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Year One - Principles of Disease > Inflammation > Flashcards

Inflammation Flashcards

1
Q

What do all inflammation names end in?

A

“itis”

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2
Q

What is inflammation?

A

Homeostatic response as a result of injury

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3
Q

What are the signs of acute inflammation?

A

Redness

Heat

Swelling

Pain

Loss of function

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4
Q

What causes acute inflammation?

A

Microorganisms that cause infection

Injury to tissue

Unstable chemical environment - unstable pH, bile or urine in an inappropriate place

Physical conditions - body exposed to extreme heat or cold, ionising radiation

Dead tissue

Hypersensitivity - allergic reaction

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5
Q

What is acute inflammation?

A

A series of localised events

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6
Q

Where does acute inflammation take place?

A

The microcirculation surrounding the affected tissue

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7
Q

What is microcirculation?

A

Defined as the capillary beds, which are fed by arterioles and drained by venules.

Also includes ECF and lymphatic channels surrounding these capillary beds

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8
Q

How is there a dynamic balance between the ECF and capillary beds?

A

Hydrostatic and colloid osmotic pressure

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9
Q

What is the first change that occurs during acute inflammation? What does this change cause?

A

Starts off with local arterial constriction which is then followed by local arterial dilation. This alters the flow of blood.

Constriction prevents blood to flow through the vessels (hypoxemia) and dilation allows more blood to flow through the vessels (hyperaemia)

Leads to the ‘triple response’ - flush, flare and wheal

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10
Q

What is the second change that occurs during acute inflammation? What is the process called? What two things does this change cause?

A

Change in the permeability of localised vessel walls, which makes them leakier and allow more molecules to flow into the surrounding tissues.

This process is called exudation. The substance that leaks out is known as the exudate.

Leads to an oedema forming, which is an accumulation of fluid in the ECF - explains swelling and pain symptoms

Increase viscosity in blood, which occurs as a result of fluid loss. The rate of blood therefore slows.

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11
Q

What happens to neutrophils in blood vessels during acute inflammation?

A

Neutrophil molecules move from the blood vessel into the extravascular space and take part in exudation.

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12
Q

Where are neutrophils and RBC’s usually found within the blood vessel?

A

Neutrophils - clustered within the centre of the lumen

RBCs - surround the cluster of neutrophils in the centre of the lumen

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13
Q

What are the three stages involved in the neutrophils moving out of the blood vessels during acute inflammation?

A
  1. Margination - movement of neutrophils to the endothelial aspect of the lumen
  2. Pavementing - adherence of neutrophils to the endothelium
  3. Emigration - movement of neutrophils between endothelial cells to extravascular tissues
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14
Q

What is the difference between diapedesis and emigration?

A

Diapedesis - passive movement of WBCs from lumen into extravascular space

Emigration - active movement of WBCs from lumen into extravascular space

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15
Q

What is the role of neutrophils in acute inflammation?

A

Mobile phagocytes - recognise foreign antigen and move towards it (chemotaxis). Bind to pathogen and release the granules in its cytoplasm into the organism. The granules are filled with enzymes. The enzymes destroy pathogen. This process is known as phagocytosis

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16
Q

What are the consequences of neutrophil action?

A

When they release their granule contents, they die

They produce pus, which can then extend into other tissues and progress inflammation

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17
Q

Other than neutrophils, which other molecules leak from the blood vessel into the extravascular space? What are their functions?

A

Plasma proteins - fibrinogen and immunglobulin

Fibrinogen - coagulation factor, involved in the formation of fibrin, cots exudate, localises processes

Immunoglobulin - induces the humoral immune response

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18
Q

What are the outcomes of acute inflammation?

A

Inciting agent is destroyed

Macrophages move from the blood into the affected tissue and clear up debris

Supparation

Epithelial surfaces regenerate

Fibrosis and formation of a scar occurs

Inflammatory exude filters away

Vascular changes return to normal

Inflammation resolves

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19
Q

What is granulation tissue?

A

New connective tissue, blood vessels, macrophages, fibroblasts and collagen that form on the surface of a wound during the healing process

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20
Q

What is supparation? What does this lead to?

A

Pus formation

Abscess forming, which can discharge pus as a result of the growth of granulation tissue placing pressure on it. When the abscess collapses, healing and repair can occur.

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21
Q

What is pus formed from?

A

Pus is formed from dead tissues, dead organisms, exudate, neutrophils, red blood cells and fibrin.

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22
Q

What surrounds pus? What happens if pus bursts through this?

A

Pyogenic membrane

It can form new cavities which means the abscess becomes multicoated

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23
Q

What is pyaemia?

A

Pus discharged into the bloodstream

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24
Q

What is empyema?

A

Pockets of pus that have collected inside the body cavity

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25
Q

What is dissemination? What does it result in?

A

When the bacteria or toxin that causes inflammation spreads to the bloodstream

Individual becomes septic

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26
Q

What are the three types of septicaemia?

A

Bacteraemia - bacteria spread to the blood

Septicaemia - growth of bacteria in the blood

Toxaemia - toxic products spreads to the blood

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27
Q

What can occur as a result of sepsis?

A

Septic shock, which can cause tissue hypoxia and necrosis.

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28
Q

What are the symptoms of septic shock?

A

Peripheral vasodilation

Tachycardia - high heart rate

Hypotension - low blood pressure

Pyrexia - raised temperature

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29
Q

What causes septic shock?

A

The release of chemical mediators as a result of acute inflammation

Chemical mediators cause vasodilation, which means that there is a loss of systemic vascular resistance. When systemic vascular resistance is loss, the hormone catecholamine is released. This hormone causes tachycardia. as this maintains cardiac output

Septic shock also results in the body releasing bacterial endotoxin, which is a molecule that results in pyrexia and coagulation.

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30
Q

What are the four benefits of acute inflammation?

A

Rapid response to injury

Neutrophils destroy organism

Plasma proteins localise process

Results in resolution and everything returns back to normal

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31
Q

What are the systemic effects of inflammation?

A

Pyrexia

Generally feeling unwell

Neutrophillia (raised white blood cell count)

Lymphadenopathy - long term effect, due to regional lymph node enlargement

Weight loss - long term effect

Anaemia - long term effect

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32
Q

What five effects do chemical mediators result in?

A

Vasodilation

Increased permeability

Neutrophil adhesion to the side of a vessel

Chemotaxis

Itch and pain

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33
Q

Where are adhesion chemical mediators found? What is their role?

A

Found on the surface of endothelial cells and help the neutrophils to stick to the endothelium

Allow neutrophils to move within and between cells

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34
Q

Name two adhesion chemical mediators

A

ICAM-1

P-selectin

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35
Q

Name six chemical mediators

A

Histamine

Serotonin (5-hydrocytrytamine)

Prostaglandins

Cytokines and chemokines

Nitric oxide

Oxygen free radicals

36
Q

What releases the chemical mediator histamine? What is its role?

A

Released from mast cells

Involved in vasodilation and increased permeability

37
Q

What releases the chemical mediator serotonin? What is its role?

A

Released from platelet cells

Involved in vasoconstriction

38
Q

What releases the chemical mediator prostaglandins? What is its role?

A

Released from various cells

Involved in promoting histamine effects and also inhibiting inflammatory cells

39
Q

What releases the chemical mediator cytokines and chemokine? What is its role?

A

Released from macrophages, lymphocytes and endothelium cells

Involved in pro-inflammatory and anti-inflammatory effects

40
Q

What releases the chemical mediator nitric oxide? What is its role?

A

Released from various cells

Involved in smooth muscle relaxation, anti-platelet aggregation, regulating leukocyte to inflammatory focus

41
Q

What releases the chemical mediator oxygen free radicals? What is its role?

A

Released from neutrophils during phagocytosis

Involved in amplifying other mediator effects

42
Q

Name the two signalling mediators

A

PAMPs - able to identify foreign antigens and alert other immune cells to destroy the initiating the innate and adaptive immune response

DAMPs - able to initiate a non-infectious inflammatory response

43
Q

How do the signalling molecules recognise antigens?

A

Pattern recognition

44
Q

What are the three intracellular pathways that can be activated during the acute inflammatory response?

A

NF-kB pathway

MAPK pathway

Jak-Stat pathway

45
Q

What is the role of the NF-kB pathway? How is it activated?

A

Results in the production of inflammatory cytokines

Activated by extracellular molecule binding to the surface of the cell

46
Q

What is the role of the MAPK pathway? How is it activated?

A

Involved in regulating pro-inflammatory cytokine production and inflammatory cell recruitment

Activated by extracellular molecule binding to toll-like surface receptors (TLRs)

47
Q

What is the role of the JAK-STAT pathway? How is it activated?

A

Production of inflammatory cytokines

Activated by extracellular molecule binding to the surface of the cell

48
Q

What are the four inflammatory pathways that take place in the plasma?

A

Blood coagulation pathway

Fibrinolysis pathway

Kinin pathway

Complement cascade pathway

49
Q

What is the role of the blood coagulation pathway?

A

Involved in clotting the exudate with fibrinogen

50
Q

What is the role of the fibrinolysis pathway?

A

Breaking down fibrin and helping to maintain the blood supply

51
Q

What is the role of the kinin pathway?

A

Releasing bradykinin, which causes contraction of smooth muscle and dilation of blood vessels

52
Q

What is the role of the complement cascade pathway?

A

Bridges the inflammatory and the immune response together.

Results in active components being stimulated which increases permeability, chemotaxis, phagocytosis and cell breakdown

53
Q

What is the main difference between acute and chronic inflammation?

A

Chronic

54
Q

What is the main difference between acute and chronic inflammation?

A

In chronic inflammation the damaged tissue or organ repairs, but doesn’t resolve. This means that there is a loss of function

Granulation tissue also forms in chronic inflammation

55
Q

What causes chronic inflammation?

A

May follow from ongoing acute inflammation

Primary pathology - usually results from an autoimmune disease

56
Q

Why can chronic inflammation follow on from acute inflammation?

A

Acute inflammation causes a large volume of debris, which is not removed

Fails to get rid of the substance causing inflammation

57
Q

What are the clinical symptoms of chronic inflammation?

A

Malaise

Weight loss

Loss of function

58
Q

What are the outcomes of chronic inflammation?

A

Organisation - which involves the formation of granulation tissue and blood vessels

Healing and repair

Fibrosis and scar formation

59
Q

What is angiogenesis?

A

Formation of new blood vessels

60
Q

How does angiogenesis occur?

A

Capillary buds growing out from existing capillaries

61
Q

Why does angiogenesis occur?

A

Release of VEGF from hypoxic cells, which is a growth factor that secretes enzymes which are able to break down proteins and enable space for blood supply to enter the damaged tissue

62
Q

What does angiogenesis limit?

A

Thrombus propagation, which is the spread of a blood clot towards the direction of the heart

Therefore it allows the reinstatement of flow

63
Q

What is the formation of granulation tissue due to?

A

Capillaries growing into the inflammatory mass, which allows plasma proteins, macrophages and fibroblasts to access the mass

Macrophages - clean up debris

Fibroblasts - lay down collagen to repair tissue damage, replaces the inflammatory exudate

64
Q

What is the granulation tissue formed from primary chronic inflammation called?

A

Pyogenic granulation tissue

65
Q

What does granulation tissue result in?

A

Formation of a scar

Fibrosis - which is the formation of excessive amount of fibrous connective tissue in an organ or tissue

66
Q

What cells are involved in chronic inflammation?

A

Lymphocytes - B-cells involved in antibody production, Th-cells involved in the production of cytokines and Tc-cells involved in cell lysis and apoptosis

Plasma cells - form B-cells which are involved in antibody production

NK cells - involved in apoptosis, which means that they release enzymes from their granules into pathogens

Macrophages - remove debris from the site of injury and cause phagocytosis. Forms APCs which are able to stimulate other cells. Release interferons, which stimulate other immune cells.

Fibroblasts - able to make and assemble structural proteins, like collagen

67
Q

What are epitheliod cells?

A

Activated macrophages

68
Q

What are macrophage monocytes?

A

Macrophages formed in the blood

69
Q

What is granulomatous inflammation?

A

Distinct from of chronic inflammation, where there is a presence of granulomas

70
Q

What stimulates granulomatous inflammation?

A

Indigestible antigen, which is an antigen that the body cannot get rid of

Serious infections

71
Q

What are granulomas?

A

Collection of epitheliod macrophages in tissue, may contain giant cells, WBCs

Surround dead material or lymphocytes

72
Q

What are giant cells?

A

Multiple macrophages which are bound together to form a multinucleate cell with a large cytoplasm

73
Q

What are silicone associated granulomas?

A

Granulomas that form as result of the body reacting to silicon.

Commonly arise due to ruptures silicone implants

74
Q

Name three giant cells

A

Langhan

Foreign body

Warthin Finkeldy

75
Q

What are Langhan giant cells?

A

Classically found in TB

Peripheral rim around the multiple nuclei contained within them

Large eosinophilic cytoplasm

76
Q

What are foreign body giant cells?

A

Often associated with pyogenic granulation tissue

Smaller than Langhan cells don’t contain as many nuclei

Contain foreign material in cytoplasm

77
Q

What are warthin finkeldy giant cells?

A

Associated with measles

Nuclei cluster in the centre of the cell

78
Q

What three serious diseases can cause granulomatous inflammation diseases?

A

TB

Leprosy

Syphillis

79
Q

What is wound healing?

A

The process of repairing tissue damage

80
Q

Describe the steps of wound healing

A
  1. An injury occurs, which results in a blood clot and acute inflammation
  2. During acute inflammation and clot formation, many growth factors and cytokines are released
  3. These growth factors and cytokines result in granulation tissue growth and angiogenesis
  4. Phagocytosis of fibrin (blood clot) occurs
  5. The fibroblasts move into the site of injury and lay down collagen
  6. A scar is formed, which leads to the process of re-epithelisation occurring.
81
Q

How do we keep inflammation to a minimum during surgery?

A

Reducing the amount of tissue damage as much as possible

82
Q

Why is it important to keep inflammation to a minimum during surgery?

A

Reduces the size of the scar, as less granulation tissue if formed

83
Q

What type of healing occurs during surgery? What does it involve?

A

Healing by the primary intention.

Keep the gap between the suture and the blood clot to minimum, which means that only a small amount of granulation tissue is formed and the patient is left with a small scar

84
Q

What is healing by secondary intention?

A

Results in lots of granulation tissue forming, which grows into the blood clot.

Causes the blood clot to contract and push into the collagen in the granulation tissue. This results in a puckered scar

85
Q

What is the difference between fracture and wound healing?

A

The granulation tissue which forms contains osteoblasts as well as fibroblasts.

Osteoblasts are involved in new bone formation, which is termed as callus. This process is then followed by bine remodelling which involves the osteoclasts removing dead bone

86
Q

What are the steps of fracture healing?

A

Trauma which results in a fracture and a haematoma

Acture inflammation occurs, which results in organisation

Granulation tissue is formed

87
Q

What is a haematoma?

A

Solid swelling of clotted blood within a tissue

Year One - Principles of Disease (15 decks)

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