Chronic Inflammation & Wound Healing Flashcards
define chronic inflammation
when acute inflammatory response fails
after repeated episodes of acute inflammation
how do you characterize chronic inflammation? (what cell types are present)
fibroblast - fibrosis
macrophage
lymphocytes
plasma cells
*VERY FEW neutrophils (acute)
fill out the chart in regards to chronic inflammation
list the four possible outcomes that occur if conditions do NOT allow full resolution of acute inflammation
abscess form
progression to chronic/granulomatous inflammation
healing with increased cellularity
healing by fibrosis
fibrin vs fibrous
which is acute and chronic?
fibrin - acute, disorganized, friable
fibrous - chronic, organized, fills within tissues
fibroUS stays with US
fibrin or fibrous?
fibrin - acute
fibrin or fibrous?
fibrous - chronic
list the main types of chronic inflammation
abscess
granuloma (nodular, diffuse)
eosinophilic granuloma (parasites)
lymphocytic to lymphoplasmacytic inflammation
ID the chronic inflammation type
abscess
how does abscess form?
neutrophils/acute liquify affected tissue/neutrophils to form pus
list the two types of abscess
septic - bacterial
sterile - partially degraded foreign body
what is myeloperoxidases role in abscesses?
enzyme in neutrophils that contributes to neutrophil necrosis and liquefaction
which abscess type requires lancing to be drained?
septic - since forms fibrous capsule, need to lance to allow drugs to be effective
ID the cells in chronic inflammation
abscess
ID chronic inflammation type
granuloma
define granuloma aka granulomatous inflammation
when monocyte-macrophage system is predominant and takes form as macrophages, epithelioid macrophages, and multi nucleated giant cells
describe epithelioid macrophages
large macrophages at site of infection
pale eosinophilic cytoplasm
secretes mediators
describe multinucleated giant cells
fused macrophages present when pathogen is resistant to elimination
has many nuclei
mediates tissue remodeling
ID the arrows
what type of chronic inflammation is this?
granuloma with epithelioid macrophages
describe fibroblasts
most common in CT, at outer part of granuloma
elongated cells, aid in integrity of tissue
helps with collagen/ECM synthesis
ID the cells
what type of chronic inflammation?
fibroblasts, granuloma
nodular vs diffuse granulomatous inflammation
nodular - masses, TH1 biased
diffuse - dispersed in sheets, TH2 biased
describe presentation of nodular granulomas grossly vs microscopically
grossly - nodular, gray to white, round, well demarcated
micro - round/oval with central core of granulomatous cells, central necrosis, and fibroblasts on outside
list the main examples of nodular granuloma
Mycobacterium bovis
Coccidiodes immitis - valley fever
ID pathology
nodular granuloma
describe the three distinctive morphologic areas of granulomas
innermost - macrophage, giant cells, some cellular necrosis
middle - macrophage, epithelioid macrophage, giant cells
outermost - lymphocytes, plasma cells, fibroblast with fibrous capsule
describe presentation of diffuse granulomas grossly vs microscopically
Gross - gray to white, poorly demarcated/delineated from adjacent tissues, firm, widespread distribution
micro- non-caseating aggregates of macrophages, few lymphocytes, and variable fibrosis
list the main examples of diffuse granuloma
johne’s disease - occurs in lamina propria if ileum/colon
ID pathology
diffuse granuloma - johne’s disease
*bottom is normal ileum
ID pathology
johne’s disease - based off presence of epithelioid macrophages
define eosinophilic granuloma
dense infiltrates of eosinophils with macrophages and some lymphocytes and plasma cells
list some examples of eosinophilic granuloma
oral eosinophilic granuloma - dog/cat
eosinophilic dermatitis - horse
ID the pathology and describe its appearance
cat eosinophilic granuloma
oral nodule, ulcer
ID pathology
eosinophilic granuloma
ID the pathology and describe it
equine eosinophilic dermatitis
nodular granulomatous and ulcerated areas on skin
ID pathology
what’s the arrow?
eosinophilic dermatitis
arrow - larvae
define lymphocytic to lymphoplasmacytic inflammation
B cells conversion to plasma cells - secrete Ig’s to start phagocytosis
list the main examples of lymphocytic to lymphoplasmacytic inflammation
IBD in dog/cat
ID pathology
Lymphoplasmacytic enteritis
ID the arrows
define chronic-active inflammation
has active part, includes acute inflammation cells - neutrophils, fibrin, plasma proteins
*due to stimulus that has NOT been removed from exudate, repeated episodes of inflammation over time
list the main examples of chronic-active inflammation
feline infectious peritonitis (FIP)
pancreatitis
describe FIP gross vs histological appearance
Gross - multifocal, gray-tan, slightly raised foci along vascular structures and coat serosal surface with thick effusion
micro- pyrogranulomatous vasculitis
FIP pathogenesis
fecal-oral ingestion of coronavirus > replication in enterocytes and peyers patch > mutation and replication in macrophage and blood monocyte > virus infected macrophages dissemination into organs > immune response > pyogranulomatous vasculitis
ID pathology
FIP
what’s the main veterinary example of chronic inflammation becoming neoplastic?
feline injection site (fibro)sarcoma
explain the possible mechanism of feline injection site (fibro)sarcoma
persistent injection site inflammation and genetic predisposition > neoplastic transformation of fibroblasts
**aggressive
ID pathology
fibrosarcoma
list the stages of wound healing
hemostasis
acute inflammation
proliferation/granulation
remodeling
what’s TGF-beta importance?
critical growth factor in wound healing
stimulates healing factors to build
describe primary vs second intention wound healing
define granulation tissue
exposed CT that forms in a healing wound
red, hemorrhagic, bleeds easily when bumped
**can overgrow and inhibit healing
what is it?
granulation tissue
what is this?
granulation tissue - fibers grow parallel to wound surface
describe colors of healthy vs poor granulation tissue
top - healthy
bottom - unhealthy
pathogenesis of healing via fibrosis
necrosis of tissue > dead tissue and acute inflammatory exudate removed by macrophages and phagocytosis > spaced filled with fibrovascular tissues (granulation tissue) > granulation tissue replaced by immature fibrous CT that is poorly collagenized > healing wound forms a scar
