Exam 1; Inflammation Flashcards by Courtney Kast

What are the four clinical signs of inflammation

redness
swelling
heat
pain

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What causes the redness, swelling, and heat associated with inflammation

vascular changes

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What causes the pain and loss of function associated with inflammation

chemical mediators and leukocytes

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What is acute inflammation characterized by

lasting from hours to days

characterized by exudation and neutrophil infiltration

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What is chronic inflammation characterized by

spans days to years
characterized by mononuclear inflammatory cells (lymphocytes, macrophages, plasma cells) infiltration with vascular proliferation and fibrosis in later stages

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What is fever mediated by

IL-1
TNF
PGE2

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This accounts for redness and localized heat, beginning in the pre capillary arterioles and results in engorgement of capillary beds

vasodilation

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What is vasodilation mediated by

endothelial cell derived NO that induces vascular smooth muscle relaxation, and mast cell release of histamine
it is maintained by prostaglandins

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This results in movement of fluid out of the microvasculature, transudate, or exudate

increased vascular permeability

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During increased vascular permeability, does the blood flow become more concentrated and flow slows down or speeds up

slows down

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This occurs at the level of the post-capillary venules

movement of inflammatory cells out of the vessels (diapedesis)

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This type of fluid accumulation has a low protein content, low specific gravity, and is clear and yellow

transudate

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What occurs when there is a non-inflammatory transudate response

then endothelium is intact, fluid accumulates due to increased hydrostatic pressure and/or decrease in serum oncotic pressure

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What occurs when there is an inflammatory transudate response

early endothelial cell contraction

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This is indicative of tissue and endothelial cell damage, has a high protein content and a high specific gravity

exudate

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This type of exudate is highly protein with few cells, cloudy

fibrinious

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This type of exudate is highly protein with many cells (neutrophils), opaque

purulent

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This type of exudate is highly protein with blood, may look pink to red

sanguineous

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This mechanism of increasing vascular permeability forms intercellular gaps due to reversible contraction; occurs rapidly and lasts for 15-30 minutes

endothelial cell contraction

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What is endothelial cell contraction mediated by

histamine and bradykinin early, then later, leukotrienes and PAF

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These induce vasoactive amine release that leads to edema

C3a and C5a

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This mechanism of increasing vascular permeability is due to the restructuring of cytoskeletal proteins and is mediated by IL-1, TNF, INF-ɣ; takes 4-6 hour to develop and lasts for 24 hours or more

endothelial cell retraction

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Increased vascular permeability due to this may start immediately or be delayed and persist for hours to days

direct endothelial injury

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direct venue endothelial injury may occur from the neutrophilic release of what

ROS and lysosomal enzymes during the inflammatory response

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What are some factors that activate endothelial cells

infectious agents hypoxia inflammatory mediators

Activated endothelial cells are characterized by what

production of PGI2 and NO that induce vasodilation contraction rearrangement of cytoskeletal proteins leading to retraction increased expression and affinity of surface cell adhesion molecules synthesis and release of inflammatory mediators

Leukocyte extravasation and accumulation at the site of injury proceeds in an orderly coordinated sequence of what events

``` margination rolling adhesion emigration or transmigration chemotaxis ```

These mediate the processes involved in the movement of leukocytes from the blood stream into the extravascular tissue

cell adhesion molecules

This is a mechanical process due to slowing of blood flow involving leukocyte extravasation

margination

This process involving leukocyte extravasation is when selectins mediate a weak, transient, sticking that slows the cells forward progression

rolling

This process involving leukocyte extravasation is mediated by interns (ICAM and VCAM)

adhesion

Transmigration of the leukocyte (cells) through the vessel wall (diapedesis) is mediated by what

PECAM-1

This is a non-random movement of leukocytes to the site of injury along a concentration gradient of chemotactic factors, these factors bind to the cell surface receptors. Chemotactic factors also stimulate leukocyte activation

chemotaxis

What are some chemotactic factors (2 potent)

``` PAF and LTB4 are potent C5a chemokines bacterial lipids and peptides fibrin degradation products ```

What are five different factors that activate leukocytes during an inflammatory response

``` bacterial products cellular debris Ab-Ag complexes cytokines and chemokines chemotactic factors ```

Activation of leukocytes is characterized by what five things

production of leukotrienes and prostaglandins from arachidonic acid degranulation and release of lysosomal enzymes production of reactive oxygen species synthesis and secretion of cytokines altered expression of cell adhesion molecules

In regards to phagocytosis attachment is mediated by this on targets and specific leukocyte receptors

opsonins

What are the steps of phagocytosis

attachment engulfment into a phagocytic vacuole lysosomal degranulation by fusion with the phagosome oxidative burst releasing ROS

What are other mechanisms besides phagocytosis on intracellular killing

lysozyme major basic protein defensins bactericidal permeability increasing protein

These cells are the morphologic hallmark of acute inflammation; beginning to accumulate within 6-24 hours

neutrophils

Neutrophils infiltrate tissues in response to what

tissue necrosis | bacteria and some fungal infections

What do the neutrophils release

ROS and lysosomal enzymes

Neutrophils undergo this, after phagocytosis and digestion

apoptosis

These replace the PMNs, usually beginning within 48 hours

monocytes (macrophages)

What are the functions of active macrophages

phagocytize and digest cellular debris and organisms take up and metabolize antigens and present membrane bound antigen to T cells elaborate various functions such as complement, ROS, etc.

What is the function of the other immune cells such as lymphocytes, eosinophils, and mast cells

lymphocytes - immune eosinophils - allergy and parasites mast cells - histamine

This inflammatory pattern involves a diffuse, permeative infiltration of neutrophils with edema

cellulitis

This inflammatory pattern involves a localized area of liquefactive necrosis

abscess

This inflammatory pattern involvers erosion of an epithelial surface exposing underlying connective tissue

ulcer

What differs regarding the duration of acute vs chronic inflammation

acute; 10 to 14 days | chronic; months to years

What differs regarding the location of acute vs chronic inflammation

acute; localized | chronic; maybe systemic

What differs regarding the immune response of acute vs chronic inflammation

acute; innate (no response) | chronic; specific, adaptive immune response

What differs regarding the reversibility of acute vs chronic inflammation

acute; often reversible | chronic; maybe reversible

What differs regarding the cells involved of acute vs chronic inflammation

actue; neutrophils | chronic; macrophages and lymphocytes

What are three causes for chronic inflammation

persistent infection prolonged exposure to a toxic agent immune-mediated inflammatory disease

Non-specific chronic inflammation is often associated with what

tissue repair (granulation/fibrosis)

This is linked to delayed-type IV hypersensitivity immune reaction

granulomatous inflammation

What is the morphology of granulomatous inflammation

epithelioid (activated) histiocytes - granular pink cytoplasm with indistinct cell borders central caseous necrosis often present epithelia histiocytes coalesce to form multinucleated giant cells a collar of mononuclear cells often surrounds the aggregated epithelia histiocytes; older granulomas develop a rim of fibroblasts and connective tissue heal by fibrosis

What are some diseases characterized by granulomatous inflammation

``` bacterial (tuberculosis) parasitic (toxo) funfal (histo) inorganic matter unknown (Crohn's) ```

What is the source and function of histamine

source; mast cells | function; vasodilation and increases vascular permeability

What is the source and function of bradykinin

source; plasma protein | function; increase vascular permeability, pain

What is the source and function of nitric oxide

source; endothelial and other cells | function; vasodilation, tissue damage

What is the source and function of prostaglandins

source; membrane phospholipids | function; vasodilation, pain, fever, potentiate other mediators

What is the source and function of leukotrienes C, D, E

source; membrane phospholipid | function; increase vascular permeability, vasoconstriction, bronchoconstriction

What is the source and function of leukotrienes B

source; leukocytes | function; leukocyte activation, chemotaxis

What is the source and function of PAF

source; leukocytes and endothelial cells | function; increase vascular permeability

What is the source and function of cytokines

source; macrophages and endothelial cells | function; endothelial cell and leukocyte activation, fever

What is the source and function of C5a and C3a

source; plasma protein | function; chemotaxis, phagocytosis, increases vascular premeability

What are the seven steps of wound healing by the first (primary) intention

blood clots (minutes) neutrophils early proliferation/migration of epithelial cells macrophages replace neutrophils; early granulation tissue peak neovascularization progressive collagen deposition increasing wound strength during the next four months

What are the two steps of wound healing by second intention

more inflammation; more granulation tissue | wound contraction due to myofibroblasts

What are six factors that affect wound healing

``` infection nutrition steroids mechanical factors poor perfusion diabetes mellitus ```

What are the three categories of the intrinsic capacity for proliferation regarding wound healing

labile (continuously dividing) stable permanent