Inflammation

Question 1

name a vascular change that occurs in inflammation

Answer 1

vasodilation

Question 2

what mediates vasodilation in inflammation?

Answer 2

histamine

nitric oxide

Question 3

what vessels undergo vasodilation in inflammation?

Answer 3

arterioles first, then capillaries

Question 4

name five cellular changes that occur during inflammation

Answer 4

stasis 
white cell margination 
rolling 
adhesions
migration

Question 5

what is white cell margination?

Answer 5

when white cells move peripherally due to slowed rate of blood flow because of vasodilation

Question 6

why do blood cells stick to vessel walls in inflammation?

Answer 6

the vessels express proteins on their luminal surface which have matching proteins on the WBC’s

Question 7

what proteins cause blood cells to stick to the vessel walls in inflammation?

Answer 7

selectins (bind to VCAM)
integrins (bind to ICAM)
VCAM
ICAM

Question 8

what does ICAM and VCAM stand for?

Answer 8

vascular cell adhesion molecule

intracellular adhesion molecule

Question 9

what effect do chemokines have on blood cells sticking to the lumen?

Answer 9

they increase the affinity of the ligands, making the bonds longer lasting

Question 10

what two things increase expression of selectin in inflammation?

Answer 10

histamine

thrombin

Question 11

what two things increase endothelial cell expression of VCAM and ICAM in inflammation?

Answer 11

TNF

IL-1

Question 12

what does vascular permeability due to inflammation cause?

Answer 12

loss of proteins

change in osmotic pressure, as water follows the proteins out

this results in swelling

Question 13

name two ways that blood vessels can become permeable

Answer 13

endothelial cell contraction resulting in gaps between cells

direct injury

Question 14

what substances cause endothelial cell contraction?

Answer 14

histamine
bradykinin
substance P
leukotrienes

Question 15

what do blood cells do after they leave the vessel and what is this called?

Answer 15

they follow a chemical gradient

chemotaxis

Question 16

what are the three phases in phagocytosis?

Answer 16

recognition + attachment

engulfment

killing + degradation

Question 17

what do phagocytes use to engulf foreign material?

Answer 17

extensions of the cytoplasm called pseudopods

Question 18

what do phagocytes produce that kill pathogens?

Answer 18

reactive oxygen species

reactive nitrogen species

Question 19

name an ROS made by phagocytes

Answer 19

NADPH oxidase

Question 20

name an RNS made by phagocytes

Answer 20

nitric oxide synthase

Question 21

what are clinical features of inflammation?

Answer 21

rubor
calor
tumor
dolor

Question 22

what is rubor?

Answer 22

redness

Question 23

what is calor?

Answer 23

heat

Question 24

what is tumor?

Answer 24

swelling

Question 25

what is dolor?

Answer 25

pain

Question 26

what cell characterises acute inflammation?

Answer 26

neutrophil

Question 27

name four possible outcomes of acute inflammation

Answer 27

resolution suppuration organisation chronic inflammation

Question 28

what two outcomes of inflammation can progress to fibrosis?

Answer 28

suppuration | chronic inflammation

Question 29

what does the outcome of acute inflammation depend on?

Answer 29

the site of injury the type of injury the duration of injury

Question 30

what is resolution?

Answer 30

the complete restoration of the tissue to normal

Question 31

when is resolution likely to occur?

Answer 31

when there is: - minimal cell death - capacity for tissue repair - a good vascular supply - easily removed injurious agent

Question 32

what is suppuration?

Answer 32

production of pus

Question 33

what is a walled off space filled with pus called?

Answer 33

empyema

Question 34

why do abscesses and empyemas need to be removed?

Answer 34

they have no blood supply so cells needed for repair and antibiotics cannot reach the area

Question 35

what is organisation?

Answer 35

scarring of damaged tissue

Question 36

when does organisation occur?

Answer 36

lots of necrosis lots of fibrin produced poor blood supply tissue damaged can regenerate

Question 37

what outcome is more likely if damage goes beyond the basement membrane and why?

Answer 37

organisation if it is not damaged it acts as a scaffold for resolution

Question 38

what is the common response to injury in all tissues?

Answer 38

formation of granulation tissue

Question 39

how is granulation tissue formed?

Answer 39

capillaries and myofibroblasts infiltrate area deposit collagen and smooth muscle that tissues can build on top of

Question 40

why does granulation tissue appear very red?

Answer 40

due to the new vascular supply forming

Question 41

what can organisation of a large area cause?

Answer 41

loss of function and contraction as normal cells are replaced with fibrosis

Question 42

what happens if the regenerative capacity of the liver is overwhelmed?

Answer 42

the liver becomes cirrhotic and can fail, meaning it can't remove toxins from the blood and make proteins

Question 43

what characterises chronic inflammation?

Answer 43

the presence of a lymphocyte

Question 44

what is a granuloma?

Answer 44

an aggregate of epithelioid histiocytes

Question 45

what can cause granulomas to form?

Answer 45

foreign body's endogenous substances (bone, keratin) exogenous substances (talc, asbestos) infections

Question 46

what do granulomas caused by mycobacterium TB cause?

Answer 46

caseous necrosis

Question 47

what is infarction?

Answer 47

death of tissue after loss of oxygen

Question 48

what does the heart require to contract?

Answer 48

ATP therefore it also needs oxygen

Question 49

what fails if no ATP is produced?

Answer 49

the sodium potassium pump | the calcium pump

Question 50

what happens when the sodium potassium pump fails?

Answer 50

hyperkalaemia | swelling

Question 51

what happens when the calcium pump fails?

Answer 51

hypercalcaemia

Question 52

what does hypercalcaemia stimulate?

Answer 52

``` ATPase phospholipase proteases endonuclease increased mitochondrial permeability ```

Question 53

how long is the window before serious damage occurs in MI?

Answer 53

20 minutes, after which damage is irreversible and cell death starts via necrosis

Question 54

what can be seen that identifies an MI in the first 20 mins?

Answer 54

only changes on an ECG

Question 55

what are the first changes due to MI that can be seen microscopically?

Answer 55

pyknosis redness shrunken, dark nucleus presence of contraction bands

Question 56

what happens within the first day after an MI?

Answer 56

cell contents leak and initiate the complement cascade causes acute inflammation, which can cause gross changes

Question 57

what are the three types of necrosis?

Answer 57

caseous liquefactive coagulative

Question 58

when is there the greatest risk of cardiac rupture post MI?

Answer 58

3-7 days after

Question 59

what replaces neutrophils in cardiac tissue?

Answer 59

macrophages these create a yellow appearance and can be seen on microscopy

Question 60

when can't an MI be dated and why?

Answer 60

if it happened more than 6 weeks ago collagen is laid down after 2 weeks and is completed at 6 weeks