03 Inflammation Flashcards
A protective response
Inflammation
A complex reaction to various injurious agents
Inflammation
Inflammation is consists of
Vascular responses
Migration
Activation of leukocytes
Systemic reactions
Ultimate goal of inflammation
Remove initial cause of injury
Remove consequences of injury
Unique features
Reaction of blood vessels
Accumulation of fluids and electrolytes in extravascular space
2 types of tissue repair
Regeneration
Scarring
Tissues and cells involved in inflammation
Fluid and plasma proteins Blood vessels Circulating cells (wbcs) CT cells (macrophages, mast cells, fibroblasts) Extracellular matrix (collagen, elastin) Adhesive glycoproteins
Cardinal signs: causes
Calor Rubor Tumor Dolor Functio laesa
Increased blood flow and increased cellular metabolism; heat
Calor
Vasodilatation and increased blood flow; redness
Rubor
Vasodilatation, edema, and neutrophilic response; swelling
Tumor
Stimulation of neuronal pathways by chemical mediators, edema (stretching of sensory receptors) and neutrophils; pain
Dolor
Loss or impairment of function from reflexive disuse due to pain, and mechanical or structural necrosis and/or healing
Functio laesa
Inflammation is terminated when the inciting agent is ________ and the mediators have ________
Eliminated, degenerated
2 types of inflammation
Acute inflammation
Chronic inflammation
A rapid response to an injurious agent that aims to rapidly bring mediators of inflammation to the site of injury
Acute inflammation
3 major components of Acute inflammation
Alterations in the vasculature
Structural changes (microvasculature)
Emigration, accumulation, and activation
Cells that infiltrate during acute inflammation
Polymorphonuclear cells (neutrophils, eosinophils, basophils)
Stimuli for acute inflammation
Infections Trauma Physical and chemical agents Tissue necrosis Foreign bodies Immune reactions
Mediators of acute inflammation
Vasoactive amines (histamine and serotonin)
Kinins (bradykinin)
Complement system (C3a)
Clotting system
Clotting system
Arachidonic acid metabolites Oxygen metabolites Platelet aggregating factor Nitric oxide Cytokines
Local manifestations of acute inflammation
Vascular dilatation and increased blood flow
Extravasation (edema)
Leukocyte emigration and accumulation
Components of inflammatory response
Vascular reaction
Cellular reaction
Vascular reaction
Vasodilation
Increased permeability
Cellular reaction
Margination Rolling Adhesion Transmigration Migration
Earliest manifestation of acute inflammation
Vasodilation
Hallmark of acute inflammation
Increased vascular permeability
WBC to interstitial tissues
Extravasation
Cellular events in acute inflammation
Extravasation Margination Rolling Adhesion Diapedesis Migration (chemotaxis)
Outcome of acute inflammation
Resolution
Chronic inflammation
Healing
Abscess formation
Refers to an excess fluid in the interstitial tissue or serous cavities
Edema
The escape of fluid, proteins and blood cells from the vascular system into interstitial tissue or body cavities
Exudation
Two types of exudation
Exudate
Transudate
Protein content of exudate
High
Specific gravity of exudate
> 1.020
Cellular components of exudate
Inflammatory cells, cellular debris
Protein content of transudate
Low (albumin)
Specific gravity of transudate
<1.020
Cellular components of transudate
None
An exudate rich in inflammatory cells (leukocytes) and cellular debris
Pus
Plasma-like effusion with no cells
Serous
Inflammation of the serous cavities
Peritonitis
Inflammation of synovial joint
Acute synovitis
Denote the production of pus
Purulent or suppurative
Caused by pyogenic bacteria
Purulent or suppurative acute inflammation
Localized collection of pus in a tissue
Abscess
Empyema
Hollow viscous fills with pus
Acute inflammation morphologic pattern; contains large amounts of fibrinogen
Fibrinous
Acute inflammation morphologic pattern; Often seen in acute pericarditis giving the parietal and visceral pericardium a ‘bread and butter’ appearance
Fibrinous
Acute inflammation morphologic pattern; Contains fibrinous or fibrinopurulent material with necrotic cells
Membranous
Acute inflammation morphologic pattern; Often found in mucous membranes, some microbial infection
Membranous
Acute inflammation morphologic pattern; Contains both serous and hemmorhagic materials
Serosanguinous
Acute inflammation morphologic pattern; Caused by bleeding, serous oxidation like injury and burns
Serosanguinous
Types of exudates in inflammatory processes
Hemorrhagic
Mucinous or Cattarhal
Contains large amount of RBCs and other cells; damaged or vascular injury or permeable blood vessels or depletion of coagulation factors
Hemorrhagic
Acute pancreatitis due to proteolytic destruction of vascular walls, and in meningococcal septicemia due to disseminated intravascular coagulation
Hemorrhagic
When mucus hypersecretion accompanies acute inflammation of a mucous membrane
Mucinous or Catarrhal
Contains large amount of mucous and epithelial cells
Mucinous or Cattarhal
Example of mucinous or cattarhal
Allergic rhinitis
Types of inflammation according to LOCATION
Abscess Ulcer Cattarhal Membranous Pseudomembranous
Localized collection of pus in a part of the body, surrounded by an inflamed area
Abscess
Area of the abscess look like?
Giant boil or cyst
An open sore of the skin, eyes or mucous membrane, often cause by an initial abrasion and generally maintained by an inflammation and an infection
Ulcer
Type of inflammation on the mucosal surface; thick mucous and white blood cells
Cattarhal
An epithelium becomes coated with fibrin, desquamated epithelial cells and inflammatory cells
Membranous
An example of membranous inflammation is the grey membrane seen in pharyngitis or laryngitis due to what bacteria?
Corynebacterium diphtheriae
Formed by the fibrin and necrotic surface epithelium; a structure which resembles the luminal surface of the tissue
Pseudomembranous
Types of inflammation according to DISTRIBUTION/ Location of lesion in an organ
Focal
Multifocal
Locally extensive
Diffuse
Single abnormality or inflamed area within a tissue
Focal
Size of focal lesion
1 mm to several cm in diameter
Arising from or pertaining to many foci (several foci separated from one another); size is variable
Multifocal
Involvement of considerable area within an organ
Locally extensive
Locally extensive is also known as
Focally extensive
Involve all the tissue or organ in which the inflammation is present
Diffuse
Example of diffuse inflammation
Interstitial pneumonia
Outcome of acute inflammation
Complete resolution
Healing (by CT replacement and scarring)
Abscess formation
Progression to chronic inflammation
An inflammation of prolonged duration; infiltration by mononuclear cells(macrophages, lymphocytes, plasma cells)
Chronic inflammation
Causes of chronic inflammation
Follows an acute inflammation
Repeated bouts of acute inflammation
Persistent infections of intracellular microbes
Tubercle bacilli
Viral infections
Prolonges exposure to nondegradable but potentially harmful substances
Silicosis
Asbestosis
Immune reactions
Autoimmune diseases
Morphologic of chronic inflammation
- Infiltration of mononuclear cells
- Tissue destruction
- Attempts at healing by CT replacement
A distinctive pattern of chronic inflammation; characterized by formation of granulomas
Granulomatous inflammation
Focal aggregation of activated macrophages which are transformed in an epithelial-like (ephetiloid) cells
Granuloma
Example of granulomatous inflammation
Tuberculosis, leprosy, syphilis
Two types of granuloma
Foreign body granuloma
Immune granuloma
Caused by inert foreign bodies; material (talc), sutures; no inflammatory or immune reactions present
Foreign body granuloma
Caused by immune T cell-mediated reactions; insoluble particles (microbial parts); inflammatory reactions present
Immune granuloma
Types of resolution inflammation (Healing)
- Simple resolution
- Regeneration
- Replacement by a CT scar
Resolution that has No destruction of normal tissue; offending agent is neutralized; vessels return to their normal permeability state; excess fluid is reabsorbed; clearance of mediators and inflammatory cells
Simple resolution
Replacement of lost or necrotic tissue with a new tissue that is structurally and functionally similar to those that were destroyed
Regeneration
The intact, healthy neighboring cells surrounding the dead cells will proliferate to replace the affected cells
Regeneration
Formation of the mature scar
Cicatrization
Scar; less vascular, pale, contracting scar tissue
Cicatrix
Systemic effects inflammation
Fever, increase in pulse and blood pressure, decreased in sweating, rigors, chills, anorexia, somnolence, malaise, lymphadenopathy
Increased plasma levels of acute phase proteins (CRP, serum amyloid A protein)
Leukocytosis
Sepsis
Shock
Factors modifying the inflammatory-reparative response
- Adequacy of blood supply
- Nutritional status of the patient
- Presence or absence of infection
- Presence or absence of diabetes mellitus
- Presence or absence of immunosuppressive drugs
- Adequate levels of circulating, normal functioning WBCs
Example of immunosuppressive drugs
Glucocorticosteroids
Reorganization of fibrous tissue, contraction of wound edges
Remodeling
Hollow viscus fills with pus
Emyema
Types of accute inflammation morphologic patterns
Serous Purulent/Suppurative Fibrinous Membranous Serosanguinous
Reorganization of fibrous tissue, contraction of wound edges
Remodeling
Hollow viscus fills with pus
Emyema
Types of accute inflammation morphologic patterns
Serous Purulent/Suppurative Fibrinous Membranous Serosanguinous
