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Pathology > Inflammation > Flashcards

Inflammation Flashcards

1
Q

What is the initial response to injury?

A

acute inflammation

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2
Q

What is the onset for acute and chronic inflammation?

A
  • acute: fast; minutes or hours
  • chronic: slow; days
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3
Q

What is the cellular infiltration for acute and chronic inflammation?

A
  • acute: neutrophils
  • chronic: macrophages and lymphocytes
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4
Q

What is the tissue injury for acute and chronic inflammation?

A
  • acute: mild and self-limited
  • chronic: severe and progressive
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5
Q

What is the objective of acute and chronic inflammation?

A
  • acute: neutralize microbe
  • chronic: initiate repair
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6
Q

What are the changes asscociated with acute inflammation?

A
  • rubor (redness)
  • calor (heat)
  • tumor (swelling)
  • dolor (pain)
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7
Q

Acute inflammation delivers what 2 things to sites of injury?

A

leukocytes and plasma proteins

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8
Q

What are the steps in acute inflammation?

A
  1. damage recognition signals initiation of response
  2. vascular response permits delivery of inflammatory cells
  3. neutrophil emigration at injured tissue to begin neutralization
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9
Q

What are the 2 ways triggers can be recognized in acute inflammation?

A
  1. toll like receptors
  2. inflammasome
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10
Q

In acute inflammation, what is produced by toll like receptors?

A

inflammatory mediators and tumor necrosis factor

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11
Q

What is a nod-like receptor?

A

protein structure on inflammasome

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12
Q

In acute inflammation, what is produced by the inflammasome?

A

caspase-1 leads to secretion of interleukin-1beta

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13
Q

What are the 2 major components of the mobilization of response elements in acute inflammation?

A

vascular changes and cellular events

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14
Q

What are the vascular changes in acute inflammation?

A
  • vasoconstriction and vasodilation
  • increased vascular permeability (edema)
  • margination
  • endothelial activation
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15
Q

What is the cellular event in acute inflammation?

A

emigration of neutrophils

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16
Q

What is a transudate in edema?

A

small amount of protein in tissue

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17
Q

What is an exudate in edema?

A

increased permeability which allows protein-rich fluid to enter extravascular tissue; protein accumulates

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18
Q

What is margination in leukocyte emigration?

A

as blood flow decreases, WBCs move towards edges of the flow

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19
Q

What is the role of endothelial activation in leukocyte emigration?

A

permits WBC tethering, rolling, activation and adhesion

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20
Q

In acute inflammation, what events are associated with endothelial cell activation?

A

margination & redistribution

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21
Q

What are the selectins associated with acute inflammation?

A

E,P, and L

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22
Q

Where are E selectins found, bound to, and induced by?

A
  • found in endothelial cells
  • bound to sialyl lewis antigens neutrophils
  • induced by TNF and IL-1
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23
Q

Where are P selectins found, bound to, and redistributed by?

A
  • found in endothelial cells
  • bound to sialyl lewis antigens on neutrophils
  • redistributed by histamine, thrombin, and PAF
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24
Q

Where are L selectins found and bound to?

A
  • found on WBCs (lymphocytes, neutrophils)
  • bound to CD34 on endothelium
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25
Q

What is important for inflammatory cell transmigration?

A

PECAM/CD31

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26
Q

What is diapedesis?

A

allows neutrophils to sqeeze between cells

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27
Q

What do inflammatory cells secrete to help direct neutrophils to inflammatory site?

A

proteases and chemotactic factors

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28
Q

What is known as the hallmark cell of acute inflammation?

A

neutrophils

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29
Q

What is the function of neutrophils?

A

phagocytize bacteria debris

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30
Q

What are the 2 systems for killing bacteria?

A

oxygen dependent and independent

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31
Q

What are the 3 steps of neutrophil phagocytosis?

A
  1. recognition/attachment of particle to leukocyte
  2. engulfment with formation of a phagocytic vacuole
  3. killing/degradation of ingested material
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32
Q

What are the characteristics of oxygen dependent?

A
  • H2O2 production
  • H2O2 -myeloperoxidase halide system
  • superoxide via NADPH system
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33
Q

What are the characteristics of oxygen independent?

A
  • lysozyme, defensins, lactoferin
  • bactericidal permeability increasing protein
  • H+ ion
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34
Q

What are the 3 types of morphology of acute inflammation?

A
  • fibrinous
  • suppurative (purulent)
  • serous
  • hemorrhagic
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35
Q

What are the characteristics of serous inflammation?

A
  • blister (clear fluid)
  • watery
  • effusion (fluid in blister cavity)
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36
Q

What are the characteristics of suppurative inflammation?

A
  • pus, bacteria, proteins, neutrophils
  • abscesses: closed chronic focal collections of pus
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37
Q

What are the characteristics of fibrinous inflammation?

A
  • endothelial cells become very permeable (fibrinogen passes)
  • occurs on lining of body cavities
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38
Q

What type of inflammation produces scar tissue?

A

chronic

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39
Q

What are the casues of chronic inflammation?

A
  • persistent infections
  • immune-mediated inflammatory diseases
  • prolonged exposure
  • persistent mild chronic inflammation
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40
Q

Macrophages play a major function in what?

A

phagocytosis

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41
Q

What are contents of eosinophile granules?

A
  • major basic protein
  • eosinophil cationic protein
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42
Q

What mediators do macrophages secrete in inflammation?

A
  • TNF
  • IL-1
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43
Q

What do macrophages ingest and eliminate?

A

dead cells/tissues and pathogens

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44
Q

What requires activation for phagocytic activity?

A

macrophages

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45
Q

What are the 2 types of macrophage activation?

A

classical and alternative

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46
Q

In classical activation, IFN-y produces what?

A
  • IL-1, IL-12, IL-23
  • ROS, NO, lysosomal enzymes
47
Q

What type of macrophage activation is responsible for microbicidal actions and inflammation?

A

classic

48
Q

In alternative activation, what does IL-13 and IL-14 produce?

A
  • TGF-beta
  • IL-10
49
Q

What type of macrophage activation is responsible for tissue repair, fibrosis, and anti-inflammatory effects?

A

alternative

50
Q

What is important for humoral response of immune system?

A

lymphocytes

51
Q

What are the type of T cells in lymphocytes?

A
  • CD8 + cytotoxic
  • CD4 + helper
52
Q

What is the role of a TH1 CD4 helper cell?

A
  • produce IFN-y
  • activates macrophages in classical pathway
53
Q

What is the role of a TH2 CD4 helper cell?

A
  • secrete IL-4, IL-5, and IL-13
  • recruits eosinophils
  • activates macrophages in alternate pathway
54
Q

What is the role of a TH17 CD4 helper cell?

A
  • secrete IL-17
  • recruits neutrophils and monocytes to inflammatory reaction
55
Q

What 2 cytokines are responsible for leukocyte recruitment and inflammation?

A

TNF and IL-1

56
Q

What are eosinophils regulated by?

A

IL-5, IL-3, and GM-CSF

57
Q

What are the granule constituents of eosinophils?

A
  • major basic protein toxic to some parasites
  • cytotoxic agents
58
Q

Where are basophils and mast cells found?

A
  • basophils: blood
  • mast cells: tissue
59
Q

What are platelets?

A

membrane bound discs of cytoplasm

60
Q

What are platelets involved in?

A
  • coagulation
  • immune reactions
  • inflammation
61
Q

What are the alpha granules?

A
  • P selectin on membrane
  • TGF-beta
62
Q

What is the delta granule?

A

histamine

63
Q

What are the types of morphology in chronic inflammation?

A

granuloma and ulcers

64
Q

What is granuloma?

A

central necrotic core containing aggregates of macrophages and ring of lymphocytes

65
Q

Macrophages can fuse into what size of cell?

A

giant

66
Q

What are granulomas associated with?

A
  • persistent T-cell
  • inert foreign body
  • certain microbes
  • tuberculosis
67
Q

What are the characteristics of cellulitis?

A
  • diffuse edematous spreading inflammation
  • red & tender
  • bacterial infection of skin & tissues beneath
68
Q

What are the characteristics of an ulcer?

A
  • damaged beyond endothelial tissue
  • local defects in surface of organ/tissue
  • produced by sloughing of necrotic tissue
69
Q

Inflammation is a …. …. event

A

self-limiting

70
Q

What are the preformed mediators in secretory granules?

A

histamine & serotonin

71
Q

What are the newly synthesized chemical mediators?

A
  • prostaglandins
  • nitric oxide
  • cytokines
72
Q

What are the plasma chemical mediators?

A
  • C3a, C5a, C3b, and C5b-9
  • bradykinin
73
Q

What are the characteristics of cell derived mediators?

A
  • in granules
  • newly synthesized
74
Q

What are the characteristics of plasma derived mediators?

A
  • complement
  • coagulation
  • kinin/fibrinolytic
75
Q

Which of the preformed mediators is distributed throughout the body?

A

histamine

76
Q

Which of the preformed mediators plays a role in vasoconstriction and vasodilation?

A

histamine

77
Q

Which of the preformed mediators is associated with platelet aggregation?

A

serotonin

78
Q

What are the 2 pathways of arachidonic acid?

A

cyclooxygenase and 5-lipoxygenase

79
Q

What is the cyclooxygenase pathway?

A

prostaglandin G2 & H2 > PGI2, TxA2, PGE1, PGE2, PGD2, and PGF2alpha

80
Q

What are the inhibitors of the cyclooxygenase pathway?

A

COX-1 and COX-2

81
Q

Which of the products from the cyclooxygenase pathway results in vasodilation and inhibition of platelet aggregation?

A

PGI2

82
Q

Which product from the cyclooxygenase pathway results in vasoconstriction and platelet aggregation?

A

TxA2

83
Q

What is the lipoxygenase pathway?

A
  • 5-lipoxygenase> LTA4, LTC4, LTD4, LTE4
  • 12-lipoxygenase> LXA4, LXB4
84
Q

What is the role of 5-lipoxygenase?

A

to produce vasoconstriction, bronchospasm, and increased vascular permeability in leukocytes

85
Q

What is LTB4 associated with 5-lipoxygenase?

A

chemotaxis/ aggregation/ adhesion of neutrophils to endothelial cells

86
Q

What is the role of 12-lipoxygenase?

A

inhibit neutrophil chemotaxis & attenuate LTC4- induced vasoconstriction

87
Q

What are the 3 isoforms of NOS?

A

endothelial-NOS, neuronal-NOS, and inducible-NOS

88
Q

What are the characteristics of endothelial and neuronal NOS?

A
  • relax smooth muscle
  • reduce platelet aggregation
  • inhibit leukocyte rolling, adhesion, degranulation
89
Q

What are the characteristics of inducible NOS?

A
  • induced monocytes and macrophages by TNF & IL-1
  • microbiocidal alone or with reactive species
90
Q

What are the 2 types of cytokines?

A

IL-1 and TNF

91
Q

What are the endothelial effects of cytokines?

A

induction of IL-1, 6, 8, PDGF, and NO production

92
Q

What are the fibroblast actions of cytokines?

A
  • fibroblast proliferation and collagen synthesis
  • collagenase and protease production
  • increased PGE synthesis
93
Q

What is the complement cascade?

A

part of immune system that enhances ability of antibodies and phagocytic cells to promote inflammation

94
Q

What is the pathway of the complement system?

A
  • C3 >C3a and C3b
  • C5 > C5a and C5b > C5-9
95
Q

What does C5b-C9 form in the complement system?

A

membrane attack complex

96
Q

What does the kinin cascade activate?

A

prekallikrein to kallikrein to produce bradykinin

97
Q

What are the physiological functions of bradykinin?

A
  • pain
  • increase vascular permeability
  • smooth muscle contraction
  • arteriolar dilation
98
Q

What is lymphangitis?

A

inflammation of lymphatic vessels

99
Q

What lymphadenitis?

A

inflammaion of enlarged lymph nodes due to infection

100
Q

What is chronic lymphadenitis?

A

proliferative process with follicular hyperplasia

101
Q

What is the systemic influence of inflammatory mediators a production of?

A

acute phase reactants/reaction

102
Q

What 2 things mediate acute phase response?

A

TNF & IL-1

103
Q

What are the 4 systemic effects of inflammation?

A
  • elevated plasma levels
  • leukocytosis
  • fever (most common)
  • septic shock
104
Q

What is the protein secreted from elevated plasma levels?

A

C-reactive protein

105
Q

Septic shock generates what cytokines?

A

TNF & IL-1

106
Q

What do high levels of cytokines induce?

A
  • adult respiratory distress syndrome
  • cardiac failure and vasodilation
  • activation of coagulation and firbinolysis
  • end organ damage
107
Q

What is adult respiratory distress syndrome characterized by?

A
  • IL-1 & TNF
  • damage to alveolar walls
  • hypoxia
108
Q

When does adult respiratory distress syndrome occur?

A
  • trauma severe burns
  • prolonged hypoxia
  • inhaled irritants
109
Q

What is midline destructive lesion? (case study)

A

perforation of nasal septum with friable granular surface and necrotic tissue

110
Q

What are the 5 main causes of midline destructive lesion? (case study)

A
  • Wegner’s/GPA
  • sarcoidosis
  • extranodal NK/T-cell lymphoma
  • cocaine
  • infections
111
Q

What did the patient with the nasal issue initially test positive for? (case study)

A

entero. faec. & staph. aureus

112
Q

What was the initial treatment for the patient with the nasal issue? (case study)

A

antibiotic therapy and fabrication of palatal obturator to restore palate function

113
Q

What stood out in the patients blood and urine analysis?

A
  • C-reactive protein was high> suggest inflammation
  • positive for (p-ANCA)
  • negative for myeloperoxidase> suspect CIMDL

Pathology (7 decks)

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