Inflammation

Question 1

What is Inflammation?

Answer 1

Response of local vascular tissue to injury.

Inflammation is a normal response in defense and healing.

(If persistent and chronic, it is pathologic)

Question 2

What is vascular tissues?

Answer 2

Vascular tissue is tissue which responds to injury.

Made up of three elements:
1. Vessels
2. Blood
3. Blood cells

Question 3

Describe Acute Inflammation?

Answer 3

Early response to injury
Short duration (hrs - days)
Localize & removes agent of injury
Precedes IR (immune response)

Question 4

Describe Chronic Inflammation?

Answer 4

Longer duration (wks - yrs)
Self-perpetuating cycle

Question 5

What are the two responses to accute inflammation?

Answer 5

1. Vacular Response
2. Cellular Response

Question 6

Describe the Vascular Response to A. Inflm?

Answer 6

1. Injury leads to stat vasoconstriction (brief) at a local level. This is the nero response to keeps bleeding to a minimum.
   i. Leukocytes, Mast Cells, & Platelets release chemical mediators (de-granulate)
   ii. Histamine & Prostaglandins released - affect nerves and blood vessels on a local level causing…
2. Vasodilation resulting in…
3. Increase permeability

Question 7

Histamine: What are the two essential functions?

Answer 7

1. Increase the permeability of the cell wall. (In addition to the normal trancapillary exhange, you now have larger gaps which allow more/larger things to move out. Eg - O2, Nitrogen)
2. Increase in capillary dilation

Question 8

What is vasodilation?

Answer 8

Increased blood flow to do dilation of capiliary and permeability of cell wall.

Question 9

What is Hyperemia?

Answer 9

Increase in blood flow from vasodilation.

Signs of hyperemia - Redness, Swelling, and Increased Blood Flow

Question 10

Prostaglandin?

Answer 10

Does both the functions of histamine PLUS:
Causes Pain

Consider them as a local hormone, produced in many tissues, do different things depending where they occur

Question 11

What is Rouleau?

Answer 11

The stacking of erythrocytes which slows blood flow in vasulature.

Question 12

Describe the Cellular Response of A. Inflm?

Answer 12

1. Chemotaxis of neutrophils and WBC’s to site of injury
2. Margination of Endothelium (Pavementing). Assisted by adhesion molecules
3. Diapedesis/Emigration of defense cells into tissue cells. Objective to localize and removal of debris.
4. Phagocytosis of cell debris & foreign particles

Question 13

5 Signs of Local Inflammation?

Answer 13

1. Redness (erythema)
2. Swelling
3. Warmth
4. Pain
5. Loss of Fx (may not be present)

Question 14

What is exudate?

Answer 14

Comprised of: i) fluid ii) protiens iii) blood cells

Fx: is to carry out healing cells and proteins into tissues
Exudate is an increase of fluid causing a dilute of toxins

Note: exudate expands, needing space it pushes out other cells causing swelling. The tissue stretch causes pain and immobility.

Question 15

Name the 5 types of exudate?

Answer 15

1. Serous
2. Purulent/Suppurative
3. Hemorrhagic
4. Fibrinous
5. Membranous

Question 16

Exudate: Serous

Answer 16

Watery, Clear - Pink, Low in Proteins and Cells
Associated with acute inflammation.

Question 17

Exudate: Purulent/Suppurative

Answer 17

Pus! Contains WBC (neutrophils) and necrotic cells.
Thick, cloudy, smells bad (infected!)
Associated with severe acute inflammation.

Question 18

Exudate: Hemorrhagic

Answer 18

Major component is RBC’s (Erythrocytes), appears red.
Associated with severe injury, severed blood vessels.

Question 19

Exudate: Fibrinous

Answer 19

High in fibrinogen. Creates a sticky mesh.
Not common.

Question 20

Exudate: Membranous

Answer 20

Mucous Membrane
Necrotic Cells in Fibropurulent Exudate
(fibro = fibers, purulent = puss)

Question 21

4 Clinical Signs of Inflammation

Answer 21

1. Headache
2. Fatigue
3. Malaise (general feeling of unwell)
4. Fever

Question 22

Fever: What are the benefits?

Answer 22

Enhances phagocytosis and the Immune Response
Inhibits growth and reproduction of pathogens

Question 23

Pathogenesis of Fever?

Answer 23

Exogenous pyrogens (from outside the body):
i) induce host cells to produce fever-producing mediators. Stimulation of a cascade of production of endogenous pyrogens (released by body called IL1 + IL6 (Interleukin), and TNF (tumor necrosis factor).
ii) increases the set point by binding to the receptor at the hypothalamic receptor, mediated by PGE3 (prostaglandin).
iii) resulting in the temp set point adjusted upwards via cAMP (adenosene monophosphate, internal cellular messenger which helps PGE2 bind)

Note: if a fever develops in an absence of infection, there is no exogenous pyrgens. Eg. Anemia which causes excessive cell breakdown makes additional sourse of pyrogens instead.

Question 24

C-reative Protein
(CRP)

Answer 24

Produced by the Liver, in response to inflammation.
Serum marker for inflammation.
Persistant elevated levels is likely marker for cardio disease and atherosclerosis.

Question 25

Tx of Inflammation

Answer 25

1. Cold (vasoconstriction - dec blood flow - dec blood loss - dec hydrostatic pressure - less exudate) = Less swelling
2. i) Elevation (inc difficult for blood to reach - dec blood flow - dec hydrostatic pressure - dec exudate) = Decrease swelling.
   ii) Pressure (inc external pressure - oppose hydrostatic pressure - dec in exucate) = Decrease swelling.
3. Heat (inc local vasodilation - in blood flow) = stimulates phagocytosis
4. NSAID’s (dec prostaglandin synthesis) = Decreas pain
5. Steroidal Anti-Inflammatory Drugs (decrease cap permeability, dec WBC, dec release of prostaglandins & histamine)