INFLAMMATION--CH 5 = 3 Q'S Flashcards
Definition of INFLAMMATION
Vascular and cellular responses whose purpose is to
localize or _________ the injurious agents.
2 TYPES: ACUTE AND CHRONIC
eliminate
_______ INFLAMMATION
Transient process that occurs within few
minutes of injury and lasts for short time
(hours or days), usually described by the suffix
-“ITIS”–preceded by the name of the tisssue or organ.
ACUTE
Causes of ACUTE INFLAMMATION X 5
1. _________ agents: bacteria, viruses, parasites,
protozoa
2. __________reaction: as due to tubercle bacilli or
parasites
3. ________ agents : trauma, heat, cold, radiation
4. _________ agents : acids, alkalis or bacterial toxins
5. Tissue_______: acute inflammatory response in
adjacent viable tissue
Infectious
Hypersensitivity
Physical
Chemical
necrosis
Cardinal Signs of Acute Inflammation
1. _______ (redness): due to blood vessels dilation
Dolor (pain): due to increased pressure by exudate and by the following mediators; bradykinin, serotonin &
prostaglandin
2. ______ (increased heat): due to increased blood flow
3. ______ (swelling): due to accumulation of exudate
4. _____ ______ (loss of function): due to pain and tissue damage
Rubor
Calor
Tumor
Functio laesa
Definitions
1. __________: Fluid , protein, and blood cells escape
from the vascular system interstitial tissue
2. _________: Ultrafiltrate of blood and plasma, result
from imbalance across the vascular endothelium
3.________: Excess of fluid in the interstitial tissue or
body cavities; can be exudate or transudate
4.______: Purulent inflammatory exudate abundant in
leukocytes and cell debris
Exudation
Transudate
Edema
Pus
Major Phases in Acute Inflammation
After a strike to the skin the following occurs:
1. Momentary white line (due to arteriolar vasoconstriction)
The steps that follow are called “_____ ______”
2. Red line called the _______ (due to capillary dilation)
3. Red irregular area called the________(due to
arteriolar dilation)
4. A swelling called the________(due to edema
caused by increased permeability)
“TRIPLE RESPONSE”
flush
flare
wheal
Major Phases in Acute Inflammation
A. Vascular Changes = ____________:
(1) changes in blood flow:
* Transient vasoconstriction of arterioles
* VASODILATION of arterioles & relaxation of
Pre-capillary sphincters leads to INCREASE blood
Flow and opening of new capillary bed
(Hyperemia).
* Slowing of circulation:
= INCREASED vascular permeability and outpouring of fluid into interstitial tissue = INCREASED blood viscosity = DECREASED rate of blood flow.
Hemodynamics
Major Phases in Acute Inflammation
(2) Increased Vascular permeability:
* Arteriolar dilation & increased blood flow =
INCREASED intravascular hydrostatic pressure =______
* vascular permeability escape of protein rich
fluid (_____________) due to:
(i) IMMEDIATE TRANSIENT LEAKAGE
- mild injury & hypersensitivity reactions
- mediated by histamine, serotonin, bradykinin
- contraction of endothelial cells widening of
intercellular junctions (Gapping)
- immediate leakage, short lived (15-30 min)
transudate.
exudate
Major Phases in Acute Inflammation
(ii) IMMEDIATE SUSTAINED (prolonged) leakage:
- _________ injury e.g. burn endothelial necrosis
- immediate leakage, sustained for long time
(several hours or days) till damaged vessel is
repaired or thrombosed
(iii) DELAYED sustained (prolonged) leakage:
- _______ or moderate injury e.g. sunburn, x-ray,
and bacterial toxins
- endothelium is injured directly or indirectly
causing intercellular gaps
- leakage begins after 2-12 hours & lasts for
several hours or days.
severe
mild
B. Leukocyte Cellular Events:
- ____________ of neutrophils:
As blood flow slows, neutrophils fall out of the central
column and roll along endothelium
2.Adhesion (________) of neutrophils:
Neutrophils adhere to endothelium by surface
adhesion molecules.
3.Emigration (__________) of neutrophils:
Neutrophils insert pseudopods in intercellular
junctions, squeeze their way, traverse basement
membrane and ESCAPE to extravascular space.
4.___________: Neutrophils move TOWARD site of injury along concentration gradient of chemotactic agents.
5.Movement of other cells: __________ emigrate first, predominate in 1st 24-48 hours, replaced later by monocytes RBCs:
- coalesce into ________ (like stack of coins) at
central axis
Margination
pavementing
Diapedesis: Passage of blood cells (especially white
blood cells) through intact capillary walls and into the
surrounding tissue.
Chemotaxis
Neutrophils
Rouleaux
TYPES OF CELLS in inflamed tissue
1. ACUTE = 6-24 hrs = ___________
- CHRONIC 24-48 hrs
- -INCREASED __________
- -INCREASED ___________
Neutrophils–Life span of neutrophils (24-48)
Monocytes–Monocytes migration sustained longer
Macrophages
B. Leukocyte Cellular Events:
- ____________:
- Recognition: attachement to agent either directly or
indirectly by IgG or complement (opsonization)
- Engulfment: cytoplasm surrounds agent, encloses it
into a membrane-bound vacuole called a phagosome. - _________ ____________:
(i) Oxygen DEPENDENT mechanism:
Phagocytosis stimulates cellular oxidative
mechanism (respiratory burst) = microbicidal
derivatives, O2, H2O2, HOCl (antimicrobial)
(ii) Oxygen INDEPENDENT mechanism:
Phagosome fuses with lysosome
(phagolysosome) release of lysosomal
enzymes degrade agent.
Phagocytosis
Intracellular killing
Types of Acute Inflammatory Cells x4 1. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_: - 60-70% of all WBCs - segmented nucleus, 1-4 lobes (polymorph) - 1st acute inflammatory cell - function: phagocytosis (oxygen dependent and independent)
Neutrophils
Types of Acute Inflammatory Cells x4
- ____________ = Macrophage = Tissue Histiocyte:
- 4-8% of all WBC
- kidneyshaped nucleus
- long-lived: replace neutrophils 1-2 days later
- in blood (4 days) & tissues (several months)
- function: phagocytosis (large particles)
Monocyte
Types of Acute Inflammatory Cells x 4
- _____________:
- 25-30% of all WBC
- chronic inflammation & acute viral or fungal infections - _____________:
- 1-4% of all WBC
- allergy and parasitic infections
Lymphocyte
Eosinophils
Mediators of Acute Inflammation x4
1. ______________ Amines:
- histamine and serotonin
- source: mast cells, basophils & platelets
- action: dilation of arterioles and increased
permeability (intercellular gaps)
- duration: immediate release, short lived
Vasoactive
Mediators of Acute Inflammation x4 2. \_\_\_\_\_\_\_\_\_ Proteases: A. Kinin System ex. Bradykinin: - dilation of arterioles - increased permeability - pain - short-lived, deactivated by kininase enzyme B. Coagulation System Activation of factor XII (Hageman factor) leads to production of thrombin from prothrombin. ex. Fibrin + Fibrinopeptides: - increased permeability - chemotactic for neutrophils
Plasma
Mediators of Acute Inflammation x4
PLASMA PROTEASES–PART 2
C. Complement System
C3b : favors ___________(opsonin)
C3a, C4a, C5a:
- vasodilation & increased permeability
- anaphylatoxins; stimulate mast cells to
release___________
C5a : ___________ to neutrophils & macrophages
phagocytosis
histamine
chemotactic
Mediators of Acute Inflammation x4
- _____________ Acid Metabolites
a. Cell membrane phospholipids
- Release of arachidonic acid, activated by phospholipase
- Corticosteroids inhibit phospholipase
b. Leukotrienes:
- increased permeability
- chemotaxis
c. Prostaglandin (vasodilation)
d. Thromboxane (vasoconstrict.)
e. Prostacyclin (vasodilation)
Arachidonic
Mediators of Acute Inflammation x4
4. Leukocyte Products:
a. Oxygen-derived______ _________:
- endothelial damage = increased permeability
b. ________ Enzymes
- Neutral proteases (elastase, collagenase):
capillary damage = sustained leakage
- Acid proteases: degrade bacteria & cellular debris
c. _______-_________ factor: (PAF)
- aggregation of platelets = release of histamine
and serotonin = increase vascular permeability.
d. _____________ (IL-1 & TNF)
– Interleukin-1 = IL-1
–Tumor necrosis factor = TNF
both produced by produced by lymphocytes & macrophages
**- acute phase reaction: fever, sleepiness, loss of apetite, and neutrophilia.
free radicals
Lysosomal
Platelet-activating
Cytokines
Systemic Clinical Signs
1. Fever
2. Changes in ___ count:
- neutrophil leukocytosis (accelerated release from B.M. & increased production), less mature forms (shift to left)
- neutropenia & lymphocytosis in viral
infections
3.__________ erythrocyte sedimentation rate (E.S.R.)
WBC
Increased
***Perhaps the simplest indicator of acute inflammation is
an increase in the white blood cell count in the peripheral
blood,
Sequelae of acute inflammation
1 - Complete resolution
2 - Healing by ______
3 - Progression to chronic inflammation
scar
Morphologic Types of Acute Inflammation x8
- ______________:
- Mildest form
- Excess thin watery clear serous fluid (poor in fibrin)
- Examples:
- blisters in burn
- skin vesicles in herpes
- inflammation of serous sacs
Serous:
Morphologic Types of Acute Inflammation x8
- ___________ inflammation:
- Severe form, virulent bacteria
- Rich in fibrinogen precipitation of fibrin masses (shaggy BREAD AND BUTTER appearance)
- Examples:
- lobar pneumonia
- inflammation of serous sacs
Fibrinous
