Rapid Review·General Pathology
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INFLAMMATION
T2High yieldChronic Inflammation
P212
Focus on
Macrophage-driven simultaneous destruction and repair.
Key takeaways
What chronic inflammation is
Chronic inflammation
a mononuclear infiltrate of macrophages, lymphocytes, and plasma cells driving simultaneous tissue destruction AND repair (angiogenesis plus fibrosis).- Stimuli: persistent infections (TB, T. pallidum, fungi, viruses) acting through type IV hypersensitivity; autoimmune disease; prolonged toxic exposure (silica); foreign material.
- Macrophages are the dominant cell, and the macrophage-to-T-cell conversation is what sustains the process:
- Th1 → IFN-γ → CLASSICAL macrophage activation, proinflammatory and microbicidal.
- Th2 → IL-4 and IL-13 → ALTERNATIVE macrophage activation, geared to repair and fibrosis.
- Outcomes: scarring, amyloidosis, and neoplastic transformation (chronic HCV → HCC; H. pylori → chronic gastritis → gastric adenocarcinoma).
Acute vs chronic
| Feature | Acute Inflammation | Chronic Inflammation |
|---|---|---|
| Onset/duration | Seconds to minutes / minutes to days | Prolonged, weeks to years |
| Dominant cell | Neutrophil | Macrophage, plus lymphocytes and plasma cells |
| Immune arm | Innate | Adaptive (CD4+ T cells) |
| Vascular change | Vasodilation, ↑ permeability | Angiogenesis |
| Tissue outcome | Resolution, abscess, or progression | Simultaneous destruction plus fibrosis |
| Sequelae | Healing or scarring | Amyloidosis, neoplasia, fibrosis |
A patient with long-standing rheumatoid arthritis develops nephrotic syndrome. Which complication of chronic inflammation is most likely, and what protein is deposited?
Amyloidosis, the secondary (AA) type: prolonged inflammation keeps serum amyloid A high, and it deposits in the kidney.
How it's tested
A biopsy of a scarred fallopian tube in chronic PID asks which cell predominates. The answer is macrophage, and "neutrophil" is wrong specifically because the stem says chronic.
Go deeper
First Aid "Chronic inflammation"; Pathoma Ch. 2 "Inflammation"; Boards & Beyond. Anchor the macrophage-to-T-cell loop (Th1 → IFN-γ → classical activation; Th2 → IL-4/IL-13 → alternative) and the three outcomes — scarring, amyloidosis, and neoplastic transformation.
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Type (...) hypersensitivity reaction
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