Chronic fucking inflammation

Question 1

what is chronic inflammation?

Answer 1

inflammation in which the cell population is especially:
-lymphocytes
-plasma cells
-macrophages
can lead to necrosis/tissue damage and loss of function

Question 2

what is the end result of granulation tissue?

Answer 2

scarring and fibrosis - loss of normal tissue function

Question 3

can chronic inflammation arise from ongoing acute inflammation?

Answer 3

yes

Question 4

what is the clinical presentation of chronic inflammation?

Answer 4

pain often not specific
malaise and weight loss (TB)
loss of function (crohns disease, leprosy)

Question 5

why would chronic inflammation arise from acute inflammation?

Answer 5

large volume of damage
inability to remove debris
acute inflammation fails to resolve and progresses

Question 6

can chronic inflammation arise as a primary lesion only?

Answer 6

yes

Question 7

what is organisation?

Answer 7

an outcome of acute inflammation that results in healing and repair via granulation tissue, leads to fibrosis and scar formation

Question 8

what is the mechanism and function of granulation tissue?

Answer 8

ingrowth of capillaries into the inflammatory mass
allows access of plasma proteins
macrophages from blood and tissue
fibroblasts lay down collagen to repair damaged tissues
collagen replaces inflammatory exudate

this patches tissue defects and replaces dead or necrotic tissue

Question 9

what are some products of granulation tissue?

Answer 9

fibrous tissue -scar

Question 10

why can fibrosis cause a problem?

Answer 10

it can cause loss of function in organs

can progress to chronic inflammation

Question 11

what is autoimmune disease?

Answer 11

autoantibodies directed against self cells and self tissue components - autoantigens

Question 12

what are some effects of autoimmune disease?

Answer 12

damage or destroy organs, tissues, cells, cell components

Question 13

what are some other causes of primary chronic inflammation?

Answer 13

material resistant to digestion
exogenous substances (sutures, metal etc, NO IMMUNE RESPONSE)
endogenous substances (necrotic tissues, keratin)
granulomatous inflammation (common)

Question 14

what is the main role of the lymphocyte?

Answer 14

immune response and immune memory

Question 15

what is the main role of the plasma cell?

Answer 15

antibody production
facilitation of immune response
immune memory
they act with macrophages (presents antigen to immune system)

Question 16

what are some functions of T cells?

Answer 16

production of cytokines
production of interferons
damage and kill (lyse) other cells and destroy antigens

Question 17

what do cytokines do?

Answer 17

attract and hold macrophages
activate macrophages
permeability

Question 18

what is the function of NK cells?

Answer 18

destroy antigens and cells via granule proteins

Question 19

what are the functions of macrophages?

Answer 19

remove debris
antigen presenting cells in the immune system
produced in the bone marrow and present in blood and tissues

Question 20

what are some different types of macrophage?

Answer 20

monocyte
histiocyte
activated macrophage
epitheloid cell
giant cell

Question 21

what are some characteristics of macrophages?

Answer 21

motile phagocyte
long lived
take over from neutrophils
contain enzyme
produce interferons and other chemicals
can influence the progression of chronic inflammation

Question 22

what are some characteristics of fibroblasts?

Answer 22

motile
metabolically active
make and assemble structural proteins such as collagen

Question 23

what are the outcomes of chronic inflammation?

Answer 23

ongoing tissue damage and destruction
insidious loss of function
cellular and stromal response (granulation tissue and angiogenesis)
scarring and fibrosis
granuloma formation

Question 24

what is granulomatous inflammation?

Answer 24

characterised by presence of granulomas in tissues and organs

Question 25

what stimulates granulomatous inflammation?

Answer 25

indigestible antigen

Question 26

what are granulomas?

Answer 26

aggregates of epitheloid macrophages in tissue
may contain giant cells
contain neutrophils and eosinophils

Question 27

what are granulomas a response to?

Answer 27

indigestible antigen

Question 28

how is a giant cell formed?

Answer 28

fusion of macrophages

comprised of epitheliod histiocytes (macrophages)

Question 29

when would you expect to see langhans type giant cells?

Answer 29

TB

Question 30

what are some different classifications of giant cells?

Answer 30

langhans
foreign body type
warthin-finkeldy type

Question 31

what are some examples of infectious granulomatous diseases?

Answer 31

TB
leprosy
syphilis

Question 32

what is caseous necrosis?

Answer 32

dead tissue surrounded by macrophages, giant cells, lymphocytes

Question 33

what are some examples of non infective granulomas?

Answer 33

rheumatoid disease
sarcoidosis
crohns disease

Question 34

what are the phases of clinical wound healing?

Answer 34

phase of acute inflammation
granulation tissue formation
local angiogenesis
fibrosis and scar formation

Question 35

how much granulation tissue would you expect to see in a wound that has been healed by primary intention?

Answer 35

small amount

Question 36

what is healing by secondary intention?

Answer 36

method used for larger defects
lots of granulation tissue ingrowth
contraction and scarring

Question 37

what is the sequence of healing by secondary intention?

Answer 37

injury, clot, acute inflammation, fibrin
granulation tissue ingrowth - angiogenesis
phagocytosis of fibrin
myofibroblasts move in and lay down collagen
contraction of scar
re-epithelialisation

Question 38

what are factors that favour wound healing?

Answer 38

cleanliness
apposition of edges (no haematoma)
good nutrition
stable, normal metabolism
normal inflammatory and coagulation mechanisms

Question 39

what are factors that impair wound healing?

Answer 39

dirty, gaping wound, large haematoma
poor nutrition
abnormal metabolism, corticosteroid therapy
inhibition of angiogenesis

Question 40

what does granulation tissue in fracture healing contain along with fibroblasts?

Answer 40

osteoblasts

Question 41

how is a callus formed?

Answer 41

osteoblasts lay down woven bone
nodules of cartilage present
bone remodelling follows

Question 42

what are the steps in bone remodelling?

Answer 42

osteoclasts remove dead bone
progressive replacement of woven bone by lamellar bone
reformation of cortical and trabecular bone

Question 43

what is angiogenesis?

Answer 43

formation of new vessels

Question 44

what are the steps in angiogenesis?

Answer 44

capillary buds form
vascular endothelial growth factor released by hypoxic cells stimulates proliferation
enzyme secretion aids process

Question 45

what does angiogenesis enable the blood supply to do in relation to damaged tissue?

Answer 45

allows the blood supply to enter it

Question 46

how does angiogenesis present in the case of thrombosis?

Answer 46

limits thrombus propagation and re-instates flow.