Inflammation (JW)

Question 1

Acute Inflammation

Answer 1

acute inflammation = cell injury + vascular changes + neutrophil leukocytosis

VASCULAR CHANGES - dilatation, activation of coagulation cascade

NEUTROPHIL LEUKOCYTOSIS + ACCUMULATION

Results in acute inflammatory exudate (fluid, fibrin, neutrophils)

Question 2

Local effects of acute inflammation

Answer 2

Warmth (calor)
Redness (rubor)
Swelling (tumour)
Pain (dolor)
Loss of function

Question 3

Systemic effects of acute inflammation

Answer 3

fever
liver secretes CRP
hormon production eg ADH, cortisol, arenaline - malaise, weakness, appetite loss

Question 4

CRP

Answer 4

acute phase protein produced by the liver
CRP is an OPSONIN
Facilitates phagocytosis of bacteria

Question 5

Outcomes of acute inflammation

Answer 5

Regeneration/resolution (best)
Repair with scarring
Progression to chronic inflammation

Depends on the severity of the injury and the type of cell damaged

Question 6

Regeneration

Answer 6

complete restoration of the normal structure and function. for example a split thickness skin graft

Question 7

Repair

Answer 7

results in fibrous scar formation

2 steps:

• organisation (granulation tissue replacement)
• scar formation (fibrous tissue)

Scars are structurally strong but have a loss of function

Question 8

What is an abscess?

Answer 8

a localised collection of pus within a newly formed cavity in a tissue

has clearly defined zones

(empyemas are different from abscesses as they form in pre-existing cavities rather than newly formed)

Question 9

Chronic inflammation

Answer 9

persistent tissue injury and destruction
ongoing inflammatory response to limit the damage
attempts to organise and heal by fibrosis/scarring

Question 10

Consequences of chronic inflammation

Answer 10

scarring = fibrosis
tissue destruction
development of cancer
diversion of nutrients
amyloidosis

Question 11

Granulomatous inflammation

Answer 11

a specific type of chronic inflammation

a granuloma is an aggregate of activated macrophages

Question 12

causes of granulomatous inflammation

Answer 12

infections eg mycobacteria
sarcoidosis
crohns disease

Question 13

TB pathology

Answer 13

most common infection disease in the world, rising incidence

mycobacterium tuberculosis - small rod shaped bacillus

latent form for many years before being reactivated

activated macrophages form granulomas around the mycobacteria - protective –> GHON COMPLEX

Question 14

People at risk of active TB

Answer 14

immunocompromised
immigrants
elderly
alcoholics
diabetes mellitus

Question 15

active pulmonary TB symptoms

Answer 15

feeling unwell for weeks or months
persistent cough
constitutional symptoms - weight loss, fever, night wets, loss of appetite

Question 16

Diagnosis of active pulmonary TB

Answer 16

• compatible history
• radiological findings (CXR, CT)
  laboratory findings (3 respiratory samples, one early morning), Ziehl-Neelsen stain
  CULTURE IS GOLD STANDARD

Question 17

Atherosclerosis

Answer 17

A chronic inflammatory process affecting the intima of arteries. characterised by the formation of lipid-rich plaques in the vessel wall.

Question 18

Modifiable risk factors for atherosclerosis

Answer 18

• smoking
• HTN
• DM
• dyslipidaemia

Question 19

Why does atherosrerlosis develop

Answer 19

damage to the endothelium
cells become dysfunctional
increased permeability
produce adhesion molecules and cytokines which attract inflammatory cells and prothrombotic molecules
recruitment of inflammatory cells which differentiate into macrophages

Question 20

What do macrophages to in athersclerosis

Answer 20

produce free radicals that drive LDL oxidation to form oxidised LDL

engulf oxidised LDL and cholesterol crystals, becoming foam cells

foam cells produce growth factors that stimulate migration of smooth muscle cells from the media to the intima

Question 21

what is the fatty streak in athersclerosis

Answer 21

oxidised LDL accumulates within macrophages and smooth muscle cells just underneath the endothelial cells.

collections of lipid-laden macrophages sitting in the intimal later may be visible as yellow elevations called fatty streaks

the fatty streak has no clinical significant but it is important because it may progress to an atherosclerotic plaque

Question 22

What is the atherosclerotic plaque

Answer 22

core of lipid debris forms as the foamy macrophages die and the lipid in their cytoplasm is released

the cap represents the boys attempt to repair by scarring