Lecture 3 - Chronic Inflammation

Question 1

what is chronic inflammation?

Answer 1

chronic response to injury with associated fibrosis

Question 2

how can ci arise?

Answer 2

1. take over from ai if damage is too severe to resolve within a few days
2. arise de novo due to autoimmue, chronic infection or chronic low level irritation
3. develop alongside ai in severe, persistent or repeated irritation

Question 3

what are the effects of ci?

Answer 3

fibrosis
impaired function
atrophy
stimulation of immune response

Question 4

what cells are involved in ci?

Answer 4

macrophages
lymphocytes
eosinophils
fibroblasts/myofibroblasts
giant cells

Question 5

what is the role of macrophages?

Answer 5

phagocytosis and destruction of debris and bacteria
processing and presentation of antigen to immune system
synthesis of cytokines, complement components, clotting factors and proteases
control of other cells via cytokine release

Question 6

what is the role of lymphocytes?

Answer 6

complex, mainly immunological
b lymphocytes differentiate to produce antibodies
t lymphocytes involved in control and cytotoxic functions

Question 7

what is the role of eosinophils?

Answer 7

allergic reactions
parasite infections
some tumours

Question 8

what is the role of fibroblasts/myofibroblasts?

Answer 8

recruited by macrophages, make collagen

Question 9

what is the role of giant cells?

Answer 9

multinucleate cells made by fusion of macrophages
langhans
foreign body type
touton

Question 10

what is chronic cholecystitis?

Answer 10

repeated obstruction of gall bladder with gallstones
repeated ai leads to ci and fibrosis of gall bladder wall
treated with surgical removal of gall bladder

Question 11

what is gastric ulceration?

Answer 11

ulceration because of imbalance between acid production and mucosal defence

Question 12

what are the signs of ulcerative colitis?

Answer 12

superficial
diarrhoea
bleedingtreat with immunosuppression and surgical removal of large bowel

Question 13

what are the signs of crohn’s disease?

Answer 13

transmural
strictures
fistulae
treat with lifestyle modifications, diet/hydration, immunosuppression

Question 14

what is liver cirrhosis?

Answer 14

ci with fibrosis leading to disorganisation of architecture and attempted regeneration leads to cirrhosis
irreversible

Question 15

what are common causes of liver cirrhosis?

Answer 15

alcohol
infection with hbv or hcv
immunological
fatty liver disease
drugs and toxins

Question 16

what is rheumatoid arthritis?

Answer 16

autoimmunelocalised and systemic immune responselocalised ci leads to joint destructionsystemic immune response

Question 17

when does a granuloma form?

Answer 17

when the immune system walls off something that it is unable to eliminate
arise with persistent, low grade antigenic stimulation and hypersensitivity

Question 18

what are the main causes of granulomatous inflammation?

Answer 18

mildly irritant foreign material
infections eg mycobacteria, syphilis, fungi
unknown causes eg sarcoid, wegeners, crohn’s

Question 19

what is tuberculosis?

Answer 19

caused by mycobacteria
produces no toxins/lytic enzymes
causes disease by persistence and induction of cell mediated immunity

Question 20

what are the outcomes of tb?

Answer 20

1. arrest, fibrosis, scarring
2. erosion into bronchus
3. tuberculous emphysema
4. erosion into blood stream