Topic 12 Immune Response & Inflammation part 2

Question 1

Non-specific response to tissue damage:

Answer 1

Response to cut is the same as a burn/radiation/infection, etc.
(Pathogens, Abrasions, Chemical irritations, Distortion / cell disturbance, Extreme temps)

Question 2

Inflammation 4 signs

Answer 2

Redness
Pain
Heat
Swelling

Question 3

3 stages of Inflammation

Answer 3

1. Vasodilation - Increase permeability of blood vessels
2. Emigration - Movement of phagocytes from blood to interstitial fluid
3. Tissue repair

Question 4

Factors that cause vasodilation and increased

permeability:

Answer 4

Histamine, Kinins, prostaglandins, leukotrienes, Complement

Question 5

Histamine

Answer 5

Mast cells in the tissues release
Basophils and platelets stimulate the release of
histamine in the blood
Causes increased dilation and permeability

Question 6

Kinins induce/act as what?

Answer 6

Polypeptides
Induce vasodilation and increase permeability
Act as chemotaxic agent phagocytes
Ex: bradykinin

Question 7

Prostaglandins

Answer 7

Lipid
Released by damaged cells
Stimulate emigration of phagocytes

Question 8

Leukotrienes

Answer 8

Basophils and mast cells produce

Increase permeability

Question 9

Complement

Answer 9

Stimulate histamine release
Attract neutrophils
Promote Phagocytosis

Question 10

Within 1hour of start of inflammatory process

what appears?

Answer 10

Phagocytes appear

Question 11

Fibrinogen converted to fibrin forms what?

Answer 11

Forms fibrin mesh

Question 12

Inflammation Neutrophils stick to blood vessel wall with increased blood flow – and do what?

Answer 12

Squeeze through blood vessel wall to tissues-“emigration”

Depends on chemotaxis

Question 13

Neutrophils attempt to destroy via what?

Answer 13

phagocytosis

Question 14

Monocytes follow neutrophils and do what?

Answer 14

Transform into macrophages
More potent phagocytes than neutrophils.
Eventually macrophages die

Question 15

Redness of inflammation is caused by?

Answer 15

Large amount of blood in damaged area
Local temperatures increase
Metabolic reactions speed up
More heat released

Question 16

Swelling of inflammation is caused by?

Answer 16

Increased permeability

More fluid in the area

Question 17

Pain caused by inflammation is caused by?

Answer 17

Symptom of inflammation–neuron injury or increased pressure (edema)

Question 18

Fever in inflammation is caused by and do what?

Answer 18

Bacteria toxins increase body temperature
Trigger release of interleukin-1 (cause fever)
Helps to inhibit the growth of some microbes
Helps to speed up body reactions
Aids in repair

Question 19

Inflammation two major components

Answer 19

vascular reaction

cellular reaction

Question 20

Acute inflammation

Answer 20

rapid onset / short duration / emigration of

neutrophils

Question 21

chronic inflammation

Answer 21

long duration / lymphocyte involvement /

proliferation of blood vessels / tissue necrosis

Question 22

Components of acute inflammation (3)

Answer 22

*dilation of capillaries and surrounding blood
vessels–increase blood flow
*structural changes in capillaries-allow plasma proteins and leukocytes to enter interstitial space
*emigration of leukocytes from capillaries where they accumulate in focus of injury-activation to eliminate offending agent

Question 23

Stimulation for acute inflammation

Answer 23

Infections and microbial toxins
Trauma
Physical and chemical agents
Tissue necrosis
Foreign bodies
Immune reactions

Question 24

Vascular changes do what?

Answer 24

Maximize movement of plasma proteins and
appropriate circulating cells into the site of injury or infection
Vasodilation
Increased capillary permeability

Question 25

Vasodilation what is involved first?

Answer 25

Arterioles involved first, followed by opening of new capillary beds

Question 26

Increased Capillary Permeability results in what?

Answer 26

Osmotic & hemodynamic changes force fluid into interstitial space (results stasis) / neutrophils begin adhering to endothelium and moving into interstitial space / physical openings in endothelium allow more fluid / protein / cells to migrate

Question 27

Margination

Answer 27

movement of leukocytes toward the wall of the capillary

Question 28

Rolling:

Answer 28

leukocytes tumble slowly along endothelium, adhere transiently, then are finally attached–endothelium completely lined with white cells

Question 29

Transmigration (diapedesis):

Answer 29

insert pseudopods into junctions between endothelial cells–move through the junction

Question 30

Chemotaxis:

Answer 30

migrate thru interstitial fluid to source of problem

Question 31

Extravasation:

Answer 31

movement of leukocytes from vessel lumen to interstitial space

Question 32

Chemotaxis how does it work?

Answer 32

Locomotion along chemical gradient Most common exogenous agents are bacterial products Common endogenous agents

Question 33

Common endogenous agents of chemotaxis (3)

Answer 33

- components of complement (C5a) - products of lipoxygenase pathway (leukotriene B4) - cytokines

Question 34

Results of Leukocyte activation (5)

Answer 34

production of arachidonic acid metabolites degrannulation and secretion of lysosomal enzymes secretion of cytokines modulation of surface receptors phagocytosis

Question 35

Leukocyte activation induced by what?

Answer 35

microbes / products necrotic cells / antigen-antibody complexes / cytokines

Question 36

Chemical mediators plasma derived must what?

Answer 36

plasma-derived must be activated

Question 37

Cell-derived chemical mediators usually stored where?

Answer 37

usually stored in intracellular granules

Question 38

Once activated and the chemical mediators released have what life span?

Answer 38

most are short lived

Question 39

Production of active mediators triggered by microbial products or host proteins (complement, etc.)

Answer 39

chemical mediators

Question 40

SIRS

Answer 40

systemic inflammatory response - common systemic response to a wide variety of insults

Question 41

2 or more of these must be present to diagnosis SIRS (4)

Answer 41

``` Body temp above 38*C or below 36*C HR >90 BPM Respiratory Rate >20/min Or PaCO2 12,000 cell/mm2 Or <10% immature neutrophils ```

Question 42

Widely accepted that SIRS is induced in what % of patients undergoing bypass?

Answer 42

ALL Incidence and severity or type of response-variable Most have a few clinical symptoms Minority develop severe hemodynamic changes or organ failure after bypass. Risk factor–Length of CPB

Question 43

Most common culprit of SIRAB is ?

Answer 43

``` = contact with foreign surface Other factor: Altered arterial blood flow patterns Sheer stress (blood pumps) Cardiotomy suction Tissue ischemia Reperfusion Hypothermia Relative anemia anticoagulants ```

Question 44

What contact proteins are activated during SIRAB?

Answer 44

Coagulation factors XII and XI Prekallikrein High molecular weight kininogen

Question 45

End result of SIRAB: formation of what? converts what?

Answer 45

Formation of bradykinin Conversion of plasminogen into plasmin Initiates fibrinolysis Triggers classical complement cascade

Question 46

Chemokine mediated generalized whole boy inflammation response

Answer 46

Activates vascular endothelium | Further neutrophil-mediated injury