Inflammation 2 Flashcards
Define Cytokines
the intercellular messenger substances secreted by cells of the immune systems (innate and acquired) that tell other cells what to do, but they don’t travel too far or else they would be hormones
Define Symptom
subjective experience of disease
Define Sign:
objective visible, audible, palpable or smell-able manifestation of disease
Define Hickam’s dictum:
A patient can have as many diseases as he darn well pleases
Define Tuberculosis:
prototype granulomatous disease, Mycobacterium tuberculosis infection
Define Sarcoidosis:
multi-system, probably autoimmune granulomatous disease
Define Lymph nodes:
processing centers of the acquired immune system, police stations in the lymphatic system
The process of using cytokines begins with what?
The process begins with Toll-like receptors on macrophages, neutrophils and endothelial cells
Other than toll like receptors, what other receptors do cytokines use?
G-coupled receptors
nucleotide oligomerization domain proteins 1 and 2 (NOD1 and NOD2, which react with intracellular pathogens)
Toll-like receptors and those similar bind to what in order to activate inflammatory cells?
bind various microbial cell wall and internal elements,
ex: bacterial cell wall lipoproteins and lipopolysaccharides; fungal wall components; bacterial and viral nucleic acids.
binding activates the inflammatory cells.
The activated inflammatory cells produce what?
- TNF,
- IL-1,
- IL-6,
- IL-8,
- IL-12,
- IL-18,
- interferon-gamma,
- high mobility group box 1 protein (HMGB1)
- other pro-inflammatory cytokines.
How do the pro-inflammatory cytokines direct leukocytes to the site of inflammation?
These pro-inflammatory cytokines upregulate the expression of endothelial cell adhesion molecules that bind leukocytes, directing them to the site of infection.
Most of the inflammation-associated cytokines are produced by what type of cells?
by mononuclear phagocytic cells.
What are the main cytokines involved in the acute phase response?
- IL-6,
- IL-1,
- TNF-alpha,
- interferon-gamma,
- TGF-beta
What are the main stimulators of fever?
IL-1 and TNF
IL-6 is the main stimulator for what?
the increased production of most acute phase reactant proteins.
What cytokines secreted by mononuclear phagocytic cells stimulate hepatic Kupffer cells (themselves part of the mononuclear phagocytic system)? What is the result of this stimulation?
IL-6, TNF and IL-1
amplify the cytokine response.
How can cytokines further induce the cytokine response?
The cytokines also act on monocytes, fibroblasts and endothelial cells, further magnifying the cytokine response.
The central nervous system participates by mediating fever. How?
by secreting adrenocorticotrophic hormone (ACTH).
Combined effects of what result in the changes in acute phase protein synthesis?
The combined effects of cytokines and glucocorticoids on hepatocytes
Is pain a sign or symptom?
Pain is a symptom.
How can fever be both a sign and symptom?
If a person experiences an elevated body temperature, that is fever as a symptom.
If measured by another person, fever is a sign.
T/F Patients can have more than one disease at the same time.
true
T/F Patients can have a single symptom caused by two or more diseases simultaneously.
true
What is dyspnea?
shortness of breath
How can heart failure cause dyspnea?
with fluid transudating into the airspaces because of high pressure due to the heart’s failure to adequately pump the blood the lung is sending it
As patients age, which is most likely to be true? Occam’s razor or Hickam’s dictum
Hickam’s dictum
Define chronic inflammation. What does it consist of?
Chronic inflammation is inflammation of prolonged duration (weeks to years).
It generally consists of (1) active inflammation with (2) tissue destruction and (3) attempted repair,
all 3 proceeding simultaneously.
Causes of chronic inflammation include what? (4)
(1) persistent infections such as tuberculosis,
(2) prolonged toxin exposure as in silicosis,
(3) autoimmunity with, for instance, systemic lupus erythematosus
(4) conditions of unknown etiology,
Who are the key cellular players in most chronic inflammation? What activates them?
Macrophages
They are activated by cytokines such as interferon-gamma, bacterial endotoxins and other factors.
What do they secrete and leak at the site of inflammation?
secrete neutrophil chemotactic factor and growth factors (TGF-beta, PDGF and FGF),
leak proteases and reactive oxygen species at sites of chronic inflammation.
Macrophages are drawn to sites of inflammation by what process? What molecules drive this process?
by chemotaxis
MCP-1, C5a, PDGF, TGF-alpha, fibrinonectin and fibrinopeptide fragments.
What is important in maintaining chronic inflammation?
Macrophage proliferation and immobilization
Why are Lymphocytes important in many chronic inflammatory conditions?
They have bidirectional interactions with macrophages, who present antigens to T cells with costimulators and produce cytokines (IL-12) that stimulate T cells.
Activated T cells secrete interferon-gamma, which activates macrophages.
T/F All chronic inflammatory diseases have a predominance of macrophages,
false, Some chronic inflammatory diseases have a predominance of macrophages, while others have a predominance of lymphocytes.
Examples of macrophage predominant diseases include what?
- atherosclerosis,
- subacute phase pneumonia,
- Gaucher disease,
- gout
- usual interstitial pneumonia;
Examples of lymphocyte predominant diseases include what?
thyroiditis (most forms),
rheumatoid arthritis
myocarditis (most forms).
What is a granuloma?
an aggregate of activated macrophages working together
granulomatous diseases are a subset of what type of predominant disease?
granulomatous diseases are really a subset of macrophage predominant diseases
Examples of granulomatous diseases include what?
- tuberculosis (the prototype),
- leprosy,
- syphilis (some forms),
- cat-scratch disease
- sarcoidosis
Tuberculous granulomas resemble what?
resemble tiny potatoes (tubercles), commonly cheesy (caseous) ones.
Tell where TB is most common and where it spreads
Tuberculosis is most common in the lungs, from which it spreads to local lymph nodes.
Decribe where cat-scratch disease begins and its spread. Tell the overall visual on it
Cat-scratch disease starts in skin and spreads to nearby lymph nodes.
Cat-scratch disease granulomas tend to be rounded or stellate, with central necrotic granular debris and neutrophils.
Tell where sarcoidosis is most common then where does it spread. Tell the appearance of it
Sarcoidosis is most common in the lungs and spreads to nearby lymph nodes.
Sarcoidosis tends to have non-necrotizing (non-caseating) tight naked granulomas without a rim of lymphocytes.
The lymphatics are what of the body?
sewer system of the body,
Describe the lymph vessels and why is this important
lined by endothelium with scant basement membrane and constituting a secondary line of defense with police stations (lymph nodes) at intervals.
allows cells to escape with relative ease to filter through the tissue
What is lymphangitis?
What is lymphadenitis?
Inflammation of lymphatic channels
Inflammation of lymph nodes
Define lymphadenopathy
Enlargement of lymph nodes
Chronic infections tend to go where? why?
to lymph nodes because they are the processing centers of the immune system in the lymphatic sewer system of the body.
T/F Chronic inflammation has systemic effects on the patient as a whole person exactly the same as acute inflammation.
Chronic inflammation has systemic effects on the patient as a whole person similar to, but not exactly the same as acute inflammation.
Describe the SED rate wrt the different inflammations
Chronic inflammation can increase the erythrocyte sedimentation rate.
**Immunoglobulins make erythrocytes sticky, but not as much as fibrinogen, so the “sed rate” tends not to be as elevated by chronic inflammation as by acute inflammation. **
Chronic inflammation causes what disease that is not found in acute inflammation unless special circumstances are present?
anemia,
not a feature of acute inflammation unless this is complicated by bleeding, hemolysis (breakdown of erythrocytes) or disseminated intravascular coagulation.
The most important systemic effects of inflammation, acute or chronic, are alterations of what 4 things?
(1) body temperature,
(2) heart rate,
(3) respiratory rate
(4) white blood cell count, usually increases in them.
Describe body temperature throughout the day, wrt gender, and locations taken
body temperature is normally lower in the morning by about 0.6 degrees C (1 degree F),
normally lower in men by about 0.3 degrees C (0.2 degrees F),
normally lower taken orally than by tympanic membrane reading by around 0.8 degrees C (1.4 degrees F),
Elevated body temperature is what?
fever
Fever as a component of the systemic inflammatory response is due to what?
the release of pyrogens (fever producing substances) from the mononuclear phagocyte system.
The main such endogenous pyrogens are what?
IL-1 and TNF-alpha.
Fever is mediated by what? Where do these molecules act?
mediated by prostaglandins, particularly PGE2 which acts directly on the hypothalamus.
Causes of fever include what?
- infection,
- infarction,
- tumors,
- non-infectious inflammation (gout, rheumatoid arthritis, etc.),
- hemorrhage,
- brain damage,
- drug reactions
- heatstroke.
Describe the process of a heatstroke. What is the result if left untreated?
- When environment is hot and humid, even mild exercise may cause a significant rise in body temperature.
- If rise is too high, heat regulating center becomes depressed so temp rises more.
- metabolic rate increases, more heat is generated and temperature rises to 41 degrees C (105.8 degrees F) or more.
- This hyperthermia is termed heatstroke.
- Unless treated promptly, the temperature may continue to rise reaching 43 degrees C at which point the person becomes comatose. Death may ensue.
T/F Brain damage can increase body temperature in the absence of inflammation.
true
The hormone can raise body temperature? and is probably responsible for the elevated temperature when?
The hormone progesterone can raise body temperature
probably responsible for the elevated temperature at the time of ovulation.
It should be remembered that a fully anesthetized patient is what wrt temperature?
poikilothermic (has ambient temperature).
nstead of fever, the systemic inflammatory response may cause an abnormally low body temperature, called what? Who is this most common in?
hypothermia
This is most common at the extreme of life in neonates and the elderly.
What are the 2 most common types of anemia?
- iron deficiency
- Anemia of chronic disease
What often seen with chronic infections, autoimmune disorders and cancer?
anemia of chronic disease
In the anemia of chronic disease, mononuclear phagocytic system cells have what function?
there is increased uptake and retention of iron by mononuclear phagocytic system cells.
The body acts as if all chronic inflammation is due to what? What is the body’s response to chronic anemia?
infection with microbes competing for our iron and hides it from them, but also from our own red blood cell production.
The body is limits the anemia of chronic disease so that it does not cause hemoglobin to fall to less than 10 g/dl.