Topic 12 Part 2 Flashcards
4 signs of inflammation
redness, pain, heat, swelling
goal of inflammation
dispose of microbes/ toxins / foreign materials Occurs at the site of injury Prevents the spread Prepare for repair Restore homeostasis
stages of inflammation
- Vasodilation- Increase permeability of blood vessels
- Emigration- Movement of phagocytes from blood to interstitial fluid
- Tissue repair
Increases permeability Allows
antibodies and clotting factors to leave the blood
Vasodilation Allows
more blood into an area
-Helps remove microbial toxins and dead cells
Factors that cause vasodilation and increased
permeability:
Histamine, Kinins, prostaglandins, leukotrienes, Complement
Histamine:
- ____ cells in the tissues release
- ______ and _____ stimulate the release of _____ in the blood
- Causes increased _____ and _______
- Mast cells in the tissues release
- Basophils and platelets stimulate the release of histamine in the blood
- Causes increased dilation and permeability
Kinins: Type of molecule: \_\_\_\_\_\_\_ Induce \_\_\_\_\_\_ and increase \_\_\_\_\_\_\_\_ Act as \_\_\_\_\_\_\_ agent phagocytes Ex: \_\_\_\_\_\_\_\_
Type of molecule: Polypeptides
Induce vasodilation and increase permeability
Act as chemotaxic agent phagocytes
Ex: bradykinin
Prostaglandins:
Type of molecule: _____
Released by _________
Stimulate emigration of ________
Type of molecule: Lipid
Released by damaged cells
Stimulate emigration of phagocytes
Leukotrienes:
_______ and ____ cells produced
Increase ______
Basophils and mast cells produced
Increase permeability
Complement:
Stimulate _______ release
Attract _______
Promote _________
Stimulate histamine release
Attract neutrophils
Promote Phagocytosis
Clotting factors move into tissues
- Initiate the _______
- Fibrinogen converted to fibrin–>Forms ______= Localizes and traps invading organisms/ Blocks spread of organism
- Initiate the clotting cascade
- Fibrinogen converted to fibrin–>Forms fibrin mesh= Localizes and traps invading organisms/ Blocks spread of organism
Within 1hour of start of inflammatory process: _____ appear
Phagocytes
Inflammation:
Neutrophils _____ to blood vessel wall with increased ______ and attempt to destroy via _______
Neutrophils stick to blood vessel wall with increased blood flow and attempt to destroy via phagocytosis
Inflammation:
- _______ follow neutrophils–>Transform into ______ (More potent _______ than neutrophils)
- Eventually macrophages _____
- Leave collection of dead cells and fluid (____)
- Monocytes follow neutrophils–>Transform into macrophages (More potent phagocytes than neutrophils)
- Eventually macrophages die
- Leave collection of dead cells and fluid (Pus)
Inflammation: Redness Large amount of blood in \_\_\_\_\_\_ Local temperatures \_\_\_\_\_ Metabolic reactions \_\_\_\_\_\_ More heat \_\_\_\_\_\_
Large amount of blood in damaged area
Local temperatures increase
Metabolic reactions speed up
More heat released
Inflammation: Swelling
Increased _______
More ____ in the area
Increased permeability
More fluid in the area
Inflammation: Pain
Symptom of inflammation–
neuron injury or increased pressure (edema)
Fever: \_\_\_\_\_\_\_ increase body temperature Trigger release of \_\_\_\_\_\_\_ (cause fever) Helps to inhibit the \_\_\_\_\_ of some microbes Helps to speed up body \_\_\_\_\_\_ Aids in \_\_\_\_\_\_
Bacteria toxins increase body temperature
Trigger release of interleukin-1 (cause fever)
Helps to inhibit the growth of some microbes
Helps to speed up body reactions
Aids in repair
2 components of inflammation
vascular reaction
cellular reaction
Acute inflammation=
rapid onset / short duration / emigration of
neutrophils
Chronic Inflammation=
long duration / lymphocyte involvement /
proliferation of blood vessels / tissue necrosis
Vascular changes purpose=
Maximize movement of plasma proteins and appropriate circulating cells into the site of injury or infection
HOW?? Vasodilation / Increased capillary permeability
Vasodilation:
Early ________
_______ involved first, followed by opening of new ____
Induced by variety of mediators (_____ / _____)
RESULT:
Increased ______ which increases ______ and _____ of tissue
Early manifestation
Arterioles involved first, followed by opening of new capillary beds
Induced by variety of mediators (histamine / nitric oxide)
RESULT:
Increased blood flow which increases redness and warmth of tissue
Increased Capillary Permeability:
- Movement of protein rich fluid into ______ tissue and concentration of red blood cells (_____ change)
- Physical changes in ______ structure of capillaries
-Movement of protein rich fluid into extravascular tissue
and concentration of red blood cells (viscosity change)
-Physical changes in endothelial structure of capillaries
Increased Capillary Permeability: Result
_____ & ______ changes force fluid into interstitial space (results stasis) / _____ begin adhering to endothelium and moving into interstitial space / physical openings in ______ allow more fluid / protein / cells to migrate
Osmotic & hemodynamic changes force fluid into interstitial space (results stasis) / neutrophils begin adhering to endothelium and moving into interstitial space / physical openings in endothelium allow more fluid / protein / cells to migrate
Extravasation=
movement of leukocytes from vessel lumen to interstitial space
Margination=
movement of leukocytes toward the wall of the capillary
Rolling=
leukocytes tumble slowly along endothelium, adhere transiently, then are finally attached–endothelium completely lined with white cells
Transmigration (diapedesis)=
insert pseudopods into junctions between endothelial cells–move through the junction
Chemotaxis=
migrate thru interstitial fluid to source of problem
Chemotaxix=
Locomotion along ______
Most common exogenous agents are _____ products
Common endogenous agents (3)
Locomotion along chemical gradient
Most common exogenous agents are bacterial products
Common endogenous agents (3)
–components of complement (C5a)
–products of lipoxygenase pathway (leukotriene B4)
–cytokines
Leukocyte activation induced by:
microbes / products necrotic cells / antigen-antibody complexes / cytokines
results of leukocyte activation (5)
- production of arachidonic acid metabolites
- degrannulation and secretion of lysosomal enzymes
- secretion of cytokines
- modulation of surface receptors
- phagocytosis
Chemical mediators: originate from
plasma or cells
–plasma derived must be activated cell-derived usually stored in intracellular granules
Chemical mediators: Production of active mediators triggered by
microbial products or host proteins (complement, etc.)
Chemical mediators:
- Usually bind to specific receptors on _______
- One mediator may stimulate the release of other ____
- Mediators can act on more than one _____
- Once activated and released, most are ______
- Most have the potential to cause ______
-Usually bind to specific receptors on target cells
-One mediator may stimulate the release of other
mediators
-Mediators can act on more than one target
-Once activated and released, most are short lived
-Most have the potential to cause GREAT HARM
2 or more present for diagnosis of SIRS:
- Body temp
- HR
- Respiratory Rate
- Leukocyte count
- Body temp above 38C or below 36C
- HR >90 BPM
- Respiratory Rate >20/min Or PaCO2 12,000 cell/mm2 Or Or <10% immature neutrophils
CPB produces “whole body” inflammatory response: Wide spectrum of injuries- All come within the “catch all” terms of SIRS
Pulmonary Renal Gut Central Nervous system Myocardial dysfunction Coagulopathy** Hemolysis Fever Increase susceptibility to infection Leukocytosis
Widely accepted that SIRS is induced in all patients undergoing bypass:
- -Incidence and severity is _____ (Most have a ___ clinical symptoms / Minority develop severe ____ changes or _____ after bypass.)
- -Degree of response is _________ nor type of response.
- -Risk factor: ______ (Frequently a risk factor, but not necessarily)
–Incidence and severity is variable (Most have a few clinical symptoms / Minority develop severe hemodynamic changes or organ failure after bypass.)
–Degree of response is not predictable nor type of
response.
–Risk factor: Length of CPB (Frequently a risk factor, but not necessarily)
SIRAB: Set in motion _____ mediated events that activate vascular endothelium: Allow further ______ mediated inflammatory injury
Set in motion cytokine mediated events that
activate vascular endothelium: Allow further neutrophil mediated inflammatory injury
SIRAB: most common culprit
contact with foreign surface
Other factor: Altered arterial blood flow patterns, Sheer stress (blood pumps), Cardiotomy suction, Tissue ischemia, Reperfusion, Hypothermia, Relative anemia, anticoagulants
SIRAB: Contact activation=
Blood passes through non-physiologic ECC
SIRAB: Activation of contact proteins…
Coagulation factors XII and XI
Prekallikrein
High molecular weight kininogen
SIRAB end result
Formation of bradykinin
Conversion of plasminogen into plasmin
Initiates fibrinolysis
Triggers classical complement cascade
Big Picture:
1-Multiple inflammatory mediators are released upon exposure to ECC- Disrupt _____
2-Generalized whole body inflammatory response: ____ mediated–>Activates _____–>Further _____ injury
3-None occur ____
4-Stimulate or catalyze other reactions in cycle of ____
1-Multiple inflammatory mediators are released upon exposure to ECC- Disrupt homeostasis
2-Generalized whole body inflammatory response: Chemokine mediated–>Activates vascular endothelium–>Further neutrophil-mediated injury
3-None occur alone
4-Stimulate or catalyze other reactions in cycle of SIRAB
Immune System and Bypass: Part 1
1-Post operatively –Shown patients more _____
2-Noted _____ and ______ are decreased
3-_____ ability of _______ are decreased
1-Post operatively –Shown patients more susceptible to infections
2-Noted serum immunoglobulins and complement are decreased
3-Chemotaxic ability of granulocytes are decreased
Immune System and Bypass: Part 2
4- _____ cells are decreased: Number and function
5-____ and _____ cells are decreased
6-____ cells are slightly increased
7-___ number remains low for about 1 week post bypass
4- NK cells are decreased: Number and function
5-CD3+ and CD4+ cells are decreased
6-CD8+ cells are slightly increased
7-Leukocyte number remains low for about 1 week post bypass
