Chronic Inflammation Overview
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Questions and Answers

What type of granuloma is specifically incited by inert foreign bodies such as talc or sutures?

  • Infective granuloma
  • Foreign body granuloma (correct)
  • Immunologic granuloma
  • Fibrinous granuloma

Which component is characteristic of caseous necrosis found in tuberculosis?

  • Granulocyte infiltration
  • Fibrous tissue formation
  • Hemorrhagic exudate
  • Presence of acid fast bacilli (correct)

What is the primary distinction between primary and secondary tuberculosis?

  • Secondary TB presents without calcification in the lungs.
  • Secondary TB arises from reactivation of asymptomatic primary disease. (correct)
  • Primary TB typically occurs in individuals with prior contact with tubercle bacilli.
  • Primary TB occurs in individuals previously sensitized.

What type of giant cells are associated with the immune response in granulomas?

<p>Langhans giant cells (C)</p> Signup and view all the answers

Which of the following best describes miliary tuberculosis?

<p>Systemic spread through the lymphatic and circulatory system. (D)</p> Signup and view all the answers

What characterizes the duration of chronic inflammation?

<p>Prolonged for weeks or months (D)</p> Signup and view all the answers

Which of the following is NOT a cause of chronic inflammation?

<p>Complete resolution of previous inflammation (C)</p> Signup and view all the answers

In chronic inflammation, what type of immune cells are primarily involved?

<p>Macrophages and Lymphocytes (D)</p> Signup and view all the answers

Which histological feature is typical of chronic inflammation?

<p>Mononuclear inflammatory cell infiltrate (C)</p> Signup and view all the answers

What is a hallmark of tissue destruction in chronic inflammation?

<p>Fibrosis replacing functional tissue architecture (B)</p> Signup and view all the answers

Which condition is an example of chronic inflammation caused by repeated acute episodes?

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

What is the primary cell type found in granulomatous inflammation?

<p>Activated macrophages (D)</p> Signup and view all the answers

Which of the following general effects is associated with chronic inflammation?

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

What unique structural feature may be present in plasma cells involved in chronic inflammation?

<p>Clock-faced nucleus (D)</p> Signup and view all the answers

Which type of granuloma is primarily associated with insoluble particles that induce a cell-mediated immune response?

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

What distinguishes primary tuberculosis from secondary tuberculosis?

<p>Secondary tuberculosis primarily affects the apex of the lungs. (A)</p> Signup and view all the answers

What type of giant cell is typically found in response to foreign bodies?

<p>Foreign body giant cells (A)</p> Signup and view all the answers

Which type of necrosis is characterized by extensive tissue destruction and the presence of cavities in tuberculosis?

<p>Caseous necrosis (C)</p> Signup and view all the answers

In miliary tuberculosis, how does the Mycobacterium tuberculosis disseminate throughout the body?

<p>Through lymphatic and blood circulation (B)</p> Signup and view all the answers

What is a distinct process of chronic inflammation that initially starts with a minimal acute phase?

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

Which cell type is primarily responsible for antibody production during chronic inflammation?

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

What characterizes the tissue response in chronic inflammation resulting in fibrosis?

<p>Replacement of functional tissue with excess fibrous tissue (D)</p> Signup and view all the answers

Which of the following chronic inflammatory conditions is characterized by repeated acute episodes?

<p>Chronic pyelonephritis (C)</p> Signup and view all the answers

Which histological feature indicates the presence of chronic inflammation?

<p>Mononuclear inflammatory cell infiltrate (A)</p> Signup and view all the answers

What systemic effect is commonly associated with chronic inflammation?

<p>Inflammatory mediators leading to reactive systemic amyloidosis (A)</p> Signup and view all the answers

Which of the following best describes chronic inflammation's relationship to acute inflammation?

<p>It can follow acute inflammation due to persistent stimuli. (A)</p> Signup and view all the answers

Which type of immune response is characterized by the predominance of activated macrophages in chronic inflammation?

<p>Cell-mediated immune reaction (B)</p> Signup and view all the answers

What is the role of eosinophils in chronic inflammation?

<p>They are abundant in reactions involving IgE and parasitic infections. (C)</p> Signup and view all the answers

Which individual component is a hallmark of granulation tissue in chronic inflammation?

<p>Vascular tissue growth with inflammatory cells (B)</p> Signup and view all the answers

Flashcards

Granuloma

A collection of modified macrophages, often surrounded by lymphocytes, and sometimes with central necrosis.

Foreign body granuloma

A granuloma formed in response to inert foreign material, like talc, sutures, or lipid/cholesterol crystals.

Immunologic granuloma

A granuloma formed in response to immune reactions against things like infections (TB, fungus), parasites, or tumors.

Tuberculosis (TB)

A chronic infectious disease caused by the Mycobacterium tuberculosis bacterium, leading to characteristic granulomas (tubercles) and potential caseous necrosis.

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Multinucleated giant cells

Large cells with multiple nuclei, playing a role in the immune response within granulomas (e.g., Langhans, foreign body, Touton).

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Chronic Inflammation Duration

Weeks or months of inflammation; the inflammation and tissue destruction happen concurrently.

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Chronic Inflammation Causes (following acute)

Persistent inciting stimulus, obstructed healing, repeated acute bouts.

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Chronic Inflammation Causes (distinct process)

Inflammation starts as a low-grade response, often minimal acute phase.

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Chronic Inflammation Cell Types

Macrophages, lymphocytes, plasma cells, eosinophils, and mast cells.

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Macrophage Role

Key cells in chronic inflammation - recruit, activate, and proliferate.

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Lymphocyte Role in Chronic Inflammation

Crucial in antibody-mediated and cell-mediated immune reactions.

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Granulation Tissue Characteristics

New blood vessels, fibroblasts, and inflammatory cells are present.

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Chronic Inflammation Tissue Effects

Tissue damage, fibrosis (scar tissue), and potentially reduced function.

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Granulomatous Inflammation Pattern

A particular chronic inflammation pattern with activated macrophages (epithelioid cells).

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Systemic Effects of Chronic Inflammation

Fever, elevated proteins, immune response, and possible amyloid protein formation.

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What are Langhans giant cells?

A type of multinucleated giant cell found in granulomas, especially in tuberculosis. Their nuclei are arranged in a horseshoe shape.

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Caseous Necrosis

A specific type of necrosis characterized by cheese-like appearance, often found in tuberculosis. The tissue structure is completely destroyed.

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What is a foreign body granuloma?

A granuloma formed in response to inert foreign material like sutures, talc, or cholesterol crystals.

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Primary TB

Tuberculosis infection in someone with no previous exposure to the bacteria. It usually resolves without serious complications.

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Secondary TB

Tuberculosis reactivation in a previously sensitized individual. This form is more severe and often involves reactivation of dormant bacteria.

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Chronic Inflammation

Inflammation that lasts for weeks or months, simultaneously involving inflammation, tissue destruction, healing, and repair.

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Why does chronic inflammation happen?

It can occur due to a persistent cause, interference with normal healing, or repeated bouts of acute inflammation.

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Chronic Inflammation: Distinct Process

Inflammation might begin with a brief, minimal acute phase, leading to a low-grade, smoldering response.

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Chronic Inflammation: beyond infection

Chronic inflammation plays a key role in diseases not typically thought of as inflammatory, such as Alzheimer's, metabolic syndrome, and certain cancers.

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Chronic Inflammation Cells: Macrophages

Macrophages are key players in chronic inflammation, recruited from circulating monocytes. They transform, activate, proliferate, and become immobilized.

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Lymphocytes in Chronic Inflammation

Lymphocytes are recruited in both antibody-mediated and cell-mediated immune reactions.

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Granulation Tissue

New vascular tissue, fibroblasts, and inflammatory cells are present. It's a sign of healing and repair in chronic inflammation.

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Tissue Destruction & Fibrosis

Destruction of functional tissue is a hallmark of chronic inflammation. Fibrosis replaces functional tissue with excess fibrous connective tissue, leading to scarring.

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Granulomatous Inflammation

A specific pattern of chronic inflammation where activated macrophages (epithelioid cells) form clusters known as granulomas.

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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

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.

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