Chronic Inflammation

Question 0

What are the functions of macrophages?

Answer 0

Phagocytosis and destruction of bacteria and debris
Processing and presenting antigens to the immune system
Synthesis of cytokines and complement proteins
Control and activation of cells by cytokine release

Question 1

Name the cells involved in chronic inflammation

Answer 1

Macrophages
Plasma cells
Eosinophils
Lymphocytes
Fibroblasts/Myofibroblasts
Giant cells

Question 2

What do lymphocytes look like?

Answer 2

Large nucleus with barely any cytoplasm

Question 3

Where are T lymphocytes produced and matured?

Answer 3

Produced in the bone marrow

Mature in the thymus

Question 4

Where are B lymphocytes produced and matured?

Answer 4

Produced and matured in the bone marrow

Question 5

What can B lymphocytes differentiate into?

Answer 5

Plasma cells or memory cells

Question 6

What can T lymphocytes differentiate into?

Answer 6

T helper (CD4)
T killer (CD8)
Natural killer cells

Question 7

Function of T lymphocytes?

Answer 7

Control
Cytotoxic functions
Can kill virally infected cells

Question 8

What do plasma cells look like?

Answer 8

Have a clock face nucleus
Pinkish-blue cytoplasm
Pale halo around the nucleus which is the Golgi apparatus

Question 9

What does the presence of plasma cells imply?

Answer 9

That the inflammation is chronic

Question 10

What do plasma cells do?

Answer 10

Produce antibodies

Question 11

In which situations are eosinophils found in?

Answer 11

Allergic reactions
Parasite infestations
Some tumours

Question 12

How do fibroblasts get there and what do they do?

Answer 12

Recruited by macrophages

Secrete collagen

Question 13

What are giant cells made up of?

Answer 13

Giant macrophages

Question 14

What is the function of giant cells?

Answer 14

Frustrated phagocytosis

Phagocytose what macrophages can’t by themselves

Question 15

What are the types of giant cells?

Answer 15

Langhans
Foreign body type
Touton

Question 16

Which type of giant cell is normally seen in TB?

Answer 16

Langhans

Question 17

Which type of giant cell is described as disorganised aggregates of multiple nuclei?

Answer 17

Foreign body type

Question 18

Which type of giant cell is described as organised nuclei with foamy cytoplasm?

Answer 18

Touton

Question 19

What type of giant cell forms in fat necrosis?

Answer 19

Touton

Question 20

What is chronic inflammation?

Answer 20

Chronic response to injury with associated fibrosis

Question 21

How does chronic inflammation arise?

Answer 21

Take over from acute inflammation if not resolved in a few days
De novo- when there has been no preceding chronic inflammation
Develop alongside acute inflammation in severe or repeated irritation

Question 22

What can cause de novo chronic inflammation?

Answer 22

Autoimmune diseases eg rheumatoid arthritis
Chronic infections eg viral hepatitis
Chronic low level irritation eg foreign body in tissue

Question 23

What are some possible complications of chronic inflammation?

Answer 23

Fibrosis
Impaired function and atrophy
Stimulation of immune response
Carcinoma

Question 24

What are gall stones caused by?

Answer 24

Repeated obstruction to the cystic duct causing acute inflammation which leads to chronic inflammtion

Question 25

What damage can gall stones cause?

Answer 25

Damage mucosa and damage gall bladder wall

Question 26

Cause of acute gastritis?

Answer 26

Alcohol and drugs

Question 27

Cause of chronic gastritis?

Answer 27

Helicobacter pylori

Question 28

Why does gastric ulceration occur?

Answer 28

Ulceration due to an imbalance of acid production and mucosal defence

Question 29

What can patients present with in IBS?

Answer 29

Diarrhoea, rectal bleeding and other symptoms

Question 30

What are strictures?

Answer 30

Narrowing

Question 31

What are fistulae?

Answer 31

Abnormal connections between two epithelium-lined organs

Question 32

What complication can IBS lead to?

Answer 32

Impaired function

Question 33

What complications can gall stones and gastric ulceration lead to?

Answer 33

Fibrosis

Question 34

What complication cam cirrhosis lead to?

Answer 34

Fibrosis and impaired function

Question 35

What complication can Grave's disease lead to?

Answer 35

Increased function

Question 36

Causes of cirrhosis?

Answer 36

``` Alcohol Hep A and B Immunological Fatty live disease Type 2 diabetes Drugs and toxins ```

Question 37

What happens in cirrhosis?

Answer 37

Nodules of regenerating hepatocytes appear in the liver as it tries to repair itself Surrounded by bands of collagen

Question 38

What happens in Grave's disease?

Answer 38

Auto-antibodies stimulate TSH receptors causing hyperthyroidism

Question 39

How is Grave's disease treated?

Answer 39

Carbimazole and sometimes surgery

Question 40

Pathology of atrophic gastritis?

Answer 40

Lymphocytes and plasma cells produce auto-antibodies which destroy parietal cells Leads to atrophy of gastric mucosa

Question 41

What can you see in atrophic gastritis?

Answer 41

Lots of lymphocytes and fibrous tissue

Question 42

Pathology of rheumatoid arthritis?

Answer 42

Local chronic inflammation leads to inflammation of synovial capsule ➡️ joint destruction

Question 43

What is a granuloma?

Answer 43

An accumulation of epithelioid histiocytes (macrophages) and lymphocytes

Question 44

What is granulomatous inflammation?

Answer 44

Inflammation with granulomas

Question 45

What is granulomatous inflammation caused by?

Answer 45

Persistent, low grade irritation such as - mildly irritant foreign material - unknown causes such as sarcoidosis and Crohn's disease

Question 46

What is sarcoidosis?

Answer 46

An autoimmune disease where there is granulomatous inflammation in tissues

Question 47

What can be seen in the middle of a granuloma?

Answer 47

Caseous necrosis

Question 48

Why are mycobacterium tuberculosis difficult for the body to remove?

Answer 48

Their cell wall contains lipids and they can survive in the cytoplasm of macrophages

Question 49

What type of necrosis is often seen in TB?

Answer 49

Caseous

Question 50

How do Tb bacteria cause disease?

Answer 50

Their persistence in the body causing induction of cell meditated immunity. Don't release any toxins or lytic enzymes.

Question 51

Outcomes of TB?

Answer 51

Arrest - stopped by immune system Progresses - erosion into bronchus. Can spread into GI tract TB empyema - erodes through plural surface of lung Erosion into blood

Question 52

What is the difference between miliary TB and single organ TB?

Answer 52

Miliary - many bugs | Single organ - few bugs