3 chronic effects Chronic Inflammation (conditions only) Flashcards
1
Q
General effects of chronic inflammation
A
- fibrosis
- impaired function
- atrophy e.g. autoimmune gastritis
- stimulation of an inappropriate immune response e.g rheumatoid arthritis
2
Q
In chronic inflammation what cell type may help with diagnosis?
A
giant cell
3
Q
Examples of fibrosis as an effect of chronic inflammation
A
- lung fibrosis
- gall baldder (chronic cholecystitis)
- chronic peptic ulcers
- cirrhosis
- skin scar tissue
4
Q
Example of impaired function as an effect of chronic inflammation
A
- chronic inflammatory bowel disease
- rarely increased function e.g. thyrotoxicosis (grave’s disease), mucus secretion
5
Q
Chronic cholecystitis:
1. How common ?
2. follows what ?
3. can affect ?
A
- very common disease
- repeated episodes of acute cholecystitis
- both sexes any age
6
Q
What is the common demographic profile for those most affected by chronic cholecystitis ?
A
“typically” described as female, fat, fertile, forty
7
Q
leading cause of chronic cholecystitis ?
A
gall stones
8
Q
Is chronic cholecystitis always symptomatic ?
A
No, it can be asymptomatic
9
Q
What are some possible syptoms of chronic cholecystitis ?
A
- biliary colic (intermittent pain in upper right abdomen)
- indigestion
- nausea
- vomiting
10
Q
What are some possible signs or complications of chronic cholecystitis ?
A
- 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
11
Q
Biliary colic involves episodes of ….1.. pain caused by …2.. temporarily blocking the ..3..
A
- severe, crampy abdominal
- gallstones
- bile ducts
12
Q
Chronic cholecystitis is associated with malignant transformation to ….?
A
cholangiocarcinoma
13
Q
Chronic peptic ulcer refers to ulcers found where ?
A
gastric and duodenal ulcer
14
Q
Example where fibrosis can be observed in a disease pathogenesis is one chronic condition of the stomach known as ?
A
chronic peptic ulcer
15
Q
Cause of chronic peptic ulcer
A
- helicobacter pylori (HP gastritis)
- hyperacidity
16
Q
Risk factors of chronic peptic ulcer
A
- Drugs = NSAIDs
- Genetic
- alcohol consumption
- cigarettes
- steroids
17
Q
Pathogenesis of chronic peptic ulcer ?
A
- 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
18
Q
Chronic peptic ulcer sites affected ?
A
- antrum (lowermost part of stomach)
- first part of duodenum
19
Q
What type of fibrosis is observed in chronic peptic ulcers (gastric/duodenal) ?
A
narrowing or pyloric stenosis
20
Q
what is pyloric stenosis ?
A
muscular valve between stomach and small intestine becomes abnormally narrowed
21
Q
List factors which promote mucosal damage
A
- gastric acid
- pepsin
- H. pylori infection
- NSAIDs
22
Q
mechanisms promoting gastroduodenal defense
A
- prostaglandins
- mucus
- bicarbonate
- muscosal blood flow
23
Q
Ulceration is due to what ?
A
imbalance of acid and pepsin attack and muscosal defence of the gut
24
Q
An example where fibrosis can be observed in a disease pathogenesis is one chronic condition of the liver known as ?
A
cirrhosis
25
# 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
26
Pathogenesis of cirrhosis ?
* chronic inflammation
* destruction of hepatocytes
* fibrosis
* nodular regeneration leading to cirrhosis
27
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)
28
What causes portal hypertension to be a complication of cirrhosis ?
increased resistance to blood flow through the scarred liver (scar tissue, fibrosis)
29
Liver failure is a complication of cirrhosis why ?
loss of functional liver tissue and metabolic dysfunction
30
Hepatocellular carcinoma is a complication of cirrhosis why ?
develops due to chronic inflammation , regenerative nodules and genetic mutations
31
A microscopic slide of liver cirrhosis shows what ?
* inflammation with destruction of hepatocytes
* fibrosis and nodular regeneration
* fibrous tissue = blue !
32
Example where impaired function can be observed in a disease pathogenesis is one chronic condition of the gut known as ?
inflammatory bowel disease
33
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
34
Cause of inflammatory bowel disease ?
idiopathic inflammatory disease affecting the large and small bowel
35
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
36
Types of inflammatory bowel disease
* ulcerative colitis
* Crohn's disease
37
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)
38
Crohn's disease inflammation is = ...1., this causes ..2.. ?
1. transmural
2. pain, loose stools, malabsorption
39
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
40
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
41
In crohn's disease what leads to the following:
1. .... leads to obstruction
2. ...... leads to fistula formation
1. fibrosis
2. full thickness inflammation
42
Ulcerative colitis:
1. Has no ..... & ..... like in Crohn's disease
2. a potential serious complication ?
1. skip lesions & granulomas
2. malignant change (development of colorectal cancer)
43
skip lesions are = areas of ..1.. tissue interspersed with areas of ..2.. tissue
1. diseased
2. healthy
44
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
45
Example where increased function can be observed in a disease pathogenesis is one chronic condition of the thyroid known as ?
thyrotoxicosis (grave's disease)
46
Cause of thyrotoxicosis ?
autoimmune disease
47
Thyrotoxicosis involves ..1.. with toxic ..2..
1. hyperthyroidism
2. goitre
48
Symptoms of thyrotoxicosis ?
* exophthalmos (protruding eyes)
* thyrotoxic signs (palpitations, tremor)
* enlarge thyroid (multinodular toxic goitre)
49
Pathogenesis of thyrotoxicosis involves ?
1. autoantibodies - long acting thyroid stimulating antibodies - TSI (thyroid stimulating immunoglobulin)
2. TSI antibody acts on TSH surface receptor on thyroid epithelium and mimics TSH
3. Increased T4 and T3 = reduced TSH
4. hyperactive thyroid (hyperthyroidism)
50
Example where atrophy can be observed in a disease pathogenesis is one chronic condition of the gut known as ?
autoimmune gastritis
51
Example where inappropriate immune response can be observed in a disease pathogenesis is one chronic conditions of the joint known as ?
rheumatoid arthritis
52
Chronic inflammation overlaps with what response ?
immune
53
Immune disease cause pathology by ...?
chronic inflammation
54
Cause of RA ?
autoimmune disease - rheumatoid factor
55
RA ratio female : male ?
3: 1
56
RA is : quite ..1.. , ..2.. disease , invariably affects ..3..
1. common
2. systemic
3. joints
57
Localised chronic inflammation leads to joint ..1... - especially which joints ?
1. destruction
2. especially small joints
58
4 examples of systemic immune response associated with RA ?
* rheumatoid nodules
* splenomegaly
* amyloidosis
* pulmonary fibrosis
59
Name 5 examples of atopic disease = ...2... characterised by ..1... ?
1. inappropriate immune responses to relatively innocuous (harmless) everyday substances
2. asthma, hayfever, eczema, food allergies, anaphylaxis
60
What is granulomatous inflammation ?
chronic inflammation with granulomas
61
Granuloma = organised collection of ...1... which are ....2... often have ..3... nuclei
1. epithelioid cells
2. modified / activated macrophages
3. elongated banana-like/slipper-like
62
A granuloma may or may not contain ..1.. / be ...2.
1. giant cells
2. necrotic
63
2 main types of granulomas are ?
* foreign body
* immune (hypersensitivity)
64
Foreign body granulomas develop around ...?
material that is not antigenic (e.g. surgical thread)
65
Immune granulomas develop around ...?
insoluble but antigenic particles = cell-mediated immune response
66
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 ...
1. poorly soluble (foreign bodies)
2. difficult to eliminate (mycobacterium tuberculosis or mycobacterium leprae)
3. immune granulomas...
67
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
68
main causes of granulomatous formation ?
1. midly irritant 'foreign' material
2. infections
3. unknown causes
69
Examples of infections as main causes of granulomatous formation
* tuberculosis
* leprosy mycobacterium
70
Examples of unknown causes as main causes of granulomatous formation
* sarcoidosis
* granulomatosis with polyangiitis (GPA)
* Crohn's disease
71
What bacteria causes TB ?
mycobacterium tuberculosis
72
what adaptations does this bacterium have to evade immune response ?
thick waxy wall of lipids (mycolic acid) that protect against ROS
73
What does tuberculosis produce none of ?
* toxins
* lytic enzymes
74
tuberculosis causes disease by ...?
persistence and induction of cell-mediated immunity
75
What is caseating granuloma?
central necrosis characteristic of TB and fungal infections
76
Ghon focus...
formation of a ..1.. , or ...2... area of bacteria, which is considered the ..3.. in tuberculosis (primary ....4... lesion caused by ..5...)
1. granuloma
2. walled off
3. primary lung lesion
4. subpleural
5. TB bacilli
77
Latent TB ...
1. symtpom/asymptomatic
2. ...... but infected by TB
3. results in ...... tuberculin skin test/ TB blood test
4. must be treated regardless
1. asymptomatic
2. noncontagious
3. positive
78
List some other granulomatous infections
* leprosy
* syphilis
* chronic fungal infections
* 'cat-scratch' disease
79
Sarcoidosis is a .... disease with fibrous lesions forming where ?
autoimmune
* lymph nodes
* liver
* skin
* lungs
* spleen
* eyes
* small bones of hands and feet
80
sarcoidosis is more common in which age group and gender ?
young adult women
