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1. Inflammation fundamentals


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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?
What 2 APRs are most increased in inflammation?
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

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