Chapter 5
Nonspecific/ innate immune system: -Protects against _____ -____ defense -More ______
-any and all invaders -immediate -primitive (found in all animal and plant life)
Nonspecific/innate: -protects against _____ -_______ -more ____ (____) Specific/adaptive: -directed against ____ -____ or _____ -only in ____
-any and all invaders -immediate defense -More primitive (found in all animal and plant life) -a specific invader -long lasting or protective immunity -vertebrates
Natural Immunity: -Is present at ____: is NOT_____ 2 types: 1._________ -humans are naturally immune to _____ -viruses can____ 2. ______: -involves ______
-birth, produced by individual's immune system 1. Species dependent: -canine distemper -mutate: humans were immune to bird flu virus 2. Host-dependent -characteristics of a specific individual (some ppl never get chicken pox)
The kinin system -The primary kinin is _____ ( ___ in the chain) -Important during the ____ of inflammation, it functions to ____ The specific functions of bradykinin are to : (4)
-bradykinin (last) -later phase, keep the inflammation going 1. Induce vasodilation more slowly than histamine 2. Increase vascular permeability 3. Increases leukocyte chemotaxis 4. Induce pain
Platelets: When activated: -they ____ and form a _____ -They form the clot by interacting with _____ (___) to form ____ (the ___)
-break apart, clot that blocks blood flow -with fibrinogen (soluble protein, component of the clotting cascade), fibrin (the mesh)
Components on Inflammation -Inflammation is a ____& ____ process that involves components of the immune system (many cells and molecules) including: (3) -The 3 components above roles are to (3)
-complex & highly orchestrated process 1. Cells of inflammation: the myeloid cell line 2. Cellular products: which induce inflammation, such as histamine and serotonin 3. Plasma protein systems: three systems- the complement, clotting, and kinin systems ***components above are carried in the exudate** 1. Kill the microorganisms 2. Remove the debris of "battle" including exudate and dead cells 3. Prepare the lesion for tissue regeneration and repair
Cellular products are called ___ -Cytokines are _____ (the ____) -they include: (2) Cytokines function as ____ to provide ____ (____,____,and ____) -They bind to ______ of ____
-cytokines -substances secreted by immune cells (hormones of the immune system) 1. Lymphokines: cytokines produced by lymphocytes 2. Monokines: produced by monocyte/macrophages messengers to provide communication between various leukocytes (granulocytes, macrophages, and lymphocytes) -receptors on plasma membrane of other immune cells
-The exudate ____ and ____ -The specific functions of the exudate (with its biochemical mediators and cells) are to: (4)
-defends the host against infection and facilitates tissue repair and healing 1. Dilute the toxic products produced by dying cells 2. Destroy the injurious agents and remove them fro the injury site by: 1 carrying WBCs and plasma proteins to the injury site 2 confining these agents to limit their effects on the host 3. carrying away dead cells and debris (pus) through the lymphatic system 3. Stimulate and enhance the immune response (lymphocytes) 4. Promote healing
Acute Inflammatory Response -The acute inflammatory response begins with ____ and ends with ___ -Mediators released from mast cells (such as ____) cause ______:_______(___,___, and ___) -The changes in microcirculation near the site of the injury include: (3)
-degranulation of mast cells, healing -(histamine), microscopic hallmark: changes in microcirculation (arterioles, capillaries, &venules) 1. Vasodilation (local): dilation of blood vessels, resulting in increased blood flow to an area 2. Increased vascular permeability: resulting in leaking of exudate to the tissue 3. Leukocyte movement (emigration) into the tissue
Microscopic hallmark of inflammation is the ____ -Macroscopic hallmarks of inflammation are (5)
accumulation of exudate at the inflammatory site 1. Redness (rumor) 2. Swelling (tumor) 3. Heath (color) 4. Pain (dolor) 5. Loss of function
Human body provides a hospitable environment for microorganisms, supplying them with ____,____,and _____ -The human gut is colonized by a large variety of microorganisms that make up the _____ -Flora are _____ -2 things that they do -The flora is kept ____ by the ______ and _____. Otherwise, _____
appropriate nutrients, temperature and humidity -normal human flora -bacteria that are beneficial to the human 1. produce enzymes that facilitate digestion of complex molecules 2. fight and prevent colonization by harmful microorganisms (pathogens) -outside the body's tissues by the intact skin and mucosal epithelium. the immune system would attack them.
_____ is the third and last line of defense -It occurs _____ than inflammation -It provides the body with ______ against a _____ due to the ____ -can be induced ____ or by ____
Immunity -more slowly -long-term and/or permanent protection, specific microorganism, presence of memory cells -naturally or by vaccination
Dysfunctional healing involves either ____ or ____ Example: _____ -collagen is a ______ that acts like ____ holding together _____ (it makes up ____% of body weight)
insufficient repair or excessive repair -collagen production -protein, glue, connective tissue (25%)
The body forms granuloma as a result of _____ -Diseases characterized by granuloma include (2) 1. ______: granulomas (with ____) in the ____ 2. _____: granulomas in the ___
unsuccessful healing in wounds or certain diseases 1. Tuberculosis: (central necrosis), lungs 2. Leprosy: skin
Inflammation is a ____ -A protective response intended to eliminate (2)
vascular and cellular response to injury 1. the initial cause of the cell injury 2. Necrotic cells and tissues that result from injury
2. Decreased blood supply (due to ____,____ and/or ___) -Vasodilation is required to _____ -the response to hypovolemia is ____ -Vasoconstriction results in ____
(hypovolemia, vasoconstriction, ischemia) -bring the inflammatory cells, nutrients and oxygen to the injury site -vasoconstriction -ischemia
Phagocytes (____ and ___) ____ -Inflammation stimulates them to _____ read a lesion/injury -They are attracted to the site of injury by ____
(neutrophils and macrophages) circulate in the blood -migrate through the vessels' walls -chemotactic factors
3. Leukocyte movement into tissue: -cells of inflammation (____) adhere to _____ and then ____
-(WBCs), inner walls of blood vessels and then emigrate through the vessel walls to the site of injury
Exudate -Inflammatory agents (____,____,___,____) cause: (2) -Vasodilation and increased vascular permeability cause _____ -Due to the increased _____ during inflammation, this fluid also contains ____,____,___ and ____ -the fluid is called _____
-(histamine, prostaglandins, leukotrienes, bradykinin) 1. arterial smooth muscle to relax ---> vasodilation 2. Endothelial cells to retract---> increased vascular permeability -increased leakage of blood fluid from the intra-vascular space to the interstitial space -vascular permeability, blood cells, clotting factors, chemical mediators, and proteins -exudate
Primary Immune Response -Begins about ____ -Dominated by ____ with lesser amount of ___ -With no further exposure, the immunoglobulins are ____ and ____ -However, the host's immune system is ____
-5 days after exposure to an antigen (virus,bacteria) or to a vaccine -IgM, IgG -broken down and their plasma levels decrease -primed
1. Fever -induced by ___, which is released from ___ and ___ during the inflammatory response -IL-1 acts one the ____, where the body's ____ is located, to ____ Fever is beneficial (2) -Fever increases the host's susceptibility to ____ from ____
-IL-1, neutrophils and macrophages -hypothalamus, thermostat, increase temperature 1. Against some microorganisms that are sensitive to increased temperature 2. Because it increases the activity of certain lymphocytes (cytotoxic T lymphocytes) -endotoxins, gram-negative bacteria
2. Leukocytosis -During most infections, there is an increase in circulating ___ levels, especially ____ -This increase is accompanied by an increase in ration of ____ to ___ (due to ____)
-WBC levels, neutrophils -immature to mature neutrophils (premature relate of not yet fully mature neutrophils)
Specific/adaptive immune system: -directed against _____ -______ immunity -Only in ____
-a specific invader -long lasting and/or protective -vertebrates
Active Acquired immunity: -produced____
-after exposure to an antigen or an immunization
Infection is the result of an interaction between ____ -Types of organisms that cause infection (5) -Infectious organisms range in size from ____ (ex. ____) to _____(ex.____)
-an invading, harmful organism and a host 1. Viruses 2. Bacteria 3. Fungi 4. Protozoa 5. Helminths (worms) (4 and 5 are parasites) -20mm (polio virus) to 10 meters (tape-warm)
3. Decreased oxygen in the blood (hypoxemia) -due to conditions like ___ and ____
-anemia and diabetes mellitus
Passive acquired immunity: -When ____ -Clinically, antibodies from a donor (human or animal) are administered in the form of ____ which is composed of ____ *Passive immunity is ___
-antibodies or T cells are transferred to the recipient either naturally (mother to fetus) or artificially (clinically) -immune serum, antibodies and plasma, without blood cells or clotting factors *temporary
Antimicrobials (antibiotics) -what do they do? -Mostly against ____ -Act by _____ -examples (3) 1. penicillin ____ 2. sulfa____ 3. tetracycline _____ *There are not many successful antiviral microbial because ____
-destroy the pathogen once the disease process has started -bacteria -preventing the function of enzymes or cellular structures unique to the specific bacteria 1. Penicillin inhibits synthesis of bacterial cell wall 2. Sulfa interferes with bacterial energy production 3. Tetracycline inhibits bacterial protein synthesis *viruses use the metabolism and enzymes of the host cells
4. Nutrition -all healing components require _____ and _____, thus optimal nutrition is important -Metabolic needs are _____ during healing -ATP is needed for ____,____,____, etc. -______ is absolutely necessary for proper healing -All cells, cell components, and mediators are made of ____ -Other nutrients are important as well (____,____)
-energy (ATP) and protein synthesis -increased -chemotaxis, phagocytosis, protein synthesis -protein -protein -vitamins, zinc
6. Infection: wound sepsis -Infection prolongs inflammation by increasing ____,____ and ____ -infection prevents complete healing because the ____ and ____ inhibit____ -Infection promotes ______ Wound sepsis is treated by (3)
-exudation, fibrin formation, and pus -pus and fibrin, wound healing -excessive scar formation 1. Debridement of necrotic tissue (surgery or dressings) 2. Wound irrigation 3. Antibiotics
Mast cells are: -cells that possess ______ -located in _____ -the most important ____ -Plasma membrane receptors of mast cells bind to ____ -Upon binding, mast cells respond by 2 processes:
-granules containing biochemicals such as histamine -vascularized tissue (loose connective tissues near blood vessels) -activator of the inflammatory response -mediators released by injured cells (eg heat-shock proteins) 1. Degranulation 2. Synthesis
When chronic inflammation does not result in healing, the body may form _____ -Granuloma is an _____ -Granuloma is formed when: (3)
-granuloma -encapsulated spherical mass of dead cells and macrophages 1. The macrophages are unsuccessful 2. The body attempts to wall off and isolate the infected site 3. There is dense infiltration of both lymphocytes & macrophages
1. Degranulation -is an _____ -it is _____ -after ____ -Degranulation consists of releasing ______ into the ____ -Biochemical mediators (factors) include: (2)
-immediate response of mast cells -how mast cells initiate inflammation -binding to heat shock proteins -pre-synthesized biochemical mediators from the mast cell's granules into the interstitial space (extracellular matrix) 1. Histamine 2. Various chemotactic factors
Acquired immunity: -A result of _____ -gained ____ -can be either ____ or ____
-immune response -after birth -active or passive
3. Increased Plasma Protiens -The concentrations of many plasma proteins are ____ during inflammation -Acute-phase reactants are _____ -These are produced by (3) -Some of them are actually ____ aimed at ___
-increased -plasma proteins which are increased during the acute phase of inflammation 1. Plasma protein systems (cascade enzymes) 2. Immune cells (cytokines) 3. The liver, lungs, and gut -anti-inflammatory proteins, reducing inflammation
Secondary Immune Responses -When ______, secondary immune response is initiated -The response is more ___ and a ____ amount of ____ than the primary response why? because presence of____ -____ is the predominant antibody -Antibody levels rise ____ and may remain ____ -examples _____,____ -Due to the _____
-individual is exposed again to the same antigen -rapid, larger amount, antibodies memory cells -IgG -immediately, elevated for many years -Epstein-Barr virus, CMV -presence of memory cells
The complement system -Induces _____ -Has at least ___ proteins (____ and ___) -Activated by: (3) One of the body's most potent defenders against bacterial infection due to a double punch: -an ____, which is a part of the body's ____ (_____) -Stimulates _____, which is the ____ (____)
-inflammation -10 (enzymes and pro-enzymes) 1. Antigen-antibody complexes 2. Bacterial toxins 3. Components of other plasma protein systems -antigen-antibody complex, 3rd line of defense (specific immunity) -inflammation, 2nd line of defense (nonspecific immune response)
B. Platelets -____ shaped, _____ bodies - Circulate in the ____ -Their function is to ____ -_____ and _____ must be present for the clot to form -They are activated when they encounter ___,___ or ____ (such as ____)
-irregularly, colorless -bloodstream -stop bleeding by forming a clot -Calcium and vitamin K -air, physical barriers or chemical mediators (mediators of inflammation)
Viral vaccines: -Contain ______ -express ____ but are not ____ (unless____) -Flu vaccines must be given every year because ____ Bacterial vaccines: -Contain _____ -Vaccines against toxins contain ____(_____) -_____,____, and ____ are examples of organisms that do not enter the body but produce toxins that result in life threatening diseases
-live but weakened (attenuated) viruses -antigens, strong enough to cause infection (the immune system is compromised) -the new virus is very distinct from the previous year's strains -Killed bacteria or extracts of bacterial antigens -toxoids (detoxified toxins that still express the antigens) -Diphtheria, cholera, tetanus
2. Synthesis: -A ____ response -Cellular injury stimulates mast cells to synthesize biochemicals that are _____ (2) -These mediators stimulate ____ and more ____ inflammatory response than ____, they keep ____
-long-term -important in the later stages of inflammation 1. Leukotrienes 2. Prostaglandins -slower, prolonged, histamine, the inflammation going
2. Increased vascular permeability: -The endothelial cells that line the capillaries _____, creating ___ -inflammatory agents such as ___ and ___ cause _____ -The larger spaces at the cellular junctions of endothelial cells make the ______, causing ____ (____)
-retract, larger spaces at the cellular junctions -histamine and prostaglandins, endothelial cells to retract -capillaries become more permeable, increased exudation (exudate leaks into the tissue resulting in edema and swelling)
Monocytes/Macrophages -Monocytes are the immature form of _____ (they ____) -Macrophages usually arrive at the injured site ____ after injury (Can arrive within ____) -They are well suited for ____ because they can ______ (their presence is characteristic of ___) -They increase their ____ in response to _____ secreted by ___(___) -They secrete substances that promote ____ during ___ -However, some bacteria can ___ and ____ inside macrophages (___,___,___)
-macrophages (differentiate into macrophages) -3-7 days (24 hours) -long-term defense, survive and divide in acidic environments (Chronic inflammation) -phagocytic activity, lymphokines secreted by T cells (immunity) -regrowth of tissue, wound healing -survive and multiply (tuberculosis, leprosy, typhoid fever)
Interferons -Proteins produced by ___ and ____ as well as by ____ that were ____ -Allow ____ in order to _____ -INFα and INFβ bind to _____ and stimulate them to produce ____ -Thus, they prevent ____ from ____, but they do not help ____
-macrophages, lymphocytes, host cells, invaded by a virus -communication between cells, trigger immune system defenses against pathogens -neighboring cells, antiviral proteins -viruses, infecting healthy cells, host cells that are already infected by a virus
1. Anti-inflammatory steroids -Prevent _____ from _____, thus decreasing the levels of ______ which further inhibit: (3)
-macrophages, migrating to the injury site, mediators released by macrophages 1. Angiogenesis: formation of new blood capillaries 2. Epithelialization: formation of new epithelial cells 3. Fibroblast migration into the wounds: resulting in decreased formation of scar tissue (mediator: fibroblast-activating factor)
Histamine -pre-synthesized by ___ and stored___ -released by ____ -A _____ amine, it causes both: (2)
-mast cells, in their granules -degranulation -vasoactive: 1. Vasodilation (can cause anaphylactic shock) 2. Increased vascular permeability
Viruses -Viral infection is _____ common than bacterial infection -ranges in severity from _____ to ___ -Viruses are very small _____ that _____ (____) of host cells Viruses defense mechanisms 1. ____: viruses resist being detected by phagocytes because _____ 2. ______: viruses bypass many defense mechanisms by ______, thus they hide within ____ and away from ______ which most commonly occur in the blood and lymph
-more -the common cold to AIDS -intracellular parasites, take over the metabolic machinery (protein production) 1. size: their extremely small size 2. Intra-cellular development: developing intracellularly, tissues, normal inflammatory and/or immune responses
Control of plasma protein systems -The activation of inflammatory process must be guaranteed by having _____ -Thus, the activation of plasma protein systems during inflammation involves ____ -Biochemical mediators are so potent that they can cause ____ -Thus, their actions must be limited to (2) -Therefore many components of inflammation are ____
-multiple means of initiating inflammation (the systems interact) -many potent biologically active substances that interact to protect the host from -damage to the host 1. the injured or infected tissue 2. a relatively short time -destroyed within seconds by plasma enzymes
Insufficient collagen production: -Predominantly due to ______ -____,____,____,____,____ and more nutrients are needed for collagen synthesis -______ (____) is one of the cofactors required for collagen formation by fibroblasts Scurvy: -A disease caused by ____ -Capillary walls ____due to ____ -Symptoms include (5) -This disease can lead to ___ unless _____ (early explorers, sailors)
-nutritional factors -protein, iron, oxygen, calcium, copper -ascorbic acid (vitamin C) -a lack of vitamin C -break down due to loss of collagen 1. internal hemorrhage 2. weakness 3. joint pain 4. skin lesions 5. loose teeth -death, vitamin C is consumed
Granulocytes Neutrophils: - _____ -the most common type of leukocytes during _____ -they enter the inflammatory cite ____ after initial injury/infection -the are _____ because they are ____ Eosinophils -Keep the inflammatory response in check by ______, thus _____ -also the body's primary defense against ____, they ____ Basophils: -signal other ___ by ___ ( act similar to ___, have ____)
-phagocytes -leukocytes, early phases of acute inflammation -6-12 hours -short lived, sensitive to the acidic environment of the inflamed area -having enzymes that degrade histamine, thus controlling mast cells' action -parasites, bind to the, and release enzymes to destroy their outer membranes -leukocytes by synthesizing and releasing cytokines (mast cells, histamine containing granules)
5. Diabetes mellitus -Persons with diabetes heal ____, mostly due to _____ and _____ -They are at risk for ____ because of ____ 1. They tend to have _____ that impair their microcirculation 2. Their ____ is ____ so it has an increased ______ and does not _____ -Ischemic tissue is susceptible to ___ (____)
-poorly, micro-vascular disease and infection -ischemic wounds, compromised oxygen delivery 1. small-vessel- diseases 2. hemoglobin, glycosylated, affinity for oxygen, readily release oxygen to the tissue -infection (sepsis)
Bacteria: -small _____ (no _____) that use either ___ or _____ to protect themselves 1. Gram-positive bacteria: have ____ to protect them, thus they stain _____ (examples: (3)) 2. Gram-negative bacteria: possess ____ in their cell wall, which are released when _____, and may cause _____ and _____; stain _____ due to _____ (examples: 4)
-prokaryotes (discrete nucleus), protective coating or endotoxins 1. thick or waxy cell wall, purple-black (staphylococci, streptococci, diphtheria) 2.endotoxins, bacteria are destroyed, fever and anaphylactic shock; pink, thin wall (E-coli, salmonella, cholera, helicobacter)
1. Interleukin-1 -Is a ____ that is secreted by ____ -Causes the ____ to induce ___ (____) -Activates _____ and stimulates them to _______ and ____
-protein, activated macrophages -hypothalamus, fever (endogenous pyrogen) -lymphocytes, mature and proliferate
2. Tumor necrosis factor (TNFα) -A _____ that is produced by _____ -Directly ____ to cells -Induces ____ by acting on the ____ -Facilitates ____ and ____ of _____
-protein, activated macrophages -lethal -fever, hypothalamus -inflammation and phagocytic activity of neutrophils
Inflammation is the ____ line of defense in the body -Inflammatory responses begin ____: within ____ of invasion -Inflammation is _____: -it occurs in the ____ no matter ____ -it occurs in the ___ whether it is ____
-second line -immediately, seconds -non-specific -same way no matter what the stimulus is -same way whether it is the first or second time of exposure to the same stimulus
Phagocytes -They are kept at ___ by the ___ formed by ___ -At that site, they ___ (___) ____ and ____ -They ___ and become a part of the ____ (___) which leaves the body through the ___ or ____ (___)
-site of injury by the meshwork formed by fibrinous exudate -ingest (phagocytose) foreign cells and dead host cells -die, pus (purulent exudate), lymph or epithelium (sinuses)
2. Synthesis Leukotrienes -they are _____ of ___ which cause ____ -they are ___ containing ___ and are ___ Prostaglandins -_______ -Continue the ___ and cause ___ -____ and other _____ block their synthesis, thereby inhibiting ____ and ____
-slow-reacting substances, anaphylaxis (SRS-A), hypersensitivity responses -lipids, sulfur, acidic -long-chain unsaturated fatty acids -inflammatory response, pain -Aspirin, non-steroidal anti-inflammatory agents, inflammation and pain
Chemotactic factors -Attract _____ -Chemotaxis is the _____, which follows ____ by _____
-specific type of leukocytes to the site of inflammation -directional movement of WBCs, chemotactic factors, detecting were they are most highly concentrated
Hallmarks of Inflammation -Heat and redness are caused by ____ -Swelling (edema) is caused by ____ -Pain occurs due to _____ which is caused by (2): -______ is caused by all of the above
-the increased blood flow to the area due to vasodilation -exudate accumulation in the tissue due to increased vascular permeability -activation of nerve endings 1. pressure exerted by swelling (exudate accumulation) 2. The presence of soluble biochemical mediators such as prostaglandins and bradykinin -loss of function
Leukocytes are ______, which are responsible for the ____ and ____ -They originate from 2 cell lines: -They are divided into 3 main types:
-white blood cells, inflammatory and immune responses 1. Lymphoid (associated with lymph system) 2. Myeloid (associated with bone marrow) 1. Granulocytes 2. Monocytes/macrophages *1 and 2 are myeloid* 3. Lymphocytes (lymphoid)
Body defenses include: (3)
1. Anatomical barriers (skin and mucosal membranes) 2. Inflammation --1 and 2 are non-specific/innate immune system------ 3. Immunity *immunity is specific, adaptive immune system
Body has 3 lines of defense:
1. Anatomical barriers (skin and mucosal membranes) 2. Inflammation *1 and 2 are non/specific/innate immune system 3. Immunity (specific/adaptive immune system)
Factors affecting the quality and intensity of the the immune response: (3) 1. ____ 2____ (6) 3. ___(5) *_____ is the most common determinant of immunodeficiency, especially _____ -important micronutrients for proper immunity include (9) Example: _____
1. Antigenic challenge (type and amount of antigen) 2. Exogenous factors such as trauma, disease, pollutants, radiation, ultraviolet light, drugs 3. Endogenous factors such as age, gender, nutritional status, genetic background, reproductive status *Malnutrition, protein malnutrition -zinc, selenium, iron, copper, vitamins A, E, C, B-6, folic acid -low-birth-weight infants may have a prolonged immunity impairment, which may be partly restored by providing extra dietary zinc
Inflammation is triggered by: 1. ______: when ______ such as ____ 2. _____ (2) -Inflammation is a biochemical and cellular process that occurs in ____ -Most components of the inflammatory process are found in the _____ -Inflammation is initiated by _____ -the granules of mast cells contain ______ such as ___ that cause the inflammatory response
1. Cellular injury: injured cells secrete mediators such as heat-shock proteins 2. Dead cells (host cells, microorganism cells) -vascularized tissue -circulatoin -mast cells -chemicals, histamine
7. Aging -Older people are at risk for impaired wound healing due to (3) -Older people are at risk for sustaining more wounds due to (4)
1. Chronic illness (diabetes, cardiovascular disease) 2. Medications (such as anti-inflammatory steroids) 3. Diminished immune functions (increase infections) 1. Impaired sensation, balance, and mobility 2. Decreased subcutaneous fat 3. Less elastic collagen fibers 4. Atrophied epidermis ---2-4 lead to less protection---
3 primary systemic (WHOLE BODY) changes:
1. Fever 2. Leukocytosis: a transient increase in circulating WBC 3. Increase in circulating plasma proteins
A.Leukocytes: 1. ____: have _____ in their ____ (4 types) 2. ________: (2 types) B. _____- form ____
1. Granulocytes: have lysosomal granules (containing digestive enzymes) in their cytoplasm -Mast cells -Neutrophils -Eosinophils -Basophils 2. Monocytes/macrophages -monocytes: the immature form of the these cells existing in the blood -macrophages: the mature cell, existing in tissues B. Platelets form blood clots
The main cytokines contributing to inflammation are: (3)
1. Interleukin-1 (IL-1) 2. Tumor necrosis factor (TNF) 3. Interferons ( INFα, INFβ, INFγ)
Steps of the immune system response to invasion (7)
1. Neutrophils arrive first but only survive a few days 2. The complement system's proteins attack the invader 3. Macrophages phagocytose the invaders ----1-3 are all inflammation---- 4. Macrophages signal other immune cells to attack, and display antigens from the ingested invaders to activate T cells 5. T cells activate B cells, other T cells, and macrophages -B cells produce antibodies, which bind to the invaders, destroy them or make them easier to phagocytose -T-cytotoxic cells (and NK cells) attack the invader directly 6. Once the invaders are destroyed, T-suppressor cells slow down the immune response 7. Memory cells (T cells &B cells) are formed ---4-7 are all immunity----
The following conditions may cause dysfunctional healing (7) which result in insufficient repair
1. Steroidal anti-inflammatory drugs (such as cortisone) 2. Decreased blood supply (ischemia, vasoconstriction, hypovolemia) 3. Decreased oxygen in the blood (hypoxemia) 4. Nutritional deficiency 5. Diabetes mellitus 6. Infection 7. Aging
3 plasma protein systems mediate inflammation: 1. _____ -induces ____ (____) 2. _______ -forms ______ to ____ 3. ______ -induces _____
1. The complement system -inflammation (all inflammatory responses) 2. The clotting system -forms a clot and meshwork to limit the spread of inflammation and/or infection 3. The kinin system -induces vascular responses in the later phase of inflammation
The difference between neutrophils and macrophages: 1. _______: -Neutrophils ______ -Macrophages ____ 2. _______ -Macrophages ____, neutrophils ____ 3. _______ 4. _____ 5________ -Macrophages ______:_____ while neutrophils ____
1. The speed with which they arrive at the site -arrive first, 6-12 hours after injury -arrive after 24 hours or more (3-7 days) 2. The length of time during which they remain active -live longer, are more sensitive to the acidic environment 3. The chemotactic factors capable of attracting them 4. The enzymes in their lysosomes 5. Their participation in immune response -interact with lymphocytes: they are involved in antigen processing and they respond to lymphokines, do not
Chronic inflammation is produced by: 1. _____ -in a traumatic wound, it is characterized by ____ and ____ 2. 3. 4.
1. Unsuccessful acute inflammatory response -pus formation and incomplete wound healing 2. The persistence of bacteria inside phagocytes 3. The persistence of toxins of the killed microorganisms 4. Prolonged irritation by chemicals or physical irritants (inhaled dust, wood splinters, suture material)
1. Local vasodilation: the ______ causing ____
1. arterioles dilate causing increased blood flow to the inflamed site (Edema and swelling)
Inappropriate or exaggerated inflammatory process can: (2) -Inflammation is difficult to control with drugs because (2) -Types of inappropriate inflammatory response: (2)
1. harm healthy tissues 2. Be painful 1. It is complex and nonspecific 2. It can be triggered and maintained by many different stimuli 1. Chronic inflammation 2. Granuloma
The clotting (coagulation system): -Forms a ___ at the site of inflammation to: (3) -Fibrin, an ____ protein, is the _____ and the _____ -It is formed when ____ (_____) is ___
1. meshwork 1 prevent the spread of infection and inflammation to adjacent tissues 2Keep microorganisms at the site of the greatest phagocytic activity 3 Form a clot that stops bleeding and provides a framework for future repair and healing (scab) -insoluble, main substance, end product of this cascade -fibrinogen (a soluble blood protein) is activated
Hallmarks of Inflammation -Local inflammation (5)
1. redness (rubor) 2. Heat (Calor) 3. Swelling (tumor) 4.Pain (dolor) 5. loss of function
When inflammation causes widespread cellular death (necrosis), the nature of subsequent healing is different, depending on the type of tissue: 1. Tissue that can ______: -most cells in the body can ____ -____ and _____ cells can regenerate most readily -_____ cell can regenerate to some extent 2. Tissue that _____ -_____: widespread cell death usually results in _____ -____ and _____: widespread cell death results in ______
1. regenerate -regenerate -hepatic and epithelial cells -smooth muscle 2. cannot regenerate -Neurons in the brain: formation of an abscess filled with necrotic tissue -cardiac and skeletal muscle: replacement of the dead tissue with a scar
The body's first line of defense is its ______: 1. ______ 2. ______ -They prevent ____,____ and ____ from penetrating tissues and cells -They are _____: protect against ____
anatomical (external, mechanical) barriers: 1. Skin 2. Mucous membranes lining the respiratory, GI, and GU (genitourinary) tracts -harmful chemicals, foreign bodies, and microorganisms -nonspecific: any and all invaders
Our immune system attempts to _____pathogens while pathogens devise ways to ______ -the most common pathogens are ___ and ___
destroy, prevent their destruction by the immune system -bacteria and viruses
Excessive collagen production results in ____ 1. hypertrophic scars are: -_____ -remain ____ -tend to ____ 2. Keloid scars are -____ -extend ______ -likely to recur _____ -have a _____
excessive scaring -raised scars -within the original boundaries of the wound -regress over time -raised scars -beyond the original boundaries of the wound and invade the surrounding tissue -after surgical removal -familial tendency with greater incidence in blacks than in whites
Tissue destruction is followed by a period of _____ -It begins with _____ and may not be completed for as long as ___ -The most favorable outcome of healing is _____ (____): which leads to _____ -Resolution is possible when: (3)
healing -acute inflammation, 2 years -resolution (regeneration): normal structure and function 1. The destroyed tissue can regenerate 2. The damage is minor 3. No complications (ex infection) occur
Inflammation is the first step of____ -Inflammation is necessary for all ____ -When inflammation does not cease after the acute inflammatory phase, _____ develops -The acute inflammatory response is ______: it usually continues from ____ after the onset of healing -When inflammation persists longer than _____ it is considered chronic
healing -tissue healing -chronic inflammation develops -self limiting: 8-10 days -2 weeks
Once the external barriers are penetrated, the second line of defense is the _____ -Inflammatory responses begin within ____ -Inflammation is _____ -Inflammatory response is mediated by: (2) -The invaders and affected host cells become surrounded by ____ and _____ which ____, ____ and _____
inflammatory response -seconds of invasion -non-specific 1. Blood cells (WBC, phagocytes) 2. Biochemical mediators (plasma proteins systems) -phagocytes and biochemical mediators, isolate, destroy, and remove the invaders
The third and last line of defense is _____ -It occurs _____ -It is ____ (___) -It can provide the body with ___ and or ______ against a ___ -It can be induced ____ or by ___ -It includes (2)
immune response (immunity) -more slowly -specific (against a certain invader) -long-term, permanent protection, specific microorganism -naturally, vaccination 1. Antibodies (serum proteins) 2. Lymphocytes (a specific type of white blood cells)
Plasma protein systems consist of a series of _____ (_____) -When the first proenzyme in the series becomes active, it ____ and initiates a ______ -Thus, the entire cascade is activated upon _____ -These systems interact with each other and can _____
inactive enzymes (proenzymes) -activates the next proenzyme and initiates a cascade in which each proenzyme activates the next component of the system -activation of the first component (proenzyme) -activate each other
Healing requires ______ -Blood supply to the site of the lesion must remain ____ for ____ -all components of healing require ____ and ____ -Thus, _____ and or _____ interfere with wound healing
increased metabolic needs -increased, continued oxygen, glucose, and protein supply -energy and protein synthesis -ischemia and or poor nutrition
Pathogens are organisms that _____ -Route of entry that pathogens may enter the body through (4) -Site of entry: (4)
infect hosts by circumventing(evading) the host's defenses 1. Direct contact (wound) 2. Inhalation 3. Ingestion 4. Animal or insect bites 1. Skin 2. Mucous membranes 3. Eyes and ears 4. Respiratory, GI, and GU tracts
Cytokines mediate both _____ (___ line of defense) and ____ (___ line) by: (8)
inflammation (2nd line) and immunity (3rd line) 1. Inducing systemic effects such as fever and accuse phase reactants (serum proteins present during inflammation) 2. Activating phagocytes (macrophages and neutrophils) 3. Stimulating cellular proliferation and differentiation of various leukocytes 4. Inducing and contributing to inflammation 5. Controlling (inhibiting) inflammation 6. Engaging the adaptive immune system (3rd line of defense) 7. Defending against viruses and tumor cells 8. Promoting healing (stimulate scare tissue production)
Regeneration and repair begin during _____, as phagocytes _____ -Debridement is the process by which _____ -Debridement occurs when ____ Fibrin: -A _____ -Forms a ______
inflammation, clean up the debris in the lesion -phagocytes clean up the debris -the phagocytes' enzymes dissolve the fibrin clots (scabs) -protein involved in blood clotting -"mesh" (plug or clot) over the wound site in conjunction with platelets
Phagocytes are the _____ -protect the body by ____ -2 main types of phagocytes: 1. _____: _____ 2. _____: ___
main WBCs that move to the inflamed area -ingestion foreign antigens, dead cells, and debris 1. Neutrophils: the first to arrive at the inflamed site (within 6-12 hours after injury) 2. Macrophages: arrive at the site from 24 hours to 7 days after injury
Multiple-drug-resistant organisms appeared because of ____ -Overuse of antibiotics can lead to ____, allowing ____ -______ and ____ re-introduce beneficial flora -Individuals commonly do not comply with instructions to complete the 10 days of antibiotics, which allows ____ -New antibiotics are ____ so they need to be take for only __ or ___ (such as ___)
overuse of antibiotics -destruction of the normal flora, the selective overgrowth of the drug-resistant strains of pathogens that were previously kept under control by the normal flora -probiotics and yogurt -the selective resurgence of more resistant organisms -time-released, 3 or 5 days (Z-Pac)
Phagocytes perform ____ which consists of 4 steps: -Phagocytes ___ after phagocytosis
phagocytosis 1. Recognizing the target and adhering to it 2. Engulfing the target: ingestion or endocytosis 3. Fusing with lysosomes inside the phagocyte (Creating vacuoles which contain both the target cell and lysosomes) 4. Destroying the target by lysosomal enzymes -die
An antigen is a ____ -The immune system can distinguish ____(____) from ____(___) proteins -Histocompatibility antigens (MHC, HLA) are proteins which are _____and help the immune system_____ -Foreign antibodies can be ____ or ___ -Infectious antigens: (4) -Noninfectious antigens (7) *The immune system defends against ____*
protein -"self" (self antigens) from "non self" (foreign antigens) -found on almost every cell in the body, distinguish self from non-self -infectious or not -viruses, bacteria, fungi, parasites -pollens, foods, venoms (bee), drugs, vaccines, blood transfusion, transplanted tissue *foreign antigens
When resolution is not possible ___ takes place -Repair rather than resolution occurs when: (3) -Regeneration is possible only in tissue that is capable of _____ -____,____ and ___ can regenerate -____,____ and ____ cannot regenerate
repair 1. The destroyed tissue cannot regenerate 2. The damage is extensive (even when tissue can regenerate) 3. Complications are present, for example: infection that results in abscess or granuloma formation (even when tissue can regenerate) -proliferation of the remaining cells -liver, skin, smooth muscle cells -nerves, skeletal muscle, and cardiac muscle cells cannot regenerate
Repair is the ____ -Scar tissue is composed of ____ -___ is the most abundant protein in the body (main protein present in _____ including ___,____,____ and ____) -Collagen is produced by ______ (_____) -During repair, _____ proliferate and increase their _____ -_____ fills the lesion and ____ but cannot ______
replacement of destroyed tissue with scar tissue -collagen -connective tissue, skin, bones, teeth and blood vessels -fibroblasts (connective tissue cells) -fibroblasts, collagen synthesis -scar tissue, restores tensile strength, carry out the physiologic function of the tissue
Vaccines induce immune responses under conditions that ____ -Some individuals cannot produce a protective ______ and will be susceptible to getting ____ -The immune response from vaccination is generally ____ so ____ are mostly necessary to ______
should not result in disease -immune response, full blown infection from the vaccine -short-lived, booster shots, produce large numbers of memory cells and protective antibodies
Depending on the ____ the exudate changes its composition: 1. ______: -present in _____ -exudate is _____ with ____ 2. ______: -Present when _____ -the exudate is ___ and ____ 3. _____: -Present with _____ -The exudate consists of _____ and is characteristic of _____
stage of inflammation 1. Serous exudate -early stage and/or during mild inflammation -watery with few plasma proteins and WBC 2. Fibrinous exudate -inflammation is more severe and advanced -thick and clotted with a large number of proteins and leukocytes 3. Purulent (suppurative exudate): -persistent bacterial infections -pus, walled-off lesions (cysts or abscesses)
When debridement is completed, the inflammatory process ____ -The exudate, toxic products, and other inflammation substances are _____ -Both ____ and ____ are reversed
stops -drained away -vasodilation and increased capillary permeability
Once a microorganism penetrates the first line of defense and invades the tissue _____ is initiated by the host -In the inflammatory response, ____ and later ____,____ (___,____, and ____) the microorganism -The next step is the _____ (____): -2 types of cells
the inflammatory response -neutrophils and later macrophages, phagocytose (attach, engulf, and destroy) -immune response (immunity): 1. B cells (B-lymphocytes) produce antibodies against the infectious microorganisms and/or their toxins 2. T cells (T-lymphocytes) either attack the microorganisms directly or secrete lymphokines to recruit macrophages and other immune components