Session 3 Lecture Notes

Question 1

What is the definition of chronic

inflammation?

Answer 1

Chronic response to injury with associated fibrosis (thickening and scarring of CT)

Question 2

What are the 3 ways in which chronic inflammation can arise?

Answer 2

1. If the acute inflammation does not resolve it
2. If there has been a chronic injury (such as a chronic infection like Hepatitus)
3. It can develop alongside acute inflammation

Question 3

Are macrophages involved in both acute and chronic inflammation?
Give 4 functions of macrophages

Answer 3

Yes - but more important in chronic inflammation
4 functions:
1. Phagocytosis
2. Presenting the antigen to the immune system
3. Synthesis of cytokines, complement proteins, blood clotting factors and proteases
4. Control cytokines release

Question 4

What are giant cells?

Answer 4

Multinucleated cells made by fusion or macrophages (this happens when macrophages are unable to phagocytose something)

Question 5

Describe a Langhans type giant cell

When are you most likely to see this?

Answer 5

You see a horseshoe of nuclei around the periphery of the cell and the cytoplasm stains pink (eosinophilic)
Most frequently seen in TB

Question 6

Describe a Foreign body type giant cell

When are you most likely to see this?

Answer 6

Groups of nuclei around a central area
This is in response to a foreign body/material that should not be there (eg displaced fragment of bone following fracture)

Question 7

Describe a Touton type giant cell

When are you most likely to see this?

Answer 7

They contain a ring of nuclei around a pink stained cytoplasm
The cytoplasm on the periphery is pale and foamy
They usually occur following fat necrosis

Question 8

What cells are mainly present in rheumatoid arthritis?

Answer 8

Plasma cells

Question 9

What is chronic cholecystitis?

Answer 9

Repeated attacks of acute inflammation of the gall bladder

Question 10

What can lead to chronic cholecystitis?

Answer 10

Repeated obstruction by gall stones

This leads to chronic inflammation and scarring of the gall bladder wall (fibrotic wall)

Question 11

What causes inflammatory bowel diseases?

Answer 11

Repeats attacks of chronic and acute inflammation together which damage the mucosal lining of the intestines

Question 12

What symptoms might patients present with an inflammatory bowel disease?

Answer 12

Diarrhoea, rectal bleeding, weight loss

Question 13

What is the difference between Crohn’s disease and ulcerative colitis?

Answer 13

Ulcerative colitis affects only
the mucous membrane lining of the intestines (the mucosa) whereas Crohn’s disease is transmural - it affects the entire wall

Question 14

What is a fistula?

Answer 14

An abnormal connection between 2 epithelium lined organs eg small and large bowel

Question 15

What is cirrhosis?

Answer 15

Chronic inflammation which leads to fibrosis and impaired function

Question 16

What condition is caused by atrophy of the gastric mucosa?

Answer 16

Atrophic gastritis

Question 17

What is a granulomatous inflammation?

Answer 17

A chronic inflammation with granulomas

Question 18

What is a granuloma?

Answer 18

Groups of macrophages and lymphocytes

Question 19

When do granulomas arise?

What is the most common infection that causes granulomas?

Answer 19

With persistent low grade antigenic stimulation (antibody stimulating) and hypersensitivity (undesirable reactions produced by the immune system)
Most commonly found in TB

Question 20

What might you expect to see in a tuberculous granuloma

Answer 20

Langhans type giant cell with caseous necrosis (soft cheese looking centre)
May also see macrophages and lymphocytes

Question 21

Name 3 types of idiopathic diseases that cause granulomas

Answer 21

1. Sarcoidosis
2. Crohn’s disease
3. Wegener’s granulomatosis