#3 Chronic Inflammation

Question 1

Characteristics of chronic inflammation

Answer 1

Accumulation of lymphocytes and macrophages
Proliferating blood vessels
Formation of connective tissue

Question 2

reasons for chronic inflammation

Answer 2

inability to get rid of the pathogen, reaction to an auto-antigen, genetic inability to mount the appropriate response.

Question 3

hepcidin

Answer 3

peptide hormone that regulates iron metabolism. increasing hepcidin causes decreased iron availability in the bone marrow.

Question 4

M1 vs M2

Answer 4

M1’s are responsible for microbicidal actions, phagocytosis and inflammation. M2’s promote tissue repaire and fibrosis, has anti-inflammatory effects

Question 5

granuloma’s morphology

Answer 5

1. Central portion is necrotic debris “caseous” or “necrotizing” granuloma, commonly in TB
2. Activated macrophages and multinucleated giant cells in periphery
3. Cuff of T-cells, the vast majority of which are CD3+/CD4+
4. The entire granuloma is rimmed by proliferating fibroblasts

Question 6

acute phase reactants

Answer 6

biochemical changes in chronic inflammation and reflect hepatic adjustments to inflammation

Question 7

changes in liver production

Answer 7

increased fibrinogen, ceruloplasmin, complement and hepcidin, and growth factors that stimulate the bone marrow production of leucocytes and platelets and decrease in albumin

Question 8

CRP (C-reactive proteins)

Answer 8

CRP production is stimulated by inflammation and is tightly linked to IL-6 levels

Can be measured rapidly, reliably and relative low cost

Can be used in semi-quantitative fashion for level of inflammation (when normal can exclude significant inflammation being present)

Obesity is the one morbidity that can cause a “false” elevation of CRP- (high M1 in adipose set higher baseline)

Question 9

Erythrocyte sedimentation rate (ESR)

Answer 9

Chronic inflammation causes clinically detectable antibody synthesis expressed as polyclonal increase in IgG

IgG and fibrinogen coat erythrocytes and the red cells then fall more rapidly through a column of plasma-the rate is the ESR. (increased ESR indicates inflammation)

Rapidly becoming obsolescent because “false elevations” can occur when there is increased IgG present for non inflammatory reason - eg., myeloma, age