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Pathophys > Inflammation > Flashcards

Inflammation Flashcards

1
Q

Coordinated vascular and cellular response of the body to cell injury and death

A

Inflammation

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2
Q

What two features does inflammation have?

A

Protective (immune)

Curative

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3
Q

What is the responsibility of inflammation?

A

Removal of injurious agent and cellular debris

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4
Q

T/F Inflammation initiates the healing process

A

True

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5
Q

T/F Inflammation does not serve a vital role in host defenses against pathogens and cell injury

A

False, IT DOES

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6
Q

T/F Inflammation is equivalent to an infection

A

False, associate it with tissue injury

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7
Q

Without an inflammatory response we can not…

A
  1. Heal

2. Have a normal immune function

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8
Q

Glucocorticoids effect on inflammation

A

Suppress immune function

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9
Q

What type of infections lead to inflammation?

A

Bacterial, viral, fungal, parasitic

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10
Q

Examples of trauma/damaged tissues that can lead to inflammation

A
  1. Blunt or penetrating trauma

2. Physical/chemical agents - thermal energy (burns or frostbite), radiation, toxicity from chemicals

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11
Q

Examples of presence of foreign bodies that can cause inflammation

A

splinters, dirt, sutures, crystal deposits

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12
Q

Other factors that can lead to inflammation?

A
  1. Tissue necrosis
  2. Immune reactions
  3. Ischemia
  4. Cancer
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13
Q

What are the 3 goals of an inflammatory response?

A
  1. Inactivate injurious agents
  2. Break down and remove dead cells and other cellular debris
  3. Initiate tissue healing
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14
Q

Erythema -

A

vasodilation and increased blood flow (redness)

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15
Q

Heat -

A

vasodilation and increase blood flow

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16
Q

Edema -

A

fluid and cells leaking from local blood vessels into extravascular spaces

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17
Q

Pain -
Secondary to what?
Caused by what?

A
  • Direct trauma
  • Chemical mediation of bradykinins, histamines, serotonin
  • Internal pressure secondary to edema
  • Swelling of the nerve endings
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18
Q

Collateral damage of inflammation -

A

Components of response capable of damaging and destroying normal tissue

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19
Q

What must inflammatory processes be tightly regulated?

A

Avoid excessive tissue damage and spillover to normal tissue

- Inflammation is normally controlled and self limiting

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20
Q

What is the hallmark of inflammation?

A

Vascular events

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21
Q

Why does vasodilation occur near site of injury?

A

Brings more plasma proteins and leukocytes to the area

- Explains heat and redness at site of injury

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22
Q

How is vasodilation induced?

A

By histamine release from platelets and mast cells causing smooth muscle relaxation

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23
Q

At site of injury, describe increase vascular permeability and what does it allow for?

A
  • Smaller arterioles become leaky or permeable

- Allows for the passage of a protein and cell rich fluid (exudate) into the interstitial spaces

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24
Q

T/F vascular permeability results in an accumulation of blood in the area of dilation and stasis (describe)

A

True, explains localized redness at site and allows for accumulation of platelets and neutrophils

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25
Q

What is the leukocytes key function at site of injury?

A

Eliminating the offending agent and cleaning up the area

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26
Q

What are the 5 types of WBC (leukocytes)?

A 
Granulocytes:
1. Neutrophil
2. Basophil
3. Eosinophil
Agranulocytes:
1. Macrophages/Monocytes
2. Lymphocytes
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27
Q

What is the job of the lymphocytes?

A

Natural cell killer

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28
Q

What are two fixed or tissue specific leukocytes?

A
  1. Mast cells

2. Langerhans cells (found on skin)

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29
Q

What type of WBC is the first responder to injury and predominant cell type found in pus?

A

Neutrophils

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30
Q

Chemotaxis -

A

movement of WBC in response to a chemical stimulus

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31
Q

Diapedesis -

A

Migration through the endothelial lining of the blood vessels

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32
Q

How does the body recognize an offender (injury)?

A

Via surface receptors

33
Q

What WBC type is the predominant leukocyte in the area of injury for about 24 hours?

A

Neutrophils

34
Q

What is the clinical implication of an increase in WBC count?

A

Mostly neutrophils = body is attempting to fight off some injury

35
Q

What is neutropenia and what does it mean to a person?

Ex:

A

Low WBC count = increased vulnerability to infection

Ex: radiation injury, cancer therapy, drug sensitivity

36
Q

Where do you find monocytes and what is their job when an injury occurs?

A
  • Circulate in the blood and replenish macrophages

- In response to inflammation signals, move to site of injury and differentiate into macrophages and dendritic cells

37
Q

What is the job of a macrophage?

A

Engulfs and digests cellular debris, foreign substances, cancer cells

38
Q

Tissue specific macrophages:
Langerhans
Kupffer cells
Microglia

A

Langerhans - skin
Kupffer cells - liver
Microglia - CNS

39
Q

What do lymphocytes do?

A

Main type of cell in lymph that produces antibodies

B-cells, T-cells

40
Q

Where are mast cells found and how do they work?

A
  • Found in most tissues of body (skin, airways, intestine)
  • Contain granules which hold several preformed immune mediators (histamines, serotonin, thromboxane, prostaglandins, platelet activating factors, cytokines
41
Q

Describe the pathology of RA:

A
  1. Synovial cells multiply
  2. Influx of leukocytes
  3. Synovial accumulates excessive fluid (edematous)
  4. Increase TNF (mast cells) -> massive inflammatory response
  5. WNC phagocytize immune complexes
  6. Release of metalloproteases - degrade cartilage
  7. Inhibits bone formation and stimulates bones resorption
42
Q

RA results in a structure called ____ that surrounds the joints.

A

Pannus

43
Q

How can collateral tissue injury occur?

A
  1. Lack of specificity in immune response
  2. Phagocytosis of local cells
  3. Free radicals/oxygen metabolites
  4. Vascular damage to allow diapedesis
44
Q

What are the systemic effects of acute inflammation?

A
  1. Fever
  2. Malaise
  3. Anorexia
  4. Hypotension
  5. Accelerated degradation of skeletal muscle (by cytokines)
  6. Increasing circulating effects of mast cell (TNF)
  7. Leukocytosis
  8. Leukopenia
45
Q

What is leukocytosis?

Normal vs abnormal values?

A

Increased WBC count
normal = 4000-10000
Abnormal = 15000-20000

46
Q

What is leukopenia and what can cause it?

A
  • Decreased WBC count

- Patient’s who are immune compromised (viral/bacterial infections)

47
Q

Pro inflammatory signaling molecules are involved in controlling inflammation by:

A
  1. Short half-lives
  2. Rapid degradation
  3. Large [ ] -> reduction in amount of pro-inflammatory signaling molecules (negative feedback loop)
48
Q

Describe the negative feedback loop of pro-inflammatory molecules

A

High [ ] -> down-regulation of receptor sensitivity -> reduced production of signaling molecules

49
Q

When inflammation slows, what can begin?

A

Tissue repair

50
Q

M1 macrophages -

A
  • Encourage inflammation
  • First on the scene of muscle injury (0-48 hrs)
  • Possible collateral damage of tissue cleanup
51
Q

M2 macrophages -

A
  • Anti-inflammatory and encourage tissue repair

- Release soluble substances that influence proliferation, differentiation, growth, repair, and regeneration of muscle

52
Q

Complete resolution of inflammatory episode -

A

No damage to CT framework -> normal function returns, clearance of injurious stimuli, clearance of all mediators and acute inflammatory cells -> replacement of injured cells

53
Q

Abscess formation -

A

Abscess - accumulation of pus in a confined space (on skin = pimple/pustule)
- Often requires draining

54
Q

How is pus formed?

A

Neutrophils destroyed by macrophages

55
Q

Healing by fibrosis or scarring?

A
  • Preinjury tissue replaced by CT (fibrosis)
56
Q

What are parenchymal cells and what are their function in recovery?

A
  • make up functional part of an organ
  • Required for normal recovery from injury
  • If not available = fibrosis
57
Q

What are some implications of inflammation for the therapist?

A
  1. Normal process that does damage adjacent healthy tissue
  2. Systemic effects
  3. Limit inflammation (RICE/OTCs)
  4. Can lead to chronic inflammation
58
Q

How does inflammation progress to chronic?

A

When neutrophils can’t remove noxious agents (weeks-months-years)

59
Q

How is chronic inflammation characterized?

A

Continuous tissue injury with ongoing attempts at repair

60
Q

Chronic inflammation can arise from what 3 things?

A
  1. Persistent infections/presence of foreign particles
  2. Hypersensitivity disease - excessive and inappropriate activation of immune system (RA, MS, asthma)
  3. Prolonged/chronic exposure to toxic agents (silica, cholesterol, cigarette smoke)
61
Q

Chronic tissue inflammation has what cells present? What cells absent?

A

Present - macrophages, lymphocytes, plasma cells

Absent - neutrophils

62
Q

Attempts at healing during chronic inflammation result in what two things?

A
  1. Angiogenesis - growth of blood vessels

2. Fibrosis

63
Q

What is granulomatous inflammation and what is it caused by?

A
  • Form of chronic inflammation

- Caused by aggregation of macrophages

64
Q

T/F granulomatous inflammation sometimes presents with central abscess

A

True

65
Q

Examples of granulomatous inflammation?

A
  1. Foreign bodies (talc, suture)
  2. TB (prototype)
  3. Fungal infections (histoplasmosis)
  4. Some immune-mediated inflammatory diseases (Crohn disease)
66
Q

When is the onset of acute inflammation?

A

Minutes - hours

67
Q

When is the onset of chronic inflammation?

A

Days

68
Q

What are the cellular infiltrates of acute inflammation?

A

Mainly neutrophils

69
Q

What are the cellular infiltrates of chronic inflammation?

A

Monocytes/macrophages and lymphocytes

70
Q

What level of tissue injury/fibrosis do you see with acute inflammation?

A

Mild - self limiting

71
Q

What level of tissue injury/fibrosis do you see with chronic inflammation?

A

sever and progressive

72
Q

What local and systemic signs do you see with acute inflammation?

A

Prominent

73
Q

What local and systemic signs do you see with chronic inflammation?

A

Less prominent (may be subtle)

74
Q

How can chronic inflammation lead to diabetes?

inflammation in presence of obesity

A

Increase activity of pro-inflammatory cells (macrophages) -> increase release of pro-inflammatory signaling molecules into blood stream -> cytokines interfere with insulin signaling and damage pancreatic beta cells -> diabetes

75
Q

Areas of chronic inflammation or small tumors affect on chronic inflammation?

A

Release pro-inflammatory signaling molecules -> system wide

76
Q

How does cigarette smoke affect inflammation?

A

Induces chronic inflammation state

77
Q

What is an example of direct chronic irritation?

A

smokeless tabaco

78
Q

T/F Heart disease is viewed as an inflammatory disease

A

True, reduction in inflammation -> reduced risk of heart attack

Pathophys (16 decks)

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