Session 3 - Chronic inflammation Flashcards
What is the definition of chronic inflammation?
Definition: chronic response to injury with associated fibrosis; may overlap with host immunity
What are macrophages derived from?
monocytes
What is the role of lymphocytes?
Chronic inflammatory cells
What are the three functions of lymphocytes?
o Adaptive immune response
o B lymphocytes > antibodies
o T lymphocytes > control & cytotoxic functions
What are plasma cells derived from?
Terminally differentiated B lymphocytes
What do plasma cells imply?
Chronic inflammation
What do plasma cells do?
Synthesis and secrete antibodies
What do plasma cells look like?
o Clock face chromatin
o Pale around nucleus – lots of golgi
What reactions are Eosinophills involved in?
- Allergic reactions, parasitic infections, some tumours
What do eosinophils look like?
- Appearance: “sunburtn face with sunglasses”`
What are fibroblasts recruited by?
Macrophages
What pathology underlies scarring?
Fibrosis
How do giant cells appear?
Multinucleated and via the fusion of macrophages
What is are the roles of macrophages?
- Phagocytosis of non-pyogenic debris and bacteria
- Anti-gen presentation
- Synthesis of cytokines, complement factors, blood clotting factors and proteases
- Control of other cells via cytokine release
What do macrophages fuse together to form?
o Langhans – TB – horse shoe shaped
o Foreign body type – disorganized
o Touton – fat necrosis
When might chronic inflammation arise?
- May take over from acute inflammation if damage too severe
- May occur De Novo
How does chronic inflammation occur de novo? (4)
- Autoimmune disease e.g. rheumatoid arthritis
- Chronic infections e.g. viral hepatitis
- Chronic low level irritation e.g. suture (considered a foreign body)
- May develop alongside acute inflammation e.g. if severe/repeated inflammation
Give five complications of chronic inflammation
- Fibrosis (scarring) e.g. cirrhosis of the liver
- Impaired function e.g. chronic inflammatory bowel disease > diarrhoea
- Increased function (rare) e.g. thyrotoxicosis
- Atropy e.g. autoimmune destruction of adrenal glands/ gastric mucosa
- Stimulated immune responsep
What is chronic cholecystitis and how is it caused?
Give a treatment
- Repeated obstruction, of cystic duct of gall bladder by gallstones > ischaemia
- Repeated acute inflammation > chronic inflammation
- Fibrosis of bladder wall
- Treated with surgicalremoval
What is gastric ulceration and how is it caused?
- Acute gastritis (alcohol, drugs)
- Helicobacter pylori > chronic gastric ulceration
- Occurs due to imbalance between acid production and mucosal defence
- Fibrosis of stomach mucosa
Give two types of inflammatory bowel disease
Ulcerative colitis
Chron’s disease
What is ulcerative colitis?
Give two treatments
o Superficial
o Diarrhoea > dehydration > malnutrition
o Bleeding
- Treat with immunosupression, surgical removal of the large bowel
What is crohn’s disease?
Give three treatments
o Transmural
o Strictures
o Fistulae: connections between two eipthelia
- Treat with lifestyle modifications, diet/hydration, immunosupression
What is inflammatory bowel disease?
Give two symptoms
- Infllammatory disease affecting the large and small bowel.
Present with diarrhea, rectal bleeding and other symptoms
What are common causes of cirrhosis?
Alcohol, infection (Hep B, HIV), immunological, fatty liver disease
What is cirrhosis?
Chronic inflammation with fibrosis and impaired function
What is fibrosis?
- Fibrosis > disorganization of architecture and attempted regeneration
What is thyrotoxicosis?
- Grave’s disease
* Increased function
What is a granuloma?
Granuloma: aggregate of macrophages which arise from persistent, low-grade antigenic stimulation and hypersensitivity.
What are tuberculosis and leprosy?
Caused by mycobacterium
What is not produced by myobacterium?
Toxins or lytic enzymes
How do tuberculosis and leprosy cause disease?
o Cause disease by persistence and induction of cell-mediated immunity
When are tuberculous granulomas present?
Caseous necrosis
What is sarcoidosis?
o Abnormal collections of granulomas in organs
o Non-caseous granulomas in lungs, lymph nodes…
Give four causes of granulomas
- Sarcoidosis
- Myobacterium (Tuberculosis and leprosy)
- Syphilis
- Foreign body reactions
What is polymyositis?
Chronic inflammation of the muscles
Patient has dificulty swallowing and muscle pain. Muscle weakness also present.
Main treatment is corticosteroids
What is a treatment for helicobacter pylori?
PPI inhibitor
Antibiotics
What is a treatment for liver cirrhosis?
Lifestyle changes to prevent further damage and a transplantation of a new liver if necessary
What is rheumatoid arthritis?
Autoimmune disease
Localised and systemic immune response
Localised chronic inflammation leads to joint destruction
Systemic immune response
When do chronic inflammation and immune responses overlap?
- Immune diseases cause pathology by chronic inflammation
- Chronic inflammatory processes can stimulate immune response
What are the outcomes of tuberculosis?
Arrest, fibrosis, scarring Erosion into bronchus Tuberculous empyema (collection of pus) Erosion into bloodstream
What is polymyositis?
What are its symptoms? (3)
What is the main treatment?
Chronic inflammation of the muscles
Patient has dificulty swallowing and muscle pain. Muscle weakness also present.
Main treatment is corticosteroids
What is a treatment for helicobacter pylori? (2)
PPI inhibitor
Antibiotics
What is a treatment for liver cirrhosis?
Lifestyle changes to prevent further damage and a transplantation of a new liver if necessary
What is rheumatoid arthritis?
Autoimmune disease
Localised and systemic immune response
Localised chronic inflammation leads to joint destruction
When do chronic inflammation and immune responses overlap?
- Immune diseases cause pathology by chronic inflammation
- Chronic inflammatory processes can stimulate immune response
What are the outcomes of tuberculosis?
Arrest, fibrosis, scarring Erosion into bronchus Tuberculous empyema (collection of pus) Erosion into bloodstream
