Acute Inflammation

Question 1

what is acute inflammation?

Answer 1

quickly developing response of living tissue to infection/damage, initiation for innate immunity

Question 2

what are the three main processes involved in acute inflammation?

Answer 2

vascular dilation, increased vascular permeability, neutrophil activation and migration

Question 3

how long does acute inflammation last for?

Answer 3

few hours to days

Question 4

what are the four main causes of acute inflammation?

Answer 4

microbial infection, physical agents, irritant and corrosive chemicals, tissue necrosis

Question 5

what does microbial inflammation result from?

Answer 5

microbial recognition

Question 6

what are the physical agents of acute inflammation?

Answer 6

physical trauma, UV radiation, heat, cold

Question 7

what are the irritant and corrosive chemicals that cause acute inflammation?

Answer 7

acids, alkali, oxidising agents, microbial virulence factors

Question 8

what causes tissue necrosis?

Answer 8

lack of oxygen or nutrients, inadequate blood flow

Question 9

what are the cardinal signs of inflammation?

Answer 9

redness, heat, swelling, pain and loss of function

Question 10

how does an inflamed area redden?

Answer 10

dilation of small blood vessels

Question 11

how does an inflamed area have heat?

Answer 11

increased blood flow

Question 12

how does swelling occur in acute inflammation

Answer 12

accumulation of fluid in extra vascular space (oedema)

Question 13

how does pain occur in inflammation

Answer 13

stretching/distortion of tissues due to oedema, chemical mediators induce pain

Question 14

give an acute inflammation

Answer 14

gingivitis

Question 15

what are the 4(5) steps of inflammation?

Answer 15

initiation, progression, amplification, resolution, no resolution?

Question 16

what is the initiation stage of gingivitis?

Answer 16

microbes in dental plaque recognised by gingival epithelial cells via pattern recognition receptors

Question 17

what is the progression stage of gingivitis

Answer 17

containment of microbes by innate immune cells and antimicrobial compounds (AMPs and secretory IgA)

Question 18

what is the amplification stage of gingivitis

Answer 18

recruitment and activation of innate immune cells via chemokine/cytokine activity and vascular dilation

Question 19

what is the resolution stage of gingivitis?

Answer 19

healing and repair

Question 20

what happens if there is no resolution in gingivitis

Answer 20

periodontitis

Question 21

what are the steps of the amplification stage of inflammation?

Answer 21

bacteria trigger macrophages to release cytokines and chemokines - vasodilation and increased vascular permeability cause redness, heat and swelling - inflammatory cells migrate into tissue, releasing inflammatory mediators that cause pain

Question 22

what are the vascular responses to inflammation?

Answer 22

small blood vessels adjacent to site of damage become dilated, endothelial cells swell and retract, exudation, endothelial cells activated to promote immune cells passage to damaged tissues

Question 23

what does retraction of endothelial cells result in?

Answer 23

migration of neutrophils and monocytes/macrophages to damaged tissues

Question 24

what does exudation mean?

Answer 24

the vessels become leaky and allow passage of water, salts and some proteins

Question 25

what is oedema?

Answer 25

defined as an excess of watery fluid collecting in the cavities or tissues of the body, increased blood and lymph flow

Question 26

what does inflammatory exudate provide to tissues?

Answer 26

fluids and salts, glucose and oxygen, complement proteins and antibodies, fibrin

Question 27

what does increased lymph flow allow?

Answer 27

increased influx of inflammatory infiltrate

Question 28

what are the different types of mediators

Answer 28

chemical or protein

Question 29

what are the main types of chemical mediators?

Answer 29

HISTAMINE, BRADYKININ, PROSTAGLANDINS, leukotrienes and serotonin

Question 30

what are the protein mediators?

Answer 30

cytokines and chemokines

Question 31

what is histamine?

Answer 31

breakdown product of histidine

Question 32

where is histamine stored?

Answer 32

in granules of immune cells such as mast cells

Question 33

what does degranulation do?

Answer 33

release histamine

Question 34

what is the role of histamine?

Answer 34

a neurotransmitter causing itching

Question 35

what does histamine cause?

Answer 35

vascular dilation

Question 36

what are prostaglandins produced by?

Answer 36

macrophages and neutrophils (with leukotreines)

Question 37

what is a prostaglandin

Answer 37

the product of fatty acid metabolism

Question 38

what is the most abundant prostaglandin?

Answer 38

prostaglandin E2 (PGE2)

Question 39

what do prostaglandins cause?

Answer 39

vascular dilation

Question 40

what are the roles of prostaglandins in acute inflammation

Answer 40

regulate cytokine production, regulate cell recruitment, act on nerve fibres causing pain, involved in tissue remodelling

Question 41

what are prostagandins released from cells in response to?

Answer 41

numerous stimuli

Question 42

what are prostaglandins regulated by?

Answer 42

cyclo-oxygenase II (COX II)

Question 43

how is cyclo-oxygenase II (COX II) activated?

Answer 43

through the stimulation of cells by TLR activation

Question 44

what type of mediators regulate blood vessel changes?

Answer 44

protein and chemical mediators (histamine and prostaglandins)

Question 45

what do inflammation processes function to do?

Answer 45

provide tissue with necessary tools to eliminate inciting cause and repair any damage

Question 46

what type of cascade are all the four systems of plasma factors?

Answer 46

proteolytic cascades, stepwise activation involving formation of enzyme complexes and protein cleavage

Question 47

what are the four enzymatic cascades of plasma factors?

Answer 47

complement, the kinin system, the fibrinolytic system, coagulation

Question 48

what is the common activator of the kinin, fibrinolytic and coagulation systems?

Answer 48

Hageman factor (coagulation factor 12)

Question 49

how are the four plasma systems interconnected

Answer 49

all activated by the same factor, kinin system produce kinins and fibrinolytic systems produce plasmin which both activate the complement systems, plasmin from fibrinolytic system degrades fibrin produced by the coagulation system

Question 50

what is the initiating factor of the classical pathway of complement?

Answer 50

antibody attached to microbe

Question 51

what are the 3 pathways of complement?

Answer 51

classical, alternative, mannose binding lectin pathway

Question 52

what is the initiating factor of the alternative pathway of complement?

Answer 52

microbial cell wall

Question 53

what is the initiating factor of the mannose binding lectin pathway of complement?

Answer 53

carbohydrates on pathogen surface

Question 54

what generates kallikrein?

Answer 54

the hageman factor

Question 55

how do neutrophils contribute to the kinin-kallikrein system?

Answer 55

release kallikreins

Question 56

what does kallikrein do?

Answer 56

converts kininogens to kinins (e.g. bradykinin)

Question 57

what are the functions of kinins e.g. bradykinin

Answer 57

stimulate complement system, promote localised vasodilation and increased capillary permeability, activate pain receptors, act as chemotaxins

Question 58

what are the three pathways of the coagulation system?

Answer 58

intrinsic, extrinsic and common

Question 59

what is the intrinsic pathway of the coagulation system?

Answer 59

activated when blood comes into contact with sub-endothelial connective tissues

Question 60

what is the extrinsic pathway of the coagulation system?

Answer 60

damaged blood vessel means Human Factor 7 leaves vessel and encounters tissue factor in surrounding tissue

Question 61

what is the common pathway of the coagulation system?

Answer 61

production of thrombin which in turn produces fibrin (clot formation)

Question 62

what does the kinin system produce?

Answer 62

kinins

Question 63

what does the coagulation produce?

Answer 63

fibrin

Question 64

what does the fibrinolytic system produce?

Answer 64

plasmin

Question 65

what is the main constituent of clotting?

Answer 65

fibrin

Question 66

what does the fibrinolytic system do?

Answer 66

involved in the breakdown of clots, prevents clotting, activates complement and indirect role as fibrin degradation products promote vascular permeability

Question 67

what do fibrin degradation products do?

Answer 67

promote vascular permeability

Question 68

what is haemostasis?

Answer 68

the balance between the coagulation and fibrinolytic system

Question 69

what does haemostasis essentially mean?

Answer 69

to stop the flow of blood

Question 70

name some congenital coagulation disorders

Answer 70

von willebrand disease, haemophilia A and B

Question 71

what drugs cause acquired coagulation disorders?

Answer 71

warfarin and heparin

Question 72

summarise complement

Answer 72

three pathways - leads to membrane attack complex formation and anaphylatoxin production

Question 73

summarise the kinin system

Answer 73

plasma proteins/enzymes that lead to production of bradykinins

Question 74

summarise coagulation

Answer 74

three pathways - formation of a stable blood clot (fibrin)

Question 75

summarise the fibrinolytic system

Answer 75

plasmin prevents excessive clotting of blood by degrading fibrin

Question 76

what is disease resolution dependent on?

Answer 76

tissue involved, amount of tissue destruction, nature of the harmful agent

Question 77

what is abscess formation (suppuration) an outcome of?

Answer 77

acute inflammation

Question 78

what is suppuration?

Answer 78

the formation of pus usually arising from an infection with pyogenic bacteria

Question 79

what is pus

Answer 79

bacteria with dead and dying neutrophils

Question 80

what surrounds pus once it accumulates?

Answer 80

a pyogenic membrane

Question 81

what are the 3 types of dental abscesses?

Answer 81

gingival, periodontal and periapical

Question 82

what is a gingival abscess?

Answer 82

an abscess formed due to infection or trauma to the surface of gum tissue

Question 83

what is a periodontal abscess?

Answer 83

abscess formed due to infection that has moved deeper into the gum areas. this is sometimes called a gum boil

Question 84

what is a periapical abscess?

Answer 84

an abscess of a tooth due to infection of the pulp

Question 85

what does the resolution of acute inflammation require?

Answer 85

minimal cell death and tissue damage, occurrence in tissues with regenerative capacity, rapid elimination of causative agent, rapid removal of fluid and debris by vascular/lymphatic drainage

Question 86

what is the most common outcome of acute inflammation?

Answer 86

resolution