CHRONIC INFLAMMATION -...
Transcript of CHRONIC INFLAMMATION -...
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CHRONIC INFLAMMATION
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CharactersCausesTypes
Persistent response to injury
Prolonged duration (weeks,months,years)
Chronic inflammation
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Chronic inflammation
Characters:1. Infiltration with mononuclear cells:
lymphocytes, microphages and plasma cells
2. Tissue destruction3. Repair,new vessel proliferation
(angiogenesis) and fibrosis
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COMMON CAUSES
Cause: continuous existence of inflammatory agents.
a. Persistent microbial infections
b. Prolonged exposure to potential toxic agents: foreign body that cannot be degradation
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c. Type Ⅳ allergic reaction caused by some special infection, e.g.TB et al.
d. Some autoimmune disease, e.g. rheumatoid arthritis, colitis, graves’ disease.
COMMON CAUSES
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Morphological patterns
Nonspecific proliferative inflammation
Granulomatous inflammation
TYPES
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Nonspecific proliferative inflammation
is characterized by coexist of many kind of inflammatory cells.
Pathological changes:mononuclear cells (lymphocytes, macrophages , plasma cells) infiltration and proliferation of fibroblasts and connective tissue, vessels , epithelial cells.
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Inflammatory polyp:an inflammatory mass formed by excess proliferation of local epithelial cells, glands and connective tissues, often with peduncle. Example : Cervical polyp, Nasal polyp
Nonspecific proliferative inflammation
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Cervical polyp
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Cervical polyp
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Nasal inflammatory polyp
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Inflammatory pseudo tumor: a clear tumor- like mass formed by local tissues and cells proliferation, it is rather difficult to distinguish with real tumor by X-ray or naked-eyes. it is located in lung and eye orbit.
Nonspecific proliferative inflammation
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tumor-like mass in lung with X-ray examination
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Inflammatory pseudo tumor
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Granulomatous inflammation
Granuloma:a distinct nodular lesion that is consisted of aggregation of macrophages or its derived cell.
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Conception of Granulomatous inflammation :
a distinctive pattern of chronic inflammation characterized by aggregation of activated macrophages.
Macrophages derived from blood monocytes.
Liver: Kupffer cells;Spleen and lymphnodes: sinus histiocytes;Nervous system: microglial cells;Lung: alveolar macrophages
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Classification of granuloma
1).Foreign body granuloma:Granuloma may occur in response to foreign body or T-cell mediated immune response to organism.silicosis
2).Infectious granuloma: it often acts as a diagnostic evidence.
tuberculosis, typhoid fever, rheumatic disease, schistosomiasis, leprosy etc.
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Note :some granulomatous inflammation
may be acute inflammation. Example : typhoid fever.
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Morphology of granuloma:
In the usual condition, there are foreign body or necrosis in the central area and they were surrounded by epithelioid cells and multinucleated giant cells.
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granuloma : surrounding fiber, epithelioid cells and multinucleated giant cells
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Infectious/Immune Granuloma
TuberculosisRheumaticTyphoid feverLeprosy
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Typhoid fever (granulomatous inflammation)
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rheumatic myocarditis
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Langhans giant cellHorseshoe pattern
Epitheloid cell
Tuberculosis
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Foamy cells
Leprosy of skin (foam cells)
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•
Egg of Schistosom
schistosomiasi s Chronic egg nodule (pseudotubercle: eggs surrounded by epithelioid cell, multinucleated giant cell; eggs are often necrotic or calcified. This structure is like that of a tubercle.
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Foreign Body Granuloma
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Foreign body granuloma
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Foreign body granuloma multinucleated giant cell
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Difference of two basic patterns
Acute inflammation
Chronic inflammation
Duration Characters
Short, minutes up to a few days
longer, days to years
Fluid and plasma protein exudation, neutrophilis accumulation
Lymphocytes,plasma cells, macrophages, vascular, proliferation and scarring
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Influence factors to the inflammation
local factors:local circulation; inflammatory exudate
general factors:• Immunity • Nutrition • Endocrine
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OUTCOMES OF INFLAMMATION
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Outcome of acute inflammation
Resolution: restoration to histological and functional normalcy
Scarring or fibrosis: extensive fibrinous exudates; abscess formation—scarring
extensive neutrophilic infiltrates in certain bacterial or fungal infections, these organisms are said to be pyogenic, or pus forming
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the persistence of a fibrinosuppurative exudate into alveolar spaces
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the exudate in the alveolar spaces undergoes progressive enzymatic digestion, debris is resorbed, ingested by macrophages, coughed out.
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Fibrosis of pneumonia
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Progression to chronic inflammation:
last months or years
Spread:
• local spread
• lymphatic spread
• vascular spread
Death : result from toxemia ,e.g. endotoxic shock and its complication, such as encephalitis and myocarditis
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Vascular spreadbacteremia: bacteria are found within the blood
toxemia: bacteria are not found within the blood , while toxins are absorbed into blood and producing a systemic illness
septicemia: bacteria within the blood are proliferating and producing a systemic illness
pyemia: pyogenic bacteria within the blood are proliferating and producing multiple abscess in different organs and a systemic illness
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• Healing:
Complete resolution (complete Healing)
Scarring or fibrosis (incomplete Healing)
• Persistence and Delay
Outcome of Chronic inflammation
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complete Healing
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Scarring
Protruding, redness,
Irregular
incomplete Healing
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