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FMS Week 8 (also some 7) Immunology > Pathology of Chronic Inflammation > Flashcards

Pathology of Chronic Inflammation Flashcards

1
Q

Outsomes of acute inflammation

A

resolution

healing by fibrosis

CHRONIC INFLAMMATION

Note that whith chronic injury we might see angiogenesis rather than vasodilation

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2
Q

Causes of chronic inflammation

A

Persistant infections ( organisms difficult to eradicate. Ex TB, fungal infections, parasites)

Prolonged exposure to toxic agents

neurodegenerative diseases (ex alzheimers)

Metabolic syndome (ex NIDDM)

Cancer

cardiovascular diseases

hypersensativity diseases

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3
Q
A

Normal lung. On the mid right side you can see that there is simple squamous through which there is gas exchange in alveolar space

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4
Q
A

Necrotic TB lung

You can see on the R side there are areas of necrosis

You can also see epithelioid macrophages

No alveolar spaces means that you can not have gas exchange

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5
Q
A

Up close of TB lung

You can see the necrosis on the R
this is caseous necrosis

You also see some macrophages

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6
Q

Granulomatous inflammation in tuberculosis is characterized by collection of cells that are often activated by

Macrophages

T lymphocytes

B lymphocytes

Neutrophils

Eosinophils

A

T lymphocytes

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7
Q

Cells in chronic inflammation

A

Stimulates macrophages -> leads to granulomatous infection

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8
Q

Persistent infections

A

Immune granulomas are caused when the inciting agent is difficult to eradicate, such as a persistent microbe or self antigen

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9
Q

Sarcoidosis

A

systematic granulomatous disease of unknown cause that may involve many different tissues and organs

prolonged chronic inflammation leads to fibrosis of the pulmonary interstitium

bilateral hilar lymphadenopathy or lung involvement is most common occuring 90% of cases

Disordered immune regulation in genetically predisposes individuals

involved tissues contain well formed nonnecrotizing granulomas

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10
Q
A

Sarcoidosis

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11
Q
A

Sarcoidosis lung. You can see that this is really different. The dark purple cells are lymphocytes

Notice the circle of cells in the top R corner. This is a langhans. Bunch of cells fused together commonly found in granulomatous conditions

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12
Q
A

Sarcoidosis lung

note that there is a lot of fibrosis and lots of inflammation

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13
Q

Cells most commonly associated with chronic inflammation

macrophages

neutrophils

eosinophils

mast cells

basophils

A

MACROPHAGES

neutrophils primarily seen in active inflammation

eosinophils primarily seen in allergic reactions

Mast cells most commonly seen in allergies and anaphylaxis

basophils seen same as mast cells

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14
Q
A

Macrophage effector function

In circulatino macrophages are monocytes

in tissues macrophages are macrophages

Some macrophages are resident (liver, lung)

two pathways for macrophage

M1 pathway/ classical activaiton of macrophages
microbes and cytokine (INF gamma) stimulates this
mainly involved in inflammation and tissue injury

M2/ alternative pathway of macrophage activation
IL4 and other cytokines do this
mainly involved in repair

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15
Q

What stimulates M1 (classical) macrophage activation

A

microbes

cytokines (INF gamma)

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16
Q

What stimulates M2 (alternative) macrophage activation pathway

A

IL-4

other cytokines

17
Q

Hypersensativity diseases

A

excessive and inappropriate activation of the immune system

immune reactions develop against the individuals own tissues, leading to autoimmune diseases

immune responses against common environmental substances are the cause of allergic diseases, such as bronchial asthma

reactions serve no useful purpose and only cause disease

18
Q

Crohn’s disease

A

unknown pathogenesis but probably involves a combination of environmental factors, abnormalities in immune regulation, and a genetic predisposition

segmental disease involving a variable extent of the colonic mucosa and wall

cancer risk correlates poitively with diease duration and the anatomic extent of the inflammatory provess

( if you can not control this you have a higher risk for cancer)

19
Q
A

Normal colon.

You can see that this looks similar to glandular

Small purple nuclei line the apical cytoplasm

Seccretes mucin

20
Q
A

Abnormal colon. Associated with IBD.

Colonic ctypt architecture destroyed

neuclei are enlarged/ reactive

TONS of inflammatory cells in here

21
Q
A

Colorectal adenocarcinoma

Looks like the glands are shaped irregularly

22
Q
A

IBD associated colorectal cancer

you can see on the bottom part of the pic that the glands have invaded the muscularis

23
Q

The most likely process cancer arises in the setting of chronic inflammation

increase DNA repair

increase apoptosis

decrease cell proliferation

increase DNA damage

A

INCREASE IN DNA DAMAGE

24
Q

Ulcerative colitis and crohn’s dz

A

Inflammatory bowel disease

persistent immune response to normal flora

activated macrophages and CD4+ T cells secrete cytokines, prostaglandins, leukotrienes, NO

characterized by diarrhea, rectal bleeding, and weight loss

Increased risk for colorectal cancer

25
Q
A

Notice that inflammation can cause release of free radicals and cytokines

these can both turn on NF-kB and activate Cox-2

There both inhibit apoptosis and lead to cell proliferation

26
Q
A

Foreign body granuloma

you can see that there is fibrosis and that there are macrophages around these white structures

turns out that the white structures are foreign body (in this case suture material from carpel tunnel surgery)
some of the macrophages on bottom R are multinucleated

27
Q

Foreign body granuloma

A

biologic response to relatively inert foreign bodies

in the absence of T cell-mediated immune responses, it is macrophage mediated

granulomas form around material such as talc, sutures, implants, or other fibers that are large enough to preculde phagocytosis by a macrophage

there materials do not incite any specific inflammation of immune response

28
Q

Granulomatous inflammation in this case (suture foreign body material) is characterized by collection of cells that are often activated by

macrophages

T lymphocytes

B lymphocytes

Neutrphils

none of the above

A

MACROPHAGES

29
Q

Atheroslerosis

A

fatty streak formation- contains lipid filled macrophages (foam cells) and activated T cells

fibrous cap- advanced stage to wall off lesion

endothelial damage

plaque rupture- material inside plaque released, thrombosis occurs

treated by statins- decrease leukocyte adhesion and NO, inhibits cholesterol synthesis

30
Q
A

Aorta

31
Q
A

Smooth muscle wall of the aorta

32
Q

Aneurysm

A

localized abdominal dilation of a blood vessel

33
Q
A

abdominal aortic aneurysm

34
Q

This form (AAA from atherosclerosis) is through to arise from

prolonged exposure to potentially toxic agents

persistant infections

hypersensativity diseases

metabolic syndrome

A

Prolonged exposure to potentially toxic agents

FMS Week 8 (also some 7) Immunology (9 decks)

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