Chronic Inflammation

Question 1

Define Chronic Inflammation

Answer 1

Prolonged inflammation with associated repair

Question 2

How can Chronic Inflammation arise

Answer 2

1. Takes over from acute inflammation
2. “De novo”- Without preceding acute inflammation
3. Alongside acute inflammation

Question 3

Give 3 examples of when Chronic Inflammation can arise “De Novo”

Answer 3

Autoimmune conditions
Prolonged exposure to toxic agents
Chronic infections

Question 4

How does Chronic Inflammation appear
What are the 2 predominant cell types
Name 3 others

Answer 4

Variable appearances
Lymphocytes and Macrophages (Histiocytes)

Eosinophils, Fibro/Myofibroblasts
Giant cells (Granulomatous inflammation

Question 5

Describe the Appearance of a Macrophage in 3 ways

Answer 5

Large cells
Abundant cytoplasm with Phagolysosomes
Can have a Slipper shaped nucleus

Question 6

Outline the functions of Macrophages

Answer 6

1. Phagocytosis and Antigen presentation
2. Synthesis of mediators
3. Control and regulation of inflammatory response

Question 7

Describe the Appearance of a Lymphocyte in 2 ways

Answer 7

1. Small cells

2. Large Central nucleus with thin rim of cytoplasm

Question 8

What are the 2 types of Lymphocyte? How can they distinguished by appearance

Which one has various types and what are the main 2 types. Outline their functions

Answer 8

T and B cells, they can’t

Main 2 T cells are;

• Helper (CD4+): Assist other inflammatory cells
• Cytotoxic (CD8+): Destroy pathogens

Question 9

What does a B cell mature into

Describe the appearance of this in 4 ways

Answer 9

A plasma cell

1. Eccentric Nucleus (Pushed to one side)
2. Clock-face chromatin (Clumped into spheres at edge of nucleus)
3. Peri-nuclear clearing (Golgi)
4. Slightly larger than a T cell

Question 10

Outline the function of a Plasma cell

Give an example

Answer 10

Produces antibodies which neutralise pathogens

Immunoglobulins

Question 11

Regarding its appearance, what does an Eosinophil look like?
In 2 ways explain why

Describe its function, and suggest 2 occasions this happens

Answer 11

1. “Tomato with sunglasses”
2. Bi-lobed nucleus
3. Granular cytoplasm stains red

Releases mediators- Parasitic infestations + Allergic/ hypersensitivity reactions

Question 12

Describe the function of Fibro/ Myofibroblasts

Answer 12

Regeneration and repair by Producing, Secreting and Laying down collagen

Question 13

What are Giant cells

Name 3 and give an example for each of when they are present

Answer 13

Multinucleate cells formed from fusion of macrophages

1. Foreign Body Giant Cell: When a foreign body is present
2. Langhans Giant Cell: Tuberculosis
3. Touton Giant Cell: Fat necrosis/ Xanthomas

Question 14

Describe the Appearance of a Foreign Body Giant Cell

Describe the appearance of a Langhans Giant Cell (What shape oftenly)

Describe the appearance of a Touton Giant Cell

Answer 14

Foreign Body: Randomly arranged nuclei

Langhans: Nuclei around periphery of cell (Horse shoe shape)

Touton: Nuclei arranged in a ring at centre of cell

Question 15

What are the main cell types present in;

1) Rheumatoid arthritis
2) Chronic Gastritis
3) Leishmaniasis

Answer 15

1) Plasma cells
2) Lymphocytes
3) Macrophages

Question 16

What are 4 Complications of Chronic Inflammation

Answer 16

1. Fibrosis (Collagen deposition)
2. Impaired function (Rarely= Increased function)
3. Atrophy
4. Immune response stimulated

Question 17

Give 2 examples of Fibrosis

Give 3 examples for Impaired function

Give 1 example for Atrophy

Answer 17

F: Cirrhosis, Cholecystitis (Gall bladder inflammation)

IF: Ulcerative colitis, Crohn’s disease, Cirrhosis

A: Gastritis

Question 18

How does Fibrosis of the gall bladder(Cholecystitis) occur in 2 steps

How does the gall bladder appear

Answer 18

Repeated obstruction of bile duct by gall stones
Repeated Acute Inflammation bouts-> Chronic

Thickened and pale

Question 19

What are 5 symptoms of Inflammatory Bowel Disease

Answer 19

• Abdominal pain
• Altered bowel motion
• Weight loss
• Rectal bleeding
• Diarrhoea

Question 20

What 2 conditions come under the term, Inflammatory Bowel Disease

Compare them in regards to;

1. Area affected
2. Pattern of inflammation
3. Part of area affected
4. Presence of granulomas
5. Likelihood of rectal bleeding

Answer 20

Crohn’s Disease:

1. Can affect all of GI tract
2. Discontinuous patches of inflammation (Skip Lesions)
3. Transmural (Full thickness of bowel wall affected)
4. Sometimes Granulomas are present
5. Rectal bleeding is less likely

Ulcerative Colitis:

1. Large bowel affected only
2. Continuous
3. Mucosa and Submucosa only
4. No granulomas
5. Rectal bleeding is more likely

Question 21

What stage of liver damage is Cirrhosis

Name 4 causes

What do the nodules on a Cirrhhosed liver show

Answer 21

End stage damage to liver

Alcohol
Hepatitis
Drugs/ Toxins
Fatty Liver disease

Areas of Fibrosis and attempted Regeneration

Question 22

What is a Granulomatous Inflammation

Answer 22

A type of Chronic inflammation in which Granulomas are seen

Question 23

What is a Granuloma

Answer 23

A collection of Epithelioid Histiocytes (Elongated macrophages that are packed together tightly) surrounded by lymphocytes

Question 24

What are 3 causes of Granulomatous Inflammation

Answer 24

• Foreign body presence
• Infection by “tough” bacteria (Hard to destroy)
• Idiopathic infections (Unknown cause)

Question 25

Name 2 “Tough” bacteria | Why are they hard to destroy (2 reasons)

Answer 25

``` Mycobacterium tuberculosis Mycobacterium leprae (Causes leprosy) ``` - Thick cell wall - Mycolic acids (Surface proteins, resist phagocytosis)

Question 26

What is happening in the centre of a Mycobacterium Granuloma Name 2 Idiopathic causes of Granulomatous Inflammation

Answer 26

Caseous Necrosis Crohn’s Disease Sarcoidosis

Question 27

Describe the histological appearance of Crohn’s disease

Answer 27

Non-caseating Granuloma

Question 28

Describe the histological appearance of Sarcoidosis Name 3 organs that are affected and how they present

Answer 28

Multiple Non-caseating granulomas Lymph nodes- Enlarged Lungs- Shortness of breath Skin- Lumps

Question 29

Name 1 condition where eosinophils count is high

Answer 29

Hodgkin’s lymphoma