Inflammation Study Guide
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Questions and Answers

What is the primary function of opsonins like IgG antibodies and C3b in the context of phagocytosis?

  • Enhancing the recognition and attachment of particles to phagocytes. (correct)
  • Directly killing ingested pathogens within the phagolysosome.
  • Stimulating the production of pseudopods for more efficient engulfment.
  • Neutralizing toxins released by bacteria at the site of infection.

    • Which of the following best describes the role of chemoattractants in the inflammatory response?

  • Directing the movement of extravasated leukocytes towards the site of injury along a chemical gradient. (correct)
  • Blocking the release of inflammatory mediators from mast cells.
  • Promoting the adhesion of leukocytes to the endothelial lining of blood vessels.
  • Inhibiting the migration of leukocytes to prevent excessive inflammation.

    • What is the typical sequence of leukocyte infiltration in acute inflammation?

  • Neutrophils followed by monocytes, then lymphocytes. (correct)
  • Lymphocytes followed by neutrophils, then monocytes.
  • Neutrophils followed by lymphocytes, then monocytes.
  • Monocytes followed by lymphocytes, then neutrophils.

    • Which of the listed mechanisms is oxygen-independent, and responsible for microbial killing by leukocytes?

    <p>Bactericidal permeability increasing protein (BPI) activity. (D)</p> Signup and view all the answers

    Regarding chemical mediators of inflammation, which statement accurately distinguishes between plasma-derived and cell-derived mediators?

    <p>Plasma-derived mediators require activation via enzymatic cleavage, whereas cell-derived mediators can be preformed or synthesized as needed. (A)</p> Signup and view all the answers

    During diapedesis, what cellular process allows leukocytes to move between endothelial cells?

    <p>Formation of pseudopods. (C)</p> Signup and view all the answers

    Which of the following outcomes of acute inflammation is characterized by necrotic tissue surrounded by inflammatory cells and exudative fluid?

    <p>Abscess formation. (B)</p> Signup and view all the answers

    Which characteristic is most indicative of chronic inflammation?

    <p>Simultaneous tissue destruction and repair by fibrosis. (D)</p> Signup and view all the answers

    In chronic inflammation, what role does fibrosis play in the affected tissue?

    <p>It represents a repair mechanism that can lead to scarring and altered tissue architecture. (C)</p> Signup and view all the answers

    Which of the following represents an exogenous chemoattractant that directs leukocyte migration during inflammation?

    <p>Bacterial products. (C)</p> Signup and view all the answers

    What is the primary characteristic of healing by secondary intention?

    <p>The wound has extensive loss of cells and tissues. (D)</p> Signup and view all the answers

    Which of the following events occurs first in both primary and secondary union?

    <p>Initial haemorrhage. (A)</p> Signup and view all the answers

    What role do myofibroblasts play in healing by secondary intention?

    <p>They cause the wound to contract. (D)</p> Signup and view all the answers

    Which factor is NOT considered a local factor affecting wound healing?

    <p>Overall health of the patient. (B)</p> Signup and view all the answers

    What occurs during the organisation phase of primary union?

    <p>Fibroblasts invade the wound area. (C)</p> Signup and view all the answers

    What is the consequence of bacterial contamination in an open wound?

    <p>It delays the healing process. (B)</p> Signup and view all the answers

    What usually happens to suture tracks after they are removed around the seventh day?

    <p>The epithelial tissue in the tracks is absorbed. (D)</p> Signup and view all the answers

    What is a key difference between wound healing in primary and secondary intention?

    <p>Wounds in secondary intention contract significantly. (B)</p> Signup and view all the answers

    Which of the following describes granulation tissue?

    <p>Composed of proliferating fibroblasts and new blood vessels. (D)</p> Signup and view all the answers

    What happens to infected wounds during the healing process?

    <p>They can lead to delayed healing. (B)</p> Signup and view all the answers

    Which cell type is primarily responsible for mediating fibrosis following tissue injury?

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

    What is a characteristic feature of granulomatous inflammation?

    <p>Formation of granulomas (A)</p> Signup and view all the answers

    Which of the following is NOT a type of tissue macrophage?

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

    In healing by primary intention, which characteristic is essential for the wound?

    <p>Clean and uninfected edges (C)</p> Signup and view all the answers

    What best describes the outcome of chronic inflammation associated with ongoing tissue damage?

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

    Which of the following conditions is typically associated with granulomatous inflammation?

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

    What feature distinguishes macrophages functioning in the nervous system?

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

    Which mechanism primarily operates in the healing of clean surgical wounds?

    <p>Healing by primary intention (B)</p> Signup and view all the answers

    What is the result of the inflammatory process involving tissue macrophages and lymphocytes?

    <p>Granulation tissue formation (C)</p> Signup and view all the answers

    Which type of healing occurs with significant tissue loss and requires more time for recovery?

    <p>Secondary union (D)</p> Signup and view all the answers

    Which of the following is the ultimate goal of inflammation?

    <p>To eliminate the injurious agent. (C)</p> Signup and view all the answers

    Which of these is NOT recognized as a cardinal sign of inflammation?

    <p>Pallor (paleness). (B)</p> Signup and view all the answers

    What is the initial vascular response to an injurious stimulus?

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

    Which mechanism primarily contributes to increased vascular permeability during inflammation?

    <p>Endothelial injury leading to necrosis and detachment. (A)</p> Signup and view all the answers

    What is the primary composition of transudate fluid formed during inflammation?

    <p>Fluid forced through vessel walls due to increased blood flow. (B)</p> Signup and view all the answers

    Which event describes margination during the inflammatory response?

    <p>Movement of WBCs toward the blood vessel periphery. (C)</p> Signup and view all the answers

    What characterises exudate fluid in comparison to transudate fluid?

    <p>Higher protein content and presence of cells. (C)</p> Signup and view all the answers

    Pavementing refers to which specific process during inflammation?

    <p>The attachment of white blood cells to the endothelium. (C)</p> Signup and view all the answers

    Rouleaux formation is caused by which of the following?

    <p>Slow blood flow in dilated capillaries. (C)</p> Signup and view all the answers

    Which of the following accurately describes the classification of inflammation?

    <p>Inflammation is classified as acute and chronic, based on its onset and duration. (D)</p> Signup and view all the answers

    Flashcards

    Inflammation

    A protective response of vascularized tissues to injury.

    Acute Inflammation

    Rapid onset inflammation lasting a few minutes to hours.

    Chronic Inflammation

    Longer-lasting inflammation following acute, or can start insidiously.

    Signs of Inflammation

    Indicators of inflammation: redness, heat, pain, swelling, loss of function.

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    Vascular Changes

    Alterations in blood vessel flow and permeability during inflammation.

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    Vasodilatation

    Widening of blood vessels to increase blood flow during inflammation.

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    Transudate

    Fluid forced through vessel walls into tissues during inflammation.

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    Exudate

    Protein-rich fluid that moves into tissues due to increased permeability.

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    Rouleaux Formation

    Arrangement of red blood cells caused by slow blood flow in capillaries.

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    Margination

    Movement of white blood cells to the vessel endothelium's periphery.

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    Diapedesis

    The process where leukocytes move through endothelial cells into extravascular space.

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    Chemotaxis

    Leukocyte movement toward a chemical stimulus in the extracellular space.

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    Chemoattractants

    Substances that attract leukocytes through chemical gradients, can be exogenous or endogenous.

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    Phagocytosis

    The ingestion of bacteria or other material by phagocytes, involving three steps: recognition, engulfment, killing.

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    Opsonins

    Molecules like IgG antibodies and C3b that enhance phagocytosis by marking targets.

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    Neutrophils

    White blood cells that are the first responders during inflammation and are short-lived.

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    Monocytes

    White blood cells that replace neutrophils in inflammation; they are longer-living and proliferate.

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    Acute Inflammation Outcomes

    Four possible outcomes: abscess formation, chronic inflammation, resolution, or repair.

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    Chemical Mediators

    Substances released during inflammation, either plasma-derived or cell-derived, that regulate the response.

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    Primary Union

    The process of healing of a clean surgical wound with no tissue loss.

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    Initial Haemorrhage

    The first event following an injury where blood loss occurs immediately.

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    Acute Inflammatory Response

    A response that occurs within 24 hours following an injury.

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    Epithelial Changes

    Basal cells of the epidermis proliferate and migrate toward the wound site.

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    Granulation Tissue

    A new tissue formed during healing characterized by fibroblast proliferation and new blood vessels.

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    Wound Contraction

    The process where the wound shrinks, reducing its size due to myofibroblasts.

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    Secondary Intention

    Healing for large wounds that involves both regeneration and scarring without closure by sutures.

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    Factors Affecting Wound Healing

    Local and systemic influences that impact how a wound heals.

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    Mechanical Factors

    Influences like movement that affect wound healing, especially near joints.

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    Infected Wound

    A wound contaminated with bacteria, delaying the healing process.

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    Mononuclear Cells

    Cells involved in chronic inflammation, mainly lymphocytes, macrophages, and plasma cells.

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    Lymphocytes

    A type of white blood cell that plays a major role in immune responses.

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    Macrophages

    Immune cells that engulf and digest cellular debris and pathogens.

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    Granuloma

    A cluster of macrophages formed in response to chronic inflammation, often with lymphocytes.

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    Fibrosis

    The thickening and scarring of connective tissue, usually due to injury.

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    Healing by First Intention

    A type of wound healing where edges are approximated for minimal scarring.

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    Healing by Second Intention

    Wound healing by granulation tissue formation, often for larger, more complex wounds.

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    Kupffer Cells

    Specialized macrophages located in the liver, part of the mononuclear phagocyte system.

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    Dendritic Cells

    Antigen-presenting cells that process antigen material and present it to T cells.

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    Study Notes

    Inflammation

    • Inflammation is a response of vascularized living tissues to injury.
    • It is a protective response with the goal of eliminating the injurious agent.

    Classification of Inflammation

    • Inflammation is classified into acute and chronic.
    • Acute inflammation is rapid in onset and short-duration, lasting from a few minutes to hours.
    • Chronic inflammation follows acute inflammation or can begin subtly. It lasts for a longer duration.

    Signs of Inflammation

    • Rubor (redness)
    • Calor (heat)
    • Dolor (pain)
    • Tumor (swelling)
    • Functio laesa (loss of function)

    Triggers of Acute Inflammation

    • Infections (bacterial, viral, parasitic) and microbial toxins
    • Trauma
    • Physical and chemical agents
    • Foreign bodies
    • Immune reactions
    • Tissue necrosis

    Changes in Inflammation: Vascular Changes

    • Vascular changes are an integral part of inflammation.
    • The initial response of arterioles to injury is vasoconstriction (lasts a few seconds).
    • This is followed by vasodilation, increasing blood flow.
    • Increased blood flow causes redness (hyperemia), mild swelling, and a rise in temperature.
    • Increased permeability of vessel walls allows fluid and cells to move into the interstitial space. This fluid is called exudate. Initially, a transudate is formed.

    Changes in Inflammation: Cellular Changes

    • Rouleaux formation: RBCs arrange in a stacked coin-like manner due to slow blood flow in dilated capillaries and venules.
    • Margination: WBCs move toward the periphery of blood vessels, closer to the endothelium.
    • Pavementing: WBCs adhere to the endothelium through adhesion molecules
    • Diapedesis: WBCs migrate out of the blood vessels through the endothelium and into the tissues.
    • Chemotaxis: WBCs migrate towards a chemical gradient towards the site of injury or infection. Chemoattractants include both exogenous (bacterial products) and endogenous (complement proteins, leukotrienes, cytokines) substances.

    Changes in Inflammation: Phagocytosis

    • Phagocytosis is the process in which cells engulf and destroy foreign particles.
    • Recognition and attachment to the foreign material via opsonins.
    • Engulfment of the foreign material by the formation of pseudopods.
    • Destruction and degradation of ingested material

    Cells in Inflammation

    • The predominant cell early in inflammation is the neutrophil (first 6-24 hours).
    • Neutrophils are short-lived and disappear within 24-48 hours.
    • Monocytes take over as the major cell type in longer-lasting inflammation as they survive longer and proliferate.

    Killing and Degradation

    • Oxygen-independent mechanisms for killing microorganisms include the proteins BPI, lysozyme, lactoferrin, and defensins, Major Basic Protein (MBP).

    Chemical Mediators

    • Plasma-derived mediators include complement proteins, kinins, and coagulation factors.
    • Complement, kinins, and coagulation factors exist as pro-forms and require enzymatic cleavage.
    • Cell-derived mediators include histamine, prostaglandins; these are preformed (mast cells) or synthesized as needed (e.g., prostaglandins).
    • Chemical mediators contribute to vasodilation, increased vascular permeability, and chemotaxis.

    Outcomes of Acute Inflammation

    • Abscess formation: necrotic tissue surrounded by inflammatory cells and exudate.
    • Progression to chronic inflammation
    • Resolution: tissue returns to its normal state
    • Repair: healing by scarring or fibrosis

    Chronic Inflammation

    • Prolonged inflammation.
    • Accompanied by tissue destruction.
    • Repair and fibrosis proceed simultaneously.
    • Causes include progression of acute inflammation, persistent infections, prolonged exposure to toxins, and autoimmunity.

    Histologic Features of Chronic Inflammation

    • Mononuclear cells (e.g., lymphocytes, macrophages, plasma cells) are prominent.

    Morphologic Features of Chronic Inflammation

    • Tissue destruction due to prolonged offending agent or inflammatory cells.
    • Attempts at healing by replacement of damaged tissue with connective tissue—achieved by angiogenesis and fibrosis.

    Types of Tissue Macrophages

    • Kupffer cells (liver)
    • Alveolar macrophages (lung)
    • Sinus histiocytes (connective tissue)
    • Fixed/free macrophages (spleen, lymph nodes)
    • Microglial cells (nervous system)
    • Osteoclasts (bone)
    • Langerhans' cells (skin)
    • Dendritic cells (lymphoid tissue)

    Possible Outcomes of Chronic Inflammation

    • Scarring: fibrosis in the injured area
    • Granulomatous inflammation: granuloma formation in response to chronic inflammation. Granulomas are aggregates of macrophages with a surrounding zone of lymphocytes and fibrosis. Granulomas can be formed in response to chronic infections. Tuberculosis is an example of a condition where a granuloma may form.

    Wound Healing

    • Healing of skin wounds is an example of a combination of regeneration and repair.
    • Wound healing may occur by first (primary) or second (secondary) intention.
    • Primary intention healing occurs when edges of a wound are closed (sutures).
    • Secondary intention healing occurs when a wound is left open. This type involves a complex series of events including inflammation, formation of granulation tissue, and scar formation.

    Factors Affecting Wound Healing-local factors

    • Site of wound: skin wounds heal faster than internal organ wounds.
    • Mechanical factors: wounds at joints heal slower.
    • Size of wound: small wounds heal faster
    • Sterile wounds heal faster than infected wounds.

    Factors Affecting Wound Healing- systemic factors

    • Diabetes mellitus: diabetes delays wound healing.
    • Malnutrition and vitamin C deficiency: malnutrition and vitamin C deficiency delay wound healing
    • Inadequate blood supply
    • Glucocorticoids: glucocorticoids inhibit collagen synthesis.
    • Infections: delay wound healing by necrosis and other processes.

    Complications of Wound Healing

    • Infection. Bacteria delay wound healing.
    • Implantation cysts . Persistence of epithelial cells after healing can result in cyst formation.
    • Pigmentation. Healed wounds may have rust-like color due to haemosiderin staining.
    • Wound dehiscence: deficient scar and corticosteroid treatment.
    • Keloids or hypertrophic scars : excessive scarring and defective remodeling.
    • Formation of contractures: resulting from large scars. Contractures over joints cause immobility.

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