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Questions and Answers
What is the primary role of bradykinin in the inflammatory process?
What is the primary role of bradykinin in the inflammatory process?
Which of the following is a characteristic of leukotrienes compared to histamine?
Which of the following is a characteristic of leukotrienes compared to histamine?
What is one risk associated with long-term treatment using systemic corticosteroids?
What is one risk associated with long-term treatment using systemic corticosteroids?
Which statement about the administration of corticosteroids is true?
Which statement about the administration of corticosteroids is true?
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Which of the following mediators is primarily responsible for the immediate transient phase of inflammation?
Which of the following mediators is primarily responsible for the immediate transient phase of inflammation?
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What is the main function of the complement system in inflammation?
What is the main function of the complement system in inflammation?
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What type of treatment is systemic corticosteroids primarily used for?
What type of treatment is systemic corticosteroids primarily used for?
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What happens when corticosteroids like cortisol are abruptly stopped after long-term treatment?
What happens when corticosteroids like cortisol are abruptly stopped after long-term treatment?
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What is a primary characteristic of serous exudate?
What is a primary characteristic of serous exudate?
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Which type of exudate is characterized by a thick drainage containing pus?
Which type of exudate is characterized by a thick drainage containing pus?
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What might result from overtreatment with systemic glucocorticoids?
What might result from overtreatment with systemic glucocorticoids?
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What is hemorrhagic exudate also known as?
What is hemorrhagic exudate also known as?
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What type of healing occurs with minimal tissue loss, defined as edge to edge healing?
What type of healing occurs with minimal tissue loss, defined as edge to edge healing?
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What is a potential cause for the formation of fibrinous exudate?
What is a potential cause for the formation of fibrinous exudate?
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An abscess is primarily characterized by the presence of which type of exudate?
An abscess is primarily characterized by the presence of which type of exudate?
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Which type of exudate occurs when there is leakage from capillaries due to damage?
Which type of exudate occurs when there is leakage from capillaries due to damage?
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Which treatment is commonly used for an acute attack of inflammatory bowel disease (IBD)?
Which treatment is commonly used for an acute attack of inflammatory bowel disease (IBD)?
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What is a potential side effect of Sulfasalazine treatment?
What is a potential side effect of Sulfasalazine treatment?
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Which statement correctly describes Crohn's disease?
Which statement correctly describes Crohn's disease?
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What is the role of 5-ASA (mesalamine) in the treatment of IBD?
What is the role of 5-ASA (mesalamine) in the treatment of IBD?
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What is a common trigger for asthma mentioned in the content?
What is a common trigger for asthma mentioned in the content?
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What is a common characteristic of atopic dermatitis?
What is a common characteristic of atopic dermatitis?
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Which of the following is NOT a common treatment for atopic dermatitis?
Which of the following is NOT a common treatment for atopic dermatitis?
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What symptom is typically associated with psoriasis?
What symptom is typically associated with psoriasis?
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What immune response is primarily involved in rheumatoid arthritis?
What immune response is primarily involved in rheumatoid arthritis?
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Which of the following could be a risk factor for developing rheumatoid arthritis?
Which of the following could be a risk factor for developing rheumatoid arthritis?
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What is a potential systemic effect of rheumatoid arthritis?
What is a potential systemic effect of rheumatoid arthritis?
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Which skin change does NOT occur in psoriasis?
Which skin change does NOT occur in psoriasis?
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What is a common feature of both atopic dermatitis and psoriasis?
What is a common feature of both atopic dermatitis and psoriasis?
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What is the primary function of clotting factors found in exudate during an inflammatory response?
What is the primary function of clotting factors found in exudate during an inflammatory response?
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Which cytokines are primarily involved in mediating the Acute Phase Response?
Which cytokines are primarily involved in mediating the Acute Phase Response?
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What effect does the release of cytokines during Systemic Inflammatory Response Syndrome (SIRS) have on the blood vessels?
What effect does the release of cytokines during Systemic Inflammatory Response Syndrome (SIRS) have on the blood vessels?
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What does the Acute Phase Response stimulate the liver to produce?
What does the Acute Phase Response stimulate the liver to produce?
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What process allows leukocytes to move towards the site of injury?
What process allows leukocytes to move towards the site of injury?
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What is one of the metabolic changes facilitated by cytokines during an inflammatory response?
What is one of the metabolic changes facilitated by cytokines during an inflammatory response?
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What is one possible consequence of dysregulation of inflammatory response in SIRS?
What is one possible consequence of dysregulation of inflammatory response in SIRS?
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Which of the following is a key role of histamine in inflammation?
Which of the following is a key role of histamine in inflammation?
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Study Notes
Systemic Manifestations of Inflammation
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Acute Phase Response is mediated by cytokines (IL-1, IL-6, TNF-α)
- Stimulates the liver to produce acute-phase proteins like fibrinogen and CRP.
- Communicates with the hypothalamus to induce fever.
- Stimulates leukocytosis in the bone marrow, increasing neutrophil count.
- Facilitates metabolic changes, such as protein breakdown for immune system use or tissue repair.
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Systemic Inflammatory Response Syndrome (SIRS) occurs when large amounts of microorganisms in the blood lead to dysregulation of the inflammatory response.
- This results in the release of a large quantity of cytokines.
- Manifestations include vasodilation, increased vascular permeability, intravascular fluid loss, and circulatory shock.
Inflammatory Mediators
- Histamine: Primarily responsible for the immediate, transient phase of increased vascular permeability during inflammation. Its effects include vasodilation of blood vessels, smooth muscle constriction, tissue swelling, and itching.
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Arachidonic Acid Metabolites:
- Prostaglandins: Present in most tissues and released by mast cells. They increase capillary permeability, attract WBCs to the site of inflammation, cause pain, potentiate histamine's effects, and promote platelet aggregation.
- Leukotrienes: Similar to histamine, but more potent. They also cause a slow and sustained bronchioconstriction. Found in tissues and released by mast cells.
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Plasma Proteins:
- Clotting Factors: Aid in coagulation during the vascular phase of inflammation.
- Complement System: Increases vascular permeability, enhances phagocytosis, and mediates vasodilation.
- Bradykinin: Increases vascular permeability and causes smooth muscle contraction.
Glucocorticoids
- Systemic steroids are synthetic derivatives of cortisol, produced by the adrenal glands. (e.g. prednisone, hydrocortisone, dexamethasone)
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Routes of Administration:
- Local: Joint injections, ear drops, topical creams
- Systemic: Primarily used for acute treatment. Long-term systemic treatment carries a risk of side effects.
- Systemic Side Effects: Potential for side effects with long-term treatment depends on mode of administration (PO, IV, or IM)
- Withdrawal Symptoms: Corticosteroids must be weaned off slowly to avoid withdrawal symptoms. Abrupt cessation can disrupt the negative feedback loop regulating adrenal glucocorticoid synthesis, leading to overcompensation and adrenal insufficiency.
- Cushing's Syndrome: This condition may result from excessive long-term systemic glucocorticoid treatment, causing exaggerated side effects leading to dysfunction in affected systems.
Exudates
- Serous Exudate: Watery fluid with low protein content, often seen in blisters. Results from plasma entering the site of inflammation.
- Hemorrhagic Exudate (Sanguineous): Occurs when significant tissue injury damages blood vessels or causes leakage of RBCs from capillaries resulting in bloody drainage.
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Purulent Exudate: Thick yellow, brown, green, or gray drainage containing pus (degraded WBCs, proteins, and tissue debris). Staphylococcus infections commonly induce pus formation.
- Abscesses: Localized inflammation containing purulent exudate, surrounded by a layer of neutrophils.
Wound Healing
- Primary Intention: Edge-to-edge healing where the wound edges are approximated with minimal tissue loss.
Atopic Dermatitis
- Also known as Eczema.
- Caused by an exaggerated IgE-mediated (allergic) response, resulting in chronic inflammation of the skin.
- Characterized by deficient innate skin barrier, itching, and scar formation (lichenification).
- Risk of Superinfection: Due to the compromised skin barrier, there is an increased risk of bacterial or viral infections.
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Treatment:
- Moisturize
- Topical Glucocorticoids
- Antihistamines
- Antibiotics or Anti-viral medications for infections.
Psoriasis
- Chronic inflammatory skin disease with autoimmune components.
- Risk Factors: Family history.
- Triggers: Skin trauma, climate changes, stress, and certain medications.
- Skin Changes: Hyperkeratosis, thinned stratum granulosum, and dilated dermal papillae.
- Signs and Symptoms: Dry, scaly skin patches, often not itchy (non-pruritic).
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Treatment:
- Glucocorticoids: Local to systemic application as needed.
- Moisturizing cream.
Rheumatoid Arthritis (RA)
- Chronic systemic rheumatic (inflammatory) disease affecting the joints.
- Involves progressive autoimmune destruction of healthy joint tissues.
- Risk Factors: Family history, gender.
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Mechanism of Action (MOA):
- Inflammation of connective tissue triggered by the immune system attacking the joint.
- Proliferation of WBCs and pro-inflammatory mediators within the tissue.
- Formation of granulation tissue (inflammatory cells, fibroblasts, endothelial cells).
- Dysfunction of the synovial cavity (pannus), leading to inflammation.
- Destruction of surrounding tissue (bone, cartilage).
- Further inflammation and pain.
- Thickening and deformity of affected tissues.
- Bilateral involvement (both sides of the body).
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Signs and Symptoms
- Swelling
- Stiffness (worse in the morning)
- Synovial joint inflammation
- Softening of joints
- Symmetrical symptoms
- Systemic effects (fever, malaise)
- Joint ankylosis (stiffening)
- Relevant Bloodwork: Elevated C-reactive protein (CRP) levels.
- Treatment: No cure, primary focus on managing symptoms and slowing disease progression.
- Risk Factors: Family history, gender.
Inflammatory Bowel Disease (IBD)
- Ulcerative Colitis: Inflammation, swelling, and sores in the large intestine (colon) and rectum.
- Crohn's Disease: Inflammation commonly affecting the small intestine and upper part of the large intestine, affecting more women than men.
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Treatment: Aims to control acute attacks and prevent relapses.
- Acute Attack: IV Glucocorticoids.
- Maintenance: Low-dose PO glucocorticoids, salicylates, and DMARDs/biologics as needed.
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Sulfasalazine (DMARD): A pro-drug activated by bacteria in the colon.
- Produces 5-ASA (mesalamine): Has local anti-inflammatory effects that block arachidonic acid metabolites (similar to NSAIDs). Can be administered orally or rectally.
- Sulfapyridine: Causes systemic anti-inflammatory effects with side effects, including photosensitivity, low urine output, kidney stones, and dehydration. Contraindicated in patients with sulfa allergies.
Asthma
- Chronic inflammatory airway disorder (not autoimmune).
- Affects up to 10% of Canadians.
- Risk Factors: Family history.
- Triggers: Noxious stimuli, including allergens, environmental particles, infections, stress, etc.
- Inflammation and pro-inflammatory mediators initiate a cycle of further inflammation.
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Description
This quiz explores the systemic manifestations of inflammation, including the acute phase response and Systemic Inflammatory Response Syndrome (SIRS). You will learn about the roles of cytokines, the effects on the liver, and the changes in leukocyte counts. Test your knowledge on inflammatory mediators like histamine and their importance in vascular permeability during inflammation.
