Inflammation and Repair Flashcards
1
Q
What is inflammation?
A
The reaction of the blood vessels, leading to the accumulation of fluid and leukocytes in the extravascular tissues
2
Q
What is the function of inflammation?
A
A protective response
- eliminate microbes and toxins
- eliminate necrotic cells and tissues
- prepare for tissue repair
3
Q
What do neutrophils do?
A
First responder (acute inflammation) bacterial or fungal infection
4
Q
What forms pus?
A
Increased activity and death of neutrophils
5
Q
What general percentage of WBC’s do neutrophils make up?
A
60%
6
Q
What do lymphocytes do?
A
Chronic inflammation
- T cell and B cell response/activation
7
Q
What general percentage of WBC’s do lymphocytes make up?
A
30%
8
Q
What do monocytes do?
A
Long lived Phagocyte that present pathogen parts to T cells
9
Q
What are monocytes when they are in tissue?
A
Macrophages
10
Q
What general percentage of WBC’s do monocytes make up?
A
5-6%
11
Q
What do eosinophils do?
A
Parasite and Allergic response
12
Q
What general percentage of WBC’s do eosinophils make up?
A
2-3%
13
Q
What do basophils do?
A
Allergic and antigen response and releasing the chemical histamine
14
Q
What are basophils when they are in tissue?
A
Mast Cells
15
Q
What general percentage of WBC’s do basophils make up?
A
<1%
16
Q
What is the order from largest to smallest of the WBC’s?
A
Neutrophils Lymphocytes Monocytes Eosinophils Basophils (Never Let Monkeys Eat Bananas)
17
Q
Where do T lymphocytes mature?
A
Thymus
18
Q
Where do B lymphocytes mature?
A
Bone maroow
19
Q
Are thrombocytes WBCs?
A
No they are platelets
20
Q
What is the function of thrombocytes?
A
To plug up holes
21
Q
What is the life span of an RBC?
A
120 days
22
Q
What is the life span of WBC?
A
days to years
23
Q
What is the life span of a platelet?
A
8 days
24
Q
What are the two types of inflammation?
A
Acute and Chronic
25
What is the duration and onset speed of acute inflammation?
Rapid onset and short duration (min/hours/days)
26
Is there edema with acute inflammation?
Yes
27
What type of leukocyte is predominantly present with acute inflammation?
Predominantly neutrophils, but also eosinophils and antibody mediated
28
What is the duration and onset speed of chronic inflammation?
```
Slower onset
Long duration (wks, months, years)
```
29
What are some characteristic appearances of chronic inflammation?
Presence of new blood vessels, fibrosis, and tissue necrosis
30
What type of leukocyte is predominantly present with chronic inflammation?
Predominantly macrophages and lymphocytes
31
What are the key signs and symptoms of acute inflammation?
1) Redness
2) Heat
3) Swelling
4) Pain
5) Loss of function
32
What is the Latin term for redness?
Rubor
33
What is the Latin term for heat?
Calor
34
What is the Latin term for swelling?
Tumor
35
What is the Latin term for Pain?
Dolor
36
What is the Latin term for Loss of function?
Functio laesa
37
What vascular changes occur with inflammation?
1) Vascular dilation and increased blood flow (causing erythema and warmth)
2) Extravasation and deposition of plasma fluid and proteins (edema)
3) Leukocyte emigration and accumulation in the site of injury
38
What is the net flow of fluid of microvasculature in normal circulation?
Small flow out of the precapillary arteriole but returned in the precapillary venuole
39
What happens to the net flow of the microvasculature with acute inflammation?
Arteriole pressure is increased and the mean capillary pressure is increased due to arteriolar dilation. The venous pressure increases and the osmotic colloidal pressure is reduced due to protein leakage across the venule which results in an excess of extravasated tissue
40
What is oncotic pressure?
Pressure bringing in fluid into vasculature from tissue due to albumin concentration
41
What causes oncotic pressure?
Albumin concentration
42
What controls arteriole pressure?
Sphincters of muscles that clamp off blood flow
43
What collects the small flow out of the capillary bed?
Lymphatic system
44
What is hyperemia?
Increased blood flow
45
What occurs with the precapillary sphincter during normal circumstances?
The precapillary sphincters are closed
46
What occurs with the precapillary sphincter during acute inflammation?
The precapillary sphincters are open
47
During normal flow how are the RBC's and platelets and neutrophils distributed?
Scattered
48
Where in a circulatory vessel is the flow the fastest?
The middle because of laminar flow
49
What is the term for the stacking of RBCs as they move towards laminar flow?
Rouleaux of RBC
50
What does marginalization of neutrophils refer to?
When the neutrophils are pushed aside and moving towards the endothelium
51
What is the rouleaux relation to erythrocyte sedimentation rate?
It elevates the ESR
52
What are the steps of leukocyte extravasation?
1) Margination
2) Pavementing
3) Extravascular migration
53
What is the main leukocyte of margination?
Neutrophils
54
What are the parts of the pavementing stage of leukocyte extravasation?
1) rolling
2) tight binding
3) diapedesis/migration
55
What are some parts of tight binding of the pavementing stage of leukocyte extravasation?
1) integrin activation
| 2) stable adhesion
56
What occurs in extravascular migration?
Chemokines and cytokines direct the leukocyte to go to specific area
57
What are the 3 steps of phagocytosis of a particle?
1) recognition and attachment
- microbes bind to phagocyte receptors
2) engulfment
- phagocyte membrane zips up around microbe
3) killing and degradation
- fusion of phagosome with lysosome
- killing of microbes by lysosomal enzymes in phagolysosome
58
What 2 groups are the mediators of inflammation divided into?
1) plasma derived
| 2) cell derived
59
Do mediators of inflammation act only on a single cell?
No, they are multifunctional and act on many cells and tissues
60
Are mediators of inflammation biochemically the same or diverse?
Biochemically diverse including biogenic amines, peptides and arachidonic acid derivatives
61
What is a histamine?
Biogenic amine that is from a cell derived source (stored in cell)
62
Where histamines released from?
Platelets and mast cells
63
What is the function of histamine?
Stimulates retraction of endothelial cells of the venules and leads to gaps therefore increased permeability
64
Is the action of histamine short or long and why?
The action of histamine is short because it is inactivated by histaminase
65
What vitamin stabilizes mast cells?
Vitamin C, during an acute response
66
What is bradykinin?
Plasma protein in the liver that is derived from kininogen through the enzymatic action of kallikrein?
67
what is Kallikrein do and what is it activated by?
Kallikrein acts on the clotting and fibrinolytic systems of the blood and activated by Hageman factor
68
What does bradykinin induce?
Pain
69
What is the relationship between bradykinin and histamine?
They both have a similar action
70
What were the mast cells called before they exited the blood vessel?
Basophils
71
What is a complement system?
A group of plasma proteins produced by the liver
72
Does the complement system circulate in an active form?
No, it circulates in an inactive form
73
How is the complement system activated?
Through a classical or alternative pathways
74
What does the activation of the complement system lead to?
The formation of biologically active fragments, intermediate complexes and terminal membrane attack complexes
75
What are the main function of activated complement derivatives?
1) Opsonization
2) Anaphylaxis
3) Chemotaxis
4) Cell lysis
76
What is opsonization
Facilitated phagocytosis of bacteria
77
What is anaphylaxis/
Histamine release with increased vessel wall permeability
78
What is the function of chemotaxis by activated complement derivaties?
migration of leukocytes
79
Through what complex does the activated complement derivatives cause cell lysis?
Through the action of Membrane attack complex (MAC)
80
What 3 pathways can activate the complement system?
1) Alternative pathway
2) Classical pathway
3) Lectin pathway
81
What stimulus activates the alternative pathway of the complement system?
Microbes
82
What stimulus activates the classical pathway of the complement system?
Antibodies
83
What stimulus activates the lectin pathway of the complement system?
mannose binding lectin
84
What do all the Complement pathways do after being initiated
C3b is deposited on the microbe and C3a is released
85
What does C3a function as?
it initiates inflammation via recruitment and activation of leukocytes
86
What does C3b of the activated complement system do/
1) Initiates phagocytosis via allowing recognition of the microbe by binding the C3b to the phagocyte C3b receptor
2) Causes formation of membrane attack complex and causes lysis of microbes
87
What are the 3 steps of phagocytosis of bacteria?
1) Attachment of the opsonized bacterium to the polymorphonuclear leukocytes
2) Engulfment of the bacterium
3) Formation of the phagocytic vacuole
88
What is the common, final pathway for the classical, mannose binding lectin and alternative pathways of the complement pathways?
When the C3 convertase (C3 con) cleaves C3 into C3a and C3b
89
What is arachidonic acid?
Arachidonic acid is derived from phospholipids through the action of phospholipases
90
How is arachidonic acid metabolized?
1) Lipoxygenase pathway
| 2) Cyclooxygenase pathway
91
What are the 5 arachidonic acid derivatives?
1) Leukotrienes
2) Lipoxins
3) Thromboxane
4) Prostacyclin
5) Prostaglandins
92
What is the function of leukotrienes?
Chemoxtaxis, vascular permeability and bronchospasm
93
What is the function of lipoxins?
vasodilatation, inhibition of neutrophil chemotaxis, and monocyte adhesion
94
What is the function of thromboxane?
Platelet aggregation, thrombosis
95
What is the function of Prostacyclin?
Opposes the effects of thromboxane
96
What is the function of Prostaglandins?
Smooth muscle contraction
97
Is Omega 3 fatty acids (fish oil) a good substrate for conversion?
No it is a poor substrate
98
Are animal fats good for conversion to substrate?
Yes, animal fat is a good substrate
99
Generally, what lymphokines are released with macrophage activation and lead to inflammation?
Interleukin-1 and Tumor Necrosis factor
100
What are the acute-phase reactions activated by interleukin-1 and tumor necrosis factor?
1) Fever
2) increased sleep need
3) decreased appetite
4) Increased acute-phase proteins
5) hemodynamic effects (shock)
6) Neutrophilia (attract neutrophils)
101
What are the endothelial effects activated by interleukin-1 and tumor necrosis factor?
1) increased leukocyte adherence
2) Increased prostacyclin synthesis
3) Increased procoagulant activity
4) decreased anticoagulant activity
5) Increased Interleukin and platelet derived growth factor
102
What are the fibroblast effects activated by interleukin-1 and tumor necrosis factor?
1) increased proliferation
2) increased collagen synthesis
3) increased collagenase
4) increased protease
5) increased prostaglandin synthesis
103
What are the leukocyte effects activated by interleukin-1 and tumor necrosis factor?
Increased cytokine secretion (interleukin 6 and 8)
104
What does long term tumor necrotic factor production lead to?
Cachexia (wasting away syndrome)
105
What leads to the pathogenesis of fever?
TNF and IL-1 that changes the set point of internal temperature in the hypothalamus
106
What are the different types of nitrous oxide synthase?
1) endothelial
2) neuronal
3) inducible
107
Where does endothelial nitrous oxide synthase have effects on?
Affects the smooth muscle of vessel walls
108
Where does neuronal nitrous oxide synthase have effects on?
effects within the macrophage
109
Is a morning erection a good or bad sign?
Good sign as it reflects cardiovascular health)
110
What can the urea cycle create?
Arginine
111
What is the effect of arginine of vessels?
It causes the relax of vessels to promote vessels so that increased blood flow occurs (good for athletes and asthmatics as it relaxes the smooth muscle of the trachea as well)
112
what are the two types of neutrophil granuoles?
primary and secondary granules
113
What is another name for secondary granules?
Specific granules
114
What is another name for primary granules?
Azurophil
115
What is the difference between azurophil and specific granules?
Azurophils are larger than specific granules
116
What causes the injury for acute inflammation?
1) infarction
2) bacterial infections
3) toxins
4) trauma
117
What are some of the outcomes of acute inflammation?
1) vascular changes
2) neutrophil recruitment
3) mediators
118
What happens if acute inflammation progresses?
It becomes chronic inflammation
119
What causes the injury directly for chronic inflammation?
1) viral infections
2) chronic infections
3) persistent injury
4) autoimmune diseases
120
What are some of the outcomes of chronic inflammation?
1) angiogenesis via platelet derived growth factor
2) mononuclear cell infiltrate
3) fibrosis (scar)
121
What does the healing of both acute and chronic inflammation lead to?
Fibrosis
122
What does fibrosis do?
Causes loss of function
123
What are the three possible outcomes of acute inflammation?
1) Resolution
2) Pus formation
3) Fibrosis
124
With resolution of an acute inflammation what occurs?
1) clearance of injurious stimuli
2) clearance of mediators and acute inflammatory cells
3) replacement of injured cells
4) normal function
125
What occurs with pus formation?
abcesses
126
What does pus formation eventually lead to?
Fibrosis
127
What are the events in the resolution of inflammation?
1) return to normal vascular permeability
2) drainage of edema fluid and proteins into lymphatics or 3) by pinocytosis into macrophages
4) phagocytosis of apoptotic neutrophils
5) phagocytosis of necrotic debris
6) disposal of macrophages
128
What are the different types of morphologic patterns of inflammation?
1) serous inflammation
2) Fibrinous inflammation
3) purulent inflammation
4) ulcerative inflammation
5) psedomembranous inflammation
6) chronic inflammation
7) granulomatous inflammation
129
What is serous inflammation?
Early stage of most inflammation
130
What are some examples of causes of serous inflammation?
1) Viral infection of skin vesicles in herpesvirus infection
2) joint swelling in rheumatoid arthritis
3) Eczema
4) Skin Burn (blister)
131
What is effusion?
secretion from lining of peritoneal, pleural or pericardial cavities. (fluid between tissue)
132
What is an abscess?
A capsulated collection of fluid (pus) within the tissue that cannot escape
133
What is a sinus?
a collection of fluid within the tissue that has an escape
134
What is a fistula?
A connection between two organs or connecting from an abscess may or may not be open to the surface
135
What does a granuloma consist of?
1) lymphocytes
2) epithelioid cells
3) multinucleated giant cells
136
Why does a granuloma become a multinucleated giant cells?
Cells fusing together (strength in numbers) to wall off/surround the infectious agent
137
What is a suppurative inflammation?
Inflammation with pus
138
What is the progression from stem cell to activated macrophage?
Stem cell -> monoblast -> monocyte -> macrophage -> activated macrophage
139
What are macrophages in the CNS?
microglia cells
140
What are macrophages in the liver?
Kupffer cells
141
What are macrophages in the lung?
Alveolar macrophages
142
What are macrophages in the bone?
Osteoclasts
143
What are macrophages in the lymph nodes?
Sinus histocytes
144
At what point does a monocyte become a macrophage?
When the monocyte moves from blood to tissue
145
What are some chemotactic stimuli to cause monocytes to become macrophage?
1) chemokines
2) C5a
3) Growth factors
4) collagen & fibronectin fragments
5) Fibrinopeptides
146
What are the two outcomes of activated macrophage?
1) Tissue Injury/ Destruction (ROS)
| 2) Fibrosis
147
What are some hallmarks and signs of chronic inflammation / tissue injury or destruction?
1) Toxic oxygen metabolites
2) Proteases
3) Neutrophil chemotactic factors
4) Coagulation factors
5) Amino acid metabolites
6) nitric oxide
148
What are some signs and effects of fibrosis due to activated macrophages?
1) growth factors
2) fibrogenic cytokines
3) angiogenesis factors (FGF)
4) Remodeling collagenesis
149
How does an activated macrophage recruit leukocytes?
TNF
| IL-1
150
What do activated macrophages do?
Present antigen to T cells and uses cytokines to stimulate T cell response
151
What occurs when a T lymphocyte is activated?
TNF and other inflammatory mediators recuit Leukocytes and cause inflammation
