MoD 4 Chronic inflammation Flashcards
How may chronic inflammation arise?
May ‘take over’ from acute inflammation
May arise de novo
May develop alongside acute inflammation in sever, persistent or repeated irritation
When may chronic inflammation arise de novo?
Some autoimmune conditions e.g RA
Some chronic infections e.g viral hepatitis
“Chronic low level irritation”
What is chronic inflammation?
Chronic response to injury with associated fibrosis
List the effects of chronic inflammation
fibrosis-e.g gall bladder(chronic cholecystitis), chronic peptic ulcers, cirrhosis
impaired function e.g chronic inflammatory bowel disease
atrophy-gastric mucosa, adrenal glands
Stimulation of immune response- macrophage-lymphocyte interactions
What is the function of macrophages?
In both acute and chronic inflammation
various levels of activation
phagocytosis and destruction of debris and bacteria
processing and presentation of antigen to immune system
synthesis of cytokines, complement components, clotting factors and proteases
control of other cells via cytokine release
What is the function of lymphocytes?
complex mainly immunological B lymphocytes (plasma cells) differentiate to produce antibodies T lymphocytes involved in control (CD4+) and some cytotoxic (CD8+) functions
What are lymphocytes sometimes called?
chronic inflammatory cells
What are the functions or eosinophils?
Allergic reactions
Parasite infections
Some tumours
What is the function of fibroblasts/myofibroblasts?
Recruited by macrophages, make collagen
What are giant cells?
Multinucleate cells made by fusion of macrophages through frustrated phagocytosis
What are the three main types of giant cells and when do they occur?
Langhans-TB
Foreign body type
Touton- fat necrosis
What is chronic cholecystitis?
Repeated obstruction of gallbladder with gallstones. Repeated acute inflammation leads to chronic inflammation and fibrosis of the gall bladder wall
How is chronic cholecystitis treated?
Surgical removal of the gall bladder
What is gastric ulceration (fibrosis)?
Acute caused by alcohol, drugs
Chronic caused by helicobacter
Ulceration occurs due to imbalance between acid production and mucosal defence
How is gastric ulceration treated?
PPI inhibitor-e.g omeprazole
2 antibiotics-e.g clarithromycin/amoxicillin
What do patients with inflammatory bowel disease present with?
diarhhoea, rectal bleeding and other symptoms
What does ulcerative colitis present with and hows it treated?
Superficial
Diarrhoea
Bleeding
Treat with immunosuppression, surgical removal of large bowel (colectomy)
What does Crohn’s disease present with and how is it treated?
Transmural
Strictures
Fistulae
Treat with lifestyle modifications, diet/ hydration, immunosuppression
What are fistulae?
abnormal connections between two epithelia
What is liver cirrhosis?
Chronic inflammation with fibrosis leading to disorganisation of architecture and attempted regeneration
What are common causes of liver cirrhosis?
Alcohol Infection with HBV/HCV Immunological Fatty liver disease Drugs and toxins
How is liver cirrhosis treated?
Cannot be reversed, lifestyle changes to prevent further damage, and transplantation of a new liver if necessary
What disease causes increased function thyrotoxicosis?
grave’s disease
What is rheumatoid arthritis?
Autoimmune disease with localised and systemic immune response
Localised chronic inflammation leads to joint destruction
The sytemic immune response can affect other organs causing amyloidosis
When do granulomas form?
When the immune system walls off something its unable to eliminate e.g bacteria, fungi, other foreign material. Arise with persistent, low grade antigenic stimulation and hypersensitivity.
What are the main causes of granulomatous inflammation?
MIldly irritant foreign material Infections: Mycobacteria- TB, leprosy Syphilis Some fungi Unknown causes: Sarcoid Wegener's granulomatosis Crohn's disease
How does TB cause disease?
Produces no toxins of lytic enzymes but causes disease by persistence and induction of cell-mediated immmunity
What are the outcomes of TB?
Arrest, fibrosis, scarring Erosion into bronchus Tuberculous emphysema (collection of pus) Erosion into bloodstream
What is a granuloma?
Epithelioid histiocyte core (modified immobile macrophages) surrounded by lymphocytes
