Etiology, type, Pathogenesis, Events, clinical feature

1. INFLAMMATION and
HEALING
Presented by
Dr. YOGITA CHANDRAKAR
B.A.M.S., M.D.
Assist. Professor
Department of Rog Nidan Avum Vikriti Vigyan

2. CAUSE / ETIOLOGY
Local body defensive response of any
living mammalian tissue to injury by
various agent.
 Infective agents
 Immunological agents
 Physical agents
 Chemical agents
 Inert materials (such as foreign bodies)
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3. INFLAMMATION
 RUBOR
 TUMOR
 CALOR
 DOLOR
 FUNCTIONLOSSIA
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4. TYPE
 ACUTE - sudden in onset, short duration,
immediate body response, neutrophil
mainly
 CHRONIC – Insidious onset, longer
duration, late body response
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5. ACUTE
INFLAMMATION
1. Vascular events –
 Heamodynamic changes
 Change in Vascular permiability
Five (5) Changes in haemodynamic
 Vasoconstriction
 Vasodilation
 Increased local hydrostatic pressure
 Stasis
 Margination of leucocyte (pavmenting)
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6. 2. Changes in vascular permeability
Contraction of endothelial cell
Retraction of endothelial cell
Direct injury of endothelial wall
Injury mediated by leukocyte cell
Neovascularization
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7. Direct injury –
Increase hemodynamic force
Hypoxia
Chemical poison and bacterial toxin
Detached atherosclerotic plug
Thermal injury and radiation
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8.  Disturbance of streamline flow
 Rolling of WBCs cell
 Cell adhere to junction between two cell
 WBCs release proteolytic enzyme
 Colligenase damage the collegen fibres
 Forming microspore
 Exudation process
 WBCs moves out due to amoeboid movement
(Diapedasis)
 Chemotaxis
 Phagocytosis of cell
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9. 2. Cellular Events
 Pavmenting
 Rolling and Adhesion
 Emigration
 Exudation of leucocyte
 Chemotaxis
 Phagocytosis
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10. Phagocytosis
 Attachment (opsonization) – chemical which
covers the bacteria and foreign agent and
forming the film
 Engulfment (Cytoplasmic pseudopodium)
 Secretion (degranulation) – vacules and
granules
 Killing by toxin and enzymes due to rupture
of lysosome pockets
 Degradation
 and digestion
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11. Chemotaxis
 Leucotrine
 Complimentary system
 Cytokines
 Soluble bacterial product
 Tumour Nacrotic factor (TNF)
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12. LEWIS EXPERIMENT
 Red line – due to local vasodilatation of
capillaries and venules
 Flare – bright reddish appearance or flush
surrounding the red line due to
vasodilatation of the adjacent arterioles
 Wheal – swelling or oedema due to
transudation of fluid into the extravascular
space
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13. MORPHOLOGY
 Pseudo membranous inflammation (eg.
Diptheria)
 Ulcer (mouth ulcer or stomatitis)
 Suppuration (Abcess)
 Cellulitis (eg.Mumps)
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14. CLINICAL FEATURE
 Fever
 Leucocytosis
 Lymphangitis and lymphadenitis
 Shock
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15. Fate Of Acute Inflammation
 Resolution (Restoration)
 Healing by scaring
 Progression to Suppuration – cavity
formed
 Progression to Chronic inflammation
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16. CHRONIC INFLAMMATION
 Mononuclear cell infiltration
 Tissue destruction or necrosis
 Proliferative changes
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17. SYSTEMIC EFFECTS
 Fever
 Anaemia
 High ESR
 Amyloidosis
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18. TYPE
 Specific
 Nonspecific
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19. HEALING
Trauma – Injury – Cell death – Tissue
destruction – Restoration – Healing
 Repair and regeneration process may be
done by simultaneously
Repair – two process
1. Granulation tissue formation
2. Contraction of wound
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20. Granulation tissue formation
 Phase of inflammation
 Phase of clearance
 Phase of ingrowths of granulation tissue –
Angiogenesis or Neovascularisation and
Fibrogenesis
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21. Contraction of wound
Starts after 2-3 days and completed upto
within 14th day
It facilitates Rapid healing
Dehydration
Contraction of Collagen – 5-6 days,
appearance of myofibroblasts (Myofibrin,
actin, myocin, protein)
Real wound contraction done by
myofibroblast
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22. WOUND HEALING
 Primary union (healing by first intention)
– Reepithelization
 Secondary union (healing by second
intention) - Fibrosis
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23. Steps of primary and secondary
union
 Clean cut
 Uninfected area
 Surgically incised
wound
 Less loss of tissue
 Edge of wound
approximate by
surgical suture
 90% epithelial and
10% fibrosis
 Lacerated wound
 Zig –zag margin
 Infected wound
 Excessive loss of
tissue
 Wound is not
approximate by
surgical tissue
 30% epithelial and
70% fibrosis
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24. Complication Of Wound Healing
 Infection
 Hyperpigmentation
 Deficient scar – depression and scar
 Hypertrophy scar
 Keloid – pinkish color skin and high
vascularity
 Wound contracture
 Incisional Hernia
 Cancer
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25. THANK
YOU