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Principles of Disease > Chronic Inflammation > Flashcards

Chronic Inflammation Flashcards

1
Q

List the cell types involved in chronic inflammation.

A 
Lymphocytes
- T-cell
- B-cell
Plasma cells
- differentiated B-cell
- act with macrophages 
- immune memory
Macrophages
Fibroblasts

(granulation tissue
collagen)

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2
Q

List the major causes of chronic inflammation.

A 
Autoimmune disease
Lymphocytes, plasma cells, macrophages, fibrosis
Material resistant to digestion
Exogenous substances
Endogenous substances
granulomatous inflammation common
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3
Q

Describe the effects of chronic inflammation.

A 
Arising from acute inflammation
- follows on from acute
- large volume of damage
- inability to remove debris
- fails to resolve – ongoing acute insult
Arising as a primary lesion
- no preceding acute phase
- only see chronic changes
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4
Q

clinical findings in chronic inflammation

A

Often no specific “sore bit”
Malaise (discomfort) and weight loss
- tuberculosis (lung, lymph node, bone, kidney, skin) – systemic effect
Loss of function
- autoimmune thyroiditis (functional gland destruction) – hypothyroidism
- Crohn’s disease (GI tract ulceration and fibrosis) – pain, diarrhoea, gut obstruction
- leprosy (cutaneous nerve destruction) – loss of sensation

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5
Q

causes and components of chronic inflammation

A 
Arising from acute inflammation
- follows on from acute
- large volume of damage
- inability to remove debris
- fails to resolve – ongoing acute insult
Arising as a primary lesion
- no preceding acute phase
- only see chronic changes
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6
Q

outcomes of chronic inflammation:

Organisation

A

granulation tissue is characteristic of organisation
involves new vessel formation – angiogenesis
results in healing and repair
leads to fibrosis and formation of a scar

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7
Q

Role of angiogenesis in granulation tissue

A

New vessels form- capillary buds
Vascular Endothelial Growth Factor (VEGF) released by Hypoxic cells stimulates proliferation
Enzyme secretion aids process
Enable blood supply to enter damaged tissue

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8
Q

Healing and repair involves

A
  • granulation tissue

- scarring and fibrosis

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9
Q

angiogenesis in malignant tumours

A
  • angiogenesis occurs as tumour grows

- potential for therapeutic control

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10
Q

Fibrosis and scarring in atherosclerosis (plaque builds up inside your arteries)

A

similarities with chronic inflammation

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11
Q

Granulation tissue mechanism and function

A
  • capillaries grow into inflammatory mass
  • access of plasma proteins
  • macrophages from blood and tissue
  • fibroblasts lay down collagen to repair damaged tissue
  • collagen replaces inflammatory exudate
  • patches tissue defects
  • replaces dead or necrotic tissue
  • contracts and pulls together
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12
Q

Acute + chronic =

A

pyogenic granulation tissue

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13
Q

Products of granulation tissue

A 
Fibrous tissue - scar
- eg small firm blemish on skin
Fibrosis as a problem
- adhesions between loops of bowel following peritonitis
Chronic inflammation
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14
Q

Endogenous substances in chronic inflammation include

A
  • necrotic tissue, keratin, hair

- cannot easily be phagocytosed

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15
Q

Products of granulation tissue

A 
Fibrous tissue - scar
- eg small firm blemish on skin
Fibrosis as a problem
- adhesions between loops of bowel following peritonitis
Chronic inflammation
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16
Q

Material resistant to digestion in chronic inflammation include

A
  • mycobacteria, Brucella, viruses

- cell wall resistant to enzymes

17
Q

T-cell mechanisms in chronic inflammation

A 
Produce cytokines
- attract and hold macrophages 
- activate macrophages
Produce interferons
- antiviral effects
- attract and stimulate other cells
Damage and kill (lyse) other cells and destroy antigen
- chemical mechanisms - granule proteins
18
Q

NK-cell mechanisms

A

Destroy antigens and cells

  • chemical mechanisms - granule proteins
  • innate immunity
19
Q

Macrophage mechanisms

A
  • removes debris
  • role in immune system - antigen presenting cell
  • monocyte, histiocyte, activated macrophage, epithelioid cell, giant cell
  • found in bone marrow, blood tissues
  • motile phagocyte move from blood
  • long lived
  • take over from neutrophils
  • contain enzymes eg lysozyme
  • produce interferons and other chemicals
    • destroy, influence process
20
Q

Fibroblast mechanisms

A
  • motile cells
  • metabolically active
  • make and assemble structural proteins
    • collagens
    • various types
21
Q

granulomatous inflammation

A

Characterised by presence of granulomas (granulomata) in tissues and organs
Stimulated by indigestible antigen
- body cannot get rid of it
Many serious infectious and idiopathic (= no known cause) diseases
Diseases important on global scale are granulomatous inflammatory diseases
- global health perspective

22
Q

granulomas are

A
  • aggregates of epithelioid macrophages in tissue
  • may contain giant cells
  • may surround dead material
  • may be surrounded by lymphocytes
  • contain neutrophils, eosinophils
  • response to indigestible antigen
  • many are type IV hypersensitivity reactions
23
Q

Describe the adverse effects of tissue scarring.

A

Nerve pain or numbness if scar tissue forms around nerves.

In certain tissues like muscle there is going to be less flexibility due to the scarring.

24
Q

Silicone associated

A

ruptured silicone implants
usually but not always breast
vacuoles contain leaked silicone

25
Q

describe wound healing

A

phase of acute inflammation
granulation tissue formation
local angiogenesis – new vessels grow
fibrosis and scar formation

26
Q

describe fracture healing

A

modified by situation in bone
have to repair bony structure as well as soft tissue

trauma, fracture, haematoma
bits of dead bone and soft tissue
acute inflammation, organisation, granulation tissue, macrophages remove debris
granulation tissue formation
local angiogenesis – new vessels grow
granulation tissue contains osteoblasts as well as fibroblasts

27
Q

granulomas are

A
  • aggregates of epithelioid macrophages in tissue
  • may contain giant cells
  • may surround dead material
  • may be surrounded by lymphocytes
  • contain neutrophils, eosinophils
  • response to indigestible antigen
  • many are type IV hypersensitivity reactions
28
Q

Infectious granulomatous diseases – examples relevant to global health

A 
tuberculosis – Mycobacterium tuberculosis
  - India, China, Indonesia, 
leprosy – Mycobacterium leprae
   - Brazil, Bhutan, India
syphilis – Treponema pallidum
29
Q

Non-infective granulomas - examples

A

rheumatoid disease - tissue specific auto-immune disease, ? cause
sarcoidosis – classical clinical picture, ? cause
Crohn’s disease – chronic inflammatory bowel disease, ? cause

30
Q

Giant cells:

Foreign body type

A 
often associated with pyogenic granulation tissue
- acutely inflamed 
- neutrophils, pus
- organisation
- giant cells
eg pilonidal abscess
31
Q

Healing of larger defects

A

healing by secondary intention
lots of granulation tissue ingrowth
contraction and scarring

32
Q

Giant cells:

Warthin-Finkeldy type

A

rarely see in measles

central cluster of nuclei

33
Q

Callus formation in bone

A

osteoblasts lay down woven bone
nodules of cartilage present
followed by bone remodelling
- osteoclasts remove dead bone
- progressive replacement of woven bone by lamellar bone
- reformation of cortical and trabecular bone

Principles of Disease (27 decks)

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