Chronic inflammation Flashcards

1
Q

chronic inflammatory conditions are

A

incredibly common - not usually life threatening - debilitating (IBD and RA)

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2
Q

definition

A

prolonged inflammation with associated repair

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3
Q

characterised by

A
  • Delayed onset - Variable duration (days years) - Variable appearances • No 5 cardinal features - Limits damage, initiates repair - Can cause debilitating symptoms
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4
Q

how does chronic inflammation arise

A
  1. Takes over from acute inflammation- if resolution not possible with acute inflammation
  2. Develops alongside acute inflammation- severe/persistent irritation
  3. Arises “de novo”- without preceding acute inflammation e.g. autoimmune conditions - Rheumatoid arthritis/ IBD/ diabetes
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5
Q

sometimes the proportion of cell types can

A

indicate diagnosis

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6
Q

which cells are indicative of rheumatoid arthritis

A

mainly plasma cells

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7
Q

which cells are indicative of chronic gastritis

A

mainly lymphocytes

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8
Q

which cells are indicative of of leishmaniasis (protozoal infections)

A

mainly macrophages

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9
Q

which cells are involved in chronic inflammation

A
  1. Macrophages 2. Lymphocytes- T/B cells 3. Mast cells 4. Eosinophils 5. Fibroblasts 6. Giant cells
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10
Q

macrophages in circulation

A

monocytes

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11
Q

macrophages once entering tissue space

A

macrophage (histiocyte)

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12
Q

features of macrophages

A
  • big cells with a large cytoplasm - abundant foamy cytoplasm - slipper shaped nucleus - can look like a cancer cell
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13
Q

primary role of maxcrophage

A

phagocytosis - removal of pathogens/ necrosis/ debris - antigen presentation to immune system

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14
Q

secondary role of macrophages

A
  • Also produce inflammatory mediators- controls and regulates inflammatory response
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15
Q

macrophages can look different depending on

A

what stimulus they are eating

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16
Q

lymphocyte features

A
  • large, spherical stained nucleus
  • thin rim of cytoplasm
  • small

subdivided into T and B lymphocytes (cant distinguish appearance- have to use immunohistochemistry)

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17
Q

T lymphocytes

A

CD8+ (protein on surface)- Cytotoxic (MHC I)

CD4+- helper T cells (MHC II)

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18
Q

B lymphocyte

A

Mature into plasma cells

Produce antibodies (immunoglobulins)

Neutralises pathogens

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19
Q

plasma cell features

A
  • Nucleus pushed off to one side (eccentric)
  • Chromatin in the nucleus clumps into spheres (clock-face)
  • Next to the nucleus there is slightly paler staining- peri- nuclear cytoplasmic clearing –> Golgi due to antibody synthesis
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20
Q

function of plasma cells

A

fully differentiated B lymphocytes

Produce antibodies

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21
Q

features of eosinophils

A
  • 2 lobes (bilobed nucleus)
  • cytolasm stains bright red and granular
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22
Q

why is the cytoplasm of an eosinophil bright red and granuklar

A
  • Full of chemical mediators- Histamine, heparin and prostaglandins
  • E.g. Release during hypersensitivity reactions and parasitic infections
23
Q

features of fibroblasts/myofibroblasts

A
  • webbed cytoplasm
  • stretched nucleus
24
Q

role of fibroblast/myofibroblast

A
  • ‘Prolonged inflammation with associated repair’
  • Role in generation and repair
  • Produce and secrete and lay down collagen- helping to reconstruct tissue
25
giant cells features
* Multinucleate * HUGE * Fusion of multiple macrophages
26
role of giant cells
* “Frustrated phagocytosis” * Increasing effectiveness of phagocytosis * E.g. if there are any resistant foreign body e.g. suture, resistant parasite of bacteria
27
how many types of giant cell
3
28
name the 3 giant cells
1) Foreign body giant cells 2) Langhans giant cells 3) Touton giant cells
29
1) Foreign body giant cells
To destroy foreign bodies One big cytoplasm Nuclei randomly assorted
30
2) Langhans giant cells
* Nuclei line up around the periphery- horseshoe * Important in TB
31
3) Touton giant cell
* Nuclei line up in a concentric circle in the middle of the cell * Can be seen in fat necrosis
32
33
which giant cell associated with TB
langhans giant cell
34
which giant cell associated with fat necrosis
touton
35
which type of giant cell
36
which type of giant cell
Langhans
37
which type of giant cell
Touton
38
Effect of chronic inflammation
1. fibrosis 2. impaired function 3. atrophy 4. stimulation of immune response
39
1. fibrosis
* a.Deposition of collagen * b.E.g. chronic cholecystitis, liver cirrhosis
40
impaired function
a. E,g, IBD b. Rarely increased function (e.g. thyrotoxicosis in Graves disease- increase production of T3/T4)
41
atrophy
atrophic gastritis
42
stimulation of immune repsosne
Antigen presentation- chronic --\> brought about by macrophages
43
fibrosis of the gall bladder
thickened and pale- collagen
44
impaired functione xample
idiopathic IBD - Crohns disease - UC
45
crohns disease
- can affect all of the GI tract (mouth to anus) - discontinous patches of inflammation (skip lesions) - inflammation affects full thickness of the bowel (transmural) - sometimes find granulomata - less likely to have rectal bleeding
46
ulcerative colitis
- affects large boewl only - continous inflammation - inflammation affects superficial bowel wall only (mucosa and submucosa only) - no granulomata - more likely to have rectal bleeding
47
cirrhosis
causes impaired function- too much fibrosis and attempted regeneration e. g. Cirrhoic liver - alcohol - hepatitis - drugs and toxins - fatty liver disease
48
granulomatous inflammation found in
chronic inflammation
49
granuloma form
A collection of epithelioid histiocytes (macrophages) with surrounding lymphocytes May also see giant cells within granuloma
50
causes of granulomatous inflammation
1. forgin body reaction 2. infection 3. idiopathic
51
foreign body granulomatous inflammation
52
granuloma caused by infection
e. g. tuberculosis e. g. leprae - dififcult to destory - thick cell walls - mycolic acids
53
idiopathic granuloma
e. g. crohns disease e. g. sacroidosis (mulitple well formed granulomas form on lymph nodes, lungs and skin - shortness of breath, lumps in lymph and skin lumps)