Inflammation Flashcards
1
Q
What is the initial response to injury?
A
acute inflammation
2
Q
What is the onset for acute and chronic inflammation?
A
- acute: fast; minutes or hours
- chronic: slow; days
3
Q
What is the cellular infiltration for acute and chronic inflammation?
A
- acute: neutrophils
- chronic: macrophages and lymphocytes
4
Q
What is the tissue injury for acute and chronic inflammation?
A
- acute: mild and self-limited
- chronic: severe and progressive
5
Q
What is the objective of acute and chronic inflammation?
A
- acute: neutralize microbe
- chronic: initiate repair
6
Q
What are the changes asscociated with acute inflammation?
A
- rubor (redness)
- calor (heat)
- tumor (swelling)
- dolor (pain)
7
Q
Acute inflammation delivers what 2 things to sites of injury?
A
leukocytes and plasma proteins
8
Q
What are the steps in acute inflammation?
A
- damage recognition signals initiation of response
- vascular response permits delivery of inflammatory cells
- neutrophil emigration at injured tissue to begin neutralization
9
Q
What are the 2 ways triggers can be recognized in acute inflammation?
A
- toll like receptors
- inflammasome
10
Q
In acute inflammation, what is produced by toll like receptors?
A
inflammatory mediators and tumor necrosis factor
11
Q
What is a nod-like receptor?
A
protein structure on inflammasome
12
Q
In acute inflammation, what is produced by the inflammasome?
A
caspase-1 leads to secretion of interleukin-1beta
13
Q
What are the 2 major components of the mobilization of response elements in acute inflammation?
A
vascular changes and cellular events
14
Q
What are the vascular changes in acute inflammation?
A
- vasoconstriction and vasodilation
- increased vascular permeability (edema)
- margination
- endothelial activation
15
Q
What is the cellular event in acute inflammation?
A
emigration of neutrophils
16
Q
What is a transudate in edema?
A
small amount of protein in tissue
17
Q
What is an exudate in edema?
A
increased permeability which allows protein-rich fluid to enter extravascular tissue; protein accumulates
18
Q
What is margination in leukocyte emigration?
A
as blood flow decreases, WBCs move towards edges of the flow
19
Q
What is the role of endothelial activation in leukocyte emigration?
A
permits WBC tethering, rolling, activation and adhesion
20
Q
In acute inflammation, what events are associated with endothelial cell activation?
A
margination & redistribution
21
Q
What are the selectins associated with acute inflammation?
A
E,P, and L
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
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
24
Q
Where are L selectins found and bound to?
A
- found on WBCs (lymphocytes, neutrophils)
- bound to CD34 on endothelium
25
What is important for inflammatory cell transmigration?
PECAM/CD31
26
What is diapedesis?
allows neutrophils to sqeeze between cells
27
What do inflammatory cells secrete to help direct neutrophils to inflammatory site?
proteases and chemotactic factors
28
What is known as the hallmark cell of acute inflammation?
neutrophils
29
What is the function of neutrophils?
phagocytize bacteria debris
30
What are the 2 systems for killing bacteria?
oxygen dependent and independent
31
What are the 3 steps of neutrophil phagocytosis?
1. recognition/attachment of particle to leukocyte
2. engulfment with formation of a phagocytic vacuole
3. killing/degradation of ingested material
32
What are the characteristics of oxygen dependent?
* H2O2 production
* H2O2 -myeloperoxidase halide system
* superoxide via NADPH system
33
What are the characteristics of oxygen independent?
* lysozyme, defensins, lactoferin
* bactericidal permeability increasing protein
* H+ ion
34
What are the 3 types of morphology of acute inflammation?
* fibrinous
* suppurative (purulent)
* serous
* hemorrhagic
35
What are the characteristics of serous inflammation?
* blister (clear fluid)
* watery
* effusion (fluid in blister cavity)
36
What are the characteristics of suppurative inflammation?
* pus, bacteria, proteins, neutrophils
* abscesses: closed chronic focal collections of pus
37
What are the characteristics of fibrinous inflammation?
* endothelial cells become very permeable (fibrinogen passes)
* occurs on lining of body cavities
38
What type of inflammation produces scar tissue?
chronic
39
What are the casues of chronic inflammation?
* persistent infections
* immune-mediated inflammatory diseases
* prolonged exposure
* persistent mild chronic inflammation
40
Macrophages play a major function in what?
phagocytosis
41
What are contents of eosinophile granules?
* major basic protein
* eosinophil cationic protein
42
What mediators do macrophages secrete in inflammation?
* TNF
* IL-1
43
What do macrophages ingest and eliminate?
dead cells/tissues and pathogens
44
What requires activation for phagocytic activity?
macrophages
45
What are the 2 types of macrophage activation?
classical and alternative
46
In classical activation, IFN-y produces what?
* IL-1, IL-12, IL-23
* ROS, NO, lysosomal enzymes
47
What type of macrophage activation is responsible for microbicidal actions and inflammation?
classic
48
In alternative activation, what does IL-13 and IL-14 produce?
* TGF-beta
* IL-10
49
What type of macrophage activation is responsible for tissue repair, fibrosis, and anti-inflammatory effects?
alternative
50
What is important for humoral response of immune system?
lymphocytes
51
What are the type of T cells in lymphocytes?
* CD8 + cytotoxic
* CD4 + helper
52
What is the role of a TH1 CD4 helper cell?
* produce IFN-y
* activates macrophages in classical pathway
53
What is the role of a TH2 CD4 helper cell?
* secrete IL-4, IL-5, and IL-13
* recruits eosinophils
* activates macrophages in alternate pathway
54
What is the role of a TH17 CD4 helper cell?
* secrete IL-17
* recruits neutrophils and monocytes to inflammatory reaction
55
What 2 cytokines are responsible for leukocyte recruitment and inflammation?
TNF and IL-1
56
What are eosinophils regulated by?
IL-5, IL-3, and GM-CSF
57
What are the granule constituents of eosinophils?
* major basic protein toxic to some parasites
* cytotoxic agents
58
Where are basophils and mast cells found?
* basophils: blood
* mast cells: tissue
59
What are platelets?
membrane bound discs of cytoplasm
60
What are platelets involved in?
* coagulation
* immune reactions
* inflammation
61
What are the alpha granules?
* P selectin on membrane
* TGF-beta
62
What is the delta granule?
histamine
63
What are the types of morphology in chronic inflammation?
granuloma and ulcers
64
What is granuloma?
central necrotic core containing aggregates of macrophages and ring of lymphocytes
65
Macrophages can fuse into what size of cell?
giant
66
What are granulomas associated with?
* persistent T-cell
* inert foreign body
* certain microbes
* tuberculosis
67
What are the characteristics of cellulitis?
* diffuse edematous spreading inflammation
* red & tender
* bacterial infection of skin & tissues beneath
68
What are the characteristics of an ulcer?
* damaged beyond endothelial tissue
* local defects in surface of organ/tissue
* produced by sloughing of necrotic tissue
69
Inflammation is a .... .... event
self-limiting
70
What are the preformed mediators in secretory granules?
histamine & serotonin
71
What are the newly synthesized chemical mediators?
* prostaglandins
* nitric oxide
* cytokines
72
What are the plasma chemical mediators?
* C3a, C5a, C3b, and C5b-9
* bradykinin
73
What are the characteristics of cell derived mediators?
* in granules
* newly synthesized
74
What are the characteristics of plasma derived mediators?
* complement
* coagulation
* kinin/fibrinolytic
75
Which of the preformed mediators is distributed throughout the body?
histamine
76
Which of the preformed mediators plays a role in vasoconstriction and vasodilation?
histamine
77
Which of the preformed mediators is associated with platelet aggregation?
serotonin
78
What are the 2 pathways of arachidonic acid?
cyclooxygenase and 5-lipoxygenase
79
What is the cyclooxygenase pathway?
prostaglandin G2 & H2 > PGI2, TxA2, PGE1, PGE2, PGD2, and PGF2alpha
80
What are the inhibitors of the cyclooxygenase pathway?
COX-1 and COX-2
81
Which of the products from the cyclooxygenase pathway results in vasodilation and inhibition of platelet aggregation?
PGI2
82
Which product from the cyclooxygenase pathway results in vasoconstriction and platelet aggregation?
TxA2
83
What is the lipoxygenase pathway?
* 5-lipoxygenase> LTA4, LTC4, LTD4, LTE4
* 12-lipoxygenase> LXA4, LXB4
84
What is the role of 5-lipoxygenase?
to produce vasoconstriction, bronchospasm, and increased vascular permeability in leukocytes
85
What is LTB4 associated with 5-lipoxygenase?
chemotaxis/ aggregation/ adhesion of neutrophils to endothelial cells
86
What is the role of 12-lipoxygenase?
inhibit neutrophil chemotaxis & attenuate LTC4- induced vasoconstriction
87
What are the 3 isoforms of NOS?
endothelial-NOS, neuronal-NOS, and inducible-NOS
88
What are the characteristics of endothelial and neuronal NOS?
* relax smooth muscle
* reduce platelet aggregation
* inhibit leukocyte rolling, adhesion, degranulation
89
What are the characteristics of inducible NOS?
* induced monocytes and macrophages by TNF & IL-1
* microbiocidal alone or with reactive species
90
What are the 2 types of cytokines?
IL-1 and TNF
91
What are the endothelial effects of cytokines?
induction of IL-1, 6, 8, PDGF, and NO production
92
What are the fibroblast actions of cytokines?
* fibroblast proliferation and collagen synthesis
* collagenase and protease production
* increased PGE synthesis
93
What is the complement cascade?
part of immune system that enhances ability of antibodies and phagocytic cells to promote inflammation
94
What is the pathway of the complement system?
* C3 >C3a and C3b
* C5 > C5a and C5b > C5-9
95
What does C5b-C9 form in the complement system?
membrane attack complex
96
What does the kinin cascade activate?
prekallikrein to kallikrein to produce bradykinin
97
What are the physiological functions of bradykinin?
* pain
* increase vascular permeability
* smooth muscle contraction
* arteriolar dilation
98
What is lymphangitis?
inflammation of lymphatic vessels
99
What lymphadenitis?
inflammaion of enlarged lymph nodes due to infection
100
What is chronic lymphadenitis?
proliferative process with follicular hyperplasia
101
What is the systemic influence of inflammatory mediators a production of?
acute phase reactants/reaction
102
What 2 things mediate acute phase response?
TNF & IL-1
103
What are the 4 systemic effects of inflammation?
* elevated plasma levels
* leukocytosis
* fever (most common)
* septic shock
104
What is the protein secreted from elevated plasma levels?
C-reactive protein
105
Septic shock generates what cytokines?
TNF & IL-1
106
What do high levels of cytokines induce?
* adult respiratory distress syndrome
* cardiac failure and vasodilation
* activation of coagulation and firbinolysis
* end organ damage
107
What is adult respiratory distress syndrome characterized by?
* IL-1 & TNF
* damage to alveolar walls
* hypoxia
108
When does adult respiratory distress syndrome occur?
* trauma severe burns
* prolonged hypoxia
* inhaled irritants
109
What is midline destructive lesion? (case study)
perforation of nasal septum with friable granular surface and necrotic tissue
110
What are the 5 main causes of midline destructive lesion? (case study)
* Wegner's/GPA
* sarcoidosis
* extranodal NK/T-cell lymphoma
* cocaine
* infections
111
What did the patient with the nasal issue initially test positive for? (case study)
entero. faec. & staph. aureus
112
What was the initial treatment for the patient with the nasal issue? (case study)
antibiotic therapy and fabrication of palatal obturator to restore palate function
113
What stood out in the patients blood and urine analysis?
* C-reactive protein was high> suggest inflammation
* positive for (p-ANCA)
* negative for myeloperoxidase> suspect CIMDL
