Inflammation 2 (Exudate, Diagnosis) Flashcards
(112 cards)
1
Q
Which exudate is formed from blood plasma
A
Serous
2
Q
What do serous exudates indicate
A
Mild injury Or- serious exudate on the way!
3
Q
Where are serous exudates normally found
A
Cavities lined by mesothelium (joints, pericardial, peritoneal) Skin, lungs, mucosa
4
Q
The exudate you have is translucent, which the slightest red tinge
A
Serous
5
Q
How can you differentiate serous exudate from edema
A
Serous has higher protein content, maybe some neutrophils and maybe some red tinge
6
Q
Fate of serous exudate
A
Usually just reabsorbed
7
Q
Microscopic appearance serous exudate
A
Homogenous, pink stained, few erythrocytes
8
Q
Your patients exudate is on a tissue and looks granular and whitish-yellow. What is it
A
Fibrinous exudate
9
Q
Whats a pseudomembrane
A
A layer of fibrinous exudate that can be pulled off Often on intestinal mucosa
10
Q
Microscopic appearnace of fibrinous exudate
A
Strands of non-homogenous pink material Usually on membrane, filling cavities
11
Q
Fate of fibrinous exudate
A
Mild: reabsorbed
Chronic: turned into fibrous adhesions, which can adhered viscera together and constrict visceral movement
12
Q
Is fibrinous the same as fibrous
A
NO - fibrin is result of inflammation
Fibrous is result of chronc change
13
Q
You have a mucous-y exudate. WHat is it
A
Catarrhal exudate
14
Q
Gross appearance catarrhal exudate
A
Thick, snot-like
15
Q
Microscopic appearance catarrhal exuate
A
Pale blue, attached to mucosal membrane surface (which is congested) Hyperplastic goblet cells
16
Q
Fate of catarrhal exudate
A
Either flushed out or persists and becomes purulent
17
Q
You have pus-like materieal oozing out. What is it
A
Purulent exudant
18
Q
What is purulent exudate
A
Accumulation of dead neutrophils + liquefied tissue
19
Q
Gross appearance purulent exudate
A
Liquefied, creamy Yellow to green to black
20
Q
Microscopic appearance purulent exudate
A
Many neutrophils - intact and degenerative
Pyknosis, karyorrhexis (signs of liquefactive necrosis)
Cellular debris
21
Q
Fate of purulent exudate
A
If inciting cause is killed: slowly cleaned up by macrophages and neutrophils
If it breaks lose and into body: septicemia!
Absorption of toxins in it can also cause toxemia and death
22
Q
Cells in acute inflammation
A
Neutrophils
23
Q
Cells in chronic inflammation
A
Lymphocytes, plasma cells, macrophages
24
Q
Edema occurs in acute or chronic inflammation
A
Acute
25
Fibrosis occurs in acute or chronic inflammation
Chronic
26
Granulation tissue occurs in acute or chronic inflammation
Chronic
27
What is granulomatous exudate compose of
Mononuclear cells (macrophages, lymphocytes, plasma cells)
28
What type of macrophages become abundant in granulomatous exudate
Epithelioid macrophages (large cytoplasm, resemble epithelial cells)
29
Whats a granuloma
Focal discreet reaction of closely packed epitheliod macrophages
Can be encapsulated with central core of caseous necrosis
30
Gross appearance granulomatous exudate
Diffuse or as granulomas
Sheet of macrophages
Cut surface white, granuloma may have pus center with necrotic core
31
Microscopic appearance of granulomatous exudate
Sheets of macrophages
32
Which disease is poster child for granulomatous exudate
Johne's disease Inflammatory bowel disease
33
Prognosis for granulomatous infection
Not very good :(
34
Whats an indication of chronic antigen stimulation
Presence of lymphocytes and plasma cells, but no macrophages (Lymphoplasmacytic infiltration)
35
When will you likely see chronic lymphoplasmacytic infiltration
Chronic bacterial and viral infections
Autoimmune disease
Drug reactions
Hypersensitivities
36
Gross appearance of lymphoplasmacytic infiltration
Difficult to see grossly!
37
Microscopic appearance of lymphoplasmacytic infiltration
Lymphocytes in lamina propria of intestine, portal triad of liver, interstitium of kidney and brochioles
38
What is perivascular cuffing
When lymphocytes surround blood vessels in tissues Chronic inflammation
39
What is peribronchial cuffing
When lymphocytes surround bronchi Chronic inflammation
40
Significance of lymphoplasmacytic infiltration
Not clear! If its severe, can limit function of organ (ie lots of lymphocytes in lamina propria of bowel inhibt absorption ---\> inflammatory bowel disease)
41
5 important categories when describing inflammation
Severity
Timeframe
Distribution
Exudate
Tissue
42
What is used to described severity
Mild Moderate Marked
43
What is used to describe timeframe of inflammation
Peracute - instantaneous with death (alive ---\> dead) Acute - hours to days Subacute: around 10 days Chronic: \>10 days
44
Type of exudates you see in acute inflammaton
Serous Hemorrhagic Fibrinous Catarrhal Purulent
45
Type of exudates you see with chronic inflammation
Granulation
Much less pus, redness, heat
46
Words to describe distribution of inflammation
Focal: one part of organ
Multifocal: several small parts of organ
Locally extensive: large part of organ
Diffuse: whole organ
47
Type of hypersensitivities
Type 1 (IgE) --\> Anaphylaxis, Atopy
Type 2 (cytotoxic antibodies) --\> IMHA, Pemphigus foliaceus
Type 3 (immune complex) --\> Glomerulonephritis, vasculitis
Type 4 (cell mediated) -\> IBD, Rheumatoid arthritis
48
Which pathway and chemical incites fever
Arachidonic Acid Pathway --\> prostaglandin E2, acts on hypothalamus
49
Which cytokines incite fever
PG-E2
IL-1
50
2 ways body heals
Regeneration
Repair
51
Which type of cells multiply throughout life
Labile cells
52
Examples of labile cells
Epithelial cells
Lympho-hematopoietic cells of lymphoid organs and bones
53
Which cells can multiply but need stimulation first
Stable cells
54
Examples of stable cells
Liver
Kidney
Pancreas
Adrenal
Bone
Tendon
Peripheral nerves
Smooth muscle cells
55
Which cells cant regenerate
Permanent cells
56
Examples of permanent cells
Cardiac and skeletal muscle
CNS
Ocular tissues (except corneal epithelium)
57
Healing by repair is mainly done by what? Why is this not idea;
Large scale deposition of fibrous CT
Can restrict movement of vital organs (ie myocardial contractility)
58
Which factor is important for regeneration
TGF-beta
Stimulates fibroblasts to synthesize procallagen
59
Mechanisms occuring in tissue repair
Deposition of fibrous CT
Granulation
Fibroblasts (TGF-beta)
Anigiogenesis
60
What triggers angiogenesis
HIF-alpha
EGF
VEGV
61
What are primary and secondary union
Occurs in healing by repair
Primary union: edges are apposing, minimal tissue loss (surgical wound)
Secondary union: edges arent opposing so a gap needs to be filled to close wound
62
Steps of Primary union
(overlapping sequence)
1) Clot formation between apposing sides
2) Inflammatory response - to remove dead tissue
3) Fibroblast and endothelial response: at edge of lesion, divide and migrate up towards dermis (granulation tissue)
4) Continuity of blood flow: between two apposing margins
5) Epithelial regeneration: surface grows over newly formed granulation tissue
6) Collagen formation: proliferation of fibroblasts, deposition of collagen fibers to strengthen wound
63
How long does primary union take in skin? Surgical wounds?
Skin: 3-5 days
Sutures are removed 10-14 days to ensure its complete
64
Burns, infarction and abscesses will likely have what kind of healing union
Secondary --- edges cant be directly apposed
65
66
Which exudate do you expect to see with mild damage to epithelium? How is it formed
Serous exudate
Formed by diapedesis through cells *- which makes it different from hemorrhage*
67
Which exudate is formed with marked vascular damage, and consists of proteins that can impair organ function/stick organs together?
Fibrinous exudate
68
Whats the term for an exudate that is tightly adhered to an area of necrosis? Removing this exudate will damage underlying tissue
Diptheric membrane (fibrinous exudate)
69
An exudate is discharge in the shape of a tubular organ. What type of exudate?
Fibrin cast (fibrinous exudate)
70
Purulent exudate in body cavities is called
Empyema
71
What happens if purulent exudate gets loose in the body?
Can introduce bacteria to bloodstream - *septicemia*
Can absorb toxic elements - *toxemia, death*
72
Two clear indications a lesion is chronic
**Fibroplasia** (proliferation of new collagen)
**Vascularization**
73
**Fibroplasia + Vascularization** cause
Granulation tissue
74
You're sent a histological sample of an exudate. You see many lymphocytes, macrophages and plasma cells. You also see a multinucleate giant cell. What type of exudate?
Granulomatous
75
Which nutrients are beneficial to wound repair
Vitamin C
Protein
76
Which chemical factors play an important role in wound healing
Tissue growth factors (csf, egf etc)
Myeloid colony stimulating factor
Cytokines (interleukins, TNF, interferons)
77
T/F body healing occurs faster in heat
True - colder bodies slow inflammation and healing
## Footnote
*Important for reptile medicine*
78
A bearded dragon is brough in with a laceration to his hindleg. You clean the wound, but what is an important factor you are going to consider in wound management?
Wounds heal best in warmer temperatures. As reptiles are poikilothermic, its important to keep them warm to promote healing.
79
What type of immune deficiency results from an inherited defect and may be associated with particular breeds?
Primary immunodeficiencies
80
What type of immune deficiency is acquired (immunosuppressive toxin, virus)
Secondary immunodeficinecy
81
What's a primary immunodeficiency affecting Holstein calves
Bovine leukocyte adhesion deficiency (BLAD)
## Footnote
*Autosomal recessive*
82
Genes for which protein are mutated in calves with BLAD
**Integrin (CD18)**
83
Pathogenesis of BLAD
* Lack of integrin
* Neutrophils cant attach to vascular endothelium/emigrate from blood vessels
* T-cells cant migrate to injury site --\> delayed type 4 immune response
84
C/S calves with BLAD
* Oral ulcers
* Servere peridontitis
* Teeth loss
* Chronic pneumonia
* Recurrent/chronic diarrhea
85
What do grey collies suffer from\>
Canine cyclical neutropenia (Grey Collie Syndrome)
86
Pathogenesis of Grey Collie Syndrome
* Autosomal recessive immunodeficiency
* Profound neutropenia
* Cyclic lack of response of bone marrow to growth factors --\> maturation defect in hematopoietic stem cells
* Neutrophil maturation arrests at 11 and 14 days
* Netruopenia for 3-4 days
* Rebound neutrophilia
* Usually fatal due to infection during neutropenic cycle
87
Diagnosis of grey collie syndrome
* Clinical signs
* CBCs over 2 week period
* DNA test for autosomal recessive gene
88
T/F grey collie syndrome cant be treated
False. It can, with bone marrow transfer, but this is uncommon
89
SCID foals are deficient in which leukocytes
B and T cells
90
What's pathagnomic for grey collie syndrom
Grey noses! (all collies have black noses except those with grey collie syndrome)
91
SCID is caused by what type of mutation
5-base pair deletion --\> frame shift (dysfunction protein)
92
Clinical and CBC signs of SCID
* Very low lymphocyte levels (\<1,000 cells/ul (normal: 1,500-6,000)
* Agammaglobinemia after maternal antibody catabolized
* Thymic and splenic hypoplasia
* Hypoplastic LNs --\> lack lymphoid follicles and germinal centers
93
Which animals are at risk of SCID
* Arabian foals
* Jack Russel Terriers
* Basset Hounds
* Welsh corgis
* Mice
94
SCID in bassett hounds and corgis affect which sex?
Males (females are carriers)
95
Which cytokine is mutated in X-linked SCID (bassets, corgis)
IL-2 (stimulates T-cell development)
96
T/F B-cells are present in X-linked SCID
Present, but not functional (due to lack of T-cell stimulation)
97
Describe antibody levels in dogs with X-linked SCID
* Low IgG
* No IgA
* Normal IgM
98
T/F - live attenuated Distemper vaccines are preferred for dogs with X-linked SCID
FALSE!
Dogs can die after modified live vaccines (causes distemper)
99
Which gene is deficient in hypotrichiosis cats and mice
FOXN1 gene --\> premature stop codon
100
What are effects of hypotrichiosis in cats and mice
* Lack of hair growth
* Lack of thymus growth ---\> NO T-cells!
101
Which cat breeds are affected by hypotrichosis
Birmans
102
Secondary immunodeficiencies are caused by which virus family? What do they target
Retroviruses
Targets: CD4+ T helper cells, follicular dendritic cells
103
What does canine distemper virus target
Lymphocytes! (and epithelial and nervous tissue)
104
One of the earliest clinical signs of canine distemper
Lymphopenia
105
Which chemo drug inhibits DNA and RNA synthesis, causing severe bone marrow suppression
Lomustine
106
Which chemo drug causes cross-linking and miscoding of DNA, leading to immunodepression
Cyclophosphamide
107
Which chemo drug is a slow acting alkylating agent causing mild to moderate immunodepression
Chlorambucil
108
Which fungal toxin causes bone marrow hipoplasia, decreased lympcyte and macrophage function
Trichothecene mycotoxins
109
T/F heavy metals suppress synthesis and expression of inflammatory cytokines
True
110
T/F - heavy metals have causd immune mediated disease
True
111
Which cells are believed to decline with age
Mononuclear cells (lymphocytes, macrophages)
112
Whats the most important immunodeficiency in foals
Failure of passive transfer (IgG)
