Chronic Inflammation

Question 1

Define chronic inflam

Answer 1

Chronic response to injury with associated fibrosis

Question 2

What cell types are principally involved in chronic inflam?

Answer 2

Macrophage, 
lymphocytes, 
eosinophils, 
fibroblasts/myofibroblasts, 
plasma cells

Question 3

What is the role of a macrophage?

Answer 3

phagocytosis,

presentation of antigens to immune system,

synthesis of complement components + clotting factors + proteases,

control of other cells via cytokines

Question 4

What is the role of a lymphocyte?

Answer 4

B type (plasma cells) produce Abs,

T type involved in control and cytotoxic functions

Question 5

Outline the function of an eosinophil

Answer 5

allergic reactions, parasite infestations

Question 6

Describe the role of a fibroblast/myofibroblast

Answer 6

make collagen

Question 7

What is the role of a plasma cell?

Answer 7

Diff B cell – now prod Abs

Question 8

What is a giant cell?

Answer 8

Multinucleate cells made by fusion of macrophages = can’t phagocytose so fuse to form giant cell

Question 9

What are the different types of giant cell and when are they found?

Answer 9

Langhans giant cell – TB – horse shoe nucleus,

Foreign body giant cell – foreign material,

Touton giant cell – occurs in fat necrosis

Question 10

How can knowing the giant cell type be useful?

Answer 10

Giant cell tyoe may be a help to diagnose

Question 11

When does chronic inflam arise?

Answer 11

After or alongside acute inflam,
Chronic persistent infections,
Autoimmune conditions,
Prolonged exposure to toxic agents

Question 12

Name the possible complications of chronic inflam

Answer 12

Tissue destruction, 
Excessive fibrosis/scaring, 
Impaired function, 
Atrophy, 
stim of immune response (macrophage-lymphocyte interactions)

Question 13

Name some clinical examples in which chronic inflam occurs

Answer 13

Rheumatoid arthritis (many plasma cells),
Ulcerative colitis: superficial + Crohn’s disease: transmural (IBD),
Chronic cholecystitis (repeated obstruction by gallstones),
Chronic gastritis (many lymphocytes),
cirrhosis

Question 14

What is chronic cholecystitis?

Answer 14

repeated obstruction by gallstones = repeated acute inflam = chronic inflam – fibrosis of gall bladder wall

Question 15

Define fistula

Answer 15

Abnormal connection between 2 epithelium-lined organs

Question 16

When does chronic inflam lead to an increase in function?

Answer 16

Thyrotoxicosis – graves’ disease = Abs to TSH receptor = prod too much thyroxin

Question 17

Define granuloma

Answer 17

organized collection of macrophages = collection of epithelioid histiocytes (modified immobile macrophage), surrounded by lymphocytes

Question 18

When does granulomatous inflam occur?

Answer 18

persistent, low grade antigenic stim by foreign material, infect (TB, fungi), unknown

Question 19

What are the major causes of granulomatous inflam?

Answer 19

foreign material,
infections (tuberculosis, leprosy, syphilis, aspergillosis),
unknown causes (sarcoidosis, Crohn’s disease)

Question 20

If granulomas are present what should be your first thought?

Answer 20

Is this TB?

Question 21

How does a tuberculous granuloma appears microscopically?

Answer 21

Caseous necrosis centre, epithelioid histiocytes surrounded by lymphocytes, langhans giant cell

Question 22

Discuss the presentation and microscoptic appearance of RA

Answer 22

pres = joint pain, worse in the morning

microscopic = presence of immune cells

Question 23

Discuss ulcerative colitis

Answer 23

pres = abdo pain weight loss, diarrhoea sometimes bloody

Dx = IBS, crohns, bowel cancer, diverticulitis

microscopic = distorted crypt

macroscopic = inflam limited to mucosa/submucosa of colon/rectal

complications = Severe bleeding, perforated colon, severe dehydration, liver disease, osteoporosis

Question 24

Discuss crohns

Answer 24

pres = abdo pain weight loss, diarrhoea sometimes bloody, mouth sores

Dx = IBS, UC, bowel cancer, diverticulitis

microscopic = granulomas, transmural

macroscopic = discontinuous distribution of any part of GI tract, cobblestone bowel, fistulas

complications = Inflammation, bowel obstruction, ulcers, anal fissure, malnutrition, colon cancer

Question 25

what is the microscopic and macroscopic appearance of chronic cholecystitis?

Answer 25

microscopic = fibrosis of gallbladder wall

macroscopic = enlargement of gallbladder

Question 26

Discuss H Pylori associated chronic gastritis

Answer 26

pathophysiology = gastritis via enzymes and ammonia

microscopic = lymphocytes, fibrosis, H pylori on pits

complications =gastric carcinoma, non-hodkins lymphoma

Question 27

Discuss cirrhosis

Answer 27

causes = alcohol, HBV, HCV, immunological, fatty liver, drugs

microscopic = large amount of blue bands of CT

macroscopic = enlarged liver, yellow

complications = ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, portal hypertension

Question 28

what is the presentation and microscopic appearance of sarcoidosis?

Answer 28

pres = cough, enlarged nodes

microscopic = giant cell in lymph nodes, non-caseating granulomas

Question 29

Discuss TB

Answer 29

pathophysiology = Mycobacterium tuberculosis

terms = acid fast (no discoloration), mantoux test, primary complex (local lung reaction), BCG vaccine, ghon focus (primary lesion), ranke complex (lesion with healing), Pott (outside lung),

microscopic = granuloma

Diff from sarcoidosis = S has non-caseating granulomas