Chronic Inflammation 2

Question 1

What is granulomatous inflammation characterised by?

Answer 1

presence of granulomas in tissues and organs

Question 2

What is granulomatous inflammation stimulated by?

Answer 2

indigestible antigen that the body can’t get rid of

Question 3

Why are granulomatous inflammatory diseases important on a global scale?

Answer 3

granulomatous inflammatory diseases are infectious and idiopathic

Question 4

What are granulomas?

Answer 4

aggregates of epithelioid macrophages
may contain giant cells, neutrophils, eosinophils
may surround dead material and be surrounded by lymphocytes

Question 5

When are granulomas made?

Answer 5

in response to indigestible antigen

many due to type IV hypersensitivity reactions

Question 6

What are epithelioid macrophages?

Answer 6

macrophages that look like epithelial cells

Question 7

What are giant cells?

Answer 7

comprised of epithelioid histioytes (macrophages)
? fusion of macrophages to form larger cells
have large cytoplasm; multiple nuclei

Question 8

What are Langerhans type giant cells?

Answer 8

classically found in TB
peripheral rim of nuclei
large eosinophilic cytoplasm

Question 9

What are foreign body type giant cells?

Answer 9

often associated w/ pyogenic granulation tissue (acutely inflamed, neutrophils, pus, organisation, giant cells), e.g. pilonidal abscess

Question 10

How would you get a silicone associated giant cell?

Answer 10

ruptured silicone implants
usually but not always breast, vacuoles contain leaked silicone
classically small bubbles in giant cells

Question 11

When would you find a Warthog-Finkeldy type giant cell? and what does it look like?

Answer 11

In appendices of children w/ measles

Has central cluster of nuclei, cytoplasm on outside

Question 12

Give examples of granulomatous diseases.

Answer 12

mycobacterium tuberculosis - tuberculosis
mycobacterium leprae - leprosy
treponema pallidium - syphilis

Question 13

Describe granulomas found in lung of TB patients.

Answer 13

most primary infections of TB occur in the lung

lumps of white material are granulomas

Question 14

What is caseous necrosis?

Answer 14

dead tissue surrounded by macrophages, giant cells, lymphocytes

Question 15

In what disease is TB a common secondary infection?

Answer 15

HIV

Question 16

Give examples of non-infectious granulomas.

Answer 16

Rheumatoid disease - tissue specific autoimmune disease
sarcoidosis
Crohn’s disease - chronic inflammatory bowel disease

Question 17

What is a rheumatoid nodule formed of?

Answer 17

Degenerate collagenous material in the middle, macrophages at edge of area

Question 18

What does Crohn’s disease look like?

Answer 18

Ulceration of surface of bowel, cobble stoned appearance

Muscosa lost completely and patients bowel lining is swollen, sore and raw and bleeds heavily

Question 19

What are the four stages of wound healing?

Answer 19

phase of acute inflammation
granulation tissue formation
local angiogenesis - new vessels grow
fibrosis and scar formation

Question 20

What is healing by primary intention?

Answer 20

occurs when tissue surfaces have been closed, e.g. surgical wounds w/ stitches or skin glue
very little tissue loss, small amount of granulation tissue
creates small linear scar

Question 21

What is healing by secondary intention?

Answer 21

healing of larger wounds
involves loss of lots of tissue, lots of granulation tissue ingrowth
contraction and scarring

Question 22

Describe in detail the events that occur from injury to scar formation.

Answer 22

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

Question 23

What conditions favour wound healing?

Answer 23

Cleanliness - no debris, germs etc. 
apposition of edges (no haematoma)
sound nutrition 
metabolic stability and normality
normal inflammatory and coagulation mechanisms 
note local mediators

Question 24

What conditions would inhibit wound healing?

Answer 24

dirty, gaping wound, large haematoma
poorly nourished, lack of vitamins A and C
abnormal carb metabolism, diabetes, corticosteroid therapy
inhibition of angiogenesis

Question 25

Fracture healing follows same principles as healing at any site, how is the situation modified in bone?

Answer 25

have to repair bony structure as well as soft tissue

Question 26

Describe the sequence of events that occur in fracture healing.

Answer 26

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

Question 27

What is callus formation in bone?

Answer 27

the bony healing tissue which forms around the ends of broken bone

Question 28

How are calluses formed?

Answer 28

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 29

What is angiogenesis?

Answer 29

formation of new blood vessels from capillary buds

Question 30

What growth factor stimulates angiogenesis (proliferation of blood vessel cells)? and where is the growth factor released from?

Answer 30

Vascular Endothelial Growth Factor (VEGF)
released by hypoxic cells (oxygen deficient)
–> enables blood supply to enter damaged tissue

Question 31

What does angiogenesis and organisation in thrombosis limit and allow?

Answer 31

limits thrombus propagation

reinstates flow

Question 32

What does angiogenesis in malignant tumours allow?

Answer 32

Angiogenesis occurs as tumour grows

–> potential for therapeutic control

Question 33

Fibrosis and scarring in atherosclerosis

Answer 33

(similarities with chronic inflammation)