1
Q
Definition of Inflammation
A
A protective response involving host cells, blood vessels, and proteins and other mediators that is intended to eliminate the initial cause of cell injury, as well as the necrotic cells and tissues resulting from the original insult, and to initiate the process of repair.
2
Q
Primary Purpose of Inflammation (Microbes)
A
Clear infections.
3
Q
Primary Purpose of Inflammation (Stimuli)
A
Clear noxious stimuli.
4
Q
Potential harm of Inflammation
A
The inflammatory reaction and the subsequent repair process can themselves cause considerable harm.
5
Q
Goal of Inflammation
A
Bring the cells and molecules of host defense, including leukocytes and plasma proteins (that normally circulate in the blood), to the site of infection or tissue damage.
6
Q
The 5 R’s of the Inflammatory Response (List)
A
- Recognition of the injurious agent; 2. Recruitment of leukocytes; 3. Removal of the agent; 4. Regulation (control) of the response; 5. Resolution (repair).
7
Q
R1 of Inflammation
A
Recognition of the injurious agent.
8
Q
R2 of Inflammation
A
Recruitment of leukocytes.
9
Q
R3 of Inflammation
A
Removal of the agent.
10
Q
R4 of Inflammation
A
Regulation (control) of the response.
11
Q
R5 of Inflammation
A
Resolution (repair).
12
Q
Cardinal Sign Calor
A
Heat.
13
Q
Cardinal Sign Rubor
A
Redness.
14
Q
Cardinal Sign Tumor
A
Swelling.
15
Q
Cardinal Sign Dolor
A
Pain.
16
Q
Cardinal Sign Functio Laesa
A
Loss of function.
17
Q
Normal Outcome of Inflammation
A
Inflammation is controlled and self-limited.
18
Q
Normal Process following Noxious Stimulus Elimination
A
Decline of the inflammatory reaction followed by repair of the damaged tissue.
19
Q
Outcome if Injurious Agent Cannot be Quickly Eliminated
A
Persistent injury resulting in chronic inflammation.
20
Q
2 Major Components of Acute Inflammation
A
- Vascular changes; 2. Cellular events.
21
Q
Vascular Changes component of Acute Inflammation (List)
A
Vasodilation; Increased vascular permeability; Increased adhesion and migration of leukocytes (through activation of the endothelial cells).
22
Q
Cellular Events component of Acute Inflammation (List)
A
Emigration of the leukocytes (mainly neutrophils) from the circulation and accumulation in the focus of injury (= cellular recruitment); Activation of the leukocytes.
23
Q
Stimulus 1 for Acute Inflammation
A
Infections.
24
Q
Stimulus 2 for Acute Inflammation
A
Trauma.
25
Stimulus 3 for Acute Inflammation
Tissue necrosis.
26
Stimulus 4 for Acute Inflammation
Foreign bodies.
27
Stimulus 5 for Acute Inflammation
Immune reactions (hypersensitivity reactions).
28
Cells that express Pattern Recognition Receptors
Phagocytes, dendritic cells, and many types of epithelial cells.
29
Pattern Recognition Receptor (Example 1)
Toll-like receptors.
30
Pattern Recognition Receptor (Example 2)
Inflammasome.
31
Overall Purpose of Vascular Changes in Acute Inflammation
Both vasodilation and increased vascular permeability are designed to bring blood cells and proteins to sites of infection or injury.
32
Vasodilation in Acute Inflammation is induced by...
Chemical mediators such as histamine.
33
Clinical sign caused by Vasodilation
Erythema and warmth.
34
Hemodynamic result of Vasodilation
Stasis of blood flow.
35
Increased vascular permeability induced by (Mediators)
Histamine, kinins, and other mediators that produce gaps between endothelial cells.
36
Increased vascular permeability induced by (Injury)
Direct or leukocyte-induced endothelial injury.
37
Increased vascular permeability induced by (Fluid)
Increased passage of fluids through the endothelium.
38
What plasma components enter sites of injury due to increased permeability?
Plasma proteins and leukocytes.
39
Result of fluid leak through blood vessels
Edema.
40
Leukocyte Recruitment Step 1
Margination and rolling along the vessel wall.
41
Leukocyte Recruitment Step 2
Firm adhesion to the endothelium.
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Leukocyte Recruitment Step 3
Transmigration between endothelial cells.
43
Leukocyte Recruitment Step 4
Migration in interstitial tissues toward a chemotactic stimulus.
44
Definition of Chemotaxis
Leukocytes move toward infection or injury along a chemical gradient.
45
Chemotactic Substance: Bacterial products
Particularly peptides with N-formylmethionine termini.
46
Chemotactic Substance: Cytokines
Especially those of the chemokine family.
47
Chemotactic Substance: Complement system
Particularly C5.
48
Chemotactic Substance: Arachidonic acid product
Particularly leukotriene B4 (LTB4).
49
Leukocyte Infiltrate Timing (6–12 hours)
Neutrophils.
50
Leukocyte Infiltrate Timing (24–48 hours)
Monocytes.
51
Function of Leukocyte Activation
Leukocytes must be activated to perform their function (e.g., Phagocytosis).
52
Purpose of Secretion of Microbicidal Substances
To destroy and digest extracellular microbes and dead tissue.
53
Downside of secreted Enzymes and ROS
Also capable of damaging normal tissue.
54
Outcome 1 of Acute Inflammation (Resolution) conditions
When injury is limited or short-lived, with minimal tissue damage, and the tissue is capable of regenerating.
55
Outcome 2 of Acute Inflammation (Chronic Inflammation) cause
Offending agent not removed (or may be present from the onset).
56
Outcome 3 of Acute Inflammation (Scarring) causes
Substantial tissue destruction (abscess) and tissue not capable of regenerating.
57
Morphologic Pattern 1 of Acute Inflammation
Serous inflammation.
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Effusion
Fluid in a serous cavity (characteristic of serous inflammation).
59
Example of Serous Inflammation
Skin blister.
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Morphologic Pattern 2 of Acute Inflammation
Fibrinous inflammation.
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Cause of Fibrinous Inflammation
Consequence of more severe injuries resulting in greater vascular permeability.
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Molecule that passes endothelial barrier in Fibrinous Inflammation
Large molecules such as fibrinogen.
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Example of Fibrinous Inflammation
Fibrinous pericarditis.
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Morphologic Pattern 3 of Acute Inflammation
Suppurative (purulent) inflammation and abscess formation.
65
Components of Purulent Exudate (Pus)
Neutrophils, necrotic cells, and edema fluid.
66
Example of Suppurative Inflammation
Abscess.
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Morphologic Pattern 4 of Acute Inflammation
Ulcer.
68
Definition of Ulcer
A local defect, or excavation, of the surface of an organ or tissue that is produced by necrosis of cells and sloughing (shedding) of necrotic and inflammatory tissue.
69
Example of an Ulcer
Aphthous ulcer.
70
Major Cell-Derived Mediator Group 1
Vasoactive amines.
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Histamine Main Effect 1
Vasodilation.
72
Histamine Main Effect 2
Increased vascular permeability.
73
Serotonin Main Effect
Vasoconstriction during clotting.
74
Major Cell-Derived Mediator Group 2
Arachidonic acid metabolites (Prostaglandins, Leukotrienes).
75
AA Metabolites are involved in (3 reactions)
Vascular reactions, leukocyte chemotaxis, and other reactions of inflammation.
76
AA Metabolites are antagonized by
Lipoxins.
77
Major Cell-Derived Mediator Group 3 (Cytokines examples)
TNF, IL-1, IL-6, and Chemokines.
78
Chemokines (Nature)
Proteins, produced by many cell types, usually act at short range.
79
Chemokines Main Effects
Multiple, mainly in leukocyte recruitment and migration.
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Major Cell-Derived Mediator Group 4
Reactive Oxygen Species (ROS).
81
ROS Effect 1
Microbial killing.
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ROS Effect 2
Tissue injury.
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Major Cell-Derived Mediator Group 5
Nitric Oxide (NO).
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NO Effect 1
Microbial killing.
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NO Effect 2
Vasodilation.
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Major Cell-Derived Mediator Group 6
Lysosomal enzymes.
87
Lysosomal Enzymes Effect 1
Microbial killing.
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Lysosomal Enzymes Effect 2
Tissue injury.
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Major Plasma Protein-Derived Mediator Group 1
Complement proteins.
90
Triggers for Complement System Activation
Microbes or antibodies.
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Complement System Function 1
Leukocyte chemotaxis.
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Complement System Function 2
Opsonization and phagocytosis of microbes and other particles.
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Complement System Function 3
Cell killing.
94
Major Plasma Protein-Derived Mediator Group 2
Coagulation proteins.
95
Coagulation proteins pathway starts with...
Activated factor XII (Hageman factor).
96
Cascades triggered by Activated Factor XII (List 4)
Clotting cascade, Kinin cascade, Complement cascade, and Fibrinolytic system.
97
Major Plasma Protein-Derived Mediator Group 3
Kinins.
98
Final product of the Kinin cascade
Bradykinin.
99
Bradykinin Effect 1
Increased vascular permeability.
100
Bradykinin Effect 2
Arteriolar dilation.
101
Bradykinin Effect 3
Pain.
102
Bradykinin Effect 4
Bronchial smooth muscle contraction.
103
Definition of Chronic Inflammation
Inflammation of prolonged duration (weeks to years) in which continuing inflammation, tissue injury, and healing, often by fibrosis, proceed simultaneously.
104
Characteristic 1 of Chronic Inflammation
Infiltration with mononuclear cells, including macrophages, lymphocytes, and plasma cells.
105
Characteristic 2 of Chronic Inflammation
Tissue destruction, largely induced by the products of the inflammatory cells.
106
Characteristic 3 of Chronic Inflammation
Repair, involving new vessel proliferation (angiogenesis) and fibrosis.
107
Cause 1 of Chronic Inflammation
Persistent infections.
108
Example of Persistent Infection (Syphilis)
Treponema pallidum.
109
Example of Persistent Infection (Tuberculosis)
Mycobacterium tuberculosis.
110
Cause 2 of Chronic Inflammation
Immune-mediated inflammatory diseases (hypersensitivity diseases).
111
Example of Immune-mediated Inflammatory Disease
Autoimmune diseases.
112
Example of Allergic Disease leading to Chronic Inflammation
Bronchial asthma.
113
Cause 3 of Chronic Inflammation
Prolonged exposure to toxic agents.
114
Example of Prolonged Exposure to Toxic Agents
Inhaled silica (causing silicosis).
115
Dominant cells of chronic inflammation
Macrophages.
116
Macrophages are derived from...
Circulating blood monocytes after their emigration from the bloodstream.
117
Macrophage Activation Pathway 1
Classical pathway.
118
Result of Classical Macrophage Activation
Harmful inflammation.
119
Macrophage Activation Pathway 2
Alternative pathway.
120
Source activating the Alternative Macrophage Pathway
Th2 cells.
121
Result of Alternative Macrophage Activation
Tissue repair and fibrosis.
122
Critical Macrophage Role 1
Ingest and eliminate microbes and dead tissue.
123
Critical Macrophage Role 2
Initiate the process of tissue repair.
124
Critical Macrophage Role 3
Secrete mediators of inflammation, propagating the inflammatory reaction.
125
Critical Macrophage Role 4
Display antigens to T lymphocytes and respond to signals from T cells.
126
Role of Lymphocytes in Chronic Disease
Major drivers of inflammation in many autoimmune and other chronic inflammatory diseases.
127
B lymphocytes may develop into...
Plasma cells, which secrete antibodies.
128
Activated CD4+ lymphocytes secrete...
Cytokines.
129
Function of TH1 cells (Cytokine)
Produce the cytokine IFN-γ.
130
Definition of Antigen Presentation
Display antigens to T lymphocytes and respond to signals from T cells.
131
Function of TH1 cells (Activation)
Activates macrophages in the classical pathway.
132
Cytokines secreted by TH2 cells (List 3)
IL-4, IL-5, and IL-13.
133
TH2 cells activate macrophages via...
The alternative pathway of macrophage activation.
Physiology and pathology
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