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neutrophil

principle leukocyte (chief phagocytic cell) in acute inflammation; aka PMN; granulocyte in which granules do not stain

eosinophils

leukocytes with granules that contain a protein toxic to parasitic worms; pink-staining granules

what do neutrophils,eosinophils, basophils have in common?

leukocytes with multi-lobed nuclei

3 cells associated with CHRONIC inflammation

monocytes/macrophages, lymphocytes

what are endothelial cells?

cells that make up the lining of blood vessels and are connected to the basement membrane

what are basophils? what is their prevalence in the blood?

leukocytes with granules that stain blue; < 1% of circulating leukocytes; important in allergic reactions mediated by IgE

monocytes

has a single nucleus with no lobes

lymphocytes

smallest leukocyte with deeply staining nucleus

neutrophils

first cells to appear at the site of acute inflammation
60-70% of circulating leukocytes

what do basophils, eosinophils, neutrophils have in common?

have granules

2 cells without granules

lymphocytes, monocytes/macrophages

mast cells

derived from same stem cells as basophils, but only activated when lodged in tissue sites; release histamine, cytokines, chemotactic facotrs, leukotrienes, prostaglandins when activated

eosinophils

2-3% of circulating leukocytes

monocytes

3-8% of circulating leukocytes

macrophages

the most phagocytic leukocyte; life span 3-4 times longer than granulocytes; produce prostaglandins, leukotrines, PAF, inflammatory cytokines, and growth factor to promote regeneration of tissue

what are circulating, immature macrocytes?

monocytes

lymphocytes

participate in immune-mediated inflammation caused by infectious agents; participate in non-immune-mediated inflammation associated with cell injury and death

5 cardinal signs of inflammation

redness, pain, swelling, heat, loss of function

lymphadenitis can also occur as nodes filter all the harmful substances from the injury site

events in the vascular stage of acute inflammation

quick vasoconstriction-->vasodilation-->increased vascular permeability with outpouring of exudate causing increased concentration of RBC, WBC, platelets and clotting factors

vasodilation (mediated by histamine, leukotrienes, prostaglandins) causes which of the clinical manifestations of inflammation?

redness and warmth

vascular permeability causes which of the clinical manifestations of inflammation?

swelling, pain, and impaired function

what is margination and adhesion?

leukocytes slow migration, adhere to endothelium and move along periphery of vessel

what is transmigration?

leukocytes extend pseudopodia and "crawl" through the vessel wall

what happens in chemotaxis?

leukocytes guided by a gradient of chemoattractants and cellular debris

what happens in phagocytosis?

neutrophils, monocytes and macrophages activated to engulf and degrade bacteria and cellular debris

plasma-derived mediators are produced where?

liver

plasma-derived mediators

these mediators need to be activated when in pre-cursor form to work; mediators that include acute-phase proteins, coagulation factors and complement proteins

cell-derived mediators

mediators that come in the form of granules that need to be secreted from the plasma-membrane.

cytokines, histamine, chemotactic factors, leukotrienes, prostaglandins, phospholipids/fatty acids (converted to mediators) like arachidonic acid.

what do kinins, products of the coagulation/fibrinolysis system & complement proteins have in common?

3 major plasma-derived inflammatory mediators

bradykinin

this is an inflammatory mediator that causes increased capillary permeability and pain

What does the complement system do?

1) vasodilation and increased vascular permeability
2) promotes leukocyte activation, adhesion and chemotaxis
3) augments phagocytosis

cell-derived mediators are produced by (4 cell types)

macrophages, mast cells, endothelial cells, platelets, leukocytes

histamine and serotonin

first mediators to be released in an acute inflammatory response; cell-derived; cause dilation of arterioles and increase venule permeability

antihistamines

drugs that antagonize the immediate inflammatory response

prostaglandins

this mediator induces inflammation and enhances other mediators

thromboxane A

promotes platelet aggregation and vasoconstriction

aspirin and NSAIDS

drugs that reduce inflammation

leukotrines

this mediator is slower to action, but similar in function to histamine

nitric oxide

this mediator relaxes vascular muscle and antagonizes platelet adhesion/aggregation

systemic responses to inflammation include:___

fever (pyrexia), leukocytosis, high plasma proteins

nitric oxide

this mediator helps to REDUCE inflammation

serous exudate

watery exudate; one of most common types

hemorrhagic exudate

bloody exudate

fibrinous exudate

exudate with large amounts of fibrinogen

membranous/pseudomembranous

exudate that on mucous membrane surface that traps necrotic cells

purulent exudate

exudate that contain pus; one of most common types

chronic inflammation

when inflammation lasts several weeks or longer. happens because acute inflammation & immune responses are unsuccessful.

develops from unrelenting injury, persistent infectious process, or autoimmune condition.

characteristics of chronic inflammation

proliferation of blood vessels, necrosis, fibrosis

causes of chronic inflammation

persistent infections, foreign bodies, viral/bacterial infection, obesity

How does obesity relate to chronic inflammation?

adipose tissue is a source of TNF which is correlated to insulin resistance

C-reactive protein

this protein binds to the surface of invading microorganisms and marks them for destruction

10 hours

life span of a neutrophil

leukocytosis

increase in WBC

leukopenia

decrease in WBC

immature neutrophils are called ________

bands

normal WBC count

5,000 -- 10, 000 cells/ml

"shift to the left" means...

increase in bands

body's 3 major lines of defense

1. skin/mucous membranes
2. inflammatory response
3. immune response

T/F: the inflammatory response is specific

false; does the same thing regardless of the invader, unlike the immune response.

injury; examples

any form of damage, harm or loss to the cell, tissue, organ or organ system. what triggers inflammation.

ex: microorg invasion, cell mutations, anoxia, phys/chem damage

3 goals of inflammation

1. increase blood flow to injury (VASCULAR RESPONSE)
2. alert products of healing to get to the site (CELLULAR RESPONSE)
3. remove injured tissue to prep for healing

what do vasoactive chemical mediators do?

facilitate the widening/loosening of blood vessels at site of injury. this is the VASCULAR response of inflammation

where can chemical mediators be found? what phases of inflammation are they active in?

plasma and many cells:
platelets
mast cells
basophils
neutrophils
endothelial cells
monocytes
macrophages

primary intention vs. secondary intention

wound is basically closed with all areas connecting/healing simultaneously

wound heals from the bottom up.

granuloma

nodular inflammatory lesions that encase harmful substances. form when injury can't be controlled w/ usual inflammatory/immune mechanisms (ex - foreign bodies, some microorganisms) regulated by macrophages

what do monocytes produce as they mature into macrophages?

fibroblasts and protinases, which break down elastin & other cell components

giant cells

macrophages adapt into these; capable of engulfing particles much larger than usual.

is there scarring after restoration from acute inflammation?

no, it's minimal. in chronic, however, there is fibrosis, scarring & granuloma formation.

epitheloid cells

macrophages adapt into these; gather small substances & form a fibrous wall surrounding them

parenchymal tissues

perform specific body functions (neuronal, epithelial, cardiac myocytes, hepatocyes)

3 processes for restoring functioning integrity (the main goal of healing)

1. resolution - mild disruption to cells; rapid recovery
2. regeneration
3. replacement

how can you accomplish regeneration or replacement of parenchymal tissue?

proliferation (growth & reproduction)
differentiation (specialization
diapedesis (migration)

labile cells

cells that constantly regenerate through mitosis (ex: skin)

stable cells

cells that stop regenerating when growth is complete, but can resume regeneration if injured (ex - heaptocytes)

permanent cells

don't undergo mitosis and can't regenerate (ex - neurons)

what component of the inflammatory response is responsible for many of the clinical manifestations?

chemical mediators

where are cell-derived chemical mediators found

plasma membrane or they are proteins within the cell

what are the 5 types of leukocytes?

basophils, neutrophils, eosinophil (granulocytes) [mast cell?]
monocyte/macrophage
lymphocyte

degranulation

release of chemical mediators in the form of extracellular granules

cytokines

"workaholic"
hormone-like cell protein that oversees the chemical mediators. triggers, enhances, and discontinues the inflammatory response.

ex - interleukins, growth factors, interferons, chemokines

corticosteroids

group of anti-inflammatory drugs that block the production of arachidonic acid, thus reducing these chem mediators: prostaglandins, lipoxins, leukotienes, thromboxane.

what activates complement? what 4 things does complement induce?

the presence of microorganisms

1. opsonization
2. chemotaxis
3. release of chemical mediators from mast cells & basophils
4. cell lysis

opsonization

complement induces this process, which makes bacterial vulnerable to phagocytosis.

what is MAC?

membrane attack complex. the goal of the complement reaction is to form this. it enables complement to recognize, attack & destroy microogs with minimal damage to surrounding cells.

3 plasma protein systems

1. complement
2. clotting system
3. kinin system

ALL INTER-RELATED. can either activate or inhibit chemical mediators

"acute phase reactants"... measured in lab tests like C-reactive protein

why are blood & fluid needed at the site of injury?

blood has cells active in phagocytosis & healing
fluid dilutes harmful substances at the site of injury

exudate

fluid mixture of protein, leukocytes & tissue debris; accumulates at the site of injury

3 steps to a successful cellular response

1. chemotaxis - moving cells to the site of injury
2. cellular adherence - attraction & binding
3. cellular migration - leukocytes moving across endothelial cells (diapedesis)

what minimizes tissue destruction?

inhibitor proteins in the plasma-derived complement, clotting & kinnin systems

what is clotting needed for?

1. trap harmful substances to prevent their spread to other areas
2. stop bleeding
3. form structural origins of repair

what % of the blood is erythrocytes?

42-48%

3 ways to treat inflammation

reduce blood flow to the area
decrease swelling
block action of chemical mediators

non-pharm treatments: rest, ice, compression, elevation (RICE)

3 goals of tissue healing/repair, and the 3 phases

1. COVER the wound
2. CLEAR the debris
3. RESTORE struct/funct integrity

1. inflammatory
2. proliferative
3. remodeling

"construction workers" of tissue healing/repair

1. clotting factors
2. chem mediators
3. proteinases
4. matrix/structural proteins
5. molecule receptors
6. adhesion molecules
7. growth factors

thrombus

protective clot & subsequent scab formed on a wound. physical barrier to keep harmful substances out.

what is granulation tissue? what is it most noted for?

connective tissue characterized by extensive macrophages/fibroblasts & the promotion of angiogenesis.

most noted for extensive network of capillaries.

dehiscence

deficient scar formation; wound spits/burst open, along suture line. caused by poor development of extracellular matrix &/or inadequate collagen.

what are agents that cause cell injury (& thus trigger inflammation?

physical (heat/cold)
chemical (acid)
microbiologic (virus, bacterium)

what are the 2 things the vascular response induces?

1. vasodilation
2. increased capillary permeability

what is the first step in the cellular stage of inflammation?

white blood cells enter the injured tissue

margination

leukocytes slow movement & accumulate/adhere to endothelium

emigration

leukocytes changes shape & squeeze thru enter-endothelial junctions

5 complications of healing

infection
ulceration
dehiscence
keloids
adhesions

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