Acute and Chronic Inflammation (complete) Flashcards
What are the 5 cardinals signs of injury?
1) Calor (heat)
2) Rubor (redness)
3) Tumor (swelling)
4) Dolar (pain)
5) Functio Laesa (loss of function)
How can rubor (redness) be explained physiologically?
Alteration in vascular caliber aka VASODILATION
causes redness
How can tumor (swelling) be explained physiologically?
Vasodilation causes increased intravascular hydrostatic pressure —» decrease intravascular osmotic pressure (stuff leaves vessels eg cells, proteins)
—-»>
net outward flow of H2O and ions
Causes tumor
How can calor (heat) be explained physiologically?
Alteration in vascular caliber aka VASODILATION
causes heat
What is the difference between transudate and exudate?
Trans etiology: increase hydrostatic pressure/reduced oncotic pressure
Ex etio: inflammation
higher specific gravity: ex higher total protein: ex higher fl/ser protein: ex higher fl/ser LDH: ex higher fl/ser glucose: trans Leukocytes? in ex, not trans
What are the organs directly exposed to the outside environment?
1) Skin
2) Respiratory system
3) Gut
What are some examples of how organs directly exposed to the outside environment maintain their barriers?
1) squamous epithelium (skin, esophagus)
- Surface cells slough w/ foreign objects as they pass
- Turnover, also mucus, lubricant secretion
2) Columnar epithelium
- Mucus secretion
- Turnover
What are the possible outcomes of acute inflammation?
1) complete resolution (macros clean up necrotic debris, tissue regen, lymphatic drainage decreases edema)
2) Scarring
3) Abscess formation (wall of infection)
4) Progression to chronic inflammation
What are the acute inflammatory cells?
Neutrophils (PMNs)
What are the chronic inflammatory cells?
Lymphocytes
Macrophages
Describe neutrophils (primary function, cytoplasmic content)
Lots of segments in nucleus
Function: acute inflammatory response, phagocytose bacteria
Content: acid hydrolases, lysozyme, glucuronidase, reactive oxygen metabolites
Describe monocytes/macrophages (primary function, cytoplasmic content)
Mononuclear - heart shape
Monocyte - in BM
Macros - in tissue
Function: chronic inflammatory response, phagocytose stuff
Content: lysozymes, cytokines, prostaglandins, reactive oxygen metabs
Describe lymphocytes/plasma cells (primary function, cytoplasmic content)
A big ass nucleus, not so much cytoplasm
Function: Chronic inflammatory response
Content: variable
Describe eosinophils (primary function, cytoplasmic content)
Bi-segmented nucleus, stained pink
Function: chronic infl response, think parasites
Content: lysozymes, reactive O2 metabs, cytokines
Describe mast cells/basophils (primary function, cytoplasmic content)
blue cytoplasm, blobby nucleus
Function: acute or chronic, release histamine
Content: histamine, serotonin, heparin, prostaglandins, cytokines
Describe platelets (primary function, cytoplasmic content)
Cleaved from megakaryocytes
Function: thrombosis (clot formation)
Content: acid hydrolases, fibrinogen, serotonin, calcium
What are the histologic variants in inflammation?
1) Fibrinopurulent
2) Granulomatous
3) Eosinophilic
Describe fibrinopurulent (cells involved, histologic features, ddx)
Cells: PMNs
Histo: neutrophils, fibrin/blood products, +/- hemorrhage
ddx: Any insult, infectious (bacteria, fungal)
AKA: PUS!
Describe granulomatous (cells involved, histologic features, ddx)
Cells: macros (GIANT CELLS, macros that come together to form 1)
Histo: mixed chronic inflammatory cells (lymph, macros); +/- central necrosis; +/- foreign material
DDx: Infectious (TB, fungus), inflammatory (collagen vascular disease, rheumatoid arthritis), foreign body
Overall: a rxn to a non-digestible material
Describe eosinophilic (cells involved, histologic features, ddx)
Cells: eosinophils
Histo: lots of eosinophils
DDX: Infectious (parasites), inflammatory (allergic, asthma)
Describe the acute inflammation phase
Onset/duration: seconds/mins —> days
Vascular response: vasodilation, ^ blood flow, ^ permeability
Source of cells: peripheral blood
Describe the chronic inflammation phase
Onset/duration: Days —> weeks/months/years
Vascular response: Endo cell proliferation —> neovascularization, ^ leakiness
Source of cells: sentinel/local cells in tissue/peri blood
Repair: Fibroblasts —> fibrosis/scarring; endo cells —-> neovascularization
Describe fibrinopurulent exudate/suppurative inflammation (location, inflammatory cells involved, ddx)
Location: anywhere, pus
Cells: neutrophils
DDX: Infectious (bacteria, fungus)
Describe abscess (location, inflammatory cells involved, ddx)
Location: w/in parenchyma/confined space (e.g. brain, lung, liver)
Cells: neutrophils
DDX: Infectious (bacteria, fungus)
Describe empyema (location, inflammatory cells involved, ddx)
Location: w/in anatomic space/cavity (e.g. pleural, subdural, appendix, gallbladder, uterus, joints)
Cells: neutrophils (EARLY) —» macros, lymphocytes (LATER)
DDX: Infectious (bacteria, fungus)
Describe cellulitis (location, inflammatory cells involved, ddx)
Location: skin, fascia, CT
Cells: neutrophils (early), mononuclear cells (later)
DDX: infectious (bacteria), inflammatory
Describe granuloma (location, inflammatory cells involved, ddx)
Location: parenchyma (lung, lymph node, liver, spleen)
Cells: Macros (giants), lymphocytes, plasma cells
DDX: Infectious (bacteria, fungus), inflammatory
Describe the process of collateral tissue damage associated with inflammation
Damage to normal tissue during inflammatory process
What are clinical examples of collateral tissue damage?
Pneumonia: inflammatory response degrades septa
Rheumatoid arthritis: inflammatory response erode through cartilage (ulnar deviation)
What is the role of lymphatics?
- Drain fluid accumulated in tissue
- Fluid is filtered in lymph nodes — analyzed by T and B cells
What are the potential outcomes if the lymphatic system cannot contain an infection?
- Infection enters into lymphatics
- Reenters circulation
- Pt is septic (infection is going allover the body)
EX: bacteremia, fungemia, viremia
List clinical exam findings associated with an inflammatory process
Local signs: rubor, calor, tumor, dolor, loss of function
Systemic signs: sleepiness, anorexia, fever, elevated WBC, BP alterations (hypotensive, shock)
List useful lab test supporting an inflammatory process
1) WBC count
2) DIC markers
3) PCR bacteria testing
