L5 - Chronic Imflammation Flashcards by Lewis Cobb

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

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What is the dominant cell in chronic inflammation?

Macrophages

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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

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Describe the characteristic appearance of a lymphocyte

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

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What kind of cell produces antibodies?

Plasma cells which are differentiated B cells (B lymphocytes)

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Describe the characteristic appearance of an eosinophil

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

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Describe the characteristic appearance of a plasma cell

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

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What sort of times would we see eosinophils present?

Parasitic infections

Hypersensitivity/allergies

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

Fibroblasts

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What are giant cells made of?

What is their function?

Fused macrophages (so will be multinucleate)

They phagocytose (frustrated phagocytosis)

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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

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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

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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

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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

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Give some potential complications of chronic inflammation

Tissue destruction
Excessive fibrosis
Impaired function
Atrophy

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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

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