Inflammation Part 2 (Chronic)

Morphologic features of chronic inflammation:

-infiltration with what types of cells? what happens to the tissue?

-cells: mononuclear cells (lymphocytes, macrophagesm plasma cells)

-tissue destruction

-attempts at repair

**mononuclear means nuclei is not bi or tri-lobed

what are 2 microscopic signs of chronic inflammtion?

angiogenesis and fibrosis

what are reversible injuries for cells?

swelling

what are irreversible injuries for cells?

ROS can puncture the plasma membrane , cause DNA damage,

what is seen microscopically when a cell is undergoing cell death?

-changes in the nucleus: condensation, fragmentation, karylysis

what are 2 mechanisms of cell death?

apoptosis- norm

necrosis- inflammation

more tissue damage with acute or chronic inflammation? which type of inflammation will you see blood vessels?

-chronic

-chronic

what are the causes of chronic inflammation?

- persistent infections

- hypersensitivity diseased

- prolonged exposure to toxins

what does a lymphocyte look like? eosionphil?

-lymp- blue dot, all nucleus no visible cytoplasm

-eos- bilobed/ trilobed nucleus and pink

what are the 4 main cells of chronic inflammation?

MONONUCLEAR:

macrophages

lymphocytes

plasma cells

MULTINUCLEATE:

eosinophils

what is the origin and functions of macrophages?

origin: dev in bone marrow > monocytes (blood) > macrophages (tissues)- activated when in a chronic inflammatory state

function: phagocytosis, antigen presenting cells (APCs), cytokine prod, tissue repair (growth factors)

A, C, P, T

is it normal for tissues to have macrophages?

Yes; doesn't always mean chronic inflammation, some tissues always have them- brain, kidney and lungs

what is the role of lymphocytes?

amplify/ "bolster" and propagate chronic inflammation

what are the 2 types of lymphocytes and their functions?

-T cells (helper- CD4 and cytotoxic T- CD8 cells)

-B cells > plasma cells

T cells work w/ what cell?

macrophage; APC (macrophage) activate T cell, thus activates more macrophages; cycle of chronic inflammation

Where do plasma cells come from and what are their functions?

from differentiated B cells; antibody production and formation of immune complexes

what is the function of eosinophils? What reaction are they associated with?

function- release cytotoxic granules, prod cytokines and chemokines, release mediators > tissue damage + remodeling; then macrophages come clean up the damage

reaction- allergic and parasitic infections

**helps w/ differential dx**

**hot pink

what is a granuloma?

chronic inflammation with wall created by immune cells (macrophages) to keep infection contained

**collection of macrophages surrounded by lymphocytes**

what cells surround the macrophages in a granuloma?

lymphocytes

What is the name for granulomas with central necrosis? What disease process is characterized by a collection ofgranulomas with necrosis?

caseating granuloma, seen in TB

chronic inflammation occurring when a material is difficult to digest/remove is called...

granulomatous inflammation definition; body has ID something hard to fight so creates a wall, and can lead to fibrosis

T/F: granulomatous inflammation is a disease

F; just a dx of a special type of chronic inflammation; sometimes due to TB, Chrohn's, or fillers (silicon particles)

in what settings are granulomatous inflammation more common? why?

- Persistent T cell response to microbes (Mycobacteria tuberculosis, T. Pallidum, fungi)

- Immune-mediated inflammatory disease (Crohn disease)

- Foreign body (suture, silicon, prophy paste, dermal filler, etc.)

- body has ID something foreign and tries to "wall off" the body from it

what is the function of granulomatous inflammation?

Granuloma "walls off" the agent, but if the body cant remove it, leads to fibrosis and organ dysfunction

Describe the histopathology of granulomatous inflammation

-macrophages w/ surrounding lymphocytes, multinucleated giant cells (large pink circle w/ sm blue dots on the periphery), w/ central necrosis

what cells are involved in granulomatous inflammation? Chronic or acute?

Chronic:

- epithelioid macrophages

-surrounding lymphocytes

-multi nucleated giant cells

-central necrosis= caseating graniuloma)

*may lead to fibrosis

what are sys effects of inflammation (acute and chronic)?

fever, lymphadenopathy, leukocytosis, acute phase proteins

what causes fever?

pyrogens like prostaglandins and cytokines

What is lymphadenopathy?

enlarged, tender lymph nodes due to immune cell proliferation; producing more lymph cells

what is leukocytosis?

increased circulating leukocytes, cytokines stimulate production from precursors in bone marrow; trying to make more WBCs

where are acute phase proteins produced?

liver

what is measured to track progression of inflammation?

acute phase proteins

what are acute phase proteins stimulated by?

cytokines

what stimulates the liver to make more CRPs? what does elevated CRP mean?

cytokines; more inflammation in body