Chronic inflammation

Question 1

chronic inflammatory conditions are

Answer 1

incredibly common - not usually life threatening - debilitating (IBD and RA)

Question 2

definition

Answer 2

prolonged inflammation with associated repair

Question 3

characterised by

Answer 3

• Delayed onset - Variable duration (days years) - Variable appearances • No 5 cardinal features - Limits damage, initiates repair - Can cause debilitating symptoms

Question 4

how does chronic inflammation arise

Answer 4

1. Takes over from acute inflammation- if resolution not possible with acute inflammation
2. Develops alongside acute inflammation- severe/persistent irritation
3. Arises “de novo”- without preceding acute inflammation e.g. autoimmune conditions - Rheumatoid arthritis/ IBD/ diabetes

Question 5

sometimes the proportion of cell types can

Answer 5

indicate diagnosis

Question 6

which cells are indicative of rheumatoid arthritis

Answer 6

mainly plasma cells

Question 7

which cells are indicative of chronic gastritis

Answer 7

mainly lymphocytes

Question 8

which cells are indicative of of leishmaniasis (protozoal infections)

Answer 8

mainly macrophages

Question 9

which cells are involved in chronic inflammation

Answer 9

1. Macrophages 2. Lymphocytes- T/B cells 3. Mast cells 4. Eosinophils 5. Fibroblasts 6. Giant cells

Question 10

macrophages in circulation

Answer 10

monocytes

Question 11

macrophages once entering tissue space

Answer 11

macrophage (histiocyte)

Question 12

features of macrophages

Answer 12

• big cells with a large cytoplasm - abundant foamy cytoplasm - slipper shaped nucleus - can look like a cancer cell

Question 13

primary role of maxcrophage

Answer 13

phagocytosis - removal of pathogens/ necrosis/ debris - antigen presentation to immune system

Question 14

secondary role of macrophages

Answer 14

• Also produce inflammatory mediators- controls and regulates inflammatory response

Question 15

macrophages can look different depending on

Answer 15

what stimulus they are eating

Question 16

lymphocyte features

Answer 16

• large, spherical stained nucleus
• thin rim of cytoplasm
• small

subdivided into T and B lymphocytes (cant distinguish appearance- have to use immunohistochemistry)

Question 17

T lymphocytes

Answer 17

CD8+ (protein on surface)- Cytotoxic (MHC I)

CD4+- helper T cells (MHC II)

Question 18

B lymphocyte

Answer 18

Mature into plasma cells

Produce antibodies (immunoglobulins)

Neutralises pathogens

Question 19

plasma cell features

Answer 19

• Nucleus pushed off to one side (eccentric)
• Chromatin in the nucleus clumps into spheres (clock-face)
• Next to the nucleus there is slightly paler staining- peri- nuclear cytoplasmic clearing –> Golgi due to antibody synthesis

Question 20

function of plasma cells

Answer 20

fully differentiated B lymphocytes

Produce antibodies

Question 21

features of eosinophils

Answer 21

• 2 lobes (bilobed nucleus)
• cytolasm stains bright red and granular

Question 22

why is the cytoplasm of an eosinophil bright red and granuklar

Answer 22

• Full of chemical mediators- Histamine, heparin and prostaglandins
• E.g. Release during hypersensitivity reactions and parasitic infections

Question 23

features of fibroblasts/myofibroblasts

Answer 23

• webbed cytoplasm
• stretched nucleus

Question 24

role of fibroblast/myofibroblast

Answer 24

• ‘Prolonged inflammation with associated repair’
• Role in generation and repair
• Produce and secrete and lay down collagen- helping to reconstruct tissue

Question 25

giant cells features

Answer 25

* Multinucleate * HUGE * Fusion of multiple macrophages

Question 26

role of giant cells

Answer 26

* “Frustrated phagocytosis” * Increasing effectiveness of phagocytosis * E.g. if there are any resistant foreign body e.g. suture, resistant parasite of bacteria

Question 27

how many types of giant cell

Answer 27

3

Question 28

name the 3 giant cells

Answer 28

1) Foreign body giant cells 2) Langhans giant cells 3) Touton giant cells

Question 29

1) Foreign body giant cells

Answer 29

To destroy foreign bodies One big cytoplasm Nuclei randomly assorted

Question 30

2) Langhans giant cells

Answer 30

* Nuclei line up around the periphery- horseshoe * Important in TB

Question 31

3) Touton giant cell

Answer 31

* Nuclei line up in a concentric circle in the middle of the cell * Can be seen in fat necrosis

Question 33

which giant cell associated with TB

Answer 33

langhans giant cell

Question 34

which giant cell associated with fat necrosis

Answer 34

touton

Question 35

which type of giant cell

Question 36

which type of giant cell

Answer 36

Langhans

Question 37

which type of giant cell

Answer 37

Touton

Question 38

Effect of chronic inflammation

Answer 38

1. fibrosis 2. impaired function 3. atrophy 4. stimulation of immune response

Question 39

1. fibrosis

Answer 39

* a.Deposition of collagen * b.E.g. chronic cholecystitis, liver cirrhosis

Question 40

impaired function

Answer 40

a. E,g, IBD b. Rarely increased function (e.g. thyrotoxicosis in Graves disease- increase production of T3/T4)

Question 41

atrophy

Answer 41

atrophic gastritis

Question 42

stimulation of immune repsosne

Answer 42

Antigen presentation- chronic --\> brought about by macrophages

Question 43

fibrosis of the gall bladder

Answer 43

thickened and pale- collagen

Question 44

impaired functione xample

Answer 44

idiopathic IBD - Crohns disease - UC

Question 45

crohns disease

Answer 45

- can affect all of the GI tract (mouth to anus) - discontinous patches of inflammation (skip lesions) - inflammation affects full thickness of the bowel (transmural) - sometimes find granulomata - less likely to have rectal bleeding

Question 46

ulcerative colitis

Answer 46

- affects large boewl only - continous inflammation - inflammation affects superficial bowel wall only (mucosa and submucosa only) - no granulomata - more likely to have rectal bleeding

Question 47

cirrhosis

Answer 47

causes impaired function- too much fibrosis and attempted regeneration e. g. Cirrhoic liver - alcohol - hepatitis - drugs and toxins - fatty liver disease

Question 48

granulomatous inflammation found in

Answer 48

chronic inflammation

Question 49

granuloma form

Answer 49

A collection of epithelioid histiocytes (macrophages) with surrounding lymphocytes May also see giant cells within granuloma

Question 50

causes of granulomatous inflammation

Answer 50

1. forgin body reaction 2. infection 3. idiopathic

Question 51

foreign body granulomatous inflammation

Answer 51

Question 52

granuloma caused by infection

Answer 52

e. g. tuberculosis e. g. leprae - dififcult to destory - thick cell walls - mycolic acids

Question 53

idiopathic granuloma

Answer 53

e. g. crohns disease e. g. sacroidosis (mulitple well formed granulomas form on lymph nodes, lungs and skin - shortness of breath, lumps in lymph and skin lumps)