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IgG

(gamma globulin)- circulating antibody; directed against common infectious agents such as viruses, bacteria, and toxins.

Hypersensitivity reactions

- Allergic reactions - Set the immune system against the host - Occur when the body's cell encounter something that they think will harm them (the antigen) - Increasing the number of asthma and allergic reactions -children being exposed to fewer microorganisms?

Cells involved in humoral immunity and cell-mediated immunity

- B cells or B lymphocytes - Humoral response uses antibodies to neutralize extracellular pathogens and toxins because antibodies work on surface of cells cannot neutralize microbes residing Continue later

Acute Inflammation

- Faster onset (2 weeks) - limited to an area - minimal and short lasting injury to tissues - Cardinal signs of inflammation

Chronic Inflammation

- Longer lasting (more than 2 weeks) - causes damage to tissues - results in disease

Lymphocytes (agranulocytes)

- Lymphocytes are leukocytes found in the lymph system - play a central role in the function of the immune system

Principal organs of the immune system

- bone marrow - thymus - lymphatic vessels & nodes - mucosa-associated lymphoid tissues

What are the outcomes of acute inflammation?

- healing - resolution - abscess - chronic inflammation

Mast Cells (agranulocytes)

- not a leukocyte - created in bone marrow - stays in connective tissue close to blood vessels and epithelial tissues of integumentary system - histamine is released when the cell's granules break open in response to a stimulus

What are the cardinal signs of inflammation?

- redness - heat - swelling - pain - loss of function

Factors that affect wound healing

- type of wound - size - location

Active vs passive immunity

1. Active: occurs when antibodies are produced by the body in response to an antigen - Naturally from pathogens - Artificially through vaccinations 2. Passive - Occurs when the host does not form his or her own antibodies but is given antibodies derived from another source; ether human or animal and is short term

Cells involved in inflammation

1. Granulocytes 2. Agranulocytes

Antibodies (Ig)

1. IgG 2. IgM 3. IgA 4. IgE 5. IgD

Phases of acute inflammation

1. Initiation 2. Amplification 3. Destruction 4. Termination

Monocytes (agranulocytes)

1. Kupffer cell: liver 2. Histiocyte (connective tissue macrophage) - histiocytes work in inflammatory response and the immune response 3. Giant cell - macrophages join to form giant cells to deal with larger items or highly resistant microbes bc they produce more highly toxic enzyme than a single macrophage - foreign body giant cell: foreign matter - Langhans giant cell: tuberculosis infection - Aschoff cell: formed during rheumatic fever

Agranulocytes

1. Monocytes - circulate in bloodstream until they enter specific tissue and become "fixed" 2. Fixed Monocytes - differentiates into macrophages specific for a particular tissue

Antibody actions against antigens

1. Neutralize bacterial toxins 2. Bind with viruses to prevent entrance into cells 3. Cause the agglutination or clumping of antigens to facilitate phagocytosis 4. Bind to the surfaces of the antigen to aid in phagocytosis (opsonization) 5. Bind with an antigen to activate the complement system

nonspecific vs specific immunity

1. Nonspecific - innate or natural immunity 2. Specific - adaptive or acquired immunity acts against previously encountered and activated

Granulocytes

1. Polymorphonuclear neutrophil (PMN) - most active granulocyte in the inflammatory process - FIRST cell to arrive in area - motile, phagocytes move independently within tissues to phagocytize offending matter - attracted by chemotaxis - active in fighting bacterial and fungal infections 2. Basophils and Eosinophils - both play a role in allergic reactions - EOSINOPHILS are active in fighting parasitic infections easily. EX: helminthic (tapeworm) - BASOPHILS contain granules in cytoplasm containing histamines (an important chemical mediator)

Different types of exudate

1. Serous - thin and clear; few cells. Ex: blisters from second degree sunburn 2. Purulent or suppurate (PUS) - somewhat thick, white, and yellowing; contains many PMN's

Four types of hypersensitivity reactions may occur in response to an antigen

1. Type I (anaphylactic/systemic) - immediate - After exposure to previously encountered antigen - IgE/Mast cells/histamine 2. Type I Atopic - atopic-skin reactions, asthma, upper respiratory 3. Type II (Cytotoxic Reactions) - occur when an antibody, usually IgG or IgM, combines with an antigen bound to the surface of specific cells in the host's body. - Example: blood transfusion reaction. 4. Type III Hypersensitivity reactions - Immune complex mediated reactions - Immediate - IgG, IgM, or IgA form antigen - antibody complexes with circulating antigen - Examples: Autoimmune diseases (lupus, RA) 5. Type IV - Cell mediated or delayed hypersensitivity reaction - Delayed - Involved T-cells that have been sensitized to an antigen - Do not require action of antibodies - Examples: contact dermatitis, graft rejection, autoimmune dysfunction

Vascular stasis

1. margination 2. adhesions (PMN's stick to the walls) 3. transmigration (squeeze through gaps of endothelial cells)

Which of the following cells is NOT a leukocyte? a. mast cell b. eosinophils c. monocyte d. macrophage e. PMNs

A

Which of the following chemical mediators is a more potent vasodilator than histamine a. PAF b. TNF c. IL-1 d. LPS

A

Which of the following is a systemic manifestation of inflammation? a. pyrexia (fever) b. edema c. redness d. hyperemia

A

Which of the following terms describes excessive scar tissue formation? a. keloid b. granuloma c. hypotrophic d. contracture e. epithelialization

A

Which of the following will slower healing? a. impaired circulation b. highly vascularized tissue c. nonmoving area of injury d. absence of irritating factors

A

leukopenia

A decrease in white blood cells. May occur in overwhelming infections or if the body has an impaired ability to produce white blood cells.

A cicatrix is the result of which of the following? a. regeneration b. fibrous repair

B

All of the following chemical mediators are essential for the healing process EXCEPT one. Which is the exception? a. cytokines b. platelet-activating factor c. epidermal growth factor d. platelet-derived growth factor

B

Granulation tissue provides which of the following during the repair process? a. blood clot b. framework c. epithelial cells d. new blood vessels

B

Ludwig angina is a form of which one of the following? a. fistula b. cellulitis c. granuloma d. angiogenesis e. fibrous repair

B

A granuloma forms as a result of which of the following? a. regeneration b. acute inflammation c. chronic inflammation d. healing by primary intention

C

All of the following are expected outcomes of acute inflammation EXCEPT one. Which one is the EXCEPTION? a. death b. repair c. edema d. resolution e. chronic inflammation

C

An association risk for cardiovascular disease is strongly associated with elevated levels of which of the following? a. interferon b. interleukin-1 c. C-reactive protein d. liptopolysaccharide e. lysosomal enzymes

C

The membrane attack complex is formed by which one of the following systems a. kinin b. coagulation c. complement

C

Which of the following is the etiology of alveolar osteitis? a. excessive bleeding b. smoking after extraction c. loss or disruption of the blood clot d. excessive trauma during the extraction

C

Healing

Completed when all of the stimuli are neutralized or removed. regeneration vs. repair

All of the following are elements of the acute phase response EXCEPT one. Which is the EXCEPTION? a. pyrexia b. malaise c. anorexia d. leukocytosis e. elevated CRP

D

Alveolar osteitis is associated with all of the following EXCEPT one. which is the EXCEPTION? a. exposed bone b. increased pain c. increased risk of infection d. excessive granulation tissue e. occurs 2 to 4 days after extraction

D

An increased in the number of white blood cells above normal levels in the blood is called: a. cellulitis b. septicemia c. hyperemia d. leukocytosis e. lymphadenopathy

D

Histiocytes are monocytes that have become fixed in which one of the following tissues? a. liver b. brain c. lung d. connective

D

Which of the following is a strong chemotactic agent? a. bradykinin b. prostaglandin c. hageman factor d. tumor necrosis factor

D

Which of the following terms denotes the process whereby a new basement membrane is formed under a scab? a. angiogenesis b. fibrous repair c. regeneration d. epithelialization e. healing by secondary intention

D

Which of the following terms describes the local response of the lymphatic system to acute inflammation? a. leukocytosis b. leukopenia c. ludwig angina d. lymphadenopathy e. generalized persistent lymphadenopathy

D

Which of the following will involve healing by secondary intention? a. paper cut b. small surgical incision c. laceration closed with sutures d. area of chronic inflammation

D

Systemic manifestations of inflammation

Fever

Autoimmune

Immune system loses ability to distinguish self from non-self or there is an alteration of the host's cells that changes their makeup (such as changes in MHC), the immune system will attack the cells of the host as if they were foreign matter - Examples: Sjogren's Syndrome, HIV/AIDS, Lupus, aphthous ulcers, lichen planus

Which of the following events in the acute inflammatory process enables leukocytes to destroy and remove resistant organisms?

Opsonization - prepares cells for phagocytosis

Regenerating

The body's attempt to restore itself to its original state. - most desired outcome - stimulus for inflammation - vascular system returns to normal - injured tissue replaced - area regains full function

3. Destruction

WBC's neutralize and clean up debris

MHS's (major histocompatibility complexes)

When the body distinguishes self from nonself by "coding" each cell surface with molecules that are equivalent of an identification tag. - molecules that code cell surface to identify - called human leukocyte antigens (HLA's) - important role in activating immune response - with injury to MHC on cells, cell no longer recognized as "self" resulting in changes that cause destruction of cell by immune system

Immunodeficiency

When the immune system or part of the immune system fails to function properly 1. Primary immunodeficiency - Genetic or Congenital abnormality - May not be caused by inherited traits - May affect all or parts of the immune system 2. Secondary immunodeficiency - Acquired - Associated with chronic illness, malnutrition, diabetes, immunosuppressive drug therapy, and other systemic problems

Increased vascular permeability

allows plasma fluid to leave vessels and the blood flow to slow down

Leukocytosis

an increase in the number of white blood cells in the blood

Bacteremia

bacteria in the blood

Ludwig angina

bilateral cellulitis involving the submandibular, submental, and sublingual spaces, is a serious condition causing rapid swelling of the floor of the mouth with elevation and posterior displacement of the tongue.

Fistula

can form through soft or hard tissues. They occur when enzymes are released by macrophages literally bore a hole through the tissues along the path of least resistance.

Chemotaxis

chemical mediators that are released by exogenous cells

2. Amplification

chemical substances direct more and different types of WBC's to the injury

4. Termination

chemical substances stop or inhibit the inflammatory process.

Granuloma

comprised of large macrophages called giant cells and other chronic inflammatory cells surrounding some type of foreign matter. The purpose of a granuloma is to form a wall around foreign substances to prevent it spreading.

Vasoconstriction

controls bleeding

vasodilation

dilation of blood vessels

alveolar osteitis

dry socket

keloid

excessive scar formation resulting in a hypertrophic scar

pyrexia

fever

IgA

found in secretions (tears, saliva, mucus secretions). Secreted by plasma cells located in the epithelium of tissue/organs; secretions form part of the primary defense mechanism of the body by preventing attachment of the pathogen to epithelial cells.

IgM

found on B cell surfaces, largest of the immunoglobulins. First antibody that is produced in response to an antigen. Main purpose is to cause clumping of antigen proteins during primary immune response.

IgD

found on surface B cells, needed for proper maturation and differentiation

Which of the following vascular events in the acute inflammatory process enables PMNs to transmigrate into the injured tissues?

increased permeability

Cellulitis

involves the spread of bacteria into the surrounding tissues, producing the inflammation of the connective tissue.

Termination

leukocytes remove and digest matter through the lymph system

Acute-phase proteins (APPs)

low molecular weight proteins produced by the liver in response to circulating chemical mediators released during the inflammatory response

Identify the cells that play a major role in chronic inflammation

macrophages, lymphocytes, and plasma cells

Phagocytosis

microbes are phagocytized (eaten) and digested by leukocytes

Repair

only happens if regeneration is not possible; fibrous repair will be the final outcome EX: cicatrix (scar formation)

Opsonization

prepare cells for phagocytosis

pyogenic

puss producing

What is the resolution of acute inflammation?

resolves in 2-3 weeks and will either contain or remove pathogens. EX: an abscess

cicatrix

scar

IgE

secreted by plasma cells in skin and mucous membranes, triggers histamine release, associated with anaphylactic reactions

pyrogens

stimulate the productions of prostaglandins, which activate thermoregulatory center in the hypothalamus causing elevation in temperature

C-reactive protein (CRP)

the first APP to be described, which binds to the surface of a foreign microorganism and targets it for destruction by complement and phagocytosis. It also interacts with T cells and B cells helping to coordinate the inflammatory and immune response.

Which of the following lists the first four events in the acute inflammatory process in the correct sequence?

vasoconstriction, vasodilation, increased vascular permeability, vascular stasis

1. Initiation

vasoconstriction, vasodilation, movement of WBC's to the area

granulation tissue

very fragile vascular tissue that is starting to form

periapical granuloma

will form at the apex of a nonvital tooth in response to substances produced by necrotic dental pulp tissue.