Circulatory Shock, types and stages, compensatory mechanisms
Chronic inflammation
1.
2. • Chronic inflammation is defined as inflammation
of prolonged duration (weeks or months) where
• Continuing inflammation,
• Tissue destruction and
• Healing proceeds simultaneously.
3. Infiltration by mononuclear cells
◦ Macrophages
◦ Lymphocytes
◦ Plasma cells
Tissue destruction
Repair
◦ Angiogenesis (formation of new blood vessels)
◦ Fibrosis
5. Distinctive pattern of chronic inflammation
characterized by formation of granulomas.
Characterized by presence of
◦ Activated macrophages
◦ Lymphocytes
◦ Occasional plasma cells
6. Tuberculosis is caused by Mycobacterium
tuberculosis
Primary tuberculosis
◦ Usually seen in children
◦ Due to initial (first) infection
Secondary tuberculosis
◦ Seen in adults
◦ Reactivation of primary infection
7. Focus of tuberculous inflammation
◦ White to tan colored lesion
◦ Round, irregular borders
◦ Central necrosis (caseation)
◦ Soft, granular, cheesy material
11. Involvement of lymph
nodes gives them a
matted appearance
The centres are filled
cheesy necrotic
material
12. Characterised by
presence of ulcers which
are transverse
(perpendicular to the long
axis of the intestines)
Compared with ulcers
caused by typhoid which
are longitudinal
13. Caseous necrosis
◦ Pink structureless centre
◦ Surrounded by lymphocytes
Epitheliod cells
◦ Activated macrophages
◦ Pink granular cytoplasm
◦ Slipper shaped nucleus
Giant cells
◦ Large mass of cytoplasm
◦ Numerous nuclei
14. H&E stained section showing a granuloma with central caseation necrosis surrounded
by a collar of lymphocytes, epithelioid cells and giant cells
15. Syphilis is a sexually transmitted disease caused
by Treponema Pallidum and has 3 stages
Primary stage- chancre in the genital region
Secondary stage- lymphadenopathy and skin
lesions
Tertiary stage- aortitis
16. Form of cardiovascular
syphilis occurring in 80%
of tertiary syphilis
Affects proximal aorta
Tree bark like
appearance
17. H & E stained sections showing fibrosis of the media of the vessel wall and
infiltration by lymphocytes and plasma cells.
18. Granular and pink
appearance of tissue
in a healing ulcer
Granulation tissue is
composed of
◦ Fibroblasts,
◦ Newly formed small
blood vessels and
◦ Inflammatory cells
19. Mycetoma is a chronic
subcutaneous infection
Initially presents as a nodule
Later swelling and multiple
discharging sinuses
Grossly visible granules of
various colors seen extruding
from sinuses
20.
21. Gross - solitary, small (1-2.5cm), punched out with sharply defined
margins, deeply penetrating.
gastric ulcer shows indrawing of the mucosal folds toward the ulcer margins due to contraction of
fibrous tissue. Healed chronic gastric ulcer shows radiating folds pointing to the site of the
healed ulcer
22. BENIGN ULCER
Flat margins in level with
surrounding mucosa
Mucosal folds converge
towards the ulcer
(radiating/spoke wheel
pattern)
MALIGNANT ULCER
Are larger, bowl shaped with
elevated and indurated
mucosa at the margin
23.
24. Gastric ulcer :Microscopically, the ulcer here is sharply demarcated, with normal gastric
mucosa on the left falling away into a deep ulcer whose base contains infamed, necrotic
debris..
25. Granular and pink appearance of tissue in a
healing ulcer
Gross examination- floor of the lesion contains
pink granulations composed of the vascular
connective tissue, while the edges are sloping
and bluish white.
26. At high magnification, granulation tissue has capillaries, fibroblasts, and a variable
amount of inflammatory cells (mostly mononuclear, but with the possibility of some
PMN's still being present).
27.
28. MICROSCOPIC EXAMINATION
• Granulation tissue is composed of proliferating
fibroblasts, newly formed small blood vessels and
varying number of inflammatory cells which are
initially polymorphs but in later stages
macrophages and lymphocytes predominate.
29. The wall of an abscess that is organizing has granulation tissue, seen here at
the left. The purulent exudate with some hemorrhage is seen at the right in the
abscess center.
