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YEAR 1 MED > Pathology 5: acute inflammation and the complement system > Flashcards

Pathology 5: acute inflammation and the complement system Flashcards

1
Q

What are the 5 cardinal features of acute inflammation?

A
  • Calor (Heat).
  • Rubor (Redness).
  • Tumor (Swelling).
  • Dolor (Pain).
  • Functio Laesa (Loss of Function).
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2
Q

Name 3 cell types which act as sentinel cells in tissues ready to react to invading microorganisms or to cell damage.

A
  • Macrophages.
  • Dendritic cells.
  • Mast cells.
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3
Q

Describe the four changes that take place to facilitate the movement of cells of the immune system from the blood stream to the tissues, mentioning one important mediator for each

A
  • Vasodilation (mediated by histamine): increases blood flow
  • Margination (mediated by integrins): integrins are adhesins molecules which allow immune cells to adhere to the endothelium
  • Emigration (mediated by histamine, bradykinins, and leukotrienes): increased vascular permeability which allows movement of fluid and cells from the vessel into tissues
  • Chemotaxis (mediated by leukotrienes and cytokines): attracts cells to site where needed
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4
Q

What causes acute inflammation? why does it happen? which cell characterises acute inflammation?

A
  • Necrosis (DAMPS) or infection (PAMPS/MAMPS)
  • to allow inflammatory cells + plasma proteins to escape from blood vessels + to enter the interstitium to remove dead cells or microbes
  • neutrophils
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5
Q

What is the main cytokine produced by sentinel cells when they are activated by DAMPs and PAMPs?

A

Interleukin 1 (IL-1).

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6
Q

List the 5 steps of acute inflammation (the 5 R’s)

A

Recognition (of the injurious agent).
Recruitment (of leucocytes).
Removal (of the agent).
Regulation (of the response).
Resolution.

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7
Q

What is the difference between a cytokine and a chemokine?

A
  • Cytokines = proteins produced by many cell types that can mediate and regulate inflammatory reactions. Cyto means cell and kine refers to kinesis or movement
  • Chemokines = chemotactic cytokines. These are produced as a chemical cloud which spreads out from the source of inflammation and can attract specific white blood cells.
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8
Q

List the 5 important mediators of acute inflammation.

A

Hageman factor (Factor XII).
The complement system.
Mast cells.
Arachidonic acid metabolites.
Toll-like receptors.

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9
Q

What is the Hageman Factor?

A
  • a factor produced by the liver as an inactive protein
  • It circulates in the blood stream until it is activated by exposure to collagen.
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10
Q

What is the link between the clotting system and the inflammatory system?

A

Hageman factor activates the coagulation cascade and also activates the kinin system.

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11
Q

What are the 3 main functions of bradykinin?

A

Vasodilation.
Increased vascular permeability.
Pain.

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12
Q

What is the Complement System?

A

A system of pro-inflammatory proteins produced by the liver which circulate as inactive precursors until they are activated by 1 of 3 pathways.

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13
Q

List 3 ways in which mast cells can be activated

A

Tissue trauma.
Complement components C3a and C5a.
Cross-linking of IgE bound to the mast cell surface by antigen.

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14
Q

Describe the consequences of mast cell activation

A

Mast cells contain pre-formed histamine granules which can be quickly released causing blood vessels to dilate and to leak. Mast cells also cause a delayed response by producing leukotrienes.

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15
Q

What enzyme is required to generate arachidonic acid from membrane phospholipids and what drug class can stop this reaction?

A

Phospholipase A2 and steroids

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16
Q

What enzymes are required to generate Prostaglandins from Arachidonic acid and name 2 drugs which can block these enzymes?

A

Cyclooxygenase 1+2 (COX 1+2) and Aspirin/Non-steroidal anti-inflammatory drugs

17
Q

What is produced when 5-lipooxygnease acts on Arachidonic acid?

A

Leukotrienes

18
Q

List 4 effects of prostaglandin production in the context of acute inflammation

A

Vasodilation.
Increased vascular permeability.
Pain (PGE2).
Fever (PGE2).

19
Q

List 4 mediators which can cause redness and heat (rubor and calor).

A

Histamine.
Prostaglandins.
Bradykinin.
Nitric oxide.

20
Q

What causes fever in the context of acute inflammation?

A

Pyrogens (eg. lipopolysaccharide) cause macrophages to release interleukin 1 (IL-1) and tumour necrosis factor (TNF) which increase COX activity in perivascular cells of the hypothalamus. This causes production of PGE2 which raises the temperature set point.

21
Q

What causes the swelling seen in acute inflammation?

A

Histamine (from mast cells) causes endothelial cells to contract and endothelial cells can also be disrupted. This results in leakage of fluid from post-capillary venules into the interstitial space.

22
Q

What is oedema?

A

An excess of fluid in the interstitial tissue or serous cavities. Can be an exudate (a fluid high in protein containing cell debris) or a transudate (a fluid low in protein).

23
Q

What is pus?

A
  • an inflammatory exudate rich in leucocytes (mostly neutrophils), the debris of dead cells and in many cases microbes
24
Q

What causes pain in the context of acute inflammation?

A

Bradykinin and PGE2 sensitise sensory nerve endings.

25
Q

Which inflammatory cell predominates in acute inflammation and which can be raised in a full blood count in the setting of acute inflammation, such as in the setting of an acute bacterial infection?

A

Neutrophil.

26
Q

Which cell dominates 3 days after acute inflammation begins?

A

Macrophage.

27
Q

How do macrophages kill organisms?

A

They ingest via phagocytosis helped by opsonins (C3b) and destroy phagocytosed material using enzymes (lysozyme) in secondary granules (Oxygen-independent killing).

28
Q

List the 4 possible outcomes to acute inflammation.

A

Resolution and healing (mediated by IL-10 and TGF-beta).
Continued acute inflammation (mediated by IL-8 with persistent pus production).
Abscess formation.
Chronic inflammation (macrophages present antigen to activate CD4+ helper T-cells).

29
Q

List two inflammatory cytokines that cause fever

A
  • TNF alpha
  • Interleukins (IL-1)
30
Q

Complement system quiz Q1…

A
31
Q

Complement system quiz Q2…

A
32
Q

Complement system quiz Q3…

A
33
Q

Complement system quiz Q4…

A

YEAR 1 MED (49 decks)

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