Chronic inflammation II Flashcards
What is granulomatous inflammation? What is it characterized by (cell types, appearance etc)?
Distinctive pattern of chronic inflammation characterized by aggregates of activated macrophages having a squamous (epithelioid) appearance
What causes granulomatous inflammation as opposed to other forms of inflammation?
Isolation of indigestible substance
What are the cells that mediate granulomatous inflammation?
Persistent T cell response with macrophage activation
Insolubles substances produce what type of immune response?
Cell mediated response
What is the prototypical Granuloma causing agent? Other notable ones?
TB/leprosy
Sarcoidosis
Fungal infx
Cat scratch fever
What does a granuloma contain?
Aggregation of macrophages that are transformed into epithelioid cells, surrounded by a collar of mononuclear leukocytes (lymphocytes)
What are Lanhans giant cells seen in?
Granulomas
What is the difference between a granuloma and granulation tissue?
Granuloma = macrophages
Granulation tissue = Walled off via fibroblasts and capillaries
What is granulation tissue?
Histological appearance of fibroblasts and a new, thin walled delicate capillaries in a loose ECM
What is the name for the arrangement of giant cells when they are located at the periphery of a granuloma?
Langhans-type
For what type of infection/stimulus are multinucleated giant cells arranged in a haphazard manner?
Foreign bodies
When are foreign body granulomas formed?
When FBs are too large to be phagocytosed
What is caseous necrosis?
Cheese-like tissue that forms around bacteria or FBs
What is lymphangitis? How does this appear clinically?
Inflammation of lymphatic channels, leukocytes and cell debris
Appears as red streaks
If an infection overwhelms a lymph node, what can happen?
Gains access to vascular circulation (bacteremia)
What is SIRS?
Systemic inflammatory response system (acute phase response)
What are the clinical symptoms of systemic inflammation?
Increased WBCs, cytokine release, fever
What are the two major cytokines released in systemic inflammation? What about the one that bacteria have that causes systemic inflammation?
IL-1 and TNF-alpha
Bacteria have LPS
How do IL-1 and TNF alpha promote fever?
stimulate PG synthesis (COX pathway converts AA to PG) in hypothalamic thermoregulatory center, resetting the body thermometer
What are the three major acute phase proteins?
- CRP
- Fibrinogen
- SAA (serum amyloid protein)
Where are acute phase proteins synthesized? What is their function?
Liver
Functions as opsonizers
Acute phase proteins can be upregulated by what proteins? (3)
- IL-1
- IL-6
- TNFalpha
What is a leukemoid reaction?
Extremely high WBC (over 40,000/microliter)
What happens to band cell production in SIRS?
Increases since bone marrow cannot keep up with demand for WBCs
What is lymphocytosis?
Increase in absolute number of lymphocytes; seen in viral infections (e.g. mononucleosis, mumps, etc)
What is leukopenia? What is this seen in?
Lower WBCs
Seen in overwhelming infections or debilitated hosts
Why is sweating decreased in systemic inflammation?
Redirected blood flow from cutaneous to deep vascular tissue to minimize heat loss
What bacterial chemical is prone to lead to sepsis?
LPS
What is the triad for septic shock?
- DIC
- Hypoglycemia
- CV failure
What is the net result of sepsis?
Multisystem organ dysfunction
What is defective inflammation?
Increased susceptibility to infections and delayed wound healing
What is excessive inflammation caused by? (3)
Autoimmune disease
CA
atherosclerosis
There is a strong relationship between chronic inflammation and what disease?
CA
What is the etiological agent associated with gastritis? What type of CA does this predispose pts to?
H. Pylori
Gastric adenocarcinoma
What is the etiological agent associated with Schistosomiasis? What type of CA does this predispose pts to?
Schistomes
Bladder, liver, and rectal CA
What is the etiological agent associated with cholangitis? What type of CA does this predispose pts to?
Liver flukes
Cholangiocarcinoma/colon CA
What is the etiological agent associated with cholecystitis? What type of CA does this predispose pts to?
Various bacteria/stones
gallbladder CA
What is the etiological agent associated with hepatitis? What type of CA does this predispose pts to?
Hep B/C
Hepatocellular carcinoma
What is the etiological agent associated with PID? What type of CA does this predispose pts to?
Gonorrhea/chlamydia/papilloma virus
Ovarian/ cervical CA
What is the etiological agent associated with osteomyelitis? What type of CA does this predispose pts to?
Various bacterial infx
Skin carcinoma
How do granulomas appear?
Macrophages with Pale, pink, and granular cytoplasm
What is reactive lymphadenitis?
Inflammation of a draining lymph node
What is chromatolysis?
Process involving the cell body following injury, caused by increased protein synthesis in an attempt to repair
What are the three characteristics of chromatolysis?
- Round cellular swelling
- Displacement of the nucleus to the periphery
- Dispersion of Nissl substance
Extravasation of WBC occurs where?
Post capillary venules
What maintains a granuloma?
Th1 cells secreting IFN-gamma, and TNF-alpha from macrophages
What are the cell types that surround a granuloma?
Macrophages surrounded by Th cells
What is the MOA of ASA blocking fever?
Inhibits cyclooxygenase and thus prostaglandin synthesis in the hypothalamus.
What is ESR and why is it measured in sepsis?
Rise in fibrinogen in sepsis = blood sticking together. ESR measures this.
What is the cause of hypoglycemia in sepsis?
Liver damage decreases gluconeogenesis
