Inflammation & Repair Flashcards
Nomenclature of Inflammatory diseases include:
Name of the organ or tissue + “itis” = inflammation in that organ or tissue
Inflammation of the tonsils:
Tonsilitis
Diagnose this image:
Tonsilitis
Inflammation of the appendix:
Appendicitis
Diagnose this image:
Appendicitis
Inflammation of the peritoneum:
Peritonitis
Diagnose this image:
peritonitis
Inflammation of the lymph node:
lymphadenitis
Means the lymph node is enlarged due to being inflamed:
lymphadenitis
Diagnose this image:
Lymphadenitis
Some of the following organs do not follow the typical nomenclature for inflammation- define the correct term for inflammation of the following organs:
- Fallopian tube
- Cornea
- Glans Penis
- Bladder
- salpingitis
- keratitis
- balanitis (Reiter’s syndrome)
- Cystitis
What are some terms to classify inflammation: (3)
- acute or chronic inflammation
- exudative or non-exudative inflammation
- Morphologic patterns (serous, fibrinous, suppurative, ulcerative)
What are the morphologic patterns that can be used to describe inflammation? (4)
- serous
- fibrinous
- suppurative
- ulcerative
What type of inflammation is being described?
- rapid onset, short duration (minutes to days)
- emigration of leukocytes, predominately neutrophils
- exudation of fluid and plasma proteins
Acute inflammation
Describe the onset & duration of acute inflammation:
rapid onset, short duration (minutes to days)
Describe the cells involved in acute inflammation:
emigration of leukocytes, predominately neutrophils
Describe the exudate patterns of acute inflammation:
exudation of fluid and plasma proteins
The following image represents acute inflammation, what cells are indicative of this?
leukocytes, primarily neutrophils
What type of inflammation is being described?
- Longer duration
- Mononuclear cells- macrophages, lymphocytes, plasma cells
- Proliferation of blood vessels and fibroblasts
Chronic inflammaton
Describe the duration of chronic inflammation:
longer duration
What cells are present in chronic inflammation?
Mononuclear cells- macrophages, lymphocytes, and plasma cells
Chronic inflammation is characterized by mononuclear cells such as:
macrophages, lymphocytes, and plasma cells
“proliferation of blood vessels and fibroblasts” describes what type of inflammation?
chronic
“exudation of fluid and plasma proteins” describes what type of inflammation?
acute
What type of cells are present in this image of chronic inflammation?
mononuclear cells: macrophages, lymphocytes, and plasma cells
What cells are shown in this image? What type of inflammation is characterized by this cell type?
neutrophils; acute inflammation
What cells are shown in this image? What type of inflammation is characterized by this cell type?
neutrophils; acute inflammation
What cells are shown in this image? What type of inflammation is characterized by this cell type?
plasma cells; chronic inflammation
How is acute vs. chronic inflammation determined by a pathologist?
Based on cell types present
How is acute vs. chronic inflammation determined by a clinician?
based on intensity and duration
What cells are shown in this image? What type of inflammation is characterized by this cell type?
neutrophils; acute inflammation
What cells are shown in this image? What type of inflammation is characterized by this cell type?
plasma cells; chronic inflammation
What cells are shown in this image? What type of inflammation is characterized by this cell type?
macrophages; chronic inflammation
What cells are shown in this image? What type of inflammation is characterized by this cell type?
lymphocytes; chronic inflammation
If a cell under the microscope has a nucleus that appears to be pushed off to the side, this is probably a:
plasma cell
If a cell under the microscope appears to be darkly staining, small, and have little cytoplasm, this is probably a:
lymphocyte
inflammation accompanied by the production of fluid:
exudative inflammaton
Inflammation accompanied by no production of fluid:
non-exudative
____ inflammation tends to be more exudative
acute inflammation
The following image shows what type of inflammation?
exudative inflammation
____ inflammation is frequently non-exudative and is often associated with fibrosis and scarring
non-exudative inflammation
What type of inflammation is associated with fibrosis and scarring (such as that seen in this image)
Chronic inflammation
The body’s response to injury:
inflammation
Inflammation may be due to what type of injuries? (5)
- thermal
- physical
- chemical
- allergic
- immune-mediated disease
Comes into play when inflammation is caused by a living organism (infection)
immunity
____ may provoke inflammation AND immunity
infection
____ may exist without infection
inflammation
____ DOES NOT imply infection
Inflammation
Hypersensitivity (allergic disease) may cause:
inflammation
The following image shows inflammation that may be caused by:
Hypersensitivity reaction
Autoimmune disease may cause:
inflammation
The body’s 3 lines of defense include:
- barriers
- inflammatory response
- immune response
The body’s barrier defense includes: (3)
- skin
- mucous membranes
- secretions
The body’s inflammatory response includes: (2)
- cells (leukocytes)
- molecules (mediators)
The body’s immune response includes: (2)
- antibodies (humoral)
- cytotoxic T-cells (cellular)
- skin
- mucous membranes
- secretions
These are all:
barriers
- cells (leukocytes)
- molecules (mediators)
These are both:
inflammatory responses
- antibodies (humoral)
- cytotoxic T-cells (cellular)
These are both:
immune responses
The body’s first and second line of defense are considered:
non-specific
The body’s 1st line of defense includes: (3)
- skin
- mucous membranes
- chemicals
The body’s 2nd line of defense includes: (5)
- phagocytosis
- complement
- interferon
- inflammation
- fever
The body’s 3rd line of defense is considered:
specific
The body’s 3rd line of defense includes: (2)
- lymphocytes
- antibodies
Components of inflammatory responses include: (3)
- circulating blood cells and plasma proteins
- cells of the blood vessel walls
- cells and proteins of the ECM
Inflammation is the body’s response to:
injury
Most defense elements are located in the:
blood
Inflammation is the means by which ___ and ___ leave the ___ and enter the ____.
defensive cells; chemicals; blood; tissue
Inflammation is a complex reaction to injury as in includes: (4)
- vascular responses
- cellular responses
- systemic reaction
- repari
Inflammation is ____ unless excessive or prolonged which may be ___.
beneficial; harmful
When might inflammation transition to harmful?
when excessive or prolonged
The inflammatory response delivers:
defensive materials
Defensive cells:
leukocytes
Defensive proteins:
plasma
The inflammatory response 5 R’s:
- recognition of the injurious agent
- recruitment of leukocytes
- removal of the agent
- regulation (control) of the response
- resolution (repair)
- Mechanical injury
- Chemical injury
- Radiation injury
- Thermal injury
- Infection
- Compromise of blood supply
- Immune injury
These are all causes of:
acute inflammation
Cardinal signs of inflammation include: (5)
- Calor
- Rubor
- Tumor
- Dolor
- Functio laesa
- calor
- rubor
- tumor
- dolor
- functio lasesa:
- heat
- red
- swelling
- pain
- loss of function
All that is ____ is not inflamed
Red (rubor)
Cellular events in acute inflammation include: (7)
- margination
- rolling
- adhesion
- diapedesis
- chemotaxis
- phagocytosis
- killing
What type of cell is involved in the cellular events in acute inflammation?
neutrophils
During margination, the neutrophil stars to lines up along:
endothelial cells lining the blood vessel
This image is showing events in:
vascular response of acute inflammation
Microbial killing by leukocytes involves: (3)
- opsonization
- phagocytosis
- lysosomal enzymes
What cells are involved in microbial killing?
leukocytes
Systemic manifestations of acute inflammation include:
- fever
- leukocytosis
- acute phase response
The systemic manifestations of acute inflammation includes fever which is due to:
pyrogens
The systemic manifestations of acute inflammation includes fever which is due to pyrogens which are:
cytokines and prostaglandins
TNF and IL-1 released by leukocytes are examples of:
cytokines
Prostaglandins that cause fever in acute inflammation come from:
membrane phospholipids
Elevated WBC count:
leukocytosis
An increase in WBC count which can mimic leukemia:
leukelmoid reaction
A higher neutrophil count in the blood than normal (left shift):
neutrophilia
An increase in white blood cells (specifically leukocytes):
lymphocytosis
Leukemoid reaction, neutrophilic and lymphocytosis are all characteristic of:
leukocytosis (systemic manifestation of acute inflammation)
When cytokines stimulate hepatocytes to synthesize and secrete acute phase proteins this is considered:
acute phase response (of systemic manifestations of acute inflammation)
In the acute phase response of systemic manifestations of acute inflammation, ____ & ____ act as opsonins
C-reactive protein (CRP); Mannose-binding lectin
Lymphatic spread of bacterial infection:
Lymphangitis
Lymphangitis may present as:
painful red streaks and regional lymphadenopathy
Diagnose the image:
Lymphangitis
Chemical mediator of inflammation stored primarily in mast cells:
histamines
Chemical mediator of inflammation stored primarily in platelets:
serotonin
Histamine and serotonin are both:
vasoactive amines
Unlike most other mediators, histamine and serotonin are:
available preformed supplies
Histamine is stored in:
granules of mast cells
Serotonin is stored in:
granules of platelets
The first mediators to be released after injury are:
histamine and serotonin
What is the result of histamine and serotonin release?
vascular dilation and leakage (helps neutrophils to squeeze out of blood vessels)
All acute inflammatory reactions may have one of three outcomes including:
- complete resolution
- healing by connective tissue replacement (fibrosis)
- Progression of the response to chronic inflammation
- infarction
- bacterial infections
- toxins
- trauma
These are all involved in:
injury that leads to ACUTE inflammation
Injury leads to:
acute inflammation or chronic inflammation
- vascular changes
- neutrophil recruitment
- mediators
These are all components of:
acute inflammation
If acute inflammation progresses, it can lead to:
chronic inflammation
If acute inflammation follows the healing pathway, it may lead to:
resolution or fibrosis
Following acute inflammation,
- clearance of injurious stimuli
- clearance of mediators and acute inflammatory cells
- replacement of injured cells
- normal function
These are all components of:
resolution
If acute inflammation is followed by pus formation, this is considered an:
abscess
If an abscess following acute inflammation heals, it may result in:
fibrosis
What is issue regarding acute or chronic inflammation healing leading to fibrosis?
loss of funtionc
- viral infections
- chronic infections
- persistent injury
- autoimmune diseases
These are all injuries that can result in:
chronic inflammation
- angiogenesis
- mononuclear cell infiltration
- fibrosis (scar)
These are characteristic of:
chronic inflammation
Inflammation characterized by a watery exudate (most often seen in little blisters):
serous inflammation
What type of inflammation is seen?
serous inflammation
What type of inflammation is seen?
serous inflammation
Fibrinous pericarditis in rheumatic fever is an example of:
fibrinous inflammation
Inflammation characterized by the formation of pus:
suppurative (purulent) inflammation
What type of inflammation is seen?
suppurative (purulent) inflammation
What type of inflammation is seen?
fibrinous inflammation
What type of inflammation is seen?
suppurative (purulent) inflammation
What type of inflammation is seen?
suppurative (purulent) inflammation
A localized collection of pus that has accumulated in a tissue cavity, producing fluctuance:
Abscess
Diffuse spread of an acute inflammatory process through the fascial planes of soft tissue producing erythema, edema, warmth, and pain without consolidation:
Cellulitis
A clinical type of exudative inflammation, occurs only on mucosal surfaces containing mucus-secreting cells, such as nasal or bronchial mucosa:
catarrhal (seromucous) inflammation
Catarrhal inflammation, a clinical type of ___ inflammation occurs only on ___ surfaces containing ____ cells.
exudative; mucosal; mucus-secreting cells
Recurrent aphthous stomatitis is an example of:
ulcerative inflammation
A defect in epithelial continuity:
ulcer
What can be seen in the following microscope image?
a defect in the epithelial continuity (ulcer)
Leukocyte Adhesion Deficiency (LAD) is an example of:
defect in neutrophil function
Lazy leukocyte syndrome is an example of:
defect in neutrophil function
Lazy leukocyte syndrome results in impaired ___ due to mutations of ___
chemotaxis; contractile proteins
A rare autosomal recessive condition associated albinism:
Chediak-Higashi Syndrome
Chediak-Higashi Syndrome is characterized by:
- Giant ___ from fused ____
- Both ____ & ____ formation are defective
- Recurrent ___
- ___ is abnormal
- lysosomal inclusions; primary granules
- chemotaxis and phagolysosome formation
- infections
- platelet function
- A rare autosomal recessive condition associated with albinism
- Giant lysosomal inclusions from fused primary granules
-Both chemotaxis and phagolysosome formation are defective - Recurrent infections
- Platelet function is abnormal
Chediak-Higashi Syndrome
- X-linked (2/3) or autosomal (1/3) recessive
- Deficient NADPH oxidase in the cell membranes of neutrophils and monocytes, resulting in an absent respiratory burst
- No H2O2 produced- HOCl- is not synthesized because of the abscence of H2O2
- Catalase-negative organisms (strep species) are killed
- Catalase-positive organisms (staph aureus) are NOT killed
Chronic Granulomatous Disease of Childhood
Chronic Granulomatous Disease of Childhood:
Describe the inheritance of this disease
2/3 x-linked recessive & 1/3 autosomal recessive
What is deficient in the cell membranes of neutrophils and monocytes and what does this result in Chronic Granulomatous Disease of Childhood ?
Deficient: NADPH which results in absent respiratory burst
What is not produced in Chronic Granulomatous Disease of Childhood? Because this is not produced, what else is not synthesized?
H2O2; HOCl-
Chronic Granulomatous Disease of Childhood - What organisms are killed? What organisms are NOT killed?
Killed: catalase negative organisms (strep species)
NOT killed: catalase positive organisms (staph aureus)
- A common (1:2,000 individuals) autosomal recessive absence of myeloperoxidase enzyme in neutrophil and monocyte granules
- Respiratory burst is normal and H2O2 IS produced
- Absence of MPO prevents synthesis of HOCl-
- No create clinical consequences in most people
- Diabetics may develop candidiasis
Myeloperoxidase (MPO) deficiency
How does this disease effect neutrophils?
Agrunulocytosis:
too few neutrophils
How does this disease effect neutrophils?
Cyclic Neutropenia
too few neutrophils
How does this disease effect neutrophils?
Leukocyte Adhesion Deficiency (LAD)
Failure in adhesion
How does this disease effect neutrophils?
“Lazy” leukocyte syndrome:
Slow chemotaxis
How does this disease effect neutrophils?
Bruton Agammaglobulinemia:
Failure to phagocytose
How does this disease effect neutrophils?
Complement Deficiency:
Failure to phagocytose
How does this disease effect neutrophils?
Chronic granulomatous disease of childhood:
Failure to kill
How does this disease effect neutrophils?
Chediak-Higashi Syndrome:
Failure to kill
How does this disease effect neutrophils?
Myeloperoxidase Deficiency:
Failure to kill
List the causes of chronic inflammation: (8)
- persistent infection
- prolonged exposure to toxic agents
- exogneous
- endogenous
- immune-mediated inflammatory disease
- autoimmune diseases
- unregulated immune responses against microbes
- immune responses against environmental substances
Give an example of persistent infection that may cause chronic inflammation:
mycobacteria
Prolonged exposure to ___ & ___ toxic agents may lead to chronic inflammation
exogenous & endogenous
Give an example of an endogenous agent in which prolonged exposure may lead to chronic inflammation:
atherosclerosis
Give an example of an exogenous agent in which prolonged exposure may lead to chronic inflammation
silicosis
Give an example of an autoimmune disease that may cause chronic inflammation:
rheumatoid arthritis
Unregulated immune responses against microbes such as ___ may lead to chronic inflammation
inflammatory bowel disease
Immune responses against environmental substances such as ____ may lead to chronic inflammation
bronchial asthma
What are the morphologic features of chronic inflammation? (3)
- mononuclear cell infiltration
- tissue destruction
- connective tissue replacement
Mononuclear cell inflammation is a morphologic feature of chronic inflammation. What cells are associated with this?
- lymphocytes
- plasma cells
- macrophages
Why is tissue destruction a morphologic feature of chronic inflammation?
due to a persistant offending agents or by the inflammatory cells
Healing via connective tissue replacement is a morphologic feature of chronic inflammation. What processes does this include?
angiogenesis & fibrosis
Why is this image indicative of chronic inflammation? Label key cells:
Contains plasma cells, lymphocytes and macrophages
Label the following cells:
A) lymphocyte
B) macrophage
C) plasma cell
D) neutrophil
E) macrophage
Granulomatous inflammation is a specific pattern of:
chronic inflammation
What are two examples of granulomatous inflammation?
- immune granulomas
- foreign body granulomas
- Aggregates of epithelium macrophages (activated)
- Multinucleated giant cells
- Mononuclear leukocytes, principally lymphocytes and occasionally plasma cells peripherally
These are all characteristic of:
granulomatous inflammation
There is a ___ variable in granulomatous inflammation
fibrosis
Label the cells in the following image. What condition do these cells indicate?
A) Langhans Giant Cell
B) Foreign Body Giant Cell
Granulomatous inflammation
The two classifications of granulomas include:
- immune granulomas
- foreign body granulomas
Coccidioides immitis is an example of:
immune granuloma
Caseation necrosis in tuberculosis is an example of:
necrotizing granulomatous inflammation
This image shows:
caseation necrosis in tuberculosis
An intracellular pathogen that blocks fusion of phagosome with lysosome:
mycobacterium tuberculosis
These images show:
Mycobacterium tuberculosis
This image shows:
Acid Fast Bacilli
A pyogenic granuloma is an example of ____ NOT ____
granulation tissue; granulomatous tissue
Restoration of tissue architecture and function after an injury:
repair
Repair may occur by:
regeneration or by healing (scar formation)
Growth of cells and tissues to replace lost structures:
regeneration
Healing consists of variable proportions of two distinct processes:
- regeneration
- scarring
The tissues involved in regeneration include:
- continuously dividing
- stable tissues
- permanent tissues
The “continuously dividing tissues” involved in regenerations are classified as:
labile
The “stable tissues” involved in regeneration are classified as:
quiescent
The “permanent tissues” involved in regeneration are classified as:
non-dividing
The labile cells of regeneration are derived from the division of:
stem cells
The labile cells of regeneration are derived from the division of stem cells, also known as:
hematopoietic cells
The labile cells of regeneration include what types of epithelium?
- surface epithelium
- stratified squamous epithelium (of the skin, mouth, pharynx, esophagus, vagina, and cervix)
- gastrointestinal epithelium
_____ tissues can readily regenerate after injury as long as the pool of stem cells is preserved
labile tissues
Labile tissues can readily regenerate after injury as long as:
the pool of stem cells is preserved
The most common forms of cancer arise from:
labile tissues
The most common forms of cancer arise from labile tissues and these include: (5)
(name labile tissue + type of cancer)
- epidermis- skin cancer
- bronchial mucosa- lung cancer
- oral mucosa- oral cancer
- cervical mucosa- cervical cancer
- hematopoietic tissue- leukemia
- epidermis- skin cancer
- bronchial mucosa- lung cancer
- oral mucosa- oral cancer
- cervical mucosa- cervical cancer
- hematopoietic tissue- leukemia
What do all of these cancers have in common?
They arise form labile tissues
Stable tissues of regeneration may also be called ____ tissues
quiescent
Stable cells of regenerations are quiescent meaning they have:
a very low rate of turnover
Stable tissues (quiescent) of regeneration include: (4)
- viscera (liver, kidneys, pancreas)
- endothelial cells
- fibroblasts
- smooth muscle cells
Replacement of the stable cells of stable (quiescent) tissues is carried out by:
mitotic division of mature cells
With the exception of liver, stable tissues have:
limited capacity to regenerate
Malignant tumors of ___ tissues are among the rarer forms for malignancies
stable
Cancers are different from malignancies in that they are specifically derived from:
epithelial cells
Permanent tissues of regeneration are considered:
non-dividing
____ cells were generated during fetal life and never divide in post-natal life
permanent cells of regeneration
Discuss the generation of permanent cells
generated during fetal life and NEVER divide in postnatal life
What type of cells of regeneration cannot be replaced if lost?
permanent cells
Permanent cells of regeneration include: (2)
neurons and cardiac myocytes
In permanent tissues, repair is dominated by:
scare formation
Fibrosis in simple terms is:
scarring
In fibrosis (scarring) the tissue is intrinsically:
unable to regenerate
The tissues of ___ & ____ must undergo fibrosis in order to heal because they are intrinsically unable to regenerate
heart & brain
Fibrosis will occur if the underlying connective tissue scaffolding is:
disrupted
When the underlying connective tissue scaffolding is disrupted, ____ occurs
fibrosis (scarring)
____ occurs following extensive exudates (organization)
fibrosis (scarring)
This image shows a healed cerebral infarct. How does this healing occur and why?
fibrosis (scarring); because brain tissue is intrinsically unable to regenerate (neurons)
How would this area of damage repair itself?
via fibrosis (due to inability to regenerate)
What are the two objectives of wound healing?
- epithelial regeneration
- connective tissue repair
Wound healing involves ____ regeneration & ____ repair
epithelial regeneration; connective tissue repair
In wound healing, restoring the integrity of the epithelial surface is known as:
epithelial regeneration
In wound healing, epithelial regeneration involves:
restoring the integrity of the epithelial surface
In wound healing, restoring the tensile strength of sub-epithelial tissue is known as:
connective tissue repair
In wound healing, connective tissue repair involves:
restoring the tensile strength of the sub-epithelial tissue
Type of healing in which the goal is to approximate the margins:
healing by primary intention/union
The goal of healing by primary intention/union is to:
approximate the margins
What do we mean by “approximate the margins” in healing by primary intention/union?
wound margins are pulled neatly together (think stitches)
This image shows what type of healing?
Healing by primary intention/union (margin approximation)
This image shows what type of healing?
Healing by primary intention/union (margin approximation)
All wound healing involves an ____ even in the absence of infection
inflammatory reaction
Healing by secondary intention involves the:
inability to approximate the margin
Healing that occurs when wound margins are NOT pulled together
Healing by secondary intention/union
What is one reason that healing by secondary intention/union may occur?
anatomic location
The following images would require what type of healing?
Healing by secondary intention/ union
In healing by secondary intention/union, the wound is left open and:
will heal by granulating in
What type of cells are seen in granulation tissue?
- endothelial cells
- fibroblasts
- myofibroblasts (contractile)
What stain can be used to visualize granulation tissue?
trichrome stain
The following image shows a ____ stain used to view ____ tissue
trichrome; granulation
The following images show wound healing by:
secondary intention/union
Excessive scar formation within the boundaries of the original wound producing a raised scar:
hypertrophic scar
These images show what type of scar?
Hypertrophic scar
Excessive scar formation that grows beyond the boundaries of the original wound:
Keloid
Keloids are often seen in what population?
african american
The following image shows:
keloid
____ is required for the hydroxylation of proline and lysine
vitamin C
Vitamin C is required for the hydroxylation of:
proline & lysine
Vitamin C is important in wound healing, but too much =
scurvy
