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2. inflamation

Inflammation is a protective response of vascularized tissue to injury, aimed at eliminating the cause of cell injury and repairing damaged tissue. It involves various cells and tissues, with acute inflammation characterized by rapid onset and neutrophilic accumulation, while chronic inflammation is longer-lasting and involves lymphocytes and macrophages. The inflammatory response can have different outcomes, including complete resolution, fibrosis, or progression to chronic inflammation.

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13 views

2. inflamation

Inflammation is a protective response of vascularized tissue to injury, aimed at eliminating the cause of cell injury and repairing damaged tissue. It involves various cells and tissues, with acute inflammation characterized by rapid onset and neutrophilic accumulation, while chronic inflammation is longer-lasting and involves lymphocytes and macrophages. The inflammatory response can have different outcomes, including complete resolution, fibrosis, or progression to chronic inflammation.

Uploaded by

mohamed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Inflammation

ABEL B.
Inflammation

Introduction
• “Inflame” – to set fire.
• Inflammation is “dynamic response of
vascularised tissue to injury.”
•Is a protective response.
•Serves to bring defense & healing
mechanisms to the site of injury.
2
General Features of Inflammation

• Inflammation is fundamentally a protective host


response, the ultimate goal of which is:

1. to rid the organism of both the initial cause of cell


injury (e.g., microbes, toxins) and the consequences
of such injury (e.g., necrotic cells and tissues).
2. Repair the tissue injured

• Without inflammation, infections would go


unchecked, wounds would never heal, and injured
organs might remain permanent festering sores. 3
Inflammation cont…
• Many tissues and cells are involved in these
reactions, including the fluid and proteins of
plasma, circulating cells, blood vessels, and
cellular and extracellular constituents of
connective tissue.

• The circulating cells include neutrophils,


monocytes, eosinophils, lymphocytes, basophils,
and platelets.

‘’’’ 4
Steps of the inflammatory response
• The steps of the inflammatory response can be
remembered as the five Rs:
(1) Recognition of the injurious agent,
(2) Recruitment of leukocytes,
(3) Removal of the agent,
(4) Regulation (control) of the response, and
(5) Resolution (repair).The outcome of acute
inflammation is either elimination of the noxious
stimulus followed by decline of the reaction and
repair of the damaged tissue, or persistent injury
resulting in chronic inflammation.
Types of inflammation

• Acute inflammation

• Chronic inflammation
Acute inflammation
• Acute inflammation is rapid in onset and of
short duration, lasting from a few minutes to as
long as a few days.
• characterized by fluid and plasma protein
exudation and a predominantly neutrophilic
leukocyte accumulation.
• is a rapid response to an injurious agent that
serves to deliver mediators of host defense—
leukocytes and plasma proteins—to the site of
injury.
Cardinal Signs of Inflammation
• Rubor : Redness

• Calor : Warm
• Dolor : Pain -Nerve, Chemical.
• Tumor: Swelling – Exudation
• Loss of Function:
9
The 5 Cardinal Signs of

Heat Redness Swelling Pain Loss Of Func.

10
STIMULI FOR ACUTE INFLAMMATION

• Infections (bacterial, viral, parasitic) and


microbial toxins
• Trauma (blunt and penetrating)
• Physical and chemical agents (thermal injury,
e.g., burns or frostbite; irradiation; some
environmental chemicals)
• Tissue necrosis (from any cause)
• Foreign bodies (splinters, dirt, sutures)
• Immune reactions (also called
hypersensitivity reactions).
11
Components of acute inflammation
• The inflammatory response consists of two
main components:

1. a vascular reaction (vasodilation and


↑vascular permeability)

2. a cellular reaction (emigration of the


leukocytes )
Vascular Changes

• Vasodilation: is one of the earliest manifestations


of acute inflammation; sometimes, it follows a
transient constriction of arterioles, lasting a few
seconds.

• Vasodilation first involves the arterioles and then


results in opening of new capillary beds in the
area.

• Thus comes about increased blood flow, which is


the cause of the heat and the redness.
13
Changes in Vascular Flow and Caliber…

• Vasodilation is quickly followed by increased permeability


of the microvasculature, with the outpouring of protein-rich
fluid into the extravascular tissues. (role of histamin & other
kinins)

• The loss of fluid results in concentration of red cells in small


vessels and increased viscosity of the blood, reflected by the
presence of dilated small vessels packed with red cells and
slower blood flow, a condition termed stasis.

• As stasis develops, leukocytes, principally neutrophils,


accumulate along the vascular endothelium.
14
Mechanism of Inflammation

inflammation 16
CELLULAR EVENTS:

• The sequence of events in the journey of leukocytes from


the vessel lumen to the interstitial tissue, called
extravasation, can be divided into the following steps:

1. In the lumen: margination, rolling adhesion to


endothelium

2. More stable adhesion to endothelium.

3. Transmigration across the endothelium (also called


diapedesis)

4. Migration in interstitial tissues toward a chemotactic


stimulus.
Neutrophil Margination
Chemotaxis
• After extravasation, leukocytes emigrate in tissues
toward the site of injury by a process called
chemotaxis, defined most simply as locomotion
oriented along a chemical gradient.

• All granulocytes, monocytes and, to a lesser extent,


lymphocytes respond to chemotactic stimuli with varying
rates of speed.

• Both exogenous and endogenous substances can act as


chemoattractants.
• The most common exogenous agents are bacterial
products.
Outcomes of Acute Inflammation

• Acute inflammation may have one of three


outcomes :
1. Complete resolution.
2. Healing by connective tissue replacement
(fibrosis).
3. Progression of the tissue response to chronic
inflammation.

… 22
….
Inflammation Outcome
Fibrosis/Scar

Resolution

Acute Chronic
Injury Inflammation Inflammation

Fungus
Abscess
Virus
Cancers
Ulcer T.B. etc.

Fistula Sinus
….
Morphologic types
• Acute:
– Exudative Inflammation: excess fluid. TB lung.
– Suppuration/Purulent – Bacterial - neutrophils
– Fibrinous – pneumonia – fibrin
– Serous – excess clear fluid – Heart, lung
– Haemorrhagic – b.v.damage
• Chronic inflammation: with healing.
– Grannulomatous – clusters of epitheloid cells eg. TB,
Fungus, Foreign body.
Pneumonia

29
Chronic Inflammation

• Chronic inflammation may be more


insidious, is of longer duration (days to
years), and is typified by influx of
lymphocytes and macrophages with
associated vascular proliferation and
fibrosis (scarring).
…Chronic Inflammation
• Although difficult to define precisely, chronic
inflammation is considered to be inflammation
of prolonged duration (weeks or months) in
which active inflammation, tissue destruction,
and attempts at repair are proceeding
simultaneously.
• Although it may follow acute inflammation,
chronic inflammation frequently begins
insidiously, as a low-grade, smoldering, often
asymptomatic response.
Chronic Inflammation:

Lung Abscess
CAUSES OF CHRONIC INFLAMMATION
• Chronic inflammation arises in the following settings:

1. Persistent infections by certain microorganisms, such as


tubercle bacilli, Treponema pallidum (the causative
organism of syphilis), and certain viruses, fungi, and
parasites.

• These organisms are of low toxicity and evoke an


immune reaction called delayed type hypersensitivity.

• The inflammatory response sometimes takes a specific


pattern called a granulomatous reaction
…. 33
CAUSES OF CHRONIC INFLAMMATION…

2. Prolonged exposure to potentially toxic


agents, either exogenous or endogenous.

• Atherosclerosis - is thought to be a chronic


inflammatory process .

3. Autoimmunity

… 34
MORPHOLOGIC FEATURES
• In contrast to acute inflammation, which is manifested by
vascular changes, edema, and predominantly neutrophilic
infiltration, chronic inflammation is characterized by:

• Infiltration with mononuclear cells, which include


macrophages, lymphocytes, and plasma cells.
• Tissue destruction, induced by the persistent offending
agent or by the inflammatory cells.
• Attempts at healing by connective tissue replacement of
damaged tissue, accomplished by proliferation of small
blood vessels (angiogenesis) and, in particular, fibrosis.

… 35
Types of chronic inflammation

 Non specific
• Characterized by diffuse infitiration with
macrophages plasma cells and lyphocytes
• Eg .chronic cholecystitis

 Specific (granulomateous)
GRANULOMATOUS INFLAMMATION

• Granulomatous inflammation is a distinctive


pattern of chronic inflammatory reaction
characterized by focal accumulations of
activated macrophages, which often develop
an epithelial-like (epithelioid) appearance. eg.
tb ,leprosy syphilis etc.
Granuloma:
Acute Vs Chronic
Acute Chronic

• Flush, Flare & Weal • Little signs - Fibrosis


• Acute inflammatory • Chronic inflammatory
cells - Neutrophils cells – Lymphocytes
• Neo-vascularisation
• Vascular damage
• No/less exudation
• More exudation
• Prominent fibrosis
• Little or no fibrosis
• More tissue damage
• Less tissue damage
Systemic Effects of Inflammation

• Fever, characterized by an elevation of body temperature, usually by


1° to 4°C, is one of the most prominent manifestations of the acute
phase response, especially when inflammation is associated with
infection.

• Acute-phase proteins are plasma proteins, mostly synthesized in the


liver, whose plasma concentrations may increase several hundred-fold
as part of the response to inflammatory stimuli.

• Leukocytosis is a common feature of inflammatory reactions,


especially those induced by bacterial infection

• leucopenia (occasional)

• Wt loss
Consequences of Inflammation

• To summarize the clinical and pathological


consequences of too much or too little inflammation.

• Defective inflammation typically results in increased


susceptibility to infections and delayed healing of
wounds and tissue damage.

(eg. HIV, congenital immunodeficiency, Medications)

….
…Consequences of Inflammation
• Excessive inflammation is the basis of many
categories of human disease.
• allergies, in which individuals mount unregulated
immune responses against commonly encountered
environmental antigens,
• autoimmune diseases, in which immune responses
develop against normally tolerated self-antigens.
• Abscess formation
– Fistula
– Sinus
– Sepsis

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