MOD 7 - Chronic Inflammation

Question 1

what is inflammation

Answer 1

a protective response involving host cells, blood vessels and proteins

Question 2

what is the purpose of inflammation?

Answer 2

remove the cause of injury, remove necrosis, initiate repair

Question 3

what is the difference in cellular response in acute and chronic inflammation

Answer 3

acute - neutrophils, chronic - lymphocytes, plasma cells and macrophages

Question 4

is granulation & scar tissue more abundant in acute or chronic inflammation ?

Answer 4

acute inflammation

Question 5

what is the common cause of primary chronic inflammation?

Answer 5

sequential from acute inflammation

Question 6

what are the 5 common causes for primary chronic inflammation?

Answer 6

infections, primary granulomatous diseases, endogenous materials (have an internal origin eg necrotic adipose tissue) , autoimmune, exogenous materials (external origin, asbestos fibres, suture)

Question 7

what is the most common outcome for acute inflammation?

Answer 7

supporative acute inflammation

Question 8

what is suppurative acute inflammation?

Answer 8

it is pus forming acute inflammation

Question 9

what happen if the suppurative acute inflammation goes deep enough in the tissue?

Answer 9

it will cause the wall of tissue to thicken and then it will be filled with granulomas and fibrous tissue

Question 10

what happen after recurrent acute inflammation?

Answer 10

it will then become chronic inflammation

Question 11

what is the main cellular morphological features of chronic inflammation?

Answer 11

chronic inflammation will have infiltration of mononuclear cells (macrophages, lymphocytes, plasma cells) along with tissue destruction and healing by fibrosis

Question 12

what is granulation tissue?

Answer 12

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

Question 13

what will granulation tissue form in the later stage of chronic inflammation?

Answer 13

production of new fibrosis tissue

Question 14

what are the 2 types of lymphocytes in chronic inflammation ?

Answer 14

B & T lymphocytes

Question 15

which B & T lymphocytes produce cytokines?

Answer 15

T does

Question 16

what does cytokines d o in chronic inflammation?

Answer 16

• attract macrophages leading to activation and so phagocytoseis
• attract neurophils (chemotaxis) and factor eg histamine that increase vascular permeability - like in acute inflammation
• cause perforins - kill invading cells by causing perforation on invading cells
• produce interferons that activate natural killer cells and macrophages - useful for attacking viruses

Question 17

what does macrophages do in chronic inflammation?

Answer 17

increase inflammation, stimulate immune system, carry out recruitment via cytokines

Question 18

what happen next after macrophages send out cytokines for recruitment?

Answer 18

monocytes are attracted and enter damaged tissue from blood vessel (this is recruitment)

Question 19

what do macrophages do local in the damaged tissue?

Answer 19

they release cytokines, proliferate and become immobilised within tissue

Question 20

what is granulation tissue?

Answer 20

new connective tissue and blood vessels

Question 21

what is the process of would healing

Answer 21

by forming granulation tissue which grows from the base of the wound upward - angiogenesis is required for the continuation of cells to be delivered, fibroblasts deposit collagen - repair by replacing with fibrosis, inflammatory cells - needed for healing process

Question 22

what is the main aim of wound healing in chronic inflammation?

Answer 22

repair by replacement of injured tissue by fibrosis tissues

Question 23

what is fibrosis?

Answer 23

formation of excess fibrosu connective tissue during repair of damaged tissue

Question 24

what is the name given for fibrosis raised from 1 cell line?

Answer 24

fibroma - 1 cell line of fibrosis tissue

Question 25

what is the role of macrophages in fibrosis?

Answer 25

macrophage induced laying down of connective tissue inc collagen

Question 26

what is a granuloma

Answer 26

a granuloma = nodule of epithelioid histiocytes & other cells eg lymphocytes & histiocytice giant cells

Question 27

what are epithelioid histiocytes?

Answer 27

they are large vesicular nuclei and eosinophilic cytoplasm (eosinophilic stain pink or purple)

Question 28

what are histiocytic giant cells

Answer 28

they are cells which are formed when materials is indigestible to macrophages eg tubercle bacilli (have cell walls resistance to macrophages), histiocytic giant cells are multinucleate giant cells

Question 29

what are macrophages known as while in tissue?

Answer 29

histiocytes

Question 30

what are some example for granulomatous inflammation?

Answer 30

Bacterial = TB, leprosy Parasitic = schistosomiasis (worm lives in fresh water in tropical area) Fungal = cryptococcus (hidden sphere in greek) Synthetic materials = silicosis Unknown = Sarcoidosis (granuloma develop in the organs of the body. It usually affects the lungs and skin), crohn’s disease.

Question 31

outline the layers of early granuloma

Answer 31

macrophages - lymphocytes

Question 32

outline layer of non-caseous epithelioid granuloma

Answer 32

macrophages (Langhans-type giant cells present) - lymphocytes & plasm cells - fibroblasts producing collagens

Question 33

outline the layers of caseous epithelioid granuloma

Answer 33

caseous necrosis - macrophage (Langhans-type giant cells present) - lymphocytes & plasm cells - fibroblasts producing collagen

Question 34

what particular condition does chronic inflammation involved in cardiovascular system

Answer 34

myocardial fibrosis (post MI), formation of atheroma

Question 35

how is atheroma formed?

Answer 35

macrophages adhere to epithelium and recruit other cells process lipids that accumulate in plaques

Question 36

what are the clinical outcome of chronic inflammation

Answer 36

persistence of infection, prolonged exposure to toxic agents, autoimmune disease

Question 37

an example of persistent of infection due to chronic inflammation?

Answer 37

H.Polyri - produces proteases - damage intestinal lining - gastritis - loss of protective layer, enzymes can access stomach wall and cause perforation. (life threatening)

Question 38

An example of what happens in prolonged exposure to toxic agents due to chronic inflammation

Answer 38

prolong exposure of toxic in liver can cause cirrhosis (macrophages cause fibrosis)

Question 39

an example of what happens in autoimmune disease due to chronic inflammation

Answer 39

rheumatoid arthritis