Pathology - Exam 1 Part 2

What are the 5 cardinal signs of inflammation?

redness, swelling, heat, pain, loss of function

What are the 5 "R's" of inflammation?

1. recognize (injury)

2. recruit (leukocytes)

3. remove (agent)

4. regulate (response)

5. resolution

What signs are associated with acute inflammation? What is the primary cellular infiltrate involved?

cardinal signs (local and systemic) no fibrosis

neutrophils

What signs are associated with chronic inflammation? What are the primary cellular infiltrate involved?

no cardinal signs, angiogenesis and fibrosis

macrophages and lymphocytes

What is the first step in the inflammatory process?

recognition of pathogens or damaged cells

What is the second step in the inflammatory process?

vascular change

What are the 2 ways in which we can identify a stimulus?

1. Non-self

2. Damage (self)

Which of the following is a class of molecule that would be recognized as a sign of viral RNA or DNA?

PAMPs - pathogen associated molecular patterns

Which of the following is a class of molecule that would be recognized as a sign of cellular injury or death?

DAMPs - damage associated molecular patterns

If ATP is free (indicating cellular injury) what is released in response? What does it do?

IL-1, recruits inflammatory signs

Which vascular change is attributed to why we have increased blood flow, redness, and warmth (cardinal signs)?

vasodilation

Which vascular change is attributed exudate? What is exudate?

increased vessel permeability

exudate = protein-rich edema

Which mechanism of increased permeability is associated with gaps in postcapillary venules?

Is this regulated?

endothelial contraction

regulated

Which mechanism of increased permeability is associated with leaking until repaired?

Is this regulated?

endothelial necrosis

not regulated

What describes the phenomenon that new vessels have immature/leaky endothelia?

angiogenesis

T/F? Burns, severe infections, and irradiation could all lead to endothelial contraction

False - endothelial necrosis

T/F? Histamine is associated with endothelial necrosis

False - endothelial contraction

Blood vessel diameter is dependent on ____________

Permeability is dependent on ___________

arterioles

venules

What is the difference between exudate and transduate?

exudate = protein rich (inflammation)

transduate = protein-poor (ascites)

Lymphadenopathy is...

disorder of lymph nodes

Lymphadenitis is...

inflammation of lymph nodes

Lymphangitis is...

inflamed lymphatic channel (red streak)

What are the 4 steps of leukocyte recruitment?

1. margination/rolling

2. firm adhesion

3. diapedesis

4. chemotaxis

What mediates the margination and rolling phase?

selectins

What mediates the firm adhesion phase?

integrins

Transmigration, extravasation, and emigration are all interchangeable terms for what?

diapedesis

What is the most numerous leukocyte killed within 48 hours? What is it replaced with?

neutrophils

replaced with macrophages and lymphocytes

What is opsonization?

marking cell for destruction

Persistent infections (TB, viral), ischemia-reperfusionn injuries, and hypersensitivity (allergies, autoimmune) are all examples of _____________ tissue injury

leukocyte-induced (secondary) tissue injury

Why do infections reemerge?

age, stress, lower immune system function - lives within nerves (DRG)

Are cardinal signs local or systemic?

local

Is infection local or systemic?

systemic

What is the BEST example of an acute-phase reaction?

fever - hypothalamus increases temperature

T/F? Elevated plasma proteins tells us exactly why we have elevated inflammation

False! generic objective findings just tell us we have inflammation, not why

Prostaglandins stimulate...

nociceptors (pain) and fever

Substance P stimulates...

pain and neurotransmitters

What 2 things are red flags for back pain associated with infection?

recent infection

history of IV drug abuse

What is a normal leukocyte count?

4,500-10,000

What is leukocytosis? What is a lab value associated with this?

increased leukocytes in blood

15,000-30,000

Bacterial leukocytosis = increased _________

neutrophils

Viral leukocytosis = increased ___________

lymphocytes

What are leukemoid reactions? What does it mimic?

extreme leukocytosis (very high)

mimics leukemia

What lab values are associated with leukemoid reactions?

40,000-100,000

What is leukopenia? What lab values are associated with this?

low blood leukocyte count

less than 4,000

Clostridium difficile and tuberculosis are associated with what levels of leukocytes?

leukemoid reactions (very high)

HIV/AIDS, chemotherapy, and radiation therapy are all associated with what levels of leukocytes?

leukopenia (low) immunosuppressed

Which pattern of inflammation do we see watery effusion (blisters)?

serous

Which pattern of inflammation do we see increased vessel permeability?

fibrinous

Which pattern of inflammation do we see local infections with pus or abscess?

purulent/suppurative

Which pattern of inflammation do we see with canker sores or superficial area of tissue necrosis?

ulcerative

Which pattern of inflammation do we see associated with corynebacterium and clostridium difficile?

pseduomembranous

Which is the ONLY chronic pattern of inflammation?

granulomatous

Which pattern of inflammation is associated with burns, viral infections, and autoimmunity?

serous

Which pattern of inflammation is associated with severe fibrosis, pericarditis or pleuritis?

fibrinous

Tuberculosis fits under the category of which pattern of inflammation?

granulomatous (chronic) or caseating granulomas

Elevated erythrocyte sedimentation rate is indicative of....

inflammation

T/F? In virtually all circumstances, chronic inflammation is characterized by both local AND cardinal signs of inflammation and generalized features such as fever

False

The _______ pattern of inflammation involves accumulated macrophages and a few lymphocytes in the tissue

granulomatous

A patient presents with blisters and serous inflammation on the skin of their right arm without history of injury or burn. What is most likely the cause if they have a leukocyte count of 18,000?

viral infection

T/F? Activation of leukocytes is very precise and unique to that microbe

True

If acute inflammation resolves - what happens to permeability and lymph drainage?

normalize

Failure to remove offending agent (from acute inflammation) leads to what

chronic inflammation

________ follows chronic inflammation if tissues can't replicate

scarring/fibrosis

Prolonged inflammation is the result of unresolved inflammatory reactions, what are 3 examples?

persistent infection/injury

immunosuppression

hypersensitivity

What are the dominant cells at areas of chronic inflammation?

macrophages

What are classically activated macrophages?

pro-inflammatory

What are alternatively activated macrophages?

anti-inflammatory - release growth factor (angiogenesis, etc)

Which mechanism of tissue repair occurs when stem cells able to proliferate?

regeneration

T/F? Tissue repair happens after inflammation is eliminated

False! - before inflammation is eliminated

Which mechanism of tissue repair occurs when stem cells are unable to proliferate?

scarring (ex: neurons and cardiac myocytes)

What is the difference between labile and stable cells?

labile = constantly dividing

stable = can divide but not constantly doing it

What is the best example of stable cells?

hepatocytes in liver

Scar formation happens when tissues....

can't regenerate

What are the 4 steps in scar formation?

1. angiogenesis

2. fibroblast migration/proliferation

3. collagen deposition to scar

4. remodeling

What is difference between a mature and an immature scar?

mature is stronger than immature BUT not as strong as original tissue

What is granulation tissue composed of?

new blood vessels, collagen, fibroblasts (within 3-5 days)

Initially scars are _______

After time, scars becomes ________

What is an indication of this?

vascular

avascular

scars go from pink to pale color

What is a primary factor in the ability to remodel connective tissue? Why?

MMP's - enzyme that breaks down collagen, have to break down old collagen before it can be replaced

What is a cofactor for MMP's? How does it affect healing?

Zinc - vitamin deficiency can impair healing

What are keloids?

excessive granulation tissue and collagen (over-healing a wound)

T/F? Keloids can be improved with excision

False - worsened with excision

How does diabetes impair connective tissue repair?

poor perfusion, decreased blood supply and venous drainage

Does age impair connective tissue repair? Why?

yes - decreased cellular activity