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ESA 2- Mechanisms of Disease > Chronic Inflammation > Flashcards

Chronic Inflammation Flashcards

1
Q

What is chronic inflammation?

A

A chronic response to injury with associated fibrosis

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2
Q

What is the timescale for chronic inflammation?

A

It is not rapid or immediate, and not short lived,

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3
Q

How does our knowledge of chronic inflammation differ from that of acute?

A

Less is known

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4
Q

Why is less known about chronic inflammation?

A

Because it’s so diverse

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5
Q

What does chronic inflammation overlap with?

A

Host immunity

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6
Q

How is the immune system different from chronic inflammation?

A

It’s very specific, and delivered by specific reactions with specific immunological reagents, whereas chronic inflammation is a generalised response to any injury

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7
Q

What is chronic inflammation usually associated with?

A

Some sort of the permanent tissue damage

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8
Q

What is the major difference between acute and chronic inflammation?

A

The long term outcomes are different

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9
Q

What are the long term outcomes of chronic inflammation?

A

No resolution, always leads to repair and scarring

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10
Q

Is function regained in chronic inflammation?

A

Sometimes

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11
Q

Can acute inflammation lead to chronic inflammation?

A

Yes, if the damage is not slight

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12
Q

When does chronic inflammation take over from acute?

A

If acute inflammatory processes don’t work immediately
If damage is too severe to be resolved within a few days
If infection arises

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13
Q

What is meant by chronic inflammation arising de novo?

A

When there is no acute phase- it goes straight to chronic

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14
Q

When may chronic infection arise de novo?

A

In some autoimmune conditions
In some chronic infections
Because of ‘chronic low level irritation’

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15
Q

Give an example of an autoimmune condition that can lead to chronic inflammation?

A

Rheumatoid arthritis

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16
Q

Why does chronic inflammation arise in some chronic infections?

A

Partly becomes of the bodies immunological response to them

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17
Q

What kind of inflammation does bacteria cause?

A

Acute

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18
Q

Give an example of an infection that causes chronic inflammation?

A

Vital hepatitis

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19
Q

What can chronic low level irritation be caused by?

A

A reaction to foreign material

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20
Q

How can a bone replacement cause chronic inflammation?

A

If there is a joint replacement, a lot of compounds are inserted during the operation which can cause chronic inflammation, e.g. cement and bone fragments

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21
Q

What may chronic inflammation develop alongside?

A

Acute inflammation

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22
Q

When may chronic inflammation arise alongside acute inflammation?

A

In severe persistent or repeated infection

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23
Q

Can repeated attacks of acute inflammation which get better result in chronic inflammation?

A

Yes

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24
Q

How is chronic inflammation characterised?

A

It’s microscopic appearance

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25
Q

How does the microscopic appearance of chronic inflammation differ from that of acute?

A

It is much more variable

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26
Q

What is the microscopic appearance of chronic inflammation characterised by?

A

What the cellular infiltrate is

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27
Q

What is the most important characteristic of the cellular infiltrate?

A

What type of cell is present

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28
Q

What cells are involved in chronic inflammation?

A 
Macrophages
 Lymphocytes
 Plasma cells
 Eosionphils
 Fibroblasts/myofibroblasts
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29
Q

Are macrophages used in acute inflammation?

A

They may be important in resolving it

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30
Q

What are macrophages more specifically associated with?

A

Chronic inflammatory reactions

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31
Q

What do macrophages have lots of?

A

Granular cytoplasm

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32
Q

Why do macrophages have a lot of granular cytoplasm?

A

Because they have lots of organelles to do with their phagocytic process

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33
Q

What are macrophages derived from?

A

Blood monocyte

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34
Q

What is a monocyte?

A

What we call a macrophage when it’s circulating in the blood

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35
Q

When is a monocyte called a macrophage?

A

When it gets into tissues

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36
Q

In what manner do macrophages get activated?

A

In various levels

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37
Q

Why are the various levels of activation of the macrophage important?

A

Because it would be bad if the monocyte performed it’s function in the circulation

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38
Q

When do blood monocytes get activated?

A

In chronic inflammation

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39
Q

What are the functions of macrophages?

A

Phagocytosis and destruction of debris and bacteria
Processing and presentation of antigen to immune system
Synthesis of substances
Control of other cells by cytokine release

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40
Q

What do macrophages synthesise?

A

Cytokines
Complement components
Blood clotting factors
Proteases

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41
Q

What do cytokines do?

A

Communicate with other cells

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42
Q

What are lymphocytes sometimes called?

A

Chronic inflammatory cells

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43
Q

Why may it be inappropriate for lymphocytes to be called chronic inflammatory cells?

A

They are a normal component of many tissues

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44
Q

What parts of the body are populated with lymphocytes?

A

Lymph nodes, gut, airway and lots of other places

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45
Q

What are the functions of lymphocytes?

A

Complex

Mainly immunological

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46
Q

What do B lymphocytes do?

A

Differentiate to produce antibodies

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47
Q

What do T lymphocytes do?

A

Involved in control and some cytotoxic functions

Signal to other cells

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48
Q

What are plasma cells largely cells of?

A

Chronic inflammation reactions

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49
Q

Describe the structure of plasma cells?

A

Bilobed nucleus

Bright pink eosinophilic cytoplasm

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50
Q

What are plasma cells?

A

Differentiated antibody producing B lymphocytes

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51
Q

What do plasma cells do?

A

They are a factor synthesising and secreting lots of antibodies

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52
Q

What do plasma cells usually imply?

A

Considerable chronicity

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53
Q

Why do plasma cells usually imply considerable chronicity?

A

Because it takes about 7 days for a plasma cell to develop an antibody response, and a chronic inflammatory response gives that duration

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54
Q

What are eosionphils involved in?

A

Allergic reactions
Parasite infections
Some tumours

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55
Q

How are eosionphils involved in allergic reactions?

A

IGE related processes

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56
Q

What tumours are eosionphils involved in?

A

Certain lymphomas

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57
Q

What are fibroblasts/myofibroblasts?

A

Connective tissue cells

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58
Q

What do (myo)fibroblasts do?

A

Produce collagen responsible for fibrosis

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59
Q

What recruits (myo)fibroblasts?

A

Macropages

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60
Q

What are giant cells?

A

Multinucleate cells made by the fusion of macrophages

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61
Q

When are giant cells made?

A

In frustrated phagocytosis

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62
Q

What is frustrated phagocytosis?

A

A situation where macrophages alone can’t phagocytose the target

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63
Q

Give 3 types of giant cells

A

Langerhans
Foreign body type
Touton

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64
Q

What do Langerhans type giant cells look like?

A

Horseshoe of nuclei around the periphery

Have very pale, foamy cytoplasm

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65
Q

When do Langerhans type giant cells occur?

A

Usually in the context of TB

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66
Q

Why does TB form Langerhans type giant cells?

A

Myobacterium TB is very resistant to phagocytosis and destruction, so can survive in the organelle/cytoplasm of a macrophage. The macrophage forms a giant cell to try and deal with them

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67
Q

When do foreign body type giant cells occur?

A

When cells engulf foreign bodies of any sort, e.g. calcium, bone fragments

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68
Q

Where do touton giant cells usually occur?

A

In areas of fat necrosis, e.g. in adipocytes

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69
Q

Why does fat necrosis cause Touton giant cells?

A

When you get fat necrosis in areas of high fat content, a lot of fat needs to be phagocytosed- can’t cope

70
Q

Is the morphology of chronic inflammations specific or non-specific?

A

Non-specificin most

71
Q

Give 3 example of conditions where the proportions of each cell in chronic inflammation vary?

A

Rheumatoid arthritis
Chronic gastritis
Leishmaniasis

72
Q

What cell types are present in chronic inflammation with rheumatoid arthritis?

A

Mainly plasma cells

73
Q

What cell types are present in chronic inflammation with chronic gastritis?

A

Mainly lymphocytes

74
Q

What cell types are present in chronic inflammation with Leishmaniasis?

A

Mainly macrophages

75
Q

Why does Leishmaniasis produce chronic inflammation with mainly macrophages?

A

Protozoa parasites can survive in macrophages, so get lots of foamy macrophages reacting

76
Q

How can the cell type present in chronic inflammation be helpful?

A

It can aid diagnosis

77
Q

What are the effects of chronic inflammation?

A 
Fibrosis
 Impaired function
 Rarely, increased function
 Atrophy
 Stimulation of the immune response
78
Q

Where may fibrosis be a problem?

A

In the gall bladder
Chronic peptic ulcers
Cirrhosis

79
Q

What is chronic cholecystitis?

A

A chronic inflammatory proces that leads to scarring of the gall bladder

80
Q

Give an example of where chronic inflammation causes impaired function?

A

Chronic inflammatory bowel disease

81
Q

Give two examples of where chronic inflammation can cause increased function

A

Mucus secretion

Thyrotoxicosis

82
Q

Give an example of thyrotoxicosis?

A

Graves disease

83
Q

What happens in Graves disease?

A

An antibody stimulates the TSH receptor, which leads to an excess of thyroxin

84
Q

What is atrophy?

A

Loss of functional tissue mass

85
Q

Give two examples of places that chronic inflammation can cause atrophy?

A

Gastric mucosa

Adrenal glands

86
Q

How can chronic inflammation cause stimulation of the immune response?

A

Macrophage-lymphocyte interactions

87
Q

Is the production of gall stones in the gall bladder a problem?

A

Not in itself

88
Q

When is the production of gall stones a problem?

A

If they go into the cystic duct, they block bile flow.

Gall stones move about, and might eventually pass down the billary tree

89
Q

What is the problem with a blockage of bile flow?

A

Bile is highly toxic, so its blockage causes tissue injury, leading to inflammation and ulceration in the gall bladder mucosa

90
Q

What happens if gall stones pass down the billary tree?

A

They cause inflammatory damage to the billary epithelium

91
Q

What is the net effect in patients with gall stones?

A

They get multiple, repeated episodes of acute inflammation, which over time develops into chronic inflammation

92
Q

What is the problem once the gall bladder is chronically inflamed?

A

It won’t resolve, and therefore can’t get better

93
Q

What does chronic inflammation in the gall bladder lead to?

A

Fibrosis of the gall bladder wall

94
Q

What is an ulcer?

A

A full thickness defect in the mucosa, which can be caused by necrosis

95
Q

What can gastric ulceration be caused by?

A

Acute gastritis or chronic gastritis

96
Q

What causes acute gastritis?

A

Alcohol and drugs

97
Q

What causes chronic inflammation?

A

Helicobacter pylori

98
Q

When does ulceration occur?

A

Because of an imbalance of acid production and mucosal defence

99
Q

How does gastric ulceration appear?

A

As a rounded, discreet area of mucosal necrosis

100
Q

What happens if gastric ulcers don’t get better quickly?

A

Can get a lot of tissue damage and scarring

101
Q

Is tissue damage and scarring in the stomach a problem?

A

Not in most of the stomach, however if the antrum or pyloris are scarred, can get gastic outlet obstruction

102
Q

What is the problem with a gastric outlet obstruction?

A

It can affect the perilstaltic function of the stomach

103
Q

What is inflammatory bowel disease?

A

The specific term for a family of idiopathic inflammatory diseases

104
Q

What is meant by idiopathic?

A

Unknown cause

105
Q

What does inflammatory bowel disease look like?

A

Get cobblestone mucosa

106
Q

What gives the cobblestone mucosa appearance?

A

Islands of surviving mucosa, inbetween which are ulcers

107
Q

How does inflammatory bowel disease usually present?

A

Most patients have relaxing and remitting course

108
Q

Why do most patients have a relaxing and remitting course of inflammatory bowel disease?

A

Because they get attacks of acute inflammation which will convert asymptomatic chronic disease into something symptomatic

109
Q

What are the symptoms of inflammatory bowel disease?

A

Bleeding and diarrhoea

110
Q

Why does inflammatory bowel disease cause bleeding?

A

It ulcerates any mucosal surface, and so the protective mucosa underneath damaged

111
Q

Why does inflammatory bowel disease cause diarrhoea?

A

The function of the colon is compromised by the degree of inflammation

112
Q

What is the prognosis for inflammatory bowel disease?

A

It pretty much stays- it can get better or worse.

If treated, it can largely go away

113
Q

What is the result of chronic inflammation to the bowel mucosa?

A

Chronic damage to the mucosa, leading to abnormal crypts and inflammation to the wall

114
Q

What are the two types of inflammatory bowel disease?

A

Ulcerative colitis and Crohn’s disease

115
Q

What is ulcerative colitis?

A

A superficial colonic disease, that leads to a lot of ulceration

116
Q

What are the symptoms of ulcerative colitis?

A

Diarrhoea, bleeding

117
Q

What is Crohn’s disease?

A

A transmural disease- inflammation through the full thickness of the bowel wall

118
Q

What does Crohn’s disease lead to?

A

Strictures

Fistulae

119
Q

What is a fistula?

A

An abnormal connection between two epithelium-lined organs

120
Q

What is cirrhosis a consequence of?

A

Severe, chronic liver disease

121
Q

What are the common causes of cirrhosis?

A 
Alcohol
 Infection with HBV, HCV
 Immunological
 Fatty liver disease
 Drugs and toxins
122
Q

How does a cirrotic liver usually appear?

A

Shrunken

Diffuse process with bands of fibrous tissue and nodules of regenerating liver

123
Q

When does cirrhosis cause complications?

A

When the normal liver architecture is destroyed

124
Q

What leads to cirrhosis?

A

Chronic inflammation with fibrosis, disorganisation of architecture and attempted regeneration

125
Q

What happens in Graves disease?

A

Get antibodies produced by plasma cells in chronic inflammatory infiltrate that stimulate the TSH receptor that causes thyroid epithelial cells to produce thyroxin

126
Q

How does an atrophic gastric mucosa appear?

A

Lots of lamina propria, lots of lymphocytes

127
Q

Why are there lots of lymphocytes with an atrophic gastric mucosa?

A

Because the epithelium has been destroyed by lymphocytes

128
Q

How does atrophic gastric mucosa cause problems?

A

Get loss of acid producing cells, giving achlorhydria

129
Q

What problems can gastric mucosa atrophy cause?

A

Gastric cancer

130
Q

What kind of disease is rheumatoid arthritis?

A

Autoimmune

131
Q

What causes rheumatoid arthritis?

A

Localised and systemic immune response

132
Q

What problem does the localised immune response cause in rheumatoid arthritis?

A

Localised chronic inflammation leads to joint destruction

133
Q

What problem does the systemic immune response cause in rheumatoid arthritis?

A

Can affect other organs and amyloidosis

134
Q

What is amyloidosis?

A

A chemical process where proteins that can be laid down as ß pleated sheets can cause tissue problems

135
Q

How does chronic inflammation lead to amyloidosis?

A

It can lead to an increase in plasma proteins, and therefore cause amyloidosis

136
Q

How does rheumatoid arthritis present?

A

Classically symmetrical disease of small joints of hands and feet, leading to ulnar deviation of the hands and marked swelling of the joints

137
Q

How do chronic inflammation and immune responses overlap?

A

Immune diseases cause pathology by chronic inflammation

Chronic inflammatory processes can stimulate immune responses

138
Q

What is granulomatous inflammation?

A

Chronic inflammation with granulomas

139
Q

What is a granuloma?

A

A cohesive group of (usually) macrophages and other inflammatory cells

140
Q

What do granulomas invariably have present?

A

Some other inflammatory cells, usually lymphocytes

141
Q

Why do granulomas usually have lymphocytes present?

A

Because the role of T lymphocytes is in communicating with the macrophages with T helper cells, which is important in forming

142
Q

What does a small granuloma consist of?

A

Epithelioid histiocytes on the inside

Lymphocytes on the outside

143
Q

What are epithelioid histiocytes?

A

Modified, immobile macrophages

144
Q

What do granulomas arise with?

A

Persistent, low-grade antigenic stimulation

Hypersensitivity

145
Q

What are hypersensitivity reactions?

A

Pathological immunological reactions

146
Q

What are the main causes of granulomatous inflammation?

A

Mildly irritant ‘foreign’ material
Infections
Granulomatous diseases of unknown cause

147
Q

What infections can cause granulomatous inflammation?

A 
Tuberculosis
 Leprosy
 Syphilis
 Chronic fungal infections
 Cat-scatch disease
 Xanthogranulomatous pyelonephritis and malakoplakia
148
Q

What unknown causes can cause granulomatous inflammation?

A

Sarcoid
Wegener’s granulomatosis
Crohn’s disease

149
Q

What is Wegener’s granulomatosis?

A

Granulomatous vasculitis, usually affecting the lung and kidneys

150
Q

What can happen if a patient gets a bowel perforation?

A

Often see little granulomas of feacel material

151
Q

What causes tuberculosis?

A

Mycobacteria, especially M. tuberculosis

152
Q

What is the problem with M. TB?

A

It is difficult and slow to culture, so to be sure of a negative result, have to give 6 weeks growth time

153
Q

What wall lipids do TB have?

A

Mycosides

154
Q

What is the result of TBs wall lipids?

A

They can be taken up by phagocytosis and survive

155
Q

How does TB cause disease?

A

By persistence (leading to chronic inflammation) and induction of cell-mediated immunity

156
Q

Does TB produce toxins or lytic enzymes?

A

No

157
Q

What does a TB granuloma have in the middle?

A

Caseous necrosis

158
Q

What are the outcomes of TB?

A

Arrest, fibrosis and scarring
Erosion into bronchus
Tuberculous empyema
Erosion into blood stream

159
Q

What is meant by arrest of TB?

A

The immune system controls it within granulomas

160
Q

What can erosion of TB into the bronchus cause?

A

Bronchopneumonia

TB in GIT

161
Q

How can TB get into the GIT?

A

If coughed up and swallowed

162
Q

What is empyema?

A

Formation of pus in pleural

163
Q

What happens is TB erodes into the blood stream?

A

It circulates in the blood and spreads to multiple organs

164
Q

What is it called when there are many TB bugs?

A

Miliary tuberculosis

165
Q

What is it called when there are few TB bugs?

A

Single organ TB

166
Q

How does sarcoidosis manifest clinically?

A

Variably

167
Q

Who does sarcoidosis occur in?

A

Young adult women

168
Q

What does sarcoidosis produce?

A

Non-caseating granulomas and giant cells

169
Q

What does sarcoidosis involve?

A

Usually upper air and digestive tract

Usually bilateral hylar lymph node

170
Q

What does the severity of sarcoidosis depend on?

A

Location

171
Q

What is Crohn’s disease?

A

Region enteritis- patchy full thickness inflammation throughout the bowl

ESA 2- Mechanisms of Disease (11 decks)

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