6. Acute Inflammation II Flashcards
Left: In order to have inflammation > stimulus (microbe, necrotic tissue, etc.); in order to initiate inflammatory response: recognize the stimulus (the sentinel cells are responsible [____, and ____]); then, recruitment of cells (in acute: mostly ____); then, removal/elimination of microbes; then, ____ of inflammatory cells (regulated because when neutrophils enter, they release mediators that kill microbes but also cause tissue damage), and lastly repair of the tissue
Middle, top: without inflammation a wound doesn’t heal properly
Right, top: pregnancy gingivitis > when someone is pregnant they are more sensitive to the presence of ____; can be a good or bad thing; necrotic tissue with inflammation surrounding it, and the inflammation responds in order to remove the dead tissue
Right, bottom: freezer burn, inflammation responds in order to heal it
All of these phrases to describe middle bottom > ____: inflamed tissue (red); erythematous: same as hyperemia; edematous: lots of fluid; and tender
mast cells
macrophages
neutrophils
regulation
bacteria
hyperemia
Left, top: inflammatory response to peanuts, this swelling is not protective > potentially lethal because it is activated inappropriately
Left, bottom: infected appendix > ruptured colon (if inflammation is produce in an ____ inflammation can be lethal); and meningitis > ____
Middle: periapical abscess > can spread ____ giving ____ thrombosis and can spread south giving ____ (appendicitis migrates ____)
open cavity
closed cavity
north
???
ludwig’s angina
laterally
A > surface of heart pericardium; this is an exudate > ____
B > lung > ____exudate (purulent implies necrotic tissue, but this has no necrotic tissue, so sometimes this is called a “____” exudate)
C > skin > blister > ____ exudate (very light fluid)
D > ____: loss of epithelium
E > bowel mucosa > red material > inflamed > yellowish material sitting on it: ____ exudate
F > abscess (____ exudate contained within a cavity)
fibrinous purulent neutrophilic serous ulcer purulent purulent
Inflammatory (Exudate) Pathogenesis: \_\_\_\_ Status of vessel: \_\_\_\_ Protein in tissue: \_\_\_\_ Tendency to clot: \_\_\_\_ Pain: \_\_\_\_ Inflam. cells: \_\_\_\_ Examples: \_\_\_\_
Non-inflammatory (Transudate) Pathogenesis: \_\_\_\_ Status of vessel: \_\_\_\_ Protein in tissue: \_\_\_\_ Tendency to clot: \_\_\_\_ Pain: \_\_\_\_ Inflam. cells: \_\_\_\_ Examples: \_\_\_\_, \_\_\_\_, \_\_\_\_, \_\_\_\_, \_\_\_\_
loss of vascular barrier increased perm. to proteins yes yes usually present yes/no inflammatory disorders
abnormal fluid dynamics unaltered: retains plasma protein no no usually absent no CHF kwashiorkor cirrhosis cancer elephantiasis
Middle: longitudinal section of BV; showing only protein
Exudate: when fluid and protein are ____
Transudate: fluid in the extravascular tissue but the protein is retained within the ____
Both are edemas, but differ in the location of the protein
Exudate would clot because now ____ are in the EC space
Mediators are produced in exudate so they trigger the ____ > pain
Exudate > ____ exudate will have inflam cells; ____ and ____ will have no inflam cells; transudate > no protein, no cells
CHF = congestive heart failure; kwashiokor: protein ____, and the others result of edema in extravascular tissue, and that edema is transudate
outside
BV
clotting factors inflammatory response purulent serous fibrinous
malnutrition
Transudate: Altered fluid dynamics/Diseases
• Increased Hydrostatic Pressure:
– Disorders with impaired ____ return
– Congestive ____, Deep ____
• Reduced Osmotic Pressure:
– ____ (malnutrition or inadequate synthesis)
– ____, Liver ____
• Lymphatic Obstruction:
– Lymphedema (____)
– Lymphedema (Breast Cancer ____)
– Lymphedema (____)
venous
heart failure
vein thrombosis
albumin
kwahiorkor
cirrhosis
breast cancer
treatment
fibrosis/elephantiasis
Increased Hydrostatic Pressure
Hyperemia (____)
Defintion: Increased ____ within tissue
Etiology: Irritation/Injury (____), Increased ____ (exercise)
Pathogenesis: Arteriolar ____/increased ____ (Active)
Gross appearance: ____
Microscopic appearance: Capillaries/Arterioles ____, Engorged with ____
Congestion (____)
Definition: Increased ____ within tissue
Etiology: ____ failure, ____ Obstruction
Pathogenesis: Impaired outflow from of ____ from tissue (Passive)
Gross appearance: ____
Microscopic appearance: Capillaries/venules ____ with blood, ____ in lung (Left sided HF)
active blood volume inflammation demand dilation blood flow redness/heat dilated blood
passive blood volume cardiac venous venous blood red blue (cyanosis) engorged hemosiderin
Increased HP
Right-sided heart failure > problem with outflow > edema (generalized ____, ____)
Left-sided heart failure > edema would develop in the ____ (____)
Deep venous thrombosis in one leg > localized edema (____)
Depending on where the heart failure is located, and whether or not there is a thrombosis, each of these examples will ensue
Increased hydrostatic pressure > ____
edema
transudate
lung
transudate
transudate
transudate
Increased HP
Middle: normal lung, and BV are tightly packed
Left: pneumonia > fluid accumulate into alveolar space and BV dilate and loss of BV > with time, formation of “____” exudate (purulent)
Left-sided heart failure > fluid w/o any protein (____), and capillaries are engorged and packed with fluid and because they are very thin you may have RBC leaking out which contain ____ > alveolar macrophages containing hemosiderin engulf dead RBC (____ cell)
neutrophilic
transudate
hemosiderin
heart failure
Reduced Osmotic Pressure: Kwashiorkor
- Severe ____ in some poor countries.
- ~25% of children may be affected.
- ____ give rise to general edema.
- Severe cases; weight ~60% of normal but the true weight lost is masked by increased ____.
Not enough protein > the blue is affected > hypoalbuminia (reduced albumin content in plasma) > if this content is reduced, then the three components are impaired > ____ forces fluid out, but not enough ____ to pull fluid back in and fluid accumulates
Weight loss masked by increased edema > if you were to not account for the fluid in their body, the weight loss would be much more than 60%
The fluid is a ____
protein-energy malnutrition (PEM)
hypoalbuminemia
edema
hydrostatic pressure
osmotic pressure
transudate
Reduced Osmotic Pressure: Liver Cirrhosis
- ____: Replacement of normal liver with fibrotic (scar tissue).
- ____ and reduced plasma osmotic pressure.
- Transudate (____)
- Portal ____.
Condition where normal liver tissue is replaced with fibrotic tissue > liver is not functioning properly (____)
Liver makes the ____, and as you destroy the liver you do not make enough albumin > hypoalbumenia > reduced ____
Fluid that accumulates in peritoneum = ____; ascites is a general term that says how there is fluid in ____, this fluid can be either exudate or transudate; if a response of liver > fluid is transudate; if infection in cavity > exudate
cirrhosis
hypoalbuminemia
ascites
hypertension
chronic alcoholism
albumin
osmotic pressure
ascites
peritoneum
Lymphatic Obstruction: Breast cancer
- ____: swelling caused by compromised lymphatic system.
- Obstruction of superficial lymphatics by breast cancer cells.
- Edema of overlying skin
- “____”
If lymphatics do not drain properly > fluid in EV space
How can you have a compromised lymphatic system > breast cancer that is initially localized and then metastasizing by invading the nearby lymph nodes > breast cancer cells will obstruct ____ > cannot drain as much fluid as it normally does
Woman has breast cancer, the redness (orange circle) = ____ > this breast cancer is invading the lymphatics > obstructing resulting in fluid accumulation
lymphedema
peau d’orange
lymphatic nodes
peau d’orange
Lymphatic Obstruction: Resection/Irradiation
• Lymphedema caused by breast cancer treatment:
– ____
– ____
• ____ lymph nodes from other body parts to relieve pain and swelling?
Woman has been treated for breast cancer by resection (removal of breast) or irradiation; if breast is removed > local lymph nodes are removed; if treating by irradiation > destroying the lymphatics
Left breast removed > the ____ can also swell up (due to the transudate) because of lymph node resection (along with breast) or destroyed because of irradiation
resection
irradiation
transplanting
left arm
Lymphatic obstruction: Filariasis/Elephantiasis
If lymphatic becomes ____ inflamed and they become ____ (replace normal lymph node with collagenous tissue) and the normal function is gone; cannot drain fluid and there is fluid accumulation in the EV space
Middle: don’t really need to know this, but if bitten by ____, they transmit a ____ that can enter lymphatic and destroy it (by bringing in macrophages as well, etc.); if fibrosis it takes a long time to occur; and once they’re destroyed you’ll have swelling of the extremities
Can be ____ or ____, depends on what part of body is infected
chronically
fibrosis
mosquito
parasite
unilateral
generalized (both legs)
Mediators of vascular permeability
Mediators as they relate to increased vascular permeability
Mast cells are located close to ____, and they have tons of granules that are released almost ____ following activation
____ mediators, and mediators that come from ____ (cytokines that come later in the inflammation process)
BV
immediately
plasma
macrophages
