Acute and Chronic Inflammation

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Acute and Chronic Inflammation

• March 4, 2009
• Dr. Eileen McKay

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Objectives

• List the five cardinal signs of inflammation.
• Describe the events that occur during acute
  inflammation.
• List chemical mediators that are involved in
  inflammation.
• List possible outcomes of acute inflammation.
• Describe the morphology of chronic inflammation.
• Describe the morphology of granulomatous
  inflammation.
• List causes of granulomatous inflammation.
• Define and differentiate pus, abscess, and ulcer.
• Describe the morphology of an ulcer.
• List the systemic effects of inflammation.

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Inflammation

• Host response to cellular injury.
• Protective function.
• Harmful effects of unchecked inflammation and
  excess tissue damage.
• Pharmaceuticals aimed at controlling the host
  response.

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• Acne
• Acute appendicitis
• Otitis media
• Conjuctivitis
• Brain Abscess
• Wound infections
• Chorioamnionitis

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5 Cardinal Signs of Inflammation

• Dolor pain
• Tumor swelling
• Rubor redness/erythema
• Calor heat
• Functio laesa loss of function

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Stage of Acute Inflammation

• Combined VASCULAR response and CELLULAR response
• 1. alterations in vascular caliber that lead to
  an increase in blood flow
• 2. structural changes in the microvasculature
  that permit plasma proteins and leukocytes to
  leave the circulation
• 3. emigration, accumulation and activation of
  leukocytes to eliminate offending agent

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ACUTE INFLAMMATION

• VASCULAR REACTION
• Vasodilation
• Increased permeability
• Stasis
• Leukocyte accumulation

• CELLULAR REACTION
• Leukocyte extravasation
• Margination
• Diapedesis
• migration
• Leukocyte activation
• Phagocytosis
• Termination of inflammatory response clean up

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Mechanisms for Increased Vascular Permeability

• Gaps due to endothelial contraction
• Direct injury
• Leukocyte-dependent injury
• Increased transcytosis
• New blood vessel formation

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NEUTROPHILS
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Chemical Mediators
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Systemic Effects of Acute Inflammation
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Evaluating a Patient for Acute Inflammation

• Superficial inflammation
• Pain, swelling, erythema
• Loss of function
• Generalized fatigue
• Loss of appetite
• Systemic signs
• Vital signs
• Fever
• Increased pulse and heart rate
• Laboratory investigations
• Elevated white blood cell count and left shift
• Acute-phase reactants

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Neutrophil left shift or bandemia
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Outcomes of Acute Inflammation

• Complete resolution
• Abscess formation
• Chronic inflammation
• Scar formation

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Morphologic Patterns of Acute Inflammation

• Serous inflammation
• Fibrinous inflammation
• Suppurative/purulent inflammation
• Ulcerative inflammation

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Serous Inflammation example blister
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Edema and Fluid Collections

• Exudate
• Associated with acute inflammation
• Increased vascular permeability
• Specific gravity gt 1.020
• Protein and cellular debris present due to
  increased vascular permeability

• Transudate
• No change in vascular permeability
• Specific gravity lt 1.012
• No increase in protein concentration
• Occurs with osmotic or hydrostatic imbalance in
  vascular compartment (ie. nephrotic syndrome)

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Fibrinous Inflammation example fibrinous
pericarditis
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Suppurative/purulent inflammation example
acute appendicitis
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Another example Bacterial pneumonia
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Ulcerative inflammation example gastric ulcer
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Acute vs Chronic Inflammation

• Acute inflammation is a more rapid event with
  shorter duration.
• Cannot be ignored
• Chronic inflammation is delayed and prolonged.
• May follow acute inflammation or arise de novo as
  a low grade process
• May be asymptomatic
• Associated with tissue destruction/ architectural
  changes with angiogenesis and possibly fibrosis.

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Morphology of Chronic Inflammation

• Characterized by mononuclear infiltrate with
  macrophages, lymphocytes, and plasma cells.

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Acute vs Chronic Inflammation
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Granulomatous Inflammation

• Granulomas can be necrotizing or non-necrotizing.
• Consist of aggregates of histiocytes/activated
  macrophages with eventual formation of external
  collar of lymphocytes.
• Multinucleated giant cells may be present.
• Response to injurious agents that cannot be
  successfully eradicated by humoral and cellular
  immune reactions.

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Causes of Granulomatous Inflammation

• Organisms
• Mycobacteria
• Cat- scratch disease
• Leprosy
• Brucellosis
• Syphilis
• Mycotic infections
• Lymphogranuloma inguinale

• Foreign Bodies
• Irritant lipids
• Berylliosis

• Autoimmune disorders
• Crohns disease
• Sarcoidosis

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