3. Chronic Inflammation

Question 1

What are some key characteristics of acute inflammation?

Answer 1

Rapid, stereotyped response of living tissue to any injury.

Question 2

What are the macroscopic features of acute inflammation?

Answer 2

Redness, swelling, heat, pain and loss of function.

Question 3

What are the microscopic features of acute inflammation?

Answer 3

Vascular dilation, exudate leaks into tissues, neutrophils migrate.

Question 4

What is the key cell type in acute inflammation and its function?

Answer 4

Neutrophils, fast acting, short-lived phagocytes that engulf and degrade bacteria, dead tissues etc.

Question 5

What is the result of chronic inflammation?

Answer 5

Repair and scarring.

Question 6

In what three occasions does chronic inflammation occur?

Answer 6

Taking over from acute inflammation.
Arise de novo - no identifiable acute inflammation, straight to chronic inflammation, e.g. autoimmune conditions, chronic infections, chronic low-level irritation.
Develops alongside acute inflammation, in sever persistent or repeated irritation.

Question 7

What are the key cells involved in chronic inflammation?

Answer 7

Macrophages, lymphocytes, plasma cells, eosinophils, fibroblasts/myofibroblasts, giant cells.

Question 8

What are the roles of macrophages in chronic inflammation?

Answer 8

Phagocytosis and destruction of debris and bacteria.
Processing and presentation of antigen to immune system.
Synthesis of cytokines and complement components, blood clotting factors and proteases.
Control of other cells by cytokine release.

Question 9

What are the functions of lymphocytes in chronic inflammation?

Answer 9

Mainly immunological and complex.
B lymphocytes differentiate to produce antibodies.
T lymphocytes involved in control and some cytotoxic functions.

Question 10

What are plasma cells?

Answer 10

Differentiated antibody-producing B lymphocytes.

Question 11

What are eosinophils very involved in?

Answer 11

Allergic reactions, parasite infestations and present in some tumours.

Question 12

What is the role of fibro/myofibroblasts in chronic inflammation?

Answer 12

Recruited by macrophages to make collagen.

Question 13

What are ‘giant’ cells?

Answer 13

Multinucleate cells made by fusion of macrophages.

Question 14

Why are giant cells made?

Answer 14

Because of frustrated phagocytosis. The macrophage can’t phagocytose something on its own so several work together to form one giant cell.

Question 15

What are the three main types of giant cell?

Answer 15

Langhans (from TB), foreign body type, touton (from fat necrosis).

Question 16

What chronic inflammation cells are most present in rheumatoid arthritis?

Answer 16

Plasma cells.

Question 17

What chronic inflammation cells are most present in chronic gastritis?

Answer 17

Lymphocytes.

Question 18

What chronic inflammation cells are most present in leishmaniasis (a protozoal infection)?

Answer 18

Macrophages.

Question 19

What are the four key effects of chronic inflammation?

Answer 19

Fibrosis, impaired function, atrophy and stimulation of immune response.

Question 20

What causes fibrosis in chronic cholecystitis?

Answer 20

Repeated obstruction by gall stones, causing repeated acute inflammation, which leads to chronic inflammation. This causes fibrosis of the gall bladder wall.

Question 21

What causes acute and chronic gastric ulceration?

Answer 21

Acute gastritis - alcohol and drugs.

Chronic gastritis - helicobacter pylori.

Question 22

What is ulceration a result of?

Answer 22

An imbalance of acid production and mucosal defence.

Question 23

What are the symptoms of inflammatory bowel disease?

Answer 23

Diarrhoea, rectal bleeding and other symptoms.

Question 24

What are the two forms of inflammatory bowel disease?

Answer 24

Crohn’s disease and ulcerative colitis.

Question 25

What is the difference between depth of inflammation in ulcerative colitis and Crohn’s disease?

Answer 25

UC is superficial but CD is transmural (through the thickness of the bowel wall).

Question 26

What are some common causes of cirrhosis?

Answer 26

Alcohol, infection with HBV or HCV, immunological, fatty liver disease or drugs and toxins.

Question 27

What causes cirrhosis?

Answer 27

Chronic inflammation with fibrosis, this causes disorganisation of architecture, and attempted regeneration (nodules form). This present as cirrhosis.

Question 28

What is an example of chronic inflammation that leads to increased function?

Answer 28

Thyrotoxicosis in Graves’ disease with hyperthyroidism.

Question 29

What is an example of chronic inflammation that leads to atrophy?

Answer 29

Gastric mucosa.

Question 30

What do the localised chronic inflammation and systemic immune response in rheumatoid arthritis lead to?

Answer 30

Localised chronic inflammation leads to joint destruction.

Systemic immune response can affect other organs and cause amyloidosis.

Question 31

How do chronic inflammation and immune response overlap?

Answer 31

Immune diseases can cause pathology by chronic inflammation, chronic inflammatory processes can stimulate immune responses.

Question 32

When do granulomas arise?

Answer 32

With persistent, low-grade antigenic stimulation. Also with hypersensitivity.

Question 33

What are the main causes of granulomatous inflammation?

Answer 33

Mildly irritant foreign material, infections (Mycobacteria etc), or unknown causes (sarcoid, Wegener’s granulomatosis, Crohn’s disease).

Question 34

What are the outcomes of tuberculosis?

Answer 34

1. Arrest, fibrosis, scarring.
2. Erosion into bronchus.
3. Tuberculous empyema.
4. Erosion into blood stream.