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MoD 3 (Chronic Inflammation) Flashcards

1
Q

Which cells are associated with chronic inflammation?

A
  • Macrophages
  • Lymphocytes
  • Eosinophils
  • Fibroblasts/Myofibroblasts
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2
Q

Which type of interferon activates macrophages?

A

Gamma Interferon

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3
Q

Name the functions of macrophages in chronic inflammation:

A
  • Phagocytosis
  • Secretion of cytokines, complement, blood clotting factors and proteases
  • Antigen presentation (initiation of immune response)
  • Stimulation of angiogenesis
  • Induce fibrosis
    Induce fever, cachexia and acute phase response
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4
Q

What are the functions of lymphocytes in chronic inflammation?

A
  • Process antigens
  • Secrete antibodies
  • Secrete cytokines
  • Kill cells
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5
Q

What type of lymphocytes kill cells?

A

T lymphocytes

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6
Q

What type of lymphocytes secrete antibodies?

A

B lymphocytes that have become plasma cells

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7
Q

Describe the appearance of eosinophils:

A
  • Pink, granular cytoplasm
  • Bi-lobed nucleus
    (Sun-burnt cell wearing sunglasses)
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8
Q

What kind of immune reactions cause the production of large amounts of eosinophils?

A
  • Allergic reactions ie Asthma
  • Parasitic infections
  • Some neoplasms (Hodgkin’s lymphoma)
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9
Q

What kind of connective tissue fibres can be secreted from fibroblasts?

A
  • Collagen
  • Elastic
  • Reticulin
  • Glycosaminoglycans
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10
Q

What name is given to fibroblasts that can contract?

A

Myofibroblasts

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11
Q

What cell type recruits fibroblasts in chronic inflammation?

A

Macrophages

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12
Q

Neutrophils are the main cell type in what kind of inflammation?

A

Acute inflammation

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13
Q

Macrophages, Lymphocytes, Eosinophils and Fibroblasts are all cell types of what kind of inflammation?

A

Chronic inflammation

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14
Q

Define ‘giant cell’:

A

Multinucleate cells made by the fusion of macrophages, due to ‘frustrated phagocytosis’

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15
Q

When does frustrated phagocytosis occur?

A

When a phagocyte is unable to engulf its target because the target is physically too large to encompass

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16
Q

Giant cells form due to the fusion of which cell type?

A

Macrophage fusion

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17
Q

Name the 3 types of giant cells:

A

1) Langhans’
2) Foreign body
3) Touton

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18
Q

Langhan’s giant cells are made by the fusion of what type of cell?

A

Epithelioid histocytes (activated macrophages resembling epithelial cells)

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19
Q

What is an epithelioid histocyte?

A

An activated macrophage resembling an epithelial cell

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20
Q

What type of giant cell is formed by the fusion of epithelial histocytes?

A

Langhans’ giant cells

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21
Q

Describe the miscroscopic appearance of Langhans’ giant cells:

A

> 15 peripherally placed nuclei arranged in horseshoe formation
eosinophilic cytoplasm

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22
Q

Langhans’ giant cells are seen in chronic inflammation caused by what?

A
  • Tuberculosis
  • Crohn’s disease
  • Sarcoidosis
  • Late stage syphilis
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23
Q

What type of giant cells are seen in a tuberculosis infection?

A

Langhans’ giant cells

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24
Q

What type of giant cell is associated with granulomatous conditions?

A

Langhans’ giant cells

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25
Q

Describe the microscopic appearance of foreign body giant cells:

A
  • Multiple nuclei scattered throughout cell

- May contain Ca2+, bone/plastic fragments etc

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26
Q

Describe the microscopic appearance of Touton giant cells:

A

Central ring of nuclei

Foamy cytosol

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27
Q

Why do Touton giant cells have a foamy cytosol?

A

Due to engulfed lipid

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28
Q

When are Touton giant cells seen?

A
  • Fat necrosis

- Xanthoma

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29
Q

Which type of giant cell has a central ring of nuclei?

A

Touton giant cells

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30
Q

Which type of giant cell has a peripheral horseshoe formation of nuclei?

A

Langhans’ giant cells

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31
Q

Which type of giant cell has nuclei randomly scattered throughout the cytoplasm?

A

Foreign body giant cells

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32
Q

In which situations does chronic inflammation typically occur?

A
  • After acute inflammation
  • Autoimmune conditions
  • Chronic persistent infections
  • Prolonged exposure to toxic agents
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33
Q

Name some possible complications of chronic inflammation:

A
  • Fibrosis
  • Atrophy
  • Stimulation of immune response
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34
Q

How does Rheumatoid Arthritis cause joints to become unstable and deformed?

A

Causes inflammation and proliferation of synovial membrane, which stretches the joint capsule

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35
Q

Which type of arthritis causes symmetrical pain and stiffness of joints?

A

Rheumatoid arthritis

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36
Q

Ulnar deviation of fingers is a sign of which type of arthritis?

A

Rheumatoid arthritis

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37
Q

Describe the distribution of ulcerative colitis:

A

Continuously proximal inflammation of colon from the rectum

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38
Q

What layers of the bowel wall are affected in ulcerative colitis?

A

Mucosa

Submucosa

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39
Q

Describe the microscopic appearance of ulcerative colitis:

A

Thinning of bowel wall
Loss of crypt architecture
Ulcer formation
Inflammation limited to mucosa and submucosa

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40
Q

What are the symptoms of ulcerative colitis?

A
  • Bloody diarrhoea
  • Abdominal pain
  • Malaise/lethargy
  • Anorexia
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41
Q

What is pancolitis?

A

When the entire colon is affected by ulcerative colitis

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42
Q

What are the 2 main types of non-specific inflammatory bowel disease?

A

1) Ulcerative colitis

2) Crohn’s disease

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43
Q

List some of the complications of ulcerative colitis:

A
  • Increased risk of colon cancer
  • Liver disease
  • Anaemia
  • Bowel perforation
  • Osteoporosis (due to treatment)
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44
Q

How do corticosteroids cause osteoporosis?

A
  • Inhibit osteoblast function
  • Inhibit Ca2+ absorption from GI tract
  • Enhance bone resorption
  • Increase urine Ca2+ loss
45
Q

Which therapy given for ulcerative colitis can cause osteoporosis?

A

Corticosteroid therapy

46
Q

Which type of non-specific inflammatory bowel disease is strongly linked with smoking?

A

Crohn’s disease

47
Q

Which type of non-specific inflammatory bowel disease causes discontinuous inflammation?

A

Crohn’s disease

48
Q

Which type of non-specific inflammatory bowel disease causes a ‘cobblestone’ appearance of the bowel?

A

Crohn’s disease

49
Q

Which layers of the bowel wall can Crohn’s disease affect?

A

Transmural:

  • Mucosa
  • Submucoa
  • Muscle
  • Connective tissue
50
Q

Which type of non-specific inflammatory bowel disease can cause transmural inflammation?

A

Crohn’s disease

51
Q

Which type of non-specific inflammatory bowel disease is always contained within the mucosa and submucosa?

A

Ulcerative colitis

52
Q

Which type of non-specific inflammatory bowel disease can affect the muscular layer of the GI tract?

A

Crohn’s disease

53
Q

What are the symptoms of Crohn’s disease?

A 
Diarrhoea
Abdominal pain
Weight loss
Lethargy
Nausea
54
Q

Name some complications of Crohn’s disease:

A
  • Fistula formation
  • Stricture formation
  • Perforation
  • Increased risk of colon cancer
  • Anal lesions
55
Q

Define fistulae:

A

Abnormal connection between 2 epithelial-lined organs

56
Q

Define stricture:

A

Narrowing or tightening of a hollow tube

57
Q

Describe the microscopic appearance of Crohn’s disease:

A
  • smooth muscle hypertrophy
  • loss of crypt architecture
  • ulcer formation
  • often transmural inflammation
  • discontinuous inflammation
  • often granulomas present
58
Q

Define granuloma:

A

Mass of granulation tissue formed by epithelioid histocytes, usually surrounded by lymphocytes
- Often in response to infection, inflammation, or foreign bodies

59
Q

Define Granulation tissue:

A

New connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process

60
Q

What is Chronic cholecystitis?

A

Continuous or repeated swelling and irritation of gallbladder

61
Q

What is the most common cause of chronic cholecystitis?

A

Gallstones

62
Q

What is the name given to a chronically inflamed gallbladder?

A

Chronic cholecystitis

63
Q

What commonly causes chronic gastritis?

A
  • Helicobacter pylori infection
  • Autoimmune conditions
  • Chronic intake of NSAIDs/ Aspirin
  • Biliary reflux
64
Q

What cell type infiltration is seen in chronic gastritis?

A
  • Plasma cell

- Lymphocyte

65
Q

Name the complications of Chronic gastritis caused by Helicobacter pylori:

A
  • Peptic ulcers
  • Increased risk of gastric cancer
  • Increased risk of MALT lymphoma
66
Q

What is pernicious anaemia?

A

Lack of red blood cells due to vitamin B12 deficiency

67
Q

How can chronic gastritis cause pernicious anaemia?

A

Chronic gastritis causes muscle atrophy and loss of gastric cells. These usually produce intrinsic factor, which allows the body to absorb vitamin B12 in the intestine.

68
Q

List some causes of Cirrhosis:

A
  • Alcoholic Liver Disease
  • Hepatitis B
  • Hepatitis C
  • Autoimmune
  • Biliary cirrhosis
  • Haemochromatosis
  • Granulomatous disease
69
Q

Describe the histological appearance of Cirrhosis:

A
  • Regenerative nodules of hepatocytes

- Surrounded by fibrous connective tissue/collagen

70
Q

Why might a blood test be performed when cirrhosis/liver disease is suspected?

A

Alanine aminotransferase and Aspartate aminotransferase are liver function enzymes which are usually raised in liver disease.
Alkaline Phosphatase is also synthesised in the liver, and is raised in liver disease.

71
Q

What are the 2 types of granulomas?

A

1- Foreign body

2- Immune/hypersensitivity

72
Q

What types of cell does a foreign body granuloma contain?

A
  • Epithelioid histocytes
  • Foreign body giant cells
  • Macrophages
  • Fibroblasts
73
Q

What type of cell does a hypersensitivity/immune granuloma contain?

A
  • Epithelioid histocytes
  • Macrophages
  • Giant cells
  • Fibroblasts
  • Lymphocytes
74
Q

Which type of granuloma does not contain lymphocytes?

A

Foreign body granulomas

75
Q

Which type of granuloma is seen in a tuberculosis infection?

A

Hypersensitivity/Immune granuloma

76
Q

Which type of granuloma is caused by silica?

A

Foreign body granuloma

77
Q

What causes Tuberculosis?

A

Mycobacterium tuberculosis infection

78
Q

How does M. tuberculosis gain entry to the body?

A

Inhaled into alveoli

79
Q

What cell type first engulfs a M.tuberculosis bacterium?

A

Macrophage

80
Q

What stimulates the formation of a granuloma after M.tuberculosis has gained entry to host?

A
  • Dendritic cell engulfs bacteria and breaks into antigens, which are presented to T-cells in lymph nodes
  • Activated T-cell stimulates granuloma formation
81
Q

Describe the granuloma formed in response to an infection with M.tuberculosis:

A

Hypersensitivity/Immune granuloma:

  • Infected macrophages (center of caseous necrosis)
  • Surrounded by foamy macrophages
  • Surrounded by macrophages
  • Surrounded by T-lymphocytes
  • Surrounded by fibrous shell (formed by fibroblasts)
82
Q

What is Latent Tuberculosis Infection?

A

Infection with M. tuberculosis, but not active disease as bacteria are contained within granulomas.

83
Q

What type of necrosis may be seen within granulomas formed due to TB infection?

A

Caseous necrosis

84
Q

What is a Ghon complex?

A

Subpleural lesion of caseous necrosis and infected hilar lymph nodes, seen with primary tuberculosis infection (particularly in children)

85
Q

Where are hilar lymph nodes?

A

Located where the lungs meet the bronchi

86
Q

Describe military tuberculosis:

A

Tuberculosis infection spreads to other organs via blood with ‘millet seed-like’ granulomas

87
Q

What is Potts disease?

A

Spinal tuberculosis which causes progressive bone destruction

88
Q

What is the name of a tuberculosis infection that has spread to the spine?

A

Potts disease

89
Q

What area of the spine is usually infected with tuberculosis?

A

Thoraco-lumbar region

90
Q

What name is given to a tuberculosis infection which has spread to the cervical lymph nodes?

91
Q

What is Scrofula?

A

Tuberculosis infection which has spread to the cervical lymph nodes

92
Q

What are some common symptoms of tuberculosis?

A
  • Severe Cough (may have bloody sputum)
  • Fever
  • Night sweats
  • Fatigue
93
Q

What is a Ranke complex?

A

A healed and calcified peripheral lung lesion (due to TB infection), with a calcified lymph node

94
Q

What is the most common test for a Latent Tuberculosis Infection?

A

Mantoux skin test

95
Q

What is the use of a Mantoux skin test?

A

Allows testing for Latent Tuberculosis Infection

96
Q

What is a positive Mantoux test characterised by?

A

Skin becomes raised and red after test

97
Q

What stain is used to visualise cultured M.tuberculosis?

A

Acid-Fast stain
- Ziehl-Nielsson
- Auramine-Rhodamine
etc

98
Q

How could you test a sputum sample for M.tuberculosis?

A

Culture the bacteria and stain using an acid-fast stain ie Ziehl-Nielsson

99
Q

What can cause Leprosy?

A
  • Mycobacterium leprae

- Mycobacterium lepromatosis

100
Q

What is Leprosy?

A

Chronic granulomatous infection

  • Poorly-pigmented skin lesions
  • Diseased peripheral nerves = damaged skin/eyes/limbs
  • Shortened fingers/toes as cartilage is reabsorbed by the body
101
Q

In what part of the world is Leprosy most commonly seen?

A

Tropical Africa and Asia

102
Q

What are the signs/symptoms of Leprosy?

A
  • Poorly-pigmented skin lesions
  • Diseased peripheral nerves = damaged skin/eyes/limbs
  • Shortened fingers/toes as cartilage is reabsorbed by the body
103
Q

What bacterium causes Syphilis?

A

Treponema pallidum

104
Q

How may someone be infected with Treponema pallidum, and what disease will this cause?

A

May be inherited (congenital) or spread as an STI

Syphilis

105
Q

What is the 1st stage of Syphilis?

A

Painless infectious sores develop where the bacteria entered the body

106
Q

What is the 2nd stage of Syphilis?

A 
Non-itchy rash (may be patchy or cover body)
Patchy hair loss
Fatigue
Anorexia
Malaise
107
Q

What is Sarcoidosis and where does it commonly affect the body?

A

Chronic granulomatous disease commonly affecting lungs and skin

108
Q

What is Wegener’s granulomatosis? (also called granulomatosis with polyangiitis)

A

Vasculitis: Inflamed, constricted blood vessels and granuloma formation

ESA2 (27 decks)

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