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Body Defence > Chronic Inflammation > Flashcards

Chronic Inflammation Flashcards

1
Q

What is chronic inflammation?

A

Inflammation of prolonged duration

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2
Q

What are the origins of chronic inflammation?

A
  • Progression from irresolved acute inflammation
  • Recurrent episodes of acute inflammation
  • Denovo process without acute phase (different mechanism)
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3
Q

What is tissue damage caused by if not pathogenic cells?

A

Inflammatory cells

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4
Q

What are the signs of chronic inflammation like in comparison to acute?

A

More attentuated, less obvious

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5
Q

What are the cells involved in chronic inflammation? (4)

A
  • Macrophages
  • Sometimes lymphocytes
  • Mast cells
  • Plasma cells
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6
Q

What type of cell is involved in chronic inflammation?

A

Mononuclear

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7
Q

What differentiates chronic inflammation from acute inflammation?

A

No neutrophilic response, just mononuclear/lymphocytic response

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8
Q

Give an example of a persistent infection turning from acute response to chronic process

A

Focus of infection cannot be reached by antibiotics in chronic osteomyelitis

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9
Q

How is osteomyelitis often insiduous?

A

In acute osteomyelitis the central area of necrosis = surrounded by:
- Possible fibrosis
- Thickened bone formation
Can’t isolate pathogen for effective treatment

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10
Q

What is primary chronic inflammation characterised by? (2)

A
  • All the histological features of a chronic process with mononuclear cells
  • Skips neutrophilic response
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11
Q

What are the causes of primary chronic inflammation? (3)

A
  • Persistent infection by organisms with low toxicity
  • Prolonged exposure to non degradable toxic agents
  • Autoimmune disease
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12
Q

How does persistent infection by organisms with low toxicity trigger primary chronic inflammation?

A

Immunoresponse called delayed hypersensitivity triggered

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13
Q

What type of response is delayed hypersensitivity?

A

Intracellular

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14
Q

W hat does delayed hypersensitivity mostly occur in response to?

A
  • Viruses

- Microbacteria e.g TB

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15
Q

What are the 2 types of non degradable toxic agents that prolonged exposure to causes primary chronic inflammation?

A
  • Exogenous

- Endogenous

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16
Q

Give 3 examples of exogenous non degradable toxic agents

A
  • Asbestos
  • Silica
  • Wood dust
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17
Q

Give an example of endogenous non degradable toxic agents

A

Plasma lipids found in atherosclerosis

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18
Q

What is autoimmune disease a response to?

A

Self antigens

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19
Q

Give 2 types of autoimmune disease

A
  • SLE

- Thyroiditis

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20
Q

What are the first cells to populate a site of injury in chronic inflammation (which are progressions of each other)? (3)

A
  • Monocytes
  • Macrophages
  • Multinucleated giant cells
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21
Q

How long does it take for monocytes, macrophages and multinucleated giant cells to populate a site of injury after damage?

A

24-48 hours

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22
Q

What are monocytes?

A

Precursors of macrophages circulating in blood

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23
Q

How long do circulating monocytes survive?

A

2 days

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24
Q

What are macrophages?

A

Monocytes that have migrated from the bloodstream into any extravascular tissue

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25
Q

What can macrophages do that monocytes cannot?

A
  • Phagocytise

- When activated: eliminate internalised microorganisms

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26
Q

What property of macrophages allows them to eliminate internalised microorganisms?

A

Increased lysosomal content

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27
Q

In what ways do macrophages contribute to chronic inflammation? (2)

A
  • Release active products = tissue damage and fibrosis

- Proliferation

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28
Q

How can the presence of cells in inflammation be used to judge the length of time from insult? (3)

A
  • Within 4 hrs: seeing neutrophils
  • Longer than 4 hrs: neutrophils and macrophages
  • In repair=fibrosis
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29
Q

What accumulation persists in chronic inflammation?

A

Macrophage accumulation

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30
Q

What are the 3 reasons chronic inflammation macrophage accumulation persists?

A
  • Continuous recruitment from circulation
  • Local proliferation
  • Peripheral macrophage immobilisation
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31
Q

What are the 2 types of peripheral macrophages that are immobilised?

A
  • Epithelioid histiocytes

- Giant cells

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32
Q

What are the 3 types of giant cell?

A
  • Foreign bodies
  • Langhan’s giant cells
  • Touton giant cells
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33
Q

What property of a giant cell differentiates it from monocytes/macrophages?

A

They are multinucleated

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34
Q

Identify the histological pics of different types of giant cells

A

See notes

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35
Q

What is a giant cell?

A

A collection of fused macrophages

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36
Q

What type of immune cell is found in chronic inflammation but not acute?

A

Lymphocytes

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37
Q

What are the 3 types of lymphocyte?

A
  • B lymphocytes
  • T lymphocytes
  • Natural killer cells/null cell type
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38
Q

What is the purpose of B lymphocytes in chronic inflammation upon activation?

A
  • Increase plasma cells

- Increase IG production

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39
Q

What are the two types of T lymphocytes?

A
  • CD4+ helper T cells

- CD8+ cytotoxic T cells

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40
Q

What is the purpose of CD4+ helper T cells?

A

Secrete cytokines in immediate cell vicinity regulating other immune cells (e.g B cells/macrophages)

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41
Q

What is the purpose of CD8+ cytotoxic T cells?

A

Cell mediated immunity

42
Q

What is the purpose of natural killer cells/null cell type? (2)

A
  • Lyse tumour cells

- Lyse infected cells

43
Q

What is formed following chronic inflammation and what is it made up of? (3)

A

Inflammatory infiltrate

  • Macrophages
  • Lymphocytes
  • Plasma cells
44
Q

What are the possible consequences of chronic inflammation? (4)

A
  • Tissue destruction/necrosis
  • Healing due to fibrous tissue replacement
  • Chronic non specific inflammation (granulation tissue)
  • Chronic granulomatous inflammation
45
Q

What are the 3 parts of fibrous tissue replacement healing in chronic inflammation? (3)

A
  • Angiogenesis
  • Fibroblastic proliferation
  • Fibrosis
46
Q

What is granulation tissue?

A

Vascularised fibrous tissue replacing fibrin clot

47
Q

What does granulation tissue contain? (5)

A
  • Loose connective tissue
  • Lots of fluid
  • Lots of blood vessels (angiogenesis)
  • Fibroblasts
  • Macrophages
48
Q

Why does granulation tissue contain macrophages?

A

To clear debris

49
Q

What is granulation tissue normally part of?

A

The repair process for existing defects

50
Q

When can granulation tissue cause issues? (2)

A
  • Too large

- Issues with healing process

51
Q

What is a granuloma?

A

Mass collection of mononuclear macrophages/granulation tissue

52
Q

What is a granuloma a type of?

A

Inflammation

53
Q

What are the two types of granuloma?

A
  • Necrotising (caseating)

- Non necrotising

54
Q

Name a condition with non necrotising granulomas

A

Sarcoidosis

55
Q

Name a condition with necrotising granulomas

A

TB

56
Q

What is a useful purpose of a granuloma?

A

Destroying/isolating pathogens/foreign material

57
Q

What negative effects can a granuloma have?

A

Tissue destruction

58
Q

Why do necrotising granulomas cause problems?

A

Tissue necrosis means macrophage can’t access granulomas

59
Q

What pathogen is TB caused by?

A

Mycobacterium tuberculosis (MT)

60
Q

What are the two types of Mycobacterium tuberculosis?

A
  • MT Hominis

- MT Bovis

61
Q

How many individuals are affected by TB in the world?

A

1.7 billion

62
Q

How many new cases of TB are there every year?

A

8 million

63
Q

How many TB deaths are there every year?

A

1.6 million

64
Q

What is the only disease that causes more deaths than TB every year?

A

HIV

65
Q

What disease is TB often associated with in epidemics?

A

HIV

66
Q

What defines a TB infection?

A

Presence of mycobacterium

67
Q

Does TB necessarily lead to clinical manifestation?

A

No

68
Q

What is the 1st stage of TB pathogenesis?

A

Primary tuberculosis

69
Q

How long does the 1st stage of primary tuberculosis last?

A

0-3 weeks

70
Q

What occurs in the 1st stage of primary tuberculosis?

A

MT enters macrophages by endocytosis mediated by macrophage receptors

71
Q

What are the features of the 1st stage of primary tuberculosis? (4)

A
  • Asymptomatic initially
  • Fever
  • Malaise
  • Primary complex
72
Q

What is there a delayed hypersensitivity to in primary tuberculosis?

A

MT antigens

73
Q

What test detects the delayed hypersensitivity to MT antigens in primary tuberculosis?

A

Tuberculin - Mantoux skin test

74
Q

What is the primary complex at the TB infection site caused by?

A

Local lymph node that has become fibrotic and calcified

75
Q

How long does the second stage of primary tuberculosis last?

A

4-6 weeks

76
Q

What occurs in the second stage of primary tuberculosis?

A
  • T helpers 1 response activates macrophages to become bactericidal
  • Phagolysome complex contains infection
  • Granuloma formation
77
Q

What type of T helper is involved in primary tuberculosis?

A

T helper 1

78
Q

What forms a phagolysosome complex in the second stage of primary tuberculosis?

A

T helpers 1 releasing IFN-gamma stimulating macrophages to form it

79
Q

How do T helpers 1 stimulate granuloma formation in the second stage of primary tuberculosis?

A

Conversion of macrophages into epithelioid histiocytes/giant cells

80
Q

What are epithelioid histiocytes?

A

Activated macrophages resembling epithelial cells

81
Q

What are the first 2 steps of TB?

A
  • Primary infection

- Primary complex

82
Q

What 3 ways can a primary complex progress in TB?

A
  • Healed lesion (scar)
  • Progressive primary TB
  • Latent lesions (dormant)
83
Q

What is a TB primary complex? (2)

A
  • Localised caesation

- Tiny granuloma fibroclacific nodule at infection site

84
Q

What type of TB can progressive primary TB become?

A

Milary TB

85
Q

What is milary TB?

A

Potentially fatal TB form from massive lymphohematogenous dissemination of MT

86
Q

What can latent dormant lesions progress to if reactivated?

A

Secondary TB

87
Q

What occurs in secondary TB? (4)

A
  • Initial lesions starts regrowing again
  • Small nodule progresses to caverna (large cystic lesion)
  • Leads to widespread caviating granulomatous inflammations
  • Localised caseating destructive lesions
88
Q

What can secondary TB progress to? (2)

A
  • Progressive secondary tubculosis

- Then malary TB

89
Q

What do patients with unhealed primary TB have?

A

Widespread multiple small granuloma scabs

90
Q

List the 3 markers of inflammation

A
  • ESR blood test
  • CRP blood test (C-reactive protein)
  • Plasma viscosity (PV)
91
Q

What needs to be disposed after TB and why? (2)

A
  • Myobacterium
  • Macrophages
    =indigestable
92
Q

What can be used to tell the stage of inflammation?

A

The type of WBC present

93
Q

What does ESR blood test stand for?

A

Erythrocyte sedimentation rate

94
Q

What does the ESR blood test measure?

A

The rate at which red blood cells separate from plasma and fall to bottom of test tube

95
Q

What causes an increased ESR? (3)

A
  • Increased proteins e.g fibrinogen covering red cells due to more inflammation
  • Proteins stick to each other
  • Cause RBCs to fall more quickly
96
Q

What is the disadvantage of the ESR blood test?

A

Not specific for acute inflammation

97
Q

What is a CRP blood test also known as?

A

Acute phase protein

98
Q

What is the advantage of a CRP blood test compared to an ESR blood test and why?

A

Very specific - measures level of 1 specific protein, ESR = many proteins

99
Q

What does CRP increase in response to?

A

When IL6 is released and activates complement cascade

100
Q

Why does increased plasma viscosity indicate inflammation?

A

Loss of fluid in inflammation

101
Q

What are the disadvantages to the PV test? (2)

A
  • More difficult to perform

- Not widely used

102
Q

PV is more specific and sensitive than ESR or CRP when monitoring the activity of which condition?

A

Rhuematoid arthritis

Body Defence (11 decks)

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