Chronic inflammation CC Flashcards
Patient comes in with 3 month history of intermittent abdo pain, diarrhoea which is sometimes bloody and weight loss. List 4 differential diagnoses
Inflammatory bowel diseases eg. Crohns disease, Ulcerative colitis
Infection (Salmonella, e-coli)
Bowel cancer
Name 7 distinguishing features of crohns disease
Discontinuous distribution Affects any part of the GI system Cobblestone appearance to bowel mucosa (ie patchy, healthy then not healthy) Granulomas are present Anal lesions common Bowel fistulae more likely Transmural
Name 6 distinguishing features of Ulcerative Colitis
Inflammation limited to mucosa and submucosa (Superficial)
Crypt abscesses common
Distorted crypt architecture very common
Significantly increased risk of colon cancer
Often most severe in distal colon
Colectomy often indicated
Name some complications of ulcerative colitis (Organs then how they’re affected)
Bile duct: Sclerosing Cholangitis
Liver: Liver disease (Back up of bile), Fatty liver disease, Cirrhosis
Osteoporosis (Constant inflammation uses up vitamins in the body, and malabsorption, so vit deficiency)
Eye disorders: Glaucoma
Skin: Erythema Nodosum (Commonly affects both shins. Inflammation of the fatty layer underneath the skin), Pyrederma gangrenosum
How would some present with rheumatoid arthritis?
A slow onset
First, notices stiffness in one or more joints,, pain on movement and tenderness
Eventually becomes polyarticular
Also some non specific systemic symptoms like fatigue, malaise, depression
Morning stiffness
In which joints is rheumatoid arthritis most common
Proximal interphalangeal joint, metacarpophalangeal joints, metatarpophalangeal joints (Foot)
Describe a rheumatoid nodule
Shell of fibrous tissue
Centre of fibrinoid necrosis
Between the necrotic centre and fibrous shell contains a cellular palisade- a densely packed layer of macrophages and fibroblasts
Extending further into the fibrotic shell are T cells, plasma cells and blood vessels
What is rheumatoid arthritis?
An autoimmune disease leading to inflammaation of joints
3 signs/symptoms of sarcooidosis
tiredness, cough, enlarged hilar lymph nodes (On xray)
What is the microscope appearance of enlarged hilar lymph nodes in sarcoidosis
Granulomas present
Non caseous necrosis
Giant cells present (Langerhans)
How would you differentiate between TB and sarcoidosis
More caseous necrosis in TB (SO no cells in the necrotic area unlike sarcoidosis)
Also Zeil nelson test for Mycobacterium
PCR
Lab culture (Mycobacterium very difficult to culture)
Also blood test for sarcoidosis indicate raised Ca2+ and raised ACE
Define cirrhosis
irreversible scarring of the liver
symptoms associaed with cirrhosis 3
jaundice, itching, extreme tiredness
4 causes of cirrhosis
alcohol, hep B and C, Fatty liver disease, congestive heart failure
Describe the macroscopic appearance of a cirrhotic liver
Regenerative nodules, bands of fibrous tissue
initially, it’ll be enlarged–> smaller
Irregular surface. firm consistency. yellow colour
describe the microscopic appearance of cirrhosis
bands of CT,
What is chronic cholesystitis
gallbladder is damaged by repeated attacks of acute inflammation
What is the primary cause of chronic cholesystitis
gallstones
Macroscopic appearance of chronic cholesystitis
Thickened, fibrotic wall, gallstones may be present
Microscopic appearance of chronic cholesystitis
Mix of acute and chronic inflammation throughout muscular wall
entrapped epithelial crypts
lymphocytes
may have foamy macrophages in the lamina propria
What bacteria can cause chronic gastritis
Helicobacter pylori
How does helicobacter pylori cause chronic gastritis
Direct epithelial injury and by causing a vigorous immune response
Both lead to chronic inflammation
Complications with chronic gastritis
stomach ulcers, bleeding, stomach cancer, anaemia
Microscopic appearance of chronic gastritis
Neutrophil infiltration into the epithelium, lymphocytes and plasma cells infiltrate into the stroma
Glandular atrophy
Intestinal metaplasia–>stomach epithlium–>intestinal mucosa
