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chronic inflammation Flashcards

1
Q

what is chronic inflammation?

A

prolonged inflammation with associated repair

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2
Q

what are the basic principles of chronic inflammation?

A
  1. delayed onset
  2. variable duration
  3. variable appearances
  4. limits damage, inititates repair
  5. can cause deibilitating symptoms
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3
Q

how does chronic inflammation arise?

A
  1. takes over from acute inflammation
  2. can occur alongside acute inflammation
  3. can arise without any preceeding acute inflammation
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4
Q

what does chronic inflammation look like?

A

variable appearances
variety of cell types

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5
Q

what are the different cells involved in chronic inflammation?

A
  1. macrophages
  2. Lymphocytes
  3. Plasma cells
  4. Eosinophils
  5. Myo/fibroblasts
  6. Giant cells
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6
Q

what are the basic principles of macrophages?

A
  • in blood = monocytes
  • in tissue = macrophage or histiocyte
  • large cells because of abundant foamy cytoplasm
  • slipper shaped nucleus
  • carry out phagocytosis + then antigen presentation
  • control and regulate release of inflammatory mediators
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7
Q

why do macrophages stain difficultly on H+E staining?

A

vary drastically on appearance based on what they are phagotycosing

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8
Q

what are the basic features of lymphocytes?

A
  • smaller cells (similar in size to RBC)
  • contain a large circular nucleus (little cytoplasm)
  • 2 types:
    1. T cells: variety of types, assist other inflammatory cells and destroy pathogens
    2. B cells: mature into plasma cells, produce antibodies, neutralises pathogens
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9
Q

what are the basic features of plasma cells?

A
  • fully differentiated B cell
  • nucleus is pushed to periphary
  • chromatin clumps in plasma cells + appears like a clock face
  • peri-nuclear clearing = slightly paler region of cytoplasm near nucleus
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10
Q

what are the basic features of the eosinophil?

A
  • bilobed nucleus
  • cytoplasm stains bright red + is granular
  • release lots of mediators
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11
Q

what are the basic features of fibroblasts/myofibrolasts?

A

regeneration + repair
lay down fibrin

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12
Q

what are the basic features of giant cells?

A
  • multinucleate cells
  • fusion of multiple macrophages in “frustrated phagocytosis”
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13
Q

what are the 3 types of giant cells?

A

foreign body giant cells:
* nuclei arranged randomly

langhans giant cell:
* partial or complete circle of nucleus on rim of cell
* can be seen in tuberculosis

touton giant cell:
* ring of nuclei right in middle of cell sorrounded by cytoplasm
* can be seen in fat necrosis

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14
Q

what are the effects of chronic inflammation?

A
  1. fibrosis - deposition of collagen
  2. impaired function - specialised cells replaced by collagen
  3. atrophy - decrease in size
  4. ongoing stimulaton of immune response - antigen presentation by macrophages
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15
Q

what are the impacts of fibrosis in the gall bladder?

A
  • repeated obstruction of bile duct by gall stones
  • repeated bouts of acute inflammation results in chronic inflammation
  • fibrosis of gall bladder wall (thickened and no longer pink)
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16
Q

what is the impact of impaired function in idiopathic inflammatory bowel disease?

A

2 main types of idiopathic inflammatory bowel disease:
1. chrons disease
2. ulcerative disease

inflammed bowel will have impaired function so patients present with:
* abdominal pain
* altered bowel function
* weight loss

17
Q

what are the differences between chrons disease + ulcerative colitis?

A

Chrons disease:
* can affect all GI tract
* discontinuous patches of inflammation
* inflammation affects full thickness of bowel wall - transmural
* can sometimes find granulomata
* less likely to have rectal bleeding

Ulcerative colitis:
* affects large bowel only
* continous inflammation
* inflammation affects superficial bowel wall only
* no granulomata
* more likely to have rectal bleeding

18
Q
  1. what is cirrhosis?
  2. what is cirrhosis of the liver caused by?
A
  1. damage to tissue (seen in end stage damage to the liver) with fibrosis and attempted regeneration
  2. alcohol, hepatitis, drugs and toxins, fatty liver disease
19
Q

what is granulomatous inflammation?

A

chronic inflammation with presence of one or more granulomata

20
Q

what is a granulomata?

A

a collection of:
* epitheliod histiocytes (macrophages which look like epithelial cells)
* presence of giant cells
* may be sorrounded by lymphocytes

21
Q

what are the 2 types of granulomatas?

A

foreign body:
* destruction and removal of foreign material
* few lymphocytes.

immune mediated:
* destruction + removal of pathogens (arises due to infection)
* can be idiopathic (disease of unknown cause)
* can undergo central (caseous) necrosis
* lots of lymphocytes

22
Q

what infections are common causes of immune mediated granulomatas?

A

myobacterium tuberculosis
myobacterium leprae

23
Q

why do granulomatas arise in response to mycobacterium?

A

mycobacterium are difficult to destroy since:
* they have a thick cell wall
* mycolic acids

PP (16 decks)

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