Acute Inflammation 2

Question 1

What is the name of inflammation at these various sites?
Peritoneal cavity
Meninges
Appendix
Lungs
Pleural cavity

Answer 1

Peritonitis
Meningitis
Appendicitis
Pneumonia
Plearisy

Question 2

What do neutrophils do?

Answer 2

Recognise foreign antigen
Move towards it - chemotaxis
Adhere to the organism

They are mobile phagocytes

Phagocytose and destroy foreign antigen

Question 3

What do the granules do that neutrophils release the contents of?

Answer 3

Possess oxidants - H202 and enzymes (proteases )

Question 4

When does a neutrophil die?

Answer 4

When granule contents are released

Question 5

What is pus?

Answer 5

Produced by neutrophils - its a soup of fluid, bits of cells, organisms, endogenous proteins

Question 6

What is fibrinogen?

Answer 6

PLasma protein - coagulating factor forming fibrin which clots exudate, localises inflammatory process

Question 7

What plasma protein is responsible for humoural immune response?

Answer 7

Immunoglobulins

Question 8

What does humoural mean?

Answer 8

Relates to the immune response that involves the release of antibodies in circulating bodily fluids

Question 9

Where are the mediators of acute inflammations?

Answer 9

Molecules on endothelial cell surface membrane - released from cells, molecules in the plasma

Question 10

What are endothelial cells?

Answer 10

Line the walls of blood vessels

Question 11

What the collective effects of mediators?

Answer 11

Vasodilation
Increased permeability
Neutrophil adhesion - mediators from different cells adhere because of their mediators
Chemotaxis
Itch and pain

Question 12

Describe the action of adhesion molecules that appear on endothelial cells

Answer 12

Help neutrophils stick
ICAM - 1

Question 13

Describe the function of P-Selectin

Answer 13

Interacts with neutrophil surface

Question 14

What releases histamine?

Answer 14

Mast cells beside vessels, platelets, basophils

Question 15

When is histamine released?

Answer 15

As a result of local injury

Question 16

What is the effect of histamine?

Answer 16

Vasodilation, increases permeability, acts via H1 receptors (histamine receptors) on endothelial cells

Question 17

What is another name for serotonin?

Answer 17

5 - hydroxytryptamine

Question 18

Where is seratonin released from?

Answer 18

Platelets, when they degranulate in coagulation
Vasoconstriction - to keep useful materials in the correct place

Question 19

What are the immediate systemic effects of inflammation?

Answer 19

Pyrexia - endogenous pyrogens from white blood cells act centrally
Feel unwell - malaise, anorexia, nausea, abdominal pain, vomiting in chilrdren
Neutrophilia - raised WBC count

Question 20

What are the long term effects of inflammation?

Answer 20

Lymphadenopathy - lymph node enlargements
Weight loss - catabolic process
Anaemia

Question 21

Describe what suppuration is

Answer 21

Pus formation
Pyogenic membrane surrounds pus (capillary sprouts neutrophils, fibroblasts - walls off pus)

Question 22

What is an abscess?

Answer 22

Collection of pus under pressure

Question 23

What is a multiloculated abscess?

Answer 23

Pus burts through the pyogenic membrane - forms new cavities

Question 24

What is empyema

Answer 24

• pus in a hollow viscus (gall bladder, pleural cavity)

Question 25

What is pyaemia

Answer 25

Discharge of pus to the blood stream

Question 26

What is organisation?

Answer 26

Healing and repair - leads to fibrosis and formation of scar Granulation tissue characteristic

Question 27

What is granulation tissue?

Answer 27

Universal patch It is formed of new capillaries Fibroblasts and collagen Macrophages

Question 28

Describe the outcome of dissemination

Answer 28

Spreads to the bloodstream - patient is now described as septic

Question 29

What is the difference between bacteraemia and septicaemia?

Answer 29

Bacteria in blood versus the growth of bacteria in blood

Question 30

What is toxaemia?

Answer 30

Toxic products in the blood

Question 31

How do you calculate cardiac output?

Answer 31

Stroke volume multiplied by heart rate

Question 32

How can you calculate blood pressure?

Answer 32

Cardiac output multiplied by systemic vascular resistance

Question 33

Define SVR

Answer 33

An index of arteriolar constriction throughout the body, calculated by dividing the blood pressure by the cardiac output.

Question 34

What is the effect of systemic infection?

Answer 34

Shock - inability to perfuse tissue

Question 35

What is the clinical picture of early septic shock

Answer 35

Peripheral vasodilation Tachycardia Hypotension Often pyrexia Sometimes haemorrhagic skin rash - blood vessels leaking

Question 36

What is the effect of bacterial endotoxin?

Answer 36

Interleukin- 1 is released - acts on hypothalamus - pyrexia

Question 37

What is the effect of prostglandins? (archidonic acid metabolite)

Answer 37

Histamine effects and inhibit inflammatory cells Thromboxan A2 - promotes platelet aggregation and vasoconstriction

Question 38

What is a leukotriene? (archidonic acid metabolite)

Answer 38

Any substance which is derived from a leucocyts (white blood cell)

Question 39

Are leukotrines vasoactive?

Answer 39

Yes, they increase permeability and constrict smooth muscle

Question 40

What is the effect of omega 3 polyunsaturated fatty acids?

Answer 40

Decreases synthesis of archidonic acid derived inflammatory mediators

Question 41

What is the function of platelet - activating factor?

Answer 41

Produced especially by mast cells and basophils, It is a lipid molecule responsible for platelet aggregation degranulation, releasing factors such as histamine and seratonin

Question 42

What are cytokines and chemokines?

Answer 42

Small molecules produced by macrophages, lymphocytes , endothelium in response to inflammatory stimuli They attract inflammatory cells

Question 43

What is the function of NO?

Answer 43

Released by various cells, responsible for smooth muscle relaxation, anti-platelet, regulate functional activity, growth and death of many cell types including macrophages, T lymphocytes, antigen presenting cells, mast cells, neutrophils and natural killer cells. It regulates leukocyte recruitment to inflammatory focus

Question 44

What are the effects of oxygen free radicals and what are their names?

Answer 44

H2O2, OH-, O2- Released by neutrophils on phagocytosis Amplify other mediator effects

Question 45

What are the different plasma enzymes involved?

Answer 45

Blood coagulation pathways - clotting fibrinogen in exudate Fibrinolysis - breaks down fibrin maintaining blood supply. The breakdown products are vasoactive Kinin system - bradykinin is responsible for pain Complement cascade - Increase permeability, chemotaxis, phagocytosis, cell breakdown

Question 46

What are the key effects of the mediators?

Answer 46

Vasodilation and constriction Altered permeability Neutrophil adhesion Chemotaxis Itch and pain

Question 47

What is the pathogenesis of septic shock?

Answer 47

There is a release of chemical mediators from cells into plasma Mediators cause vasodilation Vasodilation results in loss of systemic vascular resistance This results in catecholamine (adrenaline and noradrenaline release) Tachycardia follows to maintain cardiac output Bacterial endotoxins are released (interleukin- 1 - pyrexia)

Question 48

The increased heart rate is insufficient to maintain cardiac output during septic shock, what is the effect of this?

Answer 48

Blood pressure drops due to reduced SVR There is a reduced perfusion of tissues, hypoxia and loss of cell tissue and organ function

Question 49

What is the outcome of septic shock

Answer 49

Rapidly fatal Tissue hypoxia Haemorrhage Requires immediate intervention and support

Question 50

What are the outcomes of acute inflammation?

Answer 50

Resolution Suppuration Organisation Dissemination Chronic inflammation