Chronic Inflammation

Question 1

What factors favour resolution

Answer 1

• minimal cell death and tissue damage
• occurrence in an organ or tissue with regenerative capacity
• rapid destruction of the casual agent (the thing causing the response)
• rapid removal of fluid and debris by good local vascular drainage (drainage of oedema)

Question 2

What is Organisation

Answer 2

replacement of destroyed tissue by granulation tissue

Question 3

What factors favour organisation

Answer 3

Large amounts of fibrin
substantial necrosis
Exudate and debris cannot be removed or discharged

Question 4

If the skin is completely destroyed what kind of granulation tissue replaces it

Answer 4

vascular granulation tissue

Question 5

Inflammatory exudate replaced by:

Answer 5

– Capillaries
– Macrophages
– Fibroblasts
– Collagen

Question 6

What is the replacement of inflammatory exudate regulated by

Answer 6

TNF, EGF, FGF

Question 7

What is chronic inflammation

Answer 7

primary
progression from acute
recurrent episodes of accute

Question 8

What causes TB and leprosy

Answer 8

Resistance of infective agent to phagocytosis and intracellular killing

Question 9

What causes gout

Answer 9

Foreign body reactions to endogenous materials

Question 10

What causes the reaction to asbestos

Answer 10

Foreign body reactions to exogenous materials

Question 11

What is rheumatoid arthritis caused by

Answer 11

an autoimmune disease

Question 12

Give me an example of a primary chronic inflammation that has an unknown aetiology

Answer 12

ulcerative colitis

Question 13

What is an example of primary granulomatous disease

Answer 13

sarcoidosis

Question 14

What factors favour progression from acute to chronic

Answer 14

• foreign body reaction (indigestible substances)
• deep seated suppurative inflammation where drainage is delayed or inadequate
• Thick abscess wall
• Fibrous/granulation tissue
• pus becomes organised
• forms a fibrous scar

Question 15

What is osteomyelitis

Answer 15

A chronic abscess which is extremely difficult to eradicate (in the bone)

Question 16

What happens in the case of clinicopathological entity of chronic inflammation

Answer 16

chronic cholecystitis - replacement of wall by fibrous tissue Lymphocytes rather than neutrophils predominate

Question 17

What does chronic inflammation look like

Answer 17

chronic ulcer
-mucosa breached
-base lined by granulation tissue
-fibrous tissue throughout muscle layers
chronic abscess cavity 
thickening of the wall of a hollow viscus
granulomatous inflammation
fibrosis

Question 18

Define inflammatory response

Answer 18

an inflammatory process in which lymphocytes, plasma cells and macrophages predominate
this is usually accompanied by the formation of granulation tissue resulting in fibrosis

Question 19

Tell me about macrophages

Answer 19

•Considerable phagocytic capabilities
• Can ingest a wide range of materials
• Relatively large cells
• Can harbour viable organisms resistant to lysosomal enzymes
Produce a range of important cytokines
• Activated on migration to an area of inflammation

Question 20

What are the two factors which effect macrophages

Answer 20

macrophage activation factor MAF

migration inhibition factor MIF

Question 21

How do you differentiate between acute and chronic

Answer 21

macrophages = chronic 
acute = neutrophils

Question 22

What is a granuloma

Answer 22

an aggregate (collection) of epithelioid histiocytes

Question 23

What is a histiocyte

Answer 23

a macrophage in connective tissue

Question 24

tell me more about granulomatous inflammation

Answer 24

Little phagocytic activity

secretory function

Question 25

Tell me about a typical granuloma

Answer 25

central Giant cells
surrounded by epithelioid histiocytes
peripheral rim of activated lymphocytes

Question 26

What are the causes of granulomatous disease

Answer 26

• Specific infections

• Foreign bodies
– i) endogenous
– ii)exogenous
• Specific chemicals

• Drugs
• Unknown

Question 27

What can happen during granulomatous inflammation

Answer 27

may develop:
caseous necrosis (soft white dead cells like cheese)
Giant cells