Chapter 3- Pathology

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  1. Inflammation
    • reaction of vascularized tissue to cell injury of cell death
    • consider to be adaptive
  2. What is the function of inflammation?
    • minimize effects of injuring agent
    • isolate and limit damage to smaller area
    • removes damaged cells/tissues and sets the stage for cell division and healing
  3. What happens if excessive or chronic inflammation occurs? Give an example.
    • Can cause even more cell injury and cell death
    • Seen in bronchial asthma
  4. Acute inflammation last a few minutes to a few days. It has two phases:
    • Vascular phase: exudation of fluid and plasma
    • Cellular phase: release of chemical mediators triggering specifics actions
  5. Chronic inflammation lasts anywhere from days to years. Commonly results in:
    • abnormal proliferation of blood vessels, necrosis, and fibrosis
    • damages cell
  6. Cells of inflammation: Tissue cells
    • Fibroblats: connective tissue makes finers- collogen and elastin
    • Mast cells: Histamine release for allergy or inflammation
  7. Cells of inflammation: Endothelial cells-
    • Platelets
    • Leukocytes
  8. Cells of inflammation: Leukocytes
    Granulcytes or Aganulocytes
  9. What are the three types of granulocytes (BEN)?
    Basophils, Eosinophils, Neutrophils
  10. What are the two types of Agranulocytes?
    • Monocytes--->macrophages
    • Lymphocytes and mature plasma cells
  11. Neutrophils are the phagocytes of _____ inflammation and Monocytes are the phagocytes of _____ inflammation.
    • acute
    • chronic
  12. Eosinophils:
    proteins that are toxic to parasitic worms
  13. Basophils:
    histamine released in allergy response or inflammation
  14. Lymphocytes:
    cell-mediated and anti-body mediated immunity
  15. What are inflammatory mediators? Name two types.
    • A variety of chemicals in plasma that are released from cells with specific effects
    • Cytokine and Chemokine
  16. Cytokine:
    chemical mediator secreted by one cell that has specific effects on a different cell
  17. Chemokine:
    • chemical mediators secreted by one cell that attracts a different cell type to a specific area
    • Chemotaxis
  18. What is exudation?
    • Occurs during inflammation process
    • The movement of fluid, leukocytes, and proteins from the blood into the damaged area
  19. What can trigger acute inflammation?
    Anything that damages or kills cells
  20. List the 5 cardinal signs of inflammation:
    • Redness, swelling, heat, pain, loss of function
    • Extra: systemic manifestations such as an altered WBC count, fever, etc
  21. Acute inflammation has two distinct, overlapping phases:
    Vascular and cellular
  22. Vascular phase of Acute inflammation:
    exudation of fluid and plasma proteins, from blood vessels into tissue
  23. During the vascular phase of inflammation, what aids in clotting?
    As fluid leaves blood it causes a stagnation of blood flow that aids in clotting
  24. During vascular phase of inflammation, what causes vasoconstriction, followed by vasodilation?
    • Histamine
    • Nitric oxide
    • some other chemical mediators
  25. During the vascular phase of inflammation, what aids in increased vascular permeability after vasoconstriction/vasodilation?
    • Histamine,
    • Bradykinin
    • Leukotrienes
    • activated complement proteins
  26. Cellular phase of acute inflammation:
    release of chemical mediators, triggering specific actions by specific cells
  27. During the cellular phase of acute inflammation, chemotactic chemokines do what?
    Attract leukocytes to leave lymphoid tissues and enter the blood to go to vessels in the damaged area
  28. During the cellular phase of acute inflammation, what causes margination and adhesion of leukocytes to the endothelium in vessels of damages area?
    Activated complement proteins
  29. What happens to endothelial cells after leukocytes adhere to the endothelium?
    • Endothelial cells separate from one another and vessels become more permeable
    • Leukocytes transmigrate through the blood vessels into interstitial spaces--causes swelling
  30. During acute inflammation, _____ (monocytes/neutrophils) are attracted early on and (monocytes/neutrophils) are attracted later on.
    • Neutrophils--early on
    • Monocytes/macrophages-later on in stage
  31. What are the 4 steps of the cellular stage in acute inflammation?
    • 1. margination and adhesion of leukocytes
    • 2. transmigration
    • 3. Chemotaxis
    • 4. Phagocytosis
  32. Chemical mediators of inflammation: Plasma vs cell derived
    • Plasma: made in the liver, circulate in plasma, has three distinct groups
    • Cell: available in most cells, some found in granules inside cell (histamine), sometimes created by cell when stimulated
  33. Distinct groups of plasma derived chemical mediators:
    • 1. Acute phase proteins: bradykinin
    • 2. Coagulation factors: fibrinogen and prothrombin
    • 3. Complement proteins
  34. Bradykinin is produced in the ____ and causes:
    • liver
    • causes pain and increased vessel permeability
  35. Fibrinogen is created in the ___ and causes:
    liver; causes coagulation and Rouleaux (stacks of red blood cells)
  36. Complement proteins formed in the liver cause:
    chemotaxis or leukocytes and an enhanced release of histamine from mast cells
  37. Histamine is found in ____ and causes:
    mast cells and basophils; causes vasodilation and increased vessel permeability
  38. Serotonin comes from ___ and causes:
    platelets; causes vasodilation and increased vessel perm.
  39. Thromboxane is a protaglandin that causes:
    • Vasoconstriction
    • bronchoconstriction
    • causes platelets to clot
  40. Prostoglandins PGI2, and PGF2 alpha cause:
    • vasodilation/increased vessel perm
    • broncoconstriction
    • fever
    • pain
  41. Of the prostaglandins covered, all cause _____ but only ____ causes vasoconstriction.
    • all cause bronchoconstriction
    • only Thromboxane causes vasoconstriction
  42. Leukotrienes is a chemical mediator that causes:
    • increased vessel perm.
    • Bronchoconstriction
  43. Nitric oxide, of the inflammatory chemical mediators causes:
    • vasodilation
    • activation of phagocytes and metabolic burst
  44. What does pyogenic mean?
    "pus forming"
  45. Name some types of Exudate caused by acute inflammation:
    • Serous: low protein, water fluid in tissues
    • Hemorrhagic: damaged blood vessels allow blood to leak into fluid in tissues
    • Fibrinous: fibrinogen forms thick and sticky meshwork within fluid in tissues
    • Suppurative (purulent): pus from phagocytes engulfing and killing pathogen and or body cells
  46. Inflammation at the epithelial surface can lead to ______.
  47. What are the possible outcomes of acute inflammation?
    • 1. Resolution
    • 2. Fibrosis and scarring
    • 3. Abscess formation
    • 4. Progression to chronic inflammation
  48. Chronic inflammation results in:
    • 1. Abnormal proliferation of blood vessels (angiogenisis)
    • 2. necrosis 
    • 3. fibrosis
  49. Chronic inflammation is characterized by proliferation of ____, and infiltration of ___ and ____ into the inflamed area.
    • proliferation of fibroblasts
    • infiltration of macrophages and lymphocytes
  50. Name some causes of chronic inflammation:
    • Recurrent acute inflammation
    • Foreign bodies
    • Fungal infection
  51. Examples of foreign bodies that cause chronic inflammation:
    fibers in lung, suture, bone fragments not connected to blood vessel after crushing injury, shrapnel fragments
  52. Name a fungus that can cause chronic inflammation
    Coccidioides immitis causes Valley Fever
  53. ____ is a bacterium that causes TB and often shows chronic inflammation in lung and other body parts.
    Mycobacterium sp.
  54. ________ ________ is a protistan that causes one form of severe diarrhea and often causes chronic inflammation of the lining of the intestine.
    Entamoeba histoltica
  55. ________ can cause chronic inflammation of the liver
    Hep. C
  56. Granuloma:
    • a distinct lesion seen with chronic inflammation
    • clusters of epithelioid cells: macrophages the resemble epithelial cells surrounded by lymphocytes
  57. ________ inflammation is commonly seen with foreign body, fungal infections, and TB
  58. What leads to "acute-phase response" in inflammation?
    when inflammation doesn't remain localized or if chemical mediators leave injured area and enter circulation
  59. What are the signs and symptoms of "acute-phase response"?
    • Increase in plasma proteins (bradykinin, c-reactive protein, Serum Amyloid A protein)
    • Skelatal muscle breakdown (catabolism)
    • Negative nitrogen balance
    • Elevated erythrocyte sedimentation rate
    • Alterations in WBC count
    • Fever
    • Increased heart rate
    • Anorexia
    • Somnolence (sleepy)
    • Malaise 
  60. Systemic inflammatory response syndrome occurs when certian bacterial infections cause too much of the cytokines names _____ Factor alpha and _______ to be made.
    Tumor-necrosis and Interleukin-1
  61. During systemic inflammatory response syndrome, vasodilation of vessels throughout the body occur. This causes what to happen?
    • Causes increased perm of body vessels
    • Intravascular fluid is lost--->hypotension, circulatory shock from ischemia
    • Myocardial depression
  62. Another effect of systemic inflammation is Disseminated Inravasular Coagulation (DIC):
    formation of small clots throughout blood which cause ischemia and organ damage
  63. What is another word for pyrexia?
    • Fever!
    • Temps above: 97-99.5 deg.F or 36-37.5 deg.C
  64. Neurons located in the _______ center of the _____ determine the "set-point" for body temp.
    thermoregulatory center; hypothalmus
  65. Mechanism of Heat Production
    Image Upload 1
  66. The thyroid hormones: __ and __ increase metabolic rate and increase body temp.
    T3 and T4
  67. Increased _______ Nervous System activity causes vasoconstriction of skin blood vessels (AV shunts) and moves blood to core
    Sympathetic Nervous System (SNS)
  68. Mechanism of Heat Loss
    Image Upload 2
  69. (More/Less) SNS activity causes vasodilation of skin blood vessels (AV shunts open).
    Less SNS activity
  70. Cause of fever is often _____ and their effect on the _________.
    Cytokines cause fever and effect the Hypothamlus
  71. Cytokines that cause the hypothamlic thermoregulatory neurons to reset include:
    • Tumor-Necrosis Factor alpha (TNF-alpha)
    • Interleukin-one (IL-1)
    • Protaglandins (PGI2, PGI2 alpha)
  72. _____ are chemicals that cause fever by causing hypothalamic them. reurons to reset set-point to a higher value.
  73. Endogenous pyrogens are made by ?
    Body cells such as Macrophages in TNF aplha and IL-1
  74. Fevers higher than ____ deg. F or ____ deg. C are usually due to ?
    • Higher than 105 deg. F or 45 deg. C
    • caused by convulsions, hyper-metabolic states, damage to the brain, excessive thyroid hormone
  75. Neurologic fever:
    • fever due to brain damage
    • resistant to antipyretic therapy and NOT associated w/ sweating
  76. What is the purpose of fever?
    • Fever facilitates immune response
    • increased interferon production
    • immune cells move faster
    • phagocytes eat more
    • enzyme reactions occur faster--more products
  77. How might fever affect bacterial and viral infections?
    • Bacterial: may adversely affect growth and reproduction
    • Viral: causes lysomal destruction of infected body cells, limiting viral replication and spread of virus
  78. Four stages of Fever
    • 1. Prodomal body temp. rise
    • 2. Chill, shivering and chattering teeth
    • 3. Cutaneous flush
    • 4. Sweating (defervescence)
  79. Fever Stage 1: Prodomal during which body temperature rises:
    headache, fatigue, malaise, nonspecific aches and vague pain
  80. Fever stage 2: Chills, shivering and chattering teeth
    • AV shunts close to vasoconstriction of skin blood vessels and blood moves to core
    • piloerection
  81. Fever stage 3: Cutaneous flush
    Close AV shunts, vasodilation of skin blood vessels as blood moves to core
  82. Fever stage 4: Sweating
    due to increase in body temp. begin to sweat for evaporative cooling
  83. What are some other common symptoms associated with fever?
    • Headache
    • Confusion, incoordination, agitation, delirium
    • anorexia
    • Mylagia
    • Fatigue
    • Increased respiration
    • Dehydration
    • Breakdown of fat stores and skeletal muscle proteins
  84. Fever over ____ require emergency care
    106 deg.F
  85. How do high fevers damage the body?
    • Damage neurons, impairs neurological functions
    • increases metabolism-->more cardiac workload
    • Can damage fetus in pregnancy
  86. How is fever managed?
    • Correct underlying cause w/ diagnosis
    • 1. sponge baths, cooling blankets, remove clothes/blankets
    • 2. adequate oral and IV fluids
    • 3. Antipyretic drugs such as aspirin or acetaminophen
  87. What does FUO stand for?
    • Fever of Unknown Origin
    • Malignancies, hard to diagnose infections, some drug reactions
  88. Histamine, serotonin, cytokines, bradykinin, arachidonic acid, and platelet-activating factor are examples of __________ mediators.
  89. _________ refers to heat transfer through the circulation of air currents.
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Chapter 3- Pathology
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