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Immunology > Chronic & Granulomatous inflammation > Flashcards

Chronic & Granulomatous inflammation Flashcards

1
Q

What are the causes of chronic inflammation?

A

Primary chronic inflammation

Transplant rejection

Progression from acute inflammation

Recurrent episodes of acute inflammation

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2
Q

What are the macroscopic appearances of chronic inflammation?

A

Chronic ulcer

Chronic abscess cavity

Thickening of the wall of a hollow viscus (ie stomach)

Granulomatous inflammation

Fibrosis

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3
Q

What is fibrosis?

A

Replacing of tissue with white or grey tissue not what should be there

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4
Q

What are the microscopic appearances of chronic inflammation?

A

Lots of lymphocytes, plasma cells & macrophages

Neutrophils are scarce

Macrophages may have formed multinucleate giant cells

Evidence of tissue destruction as well as tissue regeneration & repair

Tissue necrosis

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5
Q

What are macrophages?

A

Derived from blood monocytes that have migrated out of vessels and have started living in the tissues

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6
Q

What is a granuloma?

A

An aggregate of epithelioid histiocytes

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7
Q

List some granulomatous diseases.

A

Crohn’s disease
Leprosy
Tuberculosis

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8
Q

What are epithelioid histiocytes?

A

A cell that is part of the mononuclear phagocyte system

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9
Q

What do epithelioid histiocytes look like?

A

They have a vague histological resemblance to epithelial cells

Large vesicular nuclei

Plentiful eosinophilic cytoplasm

Elongated

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10
Q

What do epithelioid histiocytes do?

A

They have little phagocytic activity

Adapted to a secretory function

They make ACE (angiotensin converting enzyme)

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11
Q

What blood test can be used to look for systemic granulomatous disease?

A

ACE levels in the blood

since epithelioid histiocytes produce ACE

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12
Q

What are histiocytic giant cells?

A

Cells with many (over 100) nuclei

Formed when two or more macrophages attempt to simultaneously engulf the same particle and they fuse

They form when foreign particles are too large to be ingested by just one macrophage

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13
Q

What do histiocytic giant cells do?

A

We don’t know!

They have little phagocytic function

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14
Q

What can macrophages not digest?

A

Inert materials like silica, asbestos

Bacteria like M. tuberculosis & M. leprae

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15
Q

Why can macrophages not digest M. tuberculosis & M. leprae?

A

Because they have cell walls containing mycolic acids and waxes that resist enzymatic digestion

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16
Q

What’s the result when macrophages try and fail to digest M. tuberculosis bacteria?

A

The macrophages harbour the bacteria and form a granuloma

This is what causes the tubercles in tuberculosis

17
Q

What can happen to granulomas over time? Two things

A

Caseous necrosis can occur, this happens in TB

The epithelioid histiocytes can become histiocytic giant cells

18
Q

What are the 3 types of histiocytic giant cells?

A

Langhan’s giant cells

Foreign body giant cells

Touton giant cells

19
Q

Describe Langhan’s giant cells.

A

Horseshoe arrangement of peripheral nuclei at one pole or cell

20
Q

What diseases to Langhan’s giant cells appear in?

A

TB
Syphilis
Sarcoidosis
Deep fungal infections

21
Q

Describe Touton’s giant cells.

A

Central ring of nuclei, peripheral to which there is foamy cytoplasm containing lipid material

22
Q

When would you see Touton’s giant cells?

A

Fat necrosis

23
Q

Describe Foreign-body giant cells.

A

Nuclei are arranged in an overlapping manner

24
Q

When would you see Foreign-body giant cells?

A

When the tissue has been exposed to a foreign substance such as talc, sutures, medical devices, prostheses.

25
Q

Chronic inflammation has a role in carcinogenesis. Give examples of this!

A

Ulcerative Colitis: chronic inflammation of the colon which can lead to colon cancer

Asbestos: the inflammatory tissue response that occurs in the lungs when they are exposed to asbestos results in cancer developing

Atheroma: inflammation plays an important role in the generation of atheroma

26
Q

Describe the role of inflammation in the development of an atheroma.

A

Macrophages adhere to the endothelium

They migrate into the arterial intima

These and T cells express cell adhesion molecules which recruit other cells to the area

Macrophages process the lipids that accumulate in the atheromatous plaque

27
Q

Describe the role of inflammation in MS.

A

Plasma cells and T cells accumulate around blood vessels (perivascular cuffing)

This is seen in the areas where macrophages break down myelin

28
Q

What infection causes chronic inflammation from the start?

A

Infectious mononucleosis

29
Q

What type of inflammation occurs in Crohn’s disease?

A

Granulomatous

Immunology (16 decks)

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