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Pathology > Inflammation and Repair > Flashcards

Inflammation and Repair Flashcards

1
Q

What is the vascular reaction to injury and when does it occur?

A
  1. Vessel dilation/congestion
  2. Vessel Permeability Increased.

There is an increased blood flow, neutrophil emigration and leakage of plasma proteins. (edema)

It is the body’s first response to injury.

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2
Q

When does the acute inflammatory cell phase start? And how long does it last?

A

It is very rapid. Minutes to hours.

Usually short.

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3
Q

What are the cells associated with the acute inflammatory phase?

A

Neutrophils.

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4
Q

When does the chronic inflammatory phase start? How long does it last?

A

Later, somewhat delayed. Can be days or longer.

Variable duration. Usually days to weeks, but if there is a lack of resolution, it can last months to years.

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5
Q

What cells are associated with the chronic inflammatory phase?

A

Macrophages and lymphocytes.

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6
Q

When is repair initiated?

A

During the chronic phase.

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7
Q

What are the critical features of acute inflammation?

A

Vasodilation and increased blood flow. Vascular permeability increase (transudate and exudate), inflammatory cell infiltrate.

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8
Q

How does transudate differ from exudate?

A

It is mostly fluid and has a low content of protein, cells, or solid materials derived from cells.

Exudate is fluid, but has a much higher concentration of cells and proteins such as fibrinogen, immunoglobulin and complement.

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9
Q

What is the etiology of transudate? Compare it to exudate.

A

Increased hydrostatic pressure/reduced oncotic pressure. (Congestive heart failure)

Etiology of exudate is inflammation.

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10
Q

What is the specific gravity of transudate? Compare it to exudate.

A

Transudate specific gravity is lower than exudate’s.

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11
Q

What is the total protein of transudate compared to exudate?

A

Transudate has less protein than exudate.

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12
Q

What is the total protein of fluid/serum protein ratio and fluid/serum LDH ratio of Transudate compared to exudate?

A

Exudate is higher on both.

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13
Q

Compare the fluid/serum glucose ratio in transudate and exudate.

A

Transudate is higher than exudate.

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14
Q

Are leukocytes present in transudate? Are they in exudate?

A

Only present in exudate.

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15
Q

What is the resolution of acute inflammation?

A

Regeneration and repair.

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16
Q

When would chronic inflammation follow acute inflammation?

A

If the offending agent is not removed, or if it is present from the onset of injury. (Viral infections or immune responses to self-antigens.

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17
Q

What is scarring?

A

A type of repair after substantial tissue destruction or when inflammation occurs in tissues that do not regenerate.

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18
Q

When is chronic inflammation initiated?

A

Alongside acute phase.

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19
Q

What are the cells associated with chronic phase?

A

Macrophages, lymphocytes and plasma cells.

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20
Q

What is the source of the cells involved in the acute phase?

A

Peripheral blood.

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21
Q

What is fibrinopurulent exudate?

A

Neutrophils or PMN!

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22
Q

What is the vascular response for acute inflammation?

A
  1. Variable persistence of dilation and “leakiness”

2. Endothelial cell activated: ready to proliferate if necessary.

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23
Q

What is the source of cells in chronic inflammation?

A

Sentinel/local cells in tissue and peripheral blood.

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24
Q

How do macrophages stimulate repair in the chronic phase?

A

Growth factors.

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25
Q

How do fibroblasts stimulate repair in the chronic phase?

A

Fibrosis and scarring.

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26
Q

How do endothelial cells stimulate repair in the chronic phase?

A

Neovascularization

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27
Q

Can you have chonic inflammation without a distinct acute phase?

A

Yes.

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28
Q

What do fibrinopurulent, purulent and suppurative all indicate?

A

Pus is present.

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29
Q

What types of cells are involved in fibrinopurulent, purulent and suppurative infections?

A

PMNs

30
Q

What are the histological features of fibrinopurulent, purulent and suppurative infections?

A

Neutrophils, fibrin and blood products, and +/- hemorage.

31
Q

What is the differential diagnosis for fibrinopurulent, purulent and suppurative infections?

A

Any insult. Infectious: Bacteria and some fungal.

32
Q

What are the cells involved in granulomatous?

A

Macrophages!

33
Q

What are the histological features of a granulomatous infection?

A

Mixed chronic inflammatory cells. Necrotic centrally. Foreign material is present.

34
Q

What are the infectious causes of granulomatous infections?

A

Acid Fast Bacteria and fungus. TB!

35
Q

What are the 3 causes of granulomatous infections?

A

Infectious, inflammatory (Rheumatoid arthritis) and foreign body (non soluble suture).

36
Q

What do these two statements describe?

  1. Reaction to various “non-digestible” material.
  2. Material is walled off.
A

Granulomatous infections.

37
Q

What type of cells are involved in eosinophilic infections?

A

Eosinophils. Abundant eosinophils is the histologic feature that indicates a eosinophilic infection.

38
Q

What causes eosinophilic inflammation?

A

Infectious parasites, inflammatory allergic process and churg-strauss syndrome.

39
Q

If eosinophils are elevated in the tissue, where else is it often elevated?

A

In the peripheral blood too.

40
Q

Where does fibrinopurulent, purulent and suppurative exudate normally occur?

A

Anywhere, but usually the terms are used to describe pus in a non-confined space.

-pus from a skin wound, meningitis, urethritis.

41
Q

Where does an abscess normally occur?

A

Within parenchyma or a confined space. Such as the brain, lung or liver. The cavity that results is newly formed by the accumulation of inflammatory cells.

42
Q

Where does empyema normally occur?

A

Loculation within an anatomic space or cavity.

  • Pleural (between parietal and visceral layers)
  • Subdural space
  • Within the appendix/gall bladder/uterus/joint lumen or cavity.
43
Q

What type of inflammatory cells are associated with empyema?

A

Neutrophils predominate early. Later, macrophages and lymphocytes.

44
Q

Where does cellulitis occur?

A

In the skin (epidermis, dermis and subcutis), fascia and deep connective tissue.

45
Q

What is cellulitis that has deep involvement in to fascia called/

A

Necrotizing fascitis.

46
Q

Where does cellulitis often start?

A

Cuts and other injuries to the skin.

47
Q

What is the architecture of a granuloma?

A

Rounded/nodular appearance.

48
Q

What is the type of inflammation that usually occurs within parenchyma (lung, lymph node, liver, spleen) and is often mineralized, so it is visible on X-ray/CT scans?

A

Granuloma. TB!

49
Q

What are the 3 phases of repair?

A
  1. Inflammatory phase
  2. Proliferative phase
  3. Re-epithelial, regeneration, and remodeling phase.
50
Q

What do infrastructure cells do during the proliferative phase? What are the infrastructure cells?

A

Provide support and respond to injury.

Fibroblasts and endothelial cells.

51
Q

How do fibroblasts respond to injury?

A

Proliferate, produce collagen and other extracellular matrix for remodeling.

52
Q

What do fibroblasts consist of?

A

Collagen fibers, elastic fibers and other extracellular material.

53
Q

How do endothelial cells respond to injury?

A

Proliferate and form new blood vessels. It is a collaborative effort.

54
Q

What organ is commonly known for regeneration and remodeling?

A

The liver.

55
Q

What type of epithelial cells are regenerated during the re-epithelial/regeneration/remodeling phase?

A

Epithelial cells of the epidermis and mucosa.

56
Q

After what type of injury does the heart scar?

A

Myocardial infarct.

57
Q

How does the body repair INFRAstructure?

A

Granulation tissue and scars.

58
Q

What is angiogenesis?

A

Formation of new blood vessels.

59
Q

What is neovasculation?

A

Formation of new vessels by endothelial cells that proliferate and junction with others.

60
Q

What is granulation tissue?

A

New connective tissue and tiny blood vessels that form on the surfaces of a wound during the healing process.

61
Q

What is regeneration? Give some examples.

A

Restitution of the normal structure. Liver, superficial skin wounds, resorption of exudate in lobar pneumonia.

62
Q

What is repair? Give some examples.

A

Scar formation. Deep excisional wounds. Myocardium infarction.

63
Q

What is fibrosis?

A

Tissue scar. Chronic inflammatory disease.

64
Q

What is the difference between fibrosis and repair?

A

Repair comes from an acute injury while fibrosis comes from persistent tissue damage.

65
Q

What is an abnormal or pathologic scar?

A

Excess or exuberant scar formation and granulation tissue.

66
Q

What is Cirrhosis?

A

Abnormal scaring in the liver. Persistent injury overcomes regeneration potential.

67
Q

What is a hypertrophic scar?

A

A raised scar that grows beyond the boundaries of injury. Eventually regresses.

68
Q

What is a kleoid?

A

A raised scare that grows beyond boundaries of injury. Does NOT regress.

69
Q

What is a desmoid tumor?

A

Aggressive fibromatoses, benign neoplasm.

70
Q

What is a contracture?

A

A deformity typically around a joint.

71
Q

What would the expected findings of chronic inflammation and repair seen on microscopic evaluation include?

A

Neutrophils.

Pathology (6 decks)

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