Chronic Inflammation 2

Question 1

What is granulomatous inflammation always characterised by?

Answer 1

Granuloma’s (granulomata) in tissues and organs

Question 2

How is Granulomatous inflammation stimulated?

Answer 2

Indigestible antigen, body cannot get rid of it

Question 3

How are granulomas formed?

Answer 3

aggregates of epithelioid macrophages in tissue

(Aggregates = collection of particles or cells)

Question 4

What is epitheliod?

Answer 4

Looks like epithelial, refers to epithelial cells

Question 5

What might granulomas surround?

Answer 5

Giant cells, dead material

Question 6

What might granulomas be surrounded by?

Answer 6

lymphocytes

Question 7

What do granulomas contain?

Answer 7

neutrophils, eosinophils

Question 8

Granulomas are formed as a result of?

Answer 8

Response to indigestible antigen
Many are type 4 hypersensitivity reactions

Question 9

What do giant cells consist of?

Answer 9

Mass formed by union of distinct cells (usually macrophages)

Question 10

Describe the structure of a giant cell?

Answer 10

large cytoplasm; multiple nuclei
- several types

Question 11

Why is the giant cell often associated with pyogenic granulation tissue

Answer 11

Foreign body type

acutely inflamed
neutrophils, pus
organisation

Question 12

Name some Infectious granulomatous diseases

Answer 12

Tuberculosis (Mycobacterium tuberculosis)
Leprosy (Mycobacterium leprae)
Syphilis

Question 13

Give examples of Non-infective granulomas

Answer 13

Rheumatoid disease - tissue specific auto-immune disease
Sarcoidosis
Crohn’s disease – chronic inflammatory bowel disease

Question 14

What is Sarcoidosis?

Answer 14

Granuloma formation in organs of body

Question 15

What are the common processes in chronic inflammation?

Answer 15

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

Question 16

What is surgical wound healing?

Answer 16

Healing by primary intention

Question 17

What are the goals of surgical wound healing?

Answer 17

Minimal gap
Small amount of granulation tissue
Small linear scar

Question 18

What is healing of larger defects?

Answer 18

Healing by secondary intention

Question 19

Describe the granulation tissue growth in larger defects

Answer 19

Lots of growth

Contraction and scarring

Question 20

What is the sequence of events in wound healing?

Answer 20

• injury, blood clot, acute inflammation, fibrin
• many growth factors/cytokines involved
• granulation tissue growth
• angiogenesis
• phagocytosis of fibrin
• myofibroblasts lay down collagen
• contraction of scar
• re-epithelialisation

Question 21

What conditions favour wound healing?

Answer 21

-Cleanliness
-Apposition of edges
-no haematoma (bleeding outside vessels)
-Sound nutrition
-Metabolic stability and normality
-Normal inflammatory and coagulation mechanisms
-Local mediators

Question 22

What conditions result in impaired wound healing?

Answer 22

-Dirty, gaping wound, large haematoma
-Poorly nourished, lack of vitamins C, A
-Abnormal CHO(carbs) metabolism, diabetes, corticosteroid therapy
-Inhibition of angiogenesis

Question 23

What is the sequence of events in fracture healing?

Answer 23

-Trauma, fracture, haematoma
-Dead bone and soft tissue
-Acute inflammation, organisation, granulation tissue, macrophages remove debris
-Granulation tissue contains osteoblasts and fibroblasts

Question 24

What are the stages of callus formation?

Answer 24

-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

Question 25

What stimulates proliferation of vessels?

Answer 25

VEGF, released by hypoxic cells, stimulates proliferation

(VEGF = Vascular endothelial growth factor)

Question 26

What aids the process of angiogenesis?

Answer 26

Enzyme secretion

Question 27

What is the benefit of angiogenesis?

Answer 27

Allows blood supply to enter damaged tissue

Question 28

What is the effect of angiogenesis on thrombus

Answer 28

Grows vessels through thrombus, limits its propagation

Question 29

What is the effect of angiogenesis in malignant tumours

Answer 29

allows tumour growth
potential for therapeutic control