1. Inflammation fundamentals
Terms
undefined, object
copy deck
- What are 5 clinical features of inflammation?
-
Tumor swelling
Rubor redness
Calor heat
Dolor pain
Functio laesa loss of function - What are the 4 phases in the biological sequence of inflammatory events?
-
1. Vascular
2. Cellular
3. Neutralization
4. Resolution - What 3 things happen in the vascular phase of inflammation?
-
1. Injury
2. Vasodilation/permeability
3. Chemical mediator release - What happens physiologically when injury occurs?
- a TRANSIENT vasoconstriction
- What happens right after the transient vasoconstriction? Why?
- Vasodilation/permeability increase allows antimicrobial chemicals and cells to extravasate into tissue.
- What 5 chemical mediators appear during the vascular phase?
-
1. Histamine/serotonin
2. Complement - C3
3. Kallekrein-kinin system
4. Coag system products
5. Arachidonic aa. metabolites - What is the purpose of histamine/serotonin?
- They initially cause vasodilation and increased permeability of vasculature.
-
What 2 things do Complement chemical mediators do?
What are their specific names? -
1. Anaphylatoxins - C3a/C5a; stimulate release of more histamine & smooth muscle contraction.
2. Opsonins - C3b/C5b; enhance phagocytosis. - What does the coag system do in the vascular phase?
- Increases permeability
- What 2 arachidonic acid metabolites are produced, and what do they do?
-
1. Prostaglandins - stimulate smooth muscle contraction
2. Leukotrienes - same as above, and increase vasoperm/dilation, allow for chemotaxis of PMNs/eosinophils - What happens to cells in the Cellular Phase of inflammation?
-
1. RBCs undergo stasis and rouleaux, to the middle of vessels.
2. WBCs move to vessel periph. - What 3 things specifically do WBCs do during cellular phase?
-
1. Margination/pavementing - move to vessel edges.
2. Diapedesis - move through endothelial cells.
3. Chemotaxis - go to injury site. - After cellular movement, what 3 things finally happen in the cellular phase?
-
1. Transudation of plasma from vessels to tissue.
2. Exudation of plasma and WBCs, creating PUS.
3. Consolidation - fibrin clots form and isolate injury. - What happens after the cellular phase of inflammation? How?
-
-Neutralization of noxious stimuli.
-PMNs and Macrophages - What four things do Macrophages do in the neutralization phase?
-
1. Phagocytize noxious stimuli.
2. Clear debris with Collagenase and Elastase.
3. Release cytokines
4. Produce angiogenic factors. - what do angiogenic factors do?
- create new blood vessels.
- What three things happen in the resolution phase of inflammation?
-
1. Fibroblasts proliferate to neutralize mediators.
2. Fibrin clots dissolve
3. Tissue regenerates. - What is the differense between Acute and chronic inflammation re: tissue regeneration?
-
Acute: complete regeneration
Chronic: scarring, abcesses, and granulomas often remain. - What are 5 systemic manifestations of inflammation?
-
1. Protein/lipid catabolism
2. Hormonal changes
3. Fever
4. Neutrophilia, lymphopenia
5. Serum proteins altered. - What 4 alterations occur to serum proteins?
-
1. Gammaglobulins increase
2. Cytokines release esp IL6
3. ESR increases
4. APRs are altered - What is the ESR and what is the ref range in males/females?
-
the Distance that RBCs fall in 1 hour. Incrs with more protein.
Male: 0-9 mm/hr
Fmle: 0-15 mm/hr - What are 6 acute phase reactants?
-
1. C-reactive protein CRP
2. Serum amyloid A SAA
3. a-1 proteinase inhibitor
4. Haptoglobin
5. Fibrinogen
6. C3 - What are the 2 negative APRs?
-
Transferrin
Albumin - What 2 APRs are most increased in inflammation?
- CRP and SAA
- What are 3 test methods for CRP detection?
-
1. Nephelometric
2. Flourescence
3. Latex agglutination - What is CRP's role in inflammation? (3 things)
-
1. Activates complement cascade.
2. Activates macrophages
3. Binds PMNs to promote phagocytosis. - On a curve of protein versus time, how does CRP compare to other APRs?
-
Rises very fast and falls quickly, to a much greater extent than any other.
SAA is similar. - What is the reference range for CRP?
-
</= 1 mg/dl
</= 10 mg/L - What are 6 clinical uses for measuring CRP?
-
1. Determines inflam. extent
2. Predicts graft rejection
3. Monitor cancer metasthesis
4. Post-surgical monitoring
5. Depth of burn determinatn
6. Monitor/predict MI - What is the difference between CRP and hsCRP?
-
-CRP normally measures inflammation, and is greatly increased above 1 mg/dl.
-hsCRP is used to measure very low levels of CRP to predict heart disease. - How, specifially does hsCRP predict myocardial infarct risk?
-
<1 mg/L is LOW RISK
1-3 mg/L is AVG risk
>3 mg/L is HIGH risk