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General Pathology VDMP832 > Chronic Inflammation > Flashcards

Chronic Inflammation Flashcards

1
Q

Acute Inflammation:
General Features

A
  • Short Time Frame:
    • inflammatory stimulus is quickly resolved
  • Cardinal Signs are prominent
    • redness
    • swelling
    • heat
    • pain
  • neutrophils and fibrin predominate
  • Outcome:
    • resolution with return to normal
    • Resolution with tissue fibrosis
    • Progression to chronic inflammation
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2
Q

Chronic Inflammation:

General Features

A
  • Long time Frame:
    • inflammatory stimulus is unresolved and persists
  • Cardinal signs are not prominent
  • Macrophages and lymphocytes predominates
  • Cell-mediated immunity is an important component
  • Outcome:
    • Ongoing without pregression/containment
    • Ongoing with progression/containment
    • Resolution with tissue damage and fibrosis
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3
Q

Chronic Inflammation:
Development

A
  • Major feature is persistence of the agent/material taht incited inflammation
    • highly resistant agent/material
      • mycobacteria, systemic fungi, foreign bodies, evasive agents
    • Low resistance of the host
      • inherited or acquired immunodeficiency, defects in the inflammatory response
  • The acute response is unable to resolve the inflammatory stimulus
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4
Q

Features of Chronic Inflammation:

Vascular Events

A
  • Mediators of acute vascular changes are degraded
  • Emigration shifts to monocytes and lymphocytes
    • neutrophils are short-lived and migrate for a short period of time
    • Neutrophils are chemotactic for monocytes
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5
Q

Features of Chronic Inflammation:

Cells

A
  • Monocytes/macrophages
    • activated macrophages have various morphologic and functional features
    • These can proliferate locally
  • Lymphocytes
    • many subsets are involved
      • T-cells, B-cells, Plasma cells
      • Lymphokines help determine features fo the response
  • NK cells
  • Fibroblasts
    • proliferate in response to injury to produce collagen
  • Endothelium
    • Meovascularization as part of the repair process
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6
Q

Features of Chronic Inflammation:

Cells derived from macrophages

A
  • Epithelioid macrophages
    • activated macrophages taht are larger, have abundant cytoplasm and a prominent secretory role
  • Giant cells
    • multinucleated cells formed from the fusion of macrophages or epithelioid cells
    • These have secretory and pagocytic properties
    • Two morphologic types are described
      • Foreign body giant cells
      • Langhans giant cells
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7
Q

Features of Chronic Inflammation:

Mediators

A
  • The cytokine microenvironment is more complex than for acute inflammation
    • lymphokines
      • these drive Th1 or Th2 responses and mediate macrophage functions
    • Monokines
      • These are directed towards removal of the inciting stimulus as well as healing/resolution responses
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8
Q

Resolution of Inflammation:

The Ideal

A
  • The inciting stimulus is removed
  • Pro-inflammatory mediators are removed and production stops
  • Vessels return to normal and leukocyte emigration stops
  • Inflammatory debris/exudate is removed
  • Normal cells repopulate the area
  • Tissue returns to normal
    • the tissue looks and functions the same as before the inflammation event
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9
Q

Resolution of Inflammation:

Not so Idea

A
  • The inciting stimulus is NOT removed
    • chronic inflammation
  • Tissue does NOT return to normal
    • Irreversible loss of structure and function
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10
Q

Healing and Repair

A

Healing is initiated at the time of injury and is promoted by factors produced during inflammation

Healing is the endpoint of injury and inflammation

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11
Q

Mechanisms of Healing:

Regeneration

A

This is the ideal situation where the tissue returns to it’s pre-injury structure and function

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12
Q

Mechanisms of Healing:

Replacement

A

This occurs when tissue is irreversibly damaged and replaced by fibrous connective tissue

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13
Q

Criteria for Regeneration to Occur

A
  • Stromal Integrity
    • basement membranes of epithelial surfaces and the exrtracellular matrix architecture of the tissue or organ must be intact
  • Regenerative capacity of the injured cells
    • injured cells must be capable of regeneration
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14
Q

Regeneration can occur with

A
  • Labile cells
    • bone marrow cells and most mucosal surfaces
  • Stable cells
    • parencymal cells such as hepatocytes and renal epithelium
    • mesenchymal cells such as fibroblasts and endothelium
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15
Q

Regeneration can NOT occur with:

A

Permanent cells:

Neurons and cardiac myocytes

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16
Q

Healing and Repari:

Replacement

A
  • Damage which disrupts the stromal framework or involves permanent cells results in replacement with collagen
  • Granulation tissue is the mechanism used to replace irreversibly damaged tissue
17
Q

Healing and Repair:

Replacement:

Granulation Tissue

A
  • Transient fibrovascular tissue that grows into a site of irreversible damage
  • It’s purpose is to fill the damaged area to enhance wound contraction and to replace the area with collagen
18
Q

Granulation Tissue

A
  • Progresses through three main stages:
    • Inflammatory stage
      • Helaing is initiated and debris is cleared from the area
    • Proliferative stage
      • Endothelium and fibroblasts proliferate
    • Remodeling stage
      • Macrophages leave and the wound contracts
      • Blood vessels and fibroblasts regress
19
Q

Granulation Tissue:

Morphological Zones

A
  • Zone of necrotic debris and inflammation
  • Zone of capillary sprouts and arches
  • Zone of capillary and fibroblast proliferation
  • Zone of mature connective tissue
20
Q

Granulation Tissue:

Cell Functions:

Macrophages

A
  • Removal of inflammatory debris
  • Production of a variety of monokines involved in healing
    • platelet derived growth factor
    • Fibroblast growth factor
    • Transforming growth factor-beta
21
Q

Granulation Tissue:

Cell Functions:

Endothelium

A
  • New vessels grow into the area in response to angiogenic factors
    • VEGF, TGF-b, angiopoetin
  • Vessels provide nutrients to the healing area
  • Vessels are highly permeable, and leak plasma and fluids into the area to support healing
22
Q

Granulation Tissue:

Cell Functions

Fibroblasts

A
  • Production of collagen to fill in the damaged area
    • collagen production is induced by TGF-b, FGF, epidermal growth factor
  • Wound contraction
    • myofibroblasts are specialized fibroblasts that are induced by TGF-b
    • They contract to diminsh the size of the wound
23
Q

Healing and Repair:

Wound Healing

A
  • Wound healing occurs within two categories based on the extensiveness of the damage:
    • First intention healing
    • Second intention healing
24
Q

Wound Healing:

First Intention

A
  • This is the best represented by incisional skin wounds
  • The defect is small and healing occurs rapidly
  • The resulting scar is usually mininal
25
Q

Wound Healing:

Second Intention

A
  • This is best represented by excisional skin wounds
  • The defect is large and healing can take a considerable period of time
  • The resulting scar can be extensive
  • Specialized tissues within the damaged area may be lost
26
Q

Healing and Repair:

Factors affecting healing

A
  • Nutritional status
  • Age
  • Presence of concurrent/systemic disease
  • Persistence of the damaging stimulus
  • Size and location of the damage

General Pathology VDMP832 (26 decks)

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