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Disease: Exam 1 Inflammation and Repair
inflammation and repair
216
Anatomy
Graduate
01/13/2011
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Term
Inflammation is the body's response to ___ , Give examples. Its purpose is to ___ the cause of ___ and initiate __ and ___
 Definition
- injury
- ischemic, infectious, immunologic, neoplastic
- eliminate cause of injury
- initiate healing and repair
Term
Ischemia will cause ___, which will be seen as elevated ____ in a CBC. This is indicative of a heart attack.
 Definition
inflammation
WBC
Term
chronic inflammation:
 Definition
something that body cannot eliminate like fungus or TB
Term
Acute inflammation:
 Definition
- usually at onset of injury such as infection, necrosis
Term
Chronic inflammation:
 Definition
- non-healing acute inflammation
- bacteria or microorganisms that cannot be eliminated (TB or fungus)
- foreign material or inorganic material (suture)
- immune reactions
Term
Acute inflammation is the ___ response to tissue injury resulting in the production of inflammatory ___ ___ which affect __ ___ and attract ___ ___ ____. This results in accumulation of ___ and ___ ____ ____. It is limited to __ and ___.
 Definition
- initial
- vasoactive mediators
- blood vessels
- inflammatory chemotactic cells
- fluid
- white blood cells
- hours and days
Term
2 roles of mediators:
 Definition
- affect blood vessels
- send out signals that attract inflammatory chemotactic cells (neutrophils, eusiniophils, monocytes)
Term
why does acute inflammation only last hours do days?
 Definition
mediators and inflammatory cells have short half lives
Term
Three major components of acute inflammation:
 Definition
1. alterations in vascular caliber that lead to an increase in blood flow> erythema
2. structural changes in microvasculature that permit plasma proteins and leukocytes to leave circulation> edema and swelling
3. emigration and accumulation of leukocytes (neutrophils) from the microcirculation to focus injury and their activation to eliminate offending agent
Term
with acute inflammation what kind of leukocyte are you dealing with?
 Definition
neutrophils
Term
main vasoactive mediator involved with acute inflammation:
 Definition
histamine
Term
4 classic signs of acute inflammation:
 Definition
Calor (heat)
Dolor (pain)
Rubor (redness)
Tumor (swelling)
Term
Rubor with acute inflammation is due to:
 Definition
increased blood flow from vasodilation (histamine)
Term
Tumor with acute inflammation is due to:
 Definition
increased vessel wall permeability which allows plasma proteins to go into perivascular space> edema
Term
Dolor with acute inflammation is mediated by :
 Definition
prostaglandin E2
Term
if acute inflammation is bad enough, one may lose function, this is called:
 Definition
functio laesa
Term
Rubor and Tumor are mediated by ___, while Dolor is mediated by ___.
 Definition
- histamine
- prostaglandin E2
Term
Inflammatory cells include:
 Definition
- eusinophils
- neutrophils
- basophils
- lymphocytes
- monocytes and macrophages

Every Nice Boy Loves Much Mail.
Term
What is the difference between monocytes and macrophages?
 Definition
- monocytes are in circulation
- macrophages are in tissues
Term
Basophils and monocytes are in the ___, while macrophages and mast cells are in ___.
 Definition
blood
tissues
Term
Eusinophills are associated with ___ and ___.
 Definition
allergies
worms
Term
acute inflammatory cells:
 Definition
neutrophils,check lungs for pneumonia, check for UTI etc. , bacterial infection, necrosis
Term
chronic inflammatory cells:
 Definition
lymphocytes and monocytes
Term
other names for a mature neutrophil, main cell of acute inflammation:
 Definition
- segmented neutrophil
- segpolymorphonuclear neutrophil
- polymorphonuclear neutrophils(PMN)
Term
process of acute inflammation and neutrophils:
 Definition
PMNS released and travel to site of inflammation (leukocytosis in peripheral blood is due to these)> leave blood and emigrate to interstitial space> phagocytosis of foreign material, necrotic debris, bacteria, etc.
Term
Majority (60-80%) of lymphocytes are __ ___, not __ ___ (5-15%).
 Definition
majority T cells not B cells
Term
Put leukocytes in order of most in blood to least:
 Definition
Never Let Me Eat Bacon.
- Neutrophils(30-70%)
- Lymphocytes (20-50%)
- Monocytes (2-12%)
- Eusinophils (0-7%)
- Basophils (0-2%)
Term
Inflammation with lots of neutrophils, think ____.
 Definition
bacteria
Term
what is a band neutrophil:
 Definition
- the stage the neutrophil goes through just before becoming mature
- lots of band neutrophils indicate bone marrow is putting things out faster than it should be
Term
differential count:
 Definition
relative concentration of various leukocytes
Term
Most of the neutrophils in blood are mature ___ neutrophils, so if you see lots of immature ___ neutrophils, you know the bone marrow is stressed. This is called a ___ ___.
 Definition
- segmented
- band
- left shift
Term
The really old and really young may not show high WBC with inflammation, thats when you look for the ___ ___.
 Definition
left shift
Term
cells that are increased with a left shift:
 Definition
band neutrophils, metamyelocytes, myelocytes
Term
what can cause a left shift to occur?
 Definition
stress, acute infections, inflammation
Term
prensence of band neutrophils is most likely caused by:
 Definition
acute bacterial infection
Term
Two signs of toxic cytoplasmic changes in neutrophils and what they indicate?
 Definition
- toxic granulations (coarse purple granules)
- dohle bodies
- These are reactive changes to inflammation indicative of acute inflammation from bacterial sepsis
- start patient on antibiotics right away and start looking for infection
Term
leukocytosis:
 Definition
increased WBC count above reference range
- can be neutrophillic, eusinophillic, lymphocytosis, or monocytosis
- most commonly from an increase in neutrophils
Term
Reactive leukocytosis is caused by:
 Definition
- infections, inflammation, necrosis
Term
Malignant leukocytosis is caused by:
 Definition
- leukemia (uncontrolled proliferation of leukocytes, causing an accumulation of leukemic cells in bone marrow and blood)
Term
If you see toxic changes, you know it is ____ leukocytosis.
 Definition
reactive
Term
With neutrophilia it is most likely a ___ ___ .
 Definition
bacterial infection
Term
The recruitment of leukocytes to sites of injury and infection is a multistep process involving attachment of ___ ____ to ___ ____ and their migration through the _____.
 Definition
- circulating leukocytes
- endothelial cells
- endothelium
Term
The sequence of events in the journey of leukocytes from the vessel lumen to interstitial tissue is called _____.
 Definition
extravasation
Term
Extravasation can be divided into the following steps:
 Definition
1. In lumen: margination, rolling, and adhesion to endothelium
2. Transmigration: across endothelium, called diapedesis
3. Migration into interstitial tissues towards the chemotactic stimulus
Term
transmigration across the endothelium is called:
 Definition
diapedesis
Term
steps of Extravasation:
 Definition
- margination, rolling, and adhesion in vessel lumen> transmigration aka diapedesis across endothelium> migration in interstitial tissues towards chemotactic agents
Term
chemotaxis:
 Definition
- process of leukocytes emigration in tissues to the site of injury, locomotion oriented along a chemical gradient
Term
cells that respond to chemotactic stimuli:
 Definition
- granulocytes
- monocytes
- lymphocytes (to a lesser extent)
Term
know about C5A, a chemoattractant agent in the complement system, know it for test, read about it.
 Definition
Term
Both ___ and ___ substances can act as chemoattractants. The most common exogenous agents are ___ ____. Endogenous chemoattractants include the ___ ___, particularly ____ and ___.
 Definition
- exogenous and endogenous
- bacterial products
- complement system
- C5a and cytokines
Term
Neutrophils follow ___ ____ to lead them to the infection site. Then ____ ____ bind to ___ ___. These mediators include: ____, ___ ___, _____ __, which all can lead to ___ formation.
 Definition
- chemical gradients
- chemotactic mediators
- neutrophil receptors
- C5a
- bacterial products
- interleukin 8 (IL-8)
- absess
Term
__ ___ ___ of leukocytes recognize different stimuli and mediate the functions of leukocytes.
 Definition
Cell surface receptors
Term
When activated, leukocytes can:
 Definition
- peform phagocytosis
- kill and degrade microbes
- produce and release mediators
Term
critical steps of phagocytosis:
 Definition
- particle/bacteria binding to receptors on the leukocyte membrane
- engulfment
- fusion of lysosomes with phagocytic vacuoles
- destruction of ingested particles within the phagolysosome
Term
During phagocytosis, ___ ___ may be released into extracellular tissues.
 Definition
granule contents
Term
After phagocytosis, neutrophils rapidly undergo ___ ___ ___ are are ingested by ____.
 Definition
- apoptotic cell death
- macrophages
Term
3 main steps of phagocytosis:
 Definition
1. Opsonization
2. Ingestion
3. Killing
Term
With Opsonization, the first part of ___, ____ attach to the ___ or ___ ___ to enhance ___ recognition and attachment to bacteria.
 Definition
- phagocytosis
- opsonins
- bacteria
- foreign bodies
- neutrophil
Term
Opsonins include:
 Definition
- IgG
- C3b fragment of complement
- C-reactive proteins

Neutrophils have membrane receptors for IgG and C3b so that once these have tagged the bacteria, they can bring the bacteria to the neutrophil.
Term
Explain the ingestion phase of phagocytosis:
 Definition
1. Neutrophils engulf and trap bacteria in vacuoles.
2. Primary lysosomes empty hydrolytic enzymes into phagocytic vacuoles producing phagolysosomes
Term
___ and ___ contain ____ granules, which when released, may contribute to the inflammatory response.
 Definition
- Neutrophils and Monocytes
- lysosomal
Term
Neutrophils have 2 main types of granules, explain:
 Definition
- smaller specific secondary granules contain lysozyme, collagenase, and others.
- larger azurophil primary granules contain myeloperoxidase, bacerticidal factors (lysozyme and defensins), acid hydrolases, and variety of proteases (elastase)
- both types of granules can empty into phacocytic vacuolues that form around engulfed material, or the granule contents can be released into extracellular space
Term
neutrophils are also called ____ ____ or ___. They have nuclei with __ to __ lobes connected by thin ___ threads. Their cytoplasm has two types of granules: small ___ granules, which give the cell a lavendar hue, and ____ granules which are purplish red and are ___.
 Definition
- polymorphonuclear leukocytes (PMNs)
- polymorphs
- 2 to 5 lobes
- chromatin
- neutrophil
- azurophilic
- lysosomes
Term
toxic granulation shows more ____ granules.
 Definition
azurophilic
Term
Endogenous pyrogens:
 Definition
- released from inflammatory cells
- stimulate the hypothalamus thermoregulatory centers
- blocked by inhibitors of cyclooxygenase (aspirin)
Term
Bruton's agammaglobulinemia:
 Definition
- opsonization defect
Term
Chediak-Higashi syndrome:
 Definition
cannot form phagolysosomes
Term
Chronic granulomatous disease:
 Definition
- absents NADPH oxidase and respiratory burst
- cannot kill certain bacteria
Term
MPO deficiency:
 Definition
normal respiratory burst

cannot kill certain bacteria
Term
With Chronic Granulomatous Disease (CGD) there is deficient ___ ____ in cell membranes of ___ and ___, resulting in an absent ___ ___, so that ___ ___ organsims that produce ____ are ___ but not ___. Example bacteria:
 Definition
- NADPH oxidase
- neutrophils and monocytes
- absent respiratory burst
- catalase positive organisms
- H2O2
- ingested but not killed
- Staphylococcus aureus
Term
with Chronic Granulomatous Disease (CGD), infection with a collection of ___ will lead to ___ ___ ____ with ___ inflammation and ____.
 Definition
- neutrophils
- post-infectious granulomas
- chronic inflammation
- granulomas
Term
With Chronic Granulomatous Disease cases person will have chronic infections and granulomas (3 year old kid case). CGD may be suspected with frequent ___ ___ infections, infections with unusual organsims and in places that are uncommon. This can be diagnosed with an ___for ___ ____ activity which would be decreased with CGD.
 Definition
- catalase positive
- assay for phagocytic oxidase
- infrequent infections that might be seen with CGD include Serratia marcescans and Staphylococcus aureus
Term
Chronic Granulomatous Disease prognosis:
 Definition
The prognosis for patients with chronic granulomatous disease has improved over the last 2 decades.
Current median survival duration for a patient with chronic granulomatous disease is estimated to be about 20-25 years, with a mortality rate of 2-3% per year.
The highest mortality rate is in early childhood.
The usual cause of death is infection.
Chronic granulomatous disease has significant clinical heterogeneity in the severity of disease in affected patients.
Term
inflammatory stimulus> plasma protein or cells release> chemical mediators> vascular and cellular reactions of inflammation
 Definition
Term
Two vasoactive amines, ___ and ___, are especially important b/c they are present in ___ ___ in cells and are the ___ mediators to be released during inflammation.
 Definition
- histamine and serotonin
- preformed stores
- first mediators
Term
___ and __ are the first mediators to be released with inflammation and they have ___ half lives.
 Definition
Histamine and serotonin
short
Term
Plasma proteins from three interrelated systems are responsible for much of the inflammatory response. What are these three systems?
 Definition
- Complement system
- Kinin system
- Clotting system
Term
The major source of Histamine are __ ___ that are normally present in ___ tissue adjacent to __ ___. Histamine is also found in blood ___ and ___.
 Definition
- mast cells
- connective
- blood vessels
- basophils
- platelets
Term
Preformed histamine is present in ___ __ ___ and is released by ___ ___ ___ in response to a variety of stimuli.
 Definition
- mast cell granules
- mast cell degranulation
Term
How does histamine cause swelling and edema?
 Definition
- increases the permeability of venules so that fluid comes out> swelling and edema
Term
Histamine and serotonin increases permeability of small veins and thus cause swelling and edema.
 Definition
Term
Histamine increases the permeability of ___ and ___ but constricts ___ ___.
 Definition
- venules and arterioles
- constricts large arteries
Term
principle mediator of the immediate transient phase of increased vascular permeability.
 Definition
histamine
Term
Serotonin aka ______ is a preformed ___ ___ with actions similar to those of ____.
 Definition
- 5-hydroxytryptamine
- vasoactive mediator
- histamine
Term
The Compliment System has very important acute inflammation mediators. ___ is important for leukocyte adhesion, chemotaxis, and activation. It is a powerful ___ ___ for neutrophils, monocytes, eusinphils, and basophils.
 Definition
- C5a
- chemotactic agent
Term
The Compliment System is also important for the phagocytosis phase in acute inflammation. ___ and its product when fixed to the bacterial cell wall, act as ____ and favor phagocytosis by ___ and ___, which bear cell surface receptors for these complement fragments.
 Definition
- C3b
- opsonins
- neutrophils
- macrophages
Term
neutrophils and macrophages have receptors for C3b b/c C3b opsonizes stuff for phagocytosis.
 Definition
Term
The Compliment System is also important for the vascular phenomena that occur during acute inflammation. ___, ___, and to a lesser extent, ___, stimulate histamine release from ___ cells and thereby increase the vascular permeability and cause ____.
 Definition
- C3a, C5a
- C4a
- mast cells
- vasodilation
Term
Bradykinin increases ___ ___ and causes __ of smooth muscle, ____ of blood vessels, and ___ when injected into the skin.
 Definition
- increases vascular permeability
- contraction of smooth muscle
- dilation of blood vessels
- pain
Term
Arachidonic acid metabolites are synthesized by what two major classes of enzymes?
 Definition
- cyclooxygenases: prostaglandins and thromboxanes
- lipooxygenases: leukotrienes and lipoxins

Think: arachidonic acid is made by CPT and LLL.
Term
Arachidonic acid metabolites binds to receptors on many cell types and can mediate almost any step of inflammation, such as:
 Definition
- vasoconstriction
- vasodilation
- increased vascular permeability
- chemotaxis
- leukocyte adhesion
Term
What would medications that suppress cyclooxygenase do?
 Definition
- reduce inflammation in vivo by preventing synthesis of arachidonic acid metabolites
- Aspirin
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- COX-2 Inhibitors
Term
What does Aspirin, NSAIDs, and COX-2 inhibitors have in common?
 Definition
- all anti-inflammatory drugs
- all act by inhibiting cyclooxygenase activity which prevents arachidonic acid metabolites from being made and causing inflammation
Term
Cytokins are proteins produced principally by ___ ___ and ____, but also ___, ____, and ___ ____ cells.
 Definition
- activated lymphoctyes and macrophages
- endothelium, epithelium, connective tissue cells
Term
what makes cytokines?
 Definition
- activated lymphocytes and macrophages
- endothelial cells
- epithelial cells
- connective tissue cells
Term
role of cytokines:
 Definition
modulate the function of other cell types
Term
what are the two major cytokines that mediate inflammation?
 Definition
- tumor necrosis factor (TNF)
- Interleukin-1 (IL-1)
Term
Fibrinous inflammation:
 Definition
- fibrin-rich exudate
- often occurs on the serosal lining of the pericardiaum, peritoneum, pleura
- danger of adhesions
-
Term
Serous Inflammation:
 Definition
- thin, watery, exudate
- insufficient amount of fibrinogen to produce fibrin
Term
4 types of inflammation:
 Definition
1. Purulent inflammation
2. Fibrinous inflammation
3. Serous inflammation
4. Pseudomembranous inflammation
Term
purulent inflammation is aka as:
 Definition
suppurative inflammation
Term
pus has lots of :
 Definition
protein and acute inflammatory cells
Term
If you see purulent inflammation, think ___ infection and ____ necrosis.
 Definition
- bacterial
- liquefactive
- this is what happens when appendix ruptures
Term
skin abscess:
 Definition
infection characterized by collection of pus underneath portion of skin
Term
A strain of staph that is resistant to most broad spectrum antiobiotics used to treat it, this can be fatal:
 Definition
- methicillin-resistant Staphylococcus aureus
- aka MRSA
Term
serous exudate:
 Definition
looks like serum, clear, few cells, protein poor fluid, acute and chronic inflammation
Term
Fibrinous exudate:
 Definition
more protein has become fibrinogen> fibrin
- more acute inflammation than chronic
Term
Fibrinopurulent exudate:
 Definition
fibrin and PMNs
Term
Suppurative exudate:
 Definition
purulent, PMNs

ACUTE INFLAMMATION ONLY
Term
Exudate is inflammatory ___ fluid that has a high ___ concentration, cellular debris, and a specific gravity above 1.020. It implies significant alteration in the normal ____ of ___ ___ ___ in the area of injury.
 Definition
- extravascular
- protein
- permeability
- small blood vessels
Term
Pus ( purulent exudate): inflammatory exudate rich in leukocytes (mostly neutrophils), the debris of dead cells and, in many cases, microbes
 Definition
Term
Pseudomembranes: layer of exudate over injured tissue; necrotic debris , fibrin, and neutrophils
 Definition
Term
Ulcerative: loss of epithelium, surface layer
Pse
 Definition
Term
Exudation is the escape of ___, ____, and ___ ___ from the vascular system into the interstitial tissue or body cavities.
 Definition
- fluid, proteins, and blood cells
Term
Edema is excess fluid in ___ or ___ cavities. It can be either ___ or ___.
 Definition
- interstitial or serous cavities
- transudate or exudate
Term
Transudate is fluid with a ___ ___ content, most of which is albumin, and a specific gravity less than ___. It is basically an ____ of blood plasma that results from ___ or ____ imbalance across the vessel wall ____ an increase in vascular permeability.
 Definition
- low protein
- less than 1.012
- ultrafiltrate
- osmotic or hydrostatic
- WITHOUT AN INCREASE IN VASCULAR PERMEABILITY
Term
the type of fluid involved with vascular permeability?
 Definition
exudate
Term
the type of fluid NOT involved with vascular permeability?
 Definition
transudate
Term
Would a heart failure patient have transudate or exudate edema?
 Definition
Transudate the edema is caused by imbalance of osmotic and hydrostatic pressures, not by a change in vascular permeability
Term
Would a kidney failure patient have transudate or exudate?
 Definition
transudate b/c losing protein in kidneys, so low systemic oncotic pressure> edema
Term
with kidney and heart disease you have ___. with kidneys it's because of ___ ___ pressure. with heart its due to ___ ___ pressure.
 Definition
- transudate
- decreased osmotic pressure
- incresed hydrostatic pressure
Term
friction blister would cause:
 Definition
serous exudate b/c increased permeability of vessels
Term
granulocytes include:
 Definition
neutrophils
eusinophils
basophils

Think Granny Ben
Term
Systemic effects of inflammation:
 Definition
- fever
- liver synthesis of proteins: C-reactive proteins and other serum markers of inflammatin
- plasma cell secretion of immunoglobulins
- leukocytosis aka leukopenia
Term
if you see leukocytosis/penia of neutrophils, you are dealing with:
 Definition
- bacteria
- necrosis
- acute inflammation
Term
If you see leukocytosis/penia of lymphocytes, you are dealing with:
 Definition
- viral
- immunologic
- chronic inflammation
Term
If you see leukocytosis/penia with eusinophils, you are dealing with:
 Definition
- allergic reaction
- asthma
- hay fever
- parasites
Term
If you see leukocytosis/penia with monocytes, you are dealing with:
 Definition
chronic infection
Term
Laboratory manifestations of inflammation:
 Definition
- hepatic synthesis of positive acute phase reactants
- increased cytokines
- index of inflammation is used to monitor acute inflammatory disorders
- non-specific, no info for cause or site> creactive protein
Term
Erythrocyte Sedimentation Rate (Sed Rate):
 Definition
- elevation is non-specific index of inflammation
- used better for chronic inflammation, increases more slowly than CRP for acute inflammation
- measures the stacking difference of in vitro red blood cells
- inflammatory proteins promote the rapid sedimentation of red cells
Term
the faster the sed rate, the more inflammaotry proteins there are
 Definition
Term
Sed rate= nonspecific measurement, just confirms thought of inflammation
 Definition
Term
Acute inflammation laboratory manifestations:
 Definition
- increased acute phase reactants
- alters the serum protein electrophoresis pattern by:
- increases catabolism of prealbumin, albumin, and transferrin
- decreased albumin with elevated alpha 1 and alpha 2 globulins
Term
what does acute inflammation do the serum protein electrophoresis pattern:
 Definition
- increased catabolism of prealbumin, albumin, and transferrin
- decreased albumin
- increased alpha 1 and alpha 2 globulins
Term
inflammatory cell response can be leukocytosis (increased cells) or leukopenia (decreased cells). this is determined by type of microorganism and type of injury
 Definition
Term
types of leukocytosis:
 Definition
: neutrophilia, lymphocytosis, eosinophilia, monocytosis
Term
types of leukopenia:
 Definition
neutrophenia, lymphocytopenia
Term
Granuloctyes:
 Definition
Basophils
Eusinophils
Neutrophils
Banded neutrophils
Term
MONONUCLEAR CELLS ARE :
 Definition
CHRONIC INFLAMMATORY CELLS
- monocytes
- lymphocytes
Term
basophils are the same thing as :
 Definition
mast cells
Term
Complete Blood Cell (CBC) count provides information about the absolute and relative numbers of blood cells in a specimen of blood
 Definition
Term
Cytosis: increased
Leukocytosis, neutrophilia, lymphocytosis,
Cytopenia: decreased
Leukopenia=Low WBC count
Neutropenia=Low neutrophil count
Lymphocytopenia
 Definition
Term
Leukocytosis Usually affects a specific type of leukocyte- neutrophil, basophil, eosinophil, lymphocyte
 Definition
Term
reactive leukocytosis happens in response to:
 Definition
infection
inflammation
tissue necrosis
Term
acute inflammation can become an abscess with ____ necrosis.
 Definition
liquefactive
Term
possible outcomes for acute inflammation:
 Definition
- resolution and healing
- scar
- abscess: PMNs, liquefactive necrosis, pyogenic (staphylococcus)
- progession to chronic inflammation
Term
Chronic inflammation:
 Definition
non-healing acute inflammation, prolonged duration
bacteria or any microorganisms that cannot be eliminated (Tb, Fungi, etc)
Foreign material or inorganic material (suture)
Immune reactions
Term
Chronic inflammation arises with persistent infections by certain microorganisms, such as ___ ___, ___ ___( the cause of syphilis), and certain ___, ____, and ___. These organisms are of ___ toxicity and evoke an immune reaction called ___ ___ ____. The inflammatory response sometimes takes a special pattern called ___ ____.
 Definition
- tubercle bacilli
- Treponema pallidum (syphilis)
- viruses
- fungi
- parasites
- low
- delayed type hypersensitivity
- granulomatous reaction
Term
Silicosis:
 Definition
chronic inflammatory lung disease caused by silica
Term
With autoimmune diseases, ____ evoke a self perpetuating immune reaction that results in chronic inflammation and damage. This is seen with rheumatoid arthritis and lupus erythematous.
 Definition
autoantigens
Term
inhaled silica(coal mine dust)> macrophages try to engulf it but cannot> macrophages die and accumulate> fibrous nodule> hindered lung expansion and gas exchange. What are they symptoms and complications of this?
 Definition
- breathing difficulty
- coughing
- chest pain
- general weakness
- predisposes patient to tuberculosis, pneumonia, lung cancer, bronchitis, and emphysema
Term
tattoos are a form of chronic inflammation. the dye goes in the macrophages, and the macrophages can't digest it, so it just sits there.
 Definition
Term
Chronic inflammation is mediated by cells with a longer life span and shorter half life than those that mediate acute inflammation. list the cells of chronic inflammation.
 Definition
- macrophages
- plasma cells
- lymphocytes
Term
Necrosis is present with ___ inflammation, while fibrosis is more predominant with ___ inflammation.
 Definition
- acute
- chronic
Term
main immunoglobin with acute inflammation:
 Definition
IgM
Term
main immunoglobin with chronic inflammation:
 Definition
IgG
Term
serum protein electrophoresis effect with acute inflammation:
 Definition
mild hypoalbuminemia
Term
serum protein electrophoresis effect of chronic inflammation:
 Definition
- greater hypoalbuminemia
- polyclonal gamopathy
Term
chronic inflammatory cells are :
 Definition
non-segmented
mononuclear
Term
Role of plasma cells and B lymphocytes:
 Definition
immune cells that secrete antibodies against foreign agents
Term
role of T lymphocytes:
 Definition
cellular immunity
Term
Macrophages are ___ ___ and ____many proteins.
 Definition
- tissue monocytes
- secrete
Term
Vascular response to chronic inflammation:
 Definition
angio-neogenesis, increased vascularity
Term
cellular response to chronic inflammation:
 Definition
infiltrates of lymphocytes, macrophages, and plasma cells (chronic pyelonephritis), granulomatous inflammation (TB)with and without caseating necrosis, eosinophils due to parasites and allergies
Term
with acute inflammation vasculature becomes more ____. With chronic inflammation ___ ___ forms.
 Definition
- permeable
- new vasculature
Term
examples of caseating necrosis:
 Definition
TB, silica, tattoo
Term
granulomatous inflammation:
 Definition
Elicit an acute inflammatory reaction, but persist as a chronic inflammatory reaction
Has some indigestible component that is stored in cytoplasm of macrophages for an indefinite period
Aggregate to form granulomas
TB, fungus, foreign body reaction
Term
Activated macrophages are called ___ cells. These are what die and accumulate with TB.
 Definition
epithelioid cells

these activated macrophages fuse and become multinucleated giant cells
Term
With TB what causes the casseous necrosis?
 Definition
lipids from the killed bacillus
Term
in a case of acute appendicitis what would expect the organ to look like?
 Definition
purulent b/c acute inflammation>increased vascular permeability
Term
chronic inflammation can resolve and not scarr, but also does scarr sometimes too.
 Definition
Term
repair of wound by regeneration depends on:
 Definition
- ability of cells to replicate
- ability to repair and restore normal structures
Term
cells can only replicate in what kinds of organs:
 Definition
organs that are composed of cells that are normally proliferating or can be induced to proliferate
Term
define stem cells:
 Definition
- labile = constantly dividing cells
Term
give examples of tissues with labile cells:
 Definition
- skin epidermis
- bone marrow cells
- GI epithelia
- respiratory mucosal cells
Term
what type of cells are most vulnerable to chemotherapy?
 Definition
- labile cells that are constantly dividing
- skin epidermis
- bone marrow cells
- GI epithelial
- respiratory mucosa
Term
As long as the ___ ___ is intact in the GI epithelia, regeneration back to normal will occur b/c the ___ cells were preserved.
 Definition
basement membrane
labile

so surface ulcers will recover
Term
restoration to normal after damage requires:
 Definition
- preservation of the basement membrane
- relatively intact extra cellular matrix(collagen and adhesive proteins)
- labile cells to replicate
Term
To reconstitute the surface, the surface has constantly dividing cells, the number of actively dividing stem cells ____ and enter the cell cycle, and the cell cycle time for replication ___, thus no scar is formed.
 Definition
- increase
- decreases
Term
more examples of labile tissues:
 Definition
- skin epidermis
- bone marrow
- GI mucosa
- respiratory epithelium
- lining of oral cavity
- vagina
- cervix
- mucosa of all excretory ducts of glands of body (salivary glands, pancreas, biliary tract)
- uterus (columnar epithelium like GI)
- transitional epithelium of urinary tract
Term
ulcerative cholitis ___ ulcers. Crohns disease ___ ulcers.
 Definition
- surface
- deep
Term
After ulceration of the surface, ___ tissues is converted to a scar composed of ___, ___ ___, ___ ___, and other ___ ____
 Definition
- fibroblasts, dense collagen, elastic tissue, and other ECM components.
Term
Permanent cells are incapable of dividing and cannot replace dead tissue. These cells are capable of ____ but not ____. So ___ ___ replaces the injured cells (fibrosis). Give two examples of this.
 Definition
- hypertrophy
- not hyperplasia
- scar tissue
- brain after stroke
- heart after MI
Term
A one day old MI will show ___ ____.
 Definition
coagulative necrosis
Term
After 3-4 days of an MI there will be ___ ____ ____ infiltrate in the area of the acute MI.
 Definition
- dense polymorphonuclear leukocytic
Term
After approximately 7-10 days of a MI, there will be nearly complete removal of ___ ___ by ____.
 Definition
- nearly complete removal of necrotic myocytes by phagocytosis
Term
granulation tissue is characterized by ___ ___ and ____ ____.
 Definition
loose collagen
abundant capillaries
Term
After an MI you will get a well healed myocardial infarct with replacement of the necrotic fibers by a ___ ____ scar. A few residual cardiac muscle cells will still be there.
 Definition
dense collagenous
Term
after an MI may have CHF or arrhythmia b/c heart doesn't pump and can't conduct as well as it did before b/c of loss of muscle fibers
 Definition
Term
___ cells only divide when forced to. ____ cells cannot divide at all.
 Definition
Stable
Permanent
Term
List 4 steps involved with scar formation:
 Definition
- angiogenesis: new blood vessels with numerous capilaries
- area becomes cellular: fibroblasts and mononuclear chronic inflammatory cells come around
- fibroblasts synthesize collagen to form fibrous scar
- collagen turnover for maturation and shaping of scar
Term
clean surgical wounds with apposed margins heal by ___ ____.
 Definition
primary intention
Term
Steps of primary intention:
 Definition
- scab forms from the blood in the defect, composed of fibrin meshwork
- macrophages phagocytize and secrete proteins to stimulate angiogenesis and collagen synthesis
- cells regenerate at the skin surface
- fibrous union with collagen
- scar maturation
Term
Large gaping, infected wounds heal by ___ ____. With this method, there are more ___ ___, especially ___ if infected. There is more ___ tissue. And wound ___ occurs by ____ to bring the margins of the wound together.
 Definition
- secondary intention
- inflammatory cells
- PMNs
- granulation
- contraction
- myofibroblasts
Term
with secondary intention, the ___ cells cannot restore the architecture so there is more ____ tissue to fill in the wound.
 Definition
parenchymal cells aren't enough
granulation tissue
Term
initial phase of wound contraction involves ___ ____ ____ at the edge of the wound. Permanent wound contraction requires ____.
 Definition
-actin-containing fibroblasts
- myofibroblasts
Term
secondary intention wounds contain more ___ and ___tissue.
 Definition
granulation and fibrous
Term
wounds healed by secondary intention:
 Definition
Require more time to close because the edges are far apart
Show a more prominent inflammatory reaction in and around the wound
Contain more granulation tissue inside the tissue defect
Term
what is the single most imoportant delay in wound healing b/c it results in persistent tissue injury and inflammation.
 Definition
infection
Term
foriegn bodies,even sutures, can impede healing
 Definition
Term
wounds in highly vascularized areas like the ___ heal faster then wounds in poorly vascularized areas like the ___.
 Definition
face
feet
Term
the most common pathogen causing infection with wound healing:
 Definition
Staphylococcus aureus

community acquired methicillin resistant staphylococcus aureus
Term
___ and __ __ deficiencies can also cause poor wound healing.
 Definition
protein
vitamin C
Term
Excess ____ interfere with collagen formation and decrease tensile strength with wound healing.
 Definition
corticosteroids
Term
in healing a skin ulcer what are 2 important growth factors:
 Definition
basic fibroblast growth factor
vascular endothelial growth factor
Term
acuummulation of excessive amounts of collagen leads to a ___ scar. If it grows outside of boundaries of original injury it is a __ scar
 Definition
hypertrophic
keloid
Term
inadequate formation of granulation tissue or assembly of scar can lead to two types of complications:
 Definition
1. Dehiscence or rupture of a wound is most common after abdominal surgery and is due to increased abdominal pressure
2. ulceration
Term
___ tissue is required for normal connective tissue repair.
 Definition
granulation
Term
wounds can ulcerate b/c of inadequate ____ during healilng.
 Definition
vascularization

seen with lower extremity wounds in pple with atherosclerotic peripheral vascular disease
Term
___ is the major fibrous component of connective tissue. ___ __ is required in ___ reactions in collagen synthesis.
 Definition
- Collagen
- Ascorbic acid
- hydroxylation
Term
Ascorbic acid hydroxylates ___ and ___ in collagen synthesis.
 Definition
proline
lysine
Term
Cross-linking increases the overall tensile strength of collagen (also elastic tissue).
Decreased cross-linking (e.g., vitamin C deficiency) reduces the tensile strength of collagen.
In vitamin C deficiency, the structurally weakened collagen is responsible for a bleeding diathesis (e.g., bleeding into skin and joints) and poor wound healing
 Definition
Term
Ehlers Danlos syndrome (EDS):
 Definition
defects in type I and III collagen
Term
Zinc is a cofactor in ____ ____ in wound remodeling, deficiency leads to poor wound healing.
 Definition
- metalloenzyme collagenase
Term
___ and __ ___ deficiencies lead to decreased cross linking in collagen and poor wound healing.
 Definition
copper and vitamin C
Term
The majority of patients undergoing amputation of the lower limb have peripheral vascular disease, often resulting in significant morbidity and mortality. The incidence of amputations is higher in smokers, rises with age and is higher in men than women, and patients with diabetes
 Definition
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