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Y2 MECHANISMS OF DISEASE > Chronic Inflammation > Flashcards

Chronic Inflammation Flashcards

1
Q

What is the difference in the immune systems involved in acute and chronic inflammation?

A

Acute inflammation involves only innate immunity

Chronic inflammation involves innate and adaptive immunity

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2
Q

How long does acute inflammation last?

A

Hours to days

The response is very rapid and short-lived

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3
Q

How do the blood vessels change in acute inflammation?

A

Blood vessels dilate and increase in permeability

This allows an increased blood flow into the area

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4
Q

What is the name of the process where fluid leaks out of blood vessels in acute inflammation?

A

Fluid exudation

The fluid is rich in proteins e.g. Igs, fibrinogen

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5
Q

What are the main cells involved in an acute inflammatory response?

A
  1. neutrophils
  2. mast cells
  3. macrophages
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6
Q

What are the 4 terms (latin) used to characterise the symptoms of acute inflammation?

A
  1. rubor - redness
  2. calor - heat
  3. tumor - swelling
  4. dolor - pain
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7
Q

What are the stages involved in resolution of acute inflammation?

A
  1. phagocytosis of the insulting agent
  2. fibrinolysis
  3. phagocytosis of debris
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8
Q

What is involved in fibrinolysis?

A

fibrin leaks out of the blood vessels and forms fibrinogen

fibrinolysis is the breaking down of the fibrin

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9
Q

What is meant by organisation in repair after acute inflammation?

A

Replacement of damaged tissue by granulation tissue

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10
Q

What are the main cells that phagocytose cell debris after resolution of acute inflammation?

A

macrophages

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11
Q

When does repair occur after acute inflammation, opposed to resolution?

A

When there is too much damage to a tissue that it can’t be repaired

Some tissues are unable to regenerate and replace lost cells

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12
Q

What is the role of granulation tissue?

A

It allows new blood vessels to form

It contains fibroblast cells that deposit collagen to form the fibrous scar

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13
Q

How long does chronic inflammation last for?

A

Weeks, months, years

It has a slow onset and a longer duration

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14
Q

What are the 2 processes in chronic inflammation that involve granulation tissue?

A
  1. angiogenesis

2. fibrosis

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15
Q

What is angiogenesis?

A

Development of new blood vessels

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16
Q

What is fibrosis?

A

Laying down of collagen that will go on to form the fibrous scar

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17
Q

What cells are involved in chronic inflammation that are not involved in acute inflammation?

A
  1. lymphocytes
  2. plasma cells

(also more macrophages are involved)

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18
Q

What are the 3 main conditions that are secondary to chronic inflammation?

A
  1. amyloidosis
  2. cachexia
  3. anaemia of chronic disease
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19
Q

What is amyloidosis?

A

Proteins misfold and form aggregates that are deposited around the body

they can cause damage to the tissues that they are deposited in

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20
Q

What is cachexia?

A

When a patient appears emaciated and thin

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21
Q

What causes anaemia of chronic disease?

A

cytokines reduce the amount of erythropoietin produced

red blood cell production decreases

cytokines affect iron production around the body, producing mild anaemia

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22
Q

What are the main chemicals involved in cachexia, anaemia of chronic disease and amyloidosis?

A

cytokines produced in chronic inflammation

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23
Q

What is meant by concomitant tissue destruction and repair?

A

Both tissue destruction and repair are happening at the same time

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24
Q

What are the types of cells involved in chronic inflammation?

A

mononuclear cells - single round nucleus

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25
Q

Under what circumstances may acute inflammation lead to chronic inflammation?

A
  1. if acute inflammation is not resolved

2. if there are frequent recurrent episodes of acute inflammation

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26
Q

What are examples of conditions that can cause acute inflammation to progress to chronic inflammation?

A
  1. if helicobacter pylori causing acute gastritis is not treated
  2. from chronic cholecystitis -inflammation of the gall bladder
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27
Q

What are the other causes of acute inflammation?

A
  1. persistent infection by certain microorganisms
  2. prolonged exposure to potentially toxic agents
  3. autoimmunity
  4. unknown
28
Q

Why do certain microorganisms cause chronic inflammation?

A

the macrophages find it difficult to remove all the bacteria

29
Q

What is meant by endogenous and exogenous toxic agents?

A

endogenous factors come from within the body

exogenous factors are external stimuli

30
Q

What is an example of an endogenous toxic agent that can cause chronic inflammation?

A

a splintered segment of bone that is difficult to break down

31
Q

What is an example of an exogenous toxic agent that can cause chronic inflammation?

A

asbestos fibres

sutures

32
Q

Why are autoimmune diseases an example of chronic inflammation?

A

The body is having an immune reaction to its own antigens which is persistent and ongoing

33
Q

What are the 3 unknown factors that cause chronic inflammation?

A
  1. crohn’s disease
  2. ulcerative colitis
  3. sarcoidosis
34
Q

What is chronic pyelonephritis?

A

chronic inflammation affecting the kidney

35
Q

What life-threatening consequence can chronic ulcers in the stomach lead to?

A

Perforations

these are holes going through the lining of the stomach that are caused by inflammation destroying the overlying tissue

36
Q

What causes liver cirrhosis?

A

prolonged exposure to toxic agents

e.g. alcohol, high lipid levels, hepatitis viruses

37
Q

What happens in liver cirrhosis?

A
  1. underlying liver tissue is destroyed
  2. it tries to regenerate, leading to nodules
  3. deposition of collagen in the liver leads to a shrunken liver with poor function
38
Q

What causes interstitial fibrosis?

A

asbestos bodies entering the alveoli in the lungs

39
Q

What happens in interstitial fibrosis?

A

the alveolar walls thicken which interferes with gas exchange

40
Q

What happens in lupus nephritis?

A

The kidney becomes shrunken and granular

The glomerulus is replaced by collagen and no longer functions

41
Q

What causes cells to become involved in the inflammatory response?

A

cytokines cause cells and proteins in the blood vessels to emigrate out of the vessels and towards the sites of injury

42
Q

Where do macrophages originate?

What are they called when they are in the blood and tissue?

A

originate in the bone marrow

in the blood, they are monocytes

when they enter tissue, they are macrophages

43
Q

What are macrophages called in the CNS, liver, bone and lungs?

A

CNS - microglia

Liver - Kupffer cells

Bone - osteoclasts

Lung - alveolar macrophages

44
Q

What causes the macrophages to become activated?

What signals do they produce?

A

they are activated in response to cytokines from t cells

they ingest agents by phagocytosis and then produce signals to the fibroblasts, b cells and t cells

45
Q

What does a plasma cell look like?

What does it do?

A

it has a clock-faced nucleus with speckles

it is a form of b cell that produces antibodies

46
Q

What do fibroblasts look like?

What do they do?

A

they are long, thin cells that produce collagen

they are responsible for forming scars

47
Q

When will eosinophils and mast cells be involved in the chronic inflammatory response?

A

eosinophils and mast cells are activated by IgE

If there is a type of chronic inflammation involving IgE

48
Q

What is involved in the cycle of chronic inflammation?

A
  1. macrophages follow chemokines to the injured area
  2. macrophage is activated in the tissue, produces cytokines and presents antigens to t cells
  3. t cells are activated and go on to activate b cells
  4. b cells become plasma cells and release antibodies
  5. inflammatory mediators from the t cells can activate more macrophages
49
Q

How can macrophages cause tissue injury and damage?

A

they release reactive oxygen species and enzymes

50
Q

What are the 2 roles of granulation tissue?

A
  1. angiogenesis is the formation of new blood vessels

2. fibroblasts are involved in collagen deposition

51
Q

When looking at chronic inflammation under the microscope, what is significant about what is seen?

A
  1. angiogenesis means that there are many blood vessels visible
  2. inflammatory cells - especially lymphocytes
52
Q

What is a granuloma?

A

a collection of activated epitheloid macrophages

53
Q

What does epitheloid mean?

A

looks like epithelial cells

54
Q

What does a granuloma look like under the microscope?

A

pink cytoplasm, indistinct cell membranes, oval nucleus

55
Q

What are the epitheloid macrophages in a granuloma surrounded by?

A

mononuclear leucocytes (b cells and t cells) and occasionally some plasma cells

56
Q

What are the 2 types of granulomatous inflammation?

A
  1. caseating

2. non-caseating

57
Q

What is significant about the appearance of a caseating granuloma?

A

when cutting into the granuloma, any area looks like cream cheese

58
Q

What is the difference between a caseating and non-caseating granuloma?

A

in a caseating granuloma, the cells in the centre are necrotic

in a non-caseating granuloma, the cells in the centre are not dead

59
Q

What infection commonly causes a caseating granuloma?

A

tuberculosis

60
Q

What other type of cells are often found in granulomatous inflammation?

A

multinucleate giant cells

61
Q

What are multinucleate giant cells?

A

many macrophages merge together to form a giant cell

62
Q

Why is it important to be able to identify a granuloma?

A

There are only a limited number of conditions that cause granulomatous inflammation

Identifying it informs further tests

63
Q

What are the 6 categories that cause granulomatous inflammation?

A
  1. bacterial
  2. parasitic
  3. fungal
  4. inorganic metals or dust
  5. foreign bodies
  6. unknown
64
Q

What are common bacterial infections that cause granulomatous inflammation?

A
  1. tuberculosis
  2. leprosy
  3. syphilis
  4. cat-scratch
65
Q

What are common parasitic and fungal infections that cause granulomatous inflammation?

A

parasitic - schistosomiasis

fungal - histoplasma, cryptococcus

66
Q

What are examples of inorganic metals/dust or foreign bodies that cause granulomatous inflammation?

A

inorganic metals - silicosis, beryliosis

foreign body - sutures, vascular grafts

67
Q

What conditions cause unknown granulomatous inflammation?

A

sarcoidosis and ulcerative colitis

Y2 MECHANISMS OF DISEASE (36 decks)

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