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Principles of Disease > Acute Inflammation 2 > Flashcards

Acute Inflammation 2 Flashcards

1
Q 
What is inflammation of the:
1. peritoneal cavity
2. meninges
3. appendix
4 lungs
5. pleural cavitiy
called?
A
  1. peritonitis
  2. meningitis
  3. appendicitis
  4. pneumonia
  5. pleurisy
    most follow rule ‘structure’-itis but there are some exceptions (e.g. 4&5)
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2
Q

What do neutrophils do?

A

They’re mobile phagocytes (recognise foreign antigen, move towards it by chemotaxis, adhere to organism).
They have granules containing oxidants (e.g. hydrogen peroxide) and enzymes (e.g. protases) which they release to destroy foreign antigens.

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3
Q

What is chemotaxis?

A

Neutrophils detect chemicals released by foreigners and move towards them by move up the concentration gradient on the chemicals.

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4
Q

What happens to neutrophils when they release the contents of their granules?

A

Neutrophils die.

This produces pus (mixture of fluid, bits of cells, organisms, endogenous proteins)

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5
Q

Name two plasma proteins involved in the inflammatory response.

A

Fibrinogen and immunoglobulins.

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6
Q

What would happen if the pus extends onto other tissues?

A

Inflammation would be progressed.

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7
Q

What are the role of immunoglobulins in inflammation?

A

Immobilise specific antigens - humour immune response.

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8
Q

What is the role of fibrinogen in inflammation?

A

It is a coagulation factor. It cleaves and polymerises to form fibrin which clots the exudate localising the inflammatory response.

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9
Q

Give examples of mediators in acute inflammation.

A

Molecules on endothelial cell surface membrane.
Molecules released from cells.
Molecules in the plasma.

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10
Q

Give examples of the collective effects of mediators.

A 
Vasodilation
Increased permeability 
Neutrophil adhesion 
Chemotaxis
Itch and pain
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11
Q

** Give examples of cell surface mediators.

A

ICAM-1 - helps neutrophils stick

P-selectin - interacts with neutrophil surface

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12
Q

Why is histamine released during inflammation?

A

Mast cell degranulation is a component of inflammation and histamine is contained within these granules.

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13
Q

Molecules released from cells: histamine

A

preformed in mast cells besides vessels, platelets, basophils
released as result of local injury, IgE mediated reactions
Causes vasodilation, increased permeability
acts via H1 receptors on endothelial cells.

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14
Q

Molecules released from cells: 5-hydroxytryptamine (serotonin)

A

Preformed in platelets
Released when platelets degranulate in coagulation
Causes vasoconstriction

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15
Q

Molecules released from cells: prostaglandins (arachidonic acid metabolites via lipoxygenase pathway)

A

Released from many cells (endothelium + leukocytes)
Many promote histamine effects and inhibit inflammatory cells
Thromboxane A2 promotes platelet aggregation and vasconstriction - opposite effect of PGD2, PGE3 etc.

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16
Q

Molecules released from cells: leukotrienes (arachidonic acid metabolites via cyclo-oxygenase pathway)

A

Released from neutrophils especially

Vasoactive - dynamic effect on vessels to increase permeability and constrict smooth muscle

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17
Q

Molecules released from cells: omega-3 polyunsaturated fatty acids

A

Decrease synthesis of arachidonic acid derived inflammatory mediators

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18
Q

Molecules released from cells: platelet-activating factor (PAF)

A

Released from cell membranes of activated inflammatory cells

Reduces permeability by enhancing platelet degranulation at site of injury

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19
Q

Molecules released from cells: cytokines and chemokines (e.g. TNFalpha, IL-1)

A

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

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20
Q

Molecules released from cells: nitric oxide (NO)

A

Released by various cells

Smooth muscle relaxation, anti-platelet, regulates leukocyte recruitment to inflammatory focus

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21
Q

Molecules released from cells: oxygen free radicals (H2O2, OH-, O3-)

A

Released by neutrophils on phagocytosis

Amplify other mediator effects

22
Q

What are the four enzyme cascades involved in inflammation?

A

Blood coagulation pathways
Fibrinolysis
Kinin system
Complement cascade

23
Q

What are the role of blood coagulation pathways?

A

Clots fibrinogen in exudate

24
Q

What is fibrinolysis?

A

Break down of a fibrin clot, helping to maintain blood supply
Fibrin breakdown products are vasoactive

25
Q

What is the kinin system?

A

It consists of blood proteins that play a role in inflammation, blood pressure control, coagulation and pain, e.g. bradykinin stimulates nerves so you feel pain at the site of inflammation

26
Q

What is the role of complement cascade in inflammatory response?

A

Ties in w/ immune system

Active components stimulate increased permeability, chemotaxis, phagocytosis, cell breakdown

27
Q

What are the immediate systemic effects of inflammation?

A 
Pyrexia (raised temp)
Fell unwell (malaise, anorexia, nausea, abdominal pain & vomiting in children
Neutrophilia (raised WBC count - bone marrow makes and releases)
28
Q

What are some of the longer term effects of inflammation?

A

Lymphadenopathy (regional lymph node enlargement due to immune response)
Weight loss - catabolic process
Anaemia

29
Q

One of the outcomes of acute inflammation is suppuration, what is this?

A

Pus formation with a pyogenic membrane surrounding this pus

30
Q

What does pus consists of?

A

Dead tissue, organisms, exudate, neutrophils, fibrin, red cells, debris…

31
Q

What does the pyogenic membrane consist of and what is its function?

A 
Capillary sprouts (little vessels growing into inflamed area), neutrophils, fibroblasts
Walls of puss - preventing spread
32
Q

What is an abscess?

A

A collection of pus (suppuration) under pressure
Can be single locule or multiloculated
Has a point and discharges
Collapses - healing and repair

33
Q

When would a multiloculated abscess form?

A

If the pus bursts through pyogenic membrane and forms new cavities

34
Q

What is an empyema and give examples of where one might happen?

A

A collection of pus in a hollow viscus

E.g.s - gall bladder, pleural cavity

35
Q

What is pyaemia?

A

Blood poisoning caused by the spread of pus into the bloodstream

36
Q

Another outcome of acute inflammation is organisation, what does this involve?

A

Granulation tissue
Healing and repair
Leads to fibrosis and formation of scar

37
Q

What is granulation tissue?

A 
A 'universal patch'
Formed of:
New capillaries (angiogenesis)
Fibroblasts & collagen
Macrophages
38
Q

Another outcome of acute inflammation is dissemination, what does this involve?

A

Spread to bloodstream - patient ‘septic’

39
Q

Define bacteraemia

A

Bacteria in blood

40
Q

Define septicaemia

A

Growth of bacteria in blood

41
Q

Define toxaemia

A

Toxic products in blood

42
Q

What is cardiac output (CO) and how is it mathematically worked out?

A

Volume of blood pumped by the heart per min.

CO = stroke volume (SV) x heart rate (HR)

43
Q

What is stroke volume?

A

Amount of blood ejected by left ventricle in one contraction

44
Q

What is systemic vascular resistance (SVR)?

A

The resistance the left ventricle must overcome to pump blood through the systemic circulation
As peripheral BVs constrict, SVR increases

45
Q

How can you mathematically work out blood pressure (BP)?

A

BP = CO x SVR

46
Q

What are the effects of systemic infection?

A

Shock - inability to perfuse tissues

47
Q

What are some symptoms of early septic shock?

A 
Peripheral vasodilation
Tachycardia (high HR)
Hypotension (low BP)
Often pyrexia 
Sometimes haemorrhagic skin rash
48
Q

Explain what brings about the symptoms of septic shock.

A

Systemic release of chemical mediators from cells into plasma
- mediators cause vasodilation (therefore loss of SVR, so BP drops)
Results in catecholamine release
Tachycardia to maintain CO as increased HR compensates (CO = SV x HR)
Bacterial endotoxin released (interleukin-1 released acts on hypothalamus = pyrexia)
Activation of coagulation (disseminated intravascular coagulation, vasoactive chemical causes vasodilation, haemorrhagic skin rash)

49
Q

When you cleave fibrinogen what does the by-product act as?

A

Causes vasodilation

50
Q

Eventually, when the HR is insufficient to maintain CO, what happens?

A

SVR low, BP falls

Reduced perfusion of tissues causing tissue hypoxia and loss of cell tissue and organ function

51
Q

What is the outcome of septic shock?

A

Rapidly fatal
Tissue hypoxia - cell death
Haemorrhage

52
Q

How should septic shock be dealt with?

A

Awareness and early recognition are important
Young people can compensate for some time
But anyone w/ septic shock must be admitting to hospital & ICU

Principles of Disease (10 decks)

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