5. Acute Inflammation I Flashcards

1
Q

Cardinal signs of Inflammation

\_\_\_\_
• \_\_\_\_
• \_\_\_\_ 
• \_\_\_\_
• \_\_\_\_

Heat, redness, swelling: ____
Pain: ____

A
Heat (calor)
Redness (rubor)
Swelling (tumor)
Pain (dolor)
loss of function

sign
symptom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Archiv für Pathologische Anatomie und Physiologie und für Klinische Medizin-1867

To a response of IRRITATION:

  • ____ of arterioles and acceleration of blood flow
  • Few min. later, WBC line the wall of the ____ (glued?)
  • Some WBC crossed venules into extravascular space
  • In some vessels, RBC tightly packed, decreased ____
  • Loss of plasma
  • ____ > Rubor (Redness)
  • Increased ____ >Calor (Heat)
  • Fluid ____ >Tumor (Swelling)
  • Pain?
A

dilation
venules
blood flow

vasodilation
blood flow
exudation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
• Phagocytosis:
• Purpose of Inflammation; engulf bacteria
and foreign matter
• Increased vascular permeability:
Allowed \_\_\_\_ along with
\_\_\_\_ to participate in inflammation.

Used transparent invert’s and observed ingestion of particles > they would go around and eat the particle > phagocytosis

When same experiment was completed with frog leuokocytes > same mechanism of action

Purpose of inflammation: engulf and rid of foreign material/bacteria (Metchnikoff)

Ehrlich & Metchnikoff > knew there was loss of ____ > increased vascular permeability due to increased ____ resulting in a recruitment of leukocytes (and ab’s) from BV to EC space

A

antibodies
leukocytes

plasma
irritation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Inflammation:
Vascular and Cellular response when living tissues are injured or irritated

All of these lead to INFLAMMATION:

*____:
•Bacteria
•Virus
•Fungus

____:
• Rheum Arthritis
• Pemphigus Vulgaris

____:
(Physical/Chemical Injury)

____:
(Ischemia/Infarct)

____:
•Anaphylactic •Pollen/Insect

____:
•Splinters, dirt, sutures
•Urate crystals (Gout)
•Cholesterol Crystals (Atherosclerosis)

A
infection
auto-immune
tissue necrosis
tissue necrosis
immune/hypersen
foreign bodies/endogenous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Purpose

  • ____ off injurious agent
  • Dilute/Destroy/eliminate the cause
  • Limit tissue damage
  • Remove dead cells and debris
  • Initiate ____
  • Return Tissue to ____.

Without Inflammation:
– Cannot Control ____
– Wound never ____

A

wall
healing
normal

infection
heals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Inflammation and healing

Steps In Inflammatory Response (5R’s):
\_\_\_\_ of Injury
\_\_\_\_ of Leukocytes
\_\_\_\_ of Injurious agents
\_\_\_\_ (Control)
\_\_\_\_ (Repair/healing)
Acute Inflam
Onset: \_\_\_\_
Cells: \_\_\_\_
Tissue Injury: \_\_\_\_
Local Effects: \_\_\_\_
Chronic Inflam
Onset: \_\_\_\_
Cells: \_\_\_\_
Tissue Injury: \_\_\_\_
Local Effects: \_\_\_\_
A
recognition
recruitment
removal
regulation
resolution

minutes/hours
neutrophils
mild, self-limited
prominent (vascular)

days/months/years
“round”
severe progressive
less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Inflammation and healing

A stimulus is required: can come in form of microbial infection (epithelial cell serves as a physical barrier), or because of necrotic tissue

Next, injury must be recognized: completed by cells located just beneath the epithelium (macrophages, dendritic cells [APC], or mast cells, known as ____ in innate immunity)

Recruit leukocytes: sentinel cells communicated with BV by secreting mediators (the biggest difference among leukocytes: mast cells are packed with tons of granules, that are released ____ upon activation

Removal of injurious agent (phagocytosis), and regulation/control (tissue damage otherwise), and finally resolution/repair

A

sentinel/gate-keeping cells

instantaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most oral diseases are inflammatory…

Acute Inflam
• Dental Caries
• *\_\_\_\_
• *\_\_\_\_
• *\_\_\_\_
• Ludwig’s Angina
• Cavernous Sinus thrombosis
• Meningitis
• \_\_\_\_
• \_\_\_\_
Chronic Inflam
• Acute/Chronic \_\_\_\_
• Pyogenic granuloma
• Periapical cyst
• Condensing Osteitis
• Orofacial granulomatosis
– Melkersson-Rosenthal syndrome 
– Cheilitis granulomatosa
A
pulpitis
periapical abscess
cellulitis
gingivitis
periodontitis

osteomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Incision in skin and there are three problems: ____, ____, and ____ (most important) > mount a response in order to maintain the infection locally

Firstly, recruit neutrophils, but they require supply: plasma > provides ____ (because neutrophils are not good “swimmers”), and they also provide ____ (important in getting rid of “them?”)

No inflammatory reaction > death; if you have one > you will have both a ____ and ____ response (acute inflammation) > neutrophils releasing mediators and ROS that will damage tissue > requires a healing process to conclude

What if infected with microbe that is difficult to rid > wound healing and ____ inflammation occur simultaneously > cannot heal adequately

A

bleeding
tissue loss
infection

fibrin meshwork
antibodies/complement

cellular
vascular

chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

OUTCOME
• Nature of the Etiologic Agent
– Is the agent harmful? ____
– /Pollen/Peanut/self-component

• Intensity of the reaction – Proportional to etiology? – Controlled?

  • Regenerative Potential
  • Skin
  • Brain, Myocradium

• Host status
- HIV, autoimmune

If individual’s are genetically predisposed > innocuous agents are recognized as harmful and the immune system reacts > creation of a problem (allergy and AID)

Skin > proliferative if damaged > return to ____
Brain/myocardium > no ____, and no regeneration > replaced by scar tissue (non-functional connective tissue)

HIV > individual may not be able to clear infection properly, but if body recognizes self-component as foreign > ____ inflammation

A

bacteria
normal
regenerative capacity
chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Inflammation occurs only in ____ tissue

Infarct > inflammation occurs ____ of the necrotic tissue (cannot have inflammation within dead tissue, but it can initiate a ____); what’s the purpose of this mechanism > ____ response in order to remove the necrotic tissue

A

living
outside
response
protective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

50-70% of pregnant women develop gingivitis during ____ due to ____ control and extra-sensitivity to ____; important to floss and clean regularly

A

pregnancy
hormonal
infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Arteriovenous shunt; precap sphincter closed > capillary bed not utilized, blood flows from arterial to venous end without the capillary bed

In normal situation (right slide) > these sphincters ____ and close intermittently, utilizing specific parts of the ____

A

open

capillary beds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mast cells located just below the epithelium, no matter the tissue, and they are universally found close to a ____

Release ____ > contract smooth muscle > dilation and gushing in of blood > and all the sphincters ____ > formation of a “20-way” highway

[Initial ____?]

How about tissue swelling? This contributes to tissue swelling because the blood remains within the BV; if there was no leakage there would not be swelling

Hyperemia: increased ____ within tissue

A

reflex vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Tissue Swelling

Normal: as blood flows > hydrostatic pressure; the squamous cell type is semi-permeable (fluid and electrolyte, but not to protein), because of the HP fluid traverses the membrane into EC space, as a result there’s formation of an ____, and as a result > you get fluid going back into the tissue > there is ____ (more fluid leaves than reenters); the factor that puts it into balance > ____ system

____ > if fluid is exiting, this exit is balanced by the inflow of fluid back in and into the lymphatic > no swelling

A

osmotic pressure
imbalance
lymphatic

starling’s law

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lymphatic vessels
• Collects lymph from ____
• Delivers it to the ____
• Returns fluid to circulatory veins near the ____

A

lymph capillaries
nodes
heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Starling’s Law

During inflammation: epithelial cells now become permeable to ____ > (albumin smaller than fibrinogen) > these factors leak out into the EC > ____ is lower > lymphatics tries to balance but is unable to do so

Swelling > because of increased ____ to protein

A

protein
osmotic pressure
vascular permeability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Fluid that accumulates in extravascular fluid due to inflammation (on venous end…) is because of ____ (normally this is called edema)

Yellow areas are BV; and white areas are all fluid (edema, contains protein would be an exudate) [look at slides]

A

exudate

19
Q

Different types of Exudate
• ____ (Exudate/Inflammation)
• ____ (Exudate/Inflammation)
• ____(Exudate/Inflammation)

Different causes of inflammation, there are different types of exudate; the type of exudate can give you an idea of the cause of ____

A

serous
fibrinous
purulent
inflammation

20
Q

Types of exudate

Serous > mostly ____, some protein, no WBC

Fibrinous > mostly ____, some fluid, little/no WBC

Purulent > mostly ____, some protein and fluid (____)

A

fluid
protein
WBC
pus

21
Q

Morphological Pattern of Acute Inflammation

• Serous Inflammation:
– Exudate; low protein, low cells, resembles ____.
– Created by injury to surface ____ (blister)
– ____: fluid in body cavity
• Increased vascular permeability (____)
• Reduced blood flow/reduced plasma protein (____)

A
serum
epithelia
effusion/ascites
exudate
transudate
22
Q

Morphological Pattern of Acute Inflammation

•Fibrinous Inflammation:
– Large increase in ____
– Fibrinogen in extravascular space, Dominant feature: ____
– Lining of ____, pericardium, ____
– Dissolved by fibrinolysis/cleared by macrophages (____)
– Fibrinous exudate in to ____ (____)

A
vascular permeability
fibrin deposition
meninges
pleura
resolution
scar tissue
organization
23
Q

Morphological Pattern of Acute Inflammation

• Purulent Inflammation:
– Pus: \_\_\_\_, \_\_\_\_, \_\_\_\_ cells
– Purulent/suppurative inflammation
– Pyogenic or pus forming \_\_\_\_
– \_\_\_\_: Localized collection of pus
A
edema
PMNs
necrotic
bacteria
abscess
24
Q

Morphological Pattern of Acute Inflammation

• Ulcer:
– Tissue necrosis/inflammation on or near a surface
– Loss of ____ due to shedding of inflamed necrotic tissue.
– Common sites: ____, GU tract, ____
– ____: Intense PMNs accumulation/vascular permeability in the margin of the defect
– ____: Margin of ulcer base-scarring

A
surface epithelia
oral mucosa
skin
acute
chronic
25
Q
Serous
• Mild \_\_\_\_
• Low \_\_\_\_
• \_\_\_\_-color 
– Skin Blister
A

inflammation
protein
straw like

26
Q
Fibrinous
• \_\_\_\_ Deposition
• e.g; \_\_\_\_
• \_\_\_\_appearance
• Resolution
• Organization
• Scarring
• \_\_\_\_ function

Pink > ____ > mostly protein

Can undergo resolution or organization

A

fibrin
pericarditis
myocardial
eosinophilic

27
Q

Purulent Exudate/Abscess

Purulent Exudate
• \_\_\_\_
• Bacterial meningitis
• \_\_\_\_
• Ulcer/\_\_\_\_
• \_\_\_\_

Abscess
• ____
• Myocardium
• ____

A

pneumonia
bowel mucosa/peritonitis
appendicitis
pulpitis

pneumonia
pericapical

28
Q

Bronchopneumonia (Purulent exudate)

Difference between first two slides: dilation of ____ and loss of fluid, and it is ____ (presence of protein) > early phase of pneumonia, no ____ present

Third slide: lots of ____, they’re not entering the alveolar space, the ones that are are the ____

A

BV
protein
neutrophils

RBC
WBC

29
Q

Purulent Exudate: Bacterial Meningitis

Arachnoid + Pia = ____

Dura mater > very hard, not ____
Arachnoid mater > a little softer, mostly ____
Pia mater > soft tissue and highly ____
Collectively, these are known as ____

Meningitis > spread through blood or a tooth infection

Over arachnoid and pia mater > leptomeninges

____ fluid on surface of brain; and look at histologically: ____ dots are neutrophils and dilated BV

Bacterial meningitis is much more lethal than pneumonia due to the ____

A
leptomeninges
vascularized
avascular
vascularized
meninges

creamy color
blue
closed cavity

30
Q

Purulent Exudate

Bowel mucositis

Bowel mucosa that is inflamed > ____ exudate

Ruptured colon > contains feces and bacteria > empty into an ____ > large inflammation in the entire ____ (purulent exudate) (lethal)

A

purulent
open cavity
peritoneum

31
Q

Ulcer
• Loss of ____
• When tissue necrosis and ____ occur on or near surface
• Mucosa of mouth, stomach, intestine

Ulcer is red due to the inflammation that is occurring on or near the ____

A

epithelium
resulting inflammation
surface

32
Q

Acute Appendicitis

____, ____ exudate (Neutrophilic), ____ exudate

Redness, Heat, Swelling, Pain

Etiology and Pathogenesis

A

ulcer
purulent
fibrinous

33
Q

Acute Appendicitis

Lining is ____

____ > ____ > ____

A

columnar epithelium
mucosa
submucosa
muscularis externa

34
Q

Etiology and Pathogenesis of appendicitis

Etiology (Why):

  • ____
  • Collapse of ____
  • Pre-disposes to ____
Pathogenesis (How):
– \_\_\_\_
– \_\_\_\_ formation 
• Mucosa
• Submucosa 
• Muscularis
A

lumen obstruction/pressure
blood vessels
infection

ulceration
exudate

35
Q

Appendicitis: Etiology and Pathogenesis

Infected: much ____, not as tightly packed

With a higher power view > presence of ____ and the presence of ____; and the presence of lymphoid tissue has ____

Vascular > ____; cellular > ____

A

larger

ulcers
neutrophils
decreased

fluid
neutrophils

36
Q

ABSCESS

• A localized collection of pus (____, ____ cells, and ____ fluid).

A

neutrophils
necrotic
edema

37
Q

Abscess Bronchopneumonia

Yellow arrows under high power > abscess contains lots of cells (full of ____ exudate); can hardly see the vasculature in the normal lung, but in inflamed lung you see the engorged ____

Yellow circles > ____ drained out leaving a space within the lung

A

purulent
BV
pus

38
Q

Micro-abscess in the myocardium

Blue dots within center > ____ contained within the abscess

A

bacteria

39
Q

Both teeth and appendices are hollow > appendix: do not remove infection in time it ruptures ____; for a tooth, pulp infections can only travel ____

A

sideways

downwards

40
Q

Pulpitis

Pulpitis is defined by ____ or ____ > dictates the treatment

Reversible > ____ BV (yellow arrow), and the presence of ____ that is not observed in normal pulp

Irreversible > ____ (same as pus) > as a result of pus formation, it has ____ the normal pulp tissue

A

reversible
irreversible

dilated
fluid

liquefactive necrosis
destroyed

41
Q

Reversible and Irreversible Pulpitis

Reversible
Pain: \_\_\_\_, \_\_\_\_ duration, \_\_\_\_ localized
EPT: \_\_\_\_ current
Histopath: \_\_\_\_
Treatment: \_\_\_\_
Irreversible
Pain: \_\_\_\_, \_\_\_\_ duration, \_\_\_\_ to localize
EPT: \_\_\_\_
Histopath: \_\_\_\_, \_\_\_\_
Treatment: \_\_\_\_
A
elicited (cold), mild/moderate
short
easily
low
hyperemia/edemia
remove irritation
thermal/spontaneous, sharp/severe
long
unable
high current/no response
necrotic tissue/PMN/edema
chronic inflammation/ fibrosis
extraction/root canal
42
Q

Periapical Abscess, Cellulitis

• Cellulitis:
• When abscess is not able to establish ____
through the skin surface or into oral cavity.
• It spreads diffusely through the facial planes of the soft tissue
• Two dangerous forms:
– ____
– ____

Irreversible pulpitis > ____

Whether it is max/mandibulartooth, and muscle attachment > one can develop ludwig’s angina or cavernous sinus thrombosis (may lead to ____)

A

drainage
ludwig’s angina
cavernous thrombosis

periapical abscess

meningitis

43
Q

Summary: Acute Inflammation

•Cardinal signs: ____, ____, ____, ____
•Definition: ____ Response to
Injury
•Purpose: Wall-off/dilute/destroy/Healing
•Outcome: Resolution/healing; may also lead to inflammatory diseases
•Vascular phase: Transient ____, then ____, increased ____
•Edema: ____ •Serous/Fibrinous/Purulent/Abscess
•Ulcers

A
redness
heat
swelling
pain
vascular/cellular
vasoconstriction
vasodilation
vascular permeability
exudate