Session 3 -> Chronic inflammation Flashcards Preview

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Flashcards in Session 3 -> Chronic inflammation Deck (84):
1

What is chronic inflammation?

-The chronic response to injury and process of healing with the production of granulation tissue and fibrosis

2

What is the predominant cell type in chronic inflammation?

-Macrophage

3

Give an example of a persisting injurous agent which can cause chronic inflammation

-Foreign body
-Necrotic tissue
-Bacteria
-Autoimmune antigen

4

When does chronic inflammation occur?

-Alongside acute inflammation
-After acute inflammation
-Begins without any preceeding inflammation
-Autoimmune conditions
-Prolonged exposure to toxic agents

5

When would chronic inflammation occur alongside acute inflammation?

-During a severe or persistent irritation eg cholecystitis

6

Give an example of when chronic inflammation would occur without any preceeding acute inflammation

-In some chronic infections such as tuberculosis

7

Give an example of an autoimmune condition where chronic inflammation occurs

-Rheumatoid arthritis

8

Name a toxic agen which can cause chronic inflammation after prolonged exposure

-Silica

9

When do macrophages become activated in tissues?

-Can live and be dormant for many months until they are activated by a local challenge

10

Which cell type are the best at destroying persistent bacteria such as TB, neutrophils of macrophages?

-Macrophages

11

What are the functions of macrophages?

-Phagocytosis
-Present antigens to adaptive immune system
-Secrete substances which summon and activate other cellls
-Stimulate angiogenesis (important in wound healing)
-Induce fever, acute phase reaction and fibrosis

12

What does lymphocyte presence in normally absent tissues indicate?

-Antigenic material is or has been present

13

Where are lymphocytes normally present?

-Lymph nodes
-Spleen
-Liver

14

What are the functions of lymphocytes?

-Secrete antibodies (plasma B cells)
-Process antigens
-Secrete cytokines
-Kill cells

15

How do plamsa cells differ phenotypically from other lymphocytes?

-They have peri-nuclear hof -> pale cytoplasm due to abundance of ER and golgi producing antibody

16

What is the main function of eosinophils?

-Attack large parasites, eg worms

17

In what immune responses are eosinophils present in high numbers?

-Asthma (in bronchi)
-Tumours such as hodgkin's lymphoma
-Allergic reactions

18

What cell types are principally involved in chronic inflammation?

-Macrophages
-Lymphocytes
-Eosinophils
-Fibroblasts and myofibroblasts

19

What is the function of fibroblasts?

-Produce connective tissue substances such as collagen, elastin and GAGs
-Differentiate into myofibroblasts

20

What is a giant cell?

-A single giant multinucleate cell formed by the fusion of many macrophages

21

In what type of inflammation are giant cells often seen?

-Granulomatous inflammation

22

What do giant cells do?

-Perform frustrated phagocytosis

23

Describe Langhan giant cells
When are they often seen?

-Cell nuclei arranged around the periphery in a horse-shoe
-Foamy cytoplasm
-Often, but not exclusively, seen in tuberculosis

24

Describe foreign-body giant cells
When are they seen?

-Nuclei arranges randomly within the cell
-Often but bot exclusively seen when a hard to digest foreign body is present

25

How do foreign-body giant cells eradicate foreign bodies?

-Small foreign bodies are phagocytosed
-Giant cells stick to the surface of large foreign bodies

26

Describe a touton giant cell
When are they often seen?

-Nuclei are arranged in a ring towards the centre of the cell
-Lipid is around the outside
-Often formed in lesions where there is a high lipid content such as fat necrosis and xanthomas

27

Is there a typical composition of cells within chronic inflammation?

-No, the response is not sterotyped and thus the proportion of cells will vary depending on the cause
eg Rheumatoid arthritis = plasma cells
Chronic gastritic = lymphocytes
Leishmanaisis (protazoal infection)= macrophages

28

What is the cause of scarring?

-Excessive fibrous tissue deposition

29

List the possible complications of chronic inflammation

-Fibrosis
-Impaired function
-Atrophy
-Stimulation of immune response

30

When does excess fibrosis occur?

-When fibroblasts are stimulated by cytokines to produce excess collagen

31

How is collagen production important in chronic inflammation?

-Walls off infected areas
-Production of a fibrous scar to replace damaged tissue

32

When does collagen deposition become problematic?

-when it is excessive or inappropriate and replaces normal parenchymal tissue and impairs the function of the organ

33

Provide an example of when collagen deposition occurs and impairs function?

-Interstitial fibrosis of the lung

34

How can myofibroblasts be problematic?

-When an area contains excess myofibroblasts there can be excessive contraction of the wound leading to contractures

35

Provide an example of when myofibroblasts can impair function

-Contraction in the cirrhotic liver will impair the flow of portal blood resulting in ascites

36

Chronic cholecystitis is an example of fibrosis, describe this process of inflammation

-Gallstones blocking the cystic duct
-Bile is not secreted and accumulates causing multiple repeated episodes of acute inflammation as it is toxic
-Chronic inflammation ensues and the gall bladder becomes increasingly fibrous and thickens over time

37

Why does the muscular component of the gallbladder thicken in cholecystitis?

-Repeated attempts at extruding gall stones

38

What is gastric ulceration?

-Necrosis of epithelia on gastric mucosal surface

39

What is another name for gastric ulceration?

-Peptic ulcer

40

Why is gastric ulceration seen in chronic gastritis?

-There is a focal imbalance of acid production and mucosal defence leading to erosion of the mucosal surface
-The submucosa becomes washed with HCl

41

What is often seen at the base of an ulcer?

-White slough

42

What is inflammatory bowel disease?

-A group of diseases characterised by relapsing and remitting inflammation of the gastrointestinal tract

43

What are the most common types of inflammatory bowel disease?

-Crohn's
-Ulcerative colitis

44

Why are inflammatory bowel diseases described as episodic?

-Repeated episodes of acute inflammation which can be treated occur in addition to the underlying chronic inflammation

45

What is the most common cause of inflammatory bowel diseases?

-It is most commonly idiopathic

46

What are the main differences between ulcerative colitis and Crohn's?

-Ulcerative colitis is inflammation and ulceration of the superficial mucosa, usually effecting the rectum but can involve part of the colon or retreat and effect the whole colon
-Crohn's disease is transmural inflammation and ulceration which is usually segmental from the mouth to the anus (skip lesions)

47

What is liver cirrhosis?

-A condition where the liver responds to injury by producing interlacing strands of fibrous tissue between which are nodules of regenerating cells

48

How do patients with inflammatory bowel disease usually present?

-Diarrhoea, rectal bleeding and varied symptoms

49

What is a stricture?

-Narrowing of a tube

50

Do strictures and fistulas form in ulcerative colitis or crohn's?

-Crohn's

51

What is a fistula?

-Abnormal connection between two epithelial lined organs

52

How does a cirrhotic liver look characteristically?

-Shruken and nobbly

53

How does cirrhosis occur?

-Chronic inflammation leads to excess collagen deposition and fibrosis
-This causes disorganisation of the architecture, whilst regeneration is attempted inbetween the bands of fibrosis
-This leads to the multinodular liver with impaired function ie cirrhosis

54

What are the common causes of liver cirrhosis?

-Alcohol
-Infection with HBV/HCV
-Fatty liver disease
-Immunological causes
-Drugs/toxins

55

What is atrophic gastritis?

-Atrophy of the gastric mucosa, possibly suceeding chronic gastritis but often occurs spontaneously as an autoimmune disease in association with pernicious anaemia

56

Can the immune response induce inflammation?

-Yes, it uses inflammation as a non-specific weapon

57

What is rheumatoid arthritis?

-An autoimmune disease where there is chronic inflammation in the synovial membrane of joints due to autoimmune antibodies

58

What does the localised chronic inflammation in rheumatoid arthritis cause?

-Destruction of joints

59

What are the systemic effects of chronic inflammation in rheumatoid arthritis?

-Can cause amyloidosis (mis-folding of fibbres into b-sheets which become insoluble and deposit as amyloid fibres)
-Can effect other organs such as skin, liver and lung

60

What is the overlap between chronic inflammation and immune response?

-Immune diseases cause pathology by chronic inflammation
-Chronic inflammatory processes can stimulate immune responses

61

What is granulomatous inflammation?

-Chronic inflammation with granulomas

62

What is a granuloma?

-A localised collection of cells characterised by the presence of epitheloid histiocytes, giant cells and monocytes/lymphocytes

63

What are epitheliod histiocytes?

-Immobile macrophages which represent epithelial cells as they are elongated, have eosinophilic cytoplasm and are tightly packed

64

When does granulomatous inflammation occur?

-Persistant, on-going low-grade antigenic stimulation
-Hypersensitivity

65

How do granulomas form in relation to the target material?

-They form around the particle which can be free or phagocytosed in the centre

66

What immune cells are often found in the centre of granulomas and why?

-Monocytes as they try to wall the particle off from the environment

67

How big are granulomas?

-Usually 0.5-1mm

68

What are the two types of granuloma?

-Foreign body granuloma
-Hypersensitivity/immune-type granuloma

69

When do foreign-body granulomas occur?

-When there is persistent, ongoing low-grade stimulation

70

Describe a foreign body granuloma

-Contains macrophages, foreign body giant cells, epitheloid cells and some fibroblasts at periphery. There are very few lymphocytes as the stimulus is non-antigenic

71

Describe hypersensitivity/immune-type granulomas

-Contain macrophages, giant cell (possible langhans), epitheloid cells, fibroblasts and lymphocytes
-Can undergo central caseous necrosis and develop around insoluble but antigenic particles

72

What is a granuloma, which has central caseous necrosis, associated with?

-TB

73

What are the main causes of granulomatous inflammation?

-Mildly irritant foreign material (artificial joint break down, surgical thread etc)
-Persistant Infections (TB, leprosy, syphyllis, cat-scratch disease)
-Unknown causes

74

What is leprosy?

-Chronic disease caused by mycobacterium leprae that effects skin, mucous membranes and nerves

75

What is cat-scratch disease?

-An infectious disease which is transmitted to humans by a cat scratch
which can become chronic

76

What is sarcoidosis?

-A chronic disorder of unknown cause in which the lymph nodes are enlarged and granulomas form in the lungs, liver and spleen, however many other sites can be effected

77

What is wegener's granulomatosis?

-An autoimmune disease predominantly effecting the nasal passages, lungs and kidneys, characterised by the formation of necrotising granulomas in addition to pulmonary vasculitis

78

Do granulomas appear in ulcerative colitis or crohn's disease?

-Crohn's disease

79

How does tuberculosis cause disease?

-Through persistance and induction of cell-mediated immunity

80

What giant cells are associated with tuberculosis?

-Langhan cells

81

Describe a granuloma associated with TB

-Granuloma contains langhan cells and has central caseous necrosis (histiologically appears pink)

82

What are the 4 possible outcomes of TB?

-Arrest, fibrosis and scarring
-Erosion into bronchus leading to bronchopneumonia or TB in the GIT through coughing and then swallowing
-Tuberculosis empyema -> chronic active infection of the pleural space with calcification of the pleura
-Erosion into the bloodstream which can result in focal tb(localised in one organ) or miliary TB (effects everywhere)

83

Who is sarcoidosis most commonly seen in?

-Young women

84

What macroscopic features of acute inflammation remain in chronic inflammation?

-Tumor and Dolor (swelling and pain)