Chronic Inflammation

Question 1

What is chronic inflammation?

Answer 1

Long term response to injury with associated fibrosis

Question 2

Causes of chronic inflammation?

Answer 2

Autoimmune e.g. Rheumatoid arthiritis, crohns
Chronic infections- viral hepatitis
Chronic low level irritation- H. pylori
Alongside acute- Chronic cholecystitis

Question 3

Which cells are present in chronic inflammation?

Answer 3

Macrophages
Lymphocytes
Plasma cells
Eosinophils
Fibroblasts/myofibroblasts
Giant cells

Question 4

What do macrophages do?

And where are they derived from?

Answer 4

They: phagocytose, Antigen present, synthesise-cytokines blood clotting factors and proteases.

They are derived from monocytes in bone marrow

Question 5

What are lymphocytes?

Answer 5

‘Chronic inflammatory cells’
B lymph: produce antibodies
T lymph: involved in control and cytotoxic functions

Question 6

What are plasma cells?

Answer 6

Differentiated antibody producing B lymphocytes

Clear sign of chronic inflammation

Question 7

What are eosinophils?

Answer 7

Allergic reactions, parasite infections and tumours

Question 8

What do fibroblasts do?

Answer 8

Recruited by macrophages to make collagen

Question 9

What are Giant cells?

What do they do?

Answer 9

Giant cells are multinucleate cells made by the fusion of macrophages.
More effective as larger aggregate
Langhans- TB
Foreign body type
Touton- fat necrosis

Question 10

List the effects of chronic inflammation

Answer 10

Fibrosis: e.g. cirrhosis, chronic cholecystitis
Impaired function: e.g. chronic IBD- crohns & UC
Atrophy: gastric mucosa/adrenal glands
Stimulated immune response: macrophage/lymphocyte interactions.

Question 11

How does fibrosis occur?

Answer 11

Repeated attacks of acute inflammation

Thickened muscle leading to lymphocytes and scarring

Question 12

Give two examples of fibrosis?

Answer 12

Chronic cholecystitis- gallstones causes acute inflammation and irritation to the gallbladder wall. This occurs repeatedly and over time causes scarring and fibrosis.

Gastric ulceration- acute gastritis or chronic gastritis
Ulceration due to imbalance of acid production
Defect in the mucosa leaving the submucosa open to acid.

Question 13

Describe typical presentation of Ulcerative colitils?

Answer 13

Typically younger female.
Abdomen pain, weight loss, rectal bleeding, diarrhoea.
No skip lesions, continous affecting the colon and cecal patch.

Question 14

How does crohns differ from U.C?

Answer 14

Crohns is transmural therefore fistula and strictures
Crohns is mouth to anus with skip lesions. Cobbles stone appearance.
No rectal involvement

Question 15

How can Rectal sparing occur in U.C?

Answer 15

UC patients are often given suppository this can heal the rectum.

Question 16

How can scarring affect the liver?

Answer 16

Fibrosis = cirrhosis
Caused by alcohol, infection, immunological, Fatty liver disease, drugs and toxins
Fibrosed nodular green appearance due to impairment of bilirubin conjugation.
High collagen content.

Question 17

Give an example of how chronic inflammation causes increased function

Answer 17

Thyrotoxicosis - Graves disease

Hyperthyroidism- caused by TSH antibodies acting on TSH receptors causing increased T3 + T4 release.

Question 18

What are the localised and systemic responses in Rheumatoid arthritis?

Answer 18

Localised: chronic inflammation of the joints, synovium covered in lymphoid tissue
Systemic: Skin, lungs and pleura affected- amyloidosis

Question 19

What is a granuloma?

Answer 19

Aggregate of activated macrophages

Immune system attempts to wall off a foreign substance which it cannot break down.

Question 20

State the main causes of granulomatous inflammation

Answer 20

Foreign material
Mycobacterium TB- casseous necrosis
Sarcoidosis 
Wegeners granulomatosis- lesions in Resp tract and kidneys
Crohns disease

Question 21

Why does TB cause granulomas?

Answer 21

TB is a mycobacterium with mycolic acid wall.

Therefore cannot be broken down via phagocytosis

Question 22

List the 4 outcomes of TB

Answer 22

1) Arrest, fibrosis, scarring.
2) Ersion into the bronchus - bronchopneumonia or TB in GIT
3) Tuberculous empyema- infection of the pleural space
4) Erosion into the blood stream = Miliary TB which is systemic and fatal.

Question 23

List 5 Granulomatous infections apart from TB

Answer 23

Leprosy
Syphilis
Chronic fungal infections
Cat scratch disease
Xanthogranulomatous pyelonephritis

Question 24

Describe the symptoms and causes of sarcoidosis

Answer 24

Normally presents in young adult women
With cough and high Calcium blood levels
Non-caseating granulomas, giant cells present involving the lymph nodes and lungs

Question 25

How is leprosy an example of chronic inflammation?

Answer 25

Mycobacterium leprae cause granulomas on nerve tissue resulting in long term nerve damage.
Also granulomas of the resp tract, skin and eyes.

Question 26

How is syphilis and example of chronic inflammation?

Answer 26

Caused by Treponema pallidum, multiple stages.
Primary Chancre at point of sexual contact.
Latent moves into tertiary- neuro and cardio syphilis.
caused by inflammation of lumps of cells called Gummas.