Inflammation
InflammationI Wayan Juli SumadiBagian/SMF Patologi Anatomi FK UNUD/RSUP SanglahInflammation???In flame ??
Inflammation Fundamentally a protective response, designed to rid the organism of both the initial cause of cell injury (e.g., microbes, toxins) and the consequences of such injury (e.g., necrotic cells and tissues) Inflammation is a complex reaction in tissues that consists mainly of responses of blood vessels and inflammatory cells (leukocytes, macrophages, lymphocytes, etc)Acute inflammation
Cardinal sign of acute inflammation
Inflammation due to gouthttp://www.whathealth.com/gout/picture-3.html
Acute inflammationRapid host response that serves to deliver leukocytes and plasma proteins (antibodies) to sites of infection or tissue injury Three major components: (1) vascular changes(2) structural changes in the microvasculature that permit plasma proteins and leukocytes to leave the circulation(3) emigration of the leukocytesVascular response + cellular response
NORMALACUTE INFLAMMATION(1) Vascular dilation and increased blood flow (causing erythema and warmth); (2) extravasation and extravascular deposition of plasma fluid and proteins (edema); (3) leukocyte emigration and accumulation in the site of injury. STIMULI FOR ACUTE INFLAMMATION InfectionTissue necrosis (ischemia, trauma, physical and chemical injury)Foreign bodiesImmune reaction
REACTIONS OF BLOOD VESSELS IN ACUTE INFLAMMATION Changes in Vascular Flow and Caliber vasodilation (heat and redness)increased permeability of the microvasculaturestasis increased levels of adhesion molecules (endothel)Increased Vascular Permeability (Vascular Leakage)
REACTIONS OF LEUKOCYTES IN INFLAMMATION In the lumen: margination, rolling, and adhesion to endothelium. Migration across the endothelium and vessel wall.Migration in the tissues toward a chemotactic stimulus.
Recognition of Microbes and Dead Tissues
Removal of the Offending Agents TERMINATION OF THE ACUTE INFLAMMATORY RESPONSE Mediators of inflammation are produced in rapid bursts, only as long as the stimulus persists, short half-lives, and are degraded after their release
Neutrophils have short half-lives in tissues
Active termination:switch in the type of arachidonic acid metabolite produced, from pro-inflammatory leukotrienes to anti-inflammatory lipoxins liberation of anti-inflammatory cytokines (TGF- and IL-10) from macrophages neural impulses (cholinergic discharge) that inhibit the production of TNF in macrophages.Mediators of Inflammation Cell-derivedPlasma protein-derivedCell - derived
Arachidonic Acid (AA) Metabolites: Prostaglandins, Leukotrienes, and Lipoxins
Cytokines and Chemokines Cytokines : proteins produced by many cell types (lymphocytes, macrophages, endothelial, epithelial, and connective tissue cells) that modulate the functions of other cell types
Chemokines are a family of small (8 to 10 kD) proteins that act primarily as chemo-attractants for specific types of leukocytes
Plasma protein - derivedComplement system
Outcomes of Acute Inflammation
Morphologic Patterns of Acute Inflammation
SEROUS INFLAMMATION
FIBRINOUS INFLAMMATION
SUPPURATIVE OR PURULENT INFLAMMATION; ABSCESS
ULCERS
Summary of Acute Inflammation
Chronic Inflammation Chronic inflammation is inflammation of prolonged duration (weeks or months) in which inflammation, tissue injury, and attempts at repair coexist, in varying combinations Chronic inflammation arises in the following settings:Persistent infections Immune-mediated inflammatory diseases Prolonged exposure to potentially toxic agentsMORPHOLOGIC FEATURES chronic inflammation is characterized by: Infiltration with mononuclear cells, which include macrophages, lymphocytes, and plasma cells
Tissue destruction, induced by the persistent offending agent or by the inflammatory cells
Healing by connective tissue replacement of damaged tissue, accomplished by proliferation of small blood vessels (angiogenesis) and, in particular, fibrosis
A, Chronic inflammation in the lung, showing all three characteristic histologic features: (1) collection of chronic inflammatory cells (*), (2) destruction of parenchyma (normal alveoli are replaced by spaces lined by cuboidal epithelium, arrowheads), and (3) replacement by connective tissue (fibrosis, arrows). B, By contrast, in acute inflammation of the lung (acute bronchopneumonia), neutrophils fill the alveolar spaces and blood vessels are congested. ROLE OF MACROPHAGES IN CHRONIC INFLAMMATION
Other cells in chronic inflammationLymphcytesPlasma cellsMast cellsEosinophils
GRANULOMATOUS INFLAMMATIONGranulomatous inflammation is a distinctive pattern of chronic inflammatory reaction.
Granuloma is a focus of chronic inflammation consisting of a microscopic aggregation of macrophages that are transformed into epithelium-like cells, surrounded by a collar of mononuclear leukocytes, principally lymphocytes and occasionally plasma cells Foreign body granulomas are incited by relatively inert foreign bodies
Immune granulomas are caused by a variety of agents that are capable of inducing a cell-mediated immune response
Systemic Effects of Inflammation Fever CRP >>ESR >>LeukocytosisOther manifestations of the acute-phase response:increased pulse and blood pressure; decreased sweatingmainly because of redirection of blood flow from cutaneous to deep vascular beds, to minimize heat loss through the skin
chills (search for warmth), anorexia, somnolence, and malaiseprobably because of the actions of cytokines on brain cells. THANK YOU
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