chronic inflammation.pptchronic inflammation.pptchronic inflammation.pptchronic inflammation.pptchronic inflammation.ppt

1. CHRONIC
INFLAMMATION
DR.FOZIA

2. What is chronic inflamamtion
General Features
Sytemic effects of chronic inflammation
Cells involved
Types
Granuloma

3. Chronic inflammation is inflammation
of prolonged duration
(weeks or months)
in which INFLAMMATION, TISSUE INJURY, AND ATTEMPTS AT REPAIR
coexist, in varying combinations.
CHRONIC INFLAMMATION

4. 1.Persistent Infection
2. Immune-mediated inflammatory
diseases
3. Toxic Agents/FOREIGN BODY
CAUSES OF CHRONIC
INFLAMMATION

5. GENERAL FEATURES

6. MONONUCLEAR CELL INFILTRATION
TISSUE DESTRUCTION//NECROSIS
PROLIFERATIVE CHANGES
FIBROSIS ANGIOGENESIS

7. CHRONIC INFLAMMATION ALWAYS ATTEMPTS TO
HEALING

8. 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.
CLINICAL FEATURES

9. CELLS INVOLVED
• MONOCYTES
• LYMPHOVYTES
• PLASMA CELLS
• ESINOPHILS

10. WHAT IS THE KEY PLAYER IN CHRONIC INFLAMMATION??

11. MACROPHAGE

12. DOES MACROPHAGE DIRECTLY COMES TO CHRONIC
INFLAMMATION
NO

13. MONOCYTE
MACROPHAGE

15. WHAT ARE THE
PRODUCTS SECRETED
BY MACROPHAGES??

16. •CYTOKINES-IL1, IL-2
•INTERFERONS –Y
•GROWTH FACTORS- TGF, PDGF, FGF,EGF
•[TGF, PDGF------- to stimulate fibroblast]
•COMPLEMENT FACTORS[C]
•ENZYMES—Proteases, endonucleases, elastases

17. Chemotactic factors
NO
Collagenases

18. ANY OTHER??
LYMPHOKINES

19. IS NORMAL LYMPHOCYTE SECRETES LYMPHOKINES??
CD4 Lymphocytes[[Th cells]

22. THE ROLES OF ACTIVATED
MACROPHAGES IN CHRONIC
INFLAMMATION :
1. Inflammatory Tissue Injury
2. Repair (Growth Factor
Mediated)
Fig 2-24 (p72)

23. MACROPHAGE-LYMPHOCYTE
INTERACTIONS IN CHRONIC
INFLAMMATION :
Fig 2-25 (p73)

25. TYPES

28. 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 granulomas.
A granuloma is a cellular attempt to control an offending agent
that is difficult to eradicate.
.
GRANULOMATOUS
INFLAMMATION

29. •In this attempt there is often strong activation of T
lymphocytes leading to macrophage activation, which
can cause injury to normal tissues

30. A granuloma is a focus of chronic inflammation consisting
of
a microscopic aggregation of macrophages
that are transformed into epithelium-like cells, surrounded
by a collar of mononuclear leukocytes, principally
lymphocytes and occasionally plasma cells.

35. TYPES OF
GRANULOMAS
I. Foreign body
granulomas
II. Immune granulomas

36. 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 response.
.

38. IMMUNE
GRANULOMAS
Caused by agents that are
capable of inducing an
immune response which
produces granulomas usually
when the inciting agent is
poorly degradable or
particulate.

45. GIANT CELLS
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 granulomas.
These giant cells may attain diameters of 40 to 50 μm.
peripherally (Langhans-type giant cell) or haphazardly (foreign body–
type giant cell).

48. WHAT IS THE SHAPE OF EPITHELOID CELL
‘SOLE SHAPE’

49. SYSTEMIC EFFECTS OF
CHRONIC
INFLAMMATION

50. •Chronic inflammation is associated with following
systemic features:
•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
inflammation.

51. Which of the following is always present in chronic
inflammation/
A. Rubor
B. Edema
C. Leucocytosis
D. Increased ESR

52. MORPHOLOGY

57. DRAW A NEAT LABELLED DIAGRAM OF GRANULOMA
PATHOGENSIS OF GRANULOMA
DIFFERENCE BETWEEN ACUTE &CHRONIC INFLAMMATION