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
Pleurisy

Question 2

What do neutrophils do?

Answer 2

Recognise foreign antigen
Move towards it - chemotaxis
Adhere to organism
Phagocytose and destroy foreign antigen (mobile phagocytes)

Question 3

What do the granules possess

Answer 3

oxidants - H202 and enzymes (proteases)

(oxidants - reactive molecules)

Question 4

When does a neutrophil die?

Answer 4

When granule contents are released

Question 5

What is pus?

Answer 5

Produced by neutrophils - fluid mixture, bits of cells, organisms, endogenous proteins

Question 6

What is fibrinogen?

Answer 6

Plasma protein - coagulating factor forming fibrin and 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

immune response involves release of antibodies in circulating bodily fluids

Question 9

Where are the mediators of acute inflammations?

Answer 9

Molecules released from endothelial membrane
Molecules in plasma and cells

Question 10

What are endothelial cells?

Answer 10

Line walls of blood vessels

Question 11

What the collective effects of mediators?

Answer 11

Vasodilation
Increased permeability
Neutrophil adhesion
Chemotaxis
Itch and pain

Question 12

Describe the action of adhesion molecules that appear on endothelial cells

Answer 12

Help neutrophils stick
ICAM-1 (intracellular adhesion molecule)

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

result of local injury

Question 16

What is the effect of histamine?

Answer 16

Vasodilation
increases permeability
Act on H1 receptors (histamine receptors) on endothelial cells

Question 17

Where is seratonin released from?

Answer 17

Platelets - degranulate in coagulation
Vasoconstriction - keep useful materials in correct place

Question 18

What are the immediate systemic effects of inflammation?

Answer 18

Pyrexia - increase body temp
Feel unwell - malaise, anorexia, nausea, abdominal pain, vomiting in chilrdren
Neutrophilia - raised WBC count

Question 19

What are the long term effects of inflammation?

Answer 19

Lymphadenopathy - lymph node enlargements
Anaemia
Weight loss - catabolic process

Question 20

Describe suppuration

Answer 20

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

(Forms small, raised, and red bumps on the skin)

Question 21

What is an abscess?

Answer 21

Collection of pus under pressure

Question 22

What is a multiloculated abscess?

Answer 22

Pus bursts through the pyogenic membrane - forms new cavities

Question 23

What is empyema

Answer 23

• pus in hollow body cavities (gall bladder, pleural cavity)

Question 24

What is pyaemia

Answer 24

Discharge of pus to blood stream

Question 25

What is organisation?

Answer 25

Healing and repair - fibrosis and scar formation Granulation tissue characteristic

Question 26

What is granulation tissue?

Answer 26

Universal patch formed of new capillaries Fibroblasts Collagen Macrophages

Question 27

Describe the outcome of dissemination

Answer 27

Spreads to bloodstream (patient is septic)

Question 28

What is the difference between bacteraemia and septicaemia?

Answer 28

Bacteraemia - bacteria in blood Septicaemia - Growth of bacteria in blood

Question 29

What is toxaemia?

Answer 29

Toxic products in blood

Question 30

How do you calculate cardiac output?

Answer 30

Stroke volume x heart rate (stroke volume = volume of blood pumped out left ventricle of heart during each systolic cardiac contraction)

Question 31

How can you calculate blood pressure?

Answer 31

Cardiac output x systemic vascular resistance

Question 32

Define SVR

Answer 32

amount of force exerted on circulating blood by the vasculature of the body

Question 33

What is the effect of systemic infection?

Answer 33

Shock - inability to perfuse tissue (supply with fluid)

Question 34

What is the clinical picture of early septic shock

Answer 34

Peripheral vasodilation Tachycardia Hypotension Pyrexia Haemorrhagic skin rash - blood vessels leaking

Question 35

What is the effect of bacterial endotoxin?

Answer 35

Pyrexia Interleukin- 1 released Acts on hypothalamus

Question 36

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

Answer 36

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

Question 37

What is a leukotriene? (archidonic acid metabolite)

Answer 37

substance derived from leucocytes (WBCs)

Question 38

What is the effect of omega 3 polyunsaturated fatty acids?

Answer 38

Decrease synthesis of inflammatory mediators derived from arachidonic acid

Question 39

What is the function of platelet - activating factor?

Answer 39

Produced by mast cells and basophils Lipid molecule responsible for platelet aggregation degranulation Releasing factors - histamine and serotonin

Question 40

What are cytokines and chemokines?

Answer 40

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

Question 41

What is the function of NO?

Answer 41

Released by various cells Smooth muscle relaxation Anti-platelet Regulate functional activity Growth/death of macrophages, T cells, APC, mast cells, neutrophils and NKC Regulates leukocyte recruitment to inflammatory focus

Question 42

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

Answer 42

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

Question 43

What are the different plasma enzymes involved?

Answer 43

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

Question 44

What is the pathogenesis of septic shock?

Answer 44

Release of chemical mediators from cells into plasma Mediators cause vasodilation Loss of SVR Catecholamine (adrenaline and noradrenaline release) Tachycardia - maintain cardiac output Bacterial endotoxins released (interleukin- 1 - pyrexia)

Question 45

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

Answer 45

Bp drops due to reduced SVR reduced perfusion of tissues, hypoxia and loss of cell, tissue, organ function

Question 46

What is the outcome of septic shock

Answer 46

Rapidly fatal Tissue hypoxia Haemorrhage Requires immediate intervention and support