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Pathological Processes > Session 3 > Flashcards

Session 3 Flashcards

1
Q

What happens after acute inflammation? (3 things)

A
  1. Complete resolution
  2. Repair with connective tissue (FIBROSIS)
  3. Progression to chronic inflammation (inflammation with repair)
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2
Q

What is chronic inflammation?

A

Prolonged inflammation with associated repair

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3
Q

What are the features of chronic inflammation?

A
  • Delayed onset
  • Variable duration
  • Limits damage and initiates repair
  • Variable appearances
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4
Q

How does chronic inflammation arise?

A
  • Takes over from acute inflammation if acute is not enough to resolve it
  • Develops alongside acute inflammation
  • Arises ‘de novo’ without any preceding acute inflammation (autoimmune conditions)
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5
Q

Why are there no cardinal features of chronic inflammation?

A

There are a variety of cell types involved, which result in variable appearances

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6
Q

What are monocytes?

A

Cells that are in the circulation and then develop into macrophages when enter the tissue.

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7
Q

What are the features of macrophages?*

A
  • Foamy, bubbly cytoplasm (phagolysosomes that allow phagocytosis)
  • Some have a ‘slipper shaped’ nucleus
  • Irregular in appearance and can sometimes look like cancer cells
  • Large cells
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8
Q

What are the functions of macrophages?

A
  • Phagocytosis: removal of pathogens and presenting the antigen to stimulate adaptive immune response
  • Synthesis and release of inflammatory mediators that regulate the response
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9
Q

What are the features of lymphocytes?*

A
  • Smaller (slightly bigger than RBC)
  • Large, central, spherical, dark staining nucleus
  • Very little thin rim of cytoplasm, sometimes can’t be seen
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10
Q

What are the functions of T cells (lymphocytes)?

A

Helper: assists inflammatory cells (CD4)
Cytotoxic: destroys pathogens directly (CD8)

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11
Q

What are the functions of B cells (lymphocytes)?

A

Maturing into plasma cells that produce immunoglobulins/antibodies

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12
Q

How to distinguish between B cells and T cells?

A

Immunohistochemistry as they all look the same

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13
Q

What are the features of plasma cells?*

A
  • Bigger
  • Have more cytoplasm
  • Nucleus is ecentric: pushed to one side
  • Clockface chromatin pattern (clumped into spheres)
  • Perinuclear clearing (lighter patch near nucleus - part of golgi)
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14
Q

What are the features of eosinophils?*

A
  • Bilobed nucleus
  • Granular cytoplasm that stains bright red (due to chemical mediators, eg. histamine)
  • “tomato with sunglasses”
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15
Q

What are the functions of eosinophils?

A
  • Releasing chemical mediators (eg. prostaglandin, histamine, NO)
  • Hypersensitivity reactions
  • Parasitic infections
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16
Q

What are the functions of fibroblasts/myofibroblasts?

A
  • Repair

- Production and laying down collagen to reconstruct tissues

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17
Q

What are giant cells?*

A
  • Multinucleate cells with one giant cytoplasm

- Formed by fusion of several macrophages

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18
Q

Why do giant cells form?

A

‘Frustrated phagocytosis’ - clumping together to increase effectiveness of phagocytosis when resistant foreign bodies are present

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19
Q

What are foreign body giant cells?*

A
  • Random assortment of nuclei

- Destroy foreign bodies

20
Q

What are Langhans giant cells?*

A
  • Nuclei line up around periphery in crescent shape

- Important in TB

21
Q

What are Touton giant cells?*

A
  • Nuclei line up in the middle and form a circle

- Can be seen in fat necrosis

22
Q

What are the cells in rheumatoid arthritis?

A

Mainly plasma cells

23
Q

What are the cells in chronic gastritis?

A

Mainly lymphocytes

24
Q

What are the cells in leishmaniasis?

A

Mainly macrophages

25
Q

What are effects of chronic inflammation?

A
  1. Fibrosis: deposition of collagen (eg. cirrhosis)
  2. Impaired function: (eg. IBD - can no longer absorb nutrients well)
  3. (rare) Increased function: eg. thyrotoxicosis increases T3 + T4 production
  4. Atrophy: reduction in organ size
  5. Continued stimulation of immune response
26
Q

When can fibrosis occur in the gallbladder?*

A

Chronic cholecystitis.

  • Repeated obstruction by gallstones
  • Chronic inflammation arises along acute inflammation
  • Fibrosis of wall (thick, pale)
27
Q

When can impaired function occur in IBD?*

A

Crohn’s disease and ulcerative colitis (not absorbing nutrients due to the inflammation)

  • Neutrophils destroy intestinal crypts
  • Pain, altered bowel motion
28
Q

What are the features of Crohn’s disease?

A
  • Affects all GI tract, mouth to anus
  • ‘Skip lesions’, discontinuous inflammation
  • Transmural inflammation of bowel wall
  • Granulomata sometimes present
  • Rectal bleeding less likely
29
Q

What are strictures and fistulae as complications of Crohn’s disease?

A
  • Strictures: narrowing of bowel

- Fistulae: abnormal connections between 2 epithelial cells.

30
Q

What are the features of ulcerative colitis?

A
  • Only affects large bowel
  • Continuous inflammation
  • Only affects superficial bowel wall (mucosa/submucosa)
  • No granulomata
  • Rectal bleeding more likely
31
Q

What is an example of fibrosis and impaired function?* (look at histology)

A

Liver cirrhosis.

  • End stage liver damage
  • Fatty liver disease
  • Attempted regeneration
32
Q

What is a granuloma?*

A
  • Collection of epithelioid histiocytes (macrophages that look like epithelial cells)
  • Surrounding lymphocytes
  • Large, polygonal
33
Q

What are causes of granulomatous infection?

A

Foreign body reaction.
(Foreign body giant cell will form first, then foreign body granuloma)

Infection
(mycobacterium) eg. tubercolosis, leprosae

Idiopathic
(eg. sometimes occurring in Crohn’s disease and sarcoidosis)

34
Q

Why are mycobacteria so difficult to destroy?

A

They have thick cell walls and mycolic acids which resist phagocytosis.

35
Q

What is the specific subtype of mycobacterium granuloma?*

A
  • CASEOUS NECROSIS in the middle of the granuloma, looks like ‘soft cheese’ to the naked eye
  • Stains pink with H&E
36
Q

What is the difference between a biopsy and a resection?

A
  • Biopsy will only have small tissue fragments (little slides)
  • Resection is the analysis of the whole organ (lots of slides)
37
Q

What are the features of benign neoplasia?

A
  • Localised
  • No invasion
  • No metastases
  • Slow growth
  • Well differentiated
  • Compress tissue
  • Uniform cell size
38
Q

What are the features of malignant neoplasia?

A
  • Metastases (vascular/lymphatic)
  • Poor differentiation
  • Invasion of other tissues
  • Destruction of other tissues
  • Varying nuclei and cell shapes
  • Rapid growth
39
Q

What are primary malignancies?

A

Neoplasia originating from the tissue it is found in.

40
Q

What are secondary malignancies/metastases?

A

Spread from a primary tumour elsewhere.

41
Q

How to determine whether the malignancy is primary or secondary?

A

Immunohistochemistry - test for the cytokeratins that are found on the cancer.

42
Q

What is the H&E stain and what does it stain?

A

Haematoxylin & Eosin.
H: stains nuclei purple, attracted to nucleic acid particles
E: stains cytoplasm pink, has a neg. charge

43
Q

What else does eosin stain?

A

Collagen.

44
Q

What are examples of histology?

A
  • Core biopsies

- Cancer resection specimens

45
Q

What are examples of cytology?

A
  • Fine needle aspirates (eg. breast/lung/lymph nodes)
  • Cervical smears
  • Sputum
46
Q

What are advantages of histology?

A
  • Therapeutic as well as diagnostic
  • Can differentiate invasive from in situ disease
  • Better for immunohistochemical testing
47
Q

What are key points about cytology?

A
  • Faster and cheaper
  • Can be used for cells in fluids
  • Noninvasive
  • Higher error rates
  • Used for confirming/excluding rather than diagnosing

Pathological Processes (10 decks)

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