Lecture 5 - Chronic Inflammation

Question 1

What is the definition for Chronic Inflammation?

Answer 1

Prolonged inflammation with associated repair

Question 2

Why is acute inflammation referred to as being stereotyped and chronic inflammation being modulated?

Answer 2

Acute stereotyped occurs rapidly and responds to any type of injury

Chronic modulated takes over if the injurious agent is not quickly removed

Question 3

How does Chronic inflammation arise?

Answer 3

Takes over from acute Inflammation (if acute inflammation cant resolve)

Develops alongside acute inflammation (at same time, e.g ongoing bacterial infection)

Develops without preceding acute inflammation

Question 4

Why might chronic inflammation arise without preceding acute inflammation?

Answer 4

Chronic infection like TB
Autoimmune conditions (Rheumatoid arthritis)
Prolonged exposure to toxic agents (silica)

Question 5

What is the main cell involved in acute inflammation?

Answer 5

Neutrophil

Question 6

What cells are involved in chronic inflammation?

Answer 6

Macrophages
Lymphocytes + Plasma cells
Eosinophils
Fibroblasts/Myofibroblasts

Question 7

What is a monocyte?

Answer 7

A blood circulating phagocyte

Question 8

What is a macrophage/histiocyte?

Answer 8

A monocyte which his migrated into tissues

Question 9

What is the appearance of a macrophage?

Answer 9

Large
Abundant “foamy” cytoplasm
Slipper shaped nucleus

Question 10

What causes the foamy cytoplasm look in a macrophage?

Answer 10

Abundant phagolysosomes

Question 11

What is the function of the macrophages?

Answer 11

Remove pathogens (degrade)
Antigen presentation
Release mediator controlling inflammation

Question 12

What is the appearance of a lymphocyte?

Answer 12

Small cell (like RBC)
Large spherical nucleus
Very thin rim of cytoplasm

Question 13

What are the 2 types of lymphocyte?

Answer 13

T Cell
B Cell

Question 14

What is the function of T Cells?

Answer 14

Helper T Cells assist other inflammatory cells
Cytotoxic T cells destroy pathogens

Question 15

What is the function of B Cells?

Answer 15

Mature into plasma cells
These produce antibodies that neutralise pathogens

Question 16

What is the appearance of a plasma cell?

Answer 16

Clumped chromatin
Eccentric non central nucleus
Paler peri-nuclear clearing

Question 17

What causes the paler peri-nuclear region around the nucleus of a plasma cell?

Answer 17

The prominent Golgi bodies

Question 18

What is the function of a plasma cell?

Answer 18

Produces antibodies

Question 19

What is the appearance of an Eosinophil?

Answer 19

TOMATO WITH SUNGLASSES

Bi-lobed nucleus
Very granular so cytoplasm stains quite red

Question 20

What is the function of Eosinophils?

Answer 20

Parasitic infections
Hypersensitivity reactions (allergies, asthma etc…)

Release variety of mediators

Question 21

What is the general function of fibroblasts/myofibroblasts?

Answer 21

Lay down collagen to regenerate and repair

Question 22

What are giant cells?

Answer 22

Multinucleated cells formed by the fusion of multiple macrophages

Question 23

What is meant by frustrated phagocytosis?

Answer 23

When a phagocyte fails to engulf a pathogen and so fuses with other macrophages to form a giant cell to be able to engulf the pathogen

Question 24

What are the 3 types of Giant cells?

Answer 24

Foreign body giant cell
Langhans giant cell
Touton giant cell

Question 25

How are giant cells named/categorised?

Answer 25

Depending on the arrangement of the nuclei

Question 26

What is the structure/appearance of a foreign body giant cell?

Answer 26

Randomly arranged nuclei

Question 27

What is the appearance/structure of a Langhans giant cell?

Answer 27

Nuclei arranged in horseshoe in rim around cell

Question 28

What is the appearance/structure of a Touton giant cell?

Answer 28

Central ring of nuclei

Question 29

When a foreign body giant cells usually formed?

Answer 29

When body is responding to a foreign body present (like a suture)

Question 30

When are Langhans Giant cells usually present?

Answer 30

Usually with TB

Question 31

What type of giant cell can be seen in fat necrosis?

Answer 31

Touton giant cell

Question 32

What is the importance of the proportions of cells present in chronic inflammation?

Answer 32

Can indicate a diagnosis

Question 33

Which cells are predominantly present in Rheumatoid arthritis?

Answer 33

Mainly plasma cells

Question 34

Which cells are mainly present in chronic gastritis?

Answer 34

Mainly lymphocytes

Question 35

Which cell is mainly present in Whipple’s disease (bacterial infection of intestines and lymph nodes)?

Answer 35

Mainly macrophages

Question 36

What are the effects of chronic inflammation?

Answer 36

Fibrosis Impaired function Atrophy Stimulation of immune response

Question 37

What is fibrosis and what is the effect of fibrosis on a tissue?

Answer 37

The deposition of collagen Fibrosis impairs tissue function

Question 38

Why is atrophy a negative effect of chronic inflammation?

Answer 38

Reduction in size of tissue (reduced amount of normal functioning tissue)

Question 39

What is Chronic Cholethiasis?

Answer 39

Repeated obstruction of bile duct by gall stones

Question 40

How does chronic inflammation occur with Chronic cholethiasis?

Answer 40

Blocking of common bile duct causes acute inflammation Repeat blockage = repeat bouts of acute inflammation = chronic inflammation Fibrosis of gall bladder wall (thickened and pale)

Question 41

How does a patient with Chronic cholethiasis and chronic inflammation present?

Answer 41

Pain in RUQ Fever Raised neutrophils

Question 42

Which 2 inflammatory bowel diseases are idiopathic?

Answer 42

Chron’s Disease Ulcerative Colitis

Question 43

What symptoms do patients present with when suffering with Crohn’s disease or Ulcerative Colitis?

Answer 43

Abdominal pain Altered bowel motion Weight loss Rectal bleeding

Question 44

Where does Ulcerative colitis affect and where can Crohn’s Disease affect?

Answer 44

Ulcerative Colitis = LARGE BOWEL ONLY Crohn’s Disease can affect all of GI tract

Question 45

Out of Crohn’s Disease and Ulcerative Colitis, which one is most likely to cause rectal bleeding and why?

Answer 45

Ulcerative colitis since it causes CONTINUOUS Inflammation Crohn’s disease = discontinuous patchy inflammation

Question 46

How is the bowel wall affected by inflammation in Crohn’s disease and ulcerative colitis?

Answer 46

Crohn’s disease = affects full thickness of wall Ulcerative colitis = affects superficial wall only

Question 47

Which inflammtory bowel disease (Crohns or ulcerative colitis) can granulomata be found?

Answer 47

Crohn’s disease

Question 48

What are the nodules caused by in liver cirrhosis?

Answer 48

Hepatocytes regenerating

Question 49

What does fibrosis look like on a liver?

Answer 49

Bands of collagen separating the nodules of regenerating Hepatocytes

Question 50

What is Granulomatous inflammation?

Answer 50

Chronic inflammation + Granuloma A specific type of chronic inflammation where at least 1 Granuloma is present

Question 51

What is a Granuloma?

Answer 51

Collection of macrophages that look like epithelial cells that may be surrounded by lymphocytes

Question 52

What is the name given to macrophages that look like epithelial cells?

Answer 52

Epithelioid Histiocytes

Question 53

What is the difference between a giant cell and a Granuloma?

Answer 53

Granuloma = all distinct cells Giant cell = 1 fused cell Granulomas can contain giant cells

Question 54

What are the 2 types of Granuloma?

Answer 54

Foreign body Granuloma Immune Mediated Granuloma

Question 55

How are Granulomas classified as either foreign body or immune mediated?

Answer 55

Depends on what they destroy

Question 56

What is the role of a foreign body Granuloma and what is the relative levels of lymphocytes?

Answer 56

Destruction and removal of foreign material Few lymphocytes

Question 57

What is the role of Immune Mediated Granuloma and what are the relative levels of lymphocytes?

Answer 57

Destruction of pathogens (bacteria/fungi) Can undergo central necrosis Many lymphocytes

Question 58

What can cause granulomatous inflammation?

Answer 58

Infections like: Mycobacterium tuberculosis Mycobacterium leprae (Leprosy) Thick cell walls hard to destroy

Question 59

What type of necrosis do mycobacterium Granulomas have?

Answer 59

Central necrosis usually caseous necrosis

Question 60

How does caseous necrosis of a Granuloma appear on an image?

Answer 60

Pale pink centre of Granuloma (lacks any structure)

Question 61

What type of granulomata does sarcoidosis cause?

Answer 61

Non-necrotising granulomata

Question 62

What type of granulomata does Crohn’s disease cause?

Answer 62

Non-necrotising granulomata?