L5 - Chronic Imflammation Flashcards
Name the other two ways that chronic inflammation can ensue considering that one way is it arising as a result of prolonged acute inflammation
Autoimmune conditions
Chronic persistent infections
May arise alongside acute inflammation in persistent or repeated irritations
Prolonged exposure to toxic agents
What is the dominant cell in chronic inflammation?
Macrophages
Different macrophage populations have different functions, name some of the functions of macrophages
Phagocytosis
Antigen presentation
Cytokines to recruit lymphocytes and complement synthesis
Angiogenesis stimulation
Describe the characteristic appearance of a lymphocyte
Hyperchromatic Big nucleus Scant cytoplasm Bigger than a RBC, but smaller than a macrophage Appear very uniform
What kind of cell produces antibodies?
Plasma cells which are differentiated B cells (B lymphocytes)
Describe the characteristic appearance of an eosinophil
Red granular cytoplasm and a bilobular nucleus - ‘tomato with sunglasses’
Describe the characteristic appearance of a plasma cell
Accentric nucleus
‘Tail’of cytoplasm
Chromatin lines the edge of the nucleus
What sort of times would we see eosinophils present?
Parasitic infections
Hypersensitivity/allergies
What kind of cells cause the fibrosis (collagen) associated with chronic inflammation?
Fibroblasts
What are giant cells made of?
What is their function?
Fused macrophages (so will be multinucleate)
They phagocytose (frustrated phagocytosis)
What giant cells do we see in
a) TB
b) fat necrosis
c) foreign bodies
a) langerhans
b) Touton
c) foreign body e.g. ulcers/tattoos
Note - look at the slides to see what these look like - important in identification
chronic cholecystitis (inflammation of the gall bladder) is generally the result of bouts of acute cholecystitis. It is typically the result of repeated bouts of what blocking the bile duct in which we eventually see fibrosis and thus thickening of the gall bladder wall (fibrotic wall)?
Gall stones
Gastric ulcers can be the result of a chronic inflammatory response to what bacteria?
Chronic gastritis (inflammation of the stomach lining can occur from this too but also?
Helicobacter pylori
Steroids/alcohol/cancer
Why is fibrosis initially helpful?
Can segregate infected areas
is needed for scar tissue production which is essential in replacing damaged tissue in wound healing.
The problem arises later when the fibrosis can affect organ/tissue function
Give some potential complications of chronic inflammation
Tissue destruction
Excessive fibrosis
Impaired function
Atrophy
Ulcerative colitis and Crohn’s disease have similar symptoms in inflammation of the colon, abdominal pain, diarrhoea and even rectal bleeding but how are they different?
Colitis is superficial, doesn’t affect whole width of the bowel, damaged regions can be removed
Crohns is transmural, affects the whole width of the bowel and can affect anywhere on GI tract from mouth to anus
Both are chronic inflammatory diseases
Name some symptoms of liver cirrhosis
Jaundice
Ascites
Liver flap (hand tremor whilst wrist is extended)
Red palms
Granulomatous inflammation can be caused by foreign bodies but also infection, give an example of one
Mycobacterium in TB or leprosy
What is a granuloma?
An aggregate of epithelioid histiocytes (immobilised macrophages)
What giant cell is Tb associated with?
Langerhans
What condition is the following patient likely suffering from?
Young woman
Non-caseating granulomas, giant cells involving lymph nodes and lungs
Sarcoidosis
Name the four cells principally involved in chronic inflammation and the role of each
Macrophages - Phagocytosis, antigen presentation, production of cytokines to recruit lymphocytes
Lymphocytes - B cells (plasma cells) produce antibodies or become memory cells, T type are involved in control and cytotoxic functions
Eosinophils - allergic reactions, parasitic infections
Fibroblasts - Make collagen for fibrosis - important for wound healing and segregating infected tissue
NOT NEUTROPHILS THOSE ARE IN ACUTE INFLAMMATION
Define chronic inflammation
A chronic response to injury associated with fibrosis
Describe the microscopic appearance of a macrophage
Fluffy cytoplasm (main way of determining) full of pigments Slipper shaped nuclei
Release of which immunoglobulin stimulates the production of eosinophils?
IgE
Describe the appearance of
a) Langerhans giant cell
b) Foreign body giant cell
c) Touton giant cell
a) looks like a horseshoe
b) clusters of loads of random nuclei
c) A ring of nuclei surrounded by fluffy cytoplasm
Granulomas form when particles are particularly hard to eliminate for some reason, commonly foreign bodies such as thorns or bacteria like mycobacterium in leprosy and Tb Granulomas fall into two major categories, what are they?
1) Foreign body granulomas - Contain macrophages, foreign body giant cells and fibroblasts. These forms around material that is NOT antigenic - e.g. surgical thread
2) Immune granulomas - Contain macrophages, giant cells (often Langerhans ones), fibroblasts and lymphocytes. These may undergo central necrosis which is classically seen in Tb granulomas. These develop around antigenic material
What is rheumatoid arthritis?
A long term autoimmune condition affecting the joints
What are some common causes of cirrhosis?
Classically liver cirrhosis - alcohol/ hepatitis/ autoimmunity/ liver disease/ drugs
Name two diseases in which we may see hypersensitivity granulomas
Tb, syphilis, leprosy, crohn’s, sarcoidosis (a disease with unknown cause where granulomas are seen in organs throughout the body)
NOTE - sarcoidosis granulomas are non-necrotising centrally (non-caseating)
What name is given to macrophages which can’t phagocytose the ingested material, and thus their nuclei elongate and they get bigger
Epithelioids. Presence of these defines epithelioid macrophages. Most of the time granulomas contain giant cells too
If we can’t see clearly defined granulomas but the chronic inflammation and setting is indicative of one we say we can see granulomatous inflammation
T
What differences are there between granulomatous inflammation and chronic inflammation?
In granulomatous the macrophages have difficulty killing the causative agent, they contain epithelioid macrophages and multinucleate foreign body giant cells which aren’t present in other forms of chronic inflammaiton
