Topic 12 Part 2

Question 1

4 signs of inflammation

Answer 1

redness, pain, heat, swelling

Question 2

goal of inflammation

Answer 2

dispose of microbes/ toxins / foreign materials
Occurs at the site of injury
Prevents the spread
Prepare for repair
Restore homeostasis

Question 3

stages of inflammation

Answer 3

1. Vasodilation- Increase permeability of blood vessels
2. Emigration- Movement of phagocytes from blood to interstitial fluid
3. Tissue repair

Question 4

Increases permeability Allows

Answer 4

antibodies and clotting factors to leave the blood

Question 5

Vasodilation Allows

Answer 5

more blood into an area

-Helps remove microbial toxins and dead cells

Question 6

Factors that cause vasodilation and increased

permeability:

Answer 6

Histamine, Kinins, prostaglandins, leukotrienes, Complement

Question 7

Histamine:

• ____ cells in the tissues release
• ______ and _____ stimulate the release of _____ in the blood
• Causes increased _____ and _______

Answer 7

• Mast cells in the tissues release
• Basophils and platelets stimulate the release of histamine in the blood
• Causes increased dilation and permeability

Question 8

Kinins:
Type of molecule: \_\_\_\_\_\_\_
Induce \_\_\_\_\_\_ and increase \_\_\_\_\_\_\_\_
Act as \_\_\_\_\_\_\_ agent phagocytes
Ex: \_\_\_\_\_\_\_\_

Answer 8

Type of molecule: Polypeptides
Induce vasodilation and increase permeability
Act as chemotaxic agent phagocytes
Ex: bradykinin

Question 9

Prostaglandins:
Type of molecule: _____
Released by _________
Stimulate emigration of ________

Answer 9

Type of molecule: Lipid
Released by damaged cells
Stimulate emigration of phagocytes

Question 10

Leukotrienes:
_______ and ____ cells produced
Increase ______

Answer 10

Basophils and mast cells produced

Increase permeability

Question 11

Complement:
Stimulate _______ release
Attract _______
Promote _________

Answer 11

Stimulate histamine release
Attract neutrophils
Promote Phagocytosis

Question 12

Clotting factors move into tissues

• Initiate the _______
• Fibrinogen converted to fibrin–>Forms ______= Localizes and traps invading organisms/ Blocks spread of organism

Answer 12

• Initiate the clotting cascade

- Fibrinogen converted to fibrin–>Forms fibrin mesh= Localizes and traps invading organisms/ Blocks spread of organism

Question 13

Within 1hour of start of inflammatory process: _____ appear

Answer 13

Phagocytes

Question 14

Inflammation:

Neutrophils _____ to blood vessel wall with increased ______ and attempt to destroy via _______

Answer 14

Neutrophils stick to blood vessel wall with increased blood flow and attempt to destroy via phagocytosis

Question 15

Inflammation:

• _______ follow neutrophils–>Transform into ______ (More potent _______ than neutrophils)
• Eventually macrophages _____
• Leave collection of dead cells and fluid (____)

Answer 15

• Monocytes follow neutrophils–>Transform into macrophages (More potent phagocytes than neutrophils)
• Eventually macrophages die
• Leave collection of dead cells and fluid (Pus)

Question 16

Inflammation: Redness
Large amount of blood in \_\_\_\_\_\_
Local temperatures \_\_\_\_\_
Metabolic reactions \_\_\_\_\_\_
More heat \_\_\_\_\_\_

Answer 16

Large amount of blood in damaged area
Local temperatures increase
Metabolic reactions speed up
More heat released

Question 17

Inflammation: Swelling
Increased _______
More ____ in the area

Answer 17

Increased permeability

More fluid in the area

Question 18

Inflammation: Pain

Symptom of inflammation–

Answer 18

neuron injury or increased pressure (edema)

Question 19

Fever:
\_\_\_\_\_\_\_ increase body temperature
Trigger release of \_\_\_\_\_\_\_ (cause fever)
Helps to inhibit the \_\_\_\_\_ of some microbes
Helps to speed up body \_\_\_\_\_\_
Aids in \_\_\_\_\_\_

Answer 19

Bacteria toxins increase body temperature
Trigger release of interleukin-1 (cause fever)
Helps to inhibit the growth of some microbes
Helps to speed up body reactions
Aids in repair

Question 20

2 components of inflammation

Answer 20

vascular reaction

cellular reaction

Question 21

Acute inflammation=

Answer 21

rapid onset / short duration / emigration of

neutrophils

Question 22

Chronic Inflammation=

Answer 22

long duration / lymphocyte involvement /

proliferation of blood vessels / tissue necrosis

Question 23

Vascular changes purpose=

Answer 23

Maximize movement of plasma proteins and appropriate circulating cells into the site of injury or infection
HOW?? Vasodilation / Increased capillary permeability

Question 24

Vasodilation:
Early ________
_______ involved first, followed by opening of new ____
Induced by variety of mediators (_____ / _____)
RESULT:
Increased ______ which increases ______ and _____ of tissue

Answer 24

Early manifestation
Arterioles involved first, followed by opening of new capillary beds
Induced by variety of mediators (histamine / nitric oxide)
RESULT:
Increased blood flow which increases redness and warmth of tissue

Question 25

Increased Capillary Permeability: - Movement of protein rich fluid into ______ tissue and concentration of red blood cells (_____ change) - Physical changes in ______ structure of capillaries

Answer 25

-Movement of protein rich fluid into extravascular tissue and concentration of red blood cells (viscosity change) -Physical changes in endothelial structure of capillaries

Question 26

Increased Capillary Permeability: Result _____ & ______ changes force fluid into interstitial space (results stasis) / _____ begin adhering to endothelium and moving into interstitial space / physical openings in ______ allow more fluid / protein / cells to migrate

Answer 26

``` Osmotic & hemodynamic changes force fluid into interstitial space (results stasis) / neutrophils begin adhering to endothelium and moving into interstitial space / physical openings in endothelium allow more fluid / protein / cells to migrate ```

Question 27

Extravasation=

Answer 27

movement of leukocytes from vessel lumen to interstitial space

Question 28

Margination=

Answer 28

movement of leukocytes toward the wall of the capillary

Question 29

Rolling=

Answer 29

leukocytes tumble slowly along endothelium, adhere transiently, then are finally attached–endothelium completely lined with white cells

Question 30

Transmigration (diapedesis)=

Answer 30

insert pseudopods into junctions between endothelial cells–move through the junction

Question 31

Chemotaxis=

Answer 31

migrate thru interstitial fluid to source of problem

Question 32

Chemotaxix= Locomotion along ______ Most common exogenous agents are _____ products Common endogenous agents (3)

Answer 32

Locomotion along chemical gradient Most common exogenous agents are bacterial products Common endogenous agents (3) --components of complement (C5a) --products of lipoxygenase pathway (leukotriene B4) --cytokines

Question 33

Leukocyte activation induced by:

Answer 33

microbes / products necrotic cells / antigen-antibody complexes / cytokines

Question 34

results of leukocyte activation (5)

Answer 34

1. production of arachidonic acid metabolites 2. degrannulation and secretion of lysosomal enzymes 3. secretion of cytokines 4. modulation of surface receptors 5. phagocytosis

Question 35

Chemical mediators: originate from

Answer 35

plasma or cells | --plasma derived must be activated cell-derived usually stored in intracellular granules

Question 36

Chemical mediators: Production of active mediators triggered by

Answer 36

microbial products or host proteins (complement, etc.)

Question 37

Chemical mediators: - Usually bind to specific receptors on _______ - One mediator may stimulate the release of other ____ - Mediators can act on more than one _____ - Once activated and released, most are ______ - Most have the potential to cause ______

Answer 37

-Usually bind to specific receptors on target cells -One mediator may stimulate the release of other mediators -Mediators can act on more than one target -Once activated and released, most are short lived -Most have the potential to cause GREAT HARM

Question 38

2 or more present for diagnosis of SIRS: 1. Body temp 2. HR 3. Respiratory Rate 4. Leukocyte count

Answer 38

1. Body temp above 38*C or below 36*C 2. HR >90 BPM 3. Respiratory Rate >20/min Or PaCO2 12,000 cell/mm2 Or Or <10% immature neutrophils

Question 39

CPB produces “whole body” inflammatory response: Wide spectrum of injuries- All come within the “catch all” terms of SIRS

Answer 39

``` Pulmonary Renal Gut Central Nervous system Myocardial dysfunction Coagulopathy** Hemolysis Fever Increase susceptibility to infection Leukocytosis ```

Question 40

Widely accepted that SIRS is induced in all patients undergoing bypass: - -Incidence and severity is _____ (Most have a ___ clinical symptoms / Minority develop severe ____ changes or _____ after bypass.) - -Degree of response is _________ nor type of response. - -Risk factor: ______ (Frequently a risk factor, but not necessarily)

Answer 40

--Incidence and severity is variable (Most have a few clinical symptoms / Minority develop severe hemodynamic changes or organ failure after bypass.) --Degree of response is not predictable nor type of response. --Risk factor: Length of CPB (Frequently a risk factor, but not necessarily)

Question 41

SIRAB: Set in motion _____ mediated events that activate vascular endothelium: Allow further ______ mediated inflammatory injury

Answer 41

Set in motion cytokine mediated events that | activate vascular endothelium: Allow further neutrophil mediated inflammatory injury

Question 42

SIRAB: most common culprit

Answer 42

contact with foreign surface Other factor: Altered arterial blood flow patterns, Sheer stress (blood pumps), Cardiotomy suction, Tissue ischemia, Reperfusion, Hypothermia, Relative anemia, anticoagulants

Question 43

SIRAB: Contact activation=

Answer 43

Blood passes through non-physiologic ECC

Question 44

SIRAB: Activation of contact proteins...

Answer 44

Coagulation factors XII and XI Prekallikrein High molecular weight kininogen

Question 45

SIRAB end result

Answer 45

Formation of bradykinin Conversion of plasminogen into plasmin Initiates fibrinolysis Triggers classical complement cascade

Question 46

Big Picture: 1-Multiple inflammatory mediators are released upon exposure to ECC- Disrupt _____ 2-Generalized whole body inflammatory response: ____ mediated-->Activates _____-->Further _____ injury 3-None occur ____ 4-Stimulate or catalyze other reactions in cycle of ____

Answer 46

1-Multiple inflammatory mediators are released upon exposure to ECC- Disrupt homeostasis 2-Generalized whole body inflammatory response: Chemokine mediated-->Activates vascular endothelium-->Further neutrophil-mediated injury 3-None occur alone 4-Stimulate or catalyze other reactions in cycle of SIRAB

Question 47

Immune System and Bypass: Part 1 1-Post operatively –Shown patients more _____ 2-Noted _____ and ______ are decreased 3-_____ ability of _______ are decreased

Answer 47

1-Post operatively –Shown patients more susceptible to infections 2-Noted serum immunoglobulins and complement are decreased 3-Chemotaxic ability of granulocytes are decreased

Question 48

Immune System and Bypass: Part 2 4- _____ cells are decreased: Number and function 5-____ and _____ cells are decreased 6-____ cells are slightly increased 7-___ number remains low for about 1 week post bypass

Answer 48

4- NK cells are decreased: Number and function 5-CD3+ and CD4+ cells are decreased 6-CD8+ cells are slightly increased 7-Leukocyte number remains low for about 1 week post bypass