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Chronic inflammation
- 2. Chronic Inflammation Chronic inflammation is inflammation of prolonged duration (weeks to years) in which continuing inflammation, tissue destruction, and healing (often by fibrosis), proceed simultaneously
- 3. Chronic Inflammation May follow acute inflammation eg. Pneumonia chronic lung abscess Repeated bouts of acute inflammation eg. cholecystitis , pyelonephritis Begin insidiously as a low grade smoldering response - Tuberculosis
- 4. Causes Persistent infections by microbes that are difficult to eradicate. Mycobacterium tuberculosis Treponema pallidum Immune-mediated inflammatory diseases Autoimmune diseases rheumatoid arthritis, inflammatory bowel disease, and psoriasis Allergic diseases, such as bronchial asthma Prolonged exposure to potentially toxic agents. Silicosis (silica)
- 5. General Features of Chronic Inflammation Mononuclear Cell Infiltration Macrophages, Lymphocytes and Plasma cells Tissue destruction or necrosis Proliferative Changes Attempts at healing by connective tissue replacement of damaged tissue – angiogenesis (proliferation of small blood vessels) and by fibrosis
- 6. MACROPHAGE
- 9. Types of Chronic Inflammation Chronic non-specific inflammation Chronic granulomatous inflammation Eg. Chronic cholecystitis Chronic pyelonephritis Eg. Tuberculosis Leprosy Syphilis
- 10. Chronic granulomatous inflammation GRANULOMA Form of chronic inflammation characterised by collections of activated macrophages, T- lymphocytes and sometimes associated with central necrosis Cellular attempt to contain an offending agent that is difficult to eliminate
- 11. Chronic granulomatous inflammation Strong macrophage and lymphocyte activation – injure normal tissues EPITHELIOID CELLS – Activated macrophages develop abundant cytoplasm and resemble epithelial cells Some activated macrophages fuse forming multinucleate GIANT CELLS Older granulomas develop an enclosing rim of FIBROBLASTS AND CONNECTIVE TISSUE
- 12. Giant cells 40 to 50 µ in diameter abundant cytoplasm Langhans‘ giant cell 20 or more nuclei in periphery ( horse shoe pattern) Foreign body giant cell nuclei scattered in cytoplasm
- 13. EPITHELIOID CELLS Activated macrophages with epithelial – cell like appearance Cells with indistinct cell boundaries Abundant pale staining granular cytoplasm Elongated/ oval, slipper shaped nuclei
- 14. CASEOUS NECROSIS Grossly This has a granular, cheesy appearance Microscopically Appears as amorphous, structureless, granular debris, with complete loss of cellular details
- 20. Macroscopic appearance Fibrosis - The most prominent feature of the chronic inflammatory reaction when most of the chronic inflammatory cell infiltrate has subsided. This is commonly seen in chronic cholecystitis 'Hour-glass contracture' of the stomach - lead to acquired pyloric stenosis Strictures - as in Crohn's disease
- 24. Chronic peptic ulcer of the stomach
- 25. Acute Chronic Duration Short (days) Long (weeks to months) Onset Acute Insidious Inflammatory cells Neutrophils Lymphocytes, plasma cells, macrophages Vascular changes Active vasodilation, increased permeability New vessel formation (granulation tissue) Fluid exudation and edema + – Cardinal clinical signs (redness, heat, swelling, pain) + – Fibrosis (collagen deposition) – + Systemic manifestations Fever, often high Low–grade fever, weight loss, anemia Changes in peripheral blood Neutrophil leukocytosis Lymphocytosis