Acute & Chronic inflammation Flashcards
What is inflammation?
The host response to tissue damage
Why does inflammation occur?
as a protective response
- to remove/contain cause
- initiate repair
- reinstate useful function
- it is essential for healing
What are the 5 triggers for inflammation?
- foreign body
- infection
- ischaemia/ infarction
- physical/ chemical injury
- immune reaction
In acute inflammation what are the vascular changes to maximise movement of plasma proteins to site of injury?
- Vasodilation
- Increased permeability (leads to OEDEMA)
- blood stasis (pooling the blood at the site of injury
In acute vasodilation the vascular change of vasodilation leads to…
- increased blood flow
- causing redness and heat (erythema)
- endothelial cells of vessel wall contract
- Transcytosis - increased transport of fluid and proteins
In acute inflammation what are the cellular changes to maximise movement of plasma proteins to site of injury?
- margination - RBCs go to centre of lumen and WBCs go peripherally
- rolling - increased amount of leucocytes roll along edge of damaged endothelium
- adhesion - leucocytes stop and adhere to endothelium (cytokines encourage this)
What do the vascular changes in acute inflammation cause?
- cause leakage of intravascular fluid into the extravascular spaces
What is the main aim of inflammation?
to recruit leucocytes to area of damage
What do neutrophils and macrophages do ?
- ingest and kill bacteria and necrotic cells
- promote repair
Where are white blood cells recruited from in inflammation?
vessel lumens
In the cellular changes of inflammation what happens at the transmigration phase?
leucocyte encouraged to pass through endothelium to extravascular space
- chemokines stimulate this
How long does it take for neutrophils to appear and what do they respond to?
6-24 hours
chemokines
How long does it take monocytes to appear ?
24-48hours
opsonin receptors recognise microbes that have been coated with proteins this targets them for what?
phagocytosis
how do leucocytes kill harmful agents?
- attaching to bacteria through opsonin receptors
- leucocytes engulfs the cell
- then kills and degrades, removing its harmful effects
What are the outcomes of the process of acute inflammation?
- healing with connective tissue replacement (fibrosis
- if not resolved chronic inflammation or abscess
What are the causes of chronic inflammation?
- persistent infection or inflammation
eg. parasite, TB, toxic agent (asbestos) or when its an auto-immune disease as cant remove are own cells
Neutrophils not normally present in chronic inflammation as others have been recruited such as ..
macrophages, lymphocytes and plasma cells
In chronic inflammation you can get granulomas, what are these?
- cells try to contain offending agent
- strong activation of macrophages and T lymphocytes
- causes damage to surrounding tissue
What examples of conditions may cause granulomas?
- TB
- rheumatoid arthritis
- chrones disease
What kind of things may cause acute inflammation?
- infarction
- bacterial infection
- trauma
- burn
What kind of things may cause chronic inflammation?
- virus
- autoimmune diease
- acute inflammation that’s not resolved
- persistent infection
What are the clinical signs of acute inflammation?
- redness (from vasodilation)
- heat (from vasodilation
- swelling ( due to vascular permilbilty and fluid moving from intra to extra vascular space)
- Pain
- loss of function
What can chronic inflammation lead to?
fibrosis
What are the medical signs and symptoms of inflammation?
- fever
- tachycardia
- hypotension
- raised white cell count
- raised CRP (blood test)
What are the signs of chronic inflammation?
- anorexia
- general malaise
- weight loss
- sepsis- large amount of toxins stimulate cytokines, can lead to cardiovascular failure (septic shock)
What is the predominate white cell in acute inflammation?
neutrophils
What can make inflammatory responses poor?
- immunodeficiency / disease
eg. chemotheraphy, steroids - HIV
- Hereditary
How can are natural inflammatory response be negative?
- asthma
- hypersensitivity
- allergic reaction
What medicines can help with inflammation?
- NSAIDs
- anti-histamine
- steroids (rheumatoid arthritis)
- targeted biologics against immune response proteins
What happens if no inflammatory response?
- increased risk of infection
- delayed healing of wounds
- tissue damage
What are examples of inflammation?
*don’t need to memorise these
- acute appendicitis
- septic arthritis
- minor injuries (sprained ankle)
- rheumatoid arthritis
- ## peptic ulcers
What are the signs of acute appendicitis?
pyrexia
raised heart rate
raised white cell count
raised CRP
What are the symptoms of acute appendicitis ?
- central abdo pain which localises to right iliac fossa
- pain is worse on movement
- may have nausea and vomiting
What is the treatment of acute appendicitis?
appendectomy
What are the complications with acute appendicitis?
perforation leading to peritonitis
abscess formation
What are the symptoms of septic arthritis?
- red, hot, swollen joint
- unable to move joint
What are the signs of septic arthritis?
pyrexia
tachycardia
raised white cell count
raised CRP
What are the risk factors for septic arthritis?
prosthetic joint recent surgery or trauma to knee age rheumatoid arthritis immunodeficiency
What are the treatment options for septic arthritis?
joint aspirate
IV antibiotics
sepsis 6
What are the signs and symptoms of a minor injury such as a sprained ankle?
- swelling, pain, heat
- muscle cells are damaged
What is the treatment for a sprained ankle?
REST - prevent further injury ICE - reverse vasodilation COMPRESS - reduce oedema ELEVATE - prevent blood stasis ANTI-INFLAMMATORY
What are the signs of rheumatoid arthritis?
- warm, swollen, stiff and painful joints
- vessels can become involved leading to vasculitis
- chronic inflammatory response
What are the treatments for rheumatoid arthritis?
steroids
DMARDs
biologics
how are peptic ulcers developed?
- acute inflammatory response from h.pylori/excess acid
- necrotic inflamed mucousa falls away
- exposed to stomach acid
- leads to chronic inflammation
What are people with peptic ulcers at risk of ?
developing a bleed/perforation
What are the treatments for peptic ulcers?
PPIs
histamine receptor agonist
antibiotics
