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Flashcards in Inflammation - Pathology Deck (93):
0

What are the sings & symptoms of inflammation? (5)

heat
redness
swelling
pain
impaired function

1

Pathology of inflammation (4)

circulatory changes
vessel wall changes
mediators of inflammation (M of I)
cellular events of inflammation

2

What are the circulatory changes?

injury stimulation-->vasoconstriction-->vasodilation--->:
1) hyperemia (redness, swelling, warmth): increased intracapillary pressure
2) edema: (in capillaries and venules) filtration of plasma through vessel wall
3) congestion: blood flow in dilated capillaries and venules is slow
--> WBCs attach to endothelium (wall of blood vessel)--> release of mediators of inflammation (derived from WBC and platelets)--> platelets initiate clotting

3

Vessel wall changes

changes in permeability of capillary walls in response to inflammation

4

Reasons for vessel wall changes during inflammation

1) increased intravascular pressure (congestion)
2) slowing of the circulation => less oxygen and nutrients to endothelial cells
3) adhesion of WBC and platelets to endothelial cells
4) release of mediator of inflammation (from WBC, platelets, endothelial cells, plasma)

5

What are the mediators of inflammation? (2)

plasma derived
cell derived

6

Plasma derived inflammatory mediator

circulate in inactive form -> transformed into active form by ACTIVATOR

7

Cell derived inflammatory mediator

1) preformed and stored in WBC, platelets ... or synthesized on demand.
2) preformed mediators - quick release (histamine)
3) synthesized mediators - released later

8

Sample of preformed cell derived inflammatory mediator

histamine

9

Chemistry of mediators of inflammation

- biogenic amines (histamine)
- peptides (bradykinin)
- arachidonic acid derivatives (prostaglandins)

10

Effects of meditoary of inflammation

- vasodilation or vasoconstriction
- alternation of vascular permeability
- activation of inflammation cells
- chemotaxis
- cytotoxicity
- degradation of tissues
- fever
- pain

11

Which cells release histamine during inflammation? (3)

platelets
mast cells
basophils

12

Effects of histamine

- increased blood vessel permeability => fluids and cells can exit into intersititial spaces
- vasodilation
- effects are quick but last less than 30 min. (histamine inactivated by enzyme histaminase)

13

bradykinin

plasma protein

14

Effects of bradykinin

- similar to histamine but slower
- amplifies and sustains response to injury
- PAIN

15

Which chemical causes pain during inflammation?

bradykinin

16

What can activate the complement system of inflammation?

antigen-antibody complexes, bacterial toxins, fungi, snake venom, etc.

17

All components of complement system promote ____.

inflammation

18

Where does arachidonic acid derived from?

phospholipids of cell membrane

19

Arachidonic acid synthesis blocks by _______.

corticosterioids

20

Prostaglandin synthesis blocks by _______.

ASPRIN

21

emigration of leukocytes (WBC)

diapedesis = active movement of WBCs through capillary wall into tissues

22

transudation

leakage of fluid rich in proteins

23

transudate from capillaries (more permeable) into interstitial space

edema

24

exudation

emigration (diapedesis) of cells and fluid through capillary wall

25

What's the difference between transudation and exudation?

exudation contains inflammatory cells (WBCs) and much more protein than transudation

26

What's chemotaxis?

active movement of WBCs towrads certain chemicals;
movement along concentration gradient of those chemicals.

27

What's chemoattractant?

It's chemotactic agent.
It derived from bacteria damaged tissues, activated complement, etc.

28

What cells arrive first in acute I inflammation?

neutrophils

29

What cells have longest life among cells of inflammation?

macrophages

30

Among cells of inflammation, which cells have similar function?

neutrophils and macrophages

31

Which cells create fever in acute I inflammation?

neutrophils

32

Among cells of inflammation, which cells are response to allergy?

eosinophils, basophils

33

What cells contain histamine among cells of inflammation?

basophils

34

List the cells of inflammation

neutrophils, eosinphils, basophils, macrophages, other cells (lymphocytes, plasma cells, platelets)

35

Among cells of inflammation, which can release histamine?

basophils, and platelets

36

What is the main function of platelets?

hemostasis (vascular spasm, platelet plug formation, blood coagulation)

37

What does histamine do during inflammation?

promoting formation of connective tissue

38

What are the 4 ways to classify inflammation?

duration
etiology
location
morphology

39

How long does Acute I inflammation last?

few hours to few days (or kill you)

40

examples of Chronic I inflammation

tuberculosis
autoimmune diseases

41

What are the infectious agents for inflammation?

bacterial, viral, protozoal, fungal, helmintic

42

What are the chemical causes of inflammation?

acids, alkaline substances

43

What are the physical causes of inflammation?

heat, radiation, etc.

44

What are the immune causes of inflammation?

eczema, autoimmunity

45

Which of the following is localized inflammation?
a) furuncle
b) furunculosis
c) measels

a) furuncle

46

Which of the following is widespread inflammation?
a) furuncle
b) furunculosis
c) measels

b) furunculosis

47

Which of the following is systemic inflammation?
a) furuncle
b) furunculosis
c) measels

c) measels

48

What is the mildest form of inflammation?

serous inflammation

49

Serous inflammation is the ___ stages of most inflammation?

early

50

Examples of serous inflammation

1) viral infection
2) autoimmune diseases (pericarditis, pleuritis, peritonitis, rheumatoid arthritis)
3) blisters caused by 2nd-3rd burn

51

Feature of fibrinous inflammation

transudate rich in fibrin (large protein molecules)

52

What's the major difference between transudation and exudation?

Transudation leaks clear fluid without cells.
Exudation leaks cells.

53

Example of fibrinous inflammation

bacterial infections: strep throat, bacterial pneumonia, fibrinous pericarditis

54

What causes purulent inflammation?

pus-forming bacteria (streptococci, staphylococci)

55

What is absecess?

localized collection of pus within an organ or tissue

56

What is empyema?

accumulation of pus in preformed cavity (gallbladder, thoracic cavity)

57

What are the locations for ulcerative inflammation?

body surface or mucosa of hollow organs

58

What is ulcer?

Defect involving epithelium, may extend into deeper connective tissue.

59

Examples of ulcerative inflammation

decubitus ulcer
gastric ulcer

60

What is pseudo-membranous inflammation?

fibrino and purulent exudation.
It has fibrin, pus, cellular debris, mucus form pseudo-membrane on the surface of ulcers.

61

Example of pseudo-membranous inflammation

pseudomembranous colitis
diphtheria

62

What's the feature of chronic inflammation?

prolonged duration
more extensive tissue destruction

63

What does chronic inflammation's exudate contain?

lymphocytes, macrophages, plasma cells

64

Chronic inflammation of kidney will cause kidney to ___.

shrink

65

Examples of chronic inflammation

obliteration of fallopian tubes

66

Healing of chronic inflammation

scars, fibrosis, adnesions

67

What is granulomatous inflammation?

A special form of chronic inflammation.
macrophages and T-lymphocytes accumulate at the site of injury and form nodules = granulomas

68

Features of granulomatous inflammation

persist for a long time
destroy tissues
undergo central necrosis
fibrosis
microorganisms can survive in fibrotic lesions

69

Tuberculosis is __________ inflammation.
a) pseudo-membranous I.
b) granulomatous I.
c) ulcerative I.
d) purulent I.

b) granulomatous I.

70

Clinicopathologic correlations of inflammation

-local findings (5 signs & symptoms of inflammation)
-fever
-leukocytosis
-constitutional (nonspecific) symptoms: fatigue, weakness, depression, lack of appetite, generalized pain, exhaustion

71

What are the constitutional symptoms for inflammation?

fatigue, weakness, depression, lack of appetite, generalized pain, exhaustion

72

What are the consequences of healing of acute inflammation?

no consequences
or progression to chronic inflammation

73

Example of mitotic cells

basal layer of skin or mucosa
bone marrow cells (precursors of blood cells)

74

What are the mitotic cells?

never stop dividing (unstable cells)
=labile cells

75

What are the facultative mitotic cells?

They are stable cells.
Do not divide regularly, can be stimulated to divide.

76

Where can you find facultative mitotic cells?

liver, kidney

77

What are the postmitotic cells?

permanent cells
nondividing

78

Examples of postmitotic cells

neurons, myocardial cells

79

Postmitotic cells can only be repaired by _____.

fibrous scarring

80

List of all cells related to healing

neutrophils, macrophages, myofibroblasts, angioblasts, fibroblasts

81

What does neutrophils do during inflammation?

scavenging the site of injury.

82

What does macrophages do during wound healing?

produce growth factors
produce chemicals (mediators) that act on other cells (fibroblasts, angioblasts, myofibroblasts)

83

What does myofibroblasts do during wound healing?

secrete substances like fibroblasts (collagen)
contract like muscle cells => reduction of defect, holding margins in close approximation

84

What does angioblasts do during wound healing?

(precusors of blood vessels)
sprout from small blood vessels around the wound

85

What does fibroblasts do during wound healing?

produce extracellular matrix of connective tissue
collagen fibers need to mature, cross-link => full strength of scar tissue (several weeks after injury)

86

What are the substances needed for collagen formation?

Vitamin C, zinc, protein

87

Describe the healing by First intention

(sterile surgical wounds)
1. blood clot -> scab
2. invasion of neutrophils and macrophages
3. ingrowth of myofibroblasts, angioblasts, fibroblasts
4. granulation tissue formation (=vascularized CT) - temporary structure, undergoes changes
5. collagenous scar (3-6 weeks)
6. proliferation of epithelial cells from margins of the wound (3-7 days)

88

Describe the healing by Second intention

(large, infected wounds)
wound contraction cannot be accomplished by myofibroblasts
granulation tissue remains exposed (more abundant)
epithelial cells take longer to cover the defect
more excessive scarring

89

What are the factors for wound healing?

1. site of the wound (skin, brain)
2. mechanical factors: approximation of margins, tension, movement, foreign particles
3. size of the wound
4. infection (prevention, treatment)
5. circulatory status: ischemic tissues heal poorly (diabetes mellitus, smoking)
6. nutritional and metabolic factors: protein, zinc, vitamin C
7. Age
8. Sleep

90

What are keloids?

hypertrophic scars composed of immature collagen.

91

What can cause excess scar formation?

keloids
contractures due to large scars, esp. after burns -> immobilization or lower ROM

92

What can cause deficient scar formation?

ischemia due to diabetic micro-angiopathy and metabolic disturbances
excess of corticosteroids
poor scar tissue development => dehiscence (separation of margins)