Learning is the beginning of wealth'

1

• Learning is the beginning of wealth.
• Learning is the beginning of health.
• Learning is the beginning of spirituality.
• Learning is where miracles begin.
• Jim Rohn

2

INFLAMMATION
Dr. Vijay Singh Pathologist Fiji School of
Medicine
3
INFLAMMATION
4
Inflammation

• Inflammation is the process in which healthy
  tissue responds to an injury
• Purpose of inflammation
• to destroy and remove substances recognized as
  being foreign to the body
• to prevent minor infections from becoming
  overwhelming
• To prepare any damaged tissue for repair

5
The Inflammatory Process

• Inflammation is a sign of healing and repair
• Involves 3 processes
• Battle the offender
• Clear impurities and toxins
• Repair damaged site

6
Inflammation

• 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.

7
Causes of Inflammation

• Infection
• Physical trauma
• Chemical trauma
• Irradiation
• Thermal injury (hot or cold)
• Immunity (hypersensitivity)
• Ischemia
• Nutrient deprivation

8
5 Cardinal Signs
Heat Red Swelling Pain
Loss Of Func.
9
(No Transcript)
10
Surgical wound
Calor, Rubor, Dolor, Tumor, Loss of function.
11
Mouth Aphthous ulcer
Calor, Rubor, Dolor, Tumor, Loss of function.
12
Gastric Ulcer
Calor, Rubor, Dolor, Tumor, Loss of function.
13
Laryngitis
Calor, Rubor, Dolor, Tumor, Loss of function.
14
Acute Enteritis
Calor, Rubor, Dolor, Tumor, Loss of function.
15
Pneumonia
Calor, Rubor, Dolor, Tumor, Loss of function.
16
Classic Signs of Inflammation

• Rubor -- erythema due to capillary dilation
• Calor -- warmth due to increased blood
  
• flow
• Tumor -- edema
• Dolor -- pain due to local pressure and
  
  stimulation of nerve endings
• Functio laesa -- alteration in function

17
Inflammation - Mechanism

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

18
Vascular Response

• Momentary vasoconstriction which decreases blood
  flow
• Vasodilation of the arterioles and venules which
  increases blood flow
• fluid flows from the capillaries into the
  interstitial spaces to dilute the injurious agent
• fluid brings complement and antibodies to the area

19
Vascular Response

• Bradykinin is formed
• stimulates capillary and venule endothelial cells
  to retract
• End Result
• creates spaces between the junctions of the cells
• allows leukocytes to squeeze through the
  junctions of the cells

20
Graphic of Vascular Changes
21
Mechanism of Inflammation
22
(No Transcript)
23
Cellular Response

• Polymorphonuclear Neutrophils
• first to arrive at the injury
• secrete powerful chemotactic chemicals

24
Fig 2.4
25
Cellular Response - Margination

• Movement of neutrophils toward the endothelial
  lining
• Causes of margination
• electrical charge on the endothelial cells
  changes
• blood viscosity increases
• blood flow slows
• chemical mediators

26
Neutrophil Margination
27
Cellular Response - Diapedesis

• When activated, neutrophils squeeze through the
  endothelial gaps into the tissues by a process
  known as Diapedesis
• Diapedesis means cell-walking

28
Emigration of Leucocytes
Diapedesis ?
29
Normal Lung
30
Pneumonia Vascular changes
31
Pneumonia - Exudation
32
They are PMNs
33
Cellular Response - Chemotaxis

• Chemotaxis is the directional and purposeful
  movement of cells by ameboid movement toward an
  area of injury in response to a chemical
  mediator.

34
Inflammation Outcome
Chronic Inflammation
Resolution/Healing Repair
Injury
Acute Inflammation
Abscess
Ulcer
Sinus
Fistula
35
Abscess

36
AbscessMicro
37
Normal Meninges
38
Meningitis
PMNs and Exudate
Brain
39
Cellular Response - Phagocytosis

• The plasma membrane of the neutrophil flows
  around the foreign particle and engulfs it.
• Lysosomes release chemicals which digest the
  foreign particle.
• The phagocyte often dies.
• Cellular debris is removed by monocytes and
  macrophages.

40
Types of Inflammation

• Acute Chronic inflammation.
• Suppurative
• Fibrinous
• Serous
• Granulomatous
• Eosinophilic

41
Morphologic types

• Exudative Inflammation
• Suppuration Purulent - Bacterial
• Fibrinous pneumonia fibrosis
• Serous excess clear fluid lung
• Haemorrhagic gtDamage - anthrax.
• Chronic inflammation with healing.
• Grannulomatous clusters of epitheloid cells
  eg. TB, Fungus, Foreign body.

42
Acute Inflammation Components
Physiology Symptoms
Release of soluble mediators Vasodilation Increa
sed blood flow Extravasation of fluid
(permeability) Cellular influx
(chemotaxis) Elevated cellular metabolism
heat (calore) redness (rubor) swelling
(tumor) pain (dolore)
43
Acute Inflammation Components
Physiology Symptoms
Release of soluble mediators Vasodilation Increa
sed blood flow Extravasation of fluid
(permeability) Cellular influx
(chemotaxis) Elevated cellular metabolism
heat (calore) redness (rubor) swelling
(tumor) pain (dolore)
44
Acute Inflammation Components
Physiology Symptoms
Release of soluble mediators Vasodilation Increa
sed blood flow Extravasation of fluid
(permeability) Cellular influx
(chemotaxis) Elevated cellular metabolism
heat (calore) redness (rubor) swelling
(tumor) pain (dolore)
45
Acute Inflammation Components
Physiology Symptoms
Release of soluble mediators Vasodilation Increa
sed blood flow Extravasation of fluid
(permeability) Cellular influx
(chemotaxis) Elevated cellular metabolism
heat (calore) redness (tubor) swelling
(tumor) pain (dolore)
46
Acute Inflammation Components
Physiology Symptoms
Release of soluble mediators Vasodilation Increa
sed blood flow Extravasation of fluid
(permeability) Cellular influx
(chemotaxis) Elevated cellular metabolism
heat (calore) redness (tubor) swelling
(tumor) pain (dolore)
47
Acute/Chronic Inflammation

• Acute
• Short term inflammatory process that complete
  resolves
• mostly Neutrophils, Eosinophils, Macrophages etc.
  

• Chronic
• long term that may or may not completely resolve
• mostly Lymphocytes, Plasma cells, Macrophages,
  etc.

48
Summary

• Definition Dynamic,vascularized, injury
• Calor, Rubor, Dolor, Tumor, Loss of funct
• Vasodilatation, exudation, chemotaxis,
  phagocytosis.
• Chemical mediators Prostaglandins, Kinins, etc
• Types Acute/Chronic, Suppurative, serous,
  fibrinous.
• Acute / Chronic differences.

49
TERMS

• Tissue Injury - Tissue injury initiates the
  inflammatory process
• A wound is a disruption of tissue integrity.
• mechanical injury
• physical injury
• Incision
• produced by a cutting instrument
• Characteristics - wound edges are
  well-approximated and aligned

50
TERMS

• Contusion (Bruise)
• Produced from a blow by a blunt object.
• Characteristics swelling, discoloration
  (ecchymosis) pain
• Abrasion
• Rubbing or scraping off of the epidermis or
  mucous membrane by friction.
• Characteristics redness, weeping
• Laceration
• Tissue or organ tearing by a blunt or irregular
  instrument.
• Characteristics tissue edges are not aligned
• Edges not well approximated
• Loose flaps of tissue

51
Systemic Manifestations

• Lymphadenopathy
• enlarged lymph node
• Lymphangiitis
• inflammation of lymphatic vessel
• Lymphadenitis
• inflammation of lymph nodes
• Fever
• endogenous pyrogens are produced by the
  macrophages, neutrophils and eosinophils

52
Systemic Manifestations

• Erythrocyte Sedimentation Rate
• the rate at which red blood cells settle in a
  test tube
• In inflammation, ESR elevates
• Leukocytosis
• elevation of white blood cell count
• Type of white blood cell gives a clue as to what
  kind of organism is invading
• neutrophils ---- pyogenic bacteria
• eosinophils ---- helminths
• lymphocytes --- viruses

53
Thank you for your Attention!