M1: Acute & Chronic Inflammation Flashcards
Cell death
Necrosis
Protective response to rid the initial cause of cell injury. Complex reactions of both blood vessels and leukocytes.
Inflammation
Fluid portion of the blood
Plasma
Body’s principal defenders against foreign invaders
Plasma proteins, Circulating leukocytes & Tissue phagocytes “PCT”
Protein is primarily synthesized in what organ
Liver
Triggers the vascular & cellular reaction
Soluble factors
Blood component, polymorphonuclear cell, responsible for Acute Inflammation.
Neutrophil
Blood component responsible for Chronic Inflammation
Macrophage & Leukocyte
Primarily from B Lymphocytes
Plasma cells
Elimination of offending agent is achieved by
Termination of Inflammation
Blood component that has a short lifespan in tissues
Leukocytes
Repair of damage tissue/cell. Example is abrasion of skin.
Regeneration
Filling of the defect with fibrous tissue
Scarring
Produce by fibroblast
Collagen
Hardening of the blood vessels
Atherosclerosis
Cardinal signs of an Infection
Rubor, Tumor, Calor, Dolor & Functio Laesa
Cardinal sign: redness
Rubor
Cardinal sign: pain
Dolor
Cardinal sign: loss of function
Functio Laesa
Cardinal sign: heat
Calor
Cardinal sign: swelling
Tumor
Rapid host response that serves to deliver leukocytes and plasma proteins. Early onset, involving fluid exudation and polymorphonuclear cell immigration.
Acute Inflammation
Two main components of Inflammation
Vascular wall response & Inflammatory response
Later onset and longer duration involving lymphocytes and macrophages, with blood vessels proliferation and fibrosis.
Chronic Inflammation
Calor is due to
Vascular dilatation
Rubor is due to
Vascular dilatation & Congestion
Tumor is due to
Increased vascular permeability
Dolor is due to
Mediator release
Functio laesa is due to
Pain, Edema, Tissue injury or scar
Three major components of Acute Inflammation: 1. Alterations in _____________, leading to increased blood flow.
Vascular caliber
Three major components of Acute Inflammation: Structural changes in the ________, permitting plasma proteins and leukocytes to leave the circulation to produce inflammatory ________.
Microvasculature. Exudates.
Three major components of Acute Inflammation: ___________ from blood vessels and accumulation of the site of injury with activation.
Leukocyte emigration
Stimuli for Acute Inflammation
Tissue necrosis, Infection & Microbial toxin “TIM”
Detects bacteria
Toll-like Receptors
Tissue necrosis is due to
Ischemia
Produced by cells deprived of O2 & activates transcription of many genes involved in inflammation
Hif 1A
Reactions of Blood Vessels in Acute Inflammation
BV, Leukocytes & Termination “BLT”
Pathological term for leaky
Vascular Permeability
Is excess fluid in interstitial tissue or body cavities
Edema
Is an inflammatory, extravascular fluid with cellular debris and high protein concentration. Specific gravity of 1.020 or more.
Exudate
Is excess, extravascular fluid with low protein content. It is essentially an ultrafiltrate of blood plasma resulting from elevated fluid pressures or diminished plasma osmotic forces. Specific gravity of 1.012 or less.
Transudate
Is a purulent inflammatory exudate rich in neutrophils and cell debris
Pus
Normal fluid exchange in vascular beds depends on an intact
Endothelium
Normal fluid exchange are modulated by two opposing factors
Hydrostatic pressure & Plasma colloid osmotic pressure
Causes fluid to move into the capillaries
Plasma colloid osmotic pressure
Causes fluid to move out of the circulation
Hydrostatic pressure
Yellowish & Turbid. Escape of fluid, CHONs & cells from the vascular system into the interstitial tissue or body cavities. Inflammatory edema. Increase protein with cellular materials.
Exudate
Increase HP & Decrease OP causing transudate
Edema
Clear, less hazy & cloudy. Non inflammatory edema. Decreased protein. Little or non cellular material. An ultrafiltrate plasma.
Transudate
One of the earliest manifestations of Acute Inflammation. Increase blood flow. Followed by Increase permeability of the microvasculature.
Vasodilation
Mediates Vasodilation
Histamine & Nitric Oxide
Lining of a vessel
Endothelium
Increases when there is vasodilation
Hydrostatic pressure
Combination of vascular dilation and fluid loss leads to
Increased blood viscosity & concentration of RBCs
Slow movement of erythrocytes
Stasis
Vascular congestion
Erythema
Increased Vascular Permeability: _________ of venule endothelium to form intercellular ______.
Contraction. Gaps.
Contraction of venule endothelium is due to these chemical mediators
Histamine, Bradykinin & Leukotrienes “HBL”
Contraction of venules/endothelial cells that occur rapidly after injury and is recersible transient. 15-30mins.
Immediate-transient response
Increased Vascular Permeability: Direct _______ injury.
Endothelial
Causes endothelial cell necrosis and detachment that affects venules, capillaries and arterioles
Sever necrotizing injury
Recruited neutrophils may contribute to the injury through
Reactive Oxygen Species “ROS”
Seen in late appearing sunburn
Prolonged delayed response
Inflammation of the lymphatics. Secondary inflamed. Red streaks.
Lymphangitis
Inflammation of the lymph nodes. Draining LN. Enlarged & painful lymph nodes. May be due to lymphoid follicle and sinusoidal phagocyte hyperplasia.
Lymphadenitis
Increased Vascular Permeability: Increased ________.
Transcytosis
Transendothelial channels form by interconnection of vesicles derived from the
Vesiculovacuolar organelle
Induce vascular leakage by increasing the increasing the number of these channels
Vascular Endothelial Growth Factor (VEGF)
Increased Vascular Permeability: _______ from new blood vessels.
Leakage
Endothelial proliferation and capillary sprouting result in leaky vessels
Angiogenesis
Represent a secondary line of defense when local inflammatory responses cannot contain an infection
Mononuclear Phagocyte System
Increased transport of fluids & proteins
Transcytosis
In Acute Inflammation, this predominates during the first 6-24 hours.
Neutrophil
In Acute Inflammation, this replaces the neutrophil after 24-48 hours.
Monocyte
Journey of Leukocytes from the vessel lumen to the interstitial tissue.
Extravasation
Extravasation Steps: in the lumen; _________, _________ & __________ to endothelium.
Margination, Rolling & Adhesion
Extravasation Steps: Migration; ________ & ________.
Endothelium & Vessel wall
Extravasation Steps: Tissue toward a ________ stimulus.
Chemotactic
Process of leukocytes redistribution peripheral position of leukocytes along the endothelial surface.
Margination
Individual & then rows of leukocytes adhere transiently to the endothelium.
Rolling
A chemical mediator that induces expression. Trigger adhesion molecules.
Cytokines
Examples of Cytokines
TNF, IL-1 & Chemokines “TIC”
These are adhesion molecules which mediates initial rolling
Selectins
Found at the surface. Mediates firm adhesion which is commonly seen in neutrophil.
Integrins
Induce endothelial expression of Ligands
TNF & IL-1
Ligand of endothelial cells for VLA-4 & B1 Integrins
VCAM
Ligand of endothelial cells for LFA & B2 Integrins
ICAM
Express Integrin in low affinity state
Leukocyte
Firm adhesion of Leukocytes to adhesion molecules which then activate & bind to rolling leukocyte. An example is Cytokine.
Chemokines
Transmigration
Diapedesis
Diapedesis is mediated by
PECAM-1 (Elastase)
Pierce the basement membrane by secreting collagenase
Leukocytes
Epithelial lining of Endothelium
Simple squamous epithelial cells
Directs specific binding location. Locomotion oriented along a chemical gradient. Both exogenous & endogenous substances can act as chemoattractants.
Chemotaxis
Leukocyte responsible for viral infection
Lymphocytes
Leukocyte responsible for hypersensitivity
Eosinophil
Responsible for Antibody production
Plasma cell
Source of cytokines
Macrophages
Recognizes components of microorganisms
TLRs
Recognize short bacterial peptides. Activation of respiratory burst.
G-protein coupled receptors
Process of coating a microbe to target it for ingestion which makes it easier to engulf microorganisms.
Opsonization
Major macrophage activating cytokine. Secreted by natural killer cells reacting to microbes & by antigen activated T lymphocyte.
Interferon-Ÿ
Coats the microbes. IgG antibodies. Mannan-binding lectin & C3B complement Proteins.
Opsonins
Steps in Phagocytosis
Recognition, Engulfment & Degradation/Killing “RED”
Extension of the cytoplasm
Pseudopods
Encloses the particle
Phagosome
Phagosome fuses with a lysosomal granule
Phagolysosome
Killing & Degradation is done by
ROS
Converts H2O2 to hypochloride which a potent antimicrobial agent
MPO in presence of Halide
Most efficient bacteriocidal system of neutrophils
H2O2-MPO-Halide
Converted to Hydroxyl radical which is another powerful destructive agent
H2O2
Produced from Arginine which is for microbial killing
Nitric Oxide
Free harmful radical
Peroxynitrite
OCl stands for
Hypochlorite
ONOO stands for
Peroxynitrite
O2’ stands for
Superoxide Anion
Defects in phagolysosome function
Chedial Higashi Syndrome
Defects in microbicidal activity & in genes encoding components of phagocyte oxidase
Chronic Granulomatous Disease
Acquired deficiencies due to radiation & chemotherapy
Bone marrow suppression
From mast cell, basophil & platelets. Causes dilation of arterioles a d increases the permeability of venules.
Vasoactive Amine: Histamine
Stimulates when platelets aggregate after contact with collagen, thrombin, adenosine diphosphate and antigen-antibody complexes.
Serotonin
Main source of serotonin
Platelets
Exposed when there is blood vessel injury
Subendothelial collagen
Converts fibrinogen to fibrin
Thrombin
Examples of Arachidonic Acid metabolites
Prostaglandin, Leukotrienes & Lipoxins “PLL”
Endothelium-derived relaxing factor. Endogenous mechanism for controlling inflammatory response.
Nitric Oxide
C3A & C5A are examples of
Anaphylatoxins
Deposition of Collagen
Fibrosis
Morphologic Patterns of AI: ________ of small blood vessels.
Dilatation
Morphologic Patterns of AI: _________ of blood flow.
Slowing
Morphologic Patterns of AI: Accumulation of _______ & _______ in the extravascular tissue.
Leukocytes & Fluid
Marked by outpouring of thin fluid derived from plasma or secretions of mesothelial cells
Serous Inflammation
Other term for Thin fluid
Effusion
From a 2nd degree burn or viral infection
Skin blisters
Development of exudate in large vascular leaks. Inflammation in the lining of body cavities. May be removed by __________.
Fibrinous Inflammation. Fibrinolysis.
Production of pus consisting neutrophils, liquefactive necrosis and edema fluid.
Suppurative/Purulent Inflammation
Pyogenic bacteria is due to what microorganism
Staph
Localized collections of purulent inflammatory tissue caused by suppuration in a tissue, organ or a confined space.
Abscess
Local defect or excavation of the surface an organ or tissue that is sloughing.
Ulcers