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Semester 2 Pathological Processes > L6: Chronic Inflammation > Flashcards

L6: Chronic Inflammation Flashcards

1
Q

Define chronic inflammation?

A

Prolonged inflammation with associated repair

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2
Q

What are the features of chronic inflammation?

A
  • Delayed onset
  • Variable duration–> days–> years
  • Variable response–> no cardinal signs
  • Limits damage and initiates repair
  • Debilitating symptoms
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3
Q

How does chronic inflammation arise?

A

1- Takes over from acute inflammation
–> acute inflammation unable to clear the pathgen
2- Arises at same time as acute inflammation
–> Repeated stimulus, persistant irritation
3- Arises without acute inflammation
–> De novo, autoimmune conditions

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4
Q

What does chronic inflammation look like?

A

Variable appearance depending on cells present

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5
Q

What are the different cells types of chronic inflammation?

A 
Macrophages (histiocyte)
Lymphocytes --> plasma cell
Eosinophil 
Fibroblast/ myofibroblasts
Giant cells 
- Foreign body giant cell
- Langhans giant cell 
- Touton giantcell
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6
Q

What is the difference between a monocyte and a macrophage?

A

Monocyte- in circulation

Macrophage- in tissue

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7
Q

What is the appearance of a macrophage?

A

Large cells
Abundant, foamy cytoplasm –> phagolysosome
Slipper shaped nucleus–> indented
However, appearance can vary a lot– can look like cancer cells

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8
Q

What is the function of macrophages?

A

Phagocytosis
- Removal of pathogens/ necrosis/ debris
- Antigen presentation to the immune system
Inflammatory mediators
- Synthesis and release of many mediators
- Controls and regulates the inflammatory response

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9
Q

What do lymphocytes look like?

A

Smaller but still bigger than RBC
Large central spherical nucleus
Dark staining nucleus
Small rim of cytoplasm

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10
Q

What is the function of lymphocytes?

A

T cells

  • -> Variety of types
  • -> ‘Helper’ –> CD4+ –> assist other inflammatory cells
  • -> ‘Cytotoxic’–> CD8+ –> destroy pathogens

B cells

  • -> Mature into plasma cells
  • -> Produce antibodies
  • -> Neutralise and destroy pathogens

Note= Not possible to distinguish between them on H&E stain

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11
Q

What are plasma cells? What are the characteristic features?

A

Mature B cells
Eccentric nucleus
Chromatin clumps into sphere around periphery of nucleus –> Clock face nucleus
Perinuclear cytoplasmic apperance–> golgi apparatus

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12
Q

What is the function of plasma cells?

A 
Fully differentiated B lymphocyte
Produces antibodies (synthesis and secrete)
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13
Q

What are eosinophils?

A

Larger than RBC
2 lobed nucleus–> bilobed
Cytoplasm stains bright red
Contains granules

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14
Q

What is the function of eosinophils?

A

Granules –> Contains mediators (eosinophil cationic proteins and elastases)
Release a variety of mediators
Hypersensitivity reactions–> allergic reactions
Parasitic infections

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15
Q

What are fibroblast/myofibroblasts?

A

Important for regeneration and repair

Lay down collagen

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16
Q

What are giant cells?

A

Multinucleated cells
Produced–> fusion of multiple macrophages –> macrophages unable to destroy pathogen on its own–> frustrated phagocytosis

17
Q

What are the different types of giant cells?

A

Foreign body giant cells–> Big cytoplasm, random nuclei
Langhans giant cells–> Nuclei line up around periphery–> horseshoe shaped–> seen in TB
Touton giantcell–> nuclei line up in concentric circle in middle–> seen in fat necrosis

18
Q

How can cell type indicate a diagnosis?

A

Generally cells involved in chronic inflammation are non specific
Sometimes–> proportion of cell types can indicate a diagnosis
- Rheumatoid arthritis= mainly plasma cells
- Chronic gastritis= mainly lymphocytes
- Leishmaniasis (protozoal infections)= mainly macrophages

19
Q

What are the effects of chronic inflammation?

A

1- Fibrosis–> repair–> deposition of collagen
2- Impaired function–> loss of function e.g. IBD, Rarely=↑ function–> thyrotoxicosis in Graves Disease
3- Atrophy–> reduction in size of an organ
4- Stimulation of the immune response–> antigen presentation, continuous by macrophages–> prolonged response

20
Q

How does fibrosis occur in the gall bladder?

A

Repeated obstruction of bile duct –> gallstone
Result in acute inflammation
Gallstones move–> bouts of acute inflammation–> chronic inflammation
Fibrosis of gall bladder–> thickened and pale

21
Q

Example of how chronic inflammation impairs function?

A 
Idopathetic inflammatory bowel disease: Crohn's and Ulcerative colitis 
Inflammation
--> Abdominal pain 
--> Altered bowel movement
--> Weight loss
--> Rectal bleeding
--> Diarrhoea
22
Q

What does idopathetic mean?

A

Unknown cause yet

23
Q

Compare and contrast Crohn’s and Ulcerative Colitis?

A

Crohn’s

  • -> Affect all GI tract
  • -> Discontinuous –> one bit inflammed one bit not
  • -> Affect full thickness of bowel wall–> transmural –> stictures/fistulae
  • -> Sometimes get granulomata
  • -> Less likely to get rectal bleeding

Ulcerative Colitis

  • -> Large bowel effected only
  • -> Continuous inflammation
  • -> Affect superficial wall only–> mucosa + submucosa
  • -> No granulomata
  • -> More likely to have rectal bleeding (result of continuous inflammation)
24
Q

Why do you get cirrhosis?

A 
End stage liver damage to liver
Caused by
--> Alcohol
--> Hepatitis
--> Drugs and toxins 
--> Fatty liver disease
Fibrosis and attempted regeneration
25
Q

What is granulomatous inflammation?

A

Specific of chronic inflammation with granuloma

26
Q

What is a granuloma?

A

Spherical collection of epithelioid histiocytes, surrounded by lymphocytes
Sometimes get giant cells in them

27
Q

What are epithelioid histiocytes?

A

Macrophages that look like epithelial cells

28
Q

What causes granulomatous inflammation?

A

Foreign body reaction
–> Foreign body giant cells–> (collection of macrophages)–> next step is to form a granuloma

Infections

  • -> Mycobacterium (mycobacterium tuberculosis and leprae)
  • -> Difficult to destroy because–> thick cell wall and mycolic acids (proteins on cell surface)
  • -> Usually caseous necrosis in middle

Idiopathic–> currently no known cause

  • ->Cronh’s disease–> Non-caseating granulomata in GI tract
  • ->Sarcoidosis–> multiple well formed granulomata in the lymph nodes, lungs and skin (enlarged lymph nodes, shortness of breath and dry cough and skin lumps)
29
Q

What is special about mycobacterium granuloma?

A

Middle of granulomatous is caseous necrosis
Caseous–> looks like cheese
Caseous necrosis, surrounded by epithelioid histiocytes and then lymphocytes

Semester 2 Pathological Processes (16 decks)

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