Acute Inflammation

Question 1

What is acute inflammation

Answer 1

Response of living tissue to injury. It is innate, immediate, stereotypes and short lived

Question 2

Give 5 causes of acute inflammation

Answer 2

1. Microbial infections
2. Hypersensitivity reactions
3. Physical agents
4. Chemicals
5. Tissue necrosis

Question 3

What are the clinical signs of acute inflammation

Answer 3

Rubor (redness)
Tumour (swelling)
Dolor (pain)
Calor (heat)
Loss of function

Question 4

What changes in the tissue occur as a result of inflammation

Answer 4

1. Changes in blood flow
2. Exudation of fluid into tissues
3. Infiltration of inflammatory cells

Question 5

What is exudation of fluid

Answer 5

Fluid that filters from the circulatory system into lesions (areas of tissue suffering from damage) or areas of inflammation

Question 6

What are the changes in the changes of blood flow

Answer 6

1. Vasoconstriction of arterioles occurs for a few seconds
2. Vasodilation then occurs
   There is an increased permeability of blood vessels

Question 7

How does the blood flow change in acute inflammation

Answer 7

It increases due to vasodilation

Question 8

What does an increase in permeability of blood vessels cause

Answer 8

Exudation of protein rich fluid

Slowing down of the circulation

Question 9

What are the 2 types of chemical mediators of acute inflammation

Answer 9

Immediate response mediators

Mediators giving a persistent response

Question 10

Give an example of an immediate chemical mediator

Answer 10

Histamine, cytokines and chemokines

Question 11

What cells release histamine

Answer 11

Mast cells, basophils and platelets

Question 12

When is histamine released

Answer 12

In response to physical damage, complementary factors C3a and C5a, interleukin and neutrophils

Question 13

What does histamine cause

Answer 13

Vasodilation, increased permeability of blood vessels and pain

Question 14

Give an example of a persistent chemical mediator of acute inflammation

Answer 14

Leukotriene and Proteases (bradykinin, complement proteins C3a and C5a, fibrin)

Question 15

What 2 pressure determine fluid flow across vessel walls

Answer 15

Hydrostatic and oncotic pressure

Question 16

If there is an increased oncotic pressure in the interstitum what happens to fluid in the vessels

Answer 16

It will move out of the vessels in to the interstitium

Question 17

What is oedema

Answer 17

Increased fluid in the tissues

Question 18

True or false: arteriolar dilation leads to an increase in hydrostatic pressure

Answer 18

True as there is more blood flow through the capillaries increasing the pressure. This forces more fluid out

Question 19

What does transudate mean

Answer 19

The fluid outside of the vessels has the same protein content as the plasma

Question 20

What is the protein content like in an exudate

Answer 20

Greater than in the plasma

Question 21

True or false: fluid loss in inflammation is a transudate

Answer 21

False - it is an exudate

Question 22

What are the 5 mechanisms of increasing vessel permeability

Answer 22

1. Endothelial contraction
2. Cytoskeleton reorganisation
3. Direct injury
4. Leukocyte dependant injury
5. Increased transcytosis

Question 23

What is transcytosis

Answer 23

When fluid moves across the endothelial cytoplasm through cells and not between cells

Question 24

What causes endothelial contraction

Answer 24

Histamine and leukotrienes

Question 25

What does endothelial contraction causes

Answer 25

Gaps inbetween the endothelial making the vessels more leaky

Question 26

What causes cytoskeleton reorganisation

Answer 26

Cytokines interleukin and TNF

Question 27

What does cytoskeleton reorganisation cause

Answer 27

Gaps in the vessel walls

Question 28

How can leukocyte dependant injury occur

Answer 28

When neutrophils release toxic oxygen species and enzymes

Question 29

What causes an increase in transcytosis

Answer 29

VEGF

Question 30

What is the primary type of white blood cell involved in inflammation

Answer 30

Neutrophils

Question 31

Describe the appearance of a neutrophil

Answer 31

Granular, multi-lobed nucleus

Question 32

What are the 4 stages in neutrophil infiltration

Answer 32

1. Margination 2. Rolling 3. Adhesion 4. Emigration

Question 33

What occurs in migration in the infiltration of neutrophils

Answer 33

Neutrophils line up at the edge of the blood vessel along the endothelium

Question 34

What is rolling in the infiltration of neutrophils

Answer 34

Neutrophils roll along the endothelium, sticking to it loosely

Question 35

What is the adhesion stage of the infiltration of neutrophils into blood vessels

Answer 35

When neutrophils tightly adhere to the endothelial lining the blood vessel

Question 36

What occurs in the emigration stage of the infiltration of neutrophils into the blood vessels

Answer 36

Neutrophils move through the blood vessel wall

Question 37

What allows neutrophils to bind onto the endothelial wall of the blood vessel

Answer 37

Inflammatory mediators cause a change to the endothelial receptors which allows the neutrophils to bind

Question 38

How to the neutrophils move through the endothelial wall

Answer 38

There is relaxation of inter-endothelial cell junction, digestion of the vascular basement membrane which then allows the neutrophil to move across

Question 39

What is chemotaxis

Answer 39

Movement along concentration gradients of chemoattractants

Question 40

What process do neutrophils do

Answer 40

Phagocytosis

Question 41

What facilitates phagocytosis by neutrophils

Answer 41

Opsonins (C3b)

Question 42

What happens during phagocytosis

Answer 42

Opsonins allows the neutrophil to recognise and make contact with the particle. The cytoskeleton then changes to allow endocytosis of the particle. Lysosomes fuse

Question 43

What are the 2 mechanisms of phagocytosis

Answer 43

Oxygen dependant and independant

Question 44

What occurs in oxygen dependant phagocytosis

Answer 44

Enzymes produce superoxide and hydrogen peroxide

Question 45

Which type of phagocytosis is particularly good for killing bacteria

Answer 45

Oxygen dependant

Question 46

What occurs in oxygen independant phagocytosis

Answer 46

Lysozymes and hydrolases break down the particle

Question 47

Why is the response by neutrophils not always 100% reliable

Answer 47

Neutrophils may release toxic metabolites and enzymes causing damage to host tissue

Question 48

Give 2 examples of cytokines

Answer 48

Interleukin and TNF alpha

Question 49

What chemicals mediators cause increased blood flow

Answer 49

Histamine

Question 50

What chemicals mediators cause vascular permeability

Answer 50

Histamine and leukotrienes

Question 51

What chemicals mediators cause neutrophil chemotaxis

Answer 51

C5a, bacterial peptides, lnterleukin

Question 52

What chemicals mediators cause phagocytosis

Answer 52

C3b

Question 53

How does the exudation of fluid combat injury?

Answer 53

1. Delivers plasma proteins, immunoglobulins, inflammatory mediators and fibrinogen to area of injury 2. Dilutes toxins 3. Increases lymphatic drainages

Question 54

Why is an increased lymphatic drainage advantageous in an inflammatory response

Answer 54

Delivers microorganisms to phagocytes and antigens in the immune system through the lymph nodes

Question 55

How does the infiltration of cells combat injury

Answer 55

Removes pathogenic organisms and debris

Question 56

How does vasodilation help combat injury

Answer 56

1. Increases delivery of helping components (plasma proteins, immunoglobin, fibrinogen, mediators) 2. Increases temperature

Question 57

How does an increased temperature help combat injury

Answer 57

The cells work more efficiently at higher temperatures

Question 58

How does pain and loss of function help combat injury

Answer 58

Reduces chance of further damage

Question 59

What complications can occur due to local inflammation

Answer 59

1. Swelling can block tubes 2. Exudate can cause compression 3. Pain and loss of function

Question 60

What is serositis

Answer 60

Inflammation of serous membranes

Question 61

What are systemic effects of inflammation

Answer 61

1. Fever | 2. Leukocytosis

Question 62

What causes a fever

Answer 62

Endogenous pyrogens

Question 63

Give 2 examples of endogenous pyrogens

Answer 63

Interleukin 1 and TNF alpha

Question 64

What chemical mediators are found in aspirin to reduce fever

Answer 64

Prostaglandins

Question 65

What is leukocytosis

Answer 65

An increase in the number of white cells in the blood normally as a response to infections

Question 66

What type of white cell increases in the blood due to bacterial infections

Answer 66

Neutrophils

Question 67

What type of white cell increases in the blood due to viral infection

Answer 67

Lymphocytes

Question 68

What are acute phase proteins

Answer 68

Plasma proteins that increase in infections

Question 69

Give 3 examples of acute phase proteins

Answer 69

C reactive protein Alpha 1 antitrypsin Fibrinogen

Question 70

What is the acute phase physiological responses of acute inflammation

Answer 70

Decreased appetite, raised pulse rate, altered sleep pattern and changes in plasma concentrations of acute plasma proteins

Question 71

What does it mean by acute

Answer 71

Rapid onset

Question 72

What is shock

Answer 72

Clinical syndrome of systemic circulatory failure

Question 73

What are the 4 outcomes of acute inflammation

Answer 73

1. Complete resolution 2. Continued acute inflammation with chronic inflammation (abscess) 3. Chronic inflammation and fibrous repair giving scarring 4. Death

Question 74

How is the plasma levels of fibrin reduced

Answer 74

Degraded by plasmin and proteases

Question 75

How is the exudate reduced

Answer 75

Drained to the lymphatics

Question 76

When is complete resolution not possible

Answer 76

If cell architecture is destroyed

Question 77

True or false: mediators of acute inflammation have short half lives

Answer 77

True

Question 78

How are the amount of mediators reduced when resolving inflammation

Answer 78

- short half lives - inactivated by degradation - inhibited - diluted in exudate

Question 79

What is lobar pneumonia

Answer 79

Inflammation of the pulmonary lobe

Question 80

What organism causes lobar pneumonia

Answer 80

Streptococcus pneumoniae (pneumococci)

Question 81

What systems are seen with lobar pneumonia

Answer 81

Fever, hypoxaemia, dry cough and breathlessness

Question 82

What is bacteria meningitis

Answer 82

Acute inflammation of the meninges (membrane outlining the brain and spinal cord) causing vascular thrombosis and reduced cerebral perfusion

Question 83

What causes bacterial meningitis

Answer 83

Streptococcus pneumoniae

Question 84

What is an abscess

Answer 84

Collection of pus (inflammatory exudate) in the tissues due to bacterial infection. This causes high pressure giving pain and can damage adjacent tissue

Question 85

What type of necrosis is associated with an abscess

Answer 85

Liquefactive in the centre

Question 86

What occurs if the inflammatory exudate pours into serous cavities

Answer 86

Ascites, pleural or pericardial effusion

Question 87

What is pericarditis

Answer 87

Swelling of the pericardium with fibrin deposits there

Question 88

List 4 examples of inflammation disorders

Answer 88

1. Hereditary angiotensin-oedema (attacks of swelling) 2. Alpha-1 antitrypsin deficiency 3. Inherited complementary deficiencies 4. Defects in neutrophil number and size

Question 89

What is diapedesis

Answer 89

Passage of blood cells through the capillary walls