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Inflammation Flashcards

1
Q

Coordinated vascular and cellular response of the body to cell injury and death

A

Inflammation

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2
Q

What two features does inflammation have?

A

Protective (immune)

Curative

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3
Q

What is the responsibility of inflammation?

A

Removal of injurious agent and cellular debris

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4
Q

T/F Inflammation initiates the healing process

A

True

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5
Q

T/F Inflammation does not serve a vital role in host defenses against pathogens and cell injury

A

False, IT DOES

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6
Q

T/F Inflammation is equivalent to an infection

A

False, associate it with tissue injury

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7
Q

Without an inflammatory response we can not…

A
  1. Heal

2. Have a normal immune function

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8
Q

Glucocorticoids effect on inflammation

A

Suppress immune function

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9
Q

What type of infections lead to inflammation?

A

Bacterial, viral, fungal, parasitic

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10
Q

Examples of trauma/damaged tissues that can lead to inflammation

A
  1. Blunt or penetrating trauma

2. Physical/chemical agents - thermal energy (burns or frostbite), radiation, toxicity from chemicals

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11
Q

Examples of presence of foreign bodies that can cause inflammation

A

splinters, dirt, sutures, crystal deposits

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12
Q

Other factors that can lead to inflammation?

A
  1. Tissue necrosis
  2. Immune reactions
  3. Ischemia
  4. Cancer
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13
Q

What are the 3 goals of an inflammatory response?

A
  1. Inactivate injurious agents
  2. Break down and remove dead cells and other cellular debris
  3. Initiate tissue healing
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14
Q

Erythema -

A

vasodilation and increased blood flow (redness)

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15
Q

Heat -

A

vasodilation and increase blood flow

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16
Q

Edema -

A

fluid and cells leaking from local blood vessels into extravascular spaces

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17
Q

Pain -
Secondary to what?
Caused by what?

A
  • Direct trauma
  • Chemical mediation of bradykinins, histamines, serotonin
  • Internal pressure secondary to edema
  • Swelling of the nerve endings
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18
Q

Collateral damage of inflammation -

A

Components of response capable of damaging and destroying normal tissue

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19
Q

What must inflammatory processes be tightly regulated?

A

Avoid excessive tissue damage and spillover to normal tissue

- Inflammation is normally controlled and self limiting

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20
Q

What is the hallmark of inflammation?

A

Vascular events

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21
Q

Why does vasodilation occur near site of injury?

A

Brings more plasma proteins and leukocytes to the area

- Explains heat and redness at site of injury

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22
Q

How is vasodilation induced?

A

By histamine release from platelets and mast cells causing smooth muscle relaxation

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23
Q

At site of injury, describe increase vascular permeability and what does it allow for?

A
  • Smaller arterioles become leaky or permeable

- Allows for the passage of a protein and cell rich fluid (exudate) into the interstitial spaces

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24
Q

T/F vascular permeability results in an accumulation of blood in the area of dilation and stasis (describe)

A

True, explains localized redness at site and allows for accumulation of platelets and neutrophils

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25
What is the leukocytes key function at site of injury?
Eliminating the offending agent and cleaning up the area
26
What are the 5 types of WBC (leukocytes)?
``` Granulocytes: 1. Neutrophil 2. Basophil 3. Eosinophil Agranulocytes: 1. Macrophages/Monocytes 2. Lymphocytes ```
27
What is the job of the lymphocytes?
Natural cell killer
28
What are two fixed or tissue specific leukocytes?
1. Mast cells | 2. Langerhans cells (found on skin)
29
What type of WBC is the first responder to injury and predominant cell type found in pus?
Neutrophils
30
Chemotaxis -
movement of WBC in response to a chemical stimulus
31
Diapedesis -
Migration through the endothelial lining of the blood vessels
32
How does the body recognize an offender (injury)?
Via surface receptors
33
What WBC type is the predominant leukocyte in the area of injury for about 24 hours?
Neutrophils
34
What is the clinical implication of an increase in WBC count?
Mostly neutrophils = body is attempting to fight off some injury
35
What is neutropenia and what does it mean to a person? | Ex:
Low WBC count = increased vulnerability to infection | Ex: radiation injury, cancer therapy, drug sensitivity
36
Where do you find monocytes and what is their job when an injury occurs?
- Circulate in the blood and replenish macrophages | - In response to inflammation signals, move to site of injury and differentiate into macrophages and dendritic cells
37
What is the job of a macrophage?
Engulfs and digests cellular debris, foreign substances, cancer cells
38
Tissue specific macrophages: Langerhans Kupffer cells Microglia
Langerhans - skin Kupffer cells - liver Microglia - CNS
39
What do lymphocytes do?
Main type of cell in lymph that produces antibodies | B-cells, T-cells
40
Where are mast cells found and how do they work?
- Found in most tissues of body (skin, airways, intestine) - Contain granules which hold several preformed immune mediators (histamines, serotonin, thromboxane, prostaglandins, platelet activating factors, cytokines
41
Describe the pathology of RA:
1. Synovial cells multiply 2. Influx of leukocytes 3. Synovial accumulates excessive fluid (edematous) 4. Increase TNF (mast cells) -> massive inflammatory response 5. WNC phagocytize immune complexes 6. Release of metalloproteases - degrade cartilage 7. Inhibits bone formation and stimulates bones resorption
42
RA results in a structure called ____ that surrounds the joints.
Pannus
43
How can collateral tissue injury occur?
1. Lack of specificity in immune response 2. Phagocytosis of local cells 3. Free radicals/oxygen metabolites 4. Vascular damage to allow diapedesis
44
What are the systemic effects of acute inflammation?
1. Fever 2. Malaise 3. Anorexia 4. Hypotension 5. Accelerated degradation of skeletal muscle (by cytokines) 6. Increasing circulating effects of mast cell (TNF) 7. Leukocytosis 8. Leukopenia
45
What is leukocytosis? | Normal vs abnormal values?
Increased WBC count normal = 4000-10000 Abnormal = 15000-20000
46
What is leukopenia and what can cause it?
- Decreased WBC count | - Patient's who are immune compromised (viral/bacterial infections)
47
Pro inflammatory signaling molecules are involved in controlling inflammation by:
1. Short half-lives 2. Rapid degradation 3. Large [ ] -> reduction in amount of pro-inflammatory signaling molecules (negative feedback loop)
48
Describe the negative feedback loop of pro-inflammatory molecules
High [ ] -> down-regulation of receptor sensitivity -> reduced production of signaling molecules
49
When inflammation slows, what can begin?
Tissue repair
50
M1 macrophages -
- Encourage inflammation - First on the scene of muscle injury (0-48 hrs) - Possible collateral damage of tissue cleanup
51
M2 macrophages -
- Anti-inflammatory and encourage tissue repair | - Release soluble substances that influence proliferation, differentiation, growth, repair, and regeneration of muscle
52
Complete resolution of inflammatory episode -
No damage to CT framework -> normal function returns, clearance of injurious stimuli, clearance of all mediators and acute inflammatory cells -> replacement of injured cells
53
Abscess formation -
Abscess - accumulation of pus in a confined space (on skin = pimple/pustule) - Often requires draining
54
How is pus formed?
Neutrophils destroyed by macrophages
55
Healing by fibrosis or scarring?
- Preinjury tissue replaced by CT (fibrosis)
56
What are parenchymal cells and what are their function in recovery?
- make up functional part of an organ - Required for normal recovery from injury - If not available = fibrosis
57
What are some implications of inflammation for the therapist?
1. Normal process that does damage adjacent healthy tissue 2. Systemic effects 3. Limit inflammation (RICE/OTCs) 4. Can lead to chronic inflammation
58
How does inflammation progress to chronic?
When neutrophils can't remove noxious agents (weeks-months-years)
59
How is chronic inflammation characterized?
Continuous tissue injury with ongoing attempts at repair
60
Chronic inflammation can arise from what 3 things?
1. Persistent infections/presence of foreign particles 2. Hypersensitivity disease - excessive and inappropriate activation of immune system (RA, MS, asthma) 3. Prolonged/chronic exposure to toxic agents (silica, cholesterol, cigarette smoke)
61
Chronic tissue inflammation has what cells present? What cells absent?
Present - macrophages, lymphocytes, plasma cells | Absent - neutrophils
62
Attempts at healing during chronic inflammation result in what two things?
1. Angiogenesis - growth of blood vessels | 2. Fibrosis
63
What is granulomatous inflammation and what is it caused by?
- Form of chronic inflammation | - Caused by aggregation of macrophages
64
T/F granulomatous inflammation sometimes presents with central abscess
True
65
Examples of granulomatous inflammation?
1. Foreign bodies (talc, suture) 2. TB (prototype) 3. Fungal infections (histoplasmosis) 4. Some immune-mediated inflammatory diseases (Crohn disease)
66
When is the onset of acute inflammation?
Minutes - hours
67
When is the onset of chronic inflammation?
Days
68
What are the cellular infiltrates of acute inflammation?
Mainly neutrophils
69
What are the cellular infiltrates of chronic inflammation?
Monocytes/macrophages and lymphocytes
70
What level of tissue injury/fibrosis do you see with acute inflammation?
Mild - self limiting
71
What level of tissue injury/fibrosis do you see with chronic inflammation?
sever and progressive
72
What local and systemic signs do you see with acute inflammation?
Prominent
73
What local and systemic signs do you see with chronic inflammation?
Less prominent (may be subtle)
74
How can chronic inflammation lead to diabetes? | inflammation in presence of obesity
Increase activity of pro-inflammatory cells (macrophages) -> increase release of pro-inflammatory signaling molecules into blood stream -> cytokines interfere with insulin signaling and damage pancreatic beta cells -> diabetes
75
Areas of chronic inflammation or small tumors affect on chronic inflammation?
Release pro-inflammatory signaling molecules -> system wide
76
How does cigarette smoke affect inflammation?
Induces chronic inflammation state
77
What is an example of direct chronic irritation?
smokeless tabaco
78
T/F Heart disease is viewed as an inflammatory disease
True, reduction in inflammation -> reduced risk of heart attack

Pathophys (16 decks)

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