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What is the main characteristic of chronic inflammation?
What is the main characteristic of chronic inflammation?
Which of the following is not a common setting in which chronic inflammation arises?
Which of the following is not a common setting in which chronic inflammation arises?
Which cell type is primarily associated with chronic inflammation?
Which cell type is primarily associated with chronic inflammation?
Which of the following statements about fibrosis in chronic inflammation is true?
Which of the following statements about fibrosis in chronic inflammation is true?
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Which factor is primarily responsible for the persistence of chronic inflammation?
Which factor is primarily responsible for the persistence of chronic inflammation?
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What type of hypersensitivity reaction can lead to chronic inflammation?
What type of hypersensitivity reaction can lead to chronic inflammation?
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Which condition is an example of chronic inflammation resulting from repeated acute inflammation?
Which condition is an example of chronic inflammation resulting from repeated acute inflammation?
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Which cell type is not typically associated with chronic inflammation?
Which cell type is not typically associated with chronic inflammation?
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What transformation do blood monocytes undergo after 24-48 hours in inflammation?
What transformation do blood monocytes undergo after 24-48 hours in inflammation?
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Which of the following is NOT a function of activated macrophages?
Which of the following is NOT a function of activated macrophages?
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What specific appearance do activated macrophages assume under certain influences?
What specific appearance do activated macrophages assume under certain influences?
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Which type of products do activated macrophages secrete that can lead to fibrosis?
Which type of products do activated macrophages secrete that can lead to fibrosis?
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Which of the following cells is specifically referred to as Kupffer cells?
Which of the following cells is specifically referred to as Kupffer cells?
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What is one major consequence of macrophage activation in tissue?
What is one major consequence of macrophage activation in tissue?
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Which of the following factors is NOT commonly secreted by macrophages that leads to tissue injury?
Which of the following factors is NOT commonly secreted by macrophages that leads to tissue injury?
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What type of macrophages are responsible for engulfing apoptotic neutrophils during acute inflammation?
What type of macrophages are responsible for engulfing apoptotic neutrophils during acute inflammation?
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What type of cells may fuse to form multinucleated giant cells under the influence of IL-4 or INF-γ?
What type of cells may fuse to form multinucleated giant cells under the influence of IL-4 or INF-γ?
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What is the primary function of B-lymphocytes in chronic inflammation?
What is the primary function of B-lymphocytes in chronic inflammation?
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Which cytokine is produced by activated lymphocytes to stimulate macrophages?
Which cytokine is produced by activated lymphocytes to stimulate macrophages?
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What is the role of macrophages in the interaction with T-lymphocytes?
What is the role of macrophages in the interaction with T-lymphocytes?
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In what type of reactions are eosinophils primarily involved?
In what type of reactions are eosinophils primarily involved?
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What is a major component of eosinophil granules that is toxic to parasites?
What is a major component of eosinophil granules that is toxic to parasites?
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What is the primary role of mast cells in chronic inflammation?
What is the primary role of mast cells in chronic inflammation?
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Which type of chronic inflammation features general characteristics but no specific process?
Which type of chronic inflammation features general characteristics but no specific process?
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What is the primary aim of chronic inflammation?
What is the primary aim of chronic inflammation?
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What type of macrophages are characteristic of granulomatous inflammation?
What type of macrophages are characteristic of granulomatous inflammation?
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What is a hallmark morphological feature of chronic granulomatous inflammation?
What is a hallmark morphological feature of chronic granulomatous inflammation?
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Which of these conditions is an example of granulomatous disease?
Which of these conditions is an example of granulomatous disease?
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Which cell type is notably increased in chronic non-specific inflammation?
Which cell type is notably increased in chronic non-specific inflammation?
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What is a common feature of granulomatous inflammation?
What is a common feature of granulomatous inflammation?
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What role do Langhans giant cells play in granulomatous inflammation?
What role do Langhans giant cells play in granulomatous inflammation?
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In the context of chronic inflammation, what is often formed as a result of increased vascularity?
In the context of chronic inflammation, what is often formed as a result of increased vascularity?
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What is the role of lymphatics during inflammation?
What is the role of lymphatics during inflammation?
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Which condition is NOT mentioned as a favored site for seeding distant infections?
Which condition is NOT mentioned as a favored site for seeding distant infections?
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Which cytokine is primarily involved in the acute phase response and acts on the thermoregulatory center?
Which cytokine is primarily involved in the acute phase response and acts on the thermoregulatory center?
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Which of the following is a systemic effect of inflammation?
Which of the following is a systemic effect of inflammation?
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In chronic inflammation, which inflammatory cells are primarily involved?
In chronic inflammation, which inflammatory cells are primarily involved?
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Which of these is NOT a characteristic of acute inflammation?
Which of these is NOT a characteristic of acute inflammation?
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What effect do IL-6 cytokines have in inflammation?
What effect do IL-6 cytokines have in inflammation?
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Which outcome is associated with chronic inflammation due to prolonged exposure to toxic agents?
Which outcome is associated with chronic inflammation due to prolonged exposure to toxic agents?
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What typically occurs in the peripheral blood during acute inflammation?
What typically occurs in the peripheral blood during acute inflammation?
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Which of these is a common systemic manifestation of chronic inflammation?
Which of these is a common systemic manifestation of chronic inflammation?
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Study Notes
Chronic Inflammation
- Definition: Inflammation of prolonged duration, where active inflammation, tissue injury, and healing occur simultaneously.
- Duration: Weeks to months or years.
- Features: Fibrosis (scarring), lymphocytes, and macrophages are key components.
Chronic Inflammation Characteristics
- Involves the persistence or recurrence of the injurious agent.
- Characterized by prolonged inflammation.
- Inflammatory cells damage tissue, while healing attempts occur.
- New vessel formation (angiogenesis) and fibrosis contribute to healing/repair.
- Mononuclear cells (macrophages, lymphocytes, and plasma cells) infiltrate the affected area.
Causes of Chronic Inflammation
- Unresolved acute inflammation: Examples include chronic abscesses.
- Repeated acute inflammation: Examples include chronic pancreatitis.
- Delayed hypersensitivity reaction: Examples of intracellular agents include brucellosis and viral infections, and examples of other agents include fungi and parasites.
- Repeated contact sensitivity: Examples include contact dermatitis.
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Foreign body reaction:
- Endogenous material: Examples include fat and uric acid crystals in gout.
- Exogenous material: Examples include suture material, asbestos, and silica.
- Autoimmune disease: Examples include Hashimoto's disease.
- Unknown reasons: Examples include inflammatory bowel disease and sarcoidosis.
Chronic Inflammatory Cells: Macrophages
- Origin: Derived from blood monocytes, migrating within the first 24 to 48 hours of acute inflammation.
- Transformation: Transform into large cells (macrophages) capable of phagocytosis.
- Activation: Can become activated, increasing cell size, lysosomal enzymes, and metabolic activity to kill ingested organisms.
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Effects in inflammation:
- Phagocytosis.
- Chemotaxis.
- Tissue injury (due to ECM lysis and increasing injury).
- Angiogenesis (increase in endothelial cells).
- Fibrosis (increase in fibroblasts).
- Multinucleated giant cells.
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Types: Different stimuli lead to the activation of two types of macrophages
- Classically activated macrophages (M1): Microbicidal actions (phagocytosis, killing of bacteria and fungi), inflammation, and tissue repair. Driven by products and cytokines, especially IFN-γ.
- Alternatively activated macrophages (M2): Tissue repair, fibrosis, and anti-inflammatory effects. Induced by IL-4 and IL-13, by TH2 cells (helper T cells) & other leukocytes.
Chronic Inflammatory Cells: Macrophages in Chronic Inflammation
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Secreted products after activation: Biologically active products, which can cause tissue injury and fibrosis. Including:
- Proteases and plasminogen activator.
- Complement components and coagulation factors.
- Reactive oxygen species and NO.
- Arachidonic acid metabolites.
- Cytokines.
- Fibrosis: Growth factors influence the proliferation of smooth muscle cells and fibroblasts, leading to extracellular matrix production. Also, cytokines, angiogenesis factors, and collagenase contribute to this process.
Chronic Inflammatory Cells: Lymphocytes
- Stimulus: Mobilized in response to specific (infection) or non-specific stimuli (infarction, tissue trauma).
- T-lymphocytes: Have a reciprocal relationship with macrophages in chronic inflammation. Crucial for cellular immunity and macrophage interaction.
- B-lymphocytes: Responsible for antibody production; differentiate into plasma cells for this purpose.
- T-lymphocyte-macrophage interaction: Lymphocytes initially activated by macrophages presenting antigens on their cell surface. Activated lymphocytes produce mediators, including interferon-γ (IFN-γ) to activate macrophages. Activated macrophages release cytokines (IL-1 & TNF) to further activate lymphocytes. Resulting in an inflammatory focus where both persistent stimulation can occur until the triggering antigen is removed.
Chronic Inflammatory Cells: Eosinophils
- Found in inflammation due to parasitic infections or allergic reactions.
- Eotaxin is a chemokine for these cells.
- Major basic protein (MBP) is a toxic protein that damages tissue and parasites.
Chronic Inflammatory Cells: Mast cells
- Widely distributed in tissues, especially near blood vessels.
- IgE receptors, crucial in allergic reactions and anaphylactic shock.
- Primary source of histamine for mediating acute inflammation, and cytokines (e.g., TNF) in chronic inflammation.
Chronic Inflammation: Morphological Types
- **1. Non-specific:**General features of inflammation; examples include chronic cholecystitis and chronic pyelonephritis. Granulation tissue characterized by the formation of blood vessels, inflammatory cells, fibroblasts, and collagen. Aims to repair damaged tissue with fibrous tissue.
- Morphology: Increased vasculature and increased numbers of lymphocytes / plasma cells are visible.
- 2. Granulomatous: A histological pattern involving granulomas; examples include leprosy, sarcoidosis, and syphilis.
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Granuloma types:
- Infectious granulomas: Caseous necrosis (central area of necrosis); contains epithelioid macrophages.
- Non-Infectious granulomas: No caseous necrosis; contains epithelioid macrophages.
Inflammation: The Other Defense Lines
- Lymphatics, lymph nodes, mononuclear phagocyte system: Secondary defense lines during inflammation. Lymphatic system drains edema fluid, leukocytes, debris, microorganisms into lymph nodes, causing lymphangitis and lymphadenitis.
- Bacteremia (infection spreading to blood): Can occur if microorganisms aren't contained within lymph nodes. Distant sites (heart valves, meninges, kidneys, joints) can be affected (e.g., endocarditis, meningitis, renal abscesses, septic arthritis).
- Phagocytic cells (liver, spleen, bone marrow): The next line of defense.
Systemic Effects of Inflammation
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Acute-phase response: Includes fever, malaise, anorexia, somnolence, wasting, hypotension; alterations in circulating leukocytes and hepatic synthesis of plasma proteins (e.g., fibrinogen).
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Cytokines (IL-1, IL-6, TNF): The most important mediators of acute-phase reaction. They're produced by leukocytes & other cells in response to infection, immune response, and toxic injury.
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Fever: TNF induces IL-1 production, which in turn stimulates IL-6 production. TNF and IL-1 act on the thermoregulatory center to induce fever via prostaglandin production.
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Changes in leukocyte count: Certain infections cause specific increases (e.g., bacteria: PMNs, parasites with allergy: eosinophils, viruses: lymphocytes).
Acute vs Chronic Inflammation
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Duration: Acute (days), Chronic (weeks/months).
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Onset: Acute (sudden), Chronic (gradual).
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Inflammatory cells: Acute (neutrophils, macrophages), Chronic (lymphocytes, macrophages, fibroblasts).
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Vascular changes: Acute (active vasodilation, increased permeability), Chronic (new vessel formation, granulation tissue).
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Cardinal signs: Acute (present), Chronic (lack of, or low-grade).
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Tissue necrosis, fibrosis: Acute (typically absent), Chronic (typically present).
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Systemic manifestations: Acute (fever), Chronic (low-grade fever, weight loss).
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Peripheral blood changes: Acute (neutrophil leukocytosis), Chronic (variable—increased plasma IG).
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Description
Test your knowledge on chronic inflammation, its characteristics, associated cell types, and mechanisms. This quiz covers various aspects including fibrosis, hypersensitivity reactions, and the role of macrophages in chronic inflammation. Assess your understanding of how chronic inflammation develops and persists in different conditions.
