Lecture 3 Study Guide- Inflammation & Repair Flashcards
The body’s response to injury (eliminate cell entry):
inflammation
Inflammation of the peritoneum:
peritonitis
Inflammation of the lymph node:
lymphadenitis
Inflammation of the Fallopian tube:
salpingitis
Inflammation of the cornea:
keratitis
Inflammation of the glans penis
Balantitis (Reiters syndrome)
Inflammation of the bladder:
cystitis
Comes into play when inflammation is caused by infection:
immunity
Infection may promote ___ & ___.
Inflammation & immunity
Inflammation may exist:
without infection
Inflammation may be caused by ____ or ____ . (give examples)
Hypersensitivity (mucositis) or autoimmune disease (mucous membrane pemphigoid, or RA)
The bodies first and second line of defenses are considered:
non-specific
The bodies third line of defense is considered:
specific
Describe the body’s first line of defense:
BARRIERS- THE MOST IMPORTANT- skin, mucous membranes & secretions (nonspecific)
Describe the body’s second line of defense:
Inflammatory response- innate- cells (leukocytes) & molecules (mediators) (nonspecific)
Describe the body’s third line of defense:
Immune responses- acquired - antibodies (humoral) & cytotoxic T-cells (cellular) (specific)
Skin, mucous membranes, and secretions=
Body’s first line of defense
Cells (leukocytes) & molecules (mediators) =
Body’s second line of defense
Antibodies (humoral) & Cytotoxic T-cells (cellular) =
Body’s third line of defense
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
What are the circulating blood cells and plasma proteins of inflammatory responses?
- PMNs/neutrophils
- Lymphocytes
- Monocytes
- Eosinophils
- Basophils
The cells of the blood vessel walls of inflammatory responses include:
- complement
- clotting factors (platelets)
The cells and proteins of the ECM of the inflammatory responses include:
- Mast cells
- Macrophages
What components of the inflammatory response is characterized by functioning to eliminate microbes and debris?
PMNs/Neutrophils
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)
- vascular responses
- cellular responses
- systemic reactions
- 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:
- recognition of the injurious agent
- recruitment of leukocytes
- removal of the agent
- regulation (control) of the response
- resolution (repair)
What are the cardinal signs of inflammation? (5)
- Calor- heat
- Rubor-redness
- Tumor- swelling
- Dolor- pain
- 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)
- margination
- rolling
- adhesion
- diapedesis
- chemotaxis
- phagocytosis
- 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)
- macrophages
- lymphocytes
- 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)
- mechanical, chemical, radiation, or thermal injury
- infection
- compromise of blood supply
- immune injury
What are the morphological patterns of acute inflammation? (4)
- serous inflammation
- fibrinous inflammation
- suppurative (purulent) inflammation
- 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)
- friction blisters
- poison ivy
- thermal bern
- 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:
- cellulitis
- 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):
- leukocyte adhesion deficiency (LAD)
- lazy leukocyte syndrome
- chediak-higashi syndrome
- chronic granulomatous disease of childhood
- 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:
- too few neutrophils
- failure in adhesion
- slow chemotaxis
- failure to phagocytose
- failure to kill invader
What immune deficiency caused by defects in leukocyte function is due to too few neutrophils?
- agranulocytosis
- cyclic neutropenia
What immune deficiency caused by defects in leukocyte function is due to failure in adhesion?
- leukocyte adhesion deficiency (LAD)
What immune deficiency caused by defects in leukocyte function is due to slow chemotaxis?
- lazy leukocyte syndrome
What immune deficiency caused by defects in leukocyte function is due to failure to phagocytose?
- bruton agammaglobulinemia
- complement deficiency
What immune deficiency caused by defects in leukocyte function is due to failure to kill invader?
- chediak-higashi syndrome
- chronic granulomatous disease of childhood
- myeloperoxidase deficiency
The cell-derived preformed mediators of inflammation, and where they come from:
- histamine
- serotonin
come from secretory granules
Source of histamine:
- mast cells
- basophils
- platelets
Source of serotonin:
platelets
The newly synthesized mediators of inflammation include:
- prostaglandins
- leukotrienes
The source of prostaglandins:
- all leukocytes
- platelets
- 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)
- leukotrienes
- 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)
- Mononuclear cell infiltration
- Tissues destruction
- 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)
- aggregates of epithelioid macrophages (epithelial histiocytes)
- Multinucleated giant cells (Langhans giant cell)
- 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?
- immune granulomas
- 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?
- continuously dividing tissues (labile)
- stable tissues (quiescent)
- 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:
- regeneration
- scarring (fibrosis)
Scarring occurs if: (3)
- tissue is intrinsically unable to regenerate (heart & brain)
- underlying connective tissue scaffolding is disrupted
- 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)
- hematopoietic cells
- surface epithelium
- stratified squamous epithelium of skin, mouth, pharynx, esophagus, vagina, and cervix
- 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
- epidermis- skin cancer
- bronchial mucosa- lung cancer
- oral mucosa- oral cancer
- cervical mucosa- cervical cancer
- 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)
- viscera (liver, kidney, pancreas)
- endothelial cells
- fibroblasts
- 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:
- neurons
- 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)
- epithelial regeneration
- 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)