Inflammation - Acute and Chronic

Question 1

What is inflammation and what is its purpose?

Answer 1

a response to tissue injury by mechanical trauma, toxins, ischemia, immune responses, tissue necrosis, infections…
purpose is to destroy or contain the damaging agent, repair, healing, regeneration

Question 2

what are the three components of acute inflammation?

Answer 2

vascular dilation, endothelial activation, neurotrophil activation and migration

Question 3

what are the three morphological variant types of acute inflammation?

Answer 3

suppurative/puruent inflammation
fibrinous inflammation
serous inflammation

Question 4

What are common examples of purulent inflammation>

Answer 4

lobar pneumonia, bronchipneumonia, acute appendicitis

URIs can spread down the respiratory tract and lead to tracheobronchitis and bronchiolitis

Question 5

what are typical pyogenic bacterias?

Answer 5

staph, strep, E coli, neisseria spp., N. meningitidis, gonorrhea

Question 6

what does tracheobronchitis and or bronchitis (acute inflammatory Suppurative/purulent inflammations) usually present with?

Answer 6

productive cough - yellow or green sputum

it can progress to bronchopneumonia

Question 7

where are fibrinous inflammation found?

Answer 7

in serous membrane-lined cavities

pleural, pericardial, peritoneal

Question 8

what are serious inflammations divided into?

Answer 8

transudate and exudate

Question 9

what is transudate?

Answer 9

low specific gravity (like water) and low protein content

Question 10

what is exudate?

Answer 10

high specific gravity (much higher than water) high protein content

Question 11

where is serous inflammation found?

Answer 11

seen in skin in response to burns

serous-lined membranes like pleural effusions

Question 12

what are the cardinal signs of inflammation - Celsus?

Answer 12

redness (rubor) - hyperemia (increase blood flow)
swelling (tumor) - fluid exudation and hyperemia
heat (calor) - hyperemia (increase blood flow)
pain (dolor) - release of bradykinin and PGE2
*inflammatory mediators bind to pain n.
added by Galen:
loss of function (functio laesa) - combined effects, mainly swelling and pain

Question 13

how are the outcomes of acute inflammation determined?

Answer 13

severity of tissue damage
capacity of stem cells within the tissue to replace the specialized cells required (regeneration)
the type of agent causing the damage

Question 14

what are the 3 possible outcomes of acute inflammation?

Answer 14

resolution - seen in sunburns, pneumonia
fibrosis (scar formation)
chronic inflammation

Question 15

when can resolution happen?

Answer 15

when CT framework is intact and the tissue has capacity to regenerate

sunburn, pneumonia

Question 16

how does the heart heal?

Answer 16

fibrosis - which is good because if you had a hole in your heart that would suck. At least there is structural integrity that is being re-established

Question 17

what is a common type of chronic inflammation?

Answer 17

abcess formation - from pyogenic bacteria!

acute to chronic

Question 18

what inflammatory infiltrates are found in chronic inflammation

Answer 18

lymphocytes, macrophages and plasma cells

Question 19

how does chronic inflammation usually heal?

Answer 19

by fibrosis

Question 20

what are some examples that can contribute to immunological chronic inflammation

Answer 20

low toxicity organisms = syphillis
infective organisms that grow in cells = virus
allergic reactions
autoimmune conditions (SLE)
fungal, protozal and parasit infections

Question 21

what are non-immulpogical examples that contribute to chonic inflammation?

Answer 21

foreigh body reactions, inert noxious materials - silica, talc, asbestos, beryllium

Question 22

what is an example of a non-granulomatous chronic inflammation?

Answer 22

hep. B virus infection = liver fibrosis

Idiopathic pulmonary fibrosis

Question 23

what is tissue damage due to in chronic inflammation?

Answer 23

due to inflammatory response rather than the virus itself

Question 24

what is an example of a granulomatous chronic inflammation?

Answer 24

Tb(caseous necrosis - cheesy appearance) crones disease, diverticulitis
granulomas = giant cell + epitheliod macrophages

Question 25

what do granulomatous chronic infections contain

Answer 25

giant cells + epitheliod macrophages + chronic inflammation cells

Question 26

Where are free plasma proteins found?

Answer 26

Components of the coagulation cascade Acute phase reactants - increase secretion of blood proteins from liver during inflammation Complement proteins Circulating immunoglobulin aka antibodies

Question 27

What is opsonization?

Answer 27

Coating bacteria with immunoglobulin and complement proteins which together, increase phagocytize activity

Question 28

What is acute pericarditis?

Answer 28

Mt of fibrin coats the visceral layer of the serous pericardium

Question 29

What are hemosiderin and where are they commonly found?

Answer 29

They are the foamy appearance of a cytoplasm of macrophages which also contains brownish pigment granules that are iron containing pigmented found commonly after an MI near necrotic cardiac muscle tissue

Question 30

What are fibrolysins?

Answer 30

Break down fibrin strands during clean up

Question 31

What are the infiltrates of chronic inflammation?

Answer 31

``` Plasma cells Lymphocytes Macrophages Eosinophils Fibroblasts ```

Question 32

What is bronchiectasis?

Answer 32

Chronic inflammation of the bronchi leading to progressive destruction of muscular and elastic components of the wall and permanent dilation - elastic and muscular components are replaced by granulation and fibrous tissue

Question 33

How are giant cells formed? What is their function?

Answer 33

Formed by the fusion of epitheliod macrophages. | They are secretory

Question 34

Usually central necrosis in granulomateous conditions form what kind?

Answer 34

Atypical mycobacterium infection - suppurative Tb- caseous necrosis Chrons - no necrosis

Question 35

what does vascular dilation equal in acute inflammation?

Answer 35

hyperemia = increase of blood flow to different tissues in the body.

Question 36

how are neutrophils attracted to inflammation sites?

Answer 36

chemotaxis

Question 37

what is the major thing in pus?

Answer 37

neutrophils | also..necrotic debris and fluid with some fibrin.

Question 38

what does the exudate in fibrrous inflammation have high content of ?

Answer 38

plasma protein

Question 39

what is the exudate in purulent inflammation rich in

Answer 39

neutrophils

Question 40

what is seen in serous inflammation?

Answer 40

transudate

Question 41

when healing by fibrosis, the defect is filled by an ingrowth of what?

Answer 41

granulation tissue called organization

Question 42

what is teh granulation tissue (organization) eventually replaced ith?

Answer 42

collagen to form a fibrous scar

Question 43

over years, when there is a progressive loss of capillaries, what happens?

Answer 43

scar deminishes

Question 44

what is a chronic access?

Answer 44

An abscess cavity encapsulated by granulation and fibrous tissue

Question 45

what are the types of chronic inflammation?

Answer 45

1) Non-specific-follows non-resolution of acute inflammation, e.g. chronic peptic ulcer, chronic abscess 2) Specific (primary) -response to certain specific types of injurious agents a. Non-immune mechanism –either granulomatousor non-granulomatous b. Immune mechanism –either granulomatousor non-granulomatous

Question 46

in non-specific chronic inflammation what goes on?

Answer 46

Tissue damage, acute inflammation, granulation tissue, tissue repair and chronic inflammation coexist, with active tissue damage and acute inflammation in one area and adjacent areas of fibrosis and chronic inflammatory infiltrates.

Question 47

what is a key feature of chronic inflammation?

Answer 47

activation of macrophages

Question 48

imune type granulomatous response like tb what is another name?

Answer 48

Immune type, delayed hypersensitivity response,

Question 49

what can chronic fibrosis lead to ?

Answer 49

can result in great morbidity and sometimes mortality