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Questions and Answers
What type of granuloma is specifically incited by inert foreign bodies such as talc or sutures?
What type of granuloma is specifically incited by inert foreign bodies such as talc or sutures?
Which component is characteristic of caseous necrosis found in tuberculosis?
Which component is characteristic of caseous necrosis found in tuberculosis?
What is the primary distinction between primary and secondary tuberculosis?
What is the primary distinction between primary and secondary tuberculosis?
What type of giant cells are associated with the immune response in granulomas?
What type of giant cells are associated with the immune response in granulomas?
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Which of the following best describes miliary tuberculosis?
Which of the following best describes miliary tuberculosis?
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What characterizes the duration of chronic inflammation?
What characterizes the duration of chronic inflammation?
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Which of the following is NOT a cause of chronic inflammation?
Which of the following is NOT a cause of chronic inflammation?
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In chronic inflammation, what type of immune cells are primarily involved?
In chronic inflammation, what type of immune cells are primarily involved?
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Which histological feature is typical of chronic inflammation?
Which histological feature is typical of chronic inflammation?
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What is a hallmark of tissue destruction in chronic inflammation?
What is a hallmark of tissue destruction in chronic inflammation?
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Which condition is an example of chronic inflammation caused by repeated acute episodes?
Which condition is an example of chronic inflammation caused by repeated acute episodes?
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What is the primary cell type found in granulomatous inflammation?
What is the primary cell type found in granulomatous inflammation?
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Which of the following general effects is associated with chronic inflammation?
Which of the following general effects is associated with chronic inflammation?
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What unique structural feature may be present in plasma cells involved in chronic inflammation?
What unique structural feature may be present in plasma cells involved in chronic inflammation?
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Which type of granuloma is primarily associated with insoluble particles that induce a cell-mediated immune response?
Which type of granuloma is primarily associated with insoluble particles that induce a cell-mediated immune response?
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What distinguishes primary tuberculosis from secondary tuberculosis?
What distinguishes primary tuberculosis from secondary tuberculosis?
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What type of giant cell is typically found in response to foreign bodies?
What type of giant cell is typically found in response to foreign bodies?
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Which type of necrosis is characterized by extensive tissue destruction and the presence of cavities in tuberculosis?
Which type of necrosis is characterized by extensive tissue destruction and the presence of cavities in tuberculosis?
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In miliary tuberculosis, how does the Mycobacterium tuberculosis disseminate throughout the body?
In miliary tuberculosis, how does the Mycobacterium tuberculosis disseminate throughout the body?
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What is a distinct process of chronic inflammation that initially starts with a minimal acute phase?
What is a distinct process of chronic inflammation that initially starts with a minimal acute phase?
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Which cell type is primarily responsible for antibody production during chronic inflammation?
Which cell type is primarily responsible for antibody production during chronic inflammation?
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What characterizes the tissue response in chronic inflammation resulting in fibrosis?
What characterizes the tissue response in chronic inflammation resulting in fibrosis?
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Which of the following chronic inflammatory conditions is characterized by repeated acute episodes?
Which of the following chronic inflammatory conditions is characterized by repeated acute episodes?
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Which histological feature indicates the presence of chronic inflammation?
Which histological feature indicates the presence of chronic inflammation?
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What systemic effect is commonly associated with chronic inflammation?
What systemic effect is commonly associated with chronic inflammation?
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Which of the following best describes chronic inflammation's relationship to acute inflammation?
Which of the following best describes chronic inflammation's relationship to acute inflammation?
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Which type of immune response is characterized by the predominance of activated macrophages in chronic inflammation?
Which type of immune response is characterized by the predominance of activated macrophages in chronic inflammation?
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What is the role of eosinophils in chronic inflammation?
What is the role of eosinophils in chronic inflammation?
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Which individual component is a hallmark of granulation tissue in chronic inflammation?
Which individual component is a hallmark of granulation tissue in chronic inflammation?
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Study Notes
Chronic Inflammation
- Prolonged duration (weeks or months), healing and repair occur simultaneously with inflammation and tissue destruction
- Causes
- Following acute inflammation
- Persistent inciting stimulus
- Interference with normal healing process
- Repeated bouts of acute inflammation
- Examples include:
- Unresolved acute inflammation (chronic suppurative inflammation)
- Chronic osteomyelitis
- Chronic abscess
- Repeated episodes of acute inflammation (e.g., chronic pyelonephritis)
- Repeated UTIs (urinary tract infections)
Examples of Chronic Inflammation
- Distinct process from outset
- Viral infections (e.g., hepatitis B, tuberculosis, syphilis, fungi)
- Insoluble particles (e.g., silica, asbestos, foreign bodies, cholesterol)
- Hypersensitivity reactions (e.g., contact dermatitis, rheumatoid arthritis)
- Non-conventional inflammatory disorders (e.g., Alzheimer's disease, metabolic syndrome, type 2 diabetes mellitus, certain cancers)
Histological Hallmarks of Chronic Inflammation
- Mononuclear inflammatory cell infiltrate
- Macrophages
Transformation into Macrophages
- Recruitment from circulating monocytes
- Chemotactic mediators
- Transformation steps:
- Bone marrow stem cell
- Monoblast
- Monocyte
- Macrophage (activation and differentiation)
Activation of Macrophages
- Lymphocytes present antigens to T cells
- Other inflammatory mediators (e.g., IL-1, TNF)
- Activated macrophages respond to inflammatory mediators
Proliferation and Immobilization of Macrophages
- Macrophages proliferate and immobilize
- Chemotactic mediators
- Cytokines
- Recruitment, Division, Immobilization
Antibody-Mediated and Cell-Mediated Immune Reactions
- Anti-body mediated immune reactions
- Cell-mediated immune reactions
Plasma Cells
- Synthesis of immunoglobulins
Cells in Chronic Inflammation
- Eosinophils (abundant in IgE-mediated reactions and parasitic infections)
- Mast cells (response in allergic reactions)
- Neutrophils (induced by persistent microbes or by mediators from activated macrophages and T lymphocytes)
- Granulation tissue (in growth of vascular tissue from surrounding connective tissue)
- Tissue destruction and fibrosis (excess fibrous connective tissue replacing functional tissue)
- Fibrosis and scarring (e.g., valvular stenosis, narrowing of hollow organs; adhesions in serous cavities, joint deformity)
Regeneration
- Regeneration of destroyed tissues (e.g., epithelial overgrowth or invagination; endarteritis obliterans)
General Effects of Chronic Inflammation
- Fever, acute-phase proteins, leukocytosis, hyperplasia of lymphoid system, immune response with antibody production, reactive systemic amyloidosis with formation of AA protein
Granulomatous Inflammation
- Distinctive pattern
- Predominant cell type is activated macrophages showing epithelial (epithelioid) arrangement
Induced by T Cell and Macrophage Activation
- Granuloma
- Collection of modified macrophages that are surrounded by a rim of lymphocytes and have central necrosis
- Types of granulomas:
- Foreign body granuloma (incited by inert foreign bodies)
- Examples: talc, sutures, lipid/cholesterol (paraffin gets dissolved), collagen
- Foreign body granuloma (incited by inert foreign bodies)
Immunologic Granuloma
- Incited by insoluble particles capable of inducing cell-mediated immune response
- Examples: infectious agents (e.g., TB, leprosy, fungi, parasites), tumors, etc
Tuberculosis (TB)
- Tubercle - aggregate of epithelioid cells and Langhans' multinucleated giant cells
- Caseous necrosis (big cavities, lots of tissue destruction)
- Acid-fast bacilli (rods)
- Cell-mediated hypersensitivity (type IV)
- Primary TB (infection in individuals without previous contact with tubercle bacilli)
- Secondary/Post-primary TB (arises in previously sensitized individuals; reactivation)
- Miliary TB
- Mycobacterium gains access to lymphatic and blood to spread to distant organs.
- Calcification of lung apexes.
Multinucleated Giant Cells
- Langhans giant cells
- Foreign body giant cells
- Touton giant cells
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Description
This quiz provides an overview of chronic inflammation, detailing its prolonged duration and causes. It also highlights various examples including chronic infections and hypersensitivity reactions. Test your understanding of the mechanisms and implications of chronic inflammatory processes.
