Outcomes of Acute Inflammation

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Questions and Answers

What roles do C-reactive protein (CRP) and serum amyloid A (SAA) play in the immune response?

CRP and SAA act as opsonins by binding to microbial cell walls, facilitating phagocytosis, and fixing complement.

How does elevated fibrinogen affect erythrocyte behavior in inflammatory conditions?

Elevated fibrinogen leads to increased erythrocyte aggregation, which raises the erythrocyte sedimentation rate.

Describe the leukocyte response in bacterial infections compared to viral infections.

Bacterial infections typically cause neutrophilia (increased neutrophils), while viral infections lead to lymphocytosis (increased lymphocytes).

What are some central nervous system symptoms associated with the acute phase response?

<p>Symptoms include increased pulse and blood pressure, chills, anorexia, somnolence, and malaise.</p> Signup and view all the answers

What occurs during sepsis in terms of cytokine production and resulting clinical manifestations?

<p>In sepsis, high levels of cytokines like TNF and IL-1 can lead to disseminated intravascular coagulation (DIC), metabolic disturbances, and cardiovascular failure known as septic shock.</p> Signup and view all the answers

What types of cells primarily form the nodules in granulomatous inflammation?

<p>Epithelioid macrophages.</p> Signup and view all the answers

Which infectious disease is characteristically associated with immune granulomas, specifically forming a tubercle?

<p>Tuberculosis.</p> Signup and view all the answers

Name one inorganic cause of granulomatous inflammation.

<p>Silicosis.</p> Signup and view all the answers

How do activated T cells influence the formation of immune granulomas?

<p>They produce IFN-γ, which causes macrophages to transform into epithelioid cells.</p> Signup and view all the answers

What systemic change is characterized by the elevation of temperature in response to pyrogens?

<p>Fever.</p> Signup and view all the answers

What role do acute-phase proteins play in the acute phase response?

<p>They are plasma proteins that significantly increase in synthesis in response to inflammatory stimuli.</p> Signup and view all the answers

What is a foreign body granuloma, and what typically incites it?

<p>A granuloma incited by particles that cannot be easily phagocytosed, such as suture or talc.</p> Signup and view all the answers

What is the role of IL-1 and TNF in fever generation during the acute phase response?

<p>They stimulate the production of prostaglandins in the hypothalamus, resetting the temperature set point.</p> Signup and view all the answers

What happens to older granulomas over time?

<p>They may become surrounded by a rim of fibrosis.</p> Signup and view all the answers

Identify one systemic response that may occur in severe inflammation.

<p>Systemic inflammatory response syndrome (SIRS).</p> Signup and view all the answers

What leads to the transition from acute to chronic inflammation?

<p>The transition occurs due to the persistence of the injurious agent or interference with the normal healing process.</p> Signup and view all the answers

Describe the nature of chronic inflammation in terms of its duration and processes involved.

<p>Chronic inflammation is prolonged, lasting weeks to months, involving simultaneous active inflammation, tissue destruction, and healing.</p> Signup and view all the answers

List two contexts in which chronic inflammation can occur.

<p>Chronic inflammation can occur after acute inflammation or due to persistence of an inciting stimulus.</p> Signup and view all the answers

What are the types of diseases that can lead to chronic inflammation?

<p>Persistent infections, hypersensitivity diseases, prolonged exposure to toxins, and certain non-inflammatory diseases can cause chronic inflammation.</p> Signup and view all the answers

What are the main morphological features of chronic inflammation?

<p>Key features include infiltration with mononuclear inflammatory cells, tissue destruction, and attempts at healing through angiogenesis and fibrosis.</p> Signup and view all the answers

Distinguish between chronic non-specific inflammation and granulomatous inflammation.

<p>Chronic non-specific inflammation is a broad category while granulomatous inflammation is characterized by focal accumulations of activated macrophages.</p> Signup and view all the answers

How does the presence of intracellular microbes contribute to chronic inflammation?

<p>Persistent intracellular microbes can evoke immunologic responses, maintaining inflammation over time.</p> Signup and view all the answers

What is the role of macrophages in granulomatous inflammation?

<p>Macrophages become activated and enlarge, forming epithelioid macrophages that aggregate into granulomas.</p> Signup and view all the answers

Explain the potential impact of prolonged exposure to lipids on chronic inflammation.

<p>Prolonged lipid exposure can lead to atherosclerosis, which is a form of chronic inflammation.</p> Signup and view all the answers

Identify one disease conventionally not considered inflammatory that may be driven by inflammation.

<p>Metabolic syndrome is an example of a disease not conventionally classified as inflammatory that can be influenced by chronic inflammation.</p> Signup and view all the answers

What are the four main factors affecting the outcome of acute inflammation?

<p>The nature of injury, intensity of injury, tissue involved, and host responsiveness.</p> Signup and view all the answers

Describe the outcome of complete resolution in the context of acute inflammation.

<p>Complete resolution involves the restoration of the site to normal, with removal of debris by macrophages and resorption of edema by lymphatics.</p> Signup and view all the answers

What indicates that healing has progressed to fibrosis in acute inflammation?

<p>Fibrosis occurs when there is substantial tissue destruction or when the injured tissue cannot regenerate.</p> Signup and view all the answers

How does the presence of abundant fibrin exudation influence the resolution of inflammation?

<p>Abundant fibrin exudation can lead to organization, where connective tissue grows into the area of damage, forming fibrous tissue.</p> Signup and view all the answers

What role do macrophages play in the complete resolution of acute inflammation?

<p>Macrophages are responsible for removing cellular debris and microbes from the inflamed site.</p> Signup and view all the answers

Give an example of a situation leading to healing by connective tissue replacement.

<p>An example is severe burns that involve a large area of the body, which result in substantial tissue destruction.</p> Signup and view all the answers

What is meant by the term 'organization' in the context of acute inflammation?

<p>Organization refers to the process where inflammatory exudates are resolved by the formation of fibrous tissue.</p> Signup and view all the answers

What are the typical outcomes of acute inflammation when the injury is limited and tissue destruction is minimal?

<p>The typical outcome is complete resolution, where the tissue is restored to its normal state.</p> Signup and view all the answers

Flashcards

Complete resolution of acute inflammation

The complete restoration of the site of acute inflammation back to its normal state.

Healing by connective tissue replacement (fibrosis)

The process of replacing damaged tissue with connective tissue (scar tissue).

Chronic Inflammation

The type of inflammation that lasts for a prolonged period, typically weeks or months.

Suppurative inflammation

Inflammation characterized by the accumulation of pus, a thick fluid containing dead white blood cells.

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Organization

The growth of connective tissue into an area of damage or exudate.

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Granulomatous Inflammation

A type of chronic inflammation characterized by the formation of granulomas, small collections of immune cells.

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Systemic inflammation

Inflammation that affects the entire body, rather than a specific location.

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Factors affecting the outcome of acute inflammation

The factors that determine the outcome of acute inflammation, including the severity of the injury, the type of tissue involved, and the body's ability to respond.

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Acute to Chronic Inflammation Transition

The progression from acute to chronic inflammation happens when the initial inflammatory response fails to resolve due to the persistent presence of the injurious agent or interference with the healing process.

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Causes of Chronic Inflammation

Chronic inflammation can occur after acute inflammation as part of normal healing or due to persistent triggers or repeated acute episodes.

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Chronic Inflammation Morphology

Chronic inflammation is characterized by infiltration of mononuclear cells (macrophages, lymphocytes, plasma cells), tissue destruction, and attempts at healing via tissue replacement.

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Chronic Inflammation - Toxic Exposure

Inflammation caused by prolonged exposure to toxic agents, such as silica or lipids, causing diseases like silicosis or atherosclerosis.

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Chronic Inflammation - Persistent Microbes

Infections by persistent microbes like viruses or bacteria can lead to chronic inflammation by constantly stimulating the immune system.

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Chronic Inflammation - Hypersensitivity

Hypersensitivity reactions can trigger chronic inflammation, particularly autoimmune diseases, inflammatory bowel disease, and allergies.

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Chronic Inflammation - Non-Traditional Diseases

Chronic inflammation can contribute to diseases not conventionally understood as inflammatory like neurodegenerative disorders, metabolic syndrome, and cancer.

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Chronic Inflammation - Causes and Factors

Chronic inflammation can be caused by various factors and often involves a combination of these factors.

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Acute-phase reactants

Proteins like C-reactive protein (CRP), fibrinogen, and serum amyloid A (SAA) increase during inflammation. They aid in clearing debris, promoting immune responses, and influencing erythrocyte sedimentation rate.

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Leukocytosis

An increase in the number of white blood cells (WBCs) in the blood, often seen during inflammation. It reflects the body's response to infection or injury.

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Neutrophilia

A specific type of leukocytosis where neutrophils (a type of WBC) are elevated, often associated with bacterial infections.

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Sepsis

A condition where the body releases massive amounts of cytokines, like TNF and IL-1, leading to widespread inflammation, blood-clotting problems, and potentially organ failure.

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Septic shock

A clinical triad of disseminated intravascular coagulation (DIC), metabolic disturbances, and cardiovascular failure caused by sepsis.

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What is granulomatous inflammation?

A type of chronic inflammation characterized by the formation of granulomas, which are small collections of immune cells.

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Describe the structure of a granuloma.

Nodules of epithelioid macrophages, a type of immune cell, form the core of granulomas. These macrophages are surrounded by a ring of lymphocytes, which are white blood cells that help to fight off infection. Activated macrophages may fuse together to form multinucleated giant cells, which can be seen in some granulomas.

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What are the common causes of granulomatous inflammation?

Granulomas can be caused by infections like tuberculosis, leprosy, syphilis, and fungal infections. They can also be caused by inflammatory conditions like temporal arteritis, Crohn disease, and sarcoidosis. And sometimes, they are caused by exposure to inorganic particles like silica or beryllium.

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What is a foreign body granuloma?

A type of granuloma that forms in response to materials that cannot be easily engulfed by a single macrophage, such as sutures or talc, but don't trigger a specific immune response.

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What is an immune granuloma?

A type of granuloma that forms in response to persistent, poorly degradable antigens and involves immune T cells. These T cells release a substance called interferon-gamma (IFN-γ), which activates macrophages and causes them to transform into epithelioid cells and form multinucleated giant cells.

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What is a tubercle?

The prototypical immune granuloma caused by the tuberculosis bacillus. It typically has a central area of caseous necrosis, which is a type of cell death that causes a cheesy-looking substance to form.

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What is the acute phase response (or SIRS)?

A systemic response to inflammation that involves various clinical and pathologic changes, particularly in severe cases. These changes are triggered by cytokines released in response to bacterial products or inflammatory stimuli.

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How does fever occur during inflammation?

Fever, a rise in body temperature, occurs during the acute phase response. It's induced by substances called pyrogens, which stimulate the production of prostaglandins in the hypothalamus. For instance, endotoxin leads to the release of IL-1 and TNF, triggering the production of prostaglandins, especially PGE2, which increases the body's temperature set point.

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What are acute-phase proteins?

Increased production of certain plasma proteins, primarily of liver origin, known as acute-phase proteins. These proteins are significantly elevated in response to inflammatory stimuli, such as cytokines like IL-6 and TNF.

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What are macrophages?

A type of immune cell that plays a critical role in the immune response. They are phagocytic cells, meaning they engulf and destroy pathogens and cellular debris.

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Study Notes

Outcomes of Acute Inflammation

  • Acute inflammation outcomes are categorized into complete resolution, healing by connective tissue, and progression to chronic inflammation.
  • Complete resolution occurs when injury is limited, tissue destruction is minimal, and damaged cells can regenerate. Removal of cellular debris and edema fluid by macrophages and lymphatics restores the area to normal.
  • Healing by fibrosis occurs when substantial tissue destruction occurs. The body replaces the damaged tissue with connective tissue. Examples include suppurative inflammation and burns.
  • Progression to chronic inflammation occurs when acute inflammation cannot be resolved due to persistent injury or interference with healing, chronic inflammation involves simultaneous inflammation, tissue destruction, and healing for extended periods.

Factors Affecting Acute Inflammation Outcomes

  • Nature of injury: The type of injury influences the outcome.
  • Intensity of injury: Severity of injury affects how much tissue is damaged.
  • Tissue involved: Different tissues regenerate or heal at different rates.
  • Host responsiveness: The body's ability to fight off infection and repair damage affects the outcome.

Outcomes of Chronic Inflammation

  • Chronic inflammation is characterized by prolonged inflammation (weeks or months) in which inflammation, tissue destruction, and healing occur concurrently.
  • It can be triggered by persistent infection, hypersensitivity diseases, prolonged exposure to toxins, or diseases not considered inflammatory.
  • Results in infiltration with inflammatory cells (macrophages, lymphocytes, and plasma cells), tissue destruction, and attempts at healing through connective tissue replacement.

Granulomatous Inflammation

  • A distinctive form of chronic inflammation characterized by focal accumulations of activated macrophages called granulomas.
  • Enlarged, flattened macrophages are often found in the center of granulomas.
  • Granulomas often form to contain persistent injurious agents.
  • May be caused by infectious agents (tuberculosis, leprosy), inflammatory conditions, or foreign materials.
  • Examples include granulomas related to tuberculosis or foreign bodies.

Systemic Effects of Inflammation

  • Systemic changes, collectively called acute-phase response or SIRS, are a body-wide reaction to inflammation.
  • Fever, elevated acute-phase proteins (like CRP and SAA), increased white blood cell count.
  • Other effects include decreased sweating, rigors and chills, anorexia, and malaise.
  • Severe cases can involve DIC, metabolic disturbances, and cardiovascular collapse (septic shock).

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