Chronic Inflammation Ii Granulomatous Inflammation (Foundations Exam 1)

Front 1

granuloma

Back 1

-focus of chronic inflammation consisting of a microscopic aggregate of macrophages
--> transformed into epithelium-like cells surrounded by collar of mostly lymphocytes and some plasma cells

Front 2

granulomatous inflammation

Back 2

-form of chronic inflammation characterized by the presence of discrete nodules of epithelioid cells

Front 3

what necessary feature of granulomas is not present in granulation tissue

Back 3

epithelioid cells

Front 4

microscopic granulomas

Back 4

- unapparent by gross examination

Front 5

macroscopic granulomas

Back 5

small granulomas: discrete, pale-yellow to pale-gray from nodules (just visible to a few millimeters)
large granulomas: detectable radiologically or by physical exam (several mm to several cm) --> fusion of several granulomas

Front 6

granulomatous inflammation

Back 6

- discrete granulomas and epithelioid cells mixed with oterh inflammatory cells such as lymphocytes, plasma cells and fibroblasts
distinguishing features: multinucleate giant cells or epithelioid cells forming discrete aggregates

Front 7

causes of granulomas

Back 7

1. infectious agents (typical and atypical mycobacteria, fungi, other bacteria, parasites)
2. various foreign materials (food, sutures, starch, and inhaled mineral dust)
3. soluble antigens producing "immunologic" granulomas

Front 8

why do granulomas form?

Back 8

- form in the presence of a persistent, offending agent that is difficult to degrade, phagocytize or otherwise eliminate
1. inert foreign bodies--> too big for one cell to phagocytize
2. poorly degradable antigenic particulates

Front 9

outcomes of granulomas

Back 9

1. fibrosis
--activated alveolar macrophages produce fibronectin
--alveolar macrophage-derived growth factor (AMDGF)
--platelet derived growth factor (PDGF)
2. necrosis --> caseous or coagulative
3. resolution --> may disappear without residual structural alteration in affected organ

Front 10

sarcoidosis

Back 10

- primarily pulmonary disease
- composed of epithelioid cells with occasional multinucleate giant cells, surrounded by a rim of lymphocytes
- increased number of T-helper cells (CD4) present in lungs
- mostly, disease remits spontaneously
- minority --> progressive fibrosis associated with chronic illness or death
- treatment: corticosteroids

Front 11

bronchoalveolar lavage (BAL)

Back 11

- performed by instilling saline into a portion of lung through a wedged flexible bronchoscope then drawing back fluid
- increased ratio of BAL helper (CD4) to suppressor (CD8), lymphocytosis of BAL fluid, and absence of micro-organism culture and cytologic exam