5. Acute Inflammation I Flashcards
Cardinal signs of Inflammation
\_\_\_\_ • \_\_\_\_ • \_\_\_\_ • \_\_\_\_ • \_\_\_\_
Heat, redness, swelling: ____
Pain: ____
Heat (calor) Redness (rubor) Swelling (tumor) Pain (dolor) loss of function
sign
symptom
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medizin-1867
To a response of IRRITATION:
- ____ of arterioles and acceleration of blood flow
- Few min. later, WBC line the wall of the ____ (glued?)
- Some WBC crossed venules into extravascular space
- In some vessels, RBC tightly packed, decreased ____
- Loss of plasma
- ____ > Rubor (Redness)
- Increased ____ >Calor (Heat)
- Fluid ____ >Tumor (Swelling)
- Pain?
dilation
venules
blood flow
vasodilation
blood flow
exudation
• Phagocytosis: • Purpose of Inflammation; engulf bacteria and foreign matter • Increased vascular permeability: Allowed \_\_\_\_ along with \_\_\_\_ to participate in inflammation.
Used transparent invert’s and observed ingestion of particles > they would go around and eat the particle > phagocytosis
When same experiment was completed with frog leuokocytes > same mechanism of action
Purpose of inflammation: engulf and rid of foreign material/bacteria (Metchnikoff)
Ehrlich & Metchnikoff > knew there was loss of ____ > increased vascular permeability due to increased ____ resulting in a recruitment of leukocytes (and ab’s) from BV to EC space
antibodies
leukocytes
plasma
irritation
Inflammation:
Vascular and Cellular response when living tissues are injured or irritated
All of these lead to INFLAMMATION:
*____:
•Bacteria
•Virus
•Fungus
____:
• Rheum Arthritis
• Pemphigus Vulgaris
____:
(Physical/Chemical Injury)
____:
(Ischemia/Infarct)
____:
•Anaphylactic •Pollen/Insect
____:
•Splinters, dirt, sutures
•Urate crystals (Gout)
•Cholesterol Crystals (Atherosclerosis)
infection auto-immune tissue necrosis tissue necrosis immune/hypersen foreign bodies/endogenous
Purpose
- ____ off injurious agent
- Dilute/Destroy/eliminate the cause
- Limit tissue damage
- Remove dead cells and debris
- Initiate ____
- Return Tissue to ____.
Without Inflammation:
– Cannot Control ____
– Wound never ____
wall
healing
normal
infection
heals
Inflammation and healing
Steps In Inflammatory Response (5R’s): \_\_\_\_ of Injury \_\_\_\_ of Leukocytes \_\_\_\_ of Injurious agents \_\_\_\_ (Control) \_\_\_\_ (Repair/healing)
Acute Inflam Onset: \_\_\_\_ Cells: \_\_\_\_ Tissue Injury: \_\_\_\_ Local Effects: \_\_\_\_
Chronic Inflam Onset: \_\_\_\_ Cells: \_\_\_\_ Tissue Injury: \_\_\_\_ Local Effects: \_\_\_\_
recognition recruitment removal regulation resolution
minutes/hours
neutrophils
mild, self-limited
prominent (vascular)
days/months/years
“round”
severe progressive
less
Inflammation and healing
A stimulus is required: can come in form of microbial infection (epithelial cell serves as a physical barrier), or because of necrotic tissue
Next, injury must be recognized: completed by cells located just beneath the epithelium (macrophages, dendritic cells [APC], or mast cells, known as ____ in innate immunity)
Recruit leukocytes: sentinel cells communicated with BV by secreting mediators (the biggest difference among leukocytes: mast cells are packed with tons of granules, that are released ____ upon activation
Removal of injurious agent (phagocytosis), and regulation/control (tissue damage otherwise), and finally resolution/repair
sentinel/gate-keeping cells
instantaneously
Most oral diseases are inflammatory…
Acute Inflam • Dental Caries • *\_\_\_\_ • *\_\_\_\_ • *\_\_\_\_ • Ludwig’s Angina • Cavernous Sinus thrombosis • Meningitis • \_\_\_\_ • \_\_\_\_
Chronic Inflam • Acute/Chronic \_\_\_\_ • Pyogenic granuloma • Periapical cyst • Condensing Osteitis • Orofacial granulomatosis – Melkersson-Rosenthal syndrome – Cheilitis granulomatosa
pulpitis periapical abscess cellulitis gingivitis periodontitis
osteomyelitis
Incision in skin and there are three problems: ____, ____, and ____ (most important) > mount a response in order to maintain the infection locally
Firstly, recruit neutrophils, but they require supply: plasma > provides ____ (because neutrophils are not good “swimmers”), and they also provide ____ (important in getting rid of “them?”)
No inflammatory reaction > death; if you have one > you will have both a ____ and ____ response (acute inflammation) > neutrophils releasing mediators and ROS that will damage tissue > requires a healing process to conclude
What if infected with microbe that is difficult to rid > wound healing and ____ inflammation occur simultaneously > cannot heal adequately
bleeding
tissue loss
infection
fibrin meshwork
antibodies/complement
cellular
vascular
chronic
OUTCOME
• Nature of the Etiologic Agent
– Is the agent harmful? ____
– /Pollen/Peanut/self-component
• Intensity of the reaction – Proportional to etiology? – Controlled?
- Regenerative Potential
- Skin
- Brain, Myocradium
• Host status
- HIV, autoimmune
If individual’s are genetically predisposed > innocuous agents are recognized as harmful and the immune system reacts > creation of a problem (allergy and AID)
Skin > proliferative if damaged > return to ____
Brain/myocardium > no ____, and no regeneration > replaced by scar tissue (non-functional connective tissue)
HIV > individual may not be able to clear infection properly, but if body recognizes self-component as foreign > ____ inflammation
bacteria
normal
regenerative capacity
chronic
Inflammation occurs only in ____ tissue
Infarct > inflammation occurs ____ of the necrotic tissue (cannot have inflammation within dead tissue, but it can initiate a ____); what’s the purpose of this mechanism > ____ response in order to remove the necrotic tissue
living
outside
response
protective
50-70% of pregnant women develop gingivitis during ____ due to ____ control and extra-sensitivity to ____; important to floss and clean regularly
pregnancy
hormonal
infection
Arteriovenous shunt; precap sphincter closed > capillary bed not utilized, blood flows from arterial to venous end without the capillary bed
In normal situation (right slide) > these sphincters ____ and close intermittently, utilizing specific parts of the ____
open
capillary beds
Mast cells located just below the epithelium, no matter the tissue, and they are universally found close to a ____
Release ____ > contract smooth muscle > dilation and gushing in of blood > and all the sphincters ____ > formation of a “20-way” highway
[Initial ____?]
How about tissue swelling? This contributes to tissue swelling because the blood remains within the BV; if there was no leakage there would not be swelling
Hyperemia: increased ____ within tissue
reflex vasoconstriction
Tissue Swelling
Normal: as blood flows > hydrostatic pressure; the squamous cell type is semi-permeable (fluid and electrolyte, but not to protein), because of the HP fluid traverses the membrane into EC space, as a result there’s formation of an ____, and as a result > you get fluid going back into the tissue > there is ____ (more fluid leaves than reenters); the factor that puts it into balance > ____ system
____ > if fluid is exiting, this exit is balanced by the inflow of fluid back in and into the lymphatic > no swelling
osmotic pressure
imbalance
lymphatic
starling’s law
Lymphatic vessels
• Collects lymph from ____
• Delivers it to the ____
• Returns fluid to circulatory veins near the ____
lymph capillaries
nodes
heart
Starling’s Law
During inflammation: epithelial cells now become permeable to ____ > (albumin smaller than fibrinogen) > these factors leak out into the EC > ____ is lower > lymphatics tries to balance but is unable to do so
Swelling > because of increased ____ to protein
protein
osmotic pressure
vascular permeability
Fluid that accumulates in extravascular fluid due to inflammation (on venous end…) is because of ____ (normally this is called edema)
Yellow areas are BV; and white areas are all fluid (edema, contains protein would be an exudate) [look at slides]
exudate
Different types of Exudate
• ____ (Exudate/Inflammation)
• ____ (Exudate/Inflammation)
• ____(Exudate/Inflammation)
Different causes of inflammation, there are different types of exudate; the type of exudate can give you an idea of the cause of ____
serous
fibrinous
purulent
inflammation
Types of exudate
Serous > mostly ____, some protein, no WBC
Fibrinous > mostly ____, some fluid, little/no WBC
Purulent > mostly ____, some protein and fluid (____)
fluid
protein
WBC
pus
Morphological Pattern of Acute Inflammation
• Serous Inflammation:
– Exudate; low protein, low cells, resembles ____.
– Created by injury to surface ____ (blister)
– ____: fluid in body cavity
• Increased vascular permeability (____)
• Reduced blood flow/reduced plasma protein (____)
serum epithelia effusion/ascites exudate transudate
Morphological Pattern of Acute Inflammation
•Fibrinous Inflammation:
– Large increase in ____
– Fibrinogen in extravascular space, Dominant feature: ____
– Lining of ____, pericardium, ____
– Dissolved by fibrinolysis/cleared by macrophages (____)
– Fibrinous exudate in to ____ (____)
vascular permeability fibrin deposition meninges pleura resolution scar tissue organization
Morphological Pattern of Acute Inflammation
• Purulent Inflammation: – Pus: \_\_\_\_, \_\_\_\_, \_\_\_\_ cells – Purulent/suppurative inflammation – Pyogenic or pus forming \_\_\_\_ – \_\_\_\_: Localized collection of pus
edema PMNs necrotic bacteria abscess
Morphological Pattern of Acute Inflammation
• Ulcer:
– Tissue necrosis/inflammation on or near a surface
– Loss of ____ due to shedding of inflamed necrotic tissue.
– Common sites: ____, GU tract, ____
– ____: Intense PMNs accumulation/vascular permeability in the margin of the defect
– ____: Margin of ulcer base-scarring
surface epithelia oral mucosa skin acute chronic
Serous • Mild \_\_\_\_ • Low \_\_\_\_ • \_\_\_\_-color – Skin Blister
inflammation
protein
straw like
Fibrinous • \_\_\_\_ Deposition • e.g; \_\_\_\_ • \_\_\_\_appearance • Resolution • Organization • Scarring • \_\_\_\_ function
Pink > ____ > mostly protein
Can undergo resolution or organization
fibrin
pericarditis
myocardial
eosinophilic
Purulent Exudate/Abscess
Purulent Exudate • \_\_\_\_ • Bacterial meningitis • \_\_\_\_ • Ulcer/\_\_\_\_ • \_\_\_\_
Abscess
• ____
• Myocardium
• ____
pneumonia
bowel mucosa/peritonitis
appendicitis
pulpitis
pneumonia
pericapical
Bronchopneumonia (Purulent exudate)
Difference between first two slides: dilation of ____ and loss of fluid, and it is ____ (presence of protein) > early phase of pneumonia, no ____ present
Third slide: lots of ____, they’re not entering the alveolar space, the ones that are are the ____
BV
protein
neutrophils
RBC
WBC
Purulent Exudate: Bacterial Meningitis
Arachnoid + Pia = ____
Dura mater > very hard, not ____
Arachnoid mater > a little softer, mostly ____
Pia mater > soft tissue and highly ____
Collectively, these are known as ____
Meningitis > spread through blood or a tooth infection
Over arachnoid and pia mater > leptomeninges
____ fluid on surface of brain; and look at histologically: ____ dots are neutrophils and dilated BV
Bacterial meningitis is much more lethal than pneumonia due to the ____
leptomeninges vascularized avascular vascularized meninges
creamy color
blue
closed cavity
Purulent Exudate
Bowel mucositis
Bowel mucosa that is inflamed > ____ exudate
Ruptured colon > contains feces and bacteria > empty into an ____ > large inflammation in the entire ____ (purulent exudate) (lethal)
purulent
open cavity
peritoneum
Ulcer
• Loss of ____
• When tissue necrosis and ____ occur on or near surface
• Mucosa of mouth, stomach, intestine
Ulcer is red due to the inflammation that is occurring on or near the ____
epithelium
resulting inflammation
surface
Acute Appendicitis
____, ____ exudate (Neutrophilic), ____ exudate
Redness, Heat, Swelling, Pain
Etiology and Pathogenesis
ulcer
purulent
fibrinous
Acute Appendicitis
Lining is ____
____ > ____ > ____
columnar epithelium
mucosa
submucosa
muscularis externa
Etiology and Pathogenesis of appendicitis
Etiology (Why):
- ____
- Collapse of ____
- Pre-disposes to ____
Pathogenesis (How): – \_\_\_\_ – \_\_\_\_ formation • Mucosa • Submucosa • Muscularis
lumen obstruction/pressure
blood vessels
infection
ulceration
exudate
Appendicitis: Etiology and Pathogenesis
Infected: much ____, not as tightly packed
With a higher power view > presence of ____ and the presence of ____; and the presence of lymphoid tissue has ____
Vascular > ____; cellular > ____
larger
ulcers
neutrophils
decreased
fluid
neutrophils
ABSCESS
• A localized collection of pus (____, ____ cells, and ____ fluid).
neutrophils
necrotic
edema
Abscess Bronchopneumonia
Yellow arrows under high power > abscess contains lots of cells (full of ____ exudate); can hardly see the vasculature in the normal lung, but in inflamed lung you see the engorged ____
Yellow circles > ____ drained out leaving a space within the lung
purulent
BV
pus
Micro-abscess in the myocardium
Blue dots within center > ____ contained within the abscess
bacteria
Both teeth and appendices are hollow > appendix: do not remove infection in time it ruptures ____; for a tooth, pulp infections can only travel ____
sideways
downwards
Pulpitis
Pulpitis is defined by ____ or ____ > dictates the treatment
Reversible > ____ BV (yellow arrow), and the presence of ____ that is not observed in normal pulp
Irreversible > ____ (same as pus) > as a result of pus formation, it has ____ the normal pulp tissue
reversible
irreversible
dilated
fluid
liquefactive necrosis
destroyed
Reversible and Irreversible Pulpitis
Reversible Pain: \_\_\_\_, \_\_\_\_ duration, \_\_\_\_ localized EPT: \_\_\_\_ current Histopath: \_\_\_\_ Treatment: \_\_\_\_
Irreversible Pain: \_\_\_\_, \_\_\_\_ duration, \_\_\_\_ to localize EPT: \_\_\_\_ Histopath: \_\_\_\_, \_\_\_\_ Treatment: \_\_\_\_
elicited (cold), mild/moderate short easily low hyperemia/edemia remove irritation
thermal/spontaneous, sharp/severe long unable high current/no response necrotic tissue/PMN/edema chronic inflammation/ fibrosis extraction/root canal
Periapical Abscess, Cellulitis
• Cellulitis:
• When abscess is not able to establish ____
through the skin surface or into oral cavity.
• It spreads diffusely through the facial planes of the soft tissue
• Two dangerous forms:
– ____
– ____
Irreversible pulpitis > ____
Whether it is max/mandibulartooth, and muscle attachment > one can develop ludwig’s angina or cavernous sinus thrombosis (may lead to ____)
drainage
ludwig’s angina
cavernous thrombosis
periapical abscess
meningitis
Summary: Acute Inflammation
•Cardinal signs: ____, ____, ____, ____
•Definition: ____ Response to
Injury
•Purpose: Wall-off/dilute/destroy/Healing
•Outcome: Resolution/healing; may also lead to inflammatory diseases
•Vascular phase: Transient ____, then ____, increased ____
•Edema: ____ •Serous/Fibrinous/Purulent/Abscess
•Ulcers
redness heat swelling pain vascular/cellular vasoconstriction vasodilation vascular permeability exudate
