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  1. 1. Inflammation and Repair Lecture 6
  2. 2. Outcome of Acute Inflammation & Morphologic Patterns in Acute Inflammation
  3. 3. OBJECTIVES AND KEY PRINCIPLES TO BE TAUGHT: Upon completion of this lecture, the student should: • 1. Enumerate the fate of acute inflammation and the conditions that leads to resolution or fibrosis • 2. Discuss abscess formation and its fate • 3 .Discuss how chronic inflammation follows acute inflammation • 4. Enumerate the morphologic patterns of acute inflammation. • 5. Define: abscess, furuncle, carbuncle, and cellulitis and identify their aetiology and morphology
  4. 4. Inflammation Outcome Acute Inflammation Resolution Chronic Inflammation Abscess SinusFistula Fibrosis/Scar Ulcer Injury Fungus Virus Cancers T.B. etc.
  5. 5. Possible outcomes of acute inflammation • Complete resolution – Little tissue damage – Capable of regeneration • Scarring (fibrosis) – In tissues unable to regenerate – Excessive fibrin deposition organized into fibrous tissue • Abscess formation occurs with some bacterial or fungal infections • Progression to chronic inflammation
  6. 6. Outcomes • Resolution – The complete restoration of the inflamed tissue back to a normal status. Inflammatory measures such as vasodilation, chemical production, and leukocyte infiltration cease, and damaged parenchymal cells regenerate. In situations where limited or short lived inflammation has occurred this is usually the outcome. • Fibrosis – Large amounts of tissue destruction, or damage in tissues unable to regenerate, can not be regenerated completely by the body. Fibrous scarring occurs in these areas of damage, forming a scar composed primarily of collagen. The scar will not contain any specialized structures, such as parenchymal cells, hence functional impairment may occur.
  7. 7. Outcomes • Abscess formation – A cavity is formed containing pus, an opaque liquid containing dead white blood cells and bacteria with general debris from destroyed cells. • Chronic inflammation – In acute inflammation, if the injurious agent persists then chronic inflammation will ensue. This process, marked by inflammation lasting many days, months or even years, may lead to the formation of a chronic wound. Chronic inflammation is characterized by the dominating presence of macrophages in the injured tissue. These cells are powerful defensive agents of the body, but the toxins they release (including reactive oxygen species) are injurious to the organism's own tissues as well as invading agents. Consequently, chronic inflammation is almost always accompanied by tissue destruction.
  8. 8. Morphologic patterns of acute inflammation • Inflammation is classified into two main morphologic groups • A) Non suppurative inflammation • B) Suppurative inflammation • A) Non suppurative inflammation • 1- Serous – Watery, protein-poor effusion (e.g., blister) and contain few leukocyte.
  9. 9. BLISTER, “Watery”, i.e., SEROUS
  10. 10. Serous
  11. 11. Organ: Pericardium Diagnosis: Fibrinous Inflammation 2-Fibrinous Exudation of fluid rich in Fibrin
  13. 13. Patterns (cont’d) • 3-Catarrhal- involve mucous secreting surfaces, fibrin and protein exudate mixed with mucus as in common cold affecting nasal passages . • 4-Membranous(pseudomembranous): false membrane formed by exudate adherent to underlying mucous surface e.g. diphtheria. • 5-Hemorrhagic: sever inflammatory exudate associated with damage to capillaries as in hemorrhagic pancreatitis • 6-Gangrenous : The acute inflammation is complicated by superadded death and putrefaction of the tissues
  14. 14. B) Suppurative inflammation • Characterized by purulent exudate containing large numbers of PMN which is localized or diffuse • 1- Localized • Abscess: cavity full of pus commonly due to Staph. Aureus infection • Special types of abscesses • 1.Boil(Furuncle):small abscess related to hair follicle or sebaceous glands • 2. Stye: Abscess in the eye lid related to eye lashes • 3. Carbuncle: multilocular abscess in the skin and subcutaneous tissue discharging pus through numerous openings
  16. 16. Abscess
  17. 17. • 2-Diffuse suppurative inflammation : • a. Phlegmonous inflammation of hollow organ: e.g. acute suppurative appendicitis • b. Diffuse suppuration in a body cavity : e.g. • suppurative pleuritis and meningitis • c. Collection of pus in the lumen of an organ : e.g. Empyema of the gall bladder • d. Cellulitis: inflammation of connective tissue, Panniculitis inflammation of subcutaneous tissue
  18. 18. Empyema of the gall bladder
  19. 19. Redness of the left foot due to cellulitis
  20. 20. Sequence of acute inflammation • Ulceration(e.g. Peptic ulcers of the stomach or duodenum and diabetic ulcer of the legs ) – Necrotic and eroded epithelial surface – Underlying acute and chronic inflammation – Trauma, toxins, vascular insufficiency
  21. 21. Peptic ulcer of the stomach
  22. 22. • Fistula :communication between two organs (epithelial surfaces) or organ and surface. • Sinus : Blind ended track from a cavity to the surface e.g. Pilonidal sinus . • Bacteremia , Toxemia , Septicemia • Pyemia : Septic emboli in blood stream arrested in different organs causing multiple small pyemic abscesses . Sequence of acute inflammation
  24. 24. Small cortical pyemic abscesses
  25. 25. Continuous assessment • Focal collection of pus is called • A) Abscess . • B) Ulcer . • C) Scar . • D) Fistula