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Pathological Processes (Milly's) > Chronic Inflammation > Flashcards

Chronic Inflammation Flashcards

1
Q

What is chronic inflammation?

A

Chronic response to injury with associated fibrosis

Longer and more variable, less known about it than acute, overlap with host immunity

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2
Q

What are the two types of insults that result in chronic inflammation?

A

Chronic and acute

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3
Q

How does chronic inflammation arise?

A
  • take over from acutes inflammation (if damage is too severe to be resolved within a few days)
  • arise de novo: autoimmune conditions (rheumatoid arthritis), chronic infection (viral hep), ‘chronic low-level irritation’
  • alongside acute acute inflammation (in severe persistent or repeated irritation)
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4
Q

What does chronic inflammation look like?

A

Defined by the cells present:

  • macrophages
  • lymphocytes ***

The mononuclear cells are the predominant cell type (macrophages and lymphocytes)

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5
Q

What are the cell types most commonly found in chronic inflammation?

A 
Macrophages 
Lymphocytes 
Plasma cells
Eosinophils 
Fibroblast/myofibroblasts
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6
Q

Discuss macrophages:
What from?
When important?
Functions? (7)

A

What from: derived from monocytes made in bone barrow (in the blood)-become macrophages (/histiocytes) in the tissue spaces

Importance: v important in acute and chronic inflammation

Functions: phagocytosis of debris and bacteria, Antigen presenting (initiation of immune response), stimulating angiogenesis, synthesis of cytokines, blood clotting factors and proteases, control other cells by cytokines release, inducing fibrosis

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7
Q

What do macrophages synthesis?

A

Cytokines, complement components, blood clotting factors and proteases

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8
Q

How do macrophages control other cells?

A

By their release of cytokines

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9
Q

Discuss lymphocytes:
Microscopic appearance?
Other names?
Functions? (4)

A

Microscopic appearance: small blue dots- large nucleus and little cytoplasm

Other names: chronic inflammatory cells

Functions: immunological-processing antigens, B lymphocytes differentiate to plasma cells and produce antibodies, T lymphocytes involved in control and some cytotoxic functions, killing cells (NK cells)

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10
Q

Where are B lymphocytes produced and what do they do?

A

Mature in bone marrow

Differentiate into plasma cells which produce antibodies

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11
Q

Where are T lymphocytes produced and what do they do?

A

Produced in bone marrow, mature in thymus

Varied in cellular functions (controlling immune reactions) and cytotoxic functions (killing cells)

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12
Q

What are plasma cells?

Why do they indicate chronic inflammation and what do they look like microscopically?

A

Differentiated antibody-producing B lymphocytes

They take a while to be produced so their presence suggests that the inflammation is long term

Open nucleus- clot phase-lots of chromatin around nucleus, cytoplasm is visible, large GA

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13
Q

Eosinophils:
When are they present?
What do they do?
What do they look like microscopically?

A

Present for v specific stimuli eg allergic reaction/parasite infestation/some tumours

Attach large parasites

Bi lope nucleus- (sun burnt face with shades on)

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14
Q

Why are fibroblast/myofibroblasts present in a chronic inflammatory response?
What to they do?

A

Because they’re recruited for by macrophages,

Fibroblasts produce C.T (collagen, elastin and glucosaminoglycans), differentiate into myofibroblasts- contractile cells

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15
Q

What is a giant cell?

A

Multinucleated cells made by fusion of macrophages happens because of frustrated phagocytosis

(If they cant deal with something alone, they fuse to make something bigger)

Seen in granulomatous inflammation

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16
Q

List some types of giant cells and what they fight (3)

A

Langhans->TB

Foreign body type-> foreign bodies

Touton-> fat necrosis

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17
Q

Describe the microscopic appearance of a langhans type giant cell, what do these cells fight?

A

Horse shoe nuclei around peripheral

TB (because TB is hard to get rid of)

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18
Q

What do foreign body type giant cells look like microscopically?

A

Not very organised, multiple irregular aggregates of nuclei (around outside?), blue-ish stuff in the middle=foreign body (exogenous/endogenous)

If the foreign body is small it is phagocytise by the giant cell and can be seen within it. If it is large the foreign body giant cell sticks to its surface

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19
Q

What does a Touton giant cell look like microscopically? And what it is involved in?

A

Nicely organised centre-multi nuclei, folded cytoplasm, accumulates a lot of fat (bubbles)

Involved in Fat Necrosis and xanthomas

Form in lesions where there is a high lipid content (such lesions will also contain cells called foam cells which are simply macrophages whose cytoplasm appears foamy as the have phagocytised a lot of lipid

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20
Q

Morphology of most chronic inflammatory
reactions is non-specific, BUT proportions of
each cell type may vary in different
conditions. Giant cell types are also helpful in diagnosis. What cell is most abundant in the following conditions:
Rheumatoid arthritis
Chronic gastritis
Leishmaniasis (a protozoan infection)

A

Rheumatoid arthritis-mainly plasma cells

Chronic gastritis- mainly lymphocytes

Leishmaniasis- mainly macrophages

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21
Q

What are the unwanted side effects of chronic inflammation? (4)
Give examples of all these effects

A

-Fibrosis (eg gall bladder-chronic cholecystitis, chronic peptic ulcer, cirrhosis)

-Impaired function (eg chronic inflammatory bowel disease- ulcerative colitis and Crohn’s disease)
(**rarely increased function eg mucus secretion thyrotoxicosis)

  • Atrophy (eg gastric mucosa, adrenal glands)
  • Stimulation of inappropriate immune response (eg macrophages-lymphocyte interactions, hay fever)
22
Q

What is chronic cholecystitis?

A

the gallbladder is damaged (mucosa) by repeated attacks of acute inflammation, usually due to gallstones, and may become thick-walled, scarred (fibrosis occurs) and small. The gallstones may block the opening of the gallbladder into the cystic duct or block the cystic duct itself. If scarring is extensive, calcium may be deposited in the walls of the gallbladder, causing them to harden (called porcelain gallbladder).

People have recurrent upper left quadrant abdominal pain (less severe and long lasting pain as in acute) and nausea

23
Q

What is inflammatory Bowel disease? Name two types

A

Idiopathic inflammatory disease affecting large and small bowel. Patients present with diarrhoea, rectal bleeding and other symptoms.

Ulcerative colitis and Crohn’s disease

24
Q

What effect of chronic inflammation is seen in inflammatory bowel disease?

A

Impaired function

25
Q

Describe the differences between ulcerative colitis and Crohn’s disease

A

UC-superficial (affected mucosa and not the deeper tissue), cause diarrhoea and bleeding

CD- transmutation (affects mucosa, submucosa, lamina propria and adventitia, causes strictures and fistulae

26
Q

What is a stricture?

A

Also called a stenosis- abnormal narrowing in a blood vessel/tubular organ/structure

27
Q

What is a fistulae?

A

Abnormal connection between two hollow spaces (ie blood vessels, intestines, hollow organs)

Abnormal anastomosis

28
Q

Name a chronic condition in which both fibrosis and impaired function occurs. What are the common causes of this condition?

A

Cirrhosis

Alcohol, infection HBV, HCV, immunological, fatty liver disease, drugs and toxins

29
Q

What is cirrhosis and when does it occur along the time line of chronic liver disease?

A

Cirrhosis is a condition in which the liver does not function properly due to long-term damage. This damage is characterized by the replacement of normal liver tissue by scar tissue

At the end stage of CLD

Sufferer may get: tired, weak, itchy, have swelling in the lower legs, develop yellow skin, bruise easily, have fluid build up in the abdomen, or develop spider-like blood vessels on the skin

Disorganisation of architecture, attempted regeneration.

30
Q

What does cirrhosis look like microscopically?

A

Lots of blue lines- collagen/ connective tissue

31
Q

Name a condition in which you get increased function and what is often the underlying cause

A

Thyrotoxicosis (hyperthyroidism)

Graves disease
(Other causes include multinodular goiter, toxic adenoma, inflammation of the thyroid, eating too much iodine, and too much synthetic thyroid hormone)

32
Q

What is thyrotoxicosis ?

A

Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism

33
Q

Name a condition in which there is chronic inflammation causing atrophy?

A

Atrophic gastritis

34
Q

What is atrophic gastritis?

A

chronic inflammation of the stomach mucosa, there is cell injury and death and the cells aren’t regenerated therefore replaced by scar tissue which impacts upon the function of the stomach

35
Q

How do chronic inflammation and immune responses overlap?

A

Immune disease cause pathology by chronic inflammation

And

Chronic inflammation processes can stimulate immune responses

36
Q

What is granulomatous inflammation?

A

Chronic inflammation with granulomas

37
Q

What is a granuloma?

A

It is a collection of immune cells (such as macrophages and lymphocytes=histiocytes) Granulomas form when the immune system attempts to wall off substances it perceives as foreign but is unable to eliminate.

Foreign bodies=infectious organisms/exogenous/endogenous material not normally there

The presence of a foreign body elicits granulomas

38
Q

Why do granulomas arise?

A

Persistent, low grade antigenic stimulation

Hypersensitivity (immunological reaction)

Body’s way of dealing with particles that are poorly soluble or difficult to eliminate

Eg thorns, splinters, TB, leprosy

39
Q

What are the main causes of a granulomatous inflammation?

A
  • mild irritant ‘foreign material’
  • infection: mycobacteria eg TB/leprosy, other infections eg some fungi
  • unknown causes: sarcoidosis, wegener’s granulomatosis, Crohn’s disease (common)
40
Q

What is tuberculosis?

A

Caused by Mycobacteria (difficult and slow to culture)

Produces no toxins or lytic enzyme- very difficult to diagnose

Causes disease by persistence and induction of cell mediated immunity

41
Q

What is a good indication of TB?

A

A granuloma in the lung-made of langhans’ type giant cells and caseous necrosis

42
Q

When someone is immmunised against TB they’re given a BCG jab, what can these cause and what so they consist of?

A

BCG granulomas

Containing giant cells

43
Q

Name 3 granulomatous diseases of unknown cause

A

Sarcoidosis-variable clinical manifestations, young adult women, non-caseating granulomas ‘sarcoid granulomas’ (different from TB), giant cells, involves lymph nodes, lungs…

Crohn’s disease- regional enteritis: patchy full-thickness inflammation through bowel (type of inflammatory bowel disease)

Wegener’s granulomatosis

44
Q

How does chronic inflammation happen?

A

Severe acute inflammation
De novo chronic inflammation
Repeated attacks of acute inflammation

45
Q

Which of the clinical signs of acute inflammation persist during chronic inflammation?

A

Swelling and pain

Tumor and dolor

46
Q

What is main cell type in chronic inflammation?

A

Macrophages

47
Q

What are the predominant cells of the immune system?

A

Lymphocytes

48
Q

What is fibrosis?

A

Means excess of fibrosis tissue
Fibroblast stimulated by cytokines to produce excess collagen, initially helpful because it walls off the infected area but can impair function etc

Myofibroblasts also causes issues because they cause the contraction of fibrotic structures

49
Q

What cell will you find in a granuloma?

A

Epithelia cells- modified macrophages to like epithelial cells (elongated), have eosinophilic cytoplasm and appear tightly packed together

50
Q

What are the two main types of granuloma?

A

Foreign body granulomas and hypersensitivity/immune type granulomas

51
Q

Describe foreign body granulomas

A 
contain macrophages, foreign body giant cells, epithelioid cells  and
some fibroblasts (at the periphery) but very few, if any, lymphocytes,

develop around material that is not antigenic, e.g., surgical thread

52
Q

Describe hypersensitivity/immune type granulomas

A

contain macrophages, giant cells (Langhans type), epithelioid cells (more prominent than in foreign body granulomas), some fibroblasts (at the periphery) and lymphocytes

Can undergo central necrosis which is particularly seen in granulomas associated with tuberculosis,

develop around insoluble but antigenic particles that cause cell-mediated immunity, e.g., the organisms that cause syphilis,tuberculosis, leprosy, cat scratch disease; fungi

also seen in sarcoidosis, a disease with an unknown cause in which
granulomas are seen in organs throughout the body, and other
diseases where the aetiology is unknown such as Wegener’s
granulomatosis and Crohn’s disease,

can be harmful as they occupy parenchymal space within an organ.

Pathological Processes (Milly's) (21 decks)

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