Inflammation 2

Question 1

What is suppuration?

Answer 1

The making of puss

Question 2

Repair, organisation and fibrosis

Answer 2

Scarring

Question 3

Once acute inflammation has been stimulated to occur what happens next?

Answer 3

Inflammation is very good at damaging tissues.
Must be controlled.
Mediators if inflammation are short lived and are only produced as long as the stimulus persists.
Neutrophils only survive for a couple of hours once outside the safety of a blood vessel.

Question 4

What are the potential outcomes that can occur after acute inflammation?

Answer 4

Resoution
Suppuration
Repair, organisation and fibrosis
Chronic inflammation
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Each outcome need not be mutually exclusive.
Suppuration can progress to fibrosis as can chronic inflammation.

Question 5

What is Resolution?

Answer 5

As good as new.

Complete restoration of the tissue to normal after removal of inflammatory components.

Question 6

When does resolution occur?

Answer 6

Minimal cell death
Tissue has capacity to repair - GI tract which frequently replaces epithelium. Cells in CNS cannot be regenerated.
Good vascular supply - delivery of white cells and rapid removal of injurious agents.
Injurious agent easily removed.
(if you have a good blood supply it will be healed quite quickly, if not, it will not be healed as quickly)
(You have to clean wounds. If you have a cut and don’t clean it properly the tissue will never go back to normal).

Question 7

What is Suppuration?

Answer 7

Pus- contains living, dying and dead cells (mostly dead and dying neutrophils).
Neutrophils, bacteria, inflammatory debris (fibrin).
May be termed an abscess.
When a space is filled by pus and walled off it may be called an empyema - gallbladder
(If a person has an internal abscess they will need to have it drained)
(If a person is being given antibiotics and they are not working then the person has an abscess).

Question 8

What is Organisation?

Answer 8

If injury produces lots of necrosis.
If injury produces lots of fibrin that isn’t easily cleared.
Poor blood supply - difficulty removing the debris.
Tissue type - Some are better at regenerating (liver).
Mucosa where damage goes beyond the basement membrane favours healing by organisation and repair and not resolution.
Require scaffold for resolution to occur around.
Erosions and abrasions describe injury with basement membrane intact. Heal rapidly with complete resolution.
(Ulcers cause scarring)

Question 9

How does Healing occur and do all structures when injured heal fully?

Answer 9

Some will resolve completely.
Many mucosae are complex structures and when injury is severe enough they cant be easily rebuilt.
Common response in all tissues is granulation tissue formation.

Question 10

What Granulation tissue and how does it work to heal wounds?

Answer 10

Defect is slowly infiltrated by capillaries and then by myofibroblasts.
Deposit collagen and smooth muscle cells.
Given constituents is looks very red.

Question 11

The liver has some regenerative capacity but what happens if it undergoes scarring and cirrhosis?

Answer 11

Has some rgenerative capacity but can be overwhelmed.
Undergoes scarring and fibrosis.
In liver known as cirrhosis
Results in liver failure - loss of liver function. Can’t remove toxins and cant make many proteins.
Large volume of blood flows through liver - vascular disturbances.

Question 12

If something has affected the whole liver, it means that the problem is not localised e.g. a stab wound. What does it suggest?

Answer 12

Suggests drugs, alcohol

Question 13

What are the characteristics of Chronic Inflammation, when does it occur and what type of lymphocytes are present?

Answer 13

Not related to time.
Implies nothing about severity.
Can occur without preceding acute inflammation.
Favoured if:
Suppuration - Walled off pus. Scarring
Persistence of injury - foreign material. Keratin.
Infectious agent - virus. Persistence of infection (mycobacterium).
Type of injury - autoimmune, Transplant rejection.
Characterised by the lymphocyte (small round blue cells).
Remember immunology lectures for types of lymphocyte.
Other cells - macrophage (monocyte within tissue).

Question 14

What are Macrophages and what do they do?

Answer 14

Also phagocytic.
Neutrophil is the shock troop,
macrophage is a tank.
Cause granulomas and aggregate of epithelioid histiocytes.

Question 15

What are some of the causes of Granulomas?

Answer 15

Foreign bodies.
Endogenous - keratin, bone, crystals
Exogenous - talc, asbestos, suture, material, oil.
(drug users often cut their drugs with talc, if you see talc sign of drug user)
Specific infections
parasites
Worms
Eggs
Syphilis
Mycobacterium - including TB

Question 16

What is caseous necrosis commonly called and what does it indicate until proven otherwise?

Answer 16

Also known as cheesy necrosis.

Tuberculous granulomas - Caseous necrosis (means TB until proven otherwise)

Question 17

What are the possible outcomes after acute inflammation?

Answer 17

Resolution
Suppuration
Repair, organisation and fibrosis
Chronic inflammation

Question 18

What are the causes of acute inflammation?

Answer 18

Injury
Vascular changes
Cellular changes

Question 19

What is each outcome dependent on?

Answer 19

• Site of injury - different organs have different capacity for repair. Different organs have different vascular supplies.
• Type of injury - severity, pathogenecity of organism.
• Duration of injury - can be removed, is it sustained/

Question 20

What happens when a wound doesn’t heal properly and instead there is scar tissue and fibrosis occurs?

Answer 20

Patch job
Loss of function
Contraction
Heart - muscle doesn't work well
Skin - tight
(Scar tissue doesn't contain hairs or sweat glands and doesn't contract as well as muscle).

Question 21

What is fibrosis and what is it called in the liver?

Answer 21

the thickening and scarring of connective tissue, usually as a result of injury.
In the liver it is called cirrhosis.