Term
| What is the first line of defense against an injury? |
|
Definition
|
|
Term
| What are the two main components of the acute inflammatory process? |
|
Definition
Vascular Changes
-dilation
-increased permeability
Cellular Response
-leukocytes leave microcirculation, accumulate at site of injury |
|
|
Term
| What causes redness & swelling in acute inflammation? |
|
Definition
Redness: vasodilation
Swelling: leaky vessels |
|
|
Term
| What causes active dilation of arterioles, capillaries & venules? |
|
Definition
-release of chemical mediators from damaged & necrotic cells
e.g. vasoactivte amines, kinins etc. |
|
|
Term
| What are mast cells & where are they found in greatest concentrations? |
|
Definition
cells with membrane bound vacuoles which contain histamine
-found concentrated around capillaries |
|
|
Term
|
Definition
| causes capillary dilation |
|
|
Term
|
Definition
| -arteriolar dilation bringing more blood the the area, which dilation of capillaries to increase flow into the tissue |
|
|
Term
| What causes the increased permeability of capillaries & venules? |
|
Definition
-widening of intercellular junctions of endothelial ccells
-inflammation increasing the permeability of the membrane allowing more fluid & larger proteins to pass through |
|
|
Term
|
Definition
| more fluid & larger proteins moving from the vessel into extavascular space due to loss of mmb selective permeability |
|
|
Term
| What causes increased vascular permeability? (5) |
|
Definition
-initial endothelial cell contraction of venules widens the junctions
-direct endothelial injury
-leukocyte-mediated endothelial injury
-increased transcytosis (movement across endothelial cells via vesicles)
-leakage from newly forming blood vessels |
|
|
Term
True or False
Blood flow slows down as fluid moves into the interstitial space |
|
Definition
True
-it becomes more viscous |
|
|
Term
| What are the differences between transudate & exudate? |
|
Definition
Transudate
-primarily albumin, a few healthy cells, clear & colourless
-low protein content
Exudte
-high protein content
-albumin, globulins, fibrin
-lots of degenerate cells, neutrophils
-turbid, yellow/white, pink |
|
|
Term
| What effect does the loss of permeability have on swelling? |
|
Definition
| because more proteins are in the interstitium, osmotic pressure of the plasma will not be able to draw fluid back so swelling is increased |
|
|
Term
|
Definition
| inflammation of the peritonium (membrane lining the abdominal cavity) |
|
|
Term
| How might you differentiated between ascites & peritonitis? |
|
Definition
-pass a needle into the peritoneal space & take a sample
-transudate = ascites
-exudate = peritonitis |
|
|
Term
True or False
Presence of an exudate indicates a change in vascular hydrostatic/oncotic pressure |
|
Definition
False
it indicates an inflammatory process is taking place in the body |
|
|
Term
| What are the benefits of exudation? |
|
Definition
-dilutes any offending agents
-brings immunoglobulins & complement proteins to the area
-increases lymphatic drainage to carry agents to lymph nodes |
|
|
Term
| What role does Factor XII play in fibrin formation? |
|
Definition
| it acts on fibrin monomers to form insoluble polymers of fibrin |
|
|
Term
| What is the role of fibrin in the tissue? |
|
Definition
| -forms a meshwork to localize the inflammatory process & aid neutrophil movement |
|
|
Term
| What are the characteristics of shipping fever? |
|
Definition
-excess fibrin production in the lung & pleural surface
-causes adhesions between pleual mmbs |
|
|
Term
| What cell line do inlammatory cells derive from? What are the two branches? |
|
Definition
myeloid cell line in bone marrow
-mononuclear cells & granulocytes |
|
|
Term
|
Definition
Neutrophils: phagocytosis of microorganisms, are motile, have degradation enzymes
Eosinophils: recruited to fight parasitic diseases |
|
|
Term
| What effects do dancer cells have on neutrophil function? |
|
Definition
| reduce levels of neutropphils, increasing the risk of infection |
|
|
Term
| What are mononuclear cells? |
|
Definition
Lymphocytes
Plasma Cells
Monocytes
Macrophages |
|
|
Term
| Which are you more likely to see in acute inflammation, neutrophils or monocytes? |
|
Definition
|
|
Term
| What is the difference between monocytes & macrophages? |
|
Definition
| macrophages are monocytes which have migrated and become fixed in tissues |
|
|
Term
|
Definition
| ingest microorganisms, phagocytosis, clean up cellular debris, secret epyrogens & complement components |
|
|
Term
| What are the steps of leukocyte recruitement? (5) |
|
Definition
1. Margination, Rolling & Adhesion of leukocytes
2. Transmigration of neutrophils
3. Chemotaxis
4. Leukocyte Activation
5. Phagocytosis & Pathogen Degradation |
|
|
Term
| What is marginationm pavementing & adesion? |
|
Definition
Margination: increased contact between leukocytes & endothelium
Pavementing: selectins on both mediate the leukocytes sticking to the endothelium
Adhesion: integrins integrate the leukocytes into tissues |
|
|
Term
| Describe the transmigration of neutrophils |
|
Definition
Diapedesis: neutrophils have adhered to the endotheliun, now need to squeeze between intercellular junctions
-secrete collagenases to degrade basement membrane & enter the intersitium |
|
|
Term
| Where does diapedesis typically occur? |
|
Definition
| in venules of systemic circulation |
|
|
Term
| What is chemotaxis? How does it work? |
|
Definition
the attraction of inflammatory cells based on concentration gradient
-chemotactic molecules bind to leukocyte receptors, increasing Ca and triggering intracellular contractile elements to allow leukocytes to move |
|
|
Term
True or False
Cytokines are chemotactic |
|
Definition
|
|
Term
| What is leukocyte activation? What does it lead to? |
|
Definition
Toll-like receptors recognize PAMPS, activating leukocytes to initiate the inflam process
Cytokines can also activate leukocytes after inflam process is underway
Leads to:
Phagocytosis
Upregulation of mechanisms for degradaing microbes
Produces inflammatory mediators |
|
|
Term
|
Definition
| recognition of an antibody or complement factor by phagocytic cells to enhance phagocytosis |
|
|
Term
| What are the steps of phagocytosis/pathogen degradation |
|
Definition
1. Recognition
2. Opsonization
3. Engulfing (phagocytosis)
4. ROS kill pathogens
5. Phagosome fuses with lysosome for hydrolysis |
|
|
Term
| What effect does phagocytosis have on aerobic metabolism in leukocytes? |
|
Definition
increases it
-results in lots of ROS being produces, which kills pathogens |
|
|
Term
| What are the 6 types of inflammatory mediators? |
|
Definition
Vasoactive Amines
Plasma Proteins
Lysosomal Constituents
Arachidonic acid metabolism
Platelet-activating factor
Cytokines |
|
|
Term
| What are the 2 vasoactive amines discussed and what do they do? |
|
Definition
Histamine & seratonin
-vasodilation & increase permeability |
|
|
Term
| What activates plasma proteases? |
|
Definition
| Hageman factor (Factor XII) |
|
|
Term
| What are the 3 plasma proteases? |
|
Definition
Kinin system
-bradykinin increases permeability
Coagulation Cascade
-activates thrombin to produce fibrin
Complement System
-C5a & C3a stimulate histamine release
-C5a is chemotactic & mediates arachidonic metabolism
-C3a is an opsonin |
|
|
Term
| What do Bradykinin, C3a & C5a have in common? |
|
Definition
| they mediate vascular permeability |
|
|
Term
| What is the role of lysosomal constituents? |
|
Definition
| oxygen-based free radicals & proteases increase vascular permeability (damage mmbs) & kill/degrade microorganisms |
|
|
Term
| What is the importance of arachidonic metabolism? |
|
Definition
| -produces prostaglandins, leukotrienes & lipoxins (eicosanoids) |
|
|
Term
| If you are using an anti-inflam agent, which mediator if inflammation are you likely targeting? |
|
Definition
| metabolism of arachidonic acid |
|
|
Term
| What does platelet-activating factor originate from? |
|
Definition
|
|
Term
| Which two cytokines are of particular importance? How are they produced & what do they do? |
|
Definition
Interleukin 1 & Tumour Necrosis Factor
-produced by activated macrophages
-induce endothelial activation & activate tissue fibroblasts
-induce systemic acute-phase responses e.g. fever & lethargy |
|
|
Term
| What do corticosteroids do? |
|
Definition
-suppress/inhibit inflam response by blocking conversion of mmb phospholipids to arachidonic acid
-reduce vasodilation & permeability to reduce exudation
-suppress almost all aspects of the inflam response to the injurious agent |
|
|
Term
|
Definition
-inhibit conversion of arachidonic acid to prostaglandins
-anti inflam & analgesic effects |
|
|
Term
| What are the local signs of inflammation? |
|
Definition
| redness, heat, swelling, pain |
|
|
Term
| What polypeptides signal pain? |
|
Definition
bradykinin
histamine
seratonin |
|
|
Term
| Aside from polypeptides of low molecular weight, what else signals pain? |
|
Definition
increased pressure due to swelling
stimulation of nerve endings |
|
|
Term
True or False
Fever is a local finding indicating inflammation |
|
Definition
false
it is a systemic finding |
|
|
Term
| What is the acute phase reaction to inflammation? (4) |
|
Definition
fever
malaise
changes in peripheral WBC count
changes in plasma proteins |
|
|
Term
| What is the difference between a sign & a sympton? |
|
Definition
Sign = objective e.g. enlarged lymph nodes, blood test
Sympton = subjective e.g. general pain, headacehe |
|
|
Term
| What are the endogenous pyrogens and how do they work? |
|
Definition
Interleukins IL-1 & IL-6 & TNF
-enter systemic circulation, travel to brain, stimulate prostaglandin synthesis to 'reset' the core body temperature |
|
|
Term
| What is the difference between leukocytosis & neutrophilia? |
|
Definition
Leukocytosis = increased WBC count
Neutrophilia = increased neutrophil #s specifically |
|
|
Term
| Why would you see an increase in immature neutrophils during acute inflammation? |
|
Definition
| -they are being released from bone marrow before completely mature in an effort to keep up with demand |
|
|
Term
| What mediates the release of leukocytes from bone marrow? |
|
Definition
|
|
Term
True or False
In viral infections, you are likely to see a decrease in WBC count |
|
Definition
|
|
Term
| What changes would you see in plasma protein levels in acute inflammation? |
|
Definition
increases in acute phase reactants
-C reactive protein, fibrinogin etc. |
|
|
Term
| Is an increase in acute phase reactants a specific or non-specific indication of inflammation? |
|
Definition
|
|
Term
|
Definition
| occurs when acute inflammation is uncomplicated, the swelling & cellular debris are removed by macrophage activity & lymphatic flow relatively quickly with no signs of it ever having happened |
|
|
Term
| When is 'repair' required to fix acute inflammation? |
|
Definition
| if the inflammation cannot be quickly resolved, and some tissue necrosis/introduction of bacteria has occured |
|
|
Term
| What is liquefactive necrosis & what causes it? |
|
Definition
-exaggerated inflow of neutrophils due to bacterial presence in the injury
-liquified mass of necrotic tissue, dead organisms & neutrophils
PUS! |
|
|
Term
| What is suppurative inflammation? |
|
Definition
| the process of forming liquefied necrotic tissue |
|
|
Term
| What causes an abscess to form? |
|
Definition
| -fibrous tissue walls off an area of suppurative inflammation |
|
|
Term
|
Definition
| local spread of infection as bacteria 'escapes' the original site of infection and travels to surrounding tissues |
|
|
Term
|
Definition
| -spread of bacteria & their toxins in their bloodstream |
|
|
Term
|
Definition
| the travel of just bacteria in the bloodstream (bacteremia) |
|
|
Term
| Which organ is particularly susceptible to abscess formation due to bacteremia? |
|
Definition
|
|
Term
| What characterizes chronic inflammation vs acute inflammation? |
|
Definition
Chronic = lots of mononuclear cells, occurs if acute inflam cannot be resolved promptly, persistence of the antigen/injurious stimulus
Acute = lots of neutrophils |
|
|
Term
| Coughing, hemoptysis, fever, weight loss & fatigue are all signs of _____ resulting from chronic inflammation & necrosis of lung tissue |
|
Definition
|
|
Term
| What causes chronic inflammation? |
|
Definition
| a continued inflammatory responses combined with an immune response against a persistent injurious agent |
|
|
Term
| What is chronic inflammation? |
|
Definition
| inflammation of prolonged duration in which active inflammation, tissue injury & healing take place simultaneously |
|
|
Term
| What are the characteristics of chronic inflammation? (4) |
|
Definition
1. An immune response (monouclear cells such as plasma cells & lymphocutes)
2. Accumulation of macrophages
3. Healing through development of granulation tissue (tissue fibrosis & angiogenesis(
4. Ongoing tissue injury & necrosis |
|
|
Term
| What happens if an antigen persists for several days in a tissue? |
|
Definition
activated T cells, blasma cells & macrophages will accumulate
tissue necrosis
fibrosis |
|
|
Term
| What determines whether chronic inflammation is successful? |
|
Definition
Degree of:
-activation & killing by T cells
-antibody formation by plasma cells
-activation of macrophages & lymphokines |
|
|
Term
| What characterizes granulomatous inflammation? |
|
Definition
| aggregates of activated macrophages that assume an epitheloid appearance |
|
|
Term
| What are epitheloid cells? |
|
Definition
activated macrophages which characterize granulomatous inflamation
-pale foamy cytoplasm due to lots of RER |
|
|
Term
| What causes granulomatous inflammation to develop? |
|
Definition
Impaired ability to phagocytise/destroy a causal agent
-causal agent may be phagocytized but persist within the macrophages
-may not be able to phagocytize the agent |
|
|
Term
| What is required for granulomatous inflammation to develop? Why? |
|
Definition
An active T-cell mediated immune response
-T cells produce lymphokines which cause macrophages to remain in the area, forming granulomas |
|
|
Term
| What causes granulomatous inflammation in tuberculosis? |
|
Definition
| mycobacteria survive inside macrophages in the lungs, forming granulomas |
|
|
Term
| What are some differential diagnoses for granulomatous inflammation? (5) |
|
Definition
1. Atypical bacteri
2. Fungal pathogens within tissues
3. Parasites within tissues
4. Inert foreign bodies
5. Immune-mediated diseases |
|
|
Term
| What are the two types of leprosy? |
|
Definition
Tuberculoid
-strong T cell response causing development of granulomas
Lepromatous
-poor T cell response so bacillus multiplies in the macrophages |
|
|
Term
| What happens to tissue affected by granulomas? |
|
Definition
-surrounding tissue will be lost due to necrosis
-scar tissue will replase it
-caseous necrosis is common
-adjacent granulomas may fuse & form large masses |
|
|
Term
| What are foreign body granulomas? |
|
Definition
inert, non-antigenic foreign material enters a tissue
-lots of macrophages congregate around to phagocytise it |
|
|
Term
|
Definition
-immunologically privileged keratin (hairs) embedded within tissues induce a foreign body reaction causing a granulomatous response
ingrown hair! |
|
|
Term
| What characterizes non-granulomatous chronic inflammation? |
|
Definition
-sensitize lymphocytes
-plasma cells
-macropages
-areas of necrosis & fibrosis
(no epitheloid cells!) |
|
|
Term
| What are some causes of non-granulomatous chronic inflammation? |
|
Definition
Chronic viral infections
Other chronic infections
Chronic autoimmune diseases
Allergic conditions & parasitic infections
Chronic toxic dieases (alcohol consumption) |
|
|
Term
| What is chronic suppurative inflammation? |
|
Definition
-body cannot clear a strong pyogenic (pus-producing) stimulus
-may have thick fibrous walls surrounding an area of suppurative inflammation & necrosis |
|
|
Term
| What is granulation tissue? |
|
Definition
mixture of fibrous connective tissue & new capillaries
-often walls off damaged tissue to form an abcess |
|
|
Term
| _______ are round cyst-like structures with a thick fibrous wall & central cavity filled with large quantities of pus & debris |
|
Definition
|
|
Term
|
Definition
| infection of bone with pyogenic bacteria |
|
|
Term
| What are the two types of osteomyelitis? |
|
Definition
Hematogenous
-bacteria carried by bloodstream
Secondary Osteomyelitis
-bacteria develop secondary from a wound/adjacent site of infection e.g. open fracture site |
|
|
Term
| Why are children at risk of hematogenous osteomyelitis? |
|
Definition
| their epiphyseal cartilage (growth plates) are highly vascular, increasing the likelihood of 'seeding' with bacteria |
|
|
Term
|
Definition
| fragment of dead, infected bone that persists despite inflammatory response trying to clear it out |
|
|
Term
| Why is chronic osteomyelitis difficult to resolve? |
|
Definition
| destruction of local blood supple means leukocytes & systemic antibodies cannot access the site of infection |
|
|
Term
| Why would you see anemia with chronic inflammation? |
|
Definition
-limited production of RBCs due to decreased transport of Fe into the plasma
-reduces formation of hemoglobin-Fe complexes leading to anemia |
|
|
Term
| Why are antibiotics often not effective in resolving chronic suppurative inflammation? |
|
Definition
| the bacteria involved are often isolated to an area with no blood supply, allowing them to continue to grow & multiply |
|
|
Term
| What is amyloid? What are the 3 common derivatives? |
|
Definition
beta-pleated fibrillar protein
Derived from
-serum amyloid-associated non-immunoglobullin protein (produced by liver) AA type
-immunoglobulin light chains (produced by plasma cell or B cell tumours) AL type
-amyloid beta (cerebral plaque in Alzheimers) AB type |
|
|
Term
| What are the classifications of amyloidosis? (3) |
|
Definition
Systemic
Localized
Familial |
|
|
Term
| What is systemic amyloidosis? (2) |
|
Definition
Primary
-AL type
-associated with cancer
Reactive
-depositions of amyloid widely in body associated with chronic inflammatory diseases e.g. tuberculosis |
|
|
Term
| What is localized amyloidosis? (2) |
|
Definition
-associated with amyloid plaques in the brain (Alzheimers)
-depositions in some endocrine tumours |
|
|
Term
| What is familial amyloidosis? |
|
Definition
| inherited disorders causing local deposition of amyloid in heart/kidney/nervous tissue |
|
|
Term
| Why is amyloid deposition significant? |
|
Definition
-can cause enlarged tissues, less flexible
-inhibits diffusion of nutrients across interstitium |
|
|
Term
| What would be the effect of amyloi in the renal glomerulus? |
|
Definition
| inhibited filtration mechanism, causing protein loss in the urine |
|
|
