Inflammation

Question 1

Five Cardinal Signs of Acute Inflammation

Answer 1

1. /2. Heat and Redness: due to increased blood flow through dilated blood vessels
2. Swelling: result of increased passage of fluid from dilated and permeable blood vessels into the surrounding tissues.
3. Pain: due to the direct effects of mediators, either from initial damage or that resulting from the inflammatory response itself, and the stretching of sensory nerves due to edema.
4. Loss of Function: refers to either simple loss of mobility in a joint, due to edema and pain, or to the replacement of functional cells with scar tissue.

Question 2

What role do Granulocytes play? Examples?

Answer 2

• Complicated nuclei 2-5 lobes
• Specialist cytoplasmic granules
• Activation of other immune cells

Types:

• Neutrophils
• Eosinophils
• Basophils

Question 3

_________:Inflammatory fluid composed mainly of neutrophils, plasma proteins and cellular debris

Answer 3

Pus

Question 4

___________:Any inflammatory process containing, consisting of or forming pus. Typical inflammations due to bacterial infections (e.g. purulent meningitis)

Answer 4

Purulent

Question 5

____________: Any inflammatory process that contains, consists of or forms serum or a fluid having a watery consistency

Answer 5

Serous

Question 6

Transudate versus Exudate?

Answer 6

•Transudate

Fluid low in protein and cellular content, which has passed through an intact membrane (as capillary wall) due to increased hydrostatic pressure or decreased osmotic forces. e.g. pleural fluid seen in heart failure (pleural effusion)

•Exudate

Fluid rich in protein and cellular content (white blood cells) which has leaked out of a tissue or its capillaries due to injury or inflammation. e.g. peritoneal pus seen in acute peritonitis

Question 7

________________: Accumulation of fluid that has escaped from blood vessels or lymphatics. Can be ___________ (non inflammatory) or ____________ (inflammatory).

Answer 7

Effusion:

Accumulation of fluid that has escaped from blood vessels or lymphatics. Can be transudative (noninflammatory) or exudative (inflammatory).

Question 8

Answer 8

Question 9

What kind of Inflammation?

Answer 9

Serous Inflammation

Question 10

Answer 10

Question 11

What type of Inflammation?

Question 12

What Type of Inflammation?

Answer 12

Suppurative Inflammation

Question 13

Answer 13

Question 14

Answer 14

Question 15

Answer 15

Question 16

Purulent meningitis is an example of_____________?

Answer 16

Acute inflammation

Question 17

Acute Inflammation Outcome:

•________________

(Complete regeneration, repair)

•________________

(Healing by connective tissue replacement)

•________________

(Acute inflammation cannot be resolved)

Answer 17

Acute Inflammation Outcome:

•Resolution

(Complete regeneration, repair)

•Healing by Fibrosis (Scar)

(Healing by connective tissue replacement)

•Progression to Chronic Inflammation

(Acute inflammation cannot be resolved)

Question 18

Threshold of different types of inflammation

Answer 18

Acute: Hours to Days

Subacute: 2-6 weeks

Chronic: Weeks to months

Question 19

What is unique about a Granulomatous Inflammation

Answer 19

• Distinct type of chronic inflammation with specific clinical correlations
• Modified Macrophage: Epithelioid Histiocyte
• May Coalesce to form Multinucleated Giant Cells

Question 20

__________________:

‒A compact collection of mature epithelioid histiocytes/multinucleated giant cells with peripherally palisaded histiocytes +/-collar of lymphocytes

‒May demonstrate central necrosis

Answer 20

Granuloma:

‒Compact collection of mature epithelioid histiocytes/multinucleated giant cells with peripherally palisaded histiocytes +/-collar of lymphocytes

‒May demonstrate central necrosis

Question 21

What makes diagnosing Granulomatous Infections?

Answer 21

INFECTIOUS AGENTS: Difficult to stain, culture, diagnose and treat if you’re not expecting them

• •Tuberculosis*
• •Leprosy*
• •Syphilis*
• •Cat scratch disease*
• •Fungi –Histoplasma, Cryptococcus*
• •Parasites –schistosomiasis*

Question 22

_________________

• Pale, white nodule
• Usually well circumscribed
• With caseous necrosis (e.g. Tuberculosis)
• Without necrosis (e.g. Sarcoidosis)

Answer 22

Granuloma

Question 23

Answer 23

Question 24

Phases of Wound Healing

Answer 24

Inflamatory

1. Coagulation
2. Inflammation

Proliferative

3. Granulation tissue formation
   a) Angiogenesis: capilaries to bring in more nutreients
   b) Fibroblast proliferation: lay down collagen, scafolding for regeneration
   c) Synthesis of Extracellular matrix

Remodeling

4. Parenchymal proliferation (if possible)
5. Contraction
6. Remodelling

Question 25

Describe the proliferative phase of healing? What tissue is created?

Answer 25

**Proliferative Phase: Granulation Tissue** * Initial response to a wound (in terms of healing process) * Consists of richly vascularised connective tissue containing new capillaries, proliferating (myo)fibroblasts, variable number of inflammatory cells (macrophages, plasma cells) * Barrier to infection * Provides scaffolding across which new tissue grows * Infrastructure supplying nutrients

Question 26

Difference between Granuloma and Granulation

Answer 26

**Granuloma**: specific type of chronic inflamtion for specific disease, consists of compact masses of epithelial macropahes **Granulation Tissue**: lots of capiilaries, repair after inflamationduring proliferative phase

Question 27

Healing by **first** versus **second** intention

Answer 27

**First:** well oposed edges, surgical insision. quicker healing **Second:** Larger wounds, ulceration. Abundant granulation tissueHealing takes longer

Question 28

Answer 28

Question 29

Answer 29

Question 30

What forms at the point of a stress fracture?

Answer 30

Callus

Question 31

What ells are the prodemoniant players in chronic inflammation?

Answer 31

Macrophages

Question 32

What roles do **macrophages** play?

Answer 32

* Destroy pathogens, foreign materials, degrade dead cells, debris * Secrete cytokines, growth factors, activate other cells (especially T Cells) * Promote tissue repair, angiogenesis, activate fibroblasts, collagen synthesis (M2 macrophage

Question 33

Difference between M1 and M2 Macrophages

Answer 33

**M1 (Classivally Activated):** responds to triggers from microbes: * proinflamatory role * tries to destroy pathogens * recruits muore leucocytes and cytokines **M2 (Alternatively Activated):** * More interested in repair process of inflammation * Triggered by anti-inflamatory triggers * Promotes tissue repair and myofibroblasts to repair damage from inflamatory response

Question 34

**Role and Activation of Lymphocytes?** Effect on inflammation?

Answer 34

* Amplify and propagate chronic inflammation * More severe and persistent inflammation when lymphocytes are activated