Path - Inflammation (Inflammation, Chromatolysis, Calcification, & Leukocyte extravasation)

Question 1

What are the 5 main findings/factors that characterize inflammation?

Answer 1

Characterized by (1) Rubor (redness) (2) Dolor (pain) (3) Calor (heat) (4) Tumor (swelling) (5) Functio laesa (loss of function)

Question 2

What does the vascular component of inflammation include?

Answer 2

Increased vascular permeability, vasodilation, endothelial injury

Question 3

In general, what cells and processes does the cellular component of inflammation involve?

Answer 3

Neutrophils extravasate from circulation to injured tissue to participate in inflammation through phagocytosis, degranulation, and inflammatory mediator release

Question 4

What are the 3 mediators of acute inflammation?

Answer 4

Neutrophil, eosinophil, and antibody mediated

Question 5

What are the 2 mediators of chronic inflammation?

Answer 5

Mononuclear cell and fibroblast mediated

Question 6

What is the onset and time course of acute inflammation?

Answer 6

Acute inflammation is rapid onset (seconds to minutes), lasts minutes to days.

Question 7

What are 3 potential outcomes of acute inflammation?

Answer 7

Outcomes include complete resolution, abscess formation, and progression to chronic inflammation

Question 8

What 2 events/processes characterize chronic inflammation?

Answer 8

Characterized by persistent destruction and repair

Question 9

With what 2 processes is chronic inflammation associated?

Answer 9

Associated with blood vessel proliferation, fibrosis

Question 10

With what type of inflammation does granuloma occur? What is a granuloma?

Answer 10

Chronic inflammation; Granuloma: nodular collections of epithelioid macrophages and giant cells

Question 11

What are 2 outcomes of chronic inflammation?

Answer 11

Outcomes include scarring and amyloidosis

Question 12

What is Chromatolysis?

Answer 12

Process involving the cell body following axonal injury

Question 13

What do the changes seen in Chromatolysis reflect, and why?

Answer 13

Changes reflect increased protein synthesis in effort to repair the damaged axon

Question 14

What are 3 histological characteristics of Chromatolysis?

Answer 14

Characterized by: (1) Round cellular swelling (2) Displacement of the nucleus to the periphery (3) Dispersion of Nissl substance throughout cytoplasm

Question 15

What are the types of calcification?

Answer 15

(1) Dystrophic calcification (2) Metastatic calcification

Question 16

What is dystrophic calcification, and what causes it?

Answer 16

Calcium deposition in tissues secondary to necrosis

Question 17

What is metastatic calcification, and what causes it?

Answer 17

Widespread (i.e., diffuse, metastatic) deposition of calcium in normal tissue secondary to hypercalcemia (e.g., primary hyperparathyroidism, sarcoidosis, hypervitaminosis D) or high calcium-phosphate product (e.g., chronic renal failure + secondary hyperparathyroidism, long-term dialysis, calciphylaxis, warfarin)

Question 18

Again, what are the causes of metastatic calcification? Give at least 3 examples of each.

Answer 18

(1) hypercalcemia (e.g., primary hyperparathyroidism, sarcoidosis, hypervitaminosis D) or (2) high calcium-phosphate product (e.g., chronic renal failure + secondary hyperparathyroidism, long-term dialysis, calciphylaxis, warfarin)

Question 19

What tends to be the extent of dystrophic calcification? Give an example.

Answer 19

Tends to be localized (e.g., on heart valves)

Question 20

What are 9 conditions/findings in which dystrophic calcification is seen?

Answer 20

Seen in (1) TB (lungs and pericardium) (2) liquefactive necrosis of chronic abscesses (3) fat necrosis (4) infarcts (5) thrombi (6) schistosomiasis (7) Monckeberg arteriolosclerosis (8) congenital CMV + toxoplasmosis (9) psammoma bodies

Question 21

What are the calcium findings in patients with dystrophic calcification versus metastatic calcification?

Answer 21

DYSTROPHIC CALCIFICATION: It is not directly associated with hypercalcemia (i.e., patients are usually NORMOCALCEMIC); METASTATIC CALCIFICATION: Patients are usuallly NOT NORMALCALCEMIC.

Question 22

In metastatic calcification, in what tissues do calcium deposits predominate, and why?

Answer 22

Calcium deposits predominantly in interstitial tissues of kidney, lungs, and gastric mucosa (these tissues loose acid quickly; increased pH favors deposition).

Question 23

Where does leukocyte extravasation predominately occur?

Answer 23

Extravasation predominantly occurs at postcapillary venules

Question 24

Give the goal and big picture of Leukocyte extravasation without going into the details of each step.

Answer 24

Leukocytes exit from blood vessels at sites of tissue injury and inflammation in 4 steps: (1) Margination and rolling (2) Tight-binding (3) Diapedesis (4) Migration

Question 25

What factors mediate margination and rolling in the vasculature/stroma versus leukocyte? Give 3 binding options (with numbers indicating what on the vasculature/stroma binds what on the leukocyte).

Answer 25

VASCULATURE/STROMA: (1) E-selectin (2) P-selection (3) GlyCAM-1, CD34; LEUKOCYTE: (1) Sialyl-Lewis X (2) Sialyl-Lewis X (3) L-selectin

Question 26

What factors mediate tight-binding in the vasculature/stroma versus leukocyte? Give 2 binding options (with numbers indicating what on the vasculature/stroma binds what on the leukocyte).

Answer 26

VASCULATURE/STROMA: (1) ICAM-1 (CD54) (2) V-CAM-1 (CD106); LEUKOCYTE: (1) CD11/18 integrins (LFA-1, Mac-1) (2) VLA-4 integrin

Question 27

What factor mediates diapedesis in the vasculature/stroma versus leukocyte?

Answer 27

VASCULATURE/STROMA: PECAM-1 (CD31); LEUKOCYTE: PECAM-1 (CD31) (i.e., same for both)

Question 28

What occurs during diapedesis?

Answer 28

Diapedesis - Leukocyte travels between endothelial cells and exists blood vessel

Question 29

What occurs during migration?

Answer 29

Migration - Leukocyte travels through interstitium to site of injury or infection guided by chemotactic signals

Question 30

In general, what are the vasculature/stroma mediators for leukocyte migration? In response to what are they released? Give 5 examples.

Answer 30

Chemotactic products released in response to bacteria: (1) C5a (2) IL-8 (3) LTB4 (4) kallikrein (5) platelet-activating factor

Question 31

What should you know about the leukocyte mediators of migration?

Answer 31

Various :-)

Question 32

Draw a visual depicting leukocyte extravasation, numbering the steps and labeling key mediators.

Answer 32

See p. 224 in First Aid 2014 for visual