The Inflammatory Response Flashcards by Francesca Polino

t/f: most diseases result from an inflammatory response

true-immune system responding to injury

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inflammatory response purpose

-pathologic/physiologic response to inflammatory mediators: eliminate cause of cell injury, removed damaged tissue, generate new tissue
-destroy, enzymatically digest, neutralize harmful agents (ex: foreign agents, infectious organisms)

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repair process

interwoven with inflammatory response, replaces damaged tissue, fills in wounds with scar tissue

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inflammatory conditions are named by…

adding the suffix -itis (appendicitis, pericarditis)

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5 cardinal signs of inflammation

-reaction of vascualized tissue to injury
-rubor (redness), tumor (swelling), calor (heat), dolor (pain), functio laesa (loss of function-results from all signs)

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acute inflammation has:

vascular phase, cellular phase (leukocyte margination, adhesion and transmigration), leukocyte activation and phagocytosis

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vascular phase of acute inflammation

-changes in small blood vessels at the site of injury marked by tissue edema
-vasodilation causes heat and redness
-loss of protein-rich fluid (exudate) into extravascular spaces from increased vascular permeability

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edema

abnormal amount of fluid in interstitial tissue

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(vascular phase) increased vascular permeability causes:

-decrease in capillary osmotic pressure
-increases interstitial osmotic pressure (edema)
-produces swelling, pain, impaired function

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vascular response patterns

immediate transient, immediate sustained, delayed hemodynamic

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immediate transient response happens with:

minor injuries, ex: paper cut, very small wounds

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immediate sustained response happens with:

more serious injuries, ex: badly skinned knee
-continues for several days, damages vessels in area

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delayed hemodynamic response happens with:

an increase in capillary permeability that occurs 4-24 hours after injury
-ex: sunburn

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cellular phase of acute inflammation

-movement of phagocytic blood cells (leukocytes) into injury site (leukocytosis)
-neutrophils>primary early arrival (shift to the left), bacteria/fungal infection
-eosinophils>parasitic, allergic responses
-basophils>respond later
-macrophages (monocytes)>secrete cytokines

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types of leukocytes

-all granulocytes: neutrophils, basophils, eosinophils
-all monocytes (largest WBC, secrete cytokines): macrophages

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“shift to the left”

increase in immature neutrophil count (inflammation)

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cytokines

-“chemical messengers of immune system”
-chemical growth signs (direct leukocytes)

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direction of cellular response

margination, transmigration, chemotaxis
-cytokines tell leukocytes where to go
-accumulation of leukocytes
-adhesion molecules (selectins, integrins, immunoglobulin)

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adhesion molecules during the cellular response (cellular phase of acute inflammation)

initiate adhesion, aggregate (cluster) inflammatory cells, move into underlying tissue

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phagocytosis in cellular phase

-last stage of cellular phase
-engulfment
-intracellular killing of toxic oxygen and nitrogen products, lysozymes, proteases and defensins

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inflammatory mediator classification

-those with vasoactive (dilate BV) and smooth-muscle constricting properties: histamine, arachidonic acid metabolites (prostaglandins, leukotrienes, platelet-activators)
-those with chemotactic factors (tell leukocytes where to go): cytokines, complement fragments
-plasma proteases that activate parts of the complement system, coagulation factors of clotting cascade, vasoactive peptides of kinin system
-reactive molecules/cytokines freed from leukocytes that can damage surrounding tissue/cells in the extracellular environment

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plasma-derived mediators

from the liver, acute-phase proteins (fever, inflammation), complement system proteins, clotting and kinin system

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cell-derived mediators

-preformed mediators (mast cells>histamine, platelets, neutrophils/macrophages)
-newly synthesized (leukocytes, macrophages, cytokines)

how corticosteroid medications work

-in the cyclooxygenase pathway: (aspirin, NSAIDs) prostaglandins inhibit inflammatory cell functions, thromboxane causes vasoconstriction, promotes platelet functoin
-in the lipoxygenase pathway: induces smooth muscle contractions, increase microvascular permeability

which of the following molecules induce endothelial cell retraction? a) omega-3 fatty acids b) leukotrienes c) histamine d) vascular cell adhesion molecules

c) histamine

inflammatory exudates

serous, hemorrhagic, membranous or pseudomembranous, purulent or suppurative, fibrinous

serous exudates

watery fluids from plasma entering inflammatory site (ex: skin blisters)

hemorrhagic exudates

blood-results from severe tissue injury that damages blood vessels or red cells from capillaries

membranous or pseudomembranous exudates

develop on mucous membrane surfaces, made of necrotic cells in a fibropurulent exudate

purulent or suppurative exudates

infections-contain pus, composed of degraded WBCs, proteins and tissue debris (ex: boils, abscess formation)

fibrinous exudates

lots of fibrinogen, form thick and sticky meshwork (ex: adhesion following surgery)

abscess formation example: splinter

1-bacterial invasion (the splinter) develops inflammation 2-suppuration (puss)-bacterial growth, neutrophil migration, tissue necrosis, purulent exudate 3-abscess formation-covers inflamed area and puss

acute inflammatory response characteristics

rapid response (minutes or hours), localized site, short duration (self-limiting), removes injurious agent, limits and repairs tissue damage from the injury/response, granulocytes and monocytes present

chronic inflammatory response characteristics

(ex: lupus) persistent and recurrent (and/or subtle), no acute response, lasts days/weeks or even years, tissue destruction from inflammatory cells, autoimmune disorders or precursors to diseases, lymphocytes and macrophages present in large numbers

granulomatous inflammation

from foreign substances (splinters, sutures, silica) or microorganisms (causes tuberculosis, syphilis, fungal infections, brucellosis)

systemic manifestations of inflammation

-acute-phase response: alterations in WBC count (leukocytosis, immunosupression, neutrophilia/shift to left if infection is severe) -fever (tachycardia), lymph node reactions (non-specific to get immune response), anorexia (loss of weight/appetite), sepsis and septic shock (circulatory chock, systemic inflammatory response syndrome: deadly)

t/f: in inflammation, blood vessels constrict

false-they dilate

t/f: chronic inflammation is self perpetuating while acute inflammation is self limiting

true

t/f: inflammatory mediators attract and guide leukocytes/plasma proteins to the injury site (chemotaxis)

true

t/f: bleeding is a localized cardinal sign of infection

false

t/f: inflammatory mediators cause vasodilation

true

acute inflammation involves which 2 stages?

vascular and cellular phase

t/f: inflammatory mediators increase leukocyte/WBC count

true

t/f: infection and injury causes inflammation but signs and symptoms are caused by chemical mediators

true

what is the term for recognition, engulfment and intracellular killing

phagocytosis

what causes the local warm during the inflammatory response

the increased blood flow

a client's WBC count includes a "shift to the left". what happened?

count of immature neutrophils increases as a result of bacterial infection

what term refers to a vesicle (blister) that bursts releasing clear fluid

serous

what is the role of mast cells during inflammation?

release histamine-a strong vasodilator

a client has an acute-onset fever and malaise revealing an elevated neutrophil count. what kind of infection do they have?

bacterial-neutrophils fight off bacteria

teresa reports pain with urination and has a temperature of 100.8. Her urine is positive for nitrates with elevated leukocyte counts. is this acute or systemic inflammation?

systemic

Kyle has a dislocated knee. it is swollen and he cannot bend it. he feels nauseous and fatigued from the pain. is this acute or systemic inflammation?

acute

David had corrective bowel surgery and has hypothermia, tachycardia, high plasma lactate, increased WBC and coagulation abnormalities. is this acute or systemic inflammation?

systemic

a client undergoing chemotherapy is lethargic, their temperature is 101.3. blood tests show leukopenia and hyperglycemia. is this acute or systemic inflammation?

systemic

a child has blisters from touching a hot pan in both hands. is this acute or systemic inflammation

acute