Session 3 Flashcards
What is chronic inflammation?
Chronic response to injury with associated fibrosis
How does chronic inflammation compare to acute inflammation?
It is more long term and more variable.
Acute inflammation is rapid and stereotyped.
In what 3 ways can chronic inflammation arise?
May ‘take over’ from acute inflammation
May arise de novo
May develop alongside acute inflammation
When may chronic inflammation take over from acute inflammation?
When damage is too severe to be resolved within a few days
When may chronic inflammation arise de novo? (3)
In some autoimmune conditions
In some chronic infections
Chronic low-level irritation
Give an example of an autoimmune condition and chronic infection that can result in chronic inflammation?
Rheumatoid arthritis
Viral hepatitis
When may chronic inflammation develop alongside acute inflammation?
In severe, persistent or repeated infection
What sort of appearance does chronic inflammation take under a microscope?
A much more variable appearance - the most important characteristic is they type of cells present
Name some cells of chronic inflammation (6)
Macrophages Lymphocytes Plasma cells Eosinophils Fibroblasts Giant cells
Macrophages are derived from __________ and are important in which types of inflammation?
Monocytes in the blood
Both acute and chronic
Name 4 functions of macrophages in chronic inflammation
Phagocytosis
Antigen presentation
Cytokine synthesis
Cytokine release to control other cells
Macrophages often present with what sort of nucleus under a microscope?
Bean shaped nucleus
What are the functions of B lymphocytes?
Differentiate into plasma cells to produce antibodies
What are the function of T lymphocytes?
Involved in control of the immune response and some cytotoxic function
T lymphocytes are produced in the _________ _________ and mature in the _________
Bone marrow
Thymus
How do lymphocytes appear under a microscope?
With a large blue nucleus and little cytoplasm
What are plasma cells? What does their presence in a blood film in chronic inflammation imply?
Differentiated antibody producing B lymphocytes
Implies considerable chronicity
How do plasma cells appear under a microscope?
With an open nucleus and visible pink cytoplasm
Can see abundant golgi (pale areas) due to synthesis of antibodies
Eosinophils are seen in… (3)
Allergic reactions, parasite infections and some tumours
How do eosinophils appear under the microscope?
With a pink cytoplasm and bilobe nucleus (sunburnt face with glasses)
Fibroblasts/Myofibroblasts are recruited by _____________ and secrete ___________
Macrophages
Collagen
What are giant cells? How are they formed?
Multinucleate cells made by the fusion of macrophages
As a result of frustrated phagocytosis
Name three types of giant cell
Langhans
Foreign Body Type
Touton
In which disease are Langhans giant cells commonly seen?
TB
In which disease are Touton giant cells commonly seen?
Fat necrosis
How do Langhans giant cells appear under a microscope?
As a horse shoe of nuclei around the periphery of foreign body
How do foreign body type giant cells appear under a microscope?
More disorganised/irregular compared to Langhans giant cells with foreign body seen in the centre
How do Touton giant cells appear under a microscope?
As cells with a foamy cytoplasm that accumulates fat
Cells found in most chronic inflammatory reactions are _____________ about the condition
Non-specific
How can the cells seen in chronic inflammation indicate the condition that the patient has?
Proportions of each chronic inflammation cell type often vary in certain conditions
Name a condition where mainly plasma cells are seen as a chronic inflammatory response?
Mainly lymphocytes?
Mainly macrophages?
Rheumatoid arthritis
Chronic gastritis
Leishmaniasis
Leishmaniasis is caused by which type of microorganism?
Protozoa
Name 4 effects of chronic inflammation
Fibrosis
Impaired function
Atrophy
Stimulation of immune response
How does fibrosis vary in chronic inflammation?
Has different effects depending on where it occurs
Give an example of a condition where there is impaired function as a result of chronic inflammation?
Increased function?
Chronic inflammatory bowel disease
Very rare - thyroid
What is atrophy?
Give an example of tissues that can undergo atrophy as a result of chronic inflammation?
Reduction in tissue size
Gastric mucosa
Adrenal glands
What causes chronic cholecystitis?
Repeated obstruction of gall bladder by gall stones. Repeated acute inflammation (damaged mucosa) leads to chronic inflammation.
What is the effect of chronic cholecystitis on the gall bladder?
Results in a thickened fibrotic gall bladder wall
What is the normal appearance of a healthy gall bladder?
Should be nearly translucent
Inflammatory bowel disease is an inflammatory disease affecting…
Both the large and small bowel
What sort of inflammation takes place in inflammatory bowel disease?
Repeated attacks of chronic and cute inflammation together
Name two symptoms of inflammatory bowel disease
Diarrhoea
Rectal bleeding
Inflammatory bowel disease is an umbrella term including which two conditions?
Ulcerative Colitis
Crohn’s disease
Name the basic difference between ulcerative colitis and Crohn’s disease
Ulcerative colitis is superficial - inflammation affects the mucosa
Crohn’s is transmural - inflammation affects deeper layers such as submucosa
Name two symptoms of UC and Crohn’s
Name two consequences of inflammatory bowel disease that are more associated with specifically Crohn’s
Diarrhoea
Rectal bleeding
Strictures
Fistulae
What is a stricture?
What is a fistulae?
A narrowing of a structure
Abnormal connection between two epithelium lined organs
Name 4 common causes of liver cirrhosis?
Alcohol
Fatty liver disease
HBV
HCV
Cirrhosis happens at the end stage of…
Chronic liver disease
What are the consequences of cirrhosis?
Lots of fibrosis and impaired liver function
Graves’ disease results in _________ thyroid function as a result of ___________ inflammation.
What type of disease is Graves’?
What effect does the change in thyroid function have on the thyroid?
Increased
Chronic
Autoimmune
Too much thyroxin is produced
How does chronic inflammation lead to atrophy?
Damages cells resulting in scarring, the inability to regenerate results in atrophy
What is granulomatous inflammation?
Chronic inflammation with granulomas
What are granulomas?
Groups of macrophages and lymphocytes that stick together
Granulomas arise with… (2)
Persistent, low-grade antigenic stimulation
Hypersensitivity
Name three causes of granulomatous inflammation
Mildly irritant foreign material
Infections
Unknown cause (idiopathic)
Give two examples of infections where granulomatous inflammation is commonly seen
TB
Leprosy
Give examples of two diseases where granulomatous inflammation may arise idiopathically with unknown cause
Sarcoidosis
Crohn’s disease
Which microorganism causes tuberculosis?
Mycobacteria - commonly Mycobacterium tuberculosis
Which type of necrosis is commonly seen in tuberculosis?
Caseous necrosis
Are mycobacteria easily cultured?
No, difficult and slow to culture and see
Why is it difficult for mycobacteria to be killed by phagocytosis?
Mycosides (wall lipids) protect against phagocytosis
What are mycosides?
Wall lipids found in mycobacteria
How does mycobacteria cause disease?
What toxins are produced by mycobacteria?
By persistence and induction of cell-mediated immunity
Doesn’t produce any toxins or lytic enzymes
What is the most common site for tuberculosis?
In the lungs, pathogens inhaled
Name 3 things you are likely to see under a microscope in tuberculosis
Langhans giant cells
Caseous necrosis
Granulomas
