Chronic Inflammation

Question 1

cell pop = lymphocytes, plasma cells, macrophages; fibrosis (primary)
scarring 
granulation, 
damage (necrosis), loss of function
often no specific “sore bit”
ongoing tissue damage and destruction

Answer 1

chronic inflammation

malaise and weight loss - TB
loss of function
autoimmune thyroiditis (functional gland destruction) – hypothyroidism
Crohn’s disease (GI tract ulceration and fibrosis) – pain, diarrhoea, gut obstruction
leprosy (cutaneous nerve destruction) – loss of sensation

Question 2

Patches tissue defects

Replaces dead or necrotic tissue

Answer 2

Granulation tissue mechanism and function

Capillaries grow (angiogenesis) into inflammatory mass
PP access
Macrophages from blood and tissue
Fibroblasts lay down collagen to repair damaged tissue
Collagen replaces inflammatory exudate

Question 3

Products of granulation tissue

Answer 3

fibrous tissue - scar

Question 4

Primary chronic inflamm could arise from:

Answer 4

Autoimmune disease: RA (nodules, foreign body), Thyroiditis (common in F, scarred lung)
Undigestable material: TB, viruses
Exogenous (sutures,metal) - do not evoke inflamm and endogenous subs (necrotic tisc, keratin, hair) - hard to phagocytosise
granulomatous inflamm

Question 5

Make collagen (structural pr)

Answer 5

Fibroblast

Question 6

long-lived, removes debris
APC - Ag presenting capacity
lysosyme
interferons
monocyte, histiocyte, activated macrophage, epithelioid cell, giant cell
BM, blood tissues

Answer 6

Macrophage

Question 7

differentiated B-cell
antibody production
immune response 
memory
work with APC

Answer 7

Plasma cell

Question 8

cytokines - activate macrophages, lymphocyte

interferons (IFN) - antiviral effects

Answer 8

T cell

Question 9

damage and kill (lyse) other cells and destroy antigen - granule proteins

Answer 9

NK cell ( differentiated T cell)

Question 10

presence of granulomas (granulomata) in tissues and organs

stimulated by indigestible antigen - cant get rid of it

Answer 10

Granulomatous inflammation

many serious infectious and idiopathic (= no known cause) diseases

Question 11

aggregates of epithelioid macrophages (histioyte) in tissue

may - giant cells, surround dead material, by lymphocytes
contain neutrophils, eosinophils
response to indigestible antigen
many are type IV hypersensitivity reactions

Answer 11

Granuloma

Question 12

? fusion of (macrophages) to form larger cells
large cytoplasm; multiple nuclei
not all giant cells form granuloma

Answer 12

Giant cell

Question 13

Infectious Granulomatous disease
Caseous necrosis - dead tissue surrounded by macrophages, giant cells, lymphocytes
no NPLs

Answer 13

TB

TB common in HIV

Question 14

Infectious Granulomatous disease

dapsone, rifampicin and clofazimine - combination kills the pathogen and cures the patient

Answer 14

Leprosy

Question 15

Infectious Granulomatous disease
Primary chancre - non granulomatous - penis
Syphilitic gumma - granuomatous - nose

Answer 15

Syphillis (pallidum)

Question 16

Rheumatoid disease, sarcoidosis, Crohn’s disease

Answer 16

Non-infective granulomas

Question 17

Healing by primary intent
minimal gap – blood clot
small amount of granulation tissue;linear scar; TIDY

Answer 17

Surgical wound healing (fibroblast)

1. Phase of acute inflammation 2. granulation tissue formation 3. angiogenesis 4. Fibrosis and scar formation

Question 18

healing by secondary intent

lots of granulation tissue ingrowth; contraction and scarring; MESSY

Answer 18

Healing of larger defects

injury, blood clot,

1. acute inflammation, fibrin
2. granulation tissue formation
3. angiogenesis
4. phagocytosis of fibrin
5. myofibroblasts move in and lay down collagen
6. contraction of scar
7. re-epithelialisation

Question 19

abnormal CHO metabolism, diabetes, corticosteroid therapy; inhibition of angiogenesis

Answer 19

Impaired wound healing (fibroblast)

Question 20

trauma, fracture, haematoma - bits of dead bone and soft tissue
acute inflammation, organisation, granulation tissue, macrophages remove debris - granulation tissue

Callus formation -
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

Answer 20

Fracture healing (granulation tisc: fibroblast & osteoblast/osteoclast)

Question 21

New vessels form- capillary buds
Stimulated by Vascular Endothelial Growth Factor (VEGF) released by hypoxic cells - proliferation
Enzyme secretion aids process
Blood supply can enter damaged tissue

Answer 21

Angiogenesis

Question 22

angiogenesis and organisation

Answer 22

Thrombosis

reinstatement of flow

Question 23

angiogenesis occurs as tumour grows

potential for therapeutic control

Answer 23

malignant tumour

Question 24

fibrosis and scarring - similarities with chronic inflammation

Answer 24

Atherosclerosis