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Inflammation
The reaction of livingtissuesto all forms ofinjury.
Advantages:
- Protective response
- Inactivate toxins
- Achieve healing&repair
Disadvantages:
- Encephalitis(swellingof brain) cause death
Types of inflammation:
1- Acute inflammation(AI)
2- Chronicinflammation(CI
ACUTE INFLAMMATION (AI)
Immediate & early response to injury.
1st
line of defense againstinjury.
Characteristics of(AI):
- Relativelyshortduration
- Fewminutesup tofewdays
- Inflammatoryexudateformation
- Predominantlyneutrophil leukocyteaccumulation.
Causesof (AI):
1- Trauma
2- Chemical injury
3- Heat
4- Cold
5- Radiation
6- Injurydue to MO(microorganisms)
7- Injurydue to immunological mechanism
Changesin (AI):
 Vascular changes
- changesin vascularcaliber:
 Initial vasoconstriction(small BV i.e terminal arterioles (ta))
 Persistentvasodilation(persistfordurationof Inflammatoryprocess)
- Alteration in local Blood flow:
 1st
Inc..inbloodvelocitydue todilationof (ta).
 Thisphase is forshort durationandfollowedby slowingof bloodstream(stasis) forINc..
vascularpermeability.
 Fluidislostfromblood& viscosityInc..thatslowsdownbloodflow.
- Increased vascularpermeability& fluid exudation:
 Permeabilityof capillaries&venulesisfunctionof pores(intercellularjunctions)b/w
vascularendothelial cells.
 In AIpermeabilityInc..due toactive contraction actinfilamentsinendothelial cells.
 As a resultwideningof poresoccurwhichallowspassage of large amountof fluid&high
molecularwt.proteinsiscalledexudation.
 Thisexudationof fluidproducestissue swelling,calledinflammatoryedema.
Featureshelpin inflammationinitiation:
i- plasmaproteins
ii- WBCs
 Patternof vascular permeability:
 Immediatetransientresponse:
 In response tomildinjury(permeabilitybegins1-2minsafterinjury&persistsfor20
mins.)
 Mediate by mediators,
o Histamine
o Bradykinins
o Leukotrienes(cause endothelial cellscontractionresultwideningof
Inter-endothelialgaps&leakage of plasmaproteins(exudate formation)
---------------
 delayed- prolonged response:
 Sunburns,bacterial toxins
 Immediate-prolongedresponse:
 Due to necrosisof endothelial cells.
- Fluidremove from vessel:
Have 2 types,
 Exudate (highproteinconcentration)
 Transudate
 Exudate:
It isinflammatoryextravascularfluidthathashighproteinconc.Much cellulardebris
whichleaksfromvesselsintointerstitial space due toincreasedvascularpermeability
e.gBacterial peritonitis&Tuberculosisperitonitis
Fluidexudationmechanism:
 Factors whichregulate thistransport,
 Forceswhichholdfluidinsidevessels,
 Plasmaoncoticpressure (pushesfluidinward) (POP)
 Vascularhydrostaticpressure (pushesfluidoutward) (VHP)
 Forceswhichexertfromoutside tovessels,
 Interstitial oncoticpressure (IOP)
 Interstitial hydrostaticpressure (IHP)
 Transudate: (Whenvascularhydrostaticpressure Inc..notdue toinflammation.)
It isan ultra-filtrate of bloodplasmawithlow proteincontentresultformincreasedvascular
hydrostaticpressure.Here endotheliumpermeabilityisnormal.
e.g, RENALFAILURE:
proteinnotabsorb& remove so,proteinDec..& theirfluidstartto
Inc..in organscause edema.
LIVER FAILURE:
ProteinconcentrationDec..&waterinbloodmove fromvessel toperitoneal &
cause fluidinorgans.
Leukocytesrole inAI:
Neutrophils(15u) &monocytes(20u) (abilitytoengulf bacteria) reachtoinjurysite tocombat
infection.
How neutrophilsgotoinflammationsite:
Steps:
1- Margination:
 In thisneutrophilsattachto intergriniscalledmargination.
[intergrin=some kindsof receptors(hooks) formonendothelial layer]
2- Rolling:
 The neutrophilsstartrollingonthe intergrin& selectrin&theystucktolumen.
3- Emigration:
 Stepwise pseudopodsformbyneutrophilspush&the neutrophilsrelease bythe
helpof pseudopods.
4- Chemotaxis:
 It ismovementof WBCsunderthe influence of differentchemicalsonthe site of
injury.
 At site of inflammationdifferentchemicalsproduces,i.e
 Bacterial products
 Complementcomponents C5a& C3a
 Arachidonicacidmetabolites i.e leukotriene B4
 TNF & plateletactivatingfactor
Thus neutrophilssensethese &reachestosite of injury.
5- Phagocytosis:
ProcessbywhichMO & otherforeignparticlesare engulfed&destroyedby
neutrophils&macrophages.
 Opsonins:recognition&attachmentof mostof MOs isfacilitatedbycoating
themserumproteinscalledopsoninswhichinturnbindtospecif receptorson
leukocytes. e.gC3b&IgG.
 Phagosome:the bacteria+ opsoninswhithneutrophil membrane ispushedinto
neutrophil iscalledphagosome.
6- Killing(Lysis):
 Neutrophil ownenzyme now begantokill bacteria&afterprocessneutrophil
auto-phagocytes(apoptosis/self-death) &cell deletedfrombody.

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Inflammation (dr.ahsan)patho.docx

  • 1. Inflammation The reaction of livingtissuesto all forms ofinjury. Advantages: - Protective response - Inactivate toxins - Achieve healing&repair Disadvantages: - Encephalitis(swellingof brain) cause death Types of inflammation: 1- Acute inflammation(AI) 2- Chronicinflammation(CI ACUTE INFLAMMATION (AI) Immediate & early response to injury. 1st line of defense againstinjury. Characteristics of(AI): - Relativelyshortduration - Fewminutesup tofewdays - Inflammatoryexudateformation - Predominantlyneutrophil leukocyteaccumulation. Causesof (AI): 1- Trauma 2- Chemical injury 3- Heat 4- Cold 5- Radiation 6- Injurydue to MO(microorganisms) 7- Injurydue to immunological mechanism Changesin (AI):  Vascular changes - changesin vascularcaliber:
  • 2.  Initial vasoconstriction(small BV i.e terminal arterioles (ta))  Persistentvasodilation(persistfordurationof Inflammatoryprocess) - Alteration in local Blood flow:  1st Inc..inbloodvelocitydue todilationof (ta).  Thisphase is forshort durationandfollowedby slowingof bloodstream(stasis) forINc.. vascularpermeability.  Fluidislostfromblood& viscosityInc..thatslowsdownbloodflow. - Increased vascularpermeability& fluid exudation:  Permeabilityof capillaries&venulesisfunctionof pores(intercellularjunctions)b/w vascularendothelial cells.  In AIpermeabilityInc..due toactive contraction actinfilamentsinendothelial cells.  As a resultwideningof poresoccurwhichallowspassage of large amountof fluid&high molecularwt.proteinsiscalledexudation.  Thisexudationof fluidproducestissue swelling,calledinflammatoryedema. Featureshelpin inflammationinitiation: i- plasmaproteins ii- WBCs  Patternof vascular permeability:  Immediatetransientresponse:  In response tomildinjury(permeabilitybegins1-2minsafterinjury&persistsfor20 mins.)  Mediate by mediators, o Histamine o Bradykinins o Leukotrienes(cause endothelial cellscontractionresultwideningof Inter-endothelialgaps&leakage of plasmaproteins(exudate formation) ---------------
  • 3.  delayed- prolonged response:  Sunburns,bacterial toxins  Immediate-prolongedresponse:  Due to necrosisof endothelial cells. - Fluidremove from vessel: Have 2 types,  Exudate (highproteinconcentration)  Transudate  Exudate: It isinflammatoryextravascularfluidthathashighproteinconc.Much cellulardebris whichleaksfromvesselsintointerstitial space due toincreasedvascularpermeability e.gBacterial peritonitis&Tuberculosisperitonitis Fluidexudationmechanism:  Factors whichregulate thistransport,  Forceswhichholdfluidinsidevessels,  Plasmaoncoticpressure (pushesfluidinward) (POP)  Vascularhydrostaticpressure (pushesfluidoutward) (VHP)  Forceswhichexertfromoutside tovessels,  Interstitial oncoticpressure (IOP)  Interstitial hydrostaticpressure (IHP)  Transudate: (Whenvascularhydrostaticpressure Inc..notdue toinflammation.) It isan ultra-filtrate of bloodplasmawithlow proteincontentresultformincreasedvascular hydrostaticpressure.Here endotheliumpermeabilityisnormal. e.g, RENALFAILURE:
  • 4. proteinnotabsorb& remove so,proteinDec..& theirfluidstartto Inc..in organscause edema. LIVER FAILURE: ProteinconcentrationDec..&waterinbloodmove fromvessel toperitoneal & cause fluidinorgans. Leukocytesrole inAI: Neutrophils(15u) &monocytes(20u) (abilitytoengulf bacteria) reachtoinjurysite tocombat infection. How neutrophilsgotoinflammationsite: Steps: 1- Margination:  In thisneutrophilsattachto intergriniscalledmargination. [intergrin=some kindsof receptors(hooks) formonendothelial layer] 2- Rolling:  The neutrophilsstartrollingonthe intergrin& selectrin&theystucktolumen. 3- Emigration:  Stepwise pseudopodsformbyneutrophilspush&the neutrophilsrelease bythe helpof pseudopods. 4- Chemotaxis:  It ismovementof WBCsunderthe influence of differentchemicalsonthe site of injury.  At site of inflammationdifferentchemicalsproduces,i.e  Bacterial products  Complementcomponents C5a& C3a  Arachidonicacidmetabolites i.e leukotriene B4  TNF & plateletactivatingfactor
  • 5. Thus neutrophilssensethese &reachestosite of injury. 5- Phagocytosis: ProcessbywhichMO & otherforeignparticlesare engulfed&destroyedby neutrophils&macrophages.  Opsonins:recognition&attachmentof mostof MOs isfacilitatedbycoating themserumproteinscalledopsoninswhichinturnbindtospecif receptorson leukocytes. e.gC3b&IgG.  Phagosome:the bacteria+ opsoninswhithneutrophil membrane ispushedinto neutrophil iscalledphagosome. 6- Killing(Lysis):  Neutrophil ownenzyme now begantokill bacteria&afterprocessneutrophil auto-phagocytes(apoptosis/self-death) &cell deletedfrombody.