Notes in 2- A&C Inflammation

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Published	02/10/2024	{{c1::Acute inflammation}} is a series of protective changes occurring in living tissue as a response to injury.Maintains integrity of organism- it is…
Published	02/10/2024	Cardinal signs of inflammation• {{c1::rubor}} - redness • {{c1::calor}}   - heat • {{c1::tumor}}   - swelling • {{c1::dolor}}   - pain …
Published	02/10/2024	Aetiology of acute inflammation1- {{c1::Micro-organisms}} → bacteria, fungi, viruses, parasites2- {{c1::Mechanical}} → trauma & injury to tissue3-…
Published	02/10/2024	Process of acute inflammation:• Series of microscopic events • Localised to affected tissue • Takes place in the {{c1::microcirculation}} • Results in…
Published	02/10/2024	{{c1::Microcirculation}} is the circulation of blood in the smallest blood vessels, capillary beds, fed by arterioles and drained by venules.• It also…
Published	02/10/2024	Steps of pathogenesis in acute inflammation: (how it happens)1- Changes in vessel {{c1::radius}} - alteration of flow2- Change in the {{c1::perme…
Published	02/10/2024	Local changes in vessel radius and blood flow when acute inflammation starts:1. Transient arteriolar constriction → few moments, probably protective2.…
Published	02/10/2024	Why does increased radius of the blood vessel (vasodilation) increase flow?
Published	02/10/2024	How does increased permeability occur in acute inflammation?
Published	02/10/2024	What are the effects of increased permeability in capillaries?
Published	02/10/2024	{{c1::Oedema}} forms as a result of exudation, it is an accumulation of fluid in the extravascular space.• Swelling of tissue in acute inflammation&nb…
Published	02/10/2024	Why is swelling of tissue associated with acute inflammation?
Published	02/10/2024	A slow rate of flow as a result of increased viscosity in blood vessels is called {{c1::stasis}}
Published	02/10/2024	Normal laminar blood flow vs Inflammatory blood flowWhat are the differences?
Published	02/10/2024	Inflammatory blood flow is characterized by:1- Loss of normal {{c1::laminar}} flow2- {{c1::Rouleaux formation}} of erythrocytes → RBC aggreg…
Published	02/10/2024	{{c1::Neutrophil/Polymorph/Neutrophil polymorphonuclear leukocyte}} is the most important cell in acute inflammation, it marginates (goes to the …
Published	02/10/2024	Phases of emigration of neutrophils:[1] {{c1::Margination}} - neutrophils move to endothelial aspect of lumen [2] {{c1::Pavementing}} - neut…
Published	02/10/2024	{{c1::Diapedesis}} is a passive process where other cells, e.g. RBC, may follow a neutrophil when it emigrates (active process) to extravascular …
Published	02/10/2024	The ideal outcome/resolution of an acute inflammation:• Inciting agent isolated & destroyed• Macrophages move in from blood and phagocytose d…
Published	02/10/2024	What is the ideal outcome/resolution of an acute inflammation?
Published	02/10/2024	Benefits of acute inflammation:• Rapid response to non-specific insult • Cardinal signs and loss of function → transient protection of inflamed area •…
Published	02/10/2024	What are the benefits of acute inflammation?
Published	02/10/2024	Outcomes of acute inflammation:• {{c1::Resolution}} → ideal outcome return to normal • {{c1::Suppuration}} → pus formation • {{c1::Organisation}} → ti…
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Published	02/10/2024	{{c1::Neutrophils}} are:• mobile phagocytes   – recognise foreign antigen   – move towards chemical where it is widely expressed - {{c1::c…
Published	02/10/2024	Consequences of neutrophil action- Neutrophils die when granule content is released- Production of a soup of fluid, bits of cell, organisms, endogenou…
Published	02/10/2024	What is the role of plasma proteins in inflammation?[1] {{c1::Fibrinogens}} → coagulation factor→ forms fibrin and clots exudate→ localises infla…
Published	02/10/2024	What is the role of plasma proteins in inflammation?
Published	02/10/2024	Mediators of acute inflammation[1] molecules on endothelial {{c1::cell surface}} membrane- adhesion molecules appear on endothelial cells e.…
Published	02/10/2024	Collective effects of mediators:• {{c1::Vasodilation}} → increase vessel radius • {{c1::Increased permeability}} → increase leakyness of end…
Published	02/10/2024	{{c1::Cell surface mediators}} are adhesion molecules, i.e. sticky tapes, that appear on endothelial cells.e.g. ICAM-1 → help neutrophils stick t…
Published	02/10/2024	Molecules released from cells:{{c1::Histamine}} is preformed in mast cells near vessels, platelets and basophils.It is released as a result …
Published	02/10/2024	Molecules released from cells:{{c1::5-hydroxytryptamine (serotonin)}} is preformed in platelets. – it is released when platelets degranulate in coagul…
Published	02/10/2024	Molecules released from cells:{{c1::prostaglandins}} are arachidonic acid metabolites formed via cyclo-oxygenase pathway- released from many cells &am…
Published	02/10/2024	Molecules released from cells• {{c1::cytokines and chemokines}} (e.g. TNFα, IL-1) are small molecules produced by macrophages, lymphocytes, endotheliu…
Published	02/10/2024	Molecules released from cells:• {{c1::nitric oxide (NO)}} cause smooth muscle relaxation, anti-platelet, regulate leukocyte recruitment to inflammator…
Published	02/10/2024	Molecules inside cells - signalling• Pattern associated molecular groups- {{c1::microbial antigen}} that are genetically hardwired to recognise:&…
Published	02/10/2024	Intracellular inflammatory pathways [1] {{c1::NF-κB (nuclear factor kappa-B)}} pathway [2] {{c1::MAPK (mitogen-activated protein k…
Published	02/10/2024	Interaction of four enzyme cascades in Plasma:[1] Blood coagulation pathways – clots fibrinogen in exudate – interacts widely with other systems [2] …
Published	02/10/2024	Why are there mediators that cause opposite effects? What's the bigger picture behind their role?e.g. vasodilation and vasoconstrictionincre…
Published	02/10/2024	Immediate systemic effects of acute inflammation• {{c1::Pyrexia}} - raised temperature – endogenous pyrogens from white cells act centrally on brain •…
Published	02/10/2024	What are the immediate systemic effects of inflammation?
Published	02/10/2024	Longer term effects of inflammation:[1] {{c1::lymphadenopathy}} - regional lymph node enlargement – immune response [2] {{c1::weight loss}} …
Published	02/10/2024	What are the longer term effects of inflammation?
Published	02/10/2024	{{c1::Suppuration}} is one of the outcomes of acute inflammation.Characterized by:1- {{c2::pus formation}}– dead tissue, organisms, exudate, neutrophi…
Published	02/10/2024	An {{c1::abscess}} is a collection of pus (suppuration) under pressure.e.g. pimple- Single locule or multiloculated → points as 'yellow head' the…
Published	02/10/2024	{{c1::Empyema}} is a pus in a hollow viscus. e.g. gallbladder & pleural cavity{{c1::Pyaemia}} is a pus discharged in the blood stream
Published	02/10/2024	{{c1::Organisation}} is one of the outcomes of acute inflammation.Characterized by:• Granulation tissue • Healing and repair • fibrosis and forma…
Published	02/10/2024	{{c1::Granulation tissue}} is the body's repair kit for all damage, it is new connective tissue and microscopic blood vessels that form on t…
Published	02/10/2024	{{c1::Dissemination}} is one of the outcomes of acute inflammation.Characterized by:• The spread of inflammation to bloodstream - patient “septic” • …
Published	02/10/2024	Basic cardiovascular physiology• Blood Pressure (BP) • Cardiac Output (CO) • Stroke Volume (SV) • Heart Rate (HR)   CO = SV x HR • Systemic vasc…
Published	02/10/2024	Effects of systemic infection:{{c1::Shock}} - inability to perfuse tissues• Clinical picture of early septic shock – peripheral vasodilatation – …
Published	02/10/2024	How does septic shock happen?• {{c1::Systemic release of chemical mediators from cells into plasma}} – Mediators cause vasodilation causing loss of sy…
Published	02/10/2024	How does septic shock happen?
Published	02/10/2024	What happens when raised HR fails to compensate for the loss in SVR?CO = SV x HRBP = CO x SVR
Published	02/10/2024	Outcomes of septic shock:• {{c1::Rapidly fatal}} • {{c1::Tissue hypoxia}} → cell death • {{c1::Haemorrhage}} • Requires urgent intervention and s…
Published	02/10/2024	What are the outcomes of septic shock?
Published	02/10/2024	{{c1::Chronic inflammation}} is inflammation that tends to be long term in which the cell population is:LymphocytesPlasma cells → production of antibo…
Published	02/10/2024	Features of chronic inflammation:[1] {{c1::malaise and weight loss}}e.g. • tuberculosis (lung, lymph node, bone, kidney, skin)   - syst…
Published	02/10/2024	When do we see chronic inflammation?[1] arising from {{c1::acute inflammation}}• follows on from acute, large volume of damage • acute and chroni…
Published	02/10/2024	{{c1::Organisation}} involves granulation tissue and angiogenesis.→ results in healing and repair → fibrosis & scar formation.can extend from acut…
Published	02/10/2024	{{c1::Angiogenesis}} is the formation of new vessels.Hypoxia stimulates the release of {{c1::Vascular Endothelial Growth Factor (VEGF)}} for prolifera…
Published	02/10/2024	Generic nature of angiogenesis:• Angiogenesis and organisation in {{c1::thrombosis}}   – limits thrombus propagation   – reinstatement of fl…
Published	02/10/2024	How does granulation tissue work and function in inflammation?
Published	02/10/2024	Granulation tissue - early(vessels red & lymphocytes & fibroblasts & macrophages & plasma cells)Granulation tissue - established(more …
Published	02/10/2024	Explain the interface between acute and chronic inflammation
Published	02/10/2024	A {{c1::scar}} is a small firm blemish on skin made from fibrous tissue as a product of granulation tissue.It can be a problem in the loops of bowel f…
Published	02/10/2024	A {{c1::primary chronic inflammation}} (i.e. not arising after an acute inflammation) Features: • lymphocytes, plasma cells, macrophage…
Published	02/10/2024	Features of chronic inflammation:• Cells– {{c1::Lymphocytes}} – {{c1::Plasma cells}} – {{c1::Macrophages}} – {{c1::Fibroblasts}} • Tissue compone…
Published	02/10/2024	{{c1::Lymphocytes}} are cells that are part of immune system.• Small round cells with lots of subtypes and functionsMain types: – T-cell – B-cell Main…
Published	02/10/2024	{{c1::Plasma cells}} are differentiated B-cells that are responsible for antibody production
Published	02/10/2024	B-cell mechanisms[1] {{c1::Differentiation to plasma cells}}→ production of antibodies (facilitates immune response)[2] {{c1::Interaction with macroph…
Published	02/10/2024	T-cell mechanisms:[1] {{c1::Production of cytokines}}– attract and hold macrophages – activate macrophages & lymphocytes – alter permeability of …
Published	02/10/2024	{{c1::Natural killer cells}} are cells of the innate immunity similar to neutrophils, they destroy antigens and cells.→ chemical mechanisms - granule …
Published	02/10/2024	{{c1::Macrophages}} are cells that remove debris, have a role in immune system - antigen presenting cells (APCs).They come from bone marrow, but also …
Published	02/10/2024	{{c1::Fibroblasts}} are motile cells & metabolically active.Make structural proteins e.g. various types of collagen.
Published	02/10/2024	{{c1::Granulomatous inflammation}} is inflammation characterised by the presence of granulomas (granulomata) in tissues and organs, which is a collect…
Published	02/10/2024	{{c1::Granulomas}} are aggregates of epithelioid macrophages in tissue that occur in response to indigestible antigen.Many are type IV hypersensitivit…
Published	02/10/2024	{{c1::Giant cells}} are cells that may be a result of a fusion of macrophages.Granuloma not needed for their presence but usually is present with them…
Published	02/10/2024	relevant Infectious granulomatous diseases:• tuberculosis – {{c1::Mycobacterium tuberculosis}} • leprosy – {{c1::Mycobacterium leprae}} • syphilis – {…
Published	02/10/2024	{{c1::Caseous necrosis}} is dead tissue surrounded by macrophages, giant cells, lymphocytes.No neutrophil presence & TB common in HIV
Published	02/10/2024	Tuberculosis prevalence
Published	02/10/2024	{{c1::Mycobacterium tuberculosis}} → Ziehl-Neelsen stain
Published	02/10/2024	Leprosy
Published	02/10/2024	SyphilisSyphilis primary stage → chancre
Published	02/10/2024	Examples of non-infective granulomas:• Rheumatoid disease - tissue specific auto-immune disease, ? cause • Sarcoidosis – classical clinical picture, ?…
Published	02/10/2024	{{c1::Wound healing}} is the process of repair of tissue damage after injury.1- Phase of acute inflammation2- Granulation tissue formation3- Local ang…
Published	02/10/2024	Surgical wound healing vs Larger defect healingWhat's the difference?
Published	02/10/2024	Describe the sequence of events in wound healing
Published	02/10/2024	How do we favour wound healing?• cleanliness • apposition of edges (no haematoma - no blood clot) • sound nutrition • metabolic stability and normalit…
Published	02/10/2024	How do we impair wound healing?• Dirty, gaping wound, large haematoma • Poor nourishment, lack of vitamins C, A • Abnormal CHO metabolism, diabetes, c…
Published	02/10/2024	Favoured wound healing vs Impaired wound healingWhat are the factors that help?
Published	02/10/2024	{{c1::Fracture healing}} is the healing of bone and the soft tissue around it.Sequence:• Trauma, fracture, haematoma→ Causes bits of dead bone and sof…
Published	02/10/2024	Callus formation:• {{c1::Osteoblasts}} lay down woven bone • Nodules of cartilage present • Followed by bone remodelling – {{c1::osteoclasts}} remove …
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