply, pus can’t drain away, pools under periosteum, portion of bone dies which stimulates chronic inflammation

Question 40

What are some consequences of chronic inflammation ?

Answer 40

Fevers, weight loss, malaise. Fibrosis and hence distortion of tissues. Amyloid deposition. Reduced growth in children. Anaemia of chronic disease.

Question 41

What can macrophages produce which is bad ?

Answer 41

Peroxynitrite and TNF which cause DNA damage. Via a multi-hit mechanism, accumulated DNA damage and hence mutations leads to cancer

Question 42

What makes TB cells difficult to kill ?

Answer 42

Waxy coating on cell walls

Question 43

What is the hallmark of chronic inflammation ?

Answer 43

Macrophages

Question 44

What do macrophages produce that can cause DNA damage ?

Answer 44

peroxynitrite and TNF

Question 45

What does accumulated DNA damage lead to ?

Answer 45

Mutations Cancer

Question 46

What increases the risk of gastric cancer ?

Answer 46

Helicobacter pylori infection

Question 47

What increases the risk of cervical cancer ?

Answer 47

Papilloma virus

Question 48

What increases the risk of liver cancer ?

Answer 48

Hepatitis B and C

Question 49

What increases the risk of bowel cancer ?

Answer 49

Chronic inflammatory bowel disease