Pathology: Inflammation
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Questions and Answers

What is inflammation?

It’s a reaction of vascularized living tissues to injury

What is the normal response of inflammation to injury or infection

To minimize the injury and maintain homeostasis

What is/are the primary goal(s) of inflammation? More than one may apply.

  • Bring defense and immune cells to the area of concern (correct)
  • Inactivate/destroy pathogens (correct)
  • Begin repair (correct)
  • Use cell mediated immunity and antigen specific recognition of molecules

Which of the following is NOT a primary function of inflammation?

<p>Suppressing all immune activity to prevent further damage (D)</p> Signup and view all the answers

What is a potential consequence of excessive or prolonged inflammation?

<p>Tissue damage and disruption of homeostasis (C)</p> Signup and view all the answers

Acute inflammation is a vasoconstrictive response that is characterized by what?

<p>It’s characterized by marked vascular changes, exudation of fluid, plasma protein, and emigration of leukocytes</p> Signup and view all the answers

There are 8 types of tissue injury that leads to inflammation, what are they?

<p>Physical trauma, chemical, thermal, infection, radiation, immunological, ischemia and necrosis</p> Signup and view all the answers

What are the five cardinal signs of inflammation?

<p>Redness, swelling, pain, heat, and loss of function</p> Signup and view all the answers

Match the examples to their respective tissue injury

<p>Necrosis = Inflammation at margins Immunological = Autoimmunity, hypersensitivity Ischemia = Inflammation when blood flow is re-established Chemical = Acid/alkali; pancreatitis</p> Signup and view all the answers

What is the primary role of chemical mediators in inflammation?

<p>To initiate and regulate both vascular and cellular inflammatory responses (A)</p> Signup and view all the answers

What is the primary purpose of increased vascular permeability during inflammation?

<p>To facilitate the leakage of plasma, proteins, and leukocytes into the extravascular space (B)</p> Signup and view all the answers

What is the term used to describe the extravascular fluid that forms due to increased inter-endothelial spaces during inflammation?

<p>Exudate (B)</p> Signup and view all the answers

What is the role of fibrin formation in the extravascular space during inflammation?

<p>To confine the stimulus to an isolated area and provide a framework for wound healing (C)</p> Signup and view all the answers

What is a key characteristic of an exudate?

<p>They have high protein and high nucleated cell counts</p> Signup and view all the answers

Match each sign of inflammation with its correct cause

<p>Redness = Increased blood flow (hyperameia) Swelling = Accumulation of fluid of cells (edema, hyperemia) Heat = Increased blood flow from core Pain = Release of chemicals that stimulate nerve endings, edema pressure leads to stretching of pain receptors</p> Signup and view all the answers

What is the ideal outcome of inflammation under normal conditions?

<p>Complete resolution of inflammation and restoration of normal tissue function (C)</p> Signup and view all the answers

What happens when an intense inflammatory response occurs, such as in an abscess?

<p>The inflammatory process is isolated by forming a protective capsule (B)</p> Signup and view all the answers

What is a likely consequence if inflammation fails to eliminate the underlying insult?

<p>Chronic inflammation occurs, leading to persistent immune cell presence and scar formation. (C)</p> Signup and view all the answers

When does scar formation occur?

<p>It occurs when normal tissue regeneration is incomplete, usually because inflammatory cells persist or the damage was too extensive to repair</p> Signup and view all the answers

What distinguishes an exudate from a transudate?

<p>Exudate has a high protein concentration, while transudate has a low protein concentration (A)</p> Signup and view all the answers

Which of the following best describes transudate formation?

<p>It occurs due to hydrostatic or osmotic pressure imbalances without increased vascular permeability. (B)</p> Signup and view all the answers

What is oedema in the context of inflammation?

<p>Excess fluid in interstitial or serous cavities (B)</p> Signup and view all the answers

What is the defining characteristic of pus (purulent exudate)?

<p>It consists of leukocytes, dead cell debris, and microbes. (C)</p> Signup and view all the answers

Which of the following is FALSE about exudate?

<p>Specific gravity of less than 1.012 (B)</p> Signup and view all the answers

What are the stages of acute inflammation?

<p>Vasodilation, increased vascular permeability, emigration of leukocytes, phagocytosis and termination</p> Signup and view all the answers

As vasodilation occurs, ________ is released from mast cells, and _______ are released from platelets. This ultimately leads to _____.

<p>Histamine; serotonin; hyperemia</p> Signup and view all the answers

During increased vascular permeability, plasma leaks through the junctions between endothelial cells activates _______, _______ and _______ factors: ___________ —> _____

<p>Complement; antibodies; clotting factors; fibrinogen to fibrin</p> Signup and view all the answers

What are the steps involved in the emigration of leukocytes?

<p>Marination, rolling, adhesion, emigration and chemotaxis</p> Signup and view all the answers

Match the following to the correct description of the leukocyte adhesion cascade (aka emigration of leukocytes)

<p>Margination = Move towards the periphery of lumen Rolling = Weak binding of selectins Adhesion = Beta 2 integrins on the Leukocyte bind firmly to the ICAM on endothelium Emigration = Transendothelial migration</p> Signup and view all the answers

Which type of adhesion molecule primarily facilitates the tethering of leukocytes to the endothelium?

<p>Selectins (B)</p> Signup and view all the answers

Which of the following is NOT a characteristic of integrins in the context of leukocyte adhesion?

<p>They are primarily involved in tethering, rather than firm adhesion. (D)</p> Signup and view all the answers

Which of the following adhesion molecules is NOT primarily involved in the firm adhesion of leukocytes to the endothelium?

<p>L-selectin (B)</p> Signup and view all the answers

Which of the following statements accurately describes the relationship between leukocyte adhesion molecules and the movement of leukocytes?

<p>Adhesion molecules facilitate leukocyte movement by providing structural support and directional cues. (D)</p> Signup and view all the answers

Which of the following best explains the need for different types of adhesion molecules in leukocyte-endothelial interactions?

<p>All of the above are accurate explanations. (D)</p> Signup and view all the answers

What role do adhesion molecules play in leukocyte extravasation?

<p>Adhesion molecules, primarily integrins, bind to glycoproteins in the extracellular matrix, ensuring that leukocytes remain in the area where they are needed. (A)</p> Signup and view all the answers

Which of the following is NOT a direct consequence of chemokines acting on leukocytes during extravasation?

<p>Leukocytes adhere to the basement membrane, preventing them from entering the extravascular space. (D)</p> Signup and view all the answers

How does leukocyte extravasation differ from chemotaxis and activation?

<p>Extravasation is the process of leukocytes exiting the bloodstream and entering the extravascular space, while chemotaxis and activation are events that occur within the bloodstream. (C)</p> Signup and view all the answers

Why is the process of leukocyte extravasation essential for the inflammatory response?

<p>It permits the delivery of immune cells to the site of injury or infection. (D)</p> Signup and view all the answers

What do neutrophils and monocytes do once they are at the injury site?

<p>They express special receptors</p> Signup and view all the answers

List the special receptors that monocytes and neutrophils express when they’re at the injury site

<p>TLR’s, GPCR, Receptors for opsonins and cytokine receptors</p> Signup and view all the answers

Match the special receptors to their function

<p>TLR = Recognize microbial products and stimulate production of cytokines GPCR = Recognize bacterial peptides, Chemokines, complement; induce migration of cells from blood and production of micorbicidal substances Opsonin receptors = Bind to particles covered by proteins/opsonins Cytokine receptors = Result in macrophage activation</p> Signup and view all the answers

What happens when these special receptors are activated? (Ie TLR, GPCR)

<p>They produce arachidonic acid from phospholipid cell membranes due to activation of phospholipase</p> Signup and view all the answers

What triggers the production of arachidonic acid metabolites in leukocytes?

<p>Activation of phospholipase (D)</p> Signup and view all the answers

How does cytokine secretion affect leukocyte function during inflammation?

<p>It recruits additional leukocytes to the site of infection (A)</p> Signup and view all the answers

What is a direct consequence of the modulation of leukocyte adhesion molecules during inflammation?

<p>Increased leukocyte avidity on endothelial cells (D)</p> Signup and view all the answers

Which of the following accurately describes the relationship between leukocyte activation and oxidative burst?

<p>Oxidative burst is a response that enhances degranulation and is subsequent to leukocyte activation (C)</p> Signup and view all the answers

Neutrophils are the first leukocytes to arrive, then they engulf and destroy injurious agents via _______

<p>Phagocytosis</p> Signup and view all the answers

After neutrophils internalize ______, ____, ____, they fuse with ______

<p>Bacteria, foreign bodies, dead cells, lysosomes</p> Signup and view all the answers

Inflammation mediators have long half lives and are produced in periodic bursts

<p>False (B)</p> Signup and view all the answers

Inflammatory responses are tightly controlled by the body

<p>True (A)</p> Signup and view all the answers

Which of the following anti-inflammatory molecules is NOT directly mentioned in the content as being involved in limiting macrophage TNF production?

<p>Interleukins (B)</p> Signup and view all the answers

Macrophages play a central role in termination, they pinocytose any excess edema fluid and proteins, phagocytose necrotic debris and produce growth factors that initiate repair

<p>True (A)</p> Signup and view all the answers

List the main cells involved in inflammation

<p>Mast cells, endothelial cells, monocytes, granulocytes and lymphocytes</p> Signup and view all the answers

Which of the following is FALSE regarding neutrophils function/characteristics?

<p>Heterophils in rabbits, reptiles, fish have myeloperoxidase (D)</p> Signup and view all the answers

Basophils promote _______ reactions and attract _______

<p>Hypersensitivity; eosinophils</p> Signup and view all the answers

Eosinophils are attracted by all but ….

<p>IgA (A)</p> Signup and view all the answers

Th1 cells are participate in humoral immunity and Th2 participate in cell mediated immunity

<p>False (B)</p> Signup and view all the answers

Which cytokines do monocytes produce?

<p>IL 1, IL6 and TNF alpha</p> Signup and view all the answers

Monocytes are the central cells in (chronic/acute) inflammation

<p>Monocytes are the central cells in chronic inflammation</p> Signup and view all the answers

Syncytial cells are formed by the fusion of two or more macrophages. The foreign body type nucleus is located in ___

<p>The center</p> Signup and view all the answers

The second type of MNGC (multinucleated giant cell), Langhans type, the nucleus is located in ______

<p>The periphery</p> Signup and view all the answers

Mast cells are the _______ of acute inflammation

<p>Initiatiors</p> Signup and view all the answers

What are the four main outcomes of acute inflammation?

<p>Resolution, healing by fibrosis, abscess formation, and progression to chronic inflammation</p> Signup and view all the answers

What determines the outcomes of acute inflammation ?

<p>Severity of tissue damage, ability of cells to regenerate and the type of injurious agen</p> Signup and view all the answers

What are the types of acute inflammation?

<p>Suppurative/purulent, fibrinous, serous and catarrhal/mucoid</p> Signup and view all the answers

Match the type of acute inflammation to its characteristic/description

<p>Purulent/suppurative = Fluid with many neutrophils and increased protein Fibrinous = Fluid with few cells, high protein Serous = Fluid with few cells and low protein (transudate) Catarrhal/mucoid = Thick fluid with mucus (GIT, Respiratory tract)</p> Signup and view all the answers

What are the preformed vasoactive amines?

<p>Histamine and serotonin</p> Signup and view all the answers

Both histamine and serotonin cause redness, swelling and heat

<p>True (A)</p> Signup and view all the answers

Which of the following are the two major classes of enzymes that act on arachidonic acid to produce metabolites?

<p>Cyclooxygenase (A), Lipoxygenase (C)</p> Signup and view all the answers

____ play a role in resolution of inflammation and inhibit neutrophil adhesion and chemotaxis

<p>Lipoxins</p> Signup and view all the answers

The main effects of IL-1 and TNF alpha are the ________ response

<p>Acute phase</p> Signup and view all the answers

If the acute phase response is severe, it can lead to shock

<p>True (A)</p> Signup and view all the answers

Flashcards

Adhesion Molecules

Surface receptors that facilitate interactions between leukocytes and endothelial cells.

Selectins

A family of adhesion molecules involved in the weak tethering of leukocytes; types include E, P, and L selectins primarily on endothelium.

Integrins

Firm adhesion molecules found on leukocytes (e.g., β1 and β2 integrins) that stabilize cell interactions.

Immunoglobulin Family

Adhesion molecules such as ICAM, VCAM, and PECAM found on endothelial cells aiding in cell interactions.

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Endothelial Cells

Cells lining the blood vessels that express adhesion molecules for leukocyte interaction.

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Leukocyte Extravasation

The process where leukocytes move out of blood vessels to tissues, also known as Diapedesis.

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Chemotaxis

The movement of leukocytes towards higher concentrations of chemokines; guides them to sites of infection or injury.

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Phagocytosis

The process by which leukocytes engulf and digest pathogens or debris.

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Degranulation

The release of granules from leukocytes that contain enzymes and mediators to attack pathogens.

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Arachidonic Acid Metabolites

Products derived from arachidonic acid through metabolic processes, involving inflammation.

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Phospholipase Activation

An enzyme activation that leads to the breakdown of phospholipids and increased intracellular calcium.

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Oxidative Burst

A rapid release of reactive oxygen species from activated leukocytes to kill pathogens.

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Cytokine Secretion

The release of signaling proteins by immune cells to amplify the inflammatory response.

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Leukocyte Avidity Modulation

Changes in the strength of interaction between leukocytes and endothelial cells due to adhesion molecule expression.

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Inflammatory Mediators

Substances that initiate or perpetuate inflammation, often short-lived.

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Pro-Inflammatory Mediators

Compounds that promote inflammation, like cytokines and neutrophils' activities.

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Anti-Inflammatory Molecules

Substances that counteract inflammation, including lipoxins and certain cytokines.

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Macrophage TNF Production

Tumor necrosis factor (TNF) is produced by macrophages to promote inflammation.

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Switch in Mediator Production

The transition from pro-inflammatory to anti-inflammatory mediators during healing.

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Study Notes

Adhesion Molecules: Leukocyte-Endothelial Interactions

  • Adhesion molecules are surface receptors on leukocytes (white blood cells) and endothelium (lining of blood vessels).
  • They are crucial for leukocyte movement through blood vessels.
  • These molecules facilitate interactions between leukocytes and endothelial cells.

Types of Adhesion Molecules

  • Selectins: These adhesion molecules are mainly found on endothelial cells. They mediate weak tethering interactions between leukocytes and endothelium. Three main types exist (E, P, and L selectins).

  • Integrins: These are stronger adhesion molecules primarily found on leukocytes. β1 and β2 integrins are examples. They form firmer bonds.

  • Immunoglobulin Superfamily: This family includes molecules like ICAM, VCAM, and PECAM, also present on endothelium. They contribute to cell-cell interaction.

Leukocyte Extravasation (Diapedesis)

  • Occurs mainly in post-capillary venules.
  • Chemokines stimulate leukocytes to migrate through inter-endothelial spaces.
  • Leukocytes pierce the basement membrane and enter extravascular spaces, following a chemotactic gradient.
  • Leukocytes adhere to glycoproteins in the extracellular matrix via integrins, ensuring they stay where needed.

Leukocyte Activation & Adhesion

  • Leukocyte activation leads to the production of arachidonic acid metabolites from phospholipids. This is triggered by increased intracellular calcium, activating phospholipase.
  • Activation also leads to degranulation, releasing lysosomal enzymes and an oxidative burst.
  • Cytokine secretion, often from activated macrophages, further amplifies and regulates the inflammatory response.
  • Crucially, leukocyte activation modulates adhesion molecules. This involves increased expression of adhesion molecules on endothelial cells and an enhancement of "leukocyte avidity".
  • Inflammatory mediators have short half-lives, limiting their duration of action. Eventually, the production of pro-inflammatory mediators shifts to anti-inflammatory molecules (e.g., lipoxins, cytokines). These anti-inflammatory molecules can limit the production of pro-inflammatory cytokines (such as TNF) by macrophages.

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