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General Pathology > Exam #1: Chronic Inflammation II > Flashcards

Exam #1: Chronic Inflammation II Flashcards

1
Q

What is granulomatous inflammation?

A

Type of chronic inflammation that is seen in a limited number of infections & some non-infectious causes (e.g. a foreign body)

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2
Q

What are the characteristics of granulomatous inflammation?

A
  • Aggregates of activated macrophages with an “epitheliod” appearance
  • Purpose is to contain an offending agent that is indigestible and difficult to get rid of
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3
Q

When does granulomatous inflammation occur?

A
  • Forms in the setting of persistent T-cell responses to microbes & fungi
  • T-cell derived cytokines are responsible for persistent macrophage activation

*Recall that strong T-cell activation leads to macrophage activation–>injures normal tissue

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4
Q

What is the prototype of granuloma formation?

A

TB

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5
Q

What are the components of a graunloma?

A

Granulomas are a focal area of inflammation

  • Consists of microscopic aggregates of macrophages i.e. epitheloid cells
  • Macrophages are surrounded by mononuclear cells i.e. lymphocytes & occasionally plasma cells
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6
Q

Describe the histological appearance of a granuloma.

A
  • Ring of epithelioid macrophages
  • Langhan’s “Giant cell”
  • Peripheral rim of lymphocytes
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7
Q

What is the difference between granuloma & granulation tissue?

A

Granulation tissue= tissue repair i.e. histological appearance of “granulation tissue” characterized by fibroblasts, capillaries, and loose ECM

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8
Q

What is a Langhan’s cell? How does the presentation of these cells differ in infectious & foreign body induced granulomas?

A

Multinucleated giant cells

*These are seen in a peripheral arrangement in infectious granulomas; haphazard arrangement in foreign body

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9
Q

What is a foreign body granuloma?

A

Granuloma formed in response to inert foreign body–>forms when material is too large to be phagocytosed by a single macrophage

  • Splinter suture material
  • Breast implant
  • Piece of glass

*In surgery, be sure to completely cut the silk thread used for sutures; if you don’t, can form granuloma at the incision

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10
Q

Describe the histological appearance of a granuloma formed in response to a foreign body.

A

Haphazard giant cells that do NOT form a ring like what is seen in an infectious granuloma

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11
Q

What can granuloma formation lead to in the lung?

A

Granulomatous inflammation with extensive tissue destruction i.e. caseous necrosis

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12
Q

What is lymphangitis?

A

Inflammation of the lymphatic channels

*Clinically, red streaks up the arm or leg are called “blood poisoning”–>this is actually an infected lymphatic vessel or “lymphangitis”

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13
Q

What is reactive lymphadenitis?

A

Inflammation of draining lymph nodes

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14
Q

What happens if an infection overwhelms lymph nodes?

A

The infection gains access to the blood, causing bacteremia

*Bacteremia is NOT sepsis, but bacteremia can lead to sepsis

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15
Q

What are the systemic effects of inflammation?

A

Acute phase response or SIRS (Systemic Inflammatory Response System)

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16
Q

Clinically, what are the effects of inflammation?

A
  • Fever
  • WBC
  • Anorexia
  • Altered sleep
  • Increase in serum acute phase proteins
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17
Q

What cytokines lead to the systemic effects of inflammation?

A

IL-1 & TNF-a

18
Q

How is a fever produced in the body?

A

Cytokines stimulate PG synthesis in hypothalamic thermoregulatory center

–>resets body thermometer

19
Q

What happens to heart rate in the presence of fever?

A

Increase in HR by 10 bpm per every increase in fever by 1 degree C

20
Q

What is the main exogenous pyogen that induces fever?

A

LPS

21
Q

What is the effect of IL-1 & TNF in the acute phase response?

A
  • Increased COX that convert AA into PG

Cyclooxygenases convert arachnadoinic acids into prostaglandins

22
Q

What are the serum acute phase proteins?

A

Plasma proteins that are mostly synthesized in the liver (hepatocytes); concentrations increased 100-fold in the presence of inflammatory stimuli

Include:

  • CRP (C-reactive proteins)
  • Fibrinogen
  • SSA (serum amyloid A protein)
23
Q

What is the function of the serum acute phase proteins?

A

Proteins bind microbial cell walls & may act as opsonins & fix complement

24
Q

What is leukocytosis?

A

Increase in total WBC count from the normal range 4,000- 10,000 to levels around 15,000- 20,000

25
Q

What is a leukemoid reaction?

A

Extremely high white cell count

  • 40,000- 100,000
26
Q

What is a left shift?

A
  • Increase in immature WBCs due to accelerated release from the bone marrow

I.e. band cells are being released from the bone marrow before maturing to full WBCs

27
Q

What is neutrophilia?

A

An increase in the number of neutrophils seen in most bacterial infections

28
Q

What is Lymphocytosis?

A

Increase the in absolute number of lymphs; seen in viral infection

29
Q

What is eosinophilia?

A

Increase in absolute number of eosinophils; seen in asthma, hay fever, and parasitic infections

30
Q

What is Leukopenia?

A

Decrease in absolute number of WBCs; seen in certain infections & in debilitated hosts/ overwhelming infection
- This can be an indication of a MORE SEVERE infection in the elderly or immunocompromised despite WBC numbers in the “normal” range

31
Q

What are the autonomic manifestations of systemic inflammation?

A
  • Increased pulse and blood pressure

- Decreased sweating secondary to redirection of blood flow from cutaneous to deep vascular beds

32
Q

What are the behavioral manifestations of systemic infection?

A
  • Shivering
  • Chills
  • Anorexia
  • Somnolence
  • Malaise
33
Q

What happens in severe bacterial infections?

A

Large numbers of organisms & LPS lead to large quantities of cytokines, esp. TNF-a & IL-1

  • Cardiovascular decompensatin
  • DIC
  • Liver injury–> hypoglycemia
  • Overproduction of NO
  • Heart failure
  • Decreased blood pressure
34
Q

What is the triad of septic shock?

A
  • DIC
  • Hypoglycemia
  • CV failure
35
Q

What is the difference between defective inflammation & excessive inflammation?

A

Defective= increased susceptibility to infections & delayed wound healing

Excessive= inflammation leading to tissue injury & contributing to athersclerosis, heart disease, neurodegenerative disease & cancer

36
Q

What is the cancer associated with gastritis? What is the etiologic agent?

A

Gastric adenocarcinoma, MALT

- H. pylori

37
Q

What is the cancer associated with Schistosomiasis? What is the etiologic agent?

A

Bladder, liver, & rectal carcinoma
- Schistosomes

*****Schistosomiasis is a disease caused by parasitic worms of the Schistosoma type. It may infect the urinary tract or intestines.

38
Q

What is the cancer associated with Cholangitis? What is the etiologic agent?

A

Cholangiocarcinoma
- Colon carcinoma

*****Note that Cholangitis= inflammation of the common bile duct

39
Q

What is the cancer associated with chronic cholecystitis? What is the etiologic agent?

A

Gallbladder cancer

  • Bacteria
  • Gallstones
40
Q

What is the cancer associated with Hepatitis? What is the etiologic agent?

A

Hepatocellular carcinoma

- Hep B & Hep C

41
Q

What is the cancer associated with PID? What is the etiologic agent?

A

Ovarian and cervical carcinoma

- Gonorrhea, chlamydia, or papillomavirus

42
Q

What is the cancer associated with Osteomyelitis? What is the etiologic agent?

A

Skin carcinoma in draining sinuses

- Various bacterial infections

General Pathology (33 decks)

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