Chronic Inflammation Flashcards by Arun Pathal

What are the 4 main cell types in chronic inflammation?

Lymphocytes
macrophages
Plasma cells (differentiated B cells)
Fibroblasts

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When does chronic inflammation arise from acute inflammation?

When theres:
- A larg evolume of damage
- Debris that cant be removed
- When it fails to resolve (e.g. repeated infection)

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When does chronic inflammation arise as a primary legion?

As a result of:
- An Autoimmune Disorder
- A material resistant to digestion
- An exogenous substance
- An endoenus substance where it shouldnt be

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Examples of exogeneous substances that cause chronic inflammation?

Glass
Sutures
Plastic/metal joint replacements

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Examples of endogenous substances that cause chronic inflammatoin?

Hair
Keratin
Necrotic Tissue

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What are the clinical presentations of chronic inflammation?

Malaise
Weight loss
Loss of function e.g. hypothyroidism in autoimmune thyroiditis

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How does granulation occur

Angiogenesis occurs so capillaries grow into inflammatory mass
New capilalries give acces for plasma proteins
Macrophages form blood/tissue arrive and clear debris
Granulation tissue made from plasma proteins, macrophages & capillaries fills wound

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How does fibrosis occur?

Fibroblasts replace inflammatory exudate with collagen
Collagen cross links & contracts or greater strength
Scar forms

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Examples of organisms resisitant to destruction that cause chronic inflammation?

Mycobacteria
Brucella
Viruses

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Why do endogenous substances int he wrong place cause CI?

They cant be easily phagocytosed

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Function of B cells in chronic inflammation?

They form plasma cells which produce antibodies &
present antigens,. The also form memory B cells

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Function of T cells in chronic inflammation?

Produce cytokine that attract leukocytes & increase vascular permeability
Produce Interferons which are antiviral and attract immune cells
Lysis of pathogenic cells

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Function of macrophages in CI:

Remove debris
Epithelioid macrophages form granulomas
Antigen presenting

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Fibroblasts in CI:

Assemble structures most notably collagen for scarring & wound repair

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What is granulomatous inflammation?

Chronic inflammation involving a granuloma.
Occurs in many serious infections & idiopathic diseases

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Why does a granuloma form?

To block off an indigestible piece of material that cant be removed from the body

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What is a granuloma?

An agregate of epithelioid macrophages in tissue.
Also contains neutrphils, eosinophils & lymphocytes

What unusual cell type may be found in a granuloma?

Giant Cells

What type of hypersensitiivity reaction canc ause granulomas?

Type 4 hypersensitivity

What is Giant cell?

An immune cell with a large cytoplasm & multiple nuclei.
There are many types

Define Langhans type giant cell

Often found in TB
Peripheral rim of nuclei
Large eosinophilic cytoplasm.

What are the 4 phases of wound healing?

Acute inflammation
Grandulation tissue formation
Local angiogenesis
Fibrosis & scar formation

What is fibrin and how is it involved in cloting?

Fibrin is a derivative of Fibrinogen
It forms the edge of a blood clot

What is the sequence of events in wound healing?

Acute inflammation & clotting
granulation tissue grows along with angiogenesis
Fibrin is phagocytosed
Fibroblasts lay down collagen
Contraction of collagen
re-epithelialisation

What is another name for surgial wound healing?

Healing by primary intention

How does surgical wound healin occur?

Sututes are used to give a minimal gap (apposition of edges) - small amount of granulation tissue forms - small linear scar forms

What is another name for healing a larger defect?

Healing by secondary intention

Whats different about healing by secondary intention?

the gap of the wound is large So lots of granulation tissue grows in The tissue contracts and a large messy scar forms

List the 6 factors favouring healing?

- Cleanliness - Apposition of edges - Good nutrition Metabolic normality/stability - Normal inflammatory & coagulatory mechanisms - Normal local mediators

List the 5 factors that impair wound healing:

- Dirty, large wounds - Large Haematomas (clots) - Poor nutrition (mainly low Vitamin C & A) - Abnormal metabolism - Inhibition of angiogenesis

Example of abnormal metabolism that effects healing?

- Abnormal CHO metabolism - Cortiocosteroid therapy - Diabetes

How is angiogenesis stimulated?

Hypoxic cells release VEGF VEGF stimulates formation of new capillary buds

What is VEGF?

Vascular Endothelial Growth Factor

What else aids aniogenesis?

Enzyme secretion from hypoxic cells

Why would you want to inhibit VEGF?

To block angiogeneis in tumours as a therapeutic control of tumour growth.

Sumarise the sequence of events in fracture healing?

- Trauma, fracture, haematoma - Acute inflammation - Organisation - Callus formation

Whats different about granulation tissue in fracture healing?

It contains both fibroblasts to lay down collagen and Osteoblasts to lay down and calcify Hydroxy Apatite crystals.

What are the steps of Callus formation?

- Osteoblasts lay down woven bone - Osteoclasts remove dead bone - Woven bone progressively replaced by lamellar bone - Cotrical/trabecular bone reformed.

How is angiogenesis involved with malignant tumour?

Angiogenesis occurs as the tumor grows. Potential for therapeutic control by inhibiting VEGF.

How is atherosclerosis similar to chronic inflammation?

They both involve fibrosis & scarring.

What is thrombosis?

Local clotting in the circulatory system

How are angiogenesis & organisation important in stoppin thrombosis?

They limit thrombus propagation & reinstate flow by breaking clots.