General Pathology Lecture 8: Chronic Inflammation

Which two cells is chronic inflammation characterized by?

1. Lymphocytes

2. Macrophages

How are tissues affected in chronic inflammation?

Tissue destruction

What two things attempt to repair tissue during chronic inflammation?

1. Proliferation of blood vessels (Angiogenesis)

2. Connective tissue fibrosis

What are the five steps of the inflammatory response?

1. Injury

2. Constriction of microcirculation

3. Dilation of small blood vessels

4. Increase in permeability of small blood vessels

5. Exudate leaves small blood vessels

What is increased blood flow that floods the capillary beds in the injured tissue?

Hyperemia

What two symptoms is hyperemia responsible for in chronic inflammation?

1. Erythema

2. Heat

What is inflammatory fluid formed as a reaction to injury of tissues and blood vessels?

Exudate

What is a passage through the tissues which allows excess exudate to drain called?

Fistula

What is the surgical procedure for the removal of excessive exudate?

Incision and drainage

What effect of inflammation leads to fluid accumulation in tissues?

Vessel permeability

What is the movement of the white blood cells to the periphery of the blood vessel walls called?

Margination

What is the directed movement of white blood cells to the area of injury by chemical mediators called?

Chemotaxis

What is the passage of white blood cells through the endothelium and wall of the microcirculation into the injured tissue called?

Emigration

What action of white blood cells at the site of injury causes tissue damage during inflammation?

Extracellular release of leukocyte products

What are the three cells that are chemical mediators during acute inflammation?

1. Cytokines

2. Prostaglandins

3. Histamine

Which two cells must be made by the cell and furthers inflammation?

1. Cytokines

2. Prostaglandins

Which cell is released from granules and increases vasodilation?

Histamine

What are the three plasma mediators for acute inflammation?

1. Complement

2. Kinins

3. Clotting

Which plasma mediator causes coagulation?

Clotting

What four things must happen for acute inflammation to be resolved?

1. Removal of inflammation mediators

2. Normalization of permeability

3. Halting leukocyte emigration

4. Clearance

What two processes help with clearance in acute inflammation resolution?

1. Lymphatic drainage

2. Macrophage digestion

What are the three conditions that lead to acute inflammation resolution?

1. Injury is limited or short lived

2. Minimal tissue destruction

3. Tissue regeneration

What happens when fibrinous exudates that cannot be absorbed are organized by ingrowth of connective tissue during acute inflammation?

Scarring (Fibrosis)

What two conditions of acute inflammation lead to scarring (fibrosis)?

1. Tissue cannot regenerate

2. Substantial tissue destruction

What is formed during acute inflammation with the presence of pyogenic bacterial or fungal infections?

Abscesses

What three things are happening at once during chronic inflammation?

1. Infiltration with mononuclear cells

2. Tissue destruction

3. Repair

What are the three possible causes of chronic inflammation?

1. Persistant infection

2. Exposure to toxic agents

3. Autoimmune diseases

What are the four chronic inflammation cells?

1. Tissue macrophages

2. T lymphocytes

3. Plasma cells

4. Eosinophils

What is the function of T lymphocytes?

Stimulate macrophage activity by producing cytokines

What is the function of plasma cells?

Make antibodies

What two things are eosinophils associated with?

1. Allergies

2. Parasites

What cells migrate out of the bloodstream and become tissue macrophages through cytokines?

Monocytes

What terminally differentiates into plasma cells

B lymphocytes

What do chemokines allow monocytes to do in order to get them to migrate to tissues?

Bind VCAMs and ICAMs on endothelium

Which cells secrete lymphokines?

T lymphocytes

What is the function of lymphokines?

Recruit and activate macrophages

What are the two factors of activated macrophages?

1. Increased size

2. Produce more lysosomal enzymes and cytokines

What two things do activated macrophages regulate?

1. Local healing

2. Formation of final scar

What are the three systemic manifestations of chronic inflammation?

1. Fever

2. Leukocytosis

3. Acute phase response

What reflects higher plasma levels of acute phase proteins?

Increased erythrocyte sedimentation rate

What kind of inflammation is characterized by granulomas of activated macrophages?

Granulomatous inflammation

What are the five possible causes of Granulomatous Inflammation?

1. Bacterial infections

2. Fungal infections

3. Parasitic infections

4. Inorganic metals/dust

5. Foreign body reactions

What is the main bacterial infection that can cause Granulomatous Inflammation?

Tuberculosis

What pattern is formed with a poor response to Granulomatous Inflammation?

Miliary

What are the cells in the center of a granuloma during Granulomatous Inflammation?

Epithelioid cells

What kind of granuloma has epithelioid cells surrounding a central area of necrosis that appears irregular?

Caseating granulomas

What cells in granulomatous inflammation has nuclei that are lined up around the periphery of the cell?

Langerhans type giant cells

What cells in granulomatous inflammation are adjacent to a segment of vegetable material aspirated into the lung with scattered nuclei?

Foreign body type giant cells

What is the non-specific granulomatous inflammation affecting the orofacial tissues?

Orofacial Granulomatosis

What is Orofacial Granulomatosis a diagnosis of?

Exclusion

What are the three clinical presentations of Orofacial Granulomatosis?

1. Cheilitis granulomatosa

2. Melkersson-Rosenthal syndrome

3. Swelling intraoral sites

What are the five vulnerable intracellular targets for cell injury?

1. Cell membrane integrity

2. Mitochondrial function

3. Protein synthesis

4. Cytoskeleton

5. Genetic integrity

What are the three types of responses to cell injury?

1. Morphological changes

2. Cell death

3. Cell aging

What is morphological change that results in the decrease in the size and function of the cell called?

Atrophy

What are the five conditions that can lead to atrophy?

1. Hypoxia

2. Ischemia

3. Cell injury

4. Loss of stimulation

5. Aging

What is the morphological change that results in the increase in the size of the cell?

Hypertrophy

What two conditions can lead to hypertrophy?

1. Hormonal stimulation

2. Increased functional demand

What is the morphological change that results in the increase in the number of the cell?

Hyperplasia

What three conditions can lead to hyperplasia?

1. Hormonal stimulation

2. Increased functional demand

3. Persistent cell injury

What is the morphological change that results in the conversion of one differentiated cell type to another?

Metaplasia

What can metaplasia give rise to?

Neoplastic transformation

What is the morphological change that results in the alteration of the cellular components of a tissue?

Dysplasia

What is the cause of dysplasia?

DNA damage

What kind of lesion is dysplasia?

Preneoplastic lesion

What are the two indications of dysplasia?

1. Disorderly arrangement of epithelial cells

2. Irregular nuclei

What is the range of risk of overall transformation rate of oral epithelial dysplasia?

6% - 36%

What are the two variables that affect transformation of oral epithelial dysplasia?

1. Site of lesion

2. Grade of dysplasia

What is the morphological change that results in the malignant alteration of the cells of a tissue?

Neoplasia

What are the two types of cell death?

1. Necrosis

2. Apoptosis

Which type of cell death is a result progressive degradative action of enzymes on an injured cell?

Necrosis

Necrosis is always caused by what?

Pathogens

What two things is necrosis characterized by?

1. Protein breakdown

2. Cellular digestion

What is the early alteration of necrosis?

Leaky, blebbing cell

What is the late alteration of necrosis?

Inflammation

Which type of necrosis is a slow cellular digestion?

Coagulative necrosis

What is Coagulative necrosis a characteristic from?

Hypoxic death of cells in all tissues except brain

Which type of necrosis is a rapid form of death resulting in cell degradation?

Liquefactive necrosis

What are the two cells that cause liquefactive necrosis?

1. Lysosomal proteolytic enzymes

2. White cells

What can form from liquefactive necrosis?

Abscesses and cysts

Liquefactive necrosis is a characteristic of what two conditions?

1. Focal bacterial infections

2. Hypoxic death in CNS

Which type of necrosis affects adipose tissues?

Fat necrosis

What organ is fat necrosis seen in?

Pancreas

Which type of necrosis is a typical lesion of tuberculosis?

Caseous necrosis

Which type of necrosis affects injured blood vessels?

Fibrinoid necrosis

What is Fibrinoid necrosis characterized by?

Accumulation of plasma proteins in blood vessels

What type of cell death is a genetically determined, internal, self-destruct mechanism of cell death?

Apoptosis

What are the three functions of apoptosis?

1. Eliminate surplus cells

2. Cancer prevention

3. Immune regulation

What are the three cellular events of apoptosis?

1. Cell shrinking

2. DNA fragmentation

3. Chromatin condensation

Does apoptosis cause inflammation?

No

What is the damage accumulated across a cell's lifetime called?

Accumulated somatic damage

What is the most important assault for cell aging?

Persistant oxidative stress

What is the genetically programmed life span for every cell dependent on?

Shortening of telomeres

Is there activity in telomeres in normal tissue cells?

No

What are the two processes of tissue repair?

1. Regeneration

2. Replacement with scar

What are the three cells that help in regeneration?

1. Labile cells

2. Stable Cells

3. Permanent cells

Which regeneration cells comprise tissues that are in a constant state of renewal?

Labile cells

Which regeneration cells form tissues that normally are renewed very slowly but are capable of rapid renewal after tissue loss?

Stable cells

What does the ability to regenerate depend on for tissues with stable cells?

Potential to replicate

Which regeneration cells are terminally differentiated and have lost all capacity for regeneration?

Permanent cells

What two signals influence regeneration?

1. Soluble growth factors

2. Cellular interactions with ECM components