Inflammation DR.HALA BADAWI LECTURER OF PATHOLOGY.
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Transcript of Inflammation DR.HALA BADAWI LECTURER OF PATHOLOGY.
DEFINITION:DEFINITION: Inflammation is the reaction of vascularized living Inflammation is the reaction of vascularized living
tissue to local injury. It is a series of vascular and tissue to local injury. It is a series of vascular and cellular reactions aiming to protect the body against cellular reactions aiming to protect the body against the injurious agent .the injurious agent .
TYPES:TYPES: -Acute: sudden onset and short duration ( hours - -Acute: sudden onset and short duration ( hours -
days) days) -Chronic: gradual onset and long duration ( days --Chronic: gradual onset and long duration ( days -
years) years)
INFLAMMATIONINFLAMMATION
INFLAMMATIONINFLAMMATION
CAUSES:CAUSES:
Living irritantsLiving irritants
Bacteria, viruses, parasites and fungiBacteria, viruses, parasites and fungi
Non-living irritantsNon-living irritants Physical, chemical and mechanicalPhysical, chemical and mechanical AntigensAntigens
• Caused by an irritant of short duration of Caused by an irritant of short duration of actionaction
• The tissue response is rapid i.e. sudden onsetThe tissue response is rapid i.e. sudden onset• Inflammation lasts for days or weeksInflammation lasts for days or weeks• Characterized by presence of fluid exudate Characterized by presence of fluid exudate
and cellular exudate mainly polymorph-and cellular exudate mainly polymorph-nuclear leucocytesnuclear leucocytes
ACUTE INFLAMMATIONACUTE INFLAMMATION
• REDNESSREDNESS• HOTNESSHOTNESS• SWELLINGSWELLING• PAINPAIN• LOSS OF LOSS OF
FUNCTIONFUNCTION
CARDINAL SIGNS AND SYMPTOMS OF CARDINAL SIGNS AND SYMPTOMS OF ACUTE INFLAMMATIONACUTE INFLAMMATION
Major events in inflammationMajor events in inflammation
Vascular events Cellular events
•Vasodilatation of arterioles and capillaries
•Increased blood flow
•Slowing of blood stream
•Increased capillary permeability
Formation of InflammatoryFluid exudate
• Margination of leucocytesMargination of leucocytes• Emigration of leucocytesEmigration of leucocytes• Emigration of monocytesEmigration of monocytes• Chemotaxis: Chemotaxis: (directed movement towards (directed movement towards
area of inflammation)area of inflammation)• Phagocytosis:Phagocytosis: (engulfment of bacteria and (engulfment of bacteria and
necrotic tissue)necrotic tissue)
Vascular Events in inflammation
•Vasodilatation of arterioles and capillaries
•Increased blood flow
•Slowing of blood stream
•Increased capillary permeability
Cellular Events in inflammation
• Margination , Emigration of neutrophils & monocytesMargination , Emigration of neutrophils & monocytes• Chemotaxis & phagocytosis Chemotaxis & phagocytosis
CHEMICAL MEDIATORSACTIONS
Bind to specific receptors on the cells
Vasodilatation
Increase vascular permeability
Chemotaxis
Histamine
Prostaglandins
C3a & C5a
Histamine, kinins, leukotriens
Leukotriens & lysosomal components
Function:Function:1.1. It dilutes bacterial toxins and chemical irritants.It dilutes bacterial toxins and chemical irritants.2.2. It brings antibodies to the area of inflammation.It brings antibodies to the area of inflammation.3.3. It brings the chemical mediators derived from plasma to the It brings the chemical mediators derived from plasma to the
area.area.4.4. It contains fibrinogen which changes to fibrin by activation It contains fibrinogen which changes to fibrin by activation
of clotting system. Fibrin helps in localization of of clotting system. Fibrin helps in localization of inflammation by surrounding the area .inflammation by surrounding the area .
Fate:Fate: Fluid exudate is absorbed by lymphatics. Fluid exudate is absorbed by lymphatics.
The Inflammatory Fluid ExudateThe Inflammatory Fluid Exudate
Fate of Acute inflammationFate of Acute inflammation
Complete resolutionComplete resolution Healing by scarringHealing by scarring Progression and spread:Progression and spread:
(direct, lymphatic & blood spread)(direct, lymphatic & blood spread) ChronicityChronicity
TYPES OF ACUTE INFLAMMATIONTYPES OF ACUTE INFLAMMATION
SUPPURATIVESUPPURATIVE INFLAMMATIONINFLAMMATION
NON-SUPPURATIVENON-SUPPURATIVE INFLAMMATIONINFLAMMATION
Types:Types:
I- SUPPURATIVE INFLAMMATIONI- SUPPURATIVE INFLAMMATION
I-Localized Supp. Inflamm.
Abscess, furuncle,
carbuncle
II- Diffuse Supp. Inflamm.
Cellulitis, Suppurative appendicitis, Suppurative cholecystitis, Suppurative peritonitis, Suppurative meningitis
…etc.
I- LOCALIZED SUPPURATIVE INFLAMMATIONI- LOCALIZED SUPPURATIVE INFLAMMATION
carbunclecarbunclefurunclefuruncle
AbscessAbscess
AbscessAbscess DefinitionDefinition:: Cavity containing Cavity containing
puspus (pus is formed of (pus is formed of
fluid exudate, fluid exudate, fibrin,pus cells, fibrin,pus cells, polymprph, polymprph, macrophages, macrophages, necrotic tissue and necrotic tissue and bacteria)bacteria)
AbscessAbscess Fate of abscess:Fate of abscess: Small abscess:Small abscess:
Pus may be absorbed followed by healingPus may be absorbed followed by healing Large abscess: Large abscess:
Should be evacuated, spontaneous or surgicalShould be evacuated, spontaneous or surgical
AbscessAbscessComplication of abscessComplication of abscess:: Ulcer (local defect on Ulcer (local defect on
the surface)the surface) Sinus (blind end tract) Sinus (blind end tract)
& Fistula (tract with & Fistula (tract with two openings)two openings)
Hemorrhage & Hemorrhage & gangrenegangrene
Spread of infectionSpread of infection
Ulcer
GangreneSinus
II- DIFFUSE SUPPURATIVE INFLAMMATIONII- DIFFUSE SUPPURATIVE INFLAMMATION
Acute supp. appendicitisDiffuse sup.cholecystitis Suppurative meningitis
Cellulitis
Cellulitis
Catarrhal inflammation: Catarrhal inflammation: e.g.common colde.g.common cold Pseudo-membranous inflam.: Pseudo-membranous inflam.: e.g.diphtheriae.g.diphtheria Fibrinous inflammation: e.g. Fibrinous inflammation: e.g. fibrinous pericarditis, fibrinous pericarditis,
fibrinous pleurisy, fibrinous peritonitis.fibrinous pleurisy, fibrinous peritonitis. Serous inflammation: Serous inflammation: e.g. burnse.g. burns Haemorrhagic inflammationHaemorrhagic inflammation Gangrenous (necrotizing) inflammationGangrenous (necrotizing) inflammation Allergic inflammationAllergic inflammation
NON-SUPPURATIVE INFLAMMATIONNON-SUPPURATIVE INFLAMMATION
NON-SUPPURATIVE INFLAMMATIONNON-SUPPURATIVE INFLAMMATION
Fibrinous pleurisy Fibrinous pericarditis
Fibrinous peritonitisHaemorhagic pericarditis.
Gangrenous inflammation
Fibrinous pericarditis
Characterized by:Characterized by: Mild irritant with a prolonged actionMild irritant with a prolonged action Tissue response is gradual and prolonged Tissue response is gradual and prolonged
(mild vascular dilatation and congestion)(mild vascular dilatation and congestion) Tissue destructionTissue destruction is progressive and is progressive and
gradually replaced by gradually replaced by fibrous tissuefibrous tissue with with thickening and narrowing of blood vessels thickening and narrowing of blood vessels (endarteritis obliterans)(endarteritis obliterans)
Scanty fluid exudate Scanty fluid exudate
CHRONIC INFLAMMATIONCHRONIC INFLAMMATION
Composed of:Composed of: LymphocytesLymphocytes Plasma cellsPlasma cells MacrophagesMacrophages Giant cellsGiant cells Esinophils in parasitic and allergic Esinophils in parasitic and allergic
inflammationinflammation..
Chronic Inflammatory Cellular Chronic Inflammatory Cellular ExudateExudate
1- 1- Chronic non-specific inflammationChronic non-specific inflammation Different irritants produce inflammatory Different irritants produce inflammatory
reaction of the same microscopic picturereaction of the same microscopic picture
2- 2- Chronic specific inflammationChronic specific inflammation Each irritant produces inflammation of a Each irritant produces inflammation of a
characteristic microscopic picturecharacteristic microscopic picture
Types of Chronic InflammationTypes of Chronic Inflammation
Definition:Definition: A type of chronic inflammation A type of chronic inflammation
characterized by focal accumulation of large characterized by focal accumulation of large number of macrophages together with number of macrophages together with lymphocytes, plasma cells, giant cells and lymphocytes, plasma cells, giant cells and fibroblasts forming tiny granulesfibroblasts forming tiny granules
GranulomaGranuloma
1-Infective granuloma1-Infective granuloma a. Bacterial e.g.TB, leprosy & syphilisa. Bacterial e.g.TB, leprosy & syphilis b. Parasitic e.g. Bilharziasisb. Parasitic e.g. Bilharziasis c. Fungal e.g. madura footc. Fungal e.g. madura foot 2-Non-infective granuloma2-Non-infective granuloma a. Silicosis and asbestosisa. Silicosis and asbestosis b. Foreign body granulomab. Foreign body granuloma 3-Granuloma of unknown cause3-Granuloma of unknown cause SarcoidosisSarcoidosis
Types of GranulomasTypes of Granulomas