Inflammation

Question 1

What at some stimulants of acute inflammation

Answer 1

Microorganism 
Trauma
Ischeamic necrosis
radiation
Chemicals

Question 2

What does acute inflammatory exudate contain

Answer 2

Blood components
Fluid
Neutrophils
Fibrin
Maybe macrophages and lymphocytes

Question 3

What is the role of fluid in exudate

Answer 3

Dilutes toxins

Carries nutrients/mediators/antibodies

Question 4

What is the role of fibrin in exudate

Answer 4

Induces migration- chemo taxis

Question 5

What is the told of neutrophils in exudate

Answer 5

Phagocytise living tissue ( bacteria) and necrotic debris

Question 6

What is the first step in exudate formation

Answer 6

Blood vessels near damage become dilated
Increased blood flow then slows
Turbulent flow-redness
Cellular contents in centre and plans and fluid at edges

Question 7

What is the second step in exudate formation

Answer 7

Vessels become more permeable and endothelial cells swell and retract
Water/salts/protein leak into damaged area

Question 8

What is the third step in exudate formation

Answer 8

Neutrophils marginate and emigrate,

Adhere to endothelial cells and migrate to damaged area under influence of chemotaxins

Question 9

What types of exudate exist

Answer 9

Serous (pericardial sac)
Purulent (pus eg meninges)
Fibrinous (coagulates)
Fibrino-purulent

Question 10

What is elevated ESR

Answer 10

Erythrocytes segmentation time, means increased viscosity

Question 11

What are the possible outcomes from acute inflammation

Answer 11

Resolution
Abscess formation
Organisation and repair
Chronic inflammation

Question 12

What processes lead to resolution

Answer 12

Damage neutralised/eliminated
Macrophages remove dead cells and exudate
Local cells re-grow
Tissue structure and function returns to normal

Question 13

Give examples of resolution

Answer 13

Pneumonia
Tubular necrosis kidney
Sunburn

Question 14

What are the processes that lead to abscess formation

Answer 14

Large accumulation of liquid purple my exudate in area of extensive necrosis due to tissue damage
especially caused by bacteria (necrotoxins)
Attempt to walk off and limit spread

Question 15

What are stages of healing by repair

Answer 15

Vascular- macrophages and enzymes remove debris and new vessels grow and support cells (
Fibrovascular- fibroblasts proliferate and lay down collagen
Collagenous- mature collagen, granulation tissues mature to scar
Finally new capillaries regress

Question 16

What does organisation always lead to

Answer 16

Scarring

Question 17

When does chronic inflammation occur. What does it always result in

Answer 17

Damaging stimulus persists. scarring

Question 18

What cell is the main effector of chronic inflammation

Answer 18

Macrophage activated by gamma interferon

Question 19

What are the roles of a macrophage

Answer 19

Phagocytise
Secretory- mediators on inflammation, oxygen metabolites, professes and hydrolases
Cytokines (il-1 and tnf-a)
Growth factors

Question 20

Why might a damaging stimuli persist

Answer 20

Gastric acid is repeatedly produced
Bacteria distance from neutrophils/antibiotics ( endocarditis)
Resistance to neutrophil phagocytosis

Question 21

What are the two outcomes from stalemate between gastric mucosa damage and repair

Answer 21

Better- gastric acid neutralised or removed and damages stops - scar
Worse- increased gastric acid or repair impaired- ulcer perforation

Question 22

What causes chronic inflammation

Answer 22

When damaging stimulus not eradicated

Stalemate between continuing damage and attempts to repairs by fibrous scar formation

Question 23

What is granulomatous inflammation.

Answer 23

Chronic inflammation in which neutrophils are ineffective so macrophages invoked as part of early immune response
Aggregates of macrophages around damaging agent, associated with surrounding lymphocytes and fibroblasts= granuloma

Question 24

What causes granulomatous inflammation

Answer 24

Low pathogenicity organisms which excite a type iv immune response 
Organic or inorganic foreign material
Fungi 
Sarcoidosis 
Parasites

Question 25

Give and example of granulomatous inflammation

Answer 25

Tuberculosis Tuberuloculosis mycobacterium resistant to neutrophils Type IV response- macrophages attracted by cytokines that T cells secrete

Question 26

How can TB get worse

Answer 26

Necrosis expands and cannot be contained in granuloma, may spread via lymphatic system/ veins/ bronchi

Question 27

What is first intention healing

Answer 27

Surgery, wound trauma minimised, edges closely appeared-minimal exudate Collagenous scar by exudate and organisation

Question 28

What is second intention healing

Answer 28

Extensive damage, infection Healing characterised by increased necrotic debris/ granulation tissue Wound contraction

Question 29

What are the problems with acute inflammatory exudate

Answer 29

Causes symptoms- meningitis | Croup/diphtheria, pericarditis, pleurisy, peritonitis

Question 30

What is the problem with scar formation

Answer 30

Skin- unslightly, | not elastic not contractile not secretory not absorptive

Question 31

Name five factors that lead to inadequate healing

Answer 31

``` Continuing infection Foreign/uncleared necrotic material Ischaemia Diabetes Steroid therapy Denervation of area Irradiation previous ```

Question 32

How does the brain parenchyma heal

Answer 32

Doesn't contain fibroblasts so cannot make collagen Necrosis= liquifactive A strictures proliferate and lay down glial fibres to walk off area- cystic

Question 33

Explain healing of a bone fracture

Answer 33

``` Defect filled with heamatoma Phagocytosis of debris Heamatoma undergoes organisation Vascular then fibrovascular granulation tissue Osteoprogenitor cells develop convert to osteoblasts Synthesis of osteiod collagen Calcified Woven bone links with old bone Active remodelling= strong lamellar bone ```

Question 34

What at the aims of acute inflammation

Answer 34

Destroy/neutralise Liquefy/remove dead tissue Prepare for healing