*UNFINISHED* MOD Session 3

Question 1

What is meant by ‘chronic’ inflammation?

Answer 1

Chronic response to injury with associated fibrosis

Question 2

How can chronic inflammation arise?

Answer 2

1) May ‘take over’ from acute inflammation (if damage is too severe to be resolved in a few days)
2) De novo e.g. RA, chronic infec HCV, ‘‘chronic low level irritation
3) Develop alongside acute inflammation e.g. in severe persistent or repeated irritation (chronic cholecystitis)

Question 3

What cell types is associated with chronic inflammation?

Answer 3

Macrophages, Lymphocytes, Plasma cells, Eosinophils, Fibroblasts/Myofibroblasts

Question 4

Give 4 functions of macrophages in C.I?

Answer 4

Phagocytosis
Processing and presentation of antigen (APC)
Synthesis of cytokines, complement, blood clotting factors and proteases
Control of other cells by cytokine release

Question 5

If plasma cells are present with C.I, what would this indicate?

Answer 5

Implies considerable chronicity

Question 6

What are eosinophils described as histologically and where are they seen?

Answer 6

1) Sun burnt with shades

2) Allergic reactions, parasitic infections, some tumours

Question 7

What are giant cells?

Answer 7

Multinucleate cells made by fusion of macrophages (during frustrated phagocytosis)

Question 8

What types of giant cells are there?

Answer 8

1) Langhans (TB)
2) Foreign body type
3) Touton (fat necrosis)

Question 9

What are the effects of C.I? Give examples of each

Answer 9

1) Fibrosis e.g. chronic cholecystitis, chronic peptic ulcers, cirrhosis
2) Impaired function e.g. chronic inflammatory bowel disease (rare to be increased e.g. thyrotoxicosis)
3) Atrophy e.g. gastric mucosa, adrenal glands
4) Stimulation of the I.S e.g. macrophage-lymphocyte interactions

Question 10

Give three features of chronic cholecystitis that lead to C.I?

Answer 10

1) Repeated obstruction by gall stones
2) Repeated A.I. leads to C.I.
3) Fibrosis of gall bladder wall

Question 11

Why does ulceration occur? Give examples of acute and chronic gastritis.

Answer 11

1) Imbalance of acid production and mucosal defence

2) Acute - alchohol, drugs e.g. NSAIDs
Chronic - H.Pylori

Question 12

What symptoms do patients with IBD present with?

Answer 12

Diarrhoea, rectal bleeding, possible abdominal pain, malabsorption.

Question 13

Describe the inflammation seen in RA?

Answer 13

1) Localised and systemic immune response
2) Local chronic inflammation leading to joint destruction
3) Systemic immune response - affect other organs and cause amyloidosis

Question 14

What is granulomatous inflammation?

Answer 14

Chronic inflammation with granulomas

Question 15

What is a granuloma?

Answer 15

Aggregate of activated macrophages. Modified, immobile macrophages

Question 16

What are the two types of granulomas and what do they contain? When do they arise?

Answer 16

1) Foreign body granulomas : contain macrophages, FBGCs that develop around material that is not antigenic e.g. surgical thread
2) Hypersensitivity granulomas: contain macrophages, Langhans GCs, undergo central necrosis developing around insoluble antigenic particles e.g. organisms causing syphillis, TB, leprosy. Seen in sarcoidosis

Question 17

What are the main causes of granulomatous inflammation?

Answer 17

1) Mildly irritant foreign material
2) Infections (Mycobacterium TB, Leporosy)
3) Unknown e.g. sarcoid, Wegener’s granulomatosis (granulomatous vasculitis), Crohn’s disease

Question 18

What are the possible outcomes from a TB infection?

Answer 18

1) Arrest, fibrosis, scarring
2) Erosion into bronchus&raquo_space;> bronchopneumonia, TB in GIT
3) Tuberculous empyema
4) Erosion into the bloodstream

Question 19

What type of giant cell and necrosis is seen in TB? How does it differ from sarcoidosis?

Answer 19

1) Langhans with caseous necrosis

2) Sarcoidosis has non-caseating granumoas

Question 20

Which of the four cardinal signs of acute inflammation persists in chronic inflammation?

Answer 20

Swelling and pain