Lecture 3 Study Guide- Inflammation & Repair Flashcards by Abagayle Moody

The body’s response to injury (eliminate cell entry):

inflammation

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Inflammation of the peritoneum:

peritonitis

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Inflammation of the lymph node:

lymphadenitis

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Inflammation of the Fallopian tube:

salpingitis

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Inflammation of the cornea:

keratitis

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Inflammation of the glans penis

Balantitis (Reiters syndrome)

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Inflammation of the bladder:

cystitis

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Comes into play when inflammation is caused by infection:

immunity

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Infection may promote ___ & ___.

Inflammation & immunity

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Inflammation may exist:

without infection

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Inflammation may be caused by ____ or ____ . (give examples)

Hypersensitivity (mucositis) or autoimmune disease (mucous membrane pemphigoid, or RA)

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The bodies first and second line of defenses are considered:

non-specific

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The bodies third line of defense is considered:

specific

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Describe the body’s first line of defense:

BARRIERS- THE MOST IMPORTANT- skin, mucous membranes & secretions (nonspecific)

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Describe the body’s second line of defense:

Inflammatory response- innate- cells (leukocytes) & molecules (mediators) (nonspecific)

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Describe the body’s third line of defense:

Immune responses- acquired - antibodies (humoral) & cytotoxic T-cells (cellular) (specific)

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Skin, mucous membranes, and secretions=

Body’s first line of defense

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Cells (leukocytes) & molecules (mediators) =

Body’s second line of defense

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Antibodies (humoral) & Cytotoxic T-cells (cellular) =

Body’s third line of defense

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List the three main components of inflammatory responses:

circulating blood cells & plasma proteins
cells of the blood vessel walls
cells and proteins of the ECM

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What are the circulating blood cells and plasma proteins of inflammatory responses?

PMNs/neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils

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The cells of the blood vessel walls of inflammatory responses include:

complement
clotting factors (platelets)

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The cells and proteins of the ECM of the inflammatory responses include:

Mast cells
Macrophages

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What components of the inflammatory response is characterized by functioning to eliminate microbes and debris?

PMNs/Neutrophils

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What components of the inflammatory response is comprised of T-cells, B-cells, and NK cells and function to produce antibodies?

Lymphocytes

What components of the inflammatory response are important for repair?

Eosinophils

Lymphocytes (circulating blood cells & plasma proteins of the inflammatory response) are specifically ______ cells and function to:

T-cells, B-cells, & NK cells; produce antibodies

The complement & clotting factors (platelets) of the inflammatory response are the source of:

cytokines & NO

What cells of the ECM that are components of inflammatory response produce histamine?

mast cells

Mast cells produce:

histamine

What cells of the ECM that are components of the inflammatory response eliminate debris and are a source of cytokines?

macrophages

Inflammation is the bodies response to:

injury

Most of the defensive elements of inflammation are located in the:

blood

Inflammation is the means by which:

defensive cells & chemicals leave the blood & enter tissue

Inflammation is a ____ to injury

complex reaction

Inflammation is a complex reaction to injury including: (4)

1. vascular responses 2. cellular responses 3. systemic reactions 4. repair

Describe the vascular responses of inflammation:

MOST IMPORTANT

What is an example of a systemic reaction of inflammation?

fever

Initially inflammation is ____, however, if excessive or prolonged it may become ____.

beneficial; harmful

Inflammatory response 5R's include:

1. recognition of the injurious agent 2. recruitment of leukocytes 3. removal of the agent 4. regulation (control) of the response 5. resolution (repair)

What are the cardinal signs of inflammation? (5)

1. Calor- heat 2. Rubor-redness 3. Tumor- swelling 4. Dolor- pain 5. Loss of function

Inflammation characterized by a rapid onset, short duration and is intense:

Acute

What cells are involved in acute inflammation?

neutrophils

What type of inflammation involves the exudation of fluid and plasma proteins?

acute inflammation

Acute inflammation involves ____ of fluid and plasma proteins

exudation

Protein-rich fluid that filters into a site (can cause swelling)

exudate

Describe the composition of exudate:

protein-rich

Describe the cellular events of acute inflammation: (7)

1. margination 2. rolling 3. adhesion 4. diapedesis 5. chemotaxis 6. phagocytosis 7. killing

Inflammation characterized by a longer duration and considered low grade:

chronic inflammation

What cells are involved in chronic inflammation?

mononuclear cells - macrophages, lymphocytes, plasma cells

Mononuclear cells of chronic inflammation include: (3)

1. macrophages 2. lymphocytes 3. plasma cells

Proliferation of blood vessels and fibroblasts occurs in _____ inflammation

chronic

Chronic inflammation is typically _____ and associated with fibrosis & scarring

non-exudative

Chronic inflammation can be described as non-exudative meaning its associated with:

fibrosis & scarring

What are the causes of acute inflammation? (4)

1. mechanical, chemical, radiation, or thermal injury 2. infection 3. compromise of blood supply 4. immune injury

What are the morphological patterns of acute inflammation? (4)

1. serous inflammation 2. fibrinous inflammation 3. suppurative (purulent) inflammation 4. ulcerative inflammation

Acute inflammation characterized by the accumulation of fluid right under the epithelium:

serous inflammation

Serous inflammation produces ____. (describe it)

transudate (low protein fluid, more watery)

Give examples of conditions involving serous inflammation: (4)

1. friction blisters 2. poison ivy 3. thermal bern 4. herpes

Acute inflammation characterized by large molecules (fibrinogen) moving into the extravascular space:

fibrinous inflammation

Describe fibrinous inflammation:

acute inflammation, exudative; lines of mucosal fibrin and CT with inflammatory cells beneath

Fibrinous pericarditis in rheumatic feber is an example of:

fibrinous inflammation

Acute inflammation characterized by the production of pus:

Suppurative (purulent) inflammation

Describe the contents of the pus produced in suppurative (purulent) inflammation:

exudate, rich in neutrophils

Streptococcal meningitis, submandibular gland abscess and abscess of infected tooth are all condition associated with:

suppurative (purulent) inflammation

Acute inflammation characterized by a defect in epithelial continuity:

ulcerative inflammation

Describe ulcerative inflammation:

clinically presents as whitish, yellowish area, surrounded by red halo

Recurrent aphthous stomatitis is an example of:

ulcerative inflammation

Other types of acute inflammation (Not the morphologic patterns) include:

1. cellulitis 2. catarrhal inflammation

Diffuse spread of acute inflammatory process through the fascial planes of soft tissue (not localized)

Cellulitis

Describe the clinical manifestations of cellulitis:

produces erythema, edema, warmth, and pain WITHOUT consolidation (its diffuse)

Clinical type of exudative inflammation, presenting with excess production of mucus:

Catarrhal inflammation

Catarrhal inflammation only occurs on ____ containing ____ cells such as ___ or ___

mucosal surfaces; mucus-secreting cells; nasal or bronchial mucosa

List all the conditions classified as "defects in neutrophil function" (5):

1. leukocyte adhesion deficiency (LAD) 2. lazy leukocyte syndrome 3. chediak-higashi syndrome 4. chronic granulomatous disease of childhood 5. myeloperoxidate Deficiency (MPO)

- Defect in neutrophil function - Patients present with periodontal bone loss (exfoliating teeth) - Primary & secondary dentition is affected - Due to failure in adhesion of neutrophils to blood vessel wall - Nothing will stop the progression of this disease (greater risk of bacterial & fungal infections)

Leukocyte Adhesion Deficiency (LAD)

- Defect in neutrophil function - Impaired chemotaxis due to mutation of contractile proteins

Lazy Leukocyte Syndrome

- Defect in neutrophil function - Rare autosomal recessive condition associated with albinism - Form giant lysosomal inclusion from fused primary granules - Both chemotaxis and phagolysosome formation are defective - Subjected to recurrent infection - Platelet function is abnormal

Chediak-Higashi Syndrome

- Defect in neutrophil function - X-linked (2/3) or autosomal recessive (1/3) - Deficient NADPH oxidase in cell membranes of neutrophils and monocytes - Absence of respiratory burst--> No H2O2 produced --> HOCl- (bleach) is NOT synthesized - Catalase negative organisms are killed - Catalase positive organisms are NOT killed

Chronic granulomatous disease of childhood

- Defect in neutrophil function - Common autosomal recessive absence of MPO enzyme in neutrophil and monocyte granules - Respiratory burst is normal and H202 is produced - Absence of MPO prevents synthesis of HOCl- - No great clinical consequences in most people - Diabetics may develop candidiasis (and additional problems)

Myeloperoxidase (MPO) Deficiency

Immune deficiency caused by defects in leukocyte function categories include:

1. too few neutrophils 2. failure in adhesion 3. slow chemotaxis 4. failure to phagocytose 5. failure to kill invader

What immune deficiency caused by defects in leukocyte function is due to too few neutrophils?

1. agranulocytosis 2. cyclic neutropenia

What immune deficiency caused by defects in leukocyte function is due to failure in adhesion?

1. leukocyte adhesion deficiency (LAD)

What immune deficiency caused by defects in leukocyte function is due to slow chemotaxis?

1. lazy leukocyte syndrome

What immune deficiency caused by defects in leukocyte function is due to failure to phagocytose?

1. bruton agammaglobulinemia 2. complement deficiency

What immune deficiency caused by defects in leukocyte function is due to failure to kill invader?

1. chediak-higashi syndrome 2. chronic granulomatous disease of childhood 3. myeloperoxidase deficiency

The cell-derived preformed mediators of inflammation, and where they come from:

1. histamine 2. serotonin come from secretory granules

Source of histamine:

1. mast cells 2. basophils 3. platelets

Source of serotonin:

platelets

The newly synthesized mediators of inflammation include:

1. prostaglandins 2. leukotrienes

The source of prostaglandins:

1. all leukocytes 2. platelets 3. EC

The source of leukotrienes:

all leukocytes

Both histamine and serotonin are ____ chemical mediators of inflammation

preformed (in secretory granules)

Both prostaglandins and leukotrienes are ____ chemical mediators of inflammation

newly synthesized

Arachidonic Acid metabolites =

eicosandoids

When you take drugs for an inflammatory process, this is where the drugs act:

Arachidonic acid metabolites (Eicosandoids)

_____ act on phospholipases preventing arachidonic acid

steroids

____ on cyclooxegenase preventing prostaglandins

Aspirins/NSAIDs

What do steroids act on? What does this prevent?

Phospholipases; arachidonic acid

What do aspirin/NSAIDs act on? What does this prevent?

cyclooxegenase; prostaglandins

Cell membrane phospholipids produce arachidonic acid which forms: (2)

1. leukotrienes 2. prostaglandins

Responsible for vasodilation/vasoconstriction, chemotaxis of neutrophils and bronchospasm:

Leukotrienes

Responsible for vasodilation/vasoconstriction, promotion/inhibition of platelet aggregation and pain & fever in inflammation:

Prostaglandins

- Persistant infection (ex. mycobacteria) - Prolonged exposure to toxic agents - Exogenous (ex. silicosis- exposure to foreign agent) - Endogenous (ex atherosclerosis- plaque build up within blood vessels) - Immune-mediated inflammatory disease - Autoimmune disease (ex. RA) - Unregulated immune responses against microbes (ex. IBS) - Immune responses against environmental substances- allergic disease (ex. bronchial asthma)

Causes of chronic inflammation

What are the morphological features of chronic inflammation (3)

1. Mononuclear cell infiltration 2. Tissues destruction 3. Angiogenesis & fibrosis

A pattern of chronic inflammation that is NON-exudative; aggregates of epithelioid macrophages (activated; histiocytes):

Granulmatous inflammation

Describe the exudate pattern of granulomatous inflammation:

Non-exudative

The macrophages involved in granulomatous inflammation are considered:

epithelial histocytes

Discuss the characteristic cells of granulomatous inflammation: (3)

1. aggregates of epithelioid macrophages (epithelial histiocytes) 2. Multinucleated giant cells (Langhans giant cell) 3. Mononuclear leukocytes (mainly lymphocytes & occasionally plasma cells on periphery)

Granulomatous inflammation is type of ____ inflammation

chronic

There is a ___ variable in granulomatous inflammation

fibrosis

What are the two classifications of granulomas?

1. immune granulomas 2. foreign body granulomas

- Coocidiodes Imitis (fungal organism inside giant cell) is an example of:

Immune granuloma

- Tuberculosis (bacterial infection that contains necrotizing granulomas) is an example of:

immune granuloma

Mycobacterium TB (intracellular pathogen, blocks fusion of phagosome with lysosome) is an example of:

immune granuloma

Sarcoidosis (immune-mediated condition) is an example of:

immune granuloma

- Coccidiodies Immitis - Tuberculosis - Mycobacterium TB - Sarcoidosis These are all examples of:

Immune granulomas

Forms when a foreign body (i.e., wood splinter) enters soft tissue and inflammation follows:

Foreign body granuloma

- Reparative tissue (ex. pyogenic granuloma) - Contains endothelial cells and fibroblasts - Formation of BVs - Body repairing from some type of injury

granulation tissue

Granulation tissue may be considered ____ tissue

reparative

What type cells are present in granulation tissue?

endothelial cells & fibroblasts

The formation of BVs is characteristic of:

granulation tissue

If the body is repairing from some type of injury what tissue will be seen?

granulation tissue

- Contains granulomas- very specific type of chronic inflammation - The granulomas within consist of epithelial histiocytes, giant multinuclear cells, and mononuclear leukocytes

granulomatous tissue

Granulomatous tissue contains ___ and is a very specific type of ____

granulomas; chronic inflammation

What is within the granulomas of granulomatous tissue?

epithelial histiocytes, grant multinuclear cells, and mononuclear leukocytes

A pyogenic granuloma is ____ NOT _____

granulation tissue; granulomatous tissue

The neutrophilia seen in leukocytosis (a systemic manifestation of acute inflammation) represents a shift to:

the left

Restoration of tissue architecture and function after an injury:

wound healing & repair

Repair of wound may occur by ____ or ____

regeneration or healing (scar formation)

Growth of cells and tissues to replace lost structures:

regeneration

What are the three components of regeneration?

1. continuously dividing tissues (labile) 2. stable tissues (quiescent) 3. permanent tissues (non-dividing)

Continuously dividing tissues of regeneration:

labile tissues

Stable tissues of regeneration:

Quiescent tissues

Permanent tissues of regeneration:

non-dividing tissues

Consists of variable proportions of 2 distinct processes - regeneration and scarring (fibrosis)

Healing

Healing consists of variable proportions of 2 distinct processes including:

1. regeneration 2. scarring (fibrosis)

Scarring occurs if: (3)

1. tissue is intrinsically unable to regenerate (heart & brain) 2. underlying connective tissue scaffolding is disrupted 3. following extensive exudates (organization)

Scarring occurs in tissues that are intrinsically unable to regenerate such as:

heart & brain

If the underlying connective tissue scaffolding is disrupted, what will occur?

scarring

Regeneration: Cell Classification: Labile cells are derived from the division of:

stem cells

Regeneration: Cell Classification Labile cells are derived from the division of stem cells: (4)

1. hematopoietic cells 2. surface epithelium 3. stratified squamous epithelium of skin, mouth, pharynx, esophagus, vagina, and cervix 4. GI tract of epithelium

Regeneration: Cell Classification Labile tissues can readily regenerate after injury as long as:

the pool of stem cells is preserved

Regeneration: Cell Classification The most common forms of cancer arise from:

labile tissues

Regeneration: Cell Classification The most common forms of cancer arise from labile tissues including: (5) List tissue & associated cancer

1. epidermis- skin cancer 2. bronchial mucosa- lung cancer 3. oral mucosa- oral cancer 4. cervical mucosa- cervical cancer 5. hematopoietic tissue- leukemias

Regeneration: Cell Classification Stable tissues:

quiescent

Regeneration: Cell Classification Stable cells are quiescent and have a:

very low rate of turnover

Regeneration: Cell Classification In stable tissues, replacement is carried out by:

mitotic division of mature cells

Regeneration: Cell Classification In stable tissues, replacement is carried out by mitotic division of mature cells including: (4)

1. viscera (liver, kidney, pancreas) 2. endothelial cells 3. fibroblasts 4. smooth muscle cells

Regeneration: Cell Classification With the exception of ___, stable tissues have limited capacity to regenerate

liver

Regeneration: Cell Classification What tissues have limited capacity to regenerate?

stable tissues

Regeneration: Cell Classification Malignant tumors of ___ tissues are among the rarer forms of cancer

stable tissues

Regeneration: Cell Classification Permanent tissues are considered:

non-dividing

Regeneration: Cell Classification Permanent cells were generated during ____ and:

fetal life; never divide in post-natal life

Regeneration: Cell Classification Describe the replacement of permanent tissues:

can NOT be replaced if lost

Regeneration: Cell Classification Permanent tissues cannot be replaced if lost, and these include:

1. neurons 2. cardiac myocytes

Regeneration: Cell Classification Because permanent tissues cannot be replaced if lost, repair is dominated by:

scar formation

The objectives of wound healing include: (2)

1. epithelial regeneration 2. connective tissue repair

In wound healing, restoring the integrity of the epithelial surface:

epithelial regeneration

In wound healing, restoring tensile strength of the sub-epithelial tissue:

connective tissue repair

Occurs when wound margins are pulled together- suture:

healing by primary intention

Ex. Mucocele- surgeons make incision and remove sac of fluid Healing occurs by:

primary intention

All wound healing involves _____, even without an infection

inflammatory reaction

Occurs when the wound margins are NOT pulled together:

healing by secondary intention

Ex. Tumor on hard palate- not a lot of tissue here so can't close if after biopsy; let ope wound fill in with granulation tissue- endothelial cells, fibroblasts, and myofibroblasts Healing occurs by:

secondary intention

Wound contraction by myofibroblasts of granulation tissue is characteristic of:

healing by secondary intention

Excessive scar formation formed WITHIN the boundaries of the original wound:

Hypertrophic scar

Excessive scar formation that grows BEYOND the boundaries of the original wound; common in african Americans:

keloid

What may cause a deficiency in wound healing?

Vitamin C deficiency (scurvy)

In wound healing, why is vitamin C important?

Vitamin C is required for the hydroxylation of proline and lysin (forms collagen)