If You Fail to Plan,

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"Opportunities are usually disguised by hard
work, so most people don't recognize them." - Ann
Landers
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INFLAMMATION
Dr. Venkatesh M. Shashidhar. Senior Lecturer in
Pathology Fiji School of Medicine
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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.

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Lewis Triple Response

• Flush capillary dilatation.
• Flare arteriolar dilatation.
• Weal exudation, edema.

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Red, Warm Swollen
(Flare, Flush Weal Lewis)
Triple response
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Gastric Ulcer
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Laryngitis
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Mouth Aphthus ulcer
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Acute Enteritis
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Pneumonia
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Cardinal Signs of Inflammation

• Rubor Redness Hyperaemia.
• Calor Warm Hyperaemia.
• Dolor Pain Nerve, Chemical med.
• Tumor Swelling Exudation
• Loss of Function

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Inflammation - Mechanism

• Vaso dilatation
• Exudation - Edema
• Emigration of cells
• Chemotaxis

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Mechanism of Inflammation
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Neutrophil Margination
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Vascular changes
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Pneumonia - Exudation
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Chemical Mediators

• Chemical substances synthesised or released which
  mediate the changes in inflammation.
• Histamine by mast cells - vasodilatation.
• Prostaglandins Cause pain fever.
• Bradykinin - Causes pain.

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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 - anthrax.
• Chronic inflammation with healing.
• Grannulomatous clusters of epitheloid cells
  eg. TB, Fungus, Foreign body.

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Inflammation Outcome
Fungus Virus Cancers T.B. etc.
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Chronic Inflammation
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Edema
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Serous Inflammation - Effusion
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Serous Inflammation - Effusion
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Fibrinous Inflammation
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Purulent - Inflammation - PUS
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Purulent - Inflammation - PUS
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Purulent - Inflammation - PUS
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Chronic InflammationLung Abscess
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Granuloma
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Acute Vs Chronic

• Flush, Flare Weal
• Acute inflammatory cells - Neutrophils
• Vascular damage
• More exudation
• Little or no fibrosis

• Little signs - Fibrosis,
• Chronic inflammatory cells Lymphocytes
• Neo-vascularisation
• No/less exudation
• Prominent fibrosis

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SwindollAuthor and Pastor
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The 5 Cardinal Signs of
Heat Redness Swelling Pain Loss Of Func.
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Healing Repair
Dr. Venkatesh M. Shashidhar. Associate Professor
of Pathology Fiji School of Medicine
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Stages of Healing

• Hemorrhage
• Inflammation
• Granulation tissue (soft callus)
• Scar Fibrosis (hard callus)
• Remodeling Wound strength

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Repair

• Regeneration of injured tissue by parenchymal
  cells of the same type
• Replacement by connective tissue
• In other words
• Regeneration
• Scar

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Proliferative Potential

• Labile cells - continuously dividing
• Epidermis, mucosal epithelium, GI tract
  epithelium etc
• Stable cells - low level of replication
• Hepatocytes, renal tubular epithelium, pancreatic
  acini
• Permanent cells - never divide
• Nerve cells, cardiac myocytes, skeletal mm

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Polypeptide growth factors

• Most Important Mediators affecting Cell Growth
• Present in serum or produced locally
• Exert pleiotropic effects proliferation, cell
  migration, differentiation, tissue remodeling
• Regulate growth of cells by controlling
  expression of genes that regulate cell
  proliferation

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Repair by connective tissue

• Occurs when repair by parenchymal regeneration
  alone cannot be accomplished
• Involves production of Granulation Tissue
• replacement of parenchymal cells with
  proliferating fibroblasts and vascular
  endothelial cells

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Components of the processof fibrosis

• Angiogenesis - New vessels budding from old
• Fibrosis, consisting of emigration and
  proliferation of fibroblasts and deposition of
  ECM
• Scar remodeling, tightly regulated by proteases
  and protease inhibitors

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Wound healing

• Induction of acute inflammatory response by an
  initial injury
• Parenchymal cell regeneration
• Migration and proliferation of parenchymal and
  connective tissue cells

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Wound healing (contd)

• Synthesis of ECM proteins
• Remodeling of parenchymal elements to restore
  tissue function
• Remodeling of connective tissue to achieve wound
  strength

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Healing byFirst IntentionFocal Disruption of
Basement Membrane and loss of only a few
epithelial cellse.g. Surgical Incision
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Healing by Second IntentionLarger injury,
abscess, infarctionProcess is similar
butResults in much larger Scar and then
CONTRACTION
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Wound Strength

• After sutures are removed at one week, wound
  strength is only 10 of unwounded skin (Walker
  Law)
• By 3-4 months, wound strength is about 80 of
  unwounded skin (Walkers Law)

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Granulation tissue
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Healing Skin wound
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Healing - Skin Scar
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Factors affecting Healing

• Systemic
• Age
• Nutrition
• Vitamin def.
• Immune status
• Other diseases

• Local
• Infection
• Size or extent.
• apposition
• Blood supply
• Mobility
• Foreign body

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Summary

• Healing Proliferation Differentiation.
• Labile, Stabe Permanent cells
• Stages of Healing 1-2-3-4.
• Healing by First or Second intention.
• Skin wound healing - bone healing.
• Factors affecting healing Local / Systemic

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