Exam 2 Flashcards
Inflammation
reaction to living tissue to injury
innate defensive mechanism. stereotyped response, blood derived components, may be more harmful than inciting injury
important to control inflammation through drugs NSAID or steroids
most things that can injure tissues, living or inanimate, endogenous or exogenous
it is a steotypical and defensive response to rid tissue of injury, reove damaged tissue, initiate healing and repair
What are the cardinal signs of inflammation?
Hemodynamic changes, increase in vascular permeability, and efflux of WBC
Arteriolar constriction
a hemodynamic event of inflammation that is a direct action of injurious stimulation on vessel wall and local neurogenic reflex with epinephrine release
Hemodynamic events of inflammation
arteriolar constriction, vasodilation and opening of capillary beds, increased hydrostatic pressure, and slowing/stasis of blood flow
Vasodilation in inflammation
a hemodynamic event where arterioles, pre-capillaries, and effluent veins dilute
histamine acts on venules
bradykinin and some prostaglandins relax vascular smooth muscle
Edema with inflammation
hyperemia and venous engorgement lead to increased hydrostatic pressure
increased hydrostatic pressure favors fluid efflux. from the vessel (edema) this fluid loss from vasculature leads to hemo-concentration and decreases blood flow
permeability changes with inflammation
primarily venular leakage but arterioles and capillaries leak in more severe injuries
increased vascular permeability- low protein with mild injurt
with further damage, protein rich exudate, leakage of proteins enhances osmotic pull of fluid into interstitium
Chemical mediators of vascular permeability
vasoactive amines (esp released by mast cells), kinins, complement fragments, arachidonic acid mediators, cytokines, platelet activating factor
serous inflammation
exudation of thin watery fluid
most apparent on body or organ surfaces
may be perceived in tissue as edema
functions to dilute or wash away injurious agent
common causes are environmental, irritants, trauma, early infectious process
Catarrhal inflammation
can only occur in tissues containing goblet cells, appears as shiny mucoid material coating mucosal surfaces
serves to dilute, wash away injurious agent (provide a barrier)
caused by irritants, infectious processes affecting mucus membrane
called an exudate but is a glandular secretory product, not a product of increased vascular permeability.
fibrinous inflammation
the increased vascular permeability results in exudation of fibrinogen from the blood which polymerizes into fibrin polymer.
visible exudate which polymerized fibrin is present
fibrin forms adherent strands and sheet which can be stripped off surfaces
most visible on serosal surfaces and in response to infectious disease
functions to wall off the agent and serves as a matrix for migration of WBC, endothelial cells and fibroblasts into the injured area
Neutrophils
first line of defense in response to any injury but often associated with foci of bacterial infection
circulating and marginated pools
short lived
actively phagocytic
glycolytic metabolism
produce oxidative species in response to phagocytic stimulus
release enzymes, antimicrobial molecules and secrete pro-inflammatory mediators
granule contents expelled by degranulation
Suppurative/Purulent Inflammation
dominated by neutrophils, marked by vascular exudation
tissue at site is typically liquified with thick creamy to yellow exudate
usually in response to infectious agent
immediate defensive reaction
acute Stimulus
WBC emigration
neutrophils emigrate within 1 hour, short lifespan in the tissue
macrophages enter after 12-48 hours, capable of long life in tissue, may undergo mitosis
lymphocytes slow to enter tissue, capable of mitosis in tissue
How do neutrophils cross endothelial cells with activation?
Neutrophils in the blood roll, adhesion, and transmigrate across endothelial cells
selectins allow neutrohpils to roll and slow across the surface and integrins
stimulus: endothelial activation, leukocyte activation and chemotaxis activation
Chemotaxis
a direct motion up concentration gradient
surface receptors sense gradient
cell rearranges its cytoplasm
molecules: C5a, bacterial products, leukotrienes, fibrin degradation products, WBC products (IL-8, MCP-1, PAF)
Phagocytosis
uptake and destruction of particulate matter
macrophages and neutrophils most important
purpose:
1) destroy injurious agent
2) clean up tissue debris
Opsonization
surface of particle coated with material that aids recognition by phagocytes and needed for phagocytosis–> allows binding
C3b and C3bi, immunoglobin, lysozyme, fibronectin
What happens once bacteria is opsonized?
It gets engulfed, a phagocytic vacuole is formed which fuses with the lysosome (phagolysosome) , this kills the bacteria and it is digested to later have debris extruded
Oxygen-dependent killing
tremendous oxygen uptake by neutrophils
NADPH oxidase reduces oxygen to super-oxide and subsequent reactions form to produce hydrogen peroxide, hydroxyl radical, singlet oxygen, secondary reactive nitrogen oxides, hydroxyl radical, singlet oxygen, secondary reactive nitrogen oxides, hypohalous species
How can neutrophils damage tissues?
destructive enzymes can be released into the tissue upon cell death and membrane rupture
Cellulitis
purulent inflammation of connective tissues
(suppurative inflammation)
contained to the skin
Phlegmon
suppurative inflammation where there is a fluctuant pocket of pus in the subcutis
Fasciitis
purulent inflammation of fascia (suppurative inflammation)
Abscess
a local collection of pus (suppurative inflammation)
Empyema
accumulation of pus in the body cavity
(suppurative inflammation)
guttural pouch common site for this
Fibrinopurulent inflammation
acute inflammation is characterized by increased vascular permeability, this means there is a concurrent exudation of both fibrin and neutrophils leading to this.
Heterophils
the avian, reptile, rabbit, and amphibian equivalent of neutrophils
essentially lack the enzymes to liquify and therefore heterophilic lesions are caseated
Heterophilic lesions
often caseous because heterophils lack the enzymes to liquify
eosinophilic inflammation
exudate that contains many eosinophils, lesions are often edematous
may give tissues greenish hue
associated with allergic, hypersensitivity reactions, fungal infections, and parasitic infestations
mucosal tissues
respond to eotaxisn from mast cells
weakly phagocytic
secretory cells
What appearance do tissues with eosinophilic inflammation commonly have?
a greenish hue from major basic protein
Eosinophil granules
secretory products inactivate mast cell-derived mediators
major basic protein - disrupts helminth cuticle
arylsulfatase- inactivates LtC4, D4, and E4
enzymes- histiminase inactivates histamine, phospholipase D inactivates PAF
Mast. cells
associated with allergic and hypersensitivity reactions
-granules stain metachromatically with T. blue
mucosal surfaces and within parenchymal organs
mitotically active
Lymphocytic and Lymphoplasmacytic inflammation
the accumulation of lymphocytes and plasma cells, may form aggregates, follicles, cuff vessels
processes with immune component, esp. viral infection
may be describe as subacute or non-suppurative
seldom visible grossly, except on mucosal surfaces (ex: cherry eye)
Macrophages
circulate for 24-72 hours
activation and differentiation into macrophage occurs upon emigration
modulate inflammation, immunity, and repair processes, actively phagocytic, and secretory, debride tissue debris, present antigen, primarily oxidative respiration
Subtypes: alveolar, pulmonary intravascular, microglia, kuppfer, epithelioid, and multinucleate giant cells
can survive in tissue and undergo mitosis
What is the function of macrophages?
modulate inflammation, immunty and repair processes (fibrogenic growth factors)
actively phagocytic and secretory
debride tissue debris
present antigen
primarily oxidative respiration
What is the outcome of acute inflammation?
1) Complete resolution (best option)
2) scarring
3) abscessation
4) chronic inflammation- if the innate response was not successful
What are the causes of chronic inflammation?
1) continuation of acute inflammation
2) chronic repeated injury
3) insidious onset without apparent acute inflammatory phase
chronic inflammation
prolonges course characterized by simulataneous inflammation, tissue destruction, and attempted healing
associated with persistent or recurrent stimulus of injury, often including persistent antigenic stimulus
What is the key cell type in chronic inflammation?
the macrophage
Chronic-active inflammation
esp. pyogranulomatous
characterized by recurrent bouts of reddening/obvious exudative change and periods of relative quiet
certain to be progressive injury and significant scaring
pyogranulomatous
chronic inflammation with responses from both neutrophils and macrophages (chronic active)
granulomatous inflammation
form of chronic inflammation in which “epithelioid” macrophages predominate
can be mixed with other cell types like pyogranulomatous (as in furunculosis)
eosinophilic granulomatous
lymphogranulomatous
Furunculosis
a deep infection of the hair follicle leading to abscess formation with accumulation of pus and necrotic tissue
pyogranulomatous
granuloma
discrete aggregate of epithelioid macrophages with mantle of lymphoid cells and peripheral fibrosis
may also have: central necrotic debris or a foreign body, dystrophic mineralization (caseation), multinucleate giant cells
foreign body granuloma
formed in response to indigestible material: keratin, hair, plant material
immune granuloma
persistent antigen with T-cell response
gossypiboma
or gauzoma where a textile or cotton substance is retained within the body following surgical procedures
becomes encapsulated by macrophages and fibrosis
Healing and repair
occurs by parenchymal regeneration
regeneration and fibrosis (scarring)
replacement by fibrous tissue, occurs when:
stomal framework destroyed, permanent cell population damaged, exudate cannot be reabsorbed
Labile populations
cells that have easy regenerative capacity of tissue (ex: gi tract, and primates with menstrual cycles)
stable population
cells with medium regenerative capacity
(smooth muscle, cartilage)
permanent cells
cells that do not have regenerative capacity
ex: neurons and cardiac muscles and red blood cells
growth factors (healing)
proteins that regulate growth and regeneration. they are also involved in neoplasia
mitogenic and chemotactic
Ex: epidermal growth factor, platelet-derived growth factor, macrophage-derived growth factors, vascular endothelial growth factors, transforming growth factor, fibroblast growth factor
Phases of wound healing
1) inflammation (+ blood clot and neutrophil)
2) cell migration (macrophage, fibroblast, endothelial)
3) matrix deposition (collagen from fibroblast)
4) vascular proliferation (to support cells)
5) collagen synthesis
6) remodeling - scar becomes smaller with remodeling
granulation tissue
proliferation of fibrovascular tissue that fills tissue defect and provides framework for elaboration of fibrous tissue
Granulation tissue formation
1) inflammatory phase- inflammatory response initiates healing process
2) proliferative phase- rapid growth of delicate fibrovascular tissue
3) remodeling phase- collagen fibers are replaced and reorganized, vascular regresses
What cells are involved in granulation tissue?
-macrophages remove exudate, secrete fibrogenic and angiogenic factors to influence healing
-fibroblasts- lay down collagen matrix. myofibroblasts have contractile activity reducing wound volume
-endothelial cells provide vascular supply to new connective tissue
Process of wound healing
wound edges opposed, rapid healing with minimal scar tissue
delayed first intention- the wound is left open to clean up tissue debris/infection before surgical closure
second intention- defect filled with granulation tissue, there is a prolonged course and potential for significant scarring
Hypertrophic scar
a raised scar that remains within the wound margin. an outcome of healing
Keloid
a raised scar that extends beyond the original wound margin
a possible outcome of healing
ankylosis
a joint is fixed in place, can be septic or fibrous (fixed by CT)
an adverse possible outcome of healing
Stricture
lumen structure that is decreased
an adverse outcome of healing
cell proliferation
the mitotic division of stem cells or partially differentiated precursors
cell differentiation
progressive acquisition of specialized structure and function as cells mature
usually by altered/restricted gene expression
progressive loss of capacity to divide
cell turnover
loss and renewal to maintain organ mass appropriately
replacement of cells lost during normal tissue function
adult- usually individual cell loss, DNA double strand breaks, toxins, etc.
development- tissue/organ shifts
Proto-oncogenes
normal genes where normal gene products involved in promotion of cell proliferation and tissue growth
oncogenes
abnormal forms with non-functional regulatory elements drive proliferation of cancer cells
drive proliferation bc they arent regulated
growth factors
drive cell differentiation and proliferation
inhibit cell death (apoptosis)
the same growth factor may cause both proliferation and differentiation
TGF-beta stimulates proliferation and differentiation of epithelial cells