Mediators Of Inflammation Flashcards
1
Q
Mediators of Inflammation
The mediators of inflammation are the substances that ________________ inflammatory reactions.
A
initiate and regulate
2
Q
The most important mediators of acute inflammation are
vasoactive _____,
lipid products (_______ and ______),
_______ (including _______),
products of _________
A
amines
prostaglandins and leukotrienes
cytokines; chemokines
complement activation
3
Q
Mediators are either secreted by ____ or generated from _______
A
cells
plasma proteins.
4
Q
Cell-derived mediators are normally sequestered in _______ and can be rapidly secreted by __________(e.g., histamine in mast cell granules) or are
Synthesized ______ (e.g., prostaglandins and leukotrienes, cytokines) in response to a stimulus.
A
intracellular granules
granule exocytosis
de novo
5
Q
Source of histamine ?
A
Mast cells
Basophils
Platelets
6
Q
Source of prostaglandins
A
Mast cells
Leukocytes
7
Q
Source of leukotrienes
A
Mast cells
Leukocytes
8
Q
Source of Cytokines
A
Macrophages
Endothelial cell
Mast cells
9
Q
Examples of cytokines
A
TNF
IL-1
IL-6, etc
10
Q
Source of chemokines
A
Leukocytes
Activated macrophages
11
Q
Source of Platelet activating factor
A
Mast cells
Leukocytes
12
Q
Source of complement protein
A
Plasma
Produced in the liver
13
Q
Source of kinins
A
Plasma
Produced in the liver
14
Q
Mention 5 broad mediators involved in vascular dilation
A
Histamine
Prostaglandins
Complement protein
Kinin
PAF
15
Q
Mention 4 broad mediators involved in increasing membrane permeability
A
Histamine
Leukotrienes
PAF
Kinins
16
Q
Mention 2 broad mediators involved in pain
A
Kinins( bradykinin)
Prostaglandins
17
Q
Mention broad mediators involved in
Leukocyte adhesion
Leukocyte activation
Leukocyte chrmotaxis
A
Leukotrienes and PAF
Leukotrienes and chemokines
Chemokines,PAF, complement protein
18
Q
Mention broad mediators involved in endothelial activation
A
Histamine
Cytokines
19
Q
The major cell types that produce mediators of acute inflammation are the sentinels that detect invaders and damage in tissues -
_____,________, and ________, but _______,_________,_________, and most epithelia can also be induced to elaborate some of the mediators.
A
macrophages, dendritic cells, and mast cells
platelets, neutrophils, endothelial cells
20
Q
Plasma derived mediators are produced mainly in the ____ and are present in the circulation as _______ that must be ______.
A
liver
inactive precursors
activated
21
Q
Most of the mediators are (short or long?) -lived.
A
Short
22
Q
One mediator can stimulate the release of other mediators.
T/F
A
T
23
Q
Vasoactive Amines: Histamine and Serotonin
They have important actions on ______
They are stored as preformed molecules in cells and are among the ___________ to be released during inflammation.
The richest sources of histamine are the ______ that are normally present in the connective tissue adjacent to blood vessels.
It is also found in blood ______ and _____
A
blood vessels.
first mediators
mast cells
basophils and platelets.
24
Q
Histamine is stored in ______ and is released by _________ in response to a variety of stimuli, including
(1) physical injury, such as trauma, cold, or heat, by unknown mechanisms;
(2) binding of _____ to mast cells, which underlies ________ reactions and
(3) products of complement called _____ (_________).
A
mast cell granules
mast cell degranulation
antibodies; immediate hypersensitivity (allergic) ; anaphylatoxins
C3a and C5a
25
_______ are thought to secrete some histamine-releasing
proteins.
leukocytes
26
Neuropeptides (e.g., substance P) and cytokines (IL-1, IL-8) may also trigger release of histamine.
T/F
T
27
Histamine
It causes ______ or _____ and ——— of ——-
dilation of arterioles and increases the permeability of venules.
28
_______ is considered to be the principal mediator of the immediate transient phase of increased vascular permeability, producing interendothelial gaps in venules.
Histamine
29
Histamine’s vasoactive effects are mediated mainly via binding to ___ receptors on microvascular endothelial cells.
H1
30
Histamine also causes (contraction or relaxation ?) of some smooth muscles.
Contraction
31
Serotonin (__________)
It is a preformed vasoactive mediator present in ______ and certain neuroendocrine cells, such as in the _________, and in _____ cells in _____ but not ______.
It function primarily as a neurotransmitter in the GIT. It is also a vaso (constrictor or dilator?)
5-hydroxytryptamine
platelets
gastrointestinal tract (GIT)
mast; rodents; humans
constrictor
32
The lipid mediators prostaglandins and leukotrienes are produced from ________ present in ____________
arachidonic acid (AA)
membrane phospholipids
33
Arachidonic acid is a ___-carbon ______ fatty acid (5,8,11,14- eicosatetraenoic acid) that is derived from ______ sources or by conversion from the essential fatty acid linoleic acid.
20
polyunsaturated
dietary
34
Arachidonic acid occurs free in the cell
T/F
F
It does not occur free in the cell but is normally esterified in membrane phospholipids.
35
Mechanical, chemical, and physical stimuli or other mediators (e.g., C5a) release AA from membrane phospholipids through the action of cellular ______, mainly _________.
phospholipases
phospholipase A2
36
AA-derived mediators, are synthesized by two major classes of enzymes:
________(which generate _______) and
__________ (which produce ________ and ______).
cyclooxygenases; prostaglandins
lipoxygenases; leukotrienes and lipoxins
37
AA-derived metabolites bind to _________ receptors on many cell types and can mediate virtually every step of inflammation
G protein-coupled
38
Which AA metabolites are involved in vasodilation
Prostaglandins I2
PGE1
PGE2
PGD2
39
Which AA metabolites are involved in vasoconstriction
Thromboxane
LT C4, D4, E4
40
Which AA metabolites are involved in increasing membrane permeability?
LT C4, D4, E4
Basically all the LT except B4
41
Which AA metabolites are involved in chemotaxis and leukocyte adhesion?
LT B4
42
Prostaglandins (PGs) are produced by _____,_______,_______, and many other cell types, and They are involved in the vascular and systemic reactions of inflammation.
mast cells, macrophages, endothelial cells
43
Prostaglandins are generated by the actions of two ______, called ______ and _____
cyclooxgenases
COX-1 and COX-2.
44
COX-1 is produced in response to _____ stimuli and is also constitutively expressed in _____ tissues, where it may serve a _____ function (e.g., fluid and electrolyte balance in the kidneys, cytoprotection in the gastrointestinal tract).
,
inflammatory
most
homeostatic
45
COX-2 is induced by _____ stimuli and thus generates the prostaglandins that are involved in inflammatory reactions, but it is (low or high?) or (present or absent?) in ________ tissues.
inflammatory
Low
Absent
most normal
46
Prostaglandins are divided into series based on structural features as coded by a letter (___________) and a subscript numeral (e.g., 1, 2), which indicates the ________ in the compound.
PGD, PGE, PGF, PGG, and PGH
number of double bonds
47
platelets contain the enzyme ________ synthase, and hence ____ is the major product in these cells.
thromboxane
TxA2
48
TxA2, a potent ________ agent and vaso______, is (stable or unstable?) and is rapidly converted to its inactive form _____.
platelet-aggregating
constrictor
Unstable
Thromboxane B2
49
Vascular endothelium lacks _____ synthase but possesses _____ synthase, which is responsible for the formation of _______ and its stable end product ______
thromboxane
prostacyclin
prostacyclin (PGI2)
PGF1a.
50
Prostacyclin is a vaso______, potent inhibitor of platelet aggregation, and also markedly potentiates the ______ and ________ effects of other mediators.
Dilator
permeability-increasing and chemotactic
51
_______ is the major prostaglandin made by mast cells; along with ______
it causes _______ and _______, thus potentiating ____ formation.
PGD2
PGE2
vasodilation and increases the permeability of postcapillary venules
edema
52
Which prostaglandin is most widely distributed
PGE2
53
PG____ stimulates the contraction of uterine and bronchial smooth muscle and small arterioles.
PG___ is a chemoattractant for neutrophils.
PG__ is hyperalgesic and makes the skin hypersensitive to painful stimuli, such as intradermal injection of suboptimal concentrations of histamine and bradykinin.
F2a; D2
E2
54
PG___ is I nvolved in cytokine-induced fever during infections
E2
55
Leukotrienes are produced by ______ and ______ by the action of ________.
They are involved in ——— and ______ reactions and _____ recruitment.
leukocytes and mast cells
lipoxygenase
vascular and smooth muscle
leukocyte
56
There are three different lipoxygenases, _________ being the predominant one in neutrophils.
This enzyme converts AA to ____________________ acid, which is chemotactic for neutrophils, and is the precursor of the leukotrienes.
5-lipoxygenase
5-hydroxyeicosatetraenoic
57
LT____ is a potent chemotactic agent and activator of neutrophils, causing aggregation and adhesion of the cells to venular endothelium, generation of ROS, and release of lysosomal enzymes.
B4
58
The ______-containing leukotrienes LTC4, LTD4, and LTE4 cause intense vaso______, _________(important in asthma), and ____________
cysteinyl
vasoconstriction, bronchospasm
increased permeability of venules.
59
Who is more potent in increasing vascular permeability and causing bronchospasm.
Histamine or leukotrienes?
Leukotrienes are more potent than is histamine in increasing vascular permeability and causing bronchospasm.
60
Lipoxins
are generated from ____ by the ______ pathway.
They (support or suppress?) inflammation by ____________
They inhibit neutrophil ____ and ______ to endothelium.
AA
lipoxygenase
Suppress
inhibiting the recruitment of leukocytes.
chemotaxis; adhesion
61
Lipoxins are also unusual in that ___ cell populations are required for the transcellular biosynthesis of these mediators.
two
62
Leukocytes, particularly ______, produce intermediates in lipoxin synthesis, and these are converted to lipoxins by _____ interacting with the leukocytes.
neutrophils
platelets
63
These anti-inflammatory drugs include the following: Cyclooxygenase inhibitors include _____ and other ________ drugs (NSAIDs), such as ______.
They inhibit _______ and thus inhibit prostaglandin synthesis.
aspirin
nonsteroidal anti-inflammatory
ibuprofen
COX-1 and COX-2
64
Selective or non selective COX2 inhibitors
Which is newer
Has toxicity
Anti inflammatory effect
increased risk of CV and cerebrovascular events
Impair prostacyclin production
affect COX1
Selective COX-2 inhibitors are a newer class of these drugs
Non selective
Both
Selective
Selective
Non selective
65
Selective cox 2 inhibitors are 200-300 fold more potent in blocking COX-2 than COX-1.
T/F
T
66
5-lipoxygenase is affected by NSAIDs,
F
It’s not
67
Pharmacologic agents that inhibit leukotriene production (e.g.,___) are useful in the treatment of _____.
Zileuton
Asthma
68
________ are broad-spectrum anti-inflammatory agents that reduce the transcription of genes encoding COX-2, phospholipase A2, proinflammatory cytokines (e.g., IL-1 and TNF), and iNOS.
Corticosteroids
69
Montelukast is useful in the treatment of ______.
asthma
70
Another approach to manipulating inflammatory responses has been to modify the __________________
The proposed explanation is that the —————————————
intake and content of dietary lipids by increasing the consumption of fish oil.
polyunsaturated fatty acids in fish oil are poor substrates for conversion to active metabolites by the cyclooxygenase and lipoxygenase pathways but are better substrates for the production of antiinflammatory lipid products.
71
Cytokines are proteins produced by many cell types (principally activated _____,_______, and dendritic cells, but also endothelial, epithelial, and connective tissue cells).
lymphocytes, macrophages
72
growth factors that act on epithelial and mesenchymal cells are grouped under cytokines.
T/F
F
They are not
73
Cytokines: Tumor Necrosis Factor (TNF) and Interleukin-1 (IL-1)
They serve critical roles in _______ by promoting _____ of leukocytes to endothelium and their _____ through vessels.
leukocyte recruitment
adhesion; migration
74
Cytokines: Tumor Necrosis Factor (TNF) and Interleukin-1 (IL-1)
These cytokines are produced mainly by activated _______ and ——— cells;
TNF is also produced by ______ and ———— cells, and IL-1 is produced by some ______ cells as well.
macrophages and dendritic
T lymphocytes and mast
epithelial
75
The production of TNF is induced by signals through ____ and other microbial sensors
The synthesis of IL-1 is stimulated by _______ signals.
TLRs
the same
76
The actions of TNF and IL-1 contribute to the _________ reactions of inflammation .
local and systemic
77
The most important roles of these cytokines (TNF, IL-1) in inflammation are the following:
______ activation: by ______
Increased production of various mediators, including ______,_______, growth factors, and eicosanoids
Increased (pro or anti?) coagulant activity of the endothelium.
Endothelial; Both TNF and IL-1
other cytokines and chemokines
Pro
78
Endothelial activation
These changes include increased expression of endothelial adhesion molecules, mostly ________________________
E- and P-selectins and ligands for leukocyte integrins.
79
Activation of leukocytes and other cells.
TNF __________ of neutrophils to other stimuli such as bacterial endotoxin and stimulates the _______ of macrophages.
IL-1 activates ______ to synthesize collagen and stimulates proliferation of synovial and other mesenchymal cells.
IL-1 also stimulates _____ responses, which in turn induce acute inflammation.
augments responses; microbicidal activity
fibroblasts
TH17
80
Systemic acute-phase response.
IL-1 and TNF (as well as ___) induce the systemic acute-phase responses including ______.
They are also implicated in the syndrome of _____.
TNF regulates energy balance by promoting _____________ and by ________
IL-6
fever
sepsis
lipid and protein mobilization ; suppressing appetite.
81
Mention 4 mediators that cause fever
PGE2
TNF
IL-1
IL-6
82
sustained production of TNF contributes to ___________ and ______ that accompanies some chronic infections and neoplastic diseases.
cachexia - weight loss
anorexia
83
Chemokines
Chemokines are a family of small (8 to 10 kD) proteins that act primarily as _______ for specific types of leukocytes.
chemoattractants
84
About ____ different chemokines and ___ different receptors for chemokines have been identified.
40; 20
85
They are classified into four major groups:
List them
C-X-C chemokines
C-C chemokines
C chemokines
CX3C chemokines
86
C-X-C chemokines
These chemokines act primarily on ________.
_____ is typical of this group.
It causes ________ and _______ of ______
Limited activity on _____ and ____
Its most important inducers are ____ products and other cytokines, mainly ____ and ____.
neutrophils
IL-8
activation and chemotaxis of neutrophils
monocytes and eosinophils.
microbial
IL-1 and TNF
87
C-C chemokines
Attract ______,________,_______ and ______
Not as potent chemoattractants for ______.
monocytes, eosinophils, basophils and lymphocytes
neutrophils
88
eotaxin selectively recruits ———-.
eosinophils
89
C chemokines
The C chemokines (e.g., _____) are relatively specific for ________.
lymphotactin
lymphocytes
90
CX3C chemokines
The only known member of this class is called __________.
This chemokine exists in two forms:
A cell surface-bound protein induced on endothelial cells by inflammatory cytokines that promotes strong adhesion of ______ and _____ cells, and
a _____ form, derived by _________, that has potent chemoattractant activity for _____ cells.
fractalkine
monocytes and T
Soluble; proteolysis of the membrane-bound protein ; the same
91
Chemokines mediate their activities by binding to __________ receptors.
seven-transmembrane G protein–coupled
92
Chemokines have two main functions:
In acute inflammation.
They stimulate ______ to ______ by increasing the __________,
they stimulate ___________ of leukocytes in tissues.
leukocyte attachment to endothelium
affinity of integrins
migration (chemotaxis)
93
Chemokines have two main functions:
Maintenance of tissue architecture.
Some chemokines are produced in tissues are called ______
chemokines.
These _____ various cell types in different ________ of the tissues, such as T and B lymphocytes in discrete areas of the spleen and lymph nodes.
Development of antagonists that block these chemokines has proven (easy or difficult?) .
homeostatic
organize; anatomic regions
Difficult
94
Other Cytokines in Acute Inflammation
The list of cytokines implicated in inflammation is huge and constantly growing.
IL-__- made by macrophages and other cells, involved in local and systemic reactions,
IL-__- produced mainly by T lymphocytes, which promotes neutrophil recruitment.
6
17
95
Type I interferons, whose normal function is to _________, contribute to some of the _____ manifestations of inflammation.
inhibit viral replication
systemic
96
Cytokines also play key roles in chronic inflammation.
T/F
T
97
Complement System
The complement system is a collection of (soluble or insoluble ?) proteins and membrane receptors.
They function mainly in host defense against ______ and in ________ reactions.
The system consists of more than 20 proteins, some of which are numbered ______________
Soluble
microbes; pathologic inflammatory
C1 through C9.
98
Complement system function in only adaptive immunity
T/F
F
Both innate and adaptive
99
Complement System
In the process of complement activation, several cleavage products of complement proteins are elaborated that cause _________,________, and ______
increased vascular permeability, chemotaxis, and opsonization.
100
The critical step in complement activation is the proteolysis of the ___ component, ___.
third
C3
101
most abundant component of the complement system is ____
C3.
102
Cleavage of C3 can occur by one of three pathways:
The classical pathway, which is triggered by fixation of _____ to _____ (___ or ___) that has _________
The alternative pathway, triggered by ___________ (e.g.,______), complex polysaccharides,______, and other substances, in the absence of _____
The lectin pathway, in which plasma ___________ binds to _____ on _____ and (directly or indirectly?) activates C1.
C1 to antibody; IgM or IgG; combined with antigen
microbial surface molecules; endotoxin, or LPS; cobra venom; antibody
mannose-binding lectin ; carbohydrates; microbes;directly
103
All three pathways of complement activation lead to the formation of _______, which splits C3 into two functionally distinct fragments, ________
_____ is _____, while ____ becomes covalently attached to the cell or molecule where complement is being activated.
C3 convertase; C3a and C3b.
C3a is released; C3b
104
Activation of complement proteins:
More C3b then binds to the previously generated fragments to form _______ which then cleaves ___ to release ___ and leave ______ attached to the cell surface and that binds the late components (__________), culminating in the formation of the ______________________
C5 convertase.; C5; C5a; C5b
C6-C9
membrane attack complex (MAC)
105
membrane attack complex is composed of multiple ____ molecules
C9
106
The complement system has three main functions:
Inflammation.
____,_____ and, to a lesser extent, ___ - stimulate _____ release from mast cells and thereby increase _______ and ______.
They are called ________
C3a, C5a,; C4a
histamine
vascular permeability and cause vasodilation
anaphylatoxins
107
Pro-inflammatory complement proteins are called ???
anaphylatoxins
108
The complement system has three main functions:
Opsonization and phagocytosis.
____ and its cleavage product ____, when
fixed to a microbial cell wall, act as opsonins
They promote ______ by _____ and _____
C3b; iC3b (inactive C3b)
phagocytosis; neutrophils; macrophages
neutrophils and macrophages.
109
C5a is also a _____ agent for neutrophils, monocytes, eosinophils, and basophils.
In addition, C5a activates the _____ pathway of AA metabolism in neutrophils and monocytes, causing further release of inflammatory mediators.
chemotactic
lipoxygenase
110
The complement system has three main functions:
Cell lysis.
The deposition of the ____ on cells makes these cells __________ and results in cell death (lysis).
MAC
permeable to water and ions
111
Regulation of complement activation
This is tightly controlled.
The most important is _______ which blocks _________
Inherited deficiency of this inhibitor is the cause of _______________
C1 inhibitor (C1 INH) - blocks the activation of C1
hereditary angioedema.
112
Regulation of complement activation
_________(DAF) and ____ are two proteins that are linked to plasma membranes by a __________ anchor.
Decay accelerating factor ; CD59
glycophosphatidyl (GPI)
113
Decay accelerating factor
Aka
_____
CD55
114
DAF prevents formation of _______
CD59 inhibits _____________
C3 convertases
formation of the membrane attack complex.
115
An acquired deficiency of the enzyme that creates GPI anchors leads to deficiency of these regulators(CD55,CD59) and excessive _______ and ______ in the disease called ____________
complement activation
lysis of red cells
paroxysmal nocturnal hemoglobinuria (PNH).
116
Other Mediators of Inflammation
Platelet-Activating Factor (PAF)
PAF is a _____-derived mediator
It causes _______.
A variety of cell types, including platelets themselves, basophils, mast cells, neutrophils, macrophages, and endothelial cells, can elaborate PAF, in both ______ and ______ forms.
PAF causes vaso_____ and broncho_____,
At (low or high?) concentrations, it induces vasodilation and increased venular permeability.
phospholipid; platelet aggregation
secreted and cell-bound
constriction; constriction
Low
117
Products of Coagulation
Discovery of protease-activated receptors (PARs), which are activated by _____, and are expressed on ______ and ———- is the link to inflammation.
thrombin; platelets and leukocytes
118
The major role of the PARs is in ______ during ______
platelet activation during clotting.
119
In fact, it is easy to dissociate clotting and inflammation
T/F
With reason
F
Very difficult since virtually all forms of tissue injury that lead to clotting also induce inflammation.
120
Kinins
Kinins are vasoactive ____ derived from _________, called ______, by the action of specific proteases called _____.
peptides; plasma proteins
kininogens; kallikreins
121
Kallikrein cleaves high-molecular-weight ———- to produce _______.
kininogen
bradykinin
122
Bradykinin increases ______ and causes (contraction or relaxation?) of smooth muscle, (constriction or dilation?) of blood vessels, and ____ when injected into the skin.
These effects are similar to those of ____.
vascular permeability
Contraction ; dilation
pain; histamine
123
The action of bradykinin is (short or long?) -lived
With reason
Short
because it is quickly inactivated by an
enzyme called kininase.
124
Bradykinin has been implicated as a mediator in some forms of ——- reaction, such as anaphylaxis
allergic
125
Neuropeptides
Neuropeptides are secreted by ____ nerves and various ______,
These small peptides, such as ______ and ______, are produced in the central and peripheral nervous systems.
sensory
leukocytes
substance P and neurokinin A
126
Neuropeptides
May play a role in the initiation and regulation of inflammatory responses.
T/F
T
127
Nerve fibers containing substance P are prominent in the ______ and ________
lung and gastrointestinal tract.
128
Substance P has many biologic functions, including the transmission of _____ signals as well as regulation
pain
129
Morphologic Patterns of Acute Inflammation
The morphologic hallmarks of acute inflammatory reactions are _______ and ___________ in the extravascular tissue.
dilation of small blood vessels
accumulation of leukocytes and fluid
130
Serous Inflammation
Serous inflammation is marked by the ______ of ______ fluid into spaces created by _____ or into body cavities lined by the peritoneum, pleura, or pericardium.
exudation; cell poor; cell injury
131
Typically, the fluid in serous inflammation is infected by destructive organisms and contains large numbers of leukocytes.
F
The fluid in serous inflammation is not infected by destructive organisms and does not contain large numbers of leukocytes.
132
Serous inflammation
In body cavities, the fluid may be derived from the _____ or from the secretions of ________
accumulation of fluid in these cavities is called an ______.
plasma
mesothelial cells
effusion
133
Serous inflammation
The ______ resulting from a burn or viral infection represents accumulation of serous fluid within or ___________ the damaged _____ of the skin.
skin blister
immediately beneath
epidermis
134
Fibrinous Inflammation
A fibrinous exudate develops when the vascular leaks are (small or large?) or there is a local (pro or anti?) coagulant stimulus (e.g., cancer cells).
A fibrinous exudate is characteristic of inflammation in the _________, such as the meninges, pericardium, and pleura.
Large
Pro
Lining of body cavities
135
Fibrinous Inflammation
Histologically, fibrin appears as an ___philic meshwork of threads or sometimes as ________.
eosino
an amorphous coagulum
136
Fibrinous exudates may be dissolved by _______ and cleared by _______.
If the fibrin is not removed, over time it may stimulate the ____________________ and thus lead to _______
fibrinolysis
macrophages
ingrowth of fibroblasts and blood vessels and thus lead to scarring.
137
Purulent (Suppurative) Inflammation, Abscess
Purulent inflammation is characterized by the production of ____ which is An exudate consisting of ____, the liquefied debris of _____ cells, and ____ fluid.
pus
neutrophils; necrotic; edema
138
The most frequent cause of purulent (also called _______) inflammation is infection with ______ that cause ______, such as ______
They are referred to as ______ ( ____-producing) bacteria.
suppurative
bacteria
liquefactive tissue necrosis
staphylococci; pyogenic; pus
139
A common example of an acute suppurative inflammation is ____________.
acute appendicitis
140
Abscesses are localized collections of __________ caused by ______ buried in a tissue, an organ, or a confined space.
Abscesses have a _____ region that appears as a _________ and ______
There is usually a zone of ______ around this necrotic focus, and outside this region there may be vascular ___- and parenchymal and fibroblastic proliferation.
purulent inflammatory tissue
suppuration buried
Central ; mass of necrotic leukocytes and tissue cells.
preserved neutrophils; dilation
141
Ulcers
An ulcer is a local defect, or _______, of the _____ of an organ or tissue that is produced by the ______ of inflamed necrotic tissue.
excavation; surface
sloughing
142
Ulceration can occur only when ____ and resultant _____ exist on or near a _____.
It is most commonly encountered in
the mucosa of the ____, ____,_____ or ______, and the skin and subcutaneous tissue of the _______ in older persons who have circulatory disturbances that predispose to extensive ________
tissue necrosis
inflammation; surface
mouth; stomach; intestines; genitourinary tract
lower extremities; ischemic necrosis.
143
Ulcerations are best exemplified by peptic ulcer of the _______ or ______, in which ______________________ coexist.
stomach or duodenum
acute and chronic inflammation
