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Surgery I > Inflammation > Flashcards

Inflammation Flashcards

(123 cards)

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1
Q

What are Halsted’s Principles?

A 
Gentle tissue handling 
Meticulous Hemostasis 
Preservation of blood supply 
Strict aseptic technique 
Minimum tension 
Accurate tissue apposition 
Obliteration of dead space
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2
Q

What is the basic principle behind inflammation?

A

Protective immunovascular response of tissues to harmful stimuli to remove the initial cause of injury

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3
Q

What are the three most basic things involved in inflammation?

A

Immune cells + Blood vessels + Molecular mediators

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4
Q

What are the four physical signs of acute inflammation?

A

Rubor - Calor - Dolor - Tumor

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5
Q

What is the result of rubor, color, dolor, and tumor?

A

Loss of function

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6
Q

What are the four major acute vascular responses in inflammation?

A

Vasodilation
Increased vascular permeability
Stasis
Leukocyte extravasation

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7
Q

What is the behavior of the blood vessels at the beginning of an insult?

A

Immediate vasoconstriction followed by vasodilation

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8
Q

What are the stimulators for the initial vasocontriction with inflammation? (Four things)

A

Catcholamines + Serotonin + Prostaglandins + NE

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9
Q

How long does it take vasodilation to occur with acute inflammation?

A

Minutes

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10
Q

What happens with vasodilation in acute inflammation?

A

Capillary beds open = Increased blood flow = Local delivery of inflammatory mediators

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11
Q

What are two major factors that increase vascular permeability?

A

Histamine + Serotonin

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12
Q

What is the behavior of serum protein with acute inflammation?

A

Loss of serum protein
Decreased osmotic pressure
Increased blood viscosity

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13
Q

What occurs with edema in interstitial space?

A

Delivery of soluble factors

Localized pain + Loss of Function

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14
Q

What are the three major steps in leukocyte extravasation?

A

Margination + Adherence + Diapedesis/Transmigration

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15
Q

What is occurring during margination of leukocytes?

A

Weak cell to leukocyte interaction

Rolling along endothelium = to BF velocity

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16
Q

What is responsible for adherence of leukocytes to endothelium?

A

Integrins

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17
Q

What occurs during recruitment of a leukocyte?

A

Halts progression of leukocyte within circulation

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18
Q

What are the four major cellular components to inflammation?

A

Neutrophils + Mast cells + Macrophages + Lymphocytes

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19
Q

Which are the first migratory cells to arrive?

A

Neutrophils

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20
Q

What do neutrophils play a predominant role in?

A

Acute inflammation

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21
Q

What is it that neutrophils do?

A

Local killing + Degradation of bacterial macromolecules

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22
Q

How do neutrophils kill/degrade bacteria?

A

Phagocytosis + Superoxide radicals

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23
Q

Are neutrophils pro or anti inflammatory?

A

Pro

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24
Q

What pro-inflammatory cytokines do neutrophils produce?

A

IL-1 + IL-6 + TNF-a

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25
How long do neutrophils last?
24 to 48 hours
26
What ends neutrophils?
Macrophages
27
What are the three big things macrophages play a role in?
Inflammatory response + Wound debridement + Tissue Repair
28
How do macrophages carry out debridement?
Phagocytosis
29
What do macrophages secrete that dissolve damaged tissue?
Collagenase + Elastase
30
Are macrophages pro or anti inflammatory?
Pro
31
What pro-inflammatory cytokines do macrophages secrete?
IL-1 + IL-6 + TNF-a
32
What cell type do macrophages stimulate to produce collagen?
Fibroblasts
33
What type of immunity are lymphocytes?
Acquired/Cell-mediated
34
What are two paths lymphocytes can take?
Cytotoxic + Helper
35
What is another name for helper T cells?
CD4
36
What is another name for cytotoxic T cells?
CD8
37
What are the two types of helper T cells?
TH-1 + TH-2
38
What is it that TH-1 cells do?
Maximize bacterial killing potential of macrophages
39
What is it that TH-2 cells do?
Helminth infections + Allergic reactions
40
What three basic things can stimulate mast cell degranulation?
Physical trauma Completment factors Microbial products
41
What is the major thing mast cells secrete?
Histamine
42
When is histamine released from mast cell? (physiological process)
Acute inflammation
43
Are mast cells pro or anti inflammatory?
Pro
44
What pro-inflammatory mediators do mast cells secrete?
Serotonin + Leukotrines + Heparin + Cytokines
45
What are the six categories of inflammatory mediators?
``` Vasoactive amines Cytokines Lipid/cell membrane derived ROS Gaseous mediators Acute phase proteins ```
46
What are the two vasoactive amines?
Histamine + Serotonin
47
What are the important pro-inflammatory cytokines?
TNF-a + IL-1/6 + Chemokines
48
What are the important anti-inflammatory cytokines?
IL-10
49
What are the two major lipid membrane derived inflammatory mediators?
Eicosanoids + PAF
50
What are the two types of eicosanoids?
Prostaglandins + Leukotrienes
51
What are the two ROS?
Hydroxyl radical + Superoxide anion
52
What are the three gaseous mediators?
Nitric oxide + Carbon monoxide + Hydrogen sulfide
53
What are negative APP?
Albulmin
54
What are the positive APP?
C-reactive protein Serum amyloid A Complement proteins Coagulation factors
55
What releases Histamine?
Mast cells
56
What does histamine do?
Arteriolar vasodilation Increased venule permeability Constriction of large arteries
57
What cells does histamine attract?
Eosinophils
58
What does histamine stimulate receptor wise?
Pruritic nociceptors
59
What are two Anti-inflammatory mediators?
IL-10 + IL-1ra
60
What is the major initiator of acute inflammation?
TNF-a
61
What are the major structural characteristics of TNF-a?
Membrane-bound surface proteins | Anti-tumor activity
62
What is TNF-a associated with in chronic diseases?
Cachexia
63
What cytokine does TNF-a stimulate production of?
IL-6
64
What is a inflammatory process that TNF-a initiates?
Cell invasion at site of inflammation
65
What, besides the cytokine, does TNF-a initiate?
ROS + Endothieal adhesion molecules
66
What can inhibit the production of TNF-a?
Steroids
67
What is IL-1 produced by?
Macrophages (and others)
68
What basic job does IL-1 have?
Mediates increases in other pro-inflammatory cytokines + prostaglandins + NO
69
What four pathologies does IL-1 cause?
Hypotension Leukopenia Hemorrhage Pulmonary Edema
70
What is the counter regulatory function to IL-1?
IL-1ra
71
What does IL-1ra do?
Compete for space at the receptor site with IL-1
72
What does IL-6 in the most basic sense?
Increase all inflammatory conditions
73
What is IL-6 produced by?
Macrophages + T cells + Epithelial cells + Enterocytes
74
What is important about IL-6 clinically?
Mediator + Diagnostic/Prognostic biomarker of inflammation, levels proportional to duration/severity of condition
75
What is IL-10 in the most basic sense?
Anti-inflammatory cytokine
76
What is IL-10 produced by?
TH-2 cells + Monocytes + B cells
77
What does IL-10 depress the production of?
TNF-a + IL-1 + IL-6
78
In a normal immune response what would the levels of IL-10 be in acute phase inflammation?
Low, will increase over time
79
What category of disease is there commonly an IL-10 deficiency?
Chronic autoimmune diseases
80
What is the fatty acid precursor to all eicosanoids?
Arachidonic acid
81
Where is arachidonic acid stored?
Cells membranes of endothelial cells + Leukocytes + etc. k
82
When is arachidonic acid released?
Stimulation but Phospholipase A2
83
What are two things that arachidonic acid can be metabolized by?
Cyclooxygenase + Lipoxygenase
84
What medication can decrease PLA2 production?
Corticosteriods
85
What are the functions of prostaglandin?
Leukocyte recruitment Vasodilation Pain Fever
86
What are the functions of Leukotrienes?
Activate neutrophils
87
What does activation of neutrophils entail?
Extravasation + Degranulation + Free-radical production
88
What are the two cyclooxygenase pathways?
COX-1 and COX-2
89
What medication works on the COX pathways?
NSAIDS
90
What is the major characteristic of COX-1?
Constitutively expressed
91
What is the major characteristic of COX-2?
Inducible
92
What is important medically for control the LOX pathway?
Asthma
93
What are leukotrienes secreted by?
Leukocytes + Platlets + Endothelial cells
94
What is platelet-activating factor metabolized by?
PLA2
95
What is PAF produced by?
Endothelial cells + Neutrophils + Platelets + Macrophages + Eosinophils
96
What does PAF do?
``` Stimulate Aracodonic Acid release Pro-inflammatory effects on neutrophils Platelet aggregation Degranulation + ROS production in EOS Vascular effects ```
97
What are the vascular effects of PAF?
Vascular permeability Bronchoconstriction Pulmonary Vasoconstriction
98
What are the PAF effects on neutrophils?
Enhanced Adhesion + Motility + Degranulation
99
What are ROS?
Unstable molecules with unpaired electrons
100
What are three important affects of ROS?
Antibacterial + Intercellular signaling + Tissue damage
101
What are two examples of free radicals?
Hydroxyl radical + Superoxide anion
102
What is an example of a non-free radical?
Hydrogen peroxide
103
What is myeloperoxidase? Where is it found?
ROS generating enzyme found in NEU | Catalyzes Hypochlorous acid from H2O2
104
What is NO synthesized from?
L-arginine by NO synthase
105
What are the three forms of NO?
Endothelial-derived + Neuronal Derived + Inducible
106
What cell types produce the inducible type of NO?
Hepatocytes + Keratinocytes + Macrophages + Neutrophils
107
What conditions will upregulate NO?
Inflammatory
108
What does NO do?
Regulation of vascular tone via smooth muscle relaxation = vasodilation
109
How is CO produced in the body?
Enzymatic break down of heme to bilirubin by heme oxygenase
110
When is heme oxygenase upregulated?
Inflammation
111
When is hydrogen sulfide produced in the body?
Cysteine metabolism
112
What is the function of hydrogen sulfide?
Regulates BP + Visceral analgesia
113
Where do acute phase proteins come from?
Liver
114
What are the cytokines that stimulate the production of ACP?
IL-6 + IL-1 + TNF-a
115
What is the most basic function of positive ACP?
Minimize tissue damage and enhance repair processes after infection/trauma/stress
116
What are the outcomes of inflammation?
``` Resolution Systemic Inflammation Multiple Organ Failure Immunosupression Chronic Inflammation ```
117
What is occurring during resolution?
Decreased NEU recruitment Increased mononuclear cell infiltration Macrophages undergo apoptosis Pro to anti inflammatory factors
118
What is systemic inflammatory response syndrome?
Imbalance of inflammatory mediators = inflammation throughout the body
119
What are some of the signs of SIRS?
Changes in Temp + HR + BP + RR + WBC
120
What else needs to occur with SIRS for it to be considered sepsis?
Infection
121
When can inflammation lead to immunosuppression?
Overwhelming anti-inflammatory response
122
What cell change occurs with chronic inflammation?
Fibroblasts --> Myofibroblasts
123
What are the basic characteristics of myofibroblasts?
Increased collagen production + Fibrosis

Surgery I (17 decks)

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