L5 - Chronic Imflammation

Question 1

Name the other two ways that chronic inflammation can ensue considering that one way is it arising as a result of prolonged acute inflammation

Answer 1

Autoimmune conditions

Chronic persistent infections

May arise alongside acute inflammation in persistent or repeated irritations

Prolonged exposure to toxic agents

Question 2

What is the dominant cell in chronic inflammation?

Answer 2

Macrophages

Question 3

Different macrophage populations have different functions, name some of the functions of macrophages

Answer 3

Phagocytosis
Antigen presentation
Cytokines to recruit lymphocytes and complement synthesis
Angiogenesis stimulation

Question 4

Describe the characteristic appearance of a lymphocyte

Answer 4

Hyperchromatic 
Big nucleus
Scant cytoplasm 
Bigger than a RBC, but smaller than a macrophage
Appear very uniform

Question 5

What kind of cell produces antibodies?

Answer 5

Plasma cells which are differentiated B cells (B lymphocytes)

Question 6

Describe the characteristic appearance of an eosinophil

Answer 6

Red granular cytoplasm and a bilobular nucleus - ‘tomato with sunglasses’

Question 7

Describe the characteristic appearance of a plasma cell

Answer 7

Accentric nucleus
‘Tail’of cytoplasm
Chromatin lines the edge of the nucleus

Question 8

What sort of times would we see eosinophils present?

Answer 8

Parasitic infections

Hypersensitivity/allergies

Question 9

What kind of cells cause the fibrosis (collagen) associated with chronic inflammation?

Answer 9

Fibroblasts

Question 10

What are giant cells made of?

What is their function?

Answer 10

Fused macrophages (so will be multinucleate)

They phagocytose (frustrated phagocytosis)

Question 11

What giant cells do we see in

a) TB
b) fat necrosis
c) foreign bodies

Answer 11

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

Question 12

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)?

Answer 12

Gall stones

Question 13

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?

Answer 13

Helicobacter pylori

Steroids/alcohol/cancer

Question 14

Why is fibrosis initially helpful?

Answer 14

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

Question 15

Give some potential complications of chronic inflammation

Answer 15

Tissue destruction
Excessive fibrosis
Impaired function
Atrophy

Question 16

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?

Answer 16

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

Question 17

Name some symptoms of liver cirrhosis

Answer 17

Jaundice
Ascites
Liver flap (hand tremor whilst wrist is extended)
Red palms

Question 18

Granulomatous inflammation can be caused by foreign bodies but also infection, give an example of one

Answer 18

Mycobacterium in TB or leprosy

Question 19

What is a granuloma?

Answer 19

An aggregate of epithelioid histiocytes (immobilised macrophages)

Question 20

What giant cell is Tb associated with?

Answer 20

Langerhans

Question 21

What condition is the following patient likely suffering from?
Young woman
Non-caseating granulomas, giant cells involving lymph nodes and lungs

Answer 21

Sarcoidosis

Question 22

Name the four cells principally involved in chronic inflammation and the role of each

Answer 22

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

Question 23

Define chronic inflammation

Answer 23

A chronic response to injury associated with fibrosis

Question 24

Describe the microscopic appearance of a macrophage

Answer 24

Fluffy cytoplasm (main way of determining) full of pigments
Slipper shaped nuclei

Question 25

Release of which immunoglobulin stimulates the production of eosinophils?

Answer 25

IgE

Question 26

Describe the appearance of

a) Langerhans giant cell
b) Foreign body giant cell
c) Touton giant cell

Answer 26

a) looks like a horseshoe
b) clusters of loads of random nuclei
c) A ring of nuclei surrounded by fluffy cytoplasm

Question 27

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?

Answer 27

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

Question 28

What is rheumatoid arthritis?

Answer 28

A long term autoimmune condition affecting the joints

Question 29

What are some common causes of cirrhosis?

Answer 29

Classically liver cirrhosis - alcohol/ hepatitis/ autoimmunity/ liver disease/ drugs

Question 30

Name two diseases in which we may see hypersensitivity granulomas

Answer 30

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)

Question 31

What name is given to macrophages which can’t phagocytose the ingested material, and thus their nuclei elongate and they get bigger

Answer 31

Epithelioids. Presence of these defines epithelioid macrophages. Most of the time granulomas contain giant cells too

Question 32

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

Answer 32

T

Question 33

What differences are there between granulomatous inflammation and chronic inflammation?

Answer 33

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