Inflammation

Question 1

Signs of inflammation

Answer 1

Rubor
Dolor
Calor
Tumour
Loss of function

Question 2

What is the triple response?

Answer 2

Blood vessels constrict
Capillaries then dilate - flush
Arterioles then dilate - flare
Fluid leakage from capillaries and local tissue swelling - wheal

Question 3

Describe acute inflammation

Answer 3

Vascular phase followed by cellular phase

Chemical mediators such as histamine cause a local increase in vascular permeatbility by causing zonula occludens between vascular endothelium to open.
This allows the leukocytes to invade the tissue and coupled with complement, phagocytosis of the offending organism

Question 4

What is chronic inflammation? Types

Answer 4

Proliferative inflammation with cellular infiltrate of lymphocytes and plasma cells (polumorphonuclear neutrophils or eosinophils)

Granulomatous and non-granulomatous

Question 5

What is granulomatous inflammation?

Answer 5

Epithelioid or giant cell
Derived from monocytes or macrophages
Abundant eosionophilic cytoplasm.

Interact with T cells and phagocytose, bind complement and Ig

Tuberculosis, Sarcoidosis

Question 6

What are the three forms of giant cells

Answer 6

Langhan’s giant cel - homogenous eosinophilic central cytoplasm and peripheral rim of nuclei
Foreign body giant cell
Touton ginat cell - rim of foamy cytoplasm peripheral to a rim of nuclei - seen in lipid disorders

Question 7

What is the main cell in tuberculosis

Answer 7

Langhan’s giant cell

Question 8

What are the main types of chornic granulomatous inflammation

Answer 8

Diffuse type:
- sympathetic uveitis
Epithelioid cells distributed randomly against a b/g of lymphocytes

Discrete type:
- sarcoidosis
Nodules or tubercles form due to accumulation of epitheliioid or giant cells with narrow rim of lymphocytes

Zonal type - tuberculosis, chalazion, rehumatoid scleritis
- CEntral area of necrosis, surrounded by epithelioid cells
Langhan’s giant cells
surrounded by lymphocytes and plasma cells

Question 9

describe non-granulomatous inflammation

Answer 9

Cell types include T and B lymphocytes, plasma cells with Russel body

Anteiror and posterior uveitis, Behcet’s, MS, retinal vasculitis, TED

Question 10

What is a russel body

Answer 10

An inclusion in a plasma cell whose cytoplasm is filled and enlarged with eosinophilic structures. Nucleus is eccentric or absent

Question 11

What is the immediate stage of corneal healing

Answer 11

Retraction of Descemet’s membrane and stromal collagen
Anterior and posterior wound gaping of the wound
Fibrin plug formation from aqueous fibrinogen
Stromal oedema

Question 12

What is the leukocytic phase of corneal healing?

Answer 12

At around 30 minutes, polymoorphonuclear leukocytes from the conjunctival vessels and from the aqueous invade the wound
Limbal wounds habe an invasion of mononuclear cells from the limbal vessels - these turn into fibroblasts after 12-24h

Question 13

What is the epithelial phase of corneal healingx

Answer 13

At 1 hour full thickness ingrowth is inhibited by healthy endothelium

Question 14

What is fibroblastic phase?

Answer 14

CEntral corneal wound fibroblasts are derived from keratocytes. They produce collagen and mucopolysaccharides to form an avascular matrix

Question 15

What is the endothelial phase of corneal healing

Answer 15

At 24 hours endothelial sliding allows for coverage of the posterior wound

Question 16

What are the phases of corneal healing

Answer 16

Immediate phase
Leukocytic phase
Epithelial phase
Fibroblastic phase
Endothelial phase