Inflammation

Question 1

Cellular Injury

Answer 1

Anything that causes damage to cells

The trigger for the inflammatory process

Question 2

The first five steps of the inflammatory process

Answer 2

Mast cell degranulation

Activation of the coagulation cascade

Activation of the kinin cascade

Release of chemotactic factors

Activation of the complement cascade

Question 3

Complement system

Answer 3

Functions include bacterial lysis, vasodilation and increased vascular permeability, triggers mast cell degranulation, chemotaxis and opsonization (immune system process that uses opsonins to tag foreign pathogens for elimination by phagocytes)

Question 4

Kinin

Answer 4

Turn into bradykinin which is responsible for pain, chemotaxis, and increased vascular permeability and vasodilation

Question 5

Coagulation cascade

Answer 5

Role in activating the kinin system, factor XII hangman factor (intrinsic coagulation cascade) also activates kinin
—> goal to form a fibrin mesh to stop bleeding and to trap microorganisms

Question 6

Chemotactic factors

Answer 6

Attract neutrophils, eosinophils and monocytes all which begin phagocytosis

Neutrophils first to respond in 6-8 hr

Monocytes respond in 1-7 days

Neutrophils and monocytes —> eventually die and release intracellular contents

—> triggers acute phase reactants

Question 7

Mast cell degranulation

Answer 7

Major step of inflammatory cascade

Results in the activation of acute cell reactants

Degranulation —> releases histamine, cytokines, leukotrienes, platelet-activating factor and prostaglandins

Question 8

Histamine

Answer 8

Histamine is responsible for causing vasodilation, increases vascular permeability and increases blood flow to the site of injury

—> erythema and swelling

H1
Receptors promote inflammation
Present in smooth muscle especially bronchi
When stimulated —> bronchoconstriction
Basis for asthma attack or reactive airway disease

H2
Receptors having anti-inflammatory properties
Found in gastric mucosa
Stimulation of H2 receptors induces secretion of gastric acid
Drugs such as ranitidine, Tagamet and famotidine inhibit H2 receptors

Question 9

Cytokines

Answer 9

Can react quickly or may be more delayed

IL4 is released early in the inflammatory response
- responsible for B cell proliferation & antibody production

IL13 is released later in the inflammatory response
- chemotaxis, B cell proliferation & antibody production

TNF (tumor necrosis factor) is releases in early and late inflammatory response
-leukocyte emigration
-increased vascular permeability

Question 10

Leukotrienes

Answer 10

Known as slow reaction substances of anaphylaxis (SRS-A)
Tend to prolong the inflammatory response
Cause vasodilation and attract neutrophils, monocytes and eosinophils

Target of inhibition for the drug singular

Question 11

Prostaglandins

Answer 11

Produced by the arachidonic pathway

Function to cause vasodilation, platelet aggregation at the site of injury, pain and fever

Question 12

Platelet-activating factor (PAF)

Answer 12

Derived from fatty acids in the plasma membrane
Can be made by neutrophils, monocytes, endothelial cells and platelets

Works in a similar fashion as leukotrienes and causes endothelial cell retraction, increased vascular permeability, activates platelets and enhances leukocyte adhesion to endothelial cells

Question 13

Monocytes (additional fx’s)

Answer 13

Monocytes become macrophages when they enter the tissue

Responsible for presenting antigens to the CD4 cells which trigger T cell immunity

Monocytes release cytokines
-IL1 :Fever, activates phagocytes and lymphocytes —> also increases the release of IL6
-IL6 :Stimulates the production of acute phase reactants and promotes the growth and stimulation of RBCs
-TNF :fever, increases secretion of pro inflammatory proteins by the liver, muscle wasting and induces thrombosis
-Growth Factor :promote the production and maturation of neutrophils

Question 14

Inflammation diseases

Answer 14

Pathophysiologic process of asthma, autoimmune diseases, lupus, RA, gout, atherosclerosis m cerebral edema, cirrhosis, and hepatitis

Inflammation can be acute or chronic

Chronic inflammation —> pathological process —> permanent organ damage/tissue scaring

Question 15

Polyunsaturated fats

Answer 15

Essential fatty acids which can only be derived from diet

Omega- 3 and Omega- 6

Question 16

Omega 6

Answer 16

Found in vegetable oils and contain linolenic acid

Some anti-inflammatory process but mainly proinflammatory

Healthy diet has less Omega 6 fatty acids

The enzyme delta-5-desturase breaks down both fatty acids —> breaks down Omega 3 first then Omega 6

Causing more Omega 6 to turn into a proinflammatory substance

Diet high in Omega 6
-increases risk of CV disease and chronic inflammation

Vegetable oil, canola oil, sesame oil, safflower oil, corn oil, and grape seed oil high in Omega 6

Sunflower oil (healthiest of the Omega 6 oils)

Question 17

Omega 3

Answer 17

Alpha-linolenic acid

Found in olive oil, avocado oil, avocados, walnuts, flaxseeds, leafy green vegetables, grass feed meat, wild fish, wild game, and free-range poultry.

Omega 3 breaks down into EPA and DHA

EPA converted into anti-inflammatory prostaglandins

Healthy ratio Omega 3 to Omega 6 —> 4:1

Delta-5-desturase—> enzymes that breaks down fatty acids (Omega 3 first)

High Omega 3 diet
Decreased risk of CV disease, CA, and other conditions associated with inflammation

Lowers triglycerides levels, BP, increases NO production, decrease thrombosis
Stabilize and reverse atherosclerotic plaques and causes endothelial relaxation

Grass feed butter, coconut oil, avocado oil are all good healthy oils