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Foundations of Medicine > Chronic Inflammation > Flashcards

Chronic Inflammation Flashcards

1
Q

Define chronic inflammaiton

A

Inflammation in which cell population is especially

Lymphocytes
Plasma cells
Macrophages

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2
Q

What are the features of chronic inflmmation?

A

Tissue or organ damage, necrosis, loss of function

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3
Q

What are the features of healling and repair in chronic inflammation?

A

Granulation tissue, scarring and fibrosis

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4
Q

What is granulation tissue?

A

Vascularized tissue that forms as chronic inflammation evolves.

Characterized by presence and proliferation of fibroblasts, keratinocytes, endothelial cells, new thin-walled capillaries, and inflammatory cell infiltration of the extracellular matrix.

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5
Q

What can cause chronic inflammation?

A

May follow from acute inflammation
Arises as primary pathology

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6
Q

What are the clinical findings in chronic inflammation?

A

No specific sore area
Malaise and weight loss
Loss of function

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7
Q

What is an example of loss of function due to chronic inflammation?

A

Crohn’s disease (GI tract ulceration and fibrosis) – pain, diarrhoea, gut obstruction

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8
Q

What is characteristic of organisation in acute inflammation?

A

Granulation tissue - healing and repair, leads to fibrosis and formation of a scar

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9
Q

What is the granulation tissue mechanism?

A

Capillaries grow into an inflammatory mass

Access of plasma proteins

Macrophages from blood and tissue

Fibroblasts lay down collagen to repair damaged tissue

Collagen replaces inflammatory exudate

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10
Q

What is the function of granulation?

A

Patches tissue defects
Replaces dead or necrotic tissue
Contracts and pulls together

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11
Q

What are the products of granulation tissue?

A

Fibrous tissue - scar
Can progress to chronic inflammation

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12
Q

What is the most likely cause of primary chronic inflammation?

A

Autoimmune disease

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13
Q

How does Autoimmune disease result in chronic inflammation?

A

Autoantibodies directed against own cell and tissue components - autoantigens

They damage or destroy organs, tissues, cells, cel components

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14
Q

What types of cells does primary chronic inflammation use?

A

Lymphocytes, plasma cells, macrophages, fibrosis

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15
Q

What are the other common methods of triggering a chronic inflammatory response?

A

Material resistant to digestion : mycobacteria, Brucella, viruses, this is because their cell wall is resistant to enzymes

Exogenous substances:
sutures, metal and plastic eg joint replacements, mineral crystals, glass

Endogenous substances: Necrotic tissue, keratin, hair, none of which can easily be phagocytosed

Granulomatous inflammation is common

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16
Q

What are lymphocytes responsible for?

A

B cells and T cells

Immune response
Immune memory

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17
Q

What is a plasma cell?

A

Differentiated B cells, differentiated to produce antibodies

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18
Q

What do NK cells do?

A

Destroy antigens and cells, granule proteins like T cells

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19
Q

Which is longer lived, macrophages or neutrophils?

A

Macrophages, they take over from neutrophils

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20
Q

What might macrophages produce?

A

Interferons and other chemicals, used to destroy

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21
Q

What are fibroblasts?

A

Motile cells which are metabollically active, they make and assemble structural proteins, including collagens

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22
Q

Where do fibroblasts originate from?

A

From the embryonic mesoderm tissue, and they are not terminally differentiated.

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23
Q

What is the outcome of chronic inflammation?

A

Ongoing tissue damage and destruction,

insidious loss of function

Granulation tissue, angiogenesis

Scarring and fibrosis

Granuloma formation

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24
Q

What is angiogenesis?

A

Angiogenesis is the formation of new blood vessels.

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25
Q

How does angiogenesis play a role in granulation tissue?

A

New vessels form- capillary buds

Vascular Endothelial Growth Factor (VEGF) released by hypoxic cells stimulates proliferation

Enzyme secretion aids process

Enable blood supply to enter damaged tissue

26
Q

Discuss angiogenesis and organisation in thrombosis

A

Limits thrombus propagation
Reinstatement of flow

27
Q

Discuss angiogenesis in malignant tumours

A

Angiogenesis occurs as tumour grows
Potential for therapeutic control

28
Q

What is granulomatous inflammation always characterised by?

A

Granulomas (granulomata) in tissues and organs

29
Q

How is Granulomatous inflammation stimulated?

A

Stimulated by indigestible antigen, body cannot get rid of it

30
Q

What are idiopathic diseases?

A

Diseases which we don’t know why they happened.

31
Q

How are granulomas formed?

A

Aggregates of epithelioid macrophages in tissue

32
Q

What is epitheliod?

A

Looks like epithelial

33
Q

What might granulomas surround?

A

Giant cells, dead material

34
Q

What might granulomas be surrounded by?

A

Lymphocytes

35
Q

What do granulomas contain?

A

Neutrophils, eosinophils

36
Q

Granulomas are formed as a result of?

A

Response to indigestible antigen

Many are type 4 hypersensitivity reactions

37
Q

What do giant cells consist of?

A

A giant cell is a mass formed by the union of several distinct cells (usually macrophages)

38
Q

Describe the structure of a giant cell

A

Large cytoplasm; multiple nuclei
- several types

39
Q

Are there always granuloma for giant cells to be present?

A

No

40
Q

Name a type of giant cell

A

Langhans type

41
Q

What is a Langhans type giant cell classically found in?

A

TB

42
Q

Describe the structure of Langhans type

A

Peripheral rim of nuclei
Large eosinophilic cytoplasm

43
Q

What is the giant cell often associated with pyogenic granulation tissue?

A

Foreign body type

Acutely inflamed neutrophils, pus
organisation
giant cells

44
Q

What type of giant cell might you see with a ruptured silicone implant? e.g breast implant

A

Silicone associated giant cells

Vacuoles contain leaked silicone

45
Q

Name some Infectious granulomatous diseases

A

Tuberculosis (Mycobacterium tuberculosis),

Leprosy Mycobacterium leprae

Syphilis

46
Q

Describe Caseous necrosis

A

Cell death in which the tissue maintains a cheese-like appearance. Dead tissue appears as a soft and white proteinaceous dead cell mass.

Dead tissue surrounded by macrophages, giant cells, lymphocytes

47
Q

Give examples of Non-infective granulomas

A

Rheumatoid disease - tissue specific auto-immune disease

Sarcoidosis - Development of granulomas within organs of the body

Crohn’s disease – chronic inflammatory bowel disease

48
Q

What are the common processes in chronic inflammation?

A

Acute inflammation
Granulation tissue formation
Local angiogenesis - new vessels grow
Fibrosis and scar formation

49
Q

What is surgical wound healing?

A

Healing by primary intention

50
Q

What are the goals of surgical wound healing?

A

Minimal gap, small amount of granulation tissue, small linear scar

51
Q

What is healing of larger defects?

A

Healing by secondary intention

52
Q

Describe the granulation tissue ingrowth in larger defects

A

Lots of it

Contraction and scarring

53
Q

What is the sequence of events in wound healing?

A
  • injury, blood clot, acute inflammation, fibrin
  • many growth factors and cytokines involved

-granulation tissue growth - angiogenesis

  • phagocytosis of fibrin
  • myofibroblasts move in and lay down collagen
  • contraction of scar
  • re-epithelialisation
54
Q

What conditions favour wound healing?

A

Cleanliness

Apposition of edges (no haematoma)

Sound nutrition

Metabolic stability and normality

Normal inflammatory and coagulation mechanisms

Note local mediators

55
Q

What conditions result in impaired wound healing?

A

Dirty, gaping wound, large haematoma

Poorly nourished, lack of vitamins C, A

Abnormal CHO metabolism, diabetes, corticosteroid therapy

Inhibition of angiogenesis

56
Q

What is the sequence of events in fracture healing?

A

Trauma, fracture, haematoma

Bits of dead bone and soft tissue

Acute inflammation, organisation, granulation tissue, macrophages remove debris

Granulation tissue contains osteoblasts as well as fibroblasts

57
Q

What are the stages of callus formation?

A

Osteoblasts lay down woven bone

Nodules of cartilage present

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

58
Q

What stimulates proliferation of vessels?

A

Vascular endothelial growth factor, released by hypoxic cells, stimulates proliferation

59
Q

What aids the process of angiogenesis?

A

Enzyme secretion

60
Q

What is the benefit of angiogenesis?

A

Allows blood supply to enter damaged tissue

Foundations of Medicine (56 decks)

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