3 chronic effects Chronic Inflammation (conditions only) Flashcards
General effects of chronic inflammation
- fibrosis
- impaired function
- atrophy e.g. autoimmune gastritis
- stimulation of an inappropriate immune response e.g rheumatoid arthritis
In chronic inflammation what cell type may help with diagnosis?
giant cell
Examples of fibrosis as an effect of chronic inflammation
- lung fibrosis
- gall baldder (chronic cholecystitis)
- chronic peptic ulcers
- cirrhosis
- skin scar tissue
Example of impaired function as an effect of chronic inflammation
- chronic inflammatory bowel disease
- rarely increased function e.g. thyrotoxicosis (grave’s disease), mucus secretion
Chronic cholecystitis:
1. How common ?
2. follows what ?
3. can affect ?
- very common disease
- repeated episodes of acute cholecystitis
- both sexes any age
What is the common demographic profile for those most affected by chronic cholecystitis ?
“typically” described as female, fat, fertile, forty
leading cause of chronic cholecystitis ?
gall stones
Is chronic cholecystitis always symptomatic ?
No, it can be asymptomatic
What are some possible syptoms of chronic cholecystitis ?
- biliary colic (intermittent pain in upper right abdomen)
- indigestion
- nausea
- vomiting
What are some possible signs or complications of chronic cholecystitis ?
- episodes of acute cholecystitis
- obstruction of bile ducts -> leads to jaundice
- obstruction of pancreatic ducts -> leads to pancreatitis
- chronic inflammation and scarring of gallbladder wall
- formation of gallstones
Biliary colic involves episodes of ….1.. pain caused by …2.. temporarily blocking the ..3..
- severe, crampy abdominal
- gallstones
- bile ducts
Chronic cholecystitis is associated with malignant transformation to ….?
cholangiocarcinoma
Chronic peptic ulcer refers to ulcers found where ?
gastric and duodenal ulcer
Example where fibrosis can be observed in a disease pathogenesis is one chronic condition of the stomach known as ?
chronic peptic ulcer
Cause of chronic peptic ulcer
- helicobacter pylori (HP gastritis)
- hyperacidity
Risk factors of chronic peptic ulcer
- Drugs = NSAIDs
- Genetic
- alcohol consumption
- cigarettes
- steroids
Pathogenesis of chronic peptic ulcer ?
- excess gastric acid secretion
- decreased mucosal defense against gastric acid
- ulceration due to imbalance between factors promoting mucosal damage and those mechanisms promoting gastroduodenal defense
can lead to fibrosis = narrowing or pyloric stenosis
Chronic peptic ulcer sites affected ?
- antrum (lowermost part of stomach)
- first part of duodenum
What type of fibrosis is observed in chronic peptic ulcers (gastric/duodenal) ?
narrowing or pyloric stenosis
what is pyloric stenosis ?
muscular valve between stomach and small intestine becomes abnormally narrowed
List factors which promote mucosal damage
- gastric acid
- pepsin
- H. pylori infection
- NSAIDs
mechanisms promoting gastroduodenal defense
- prostaglandins
- mucus
- bicarbonate
- muscosal blood flow
Ulceration is due to what ?
imbalance of acid and pepsin attack and muscosal defence of the gut
An example where fibrosis can be observed in a disease pathogenesis is one chronic condition of the liver known as ?
cirrhosis
A Fat Idiotic Primary Child Hated Banana Cupcakes
Common causes of cirrhosis ?
- alcohol consumption
- fatty liver disease
- infection with Hepatitis B/C (HBV/HCV)
- immunological - primary biliary cirrhosis
- idiopathic / unknown
Pathogenesis of cirrhosis ?
- chronic inflammation
- destruction of hepatocytes
- fibrosis
- nodular regeneration leading to cirrhosis
Complications associated with cirrhosis ?
- portal hypertension - scar tissue (fibrosis) from cirrhosis obstructs blood flow through liver
- liver failure - loss of functional liver tissue
- hepatocellular carcinoma (HCC)
What causes portal hypertension to be a complication of cirrhosis ?
increased resistance to blood flow through the scarred liver (scar tissue, fibrosis)
Liver failure is a complication of cirrhosis why ?
loss of functional liver tissue and metabolic dysfunction
Hepatocellular carcinoma is a complication of cirrhosis why ?
develops due to chronic inflammation , regenerative nodules and genetic mutations
A microscopic slide of liver cirrhosis shows what ?
- inflammation with destruction of hepatocytes
- fibrosis and nodular regeneration
- fibrous tissue = blue !
Example where impaired function can be observed in a disease pathogenesis is one chronic condition of the gut known as ?
inflammatory bowel disease
Name 3 features that can be observed with inflammatory bowel disease
- oedematous mucosa (mucous membrane becomes swollen due to accumulation of fluid)
- ulceration
- scar tissue
Cause of inflammatory bowel disease ?
idiopathic inflammatory disease affecting the large and small bowel
GI and non-GI symptoms of inflammatory bowel disease ?
GI
* abdominal pain
* diarrhoea
* rectal bleeding
Non-GI
* sometimes presents with symptoms like uveitis - autoimmune and systemic inflammatory response affecting the eyes
Types of inflammatory bowel disease
- ulcerative colitis
- Crohn’s disease
What’s the difference between what is involved with Crohn’s disease and ulcerative colitis ?
Crohn’s disease -> may involve any part of the GI tract
Ulcerative colitis -> usually involves large bowel (90% - rectum)
Crohn’s disease inflammation is = …1., this causes ..2.. ?
- transmural
- pain, loose stools, malabsorption
Crohn’s disease & ulcerative colitis difference in inflammation involved and what each inflammation is ?
C: Transmural = affects all layers of bowel wall , intermost mucosa to outermost serosa
U: continuous mucosal inflammation = only mucosal and submucosal layers of colon
Crohn’s disease transmural inflammation is a hallmark feature contributing to complications such as what ?
- strictures/ obstruction , narrowing of the bowel
- fistulas = abnormal connections between different parts of the bowel or other organs
In crohn’s disease what leads to the following:
1. …. leads to obstruction
2. …… leads to fistula formation
- fibrosis
- full thickness inflammation
Ulcerative colitis:
1. Has no ….. & ….. like in Crohn’s disease
2. a potential serious complication ?
- skip lesions & granulomas
- malignant change (development of colorectal cancer)
skip lesions are = areas of ..1.. tissue interspersed with areas of ..2.. tissue
- diseased
- healthy
List features that Crohn’s disease has that ulcerative colitis does not ?
- skip lesions (areas of diseased tissue interspersed with areas of healthy tissue)
- granuloma formation
Example where increased function can be observed in a disease pathogenesis is one chronic condition of the thyroid known as ?
thyrotoxicosis (grave’s disease)
Cause of thyrotoxicosis ?
autoimmune disease
Thyrotoxicosis involves ..1.. with toxic ..2..
- hyperthyroidism
- goitre
Symptoms of thyrotoxicosis ?
- exophthalmos (protruding eyes)
- thyrotoxic signs (palpitations, tremor)
- enlarge thyroid (multinodular toxic goitre)
Pathogenesis of thyrotoxicosis involves ?
- autoantibodies - long acting thyroid stimulating antibodies - TSI (thyroid stimulating immunoglobulin)
- TSI antibody acts on TSH surface receptor on thyroid epithelium and mimics TSH
- Increased T4 and T3 = reduced TSH
- hyperactive thyroid (hyperthyroidism)
Example where atrophy can be observed in a disease pathogenesis is one chronic condition of the gut known as ?
autoimmune gastritis
Example where inappropriate immune response can be observed in a disease pathogenesis is one chronic conditions of the joint known as ?
rheumatoid arthritis
Chronic inflammation overlaps with what response ?
immune
Immune disease cause pathology by …?
chronic inflammation
Cause of RA ?
autoimmune disease - rheumatoid factor
RA ratio female : male ?
3: 1
RA is : quite ..1.. , ..2.. disease , invariably affects ..3..
- common
- systemic
- joints
Localised chronic inflammation leads to joint ..1… - especially which joints ?
- destruction
- especially small joints
4 examples of systemic immune response associated with RA ?
- rheumatoid nodules
- splenomegaly
- amyloidosis
- pulmonary fibrosis
Name 5 examples of atopic disease = …2… characterised by ..1… ?
- inappropriate immune responses to relatively innocuous (harmless) everyday substances
- asthma, hayfever, eczema, food allergies, anaphylaxis
What is granulomatous inflammation ?
chronic inflammation with granulomas
Granuloma = organised collection of …1… which are ….2… often have ..3… nuclei
- epithelioid cells
- modified / activated macrophages
- elongated banana-like/slipper-like
A granuloma may or may not contain ..1.. / be …2.
- giant cells
- necrotic
2 main types of granulomas are ?
- foreign body
- immune (hypersensitivity)
Foreign body granulomas develop around …?
material that is not antigenic (e.g. surgical thread)
Immune granulomas develop around …?
insoluble but antigenic particles = cell-mediated immune response
Foreign body granulomas:
1. deal with particles which are … (& an example)
2. deal with organisms which are …. (2 examples)
3. But when the fail, they need to bring in …
- poorly soluble (foreign bodies)
- difficult to eliminate (mycobacterium tuberculosis or mycobacterium leprae)
- immune granulomas…
Foreign body granulomas & Immune granulomas are either non-caseating / caseating , which one is which ?
- foreign body granulomas = non-caseating
- immune granulomas = caseating (central necrosis) e.g .TB
main causes of granulomatous formation ?
- midly irritant ‘foreign’ material
- infections
- unknown causes
Examples of infections as main causes of granulomatous formation
- tuberculosis
- leprosy mycobacterium
Examples of unknown causes as main causes of granulomatous formation
- sarcoidosis
- granulomatosis with polyangiitis (GPA)
- Crohn’s disease
What bacteria causes TB ?
mycobacterium tuberculosis
what adaptations does this bacterium have to evade immune response ?
thick waxy wall of lipids (mycolic acid) that protect against ROS
What does tuberculosis produce none of ?
- toxins
- lytic enzymes
tuberculosis causes disease by …?
persistence and induction of cell-mediated immunity
What is caseating granuloma?
central necrosis characteristic of TB and fungal infections
Ghon focus…
formation of a ..1.. , or …2… area of bacteria, which is considered the ..3.. in tuberculosis (primary ….4… lesion caused by ..5…)
- granuloma
- walled off
- primary lung lesion
- subpleural
- TB bacilli
Latent TB …
- symtpom/asymptomatic
- …… but infected by TB
- results in …… tuberculin skin test/ TB blood test
- must be treated regardless
- asymptomatic
- noncontagious
- positive
List some other granulomatous infections
- leprosy
- syphilis
- chronic fungal infections
- ‘cat-scratch’ disease
Sarcoidosis is a …. disease with fibrous lesions forming where ?
autoimmune
- lymph nodes
- liver
- skin
- lungs
- spleen
- eyes
- small bones of hands and feet
sarcoidosis is more common in which age group and gender ?
young adult women
