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Pathology - Exam 1 > Overview of Inflammation > Flashcards

Overview of Inflammation Flashcards

1
Q

What are the major signs of inflammation?

A

Calor (heat)
Rubor (redness)
Tumor (swelling)
Dolor (pain)

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2
Q

Acute inflammtion

A

Lasts from hours to days

Characterized by exudation and neutrophil infiltration

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3
Q

Chronic inflammtion

A

Lasts days to years
Characterized by mononuclear inflammatory cell infiltration (lymphocytes, macrophages, plasma cells) with vascular proliferation and fibrosis in later stages

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4
Q

Fever stemming from inflammation is mediated by what?

A

IL-1
TNF
PGE2

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5
Q

Vasodilation of acute inflammation

A

Begins in the precapillary arterioles and results in engorgement of capillary beds
Accounts for the redness and localized heat of inflammation

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6
Q

What mediates the vascular changes associated with Acute inflammation

A

NO (endothelial derived) that induces vascular smooth muscle relaxation
Mast cell release of histamine
Prostaglandins

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7
Q

What maintains vasodilation associated with acute inflammation?

A

Prostaglandins (PGI2, PGD2, PGE3, PGF2)

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8
Q

What are the major vascular changes associated with acute inflammation?

A

Vasodilation

Increased vascular permeability

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9
Q

What two things can cause increased vascular permeability?

A

May be due to inflammatory mediators
OR
Direct injury to endothelial cells

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10
Q

Accumulation of fluid in the extravascular tissue leads to what?

A

Swelling (edema)

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11
Q

Transudate

A

Low protein content

Low specific gravity (

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12
Q

What are the two types of Transudate?

A

Inflammatory

Non-inflammatory

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13
Q

Inflammatory Transudate

A

Early endothelial contraction

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14
Q

Non-inflammatory Transudate

A

Intact endothelium

Some fluid can still escape - due to increased hydrostatic pressure and/or decreased serum oncotic pressure

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15
Q

Exudate

A

Indicative of tissue and endothelial cell damage
High protein content and specific gravity (>1.012)
Often contains inflammatory cells

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16
Q

What are the different types of exudate

A

Fibrinous exudate
Purulent exudate
Sanguineous

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17
Q

Fibrinous exudate

A

High protein (fibrin) content
Few cells
Cloudy

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18
Q

Purulent exudate

A

Pus
Contains cells (neutrophils)
Opaque

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19
Q

Sanguineous exudate

A

Pink to red fluid due to blood

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20
Q

Endothelial cell contraction

A

Forms intercellular gaps (mainly in postcapillary venules) due to reversible contraciton
This occurs rapidly and lasts for 15-30 min

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21
Q

What mediates endothelial cell contraction?

A

Early = Histamine and Bradykinin
Later = Leukotrines and PAF
C3a and C5a induce vasoactive amine release that leads to edema

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22
Q

Endothelial cell retraction

A

Delayed - takes 4-6 hrs to develop and lasts 24+ hours

Occurs due to the restructuring of cytoskeletal proteins

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23
Q

What mediates endothelial cell retraction?

A

IL-1
TNA
IFN-y

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24
Q

Direct venule endothelial injury

A

Can be immediate or delayed

May occur from neutrophilic release of ROS and lysozomal enzymes from inflammation, or injurious agent

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25
What are some factors that activate endothelial cells?
Infectious agents Hypoxia Inflammatory mediators
26
Activated endothelial cells are characterized by what?
Produce PGI2 and NO (vasodilation) Contraction/retraction Increase expression of adhesion molecules Increased synthesis of inflammatory mediators
27
What is the sequence of leukocyte events?
``` Margination Rolling Adhesion Emigration or transmigration Chemotaxis ```
28
Margination
Mechanical process due to slowing of blood flow RBCs flow in the middle of the vessel at a slightly faster rate Neutrophils are closer to the cell wall moving slower
29
Leukocyte rolling
Selectins mediate a weak, transient, sticking that slows the cells forward progression
30
What mediates leukocyte adhesion
Integrins - ICAM and VCAM on endothelial cells
31
What mediates leukocyte transmigration through vessel walls?
PECAM-1
32
Chemotaxis
A non-random movement of leukocytes to the site of injury along a concentration gradient of chemotactic factors Chemotactic factors bind to cell surface receptors These factors also stimulate leukocyte activation
33
What are some chemotactic factors?
``` C5a LTB4 PAF Cytokines Bacterial lipids and peptides FDP ```
34
What factors activate leukocytes during an inflammatory response?
``` Bacterial products Cellular debris Ab-Ag complexes Chemokines Cytokines Chemotactic factors ```
35
Activation of leukocytes is characterized by what?
Production of Leukotrines and Prostaglandins from Arachadonic Acid Degranulation and release of Lysozomal enzymes Production of ROS Synthesis and secretion of cytokines Altered expression of cell adhesion molecules
36
Phagocytosis steps
1) Attachment mediated by opsonins on targets and specific leukocyte receptors 2) Engulfment into a phagocytic vacuole 3) Lysozomal degranulation by fusion with the phagosome 4) Oxidative burst releasing ROS
37
What are some additional mechanisms of intracellular killing by Leukocytes?
Lysozyme Major basic protein Defensin Bactericidal permeability-increasing protein
38
What are the major cells involved in Acute Inflammation?
Neutrophils | Monocytes (Macrophages/Histocytes)
39
Neutrophils
Morphologic hallmark of acute inflammation Begin to accumulate within 6-24 hours Infiltrate tissue in response to tissue necrosis, bacterial, and some fungal infections Undergo apoptosis after phagocytosis and digestion Release ROS and lysozomal enzymes
40
Monocytes
Emigrate within 48 hours and replace PMNs Called histocytes, or macrophages after they enter the tissue Half-life is months in tissue as compared to one day for circulating phagocytes
41
What are some of the functions of activated Monocytes
Phagocytize and digest cellular debris and organisms | Take up and metabolize antigens and present membrane=bound antigen to immunocompetent T-cells
42
What are the different types of Inflammatory patterns?
Cellulitis Abscess Ulcer
43
What are some other Inflammatory cells?
Lymphocytes - immune function Eosinophils - allergic reactions and parasites Mast Cells - histamine
44
Cellulitis
Diffuse, permeative infiltration of neutrophils with edema into the tissues Firm, 'woody' feel
45
Abscess
Localized area of liquefactive necrosis or PMNs
46
Ulcer
Erosion of an epithelial surface, exposing underlying connective tissue
47
How does acute inflammation differ from chronic inflammation?
Acute inflammation takes 10-14 days, Chronic occurs from months-years Acute inflammation is innate, wheras chronic inflammation relies upon specific, adaptive immune system Both may be reversible or fatal
48
What are some potential causes for chronic inflammation?
Persistent infections Prolonged exposure to a toxic agent Immune-mediated inflammatory response
49
Non-specific chronic inflammation
Often associated with tissue repair (granulation tissue/fibrosis) The cellular infiltrate may contain macrophages, lymphocytes, plasma cells and/or eosinophils A few neutrophils may also be present
50
Degranulomatous Chronic Inflammation
Linked to the delayed-type IV hypersensitivity immune reaction
51
Histamine Source and function
``` Source = Mast cells Function = Vasodilation and increase vascular permeability ```
52
Bradykinin Source and function
``` Source = Plasma protein Function = Increase vascular permeability, pain ```
53
NO Source and function
``` Source = Endothelial cells Function = Vasodilation, tissue damage ```
54
Prostaglandins Source and function
``` Source = Membrane phospholipids Function = Vasodilation, pain, fever, potentiate other mediators ```
55
PAF Source and funciton
``` Source = Leukocytes, endothelial cells Function = Increase vascular permeability, chemotactic ```
56
Cytokines source and function
``` Source = Macrophages, endothelial cells Function = Endothelial cell and leukocyte activation, fever ```
57
Leukotrines C, D, E source and function
``` Source = Membrane phospholipids Function = Increase vascular permeability, vasoconstriction, bronchoconstriction ```
58
C5a and C3a source and funciton
``` Source = Plasma protein Funciton = Chemotaxis (C5a), Phagocytosis (C3b), Increase vascular permeability (both) ```
59
What are the different types of wound healing?
Labile Stable Permanent
60
What does Labile mean and what tissues do it?
Continuously dividing | Hematopoeitic cells and surface epithelium
61
What does stable mean (for wound healing), and what tissues do it?
``` Some replicative activity Parenchymal cells (liver), smooth muscle cells, fibroblasts ```
62
What does Permanent mean (for wound healing) and what tissues fall in this category?
Non-proliferative - replaced by scar tissue | Neurons and cardiac muscle
63
Healing by Primary Intention
1. Blood clot (minutes) 2. Neutrophils (within 24 hours) 3. Early proliferation/migration of epithelial cells (24-48 hrs) 4. Macrophages replace neutrophils; early granulation tissues (day 3) 5. Peak neurovasculature (day 5) 6. Progressive collagen deposition (2nd week) 7. Increased wound strength during next 4 months
64
Healing by Second Intention
More inflammation and granulation tissue | Wound contraction due to fibroblasts
65
What is the effect of GF on wound healing?
``` Epithelial proliferation Monocyte chemotaxis Fibroblast proliferation Angiogenesis Collagen synthesis ```
66
What factors affect wound healing?
``` Infection (this is the primary cause of delayed healing) Nutrition Steroids Mechanical factors Poor tissue perfusion ```

Pathology - Exam 1 (9 decks)

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