Pulse Check Decisions - RRT and Code Blue Workshop
U-1, PATHOPHYSIOLOGY-1, CAREWELL PHARMA.pdf
1. REWELL
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Dasi Principles
of lelLJnjury-
and ddoblation
elnjuYyoben a
cull_enlounlus_a vaieiy o
Sinsseclue o chang in inieYnallas
oell exionaunuiromuni,1t leady b_ull injYY
Cux bocdy
cll baue inbuit mtthanium lo deas
th udkious nuixomehial chanq Ihe Rsponse
ohe ll lo,slxtssdebendsonMo VaYLables
úshich ybe of ells_and lissue ayeihwliurd.
Uuxadion andupe oinju
be sponsesolhe lltoinjuuy my be
1Revexaibl Lell iniuyySometimesiniuLd l
Louerecd bach 1 kest nmild to modual
Thi i XnoLan a xevexaible.
ell inu-
xnexible («llinjuy sss vexySevLse
land priuteni Lellnsdy dird Thi is buna
essible cll iniury NeLxasis and Hpoptasi
3.lulax ldapladlonsisomt li adapt to ihe
hang oheh ihex isinxeaedun dional
dempindand Hhtn yeueT bac io normalsiale
xsis tmoued his s Anozon allulax
Ciclapioiion t4Hfophyhyhr Iiophy huþeplaia,
hiablasia ind 6lysp1asia
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2. CAREWELL PHARMA
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ate
OPageNo
Cause o in
he cauuLLOL both eey.shle. Ci xe.ueYLble
Cel injuYY_akeSimilar lany O Iht 9Len
belos m yRSult initially inYeveYlbr
njy he. iniury is6SuuitnT See
Hhe YaLhes oini s ná Yelun ad
IYXEVeXShleiniuyyhul minajingih tldcath
Loi oCuY assiHe CausE 6 &ll inuiy 1ndud
1HybOxÍOand sbaemia L
2. PhiLal cGrni
3 munaladiLal',aqin
hemigal agtnisand Dhug
5 iabial acon
6. thsloqical Jalo
7 N idml imbalante
2 neliu deungtmenls
1Hpoia qe Larmia.Hyoxia iione ohe
mal imboxianT (au tll inuy icind
cell elealK Hybouia i dilienio lhatminf
shicb i lauablbod lou o and hereloxe
Oxygenalion Oflhe tiuug In lon lyaT to
b iaduring shich glytolulirehexq
lbSdulioncan (oninutchdenia coprisu
he aunilabiliy omla bolitSuhsiaps
nuding qluhig muaLadialkuhacmia
ecucd bcd lots cihereore
yqtnalion 0he htartJasa sksult o
tenayy arltyalher Oicltiosis
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"********
bysiLa agenis axious bhyical agirls which
Oxexsponible or cel jnitny intuce iyaumá
hrat coldLhan
and adiationssuch asSun buan,due do UU-
ghi doamaq
bihe sbin
Sh_almos pheyiL pressure
mmunalçqical qqtnis Immune SYlem_StVs-
Csoneo h desni ggaint BioloiLal
aganisbut inmmunt adion y a6 CusE-
injtYSuch_asanaphy_ladii
hypeysniUiy Xiadion
OId damúy (awrd by(Lu toan iiboclits
Lnlindie bxodted byl lhetody cLDT
oan iissuuK
Cand
4ChumiLalaqents anddauqs lheye a1u aaiOus
chemital adenlsand diues ohich: my Laus
SeveyeaPin juyIhasddinlud
uluose AY alt in lhupeonit Lonc
tnAT high_(ontl
Kons Suth % merLuic sadu, axesenit and
yanide
sisjdes andhabiidesltoi lablani_
Thexapedic dug
ic damcaetoorsophagtal mluLasa (acidenal
delibead
Sibial aqnlhrious miLiob such 4s
iniion Latstd by sichfsia, iuLAbXoozod
ond baciria cauXt (4 inury
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ja PageNo. uama**
ubeitulous intion o ihe lung p
amageb upi adory mutasaDYh4uno
NBUS
holoqilal adoa Vaious þrablems (
alsbolish drug dcidion ancd Smabing
ALltin djiehESSuLh as liuàdame-
Lg Lante,peplitulcer adi tardiauatulá
ditases
NLilionalmalantt-Relalive oi abiolui
deirienty Oy exLAOong omorehuilen
lead io (lLipjuh y'roltin caloxic
inyCaust anappallino number o dedh
NLidiondLauS_also'lus ll inju
q exSS O iþids calus atheaSClexaI? and
obei
84netiadoxsi Gineli iniuayLan kstlt ina
dt a aioss a dhe Condtnialmaloilon
asaciaded Pailh auan sundrdme,or imle
amino Aid SubxiiuliontInihatm 0q obin as
Seen in Sichle ulLanARmia
4
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athoq.en tis ol tellinj
ahoqnesioIcdemioa_anchyhoria idurd
cll njuR
edhoqenesiso Raveasible Lellinju
Lhe eledsof linjyynrVEALdontloaai1on
Ohebbocd Subbly heischatm.ia 0 nybonia-
1SOSbosi cluxationhis i bousn_as Hwtsiblk
Cel inuyytlhe yaxious Chanqts ou h
Yible ull injuyore
Hooxia Ad Iscbamia
AIP.
Decaease p
in la
Scdium pump
Dapaoe
Dicxcase pzalein
sypibesi
Aanclionalard uldhasduleaol
hunqts
RvexstbleLtllinjury
adogtnesis o iszhaemía índuld iniiibl. tll inlau
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EDale d
Page No.
1|Dxeass A1? oduciion
IY iequisedox many syniheig a
ceqsac.cative_þyoLAs in ih ill FTY roclu
hy aobiL nispixadion (whith Xequle Oxuotn
R miiochondzia lsthaemia and nyboxa
aeceasethe_oxygin Subply do dhe ells uhith
aturRae HTP DidduLiion om dhe 14DP_
Hexobi spiyaiion (hd qlutoseallabili
both_afe (ombromiscd In hamia obIth
ultsin more seVeye T
O nu-
2 DecXECLe phBetaue o_deheCLLe xygen subpl
heuL mibhndrial acohi xitpi iian
i lolloyoed by suoilebh to_ahaexabialutolli
athdy ox lheATP zequiyements
aumulation o laiL akd YsiU
Hhe pin dhe'ulasol
edium DUmb_cdamaqedgdium_pimb ie
Na- ATPaie obexde qt theploa memb
tabilh allous adive anspeat Sodium oui
Hh _aandbaiasium into dh ell. 1tad
ATP ea in he el intpaIeLilhhs
nm.ban oL his leédsto ineauluar
acumladion oliodium_and diuion a
btasium Oufnd ihe. llLue to aluiulaton
Sodium in dhe cel it Ladc do intx in
initactlular gid lo_minlain Ls0-0Smi
toncdilion.
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ate d.
eeaeosoein ynlhis Riho.oms arg delashd
som doplasieiiulum ERLCndoyso ms
are clecraclkd o mahosame clueip hyKiO-
hiutimtily leadsbdecxLask_pio1žin.
sqhlhuis
O0 PageNC.
unLtional changasundional disiur babce acL
in JeVexible _cHLinusy g due ioLo nohaa
olusion myoLajdral eonKaiililg-Last
Lhin_onYhinuie buT, (an be yeLSecl on
uloxation o Liulaiion.
Hasyuutual thanggsi o chondiialsuo:lline
i lin iqluILs aXL Uingin the Lqlaplasm-
_oLside ihe u
iiy mhne bund paysomtsge detachid aom
hSuxlar O OuGK fhdo plaumiL Ytliulum
athoqenxsis oSne vezible cillinuxY-
yveYsible_(tll inuyy Ocus due b_pesiant
schaemia or hymalp isxeveysible (clL injuay
Hh pilahondria dusuntion is noT
exuion uoanation _and all membTane
inicons axeditrbec hiious tvenis Occu
iweyLXsible_alinjuay_a iven brloi
itochondxial_dyslune 1fon
Due lo hyparig ylosolic inluxbaions
LuLSmdilyin yLeYSible n jUied lla1e
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WEL
Date
GD Page No. .
BeYSIon, uwhichisahin up bythe
mio hndxia and lecds omi 18(hon cia
uuntioh he xiou (hangsDbstULGlh
milbthondrial_aTe deolien amaphu
Calcium salis in lhc. milachanCialtli}
ermbrgne daaatT
nshaemia Hducd imeveSiblc (
huypaiulaaly plqsma membYane
damaed
n His pxoLcSS AscAtpirfrd in-
huous me, hgnLLm axe lnuolu
shmiolhyporia
AIP Paadurdton
PhoaphsFd lhal
nthrsi
Endothrlium
milochardhia)
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9. CAREWELL PHARMA
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LsLbaepnialhypoxia
APhcdulion
Pospholipid
4nihcais
Repekusien
£ndoibrlium
paenhymaltrll
1GLdag
Rþexlusion
amibrhorduio
L4tosol)
Pdhpliono Hdiaionol
phapalpose. pofr ase bid.
piodaiioh h
Phosaholi
los
uAbuab ulesaldal
damaq
ldouh Diodni
mbyaTK
laiaatalluon tn2yme libraaiian
auath
melin
Knosi, doyalyais
ayomhžir
(Yuclem Lhong
_
imume-
SGOT, MB
ln DH.
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O
membxane_pbashholipid.llue b defititn
XyALh talcium shi pom mitachordria
ond oblasmiYdicúlum inladhe (ylosol
Chen 1he level_of calcium incaease in he
iasol it adinls tdcgehaus bhasph»liase
omischatnaiaissue Yabich da0 th
Phasbha lipids o4 the membxane -hothey
eson ox membrane bhospholipid damage
is decxeastd leveo HTL
LGbsheleal anmoge-Theunciion of the uoskelel
Hamenfis o tonne he lasma memban
the (ell_inteioz ddialon o dltaJes b
incxeased_ (an damage he (b sheleto
elenehts
Rative xygtn speciesdee oditals axg cilso
nvalued
inh xoceus
oine vasible cell
iniuxyhxiou loiL CyGin oditals such4s
supeoxide Lo, bydaoxy odicals loH) and
lhehboqen bexoidCH,&) A incxeased in
hdemia ee clitalinunyS Asa opexal
in sihey_xOtsA SuLhA n_Lhemical injudy
odiation injuy-mitnobial 4iling y aziq
enesis and athnasclexasiL
N bid bxeaadoLsn ocduds aeah_danbeduc
pid shith_aumtulale în dhe ischarmi
el xesuHs in ulbex damaqe a 6ther
L membiane
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EPageNa.
magebiccuced by Rha lusion-alium,
homeuis isdiluabec üan ebrlion_o
njuxtd ells, Luhich 1tsults inlag
nlluecalcium inta dhe ytasollhiA inuxtase
|leieloalcjum in the cydass ay ltad o
aciivaiion qf mtmbygneShospholpasesLohib
CCALustS
dqadalion ophosphalipids
Hydxolytic.cn2ymts
iouhudza ii tn2ymt suth_as DNHaut
RNAaseaf pxotaasES d2 AxL Tleased ducdo
asomal mtmbxant damage_onen ihese t3yme
eatialed Ldhy Ous digcsdion 6 lluax
Comontnjiand induce ipiots nudleax chan4es
Stuth aspybnosis dayyolsis apcd daz yol beis
hes m fiquusua phogotoed bh
hoaaabaS
4Estimdion olEmyme ibithuseuma
Due bdaúg ohe Cell mcmbxan aaious
Lenume_Such asSGOT,1OH cIn A- MG_a
ibekaded inb ibe Sexum Lehich may be stimaied
ox linital puapose
schami /Rebeyuionu R iniur
Lohen cluxaionO haimia is shoxIepe.Lian
e lonedheuntlional ardsisuLlural slale a
HhcellLI ihousn a VErsible tellinuy
ashenduxction_o chaumia ilanqty hth
speruion,xalher lhan ii toxation a}he
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Dare
dOPage No.
he suclure and lunulion, deltaiom
alxtadyinjuxtdcell Thii irausn a
schohmia x«preasusion iniu h bmoin
mchanism behind_lhe iHatmia X2pEsAia
nduridc injuay islhol scNaLmia_
Ooducesalyheo (ellulan damaa
genexalidh olh e xditaPspeis
ubsequendlyYérusion_hovides abuhcant
mo kuay byygen (o) o tombint_utbse
xadicals om ealive oxygLn sperieiCkGS
thot ead
deeodial-induud ell injuy
adicals axeqnaaled sithin inny
mlochondaial mebyanespaue dungpux
lecinon duciion o gin lo)lalilu
HO) olaysd by toHomtcxidastlhe
ileamedindedrred oysan Sbrc ax
thcard debending upohnumbe a eledon
ansexd duirg con Vesion oloaun b
nlThese inclda
bEupxoide O
Hydaoqen pxonide(4Q) lo dedions
Hdadtgl xadical (ot) lhire tlecdhons
one ledon
ome odhex oxuqtn adicalSuch as hybochloxu
aid (Hotl, bikoxynitnalONo)ni onide
NO) axe also atneXaled by 0ilous bocly (tk
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ete:
HEXatian o te dica.
xec xodical 'axdquntyad.d_duaing Lonitision_o-
bHO
uo-oidalion n2ymali
Xanthine.oidas
SupI axide Dismuae(SOn)_
-2HO
Kalalase GSH
Racdudqlulalhiont
RH,O0 frmmon raction.
Rodio lyis
TENERATION OTREE KADÍZAZS5
Hxee yaci.ca medialid Madion
Ot oall ihe aee kaditals,hydxox 1adiuals axc
mostseaLiiwecx4qn speci Hedhonyxadlital
W
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hccluc.es mmbane clameq by aaiOus
meuhanisms
QH-
pid pea.oxicklan olip OMA,danaqt
Oxidalion
>l_dialk
1Lipid_beroxidalion-lhe hydoxyaclital yimqua
hycxoqn om ih uhatuaiicd_JalH aud
o mtmbxane bhasbholipids lhe ibid sadilal|
ssith molkLubr oqun and
ipicpxoide Yocical Ih peoxide xadica
emavin4 únoihiy hydcqen alom
SLond unsaluyaltd atauid. A1pid _beid
ando hus lipid mdiYJult, ando Lhain
XROLlian ls initialtd
omsa
YOm
2o1in oxidalion Hdaoxyladial may also
atquh boieins(ysiine mtihianine,dginine
lad hiadidint omoe yulniagble,loHleh
byO ue ooxidhfivedomaaeyaq mtnllka
asslinhi ng
ad euenlualy degdicdalio
bxoltin hs_plaue
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Page ******snneseeussn**ns*
3ONAdamq4t Hudsox sadiLal induu uaious
allnalon n NA Ych as Sianbitahs, -
mdiitd bass and cias inbblus shOnds
tnsTu4 Oxidaiiwe damgqs OnA leods
Ho celldealh
Ihtioudants-
hrse axe subsiancesLohih inbibi1 he quntaliar
x xadicals o inaulive lhtm cnd 1hibil-
Nadical mtdialtd (llulax dama44 biíous
Cinlioxidanis ae iiaminA, dhd
Sulph hydxyl_ (ontaining_omino aids suh a
iin hnd glulathion
MaihogenaNL Oohysia injuy
Lidtnial a thYapeuiiz irpdsuxe o humans
hodiatian is cimpeanie in ih ataf mtnf_o
e son
Liih fumouas. Jonizing qdialian
tnades hydaoxy odicol bsodialyi oalx
Ths hydioxl dial tau ddlh blhe
othanLsm
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a nenesanan
LonizingIadialion.
H
OH
Non_ xotaling
tlls i
Psoliyali ell
d Deaoidalion
OwAcamg
amg ull
mmbxine
TnbihitDvA
plitadlion..
NtLxosis- Abpolosi
ttH-dtath4-
YadhogtnsisOpH
usicalinju
TORPHOLO4 OC INJURY
ophalogy o Reuexuihle ellinu.
lhemoohobaA hc
xVeible-rl injuay
dencdd bythe lum lhoqaietau
arious moißhologital Lingt whithoLLu
duxingtl Injdry anei
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"
1Hucopi hapgeslulox Sarlling+
2Hlint hanges
3PLoid honos
1atyhanq
Hcropi qhangs HudaopiL chanqtis ont o 1ht
litandLdamonomo u injuay
Hdsopic_cbange bm
olhxsunonumsha
Cudly Su ngdue to qidu ipp xant o
be itd axátan.s_and aLuolaa deatntailion
duc loiapluthmi aLualadion. anbhltzial
Hexinshemical buanbigh {avtcx
(aus af hydopie chanae
Hyalint changHylaint meansqloss ohithL
Aed o dudibe hista legial tam r glouy
hatmaloz ylin abpiaaan in_ hat mddoxin
osin laining These cmmu may be
inaululaz tLihacellulax axe asodialec
ith heltognoLLs oa1hologicLndilion
oniaaululaa hyaline
H obsrzvadUin hiiheliael
Ma lay hyalina4gne4ai o ilamenih
hbadyddluing oHoli. lvey iliniuxg
RSl bdiraiLosiveimmunoqlabulin
RERoohsma.
Hyaline dxapletsiEaive tahso blfon o
peunca
xolin in xainallu bulaa Lthelum
L
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hEliallulay Hyalinti Mostly sitnin
Conniive istue eq
Hualine artoxisclesdi in une vesst
cting hypryltnsian
Lopo dmylaxta in Oudcd. mss o
Lonunlxi Dhyaline. hmime 1n posla
in eldeslu-
HPAge
3 uLoid chanqtsMuLAus_Ís a combiali
olein cbmblexud ith muspcl4 sa
hasicke whith is Seziled by muusqlar
Epitheliab ull o mucu mimbah
glcinca oelL_as Conneuiiveissu
Paodu muin
aEpihe lia muuin
tain Stcxeting lumo o,oaxy STotich
Cadax shal Jn mmcalioh omulotumembra
bonnedive dissur_muin 1-
7n myxacltma, myX6 natóLS Chahgt
uoicd chang in sam umo3 such
>yxoid hahg in syhonlum in
aqlion o isd
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Thnalluloy HLtiations in lipiclh, holtins dnd
Cor bohyedrcts
ATniaacllular accumulatlon o libids
HIL Rhids such as iniqlueacyide,chalateol,-
chalestol uig and pKasbholibds aumulai
in iheully. Hh no ma comblex a lipdscand
Caxbahycdxais acumulaie in ihe ysotomal
stosqgdiseaseshospholibids cremaia
CmponinT Al myilin iquu ohith_aiesLen-
in necxoliu w ,
Steatosis or aty change blealasisand jatly|
hangcs_descaibe. hg anoymalaltumulafiam|
hiqlultides ioiihin_banthymdltlls,
in Jat mtomlismo lafly cbang ae mOsil
SAh in_ ljvY buutalo my &uas in hti
and dnty _nd other Osgak VaiousLauit
osieatosi inlude
iuss gloho (onsLumbiion
Obeaiiy
oin
soin malnutiion
Dfa bels mellius
Hnoxa
Sv 1llnts g lubeLulosis_
Hyho ia
alh o4tn&ai o suasasis qids,lipids
eniay the_liur Lell_tither Yom dff ohom
adibase isueInh livercll nolmm imal
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theact jals
hoost a the aaidi o aig
Lanc som cumount is changed
holtieyGsleDS4ton bedtsand
phosphalipids Jn he v elliqlyitide
qui ibidauplo_byalin tooIm
lipa prollin,
Lathoqtnasis osteataiks
Dit 2ueaty Aid Hdiascke
Oxidadienb
apid
quuephaiphate
Ilone bedi
>Phesbholi bis.
thokdraldas.
>Liv-
iglycaide.
Libjd aupta
rotein
Lihopralein
APlama ihobialein
Tn at livadue to d is onc or moiLa
hsizR giun_belous inat mtabaliim, leods
inlacallulan tunulaffon of triglycerida
Inatad_aHy auicl_eniy indhe li
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2nCasedaHy aid synlhesis by lhe ivtr.
3-|De CMLc aty aid_snuey sionsinis lont
bocias
Dseaed kbicd acupto prolein qnihesis
b nhihiiionoibòbiotein Cxueafion -o m
Hhe ivEx.
n eo v llinfuay due la chionic
holismaiouadoaxe inalurd suchu
1 nasd ipalysis
2nCsedsyndhuis ol hee_aty aid
3 DeLise uii2alion ohidy icle
D rd oxiadalion_aaHy 4hd6 elanesbadis
5Thhibiiion in lihop sallin xuetion
Btaullular auumublicon _ol ca bohy.cxates
CGlytog4tn)
uulaiion al in the tablasm ls may
kads a þadhalogical stayein ihe vakious
Londition Suths
Ln alcinlnia n whith, ihexe is xassive xenal
ubula ILabsaypiion o2101tin by thioxi
Hubulaxeiibe lial lly ohith uhoLsP haline
hanqghe hyalint chargidisabbeas oiih
LOn1o o iinuia,
2.n anl
alobular depaik, oamutaNtbraiiins in lh
blam a hbais ys
san deiuny fosinobhilic
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PageNo
(Ohhatelula attumulatfsnolabbhdad
Godn iy a adtly cauailable ene l
Hhat _bxesrnt in Yh uaplasm umuly. h
lloan ours in adousiLonditio0ss
1In diabtes meliiu. Noumalublabe lue
imbtaixed whith leads to iniYaLLllula
aumulcdfon o qlucoges deosiiI
AYLStn
in ebihlium o IAY bition o OXim
Conalultd dubulk am desiinding aop nlk
npanatiL E- cllsioivi indn inHh{_
ardia muLglL lly lLa1aLuali in lh
loblaim odh afLltd itllsartSitn du
togin depasilion.
2 Jitc
hstoag CieaSLL O,
In
SunihsiLox bytah dduon bglytogen xaulh
maufsiocapilinq, silbtuohdary injuu
anc ll deadh d
TO
XPigmtntu Thgseatthedolouudoisuhulanta.
imenis ant þrtstnt in most liuing being
inudin4 human hese ais cassid inb
u ma?n_(cle goii
Encloqthou bigeniL
2Exanous biqmnisa
1Endo9noupiaminishas ae_o1md
Lonsuuns ohe lkllsad acumubleund
speicalLoncdiiion laious tdoqnalusLbiqmenisa
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FDate:.
Mlanin.
IOchahasis.
LHazm9pio14in
deaived piqmtnis.
D paussion
Page NO. i ammnaaae
lanin tis non hatmoqlabincluiud brOLon
Douh _igmunToxmicd sht lhe thumtiyiosin ¥
cdlalyhg_oxidalion o oafnco dihychoy
phinylaluminein mtlanoi Houweve Somei1.
no melanin pigmeni i visibl becausL y0SLne
Dsnt hutit i notiadivt Melanin
Lbiamenation Laur
unalistd hpebiomendalfan.eg Hcdison'
disra hleasma
oal hybpig mtnalian eq Mlarosis coli
milaioh iqumOUIS.
tntalised bybopiomeptation.eq lbioiam
Localisrd habiadnidlion q Miligo, ltucdoa
LOLhopasi Ti anaudasp.mal tcesiuedispd
n och onasisheeis deicitniy,o an_oxidas
tnymquizudobaraadouen homa9tnlisie
lacid ohich dhenátumulaies in issue ançexxeted
nthe usine igmerismelahin libeian mosi
aeleddiue t Lasule joint,Lalilagts
igcamenL ad_ lendoni
HaemoYolin dexived iamen
LaHatnpsidevinis a heatmoqlobin deviupd 4oldtnyt ls
broonLIlalline oncP gonula pighdni i ihe
om ahih Icn is slotod inlhe ll
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do Page No. s
Hatmasideain_uessleads doi
otalised huzmasideasis ie ta haemo
hgaein
HissLLe loalised _batmosidiosisdeelabi Háemcal
ibpted due o lgais o d
tls, Lshiu
Halatn up _by macahhaqes uheii1diqlod
ad sloxed a hazmoiceain
* nealžstd hatnaidoosiilue bhaemohagin
he iuue localied aemosiderasiu develops
aemcqbbin i libevaled_cdue to lyi ol td l,
hith i taan ub by maLahbaqrs htr t
dqaacedand siaId as hacmidein
tnealised_hatmaidexasis.touuxs_clue Si
on ourload. lu yhe aam may hthe:
nchmadou debaslion_dhamasidešin C
xhchymal e oihr liue
*Reliuulaenddilha lialdeboslion ocur in -lheliva
ord splen-
ub Rzubin. IEisþrun in hebile Biliubin
s drivd apm Ahe psxphyiniing o h
uim moitiyo he ba moqlobih phen
bilndbin'inuueasts, i lkads do a
iniLa (ondilion Xnou9n ai jaundite
M
hustin.It i foton (Lwea and 1tar, agir
bigme'nton lihochiom Lialuini qullbui
oonn colbus i laund in olraphiedrulls
old_gge hinu fnouin á weay and tal or
cinq bimunIti madly Steniin li, htasl
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Marpba.logy o iueLsible tl infuy.
IANEYSible e|Linju1y os eceah 'mayOLULs
n iheliving body a lotal Ox oca ang-
Schasauysinasi andiabohlasislakMd
Hhe changts ha sllous Such palholoqical
(aliicaion and qanqinehe yanfous
athologícal bracess bhih_arein ohed in
Hh eM dealh-CLrt
uHalsistliblyiis alo 4noLon_a salfdiali
od wheniving bady issuxxoundedb
nammtaiy LaLti8n on may oltu As
imoailtn Yhange tahen lhgae Lomplele absent
inlammalosy sincundinq tutolysis oun by the
ndolaictn2umsliberaled b dhe osome
INLaosisL iihe lldealh aciunsby lhe ibuaion
o thehdso luliL enzyncsom the el Vaxiou
aqunis such ca hypoxia, bhyiital 0qni,Lhemic
ainlsimmunaloita agent ancmityabia agtnt
can tauseneuiosi, kdigesiion y he 4di
2ynme ad denaILukalion o acleihs a1
Lsshlial chonqssbrinq aboui Imcuezsible cellinjuy
in nuiosi
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s Neciosis
Ch h 'basis of mouphalogNlecais Ldir
ino allaLaing yba
Cooquulaive Netiosis
II|Liatelaiiue NecsasisS
at Ncosis
(ae.aus NleLKasi
VHibinoid NeLosis.
L|GanqKenous Nosis
I oaquladiue neLxosisiTtian ireiezihe
dalh_cousd by ischatma andmo1rdly
Haom hemitalond baLteaial aqenis. Lt is one
lhemo(ommah ybe ne
rOsÍsnd
ainlyG{t_hrart 4dhey ad spleen H ihe
ceath O lhe ul i Aulineis main talha
Lshen clisslaintd oiih ha madoxy linad
osin,he yio þlosimO heoliu lM i
mo eo.sindphili Ahanhe lu ual
yhnasisé whtn muL lkus hromisSmalleä due io!
Londensaiion o nucleo hiomalin.
aryonbexi ahtn lhhuanaii nuleus
agminidinomanymcillid gaamdai
4aauclyis.shih thepyhnoii dular zkudd
aom he
T qlanlive NecrosisTtis dlss naLonas
Lolliqualive neTOsi uhn
Hhealeddiisalulion oh hcioliuull is
ie han Jhe ale ol iuaia, lhe sulling
xpho logLal appLaante is anoan aake Jaudi
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27. PH
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LE is masilycausid by bydalylc tn2ymts 9
na baain Gnd abstcsš cauiiy omd By
iqueactive neciosis in asolid issur
Date:
O Page NO.
1 at Nagsis It asily alds odiþai issu and
Om_un(Jeatiiisho ihauma.he tatuns
ohich clkleymine lhis ype O nIOsLL Be
xsth paiglyt idzs in 'cdiboc issu The
Dxotsof hedM slais tobih, digelive tnumtiy|
Lushih a nOxmally lound in nYeadi duk4
cnd small inlulin ce Xeleastd om Inud
baneaii aihax (alls
Koleas and phospxa liba uleas sdomd diglyu
des Qmatl.
on seatic iasehyd olustd Ahis iiqlycuídes
înioee
Theseaty ad aie bi piiald as laljum soabs,
ohithdeposiisiai ihe pipheiyo hc iqulax-
islanc
a ty aid
astos nasisen ubeyulosi lnalion neuoi
aundin the tnire olhe ou i AnoLin_as,
ase.ous nyiQsiL. 1Bolh éoagulaiive. and liqueadi
nLaili Tu axond in caweaui neosis
n Laoy htLaaisunliacougulaliue necroi,
he neioiin ullail o elain lhin ullular
loulline
binoid necxosis t ik alsa anaan asibinoicd
degenexaiionn ibinoid ndoSÍl,blasmapratin
lacamuledts in dhe injuud bload ueiels ushidh_causa
h nllo tain inienuyib tasin
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.
d
Page No
naienOLS HELIOssLgan4zene) hili
thaedtthing netion Bypuiaeloadive, bcleajn
hese ane uwually ancdexobi4am-po31Live
loslaidiun spp desved omlhequt o
sbith_thive"in Londiifong aloLOqn
thsion.
yanqsenous isur sOL Sm IIng
Had blaa. h g LGmple is gin4theOfeaey
imb caused b a_booa blooc subbly dhdd
SLubeimpoard baiaial inhdion.
he Loord qn4xeng is ustd lo desbc the
holidad o a ofa limb shen lho
DAmeum
bobasis Abobiosis ia paoqammeclcl
cleathlhe tuim apoblosisideaiyec o
9hLaad manin diobhing o O
allinga bsbi6sisbloys n nieg1alok|
hqdax iey o4 bialoqica uens, hludiry
mozphogeni issuc 6meosidalsdd
movaY o unaahted 6r haamul(ulls.
he moabhalogital Lhanges oaobbis inckdea
ellShain A44
2ONAamelaiion
3 auima mtmbrúNe blabbing
ondansadianallohlasm anc Nurleus
5.loxmadion aao balibadies
6Pho4Olosir ol amblalit bodies by dhe
ma paga
No ina mmalo1 eALionOCLuas
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Biochemical chancgs
Bpoplailinullk ashally exhibit ditinctiue hiochemical
LhangusSuth as
CO Page NO.
1 Koltin leavgqaCne ahe sptili aluothe
abptosi i prolein hudiolysis invaluing ihe
autiuotion_osVEYal Kaumtrsoyliheolidies
nantd_ú Lapau
dinoss linhoqe itnsive_bialtin_(iossinbi
by aansguamiar audiciion conuei (ytoplaimit.
ioltins Inio (ovale ndlylinhed shyunhenulls ihl
l beos inb oboptdii bodies
hoholidylsexïnc Bhsptoic ella dlinguisoble
bphosbhatidylseiint exirnalizaiion,idtniyinj
Re meluE dispasal hough_þhagayiais
oplolialls tan be idunli|iec by niousmtdhd
L DNA caqes dedtuid by gel etho pho isi
Ennoin yshih hpoti
apepioli ll mm.bxane aingphos.hhailid ylarini
on he plena saxau oll
TLHaemakylin slaining of Chxomadn_tondensallon
hanii oapspbsis
Aobiosis Lan'be isgued byieapal and inlend
dimuli The sptiliplasma membrpnt dealh seepla
tonile heîteanal palhusny oxiginate oiihin the
mitoubondion
ADadh Recebtoa athuny
LBMikcbondial athun
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SDate
To Page No. .d
optosis isbiolgiLal baocei
papiosis is 1esbankfhe o2 mtdiaiing ilda
auide ariiy o_physialocital abd_pai»
logutal oCtis aY undka
hsiolital _apopiosis
Ebrydqunais ormation ofligitsasm
limb buds
lnsirual tgleiendamtiricl (ll_lass.
cast ding xNaial of changt ln h
adalind batut onte batcast ecling 1s1zishs
Nmmune ull_devlopmeniidzlyelion a muni
celk C-all Ahat ay1Lad ouih he body
*athological abo blosis
umou h balan(e blusapo þiosSi anclca
xolieralionjsdistusbed in heapla.iia
LAnophy os in anaphic iuesis bu
gabloris eg ial he it heilis
OS lassof ymphosei by ahapi.sis
alhologi Lliicalion
ialka anpcon as htlesihobi calciltcadan
lhologi caluiicalian s C_Condion ahen
alium all ai dasiid in lisue dlhesthan
aeoicd o emmil. here01 a gineial
O aihGlbgi_Lalitaion_
DabhialiIicaiion
LDeiastaliu Lalfitation.
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W3LI
Date:. .
OD Page No.
1U4shophiu Caliliialion.IHislaLondiiionin
oich thtae is deposilion_o alium and olher
mintials in drad o1deguhealed liau iih
hoaalcaltium levelu_and calcium milabolisn
ometors lihe changeof pn lha htLotic
Aue and aleass oYnmts, q alboline_phosbh
ase
das iali talciialion2Tisa (ondidion in.
hich (olCium_ dasils in boxmaliSUsO -
assoLiciled uoih hype_ (al (atmia and de1onged
Calkiummeiaoih Becaus byp talcatmie
Casts mtlauiaiiL
T may be due do
LAS idemobil2aiion oalium om lhebans
ive ahorolion Ldluium om ihe 9ui
Bony deshudian leaians Juch 'a msiasli
aliiaalfonin normolí lissue
Abopiosis
Loss oellHscullconladNo such los
OLu-
2Csbinbage
homalin codepsaiion Nucleusdiuluxed gnc DNA
rd DNIA hog mtndadion damaq LLu aandomly
Nsilamuion
5Dah o ngle ll ulo munodatntulldaur
eLie aildimuli Requi seE dinali
enta4 debdent
O elk and plasmaOgaKllkra1 dama4Ld andd
mmbiont is iniad_ plaima_mem bsan
NtLIOSL
Sue llina
nbmiion OLur 4
Eneyqy loRS noT 3e4uir/
Laupled.
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dO Page No. .
llular AdaplalionaLullula odabialion i
kodilion whtn Lls maht0umtnis usip
h hnangis in lhe nuiIomnT, o the noh-
cdtusiaests liba patholoqitdl njuy ad h
Physiol0gical nttds Sameo these odablalic
Dyolvehangesi llular91osihi2e y
Heto iionand includehyhyplasia,_
hyaiiophy adsophy Onc dyfaophy..
1HHprblasigHyperblasia isan inuta1tin h
numb Quis in aD Oxqah 0iSSutohi
yhen_ öueinCTLased Utumt.Hhoug h_-
ber 1boobb
Rinciive_paLtsi, htqunlly boih octun
rother dogdht Hypta blasia cahbe physidlogi|
oxpaiholoqic
nd hybea þlasia_re lua
hysioloqital hyþ blasia' Thi Julher an be
diidedino
*Homoal hype plasia e9. lhe prolieqlionLo
andular lhllum o he Jemale breastot|
ubiy apd
omhsalosy hypblost atntoliono
alloolhg bartia he hiim.
L
duxing xanCiny
alhalogira hyprplasia- lMart oxm o
patholo hyblasia ox due so
tnskive
homo sHmluladion ox duc do eles o
asouthacdor on
Ja4i
Kuda Laz(ind malolus hypiaplasia ohe
Sin
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CO Date J.
HpeiiophyHyber1iophy ison ine. in the
hel Slubmpained by on_augmenle
unci1ona tapoLiiypilhoui_ any Yhan1 n 1be
humbAO4 lls. H4pr12ohhycan De-pnyclbbs
D_tholoqï h b&th_oih& cases hf
may be inLeaLed unztonalglP mándOY
t eksivehoxoonalsiimulailon.
CO Page no. *
ysioloqial 4peiophy, eqi dhe inlangmen
oheJudenur in pis4any
Pahalogia
bP Lmule
H ophy o htle al musle
hpy phktdl imulLles in manlualklbauxtàS
he tin Mon milal insuiihy_and
SHhos
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141
TRIPLE RESPONS
nplaining hauoaurauc clhaun
ACUTE INFLAMMAT ION
nduu Hu chamqs in Hie
in aspe
a by fium
short dumaion
Cany body heaciom
nesot quicbly
ualy obloud by hualing
mam atus -
accutulaten o Huiad bplasma at
sheduing t blunt poimt.
Kuaction liited 'u iplolud lineKesporue.
a)
Kad nt aPps yiw ecs atn
aokng
oapillaus, unul
() Fla buget nuddish apptaaute
uwnoundivg #he ud luu nulli
Hom vasdailauon o adiaeut atuiols
lheal utlig lodeua of
uusbureln9 kin due to trausudation
kuid ulo eukavaacular 4pau.
thse teatuns eliui Ku dauial
Aigms infammatuon:hudness
,ueat,
uuellug b uluch pam added.
: duu to loal vasodilatuon
Inhauasculas actunlin o platelet
polynuorphuonuclar nubopili os
inlammatoy cells
&euwe aute nlammatoy HLsponse
FULHINANT ACVTE INFÜAMMATION
Diuided ntli golloiny 2 uenu
OVASCULAR EVENTS
Alaatuos in miuovasculatua earlist
altuahos: Haumodynamic chaugu
chamgs m vosular pumuab. 12 ALTERED VASCDLAR PERMEA8ILITY
Patuxgneiu :Accumulation of oedena
luid in the itonstulial pae
auoundHu infiamud amu
Suituall, esapt ouid
due to vasodilation uotauent
n ydottatc muwe-TRANSUOATE
lsbsuquently, A
vasulan pumahilily
micnocioulation cauns harautuibhe
tnglaunmatoy odema - ExUDATE
ndlammatoy oedsua duu to ta VasCulav
tmLabikly nplaind by snaRlING's
1-4 HAEMODYNAMC CHANGES
bWood plakma
mmaiate vascula Jusponse
TRANSIENT VASO CONSTRICTION OF
ARTERIOLES . Mild injuy uflow
m 5 himatu.
(6)PERSISTENT PROGRESSIVE VASODILAION
nn alp, mainy.4edh nmls
Capillasies. Ruuls n1d bood
#e
volume m miuovasulatut ,Kusonmiblu HNPorHESIS {uid balame "maimtanud ba
o udniswun at hu aik.
OINTRA
HYDROSTANC PRESSURE
)oCAL HYDROSTATIC PRESsSURE - elevald
by vasodilation, usuulh in trammudation
Huid m enhatellular space.
Raspbnaible pr sulling at te ite.
(a)SuowINGSTASIS miaoirulatuon
olous 1o me o ud ulls
raiud lood uisuosih
l
LEvCDOYTIC MARGINATION/PERIPHERAL
ORIENTATION OF LEDcoo¥TES along HnL
vasculan doHuum uhu huy c
biy mirate to tu
Clavasculan space-
iratuon
Mane
INTERSTITIAL
FLUID
Pe Causng outwaad
aid hom iaoiyulation
CoLLoID aSHOnC PRESSURE oF
mut
UASWLAR COLLOID OSMOTC PRESSURE
HNDROSTATIC PRESSURE O
INTEL
STIAL FLUID - Koies aulany
MGMiment
uteutitial Huid in
nuvard
cArTulatuon
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PATTERNS oF
INCREASED
VAScUUK
PELMEASILTY
9LEbCoONTE MEPIATED. ENDoTHEUAL
INJURY
Adhuunce ol lucouyks to mdohelin
may Huull' n Hui ativataon
Thece atuvakd lucoyts kuluau uclolylic
4m tonic O2 4prcits uuliuch
ay taui mdotulial cell lju
1d vascular uaks
'Auus enules
Late nesponse
lur non peaumahle eudotelial lay
wiOno vasuulature kcomu Leaky
aused by fd vaslas pumuabilu
ollouuing pallms ocC
) Coihaton o cndokulial ull
MOst uommon
uchmm
beou umuls, not capillanis,autaiolus
upoay gap dullopd blw endolluelial
culls duxdg conbacton uullug
uatagt
Madiakd by luskanunt, bradybun
Rspense ahot dwatn HUUL be aly omuud tapi llanis N
' hot uuelu immediate trausiunt
rupone wila Homal injuny
Hin o kaua
9 itu wluu lutocyka aduunu to
VQsCulan
uudbhelim -iu
ona unules k apillanits
6) LEARINESS
IN NEDUASCULARISAON
nlucine Vula ndotulial
Grouwh Fator (VEGF), dunung He
POUK 6 kepain u Leaky
: in ualug
, tumos
(2) Cowtnauon a wld wdohulial
damag
stuctual u-ogauinalun yloukelutern
dohuial tells
Ruuwuible ebracun al utndlulan
uundiont
a4tch ulu apillaius
Meaiakd by ytvbus utnteukin I
RespomAu laiu Kon Atuual hous twdauy. apt oucoe hm umeun
g oi dlayd puoougdl lakage
ptaramce eLneunns muliated
by UV radialm
() Dinut injuny to udoulial ulls:
dinnct inuy auss ull nuuou
puyskcal q2ps
9locoss o uuombou mvoluung
Katelelä, ibin uitiatd
hamgt alttus a muaOvasulatu
1d nummiabilily may iu appeas
immadiatdy n may Dcu altu
adelay o2-12 hs
o imudiate Austaud
Liakag bactuial tukcions
o uolongaa luatag umal
CELLULAR EVENTS
oceKtstudahon od lucoyks
phagocytbiu
2 ExUDATON OF UEUCDCY TES
intinstulial uu mout mup
hatuu of glammaton
9n aute uklammaluon, fdmapho -
nuduan neuhopid coupef Liua
o duleust ollouuct by monoyks k
mauophags
CHANGES IN FORMED GLEH6NTS
OF BLDOD:
Rlauy dage- bload {low nale 1 due
to vadilaton
uheguent slouuung HoodilNam
du tw
Moung, tenral osiam
cellsluuoayk RBCs) uidun
paphusal
namou los oplama by
mudaum-MARGlNATON
poma e betems
&radiatubn uy
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22PHAGOCYTOSIS_
Paoes ol ullulas vgulbmnt of a
40lid paxdueulate matter Imiunobs)
wll taling ( ull dinkg rinouytosu)
main typs q phagocyte cells:
O PMNs- appeas tay n acute
iawnatony ksponuë ; hometiumts
calud as mácophages.
(2)ROUNG AND ADHESION
'
nipunatly magnattd &
paunnenkd
(nurophil "ounal column tonuug
uoe to wall) nuoptuils Aol oun
Hhe ndohaelial tells" luun Hw
w
wall (adktcia plhael rlliug phaue
ollouud y bonds blw eutcyte b
mdohuliat cells beuemung
ladhuion puauu)
Foll moleculls buuy alut rollung,adlusim: e Monoyts oud mut mmonuduas
SELECNNS
pAd on sulae d
aivatd ndoHulial clls
Coll reuoqniuu bund to quytopaolmu
gyolipids tn u udl
sfat o
nukopub
(i1) INTEGRINS:
ndotlial utl awface
bkiu auing a o suhuuli uluch
u adivad duuin Hu uvun
Adhuim blw mdoHuial ulls
Lcoks
iiy IMMUNDGLOBUUN
GENE SUPERFAMILY
ADHESION MOLECULES
partake un
ull - to -
ull ontat
phagoyts caltid. as mauophags:
Poh ust om neaching Hu ill o
lnkectie uaduce uottolytu ungy*s
ome, uateasu, colagunae, upasu de
hse nzymu duqmde cllagn
Cnhacellulau matrix.
3 seps phagouytvs
O Ruognulion v Atachmunt
.tell buuau neuuptors o mauophags
KcoqNis miuoo1gamims
(manos Heuptor Scauengu keuptor)
MicLoorg upaid ho taling lopkeisatuon)
when coakd t speihie juotus
OPSONINS
(3) EMIGRATION:
Ae stiching to mdoHmelial ellh,
uthoptil mone along u Auyace
HL a suitable sili_ blio undokaelial
Culls is tpuudjhaow out ytoplalmic pod
Neubropuils lodgd lw udokulial
ws & bazemant. mmbranw uDs
by damagiug' it locally t Aouagenase
Lstape no urawasculas space
Simuulhanous b uigralion o uuoyka,
ed uls Huu u aps also luaue -
DIAPEDES1S
lgCi opsorrien -naturaly occuning
amt body n sum ccat bactuia
Ruupor:Fekpor or lga
C3b opkoiun - strcnaly chumötaclhe hon
allhactg PMNs to hmctuiu
Reuptor: complment huupor 13.
llectis - Canbohydate bundu ucns
plasma uli
cell wall
kuptor Ua)
Opsovnns utablsh a bomd blw bactria
& ull mumbame el
bind to bakuial
) CHEMOTRXIS:Hisratuon of ucoyleu
a uouiug uat bauinsto
intoutdal tusus
phaaouyhc
Ggulment
yhoplasmic rseudopods houm auouwnd Hu
paticte duu to adivation o aclun
lamu unulopiug ub n phagry
vacuole-(hagosomef:s
n
larma mmbranu nlourg pastile tuahs
ko at phagesomubuoms intunalud
Chonuotans
ehmotaclic uubutavne hor
utroplil: ukotiune
4
ytokins (udulubin), solubls
bactuial poduch
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Hhe ell s lishu in the
wll uytoplam.
*
Phagosem ms t yso tomu to fouw
a bigo Vatuolu phagoysodome
Killing and degradation:
mamuncaom skoo plhagocyts-
illing diradation miuðbu
Htn biwg billud by anlubattuial,
daradudby hydnslyluo uzmes
hails bo
El Aomu bactuia üku
tubude bacilli.
*Foll muchamiam invoued udisposal
)&mhrauellular mthanins
Rtactit 0, 4puies Nime onide
wosomal qrauls
8) Ensautular muchamisms
Actvated ucouyts Qmmue methaniwis
Nuctaophil enhacillulas tmes (NETe
CHEMICAl MEDIATORS
OF INFLAMMATION
ndogunous chunita uubstanus
uhic mediat tu mous o
inlamation
Ptopesbias:
O Ruluaud Ham ullh (skorage ot tunmesisud
n cell) o deriued Hom plasma
Motms(most tommomsilh - liun)
uluasd m tponst to uutam slimuli
(muious agm dead su mdiakor
At om dih taageti :may at on ulls
kowmed
body cel4
uucw
Ahort pan altr nelease :
rapidly
nemana nymatuc inadtvätun,
amuonidamla"
mast wmp
Hau suuenal acions
Id vasulan umabuity.
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Aystemie 6eek o
c:
CHRONIC INFLAMMATION
Pholonged elt eaas MOes w uhih
tmue dstuuchon ad intaMmaton
Ocuus at Hu lme me
may occu by nt Ha ays
o Fu :mla u t lou
eig mioku
AUamia: chl n acompaniud by
anauia uajiug du
Luoytoiu tuucoytois alorg
t
rulalue ymphouytosu
O thuonic inklammaton (oll autu
intlammatuon
uthun tusue duhuchen u entemsue
o Hu batvia swmie rUList
oskomyius
,puruumenia tuminaiug
n ung abses
ESR elvated u all us
Long tum casus o cw
nmay duulop 2° aytmic
amsoidous
Antoidosis
Reurnunt allaks e auili ullaunh
uhun upeaked bould o auute " tlamm
ulminate n chsoniwy of paoeis
: im necwnent winay raut nlectuon OuouC nm-sptcikc inlamwnation
ading to dhaeniu Opyelenuphiibs.
yps o chuonic iukamwmnalun
chuonit lammauon starbung dinovo:
ineetion't of low pallauitiy
baginmwng
4 ction t Myiobactiiun
ritant uoduus non-ip du ig rxn
on ramuulaln ine
ualung by kbrois
uonic outtomyeliu
a vaniant of tuis tyPe 's chaouic
uppatue iutammatum
atnonyosit
Hubuwloss
Gunal katunes
chuonic qyanulomatous inklammatuon
injmious ageuls cause haiatuuhe
utlogic tuaue rupmue by kom" f
raulomas
bubeuuloais, lepray, 4uphilis.
0 Menonudear ull infilbalon
Clu. i luions a ufibraked hy
uonoulan wlls ike phagouytes.
(Pagocybts mnoyks, maciophages
cpikuldtd ulls)
Mauophags mast inep cell m using
o
n adwatuon, ndau biologially "aduw
AMbs
Qcid nuubral paöteasus
ingaboub hssue desucton
,
fbo
toku i ulds : luympbuouks, plasrma
uls, e0inophuils, mast ells).
Ti desbuction/ Netoris
Rupuglt abaut by autivaka mauophag4
which
Lpas ROs, ND, yokunes
solienatuw changu
Kuleas latasu, colagunae
mf amdlU loal unels
toroblaal, 4timulaked koums g
qramulabuon Uu buwna Kibro0
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39. Page 6 of 6
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har:
by 2 iutuntivn (2° uionm):
peun t a Lamge usue duect
ug tusuu lou e ells b nus
wound notapuosimattd
ungical suluu but iu kE ep
HEAUNG dy'k nsrense
u a atunpt to Hstoie nomä zr
" 9mouits 2 mouns
Lgunation hiaung bynoliatuon
panhymal ullsconplete
estouation onigunal tiues
Lepous hualing by uolijeation
Conuutiu tnie "rultiug w hbroe
Healing o kim wounds
lasical enample of comb" of varep
OHealing by 1 itntuon (1° uwin)
dhas
clan niuetd wgically musud
Tout much lou of wlls' wmues
dgs owound apruoKimatu bu
Uagical &uhues.
ial hamornhag mmdiatly
torainguwy, pau blw ntgus
miud wound fitlud t blood Huu
doty t seals Hu uwound agimst
dey diatuon t inkduon
CAcule inlaunmatoy HupruL n 24 has,
appeanana
f polydoyhs hem mangin
incion
iEpiHulial thagrsl aolindton o
basal culUb q epidumis owards
inasional spaulw thw hown eplelial
spuw). Miorated pidmial ulls deparat
Hu unduntyng wiable dumis hom
lying aöhe matuial komuing Stab
wlich id (at ohb By 5" day,mulhlayoad
w tpudmis u omd
Dgamuau.onl: By 34 day ibroblaut
wade tu wound a. by 5" day, tollagen
kbrils komm uuich dewunate u alg umplt. tiuue is dup kud, qrmulan, fragile .
uuks, 5an mue, a u b uus,
ept multalisd mutau u fowud
Sukune tradks
7aas kom 1 uin in tai lag
L
diet uluich has o bu bridg
ALalug hyom baLL upwand & mangn
inuwnd
douw hualung ,
luge,ugy scaA
(as compand to apid 0hualing neat
Scaa o 1 uuion)||
Auaunu ol
ubna
(D[9udial Jhacmouhae As a nulk
9 uuy uwd spau jilled t
blood kibin dot
fi lammatou phae] uilhal auull
in naspomau ollouud by apptaMnLL
mauophages utih deas
d Hu debis .
üi) Epikalial haugu pidmal wlls
udliuate inlo tu uwound wl Huy
met he uiddle k rt-pikelialisu
e gpp coplekely. henu alls don't
Leuu Hu 4nfae huly ml ramalati
6n umuom base itas iliug
wnmd pÃte. Tuus me euislwq uiabl
lennctiuw mu Apaakd hom
Hnotuc mateial L
dot, kemmuig a sab
replated by mauphags
armulaion ieue Maim bulk of hualing
u by. 9rauulatins hpmed by
ucilaat onm
6 kboblasts &
üovasuulas-
abon uuuy pmd qrmulation
Scan en matnaho buems pale & uuliila
duw to 1 m calaqenk m vaaculaiiliy.
Mlaund. owtraction saea 2 kalirg
up, ot n l alung
.aue to aiuon
/34 toVy
myhbrobDAlA
, uiond
(iPrune iukctnl kactuial wvtamiur
a epun uwound dulays Hu
QuL
huiling duu to nulease o
hat noucku neioia,
dou..gal ronuval o dead Hat-
tonius
DEBAIDEMENT
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