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• What is chronic inflamamtion
• General Features
• Sytemic effects of chronic inflammation
• Cells involved
Chronic inflammation is inflammation
of prolonged duration
(weeks or months)
inflammation, tissue injury, and attempts at repair
coexist, in varying combinations.
CAUSES OF CHRONIC INFLAMMATION
3. Toxic Agents/FOREIGN
• DOES SURGERY ASSOCIATED WITH CHRONIC
• HOW COME?
• SUTURE MATERIAL
• MONONUCLEAR CELL INFILTRATION
• TISSUE DESTRUCTION//NECROSIS
• PROLIFERATIVE CHANGES
• CHRONIC INFLAMMATION ALWAYS ATTEMPTS
Chronic inflammation is characterized by:
1. Infiltration with mononuclear cells, which include
macrophages, lymphocytes, and plasma cells
2. Tissue destruction, induced by the persistent
offending agent or by the inflammatory cells
3. Attempts at healing by connective tissue
replacement of damaged tissue, accomplished by
proliferation of small blood vessels (angiogenesis)
and, in particular, fibrosis.
• WHAT IS THE KEY PLAYER IN CHRONIC
• DOES MACROPHAGE DIRECTLY COMES TO
WHAT ARE THE PRODUCTS
SECRETED BY MACROPHAGES??
• CYTOKINES-IL1, IL-2
• INTERFERONS –Y
• GROWTH FACTORS- TGF, PDGF, FGF,EGF
• [TGF, PDGF------- to stimulate fibroblast]
• COMPLEMENT FACTORS[C]
• ENZYMES—Proteases, endonucleases,
• Chemotactic factors
• ANY OTHER??
• IS NORMAL LYMPHOCYTE SECRETES
• CD4 Lymphocytes[[Th cells]
THE ROLES OF ACTIVATED
MACROPHAGES IN CHRONIC
1.Inflammatory Tissue Injury
2.Repair (Growth Factor Mediated)
Fig 2-24 (p72)
INTERACTIONS IN CHRONIC
Fig 2-25 (p73)
Granulomatous inflammation is a distinctive pattern
of chronic inflammation that is encountered in a
limited number of infectious and some
noninfectious conditions. Immune reactions are
usually involved in the development of
A granuloma is a cellular attempt to control an
offending agent that is difficult to eradicate.
• In this attempt there is often strong
activation of T lymphocytes leading to
macrophage activation, which can cause
injury to normal tissues
A granuloma is a focus of chronic
inflammation consisting of
a microscopic aggregation of
that are transformed into epithelium-
like cells, surrounded by a collar of
mononuclear leukocytes, principally
lymphocytes and occasionally
Types of Granulomas
I. Foreign body granulomas
II. Immune granulomas
Foreign body granulomas
Incited by relatively inert foreign bodies.
Typically, foreign body granulomas form around
material that are large enough to preclude
phagocytosis by a single macrophage and do not
incite any specific inflammatory or immune
Caused by agents that are capable
of inducing an immune response
which produces granulomas
usually when the inciting agent is
poorly degradable or particulate.
Older granulomas develop an enclosing rim of
fibroblasts and connective tissue.
Frequently, epithelioid cells fuse to form giant cells
in the periphery or sometimes in the center of
These giant cells may attain diameters of 40 to 50
peripherally (Langhans-type giant cell) or
haphazardly (foreign body–type giant cell).
• WHAT IS THE SHAPE OF EPITHELOID CELL
• ‘SOLE SHAPE’
SYSTEMIC EFFECTS OF CHRONIC
• Chronic inflammation is associated with following systemic
• 1. Fever. Invariably there is mild fever, often with loss
of weight and weakness.
• 2. Anaemia:chronic inflammation is accompanied by
anaemia of varying degree.
• 3. Leucocytosis. As in acute inflammation, chronic
inflammation also has leucocytosis but generally there
is relative lymphocytosis in these cases.
• 4. ESR. ESR is elevated in all cases of chronic
• Which of the following is always present in
• A. Rubor
• B. Edema
• C. Leucocytosis
• D. Increased ESR
• DRAW A NEAT LABELLED DIAGRAM OF
• PATHOGENSIS OF GRANULOMA
• DIFFERENCE BETWEEN ACUTE &CHRONIC