Inflammation & Repair - Friedlander Flashcards
1
Q
Inflammation
A
The response of vascularized tissue to injury
2
Q
Acute inflammation
A
Vessels dilate - histamine - red and hot
Vessels leak protein
(albumin, IgG and fibrinogen depending on severity)
Neutrophils pass through venues and damage anything they think is bacteria - pain, loss of function
3
Q
If you hurt a little what comes out?
A
Albumin - swelling
4
Q
If you hurt worse what comes out?
A
IgG
5
Q
If you hurt real bad what comes out?
A
Fibrinogen/fibrin for mesh
6
Q
Chronic inflammation
A
Orchestrated mostly by T-cells
B cells become plasma cells and make antibodies
Macrophages gobble things up
7
Q
What do eosinophils kill?
A
Worms
8
Q
Granulomas
A
Pissed off macrophages form walls
9
Q
What does a scar do?
A
CONTRACTS
10
Q
What happens to the fibrin meshwork?
A
If not destroyed by plasmin, will be organized into granulation tissue by endothelial cells and fibroblasts
11
Q
What do fibroblasts make?
A
Collagen fibers
12
Q
How does the body defend itself?
A
Inflammation
13
Q
What cell type has 3 segments with 2 bridges?
A
Neutrophils
14
Q
What cell type has a kidney bean shaped nucleus with a dent?
A
Monocyte
15
Q
What is a band cell?
A
Immature neutrophil
16
Q
What cell has a nucleus that takes up almost the entire cell?
A
Lymphocyte
17
Q
What changes to a macrophage when it leaves the bloodstream?
A
Monocyte
18
Q
What are the commandos of acute inflammation?
A
Neutrophils
19
Q
What is diapedesis?
A
Transmigration of neutrophils through a blood vessel
-not through the capillary, too big, would damage it
20
Q
What are azurophil granules?
A
Myeloperoxidase
Elastase
Cathepsins
Lysozyme
21
Q
What are specific granules in neutrophils?
A
Alkaline phosphatase, lactoferrin and collagenase
Lysozyme
22
Q
Myeloperoxidase
A
A heme based protein that produces hypochlorite like in household bleach
23
Q
Free radical pathway
A
Oxygen —-(NADPH oxidase)—> Superoxide –(superoxide dismutase)—-> H2O2 —-(myeloperoxidase)—-> Hypochlorite (OCl-)
24
Q
What is the effect of ongoing inflammation on neutrophils?
A
Makes neutrophils stick better and get through the endothelium
25
If you see an single inflamed joint, what should you expect?
Gonococcal infection
26
Hyperemia
Extra blood flow through dilated arteries
27
Neutrophils and all human tissue are gram____
Negative
28
What is the adjective for pus?
Purulent
29
What is the verb for making pus?
Suppurate
30
Abscess
Pus surrounded by more normal tissue
31
Empyema
Pus filling a body cavity
| ie. pleural space, gall bladder
32
What happens to neutrophil nuclei after death?
Lose segmentation
33
Why does pus build up pressure?
Because of the osmotic pull of the small molecules produced by hydrolysis of big proteins
34
Gum abscess
From a deep root infection
Feels great when it ruptured outward
Used to be a common killer
35
The greenish tinge of pus on exposure to air is due to?
Neutrophil myeloperoxidase
36
Pseudomonas infections? What is the pigment
Fluorescent green pus that smells like grapes
| Pigment is pyocyanin
37
Clostridial infections
Thin (hyrolyzed), gray (lipolyzed) dishwater pus
38
What is a toxic granulation?
A powered up neutrophil
39
Left shifted
When a peripheral smear shows a lot of immature neutrophils (child soldiers)
40
What is a leukemoid reaction?
> 50,000 WBC in the absence of true leukemia
| High leukocyte alkaline phosphatase, toxic granulation and will lack the chromosome markers for leukemia
41
What is the alk phos level in leukemia?
Low
| vs. high in leukemoid reaction
42
Systemic inflammatory response
Current term for multiple organ failure developing as a result of a bad infection
Extreme elevations of IL-1 and TNF-a
--treating the cause may not save the patient
43
How does staphylococci try to evade host defense?
Sequester and hide themselves
44
How does streptococci try to evade host defense?
Try to outrun them
45
Meningitis
Pus at the base of the brain
46
Chediak-Higashi
Problems with organelles (lysosomes, melanocytes) and thus impaired neutrophil killing of microbes
47
Chronic granulomatous disease
Several defects in neutrophil killing of common staphylococci
-body walls off staph using granulomas instead
48
The fluid released from vessels in inflammation is called?
An exudate
| -protein rich
49
Friction blister
Epidermis detached from dermis
| -very mild inflammatory cellular reaction
50
Reactive oxygen species
ROS - free radicals
| Need these to kill germs
51
How long do neutrophils last? And then what do they do?
72 hours or so and then turn into traps
| -neutrophil extracellular traps
52
Sunburn is an example of
Vessel dilaltion
| --the molecular and cellular mediators of inflammation aren't even involved
53
After a scratch what is the triple response of Lewis?
1. local redness
2. a flare surrounding the scratch - cap dilate
3. swelling (a wheal) surrounds the scratch
54
Which step of the triple response of Lewis is dependent on an intact nerve supply?
Flare (2)
55
Histamine and functions in inflammation
```
Major mediator
Dilate blood vessels
Make them leaky to proteins, especially albumin
Contribute to pain and itching
Bronchoconstriction
```
56
Serotonin
Released from platelets
Constricts vessels
Emotional health
57
Bradykinin
Inflammatory protein that dilates vessels, partly by producing PGI2/prostacyclin
Produced in the blood by kinin-kallikrein system
Bronchoconstrictor and inflames the airway mucosa
58
How are prostaglandins and thromboxanes made?
From arachidonic acid by means of cycle-oxygenase
59
Prostaglandin E2 (and D2)
Variety of effects in acute inflammation
Fever
Vessels permeable and dilate
60
Prostacyclin (PGI2)
Inhibits platelet aggregation and dilates blood vessels
| -keep the vessels open for the troops
61
Thromboxane A2
Promotes platelet aggregation and constricts blood vessels
| -let's not have a hemorrhage right now, troops
62
When cyclo-oxygenase is inhibited pharmacologically what happens to AA?
Gets shunted into the lipo-oxygenase pathway instead - this favors production of neutrophils and macrophages
-leukotrienes and lipoxins
63
Leukotriene B4
Famous promoter of neutrophil attachment and chemotaxis
64
Leukotrienes C4, D4 and E4
Generally constrict vessels, permeable and constrict airway smooth muscle
--meds for asthmatics
65
5-HETE
Also produced by neutrophils and lymphocytes via the lipoxygenase pathway is a powerful chemotactic agent
66
Lipoxins
Produced by neutrophils and macrophages when inflammation is about to end
67
C3a
Powerful chemotactic agent
| -second only to C5a
68
C3b
Binds to microbes via Abs and allows more complement activation nearby
Promotes opsonization and therefore phagocytosis
69
C5a
Promotes chemotaxis
Makes more adhesion molecules on endothelium
Makes vessels dilate
Makes vessels leak
70
Membrane attack complex
MAC
Produced at end of complement cascade
Punches holes in membranes
71
IL-1
Produce by macrophages, and others
```
Effects:
Fever
Increased neutrophil production
Increase in adhesion molecules
recruit lymphocytes
Fatigue and sensitivity to pain
Dilates blood vessels
```
72
Anakinra
Blocks IL-1Ra
| Works against RA
73
IFN-y
Made by T cells mostly
Proinflammatory cytokine
-recruit neutrophils and macro
-activate macros and make more deadly
-make cells produce more IL-1, IL-12, IL-23
Used for chronic granulomatous disease and osteopetrosis
74
IL-2
Regulate whether T-cells respond to antigens or tolerate them
Tx of malignant melanoma and renal cell carcinoma
75
IL-4 and IL-13
Anti-inflammatory
| Produced in macrophages and tell them to produce other anti-inflammatory mediators - TGF-B, IL-10
76
Which macrophages are the 'nicer' ones?
Alternatively activated - M@
| Oriented toward healing, pump out osteopontin
77
IL-5
From Th2 and mast cells
| Attracts and activates eosinophils
78
IL-6
Some pro-inflammatory - fever, neutrophil production
Some anti
When produced from muscle has anti-inflammatory properties
79
What is the one major cytokine produced by skeletal muscle?
IL-6
80
Which cytokine is credited for much of the acute phase reaction?
IL-6
81
IL-12
From stimulated dendritic macrophages and stimulated b-cells
| Turns undifferentiated T cells into T-helper cells
82
IL-17
Produced mostly by T-helper 17 cells
| Promote recruitment of neutrophils, macrophages and Th17 cells to sites of inflammation
83
Tumor necrosis factor
Produced by macrophages and has pro inflammatory effects
- fever
- neutrophil production
- activates neutro and macro
- mediates acute phase reaction
- promotes thrombosis
- promotes insulin resistance
84
Which cytokine is most important for treating asthma, RA, ankylosing spondylitis, IBD, psoriasis
What are the chief risks of these meds?
TNF
| TB and fungal infections are chief risks
85
Platelet derived growth factor
Powerfully promotes growth of new vessels
| --granulation tissue/young scar
86
TGF-B
Key to effective collagen production in scar and is blamed for fibrosis in chronic inflammation
Slows inflammation, promotes fibrosis and restoration of damaged epithelial populations
87
CRP
C Reactive Protein
Produced in liver in response to the acute phase reaction
'Pop' blood test for coronary risk factor
Clear value in rheumatology
88
SAA
the protein that is often beta-pleated to amyloid in chronic inflammation
ie. leprosy
89
what is the disease that can mimic anyting
Familial mediterranean fever
90
The acute phase reaction
The quantities of various proteins in the plasma change when significant inflammation has been going on for a while
This causes the red blood cells to sink faster in the plasma
91
Neutrophils
Classic bacteria infection, candida, bad injury
92
Lymphocytes
Autoimmunity, viruses, pertussis
93
Monocytes
Mycobacteria, other fungi, typhoid
94
Eosinophils
Worms, asthma, Hodgkin's, dermatits herpetiformis
| They have extremely alkaline granules
95
Plasma cells/activated B cells
Especially abundant with spirochetes
| -syphilis, Lyme disease
96
What has no inflammatory cells?
Prions
Gas gangrene - very aggressive clostridia
The very immunocompromised
97
A lymphocyte with a nuclear mini-dent is often what type of cell?
T killer
98
The inflammatory reaction in most viral infections is mostly what?
Lymphocytes
99
What do plasma cells look like?
Nucleus to one side, looks like a soccer ball
100
The hardness of a chancre in primary syphilis is due to what?
Great abundance of mostly plasma cells
101
Where is tattoo ink located?
In fixed macrophages
102
In an infection, what comes first and then later on?
Neutrophils first
| Monocytes/macrophages later
103
Talk to me about splinters
Epithelium doesn't tolerate free edge, so grows along splinters
Macrophages adhere to splinter and to one another forming a granuloma
104
Epithelioid
Macrophages are called this because they stick together
Mimic epithelium
Aka granuloma
105
Foreign body giant cells
Are fused clusters of macrophages with nuclei distributed throughout
106
Langhans giant cells
Fused macrophages with nuclei in a horseshoe around the edge
107
What is the sealant for abrasions?
Fibrin
108
Fibrous means
Collagen
109
Fibrinous means
Fibrin
110
Ulcer
The epithelium and a significant amount of the CT underneath have been lost to necrosis
Crater of an ulcer is always inflamed and fibrin-sealed
111
Erosion
Loss of epithelium without significant damage to the underlying CT
112
Pseudomembrane
Very broad, very shallow ulcer
Common in diphtheria and C. difficult
Often looks like a mushroom cloud
113
Scab
Fresh clot
Factor 13 crosslinks fibrin
Ready to fall off, immature scar tissue underneath
114
Law of epithelium? What eventually stops it?
Does not tolerate free edge
| Stopped by contact inhibition
115
Scar
New collagen laid down at a site of healing injury
116
When do you get a scar?
If you damage the CT below the lamina propria
117
Labile cell populations
Always renewing themselves
| -bone marrow, gut epithelium, epidermis
118
Stable cell populations
Renew themselves if some members die
| -liver, other glands, fibroblasts
119
Permanent cell populations
Very limited ability to replace lost members
| -brain, heart
120
4 steps of wounds healing
Fibrin
Becomes granulation tissue
Becomes scar
Scar contracts
121
Who are budding pathologists?!
Maybe not us....but we are gonna kick some path ass on this test!!!!
122
Exuberant granulation tissue
After injury
An exaggeration of healing, not sure why
May require surgical debridement
123
Most famous angiogenic factor?
VEGF-A
124
What color is dense collagen?
Deep blue
125
Wounds heal by primary intention
When they are well-approximated, well-nourished, no diabetes, not on glucocorticoids, clean
126
Healing by secondary intention
When it is complicated
| Ie. motorcycle wreck
127
Keloid
Scar that is overly large, tends to expand over time and has thick 'glassy' collagen fibers
The related hypertrophic scar lacks the serrated edge and has tendency to keep oxpanding
128
What happens in healing bone?
Fibroblasts to cartilage to new bone
| Just like in kids
129
-tomy
cut something
130
-ectomy
cut something out
131
-ostomy
made a mouth to outside/between two organs
132
-plasty
reshaped
133
-pexy
moved something to the right place
134
-rraphy
sewed something up
135
-desis
made two things stick together
136
Aching pain
Periosteum, tooth, dura, circuit in brain
137
Burning pain
Mucosal injury
| Nerve injury
138
Crampy pain
Hollow organ
139
Stabbing pain
Serosal membrane
