Pathology of Inflammation

“The investment you make in yourself must receive ‘Top Priority’. When you GROW your entire world Expands...when you do not grow your whole world starts to become ‘Very Small’...that smallness reflects in all areas of life including your income." Bob Proctor Author and Personal Coach Inflammation Pathology of Inflammation Dr. Venkatesh M. Shashidhar. Associate Professor of Pathology Fiji School of Medicine Shashi-3/04 3 Inflammation Introduction:     “In-flame” – to set fire. (red, hot, pain) Inflammation is “dynamic response of vascularised tissue to injury.” It is physiologic, protective response. Serves to bring defense & healing mechanisms to the site of injury. Mar-05 Inflammation INFLAMMATION Shashi-3/04 5 Inflammation Inflammation Causes: ..Injury      Physical agents – Trauma, radiation, Infection – microbial agents Chemicals – acid, alkali, toxins Ischemia / Infarction – lack of blood.. Immune reaction Mar-05 6 Inflammation Appearance of Inflammation:    Flush: Red spot - capillary dilatation. Flare : Red area - arteriolar dilatation. Weal : Swelling - exudation, edema. Lewis Triple Response: - old…! Mar-05 7 Inflammation Cardinal Signs of Inflammation      Calor : Warm – Hyperaemia. Rubor : Redness – Hyperaemia. Dolor : Pain – Nerve, Chemical med. Tumor : Swelling – Exudation Functio laesa: Loss of function …(Virchow 1902) Celsus, 30 BC - Latin Mar-05 8 Inflammation Calor, Rubor, Dolor, Tumor, Loss of function. Mar-05 9 Inflammation Surgical wound inflammation: Calor, Rubor, Dolor, Tumor, Loss of function. Mar-05 10 Inflammation Inflammation - Mechanism 1. Vaso dilatation 2. Exudation - Edema 3. Emigration of cells 4. Chemotaxis 5. Phagocytosis Mar-05 Mechanism of Inflammation: 12 Inflammation Mouth Aphthus ulcer Calor, Rubor, Dolor, Tumor, Loss of function. Mar-05 13 Inflammation Laryngitis: Calor, Rubor, Dolor, Tumor, Loss of function. Mar-05 14 Inflammation Acute Enteritis: Calor, Rubor, Dolor, Tumor, Loss of function. Mar-05 15 Inflammation Pneumonia Inflammation of lung Calor, Rubor, Dolor, Tumor, Loss of function..! Mar-05 17 Inflammation Emigration of Leucocytes Mar-05 18 Inflammation Neutrophil Margination Mar-05 19 Inflammation Lung Normal / Pneumonia Mar-05 20 Inflammation Pneumonia - Exudation Mar-05 21 Inflammation Normal - Meningitis Mar-05 22 Inflammation The 5 Cardinal Signs of Heat Redness Swelling Pain Loss Of Func. Mar-05 23 Inflammation Chemical Mediators of Inflammation:       Cellular hormones – cytokines. Released by cells act on same or nearby cells Each phase of Inflammation is orchestrated by several chemical mediators – cytokines. Modifying these modifies inflammation – drugs Endogenous & Exogenous. Locally produced & Plasma factors. Mar-05 24 Inflammation Chemical Mediators of Inflammation: Locally produced Histamine Seratonin/5HT Interleukins. Prostaglandins* Leukotrienes* Plasma derived Kinins Complements Coagulation system Plasminolysis system Others: H2O2, NO, O2*rad. Mar-05             25 Inflammation Chemical Mediators of Inflammation: Vasodilatation: Histamine, Pgs, Nitric oxide BV permeability: Hist, bradykinin, C5a, LB4 Leukocyte adhes: IL8, LB4, C5a, TNFα Chemotaxis: LB4, IL8, bacterial toxins, C3, C5. Pain: Prostaglandins & Bradykinin.      Mar-05 26 Inflammation Chemical Mediators of Inflammation:  Vasoactive amines - Histamine, Seratonin – vaso dil.     Complement system – C1-9 cytolysis, opsonins.  Kinin System – Kallikreins  Bradykinin Clotting system – FXII, FX, Fibrin, Plasmin Arachidonic acid metabolites:  Prostaglandins - (cyclooxigenase) - Pyretic  Leukotrienes – (Lipoxigenase)  Lipoxins – anti-inflammatory action also. Others: Mar-05 Chemical mediators in inflam. Cell Damage Cell Membrane Phospholipids Arachidonic Acid Steroids Cyclooxygenase 5-Lipoxygenase NSAID 5-LO inhibitors Leukotrienes LTC4, D4, E4 Prostaglandins Prostacyclins 29 Inflammation Types of Inflammation:  Time:  Acute & Chronic Suppurative – neutrophils - bacterial Fibrinous - fibrin - immune Serous – fluid - viral Granulomatous – chronic – TB/fungus/Foreign body. Eosinophilic – parasite, immune. Mar-05  Predominant process:      30 Inflammation Inflammation Types  Acute – upto days.   Vascular changes : Hyperemia & exudation. PMN’s – Neutrophils, Pus/suppuration. No Vascular changes. Fibrosis – Scarring. MN’s - Lymphocytes and macrophages  Chronic - Weeks to Months or Years    Mar-05 31 Inflammation Inflammation Outcome Chronic Inflammation Injur y Acute Inflammation Healing Abscess Fistula Ulcer Sinus Mar-05 32 Inflammation "It gives me great pleasure to converse with the aged. They have been over the road that all of us must travel and know where it is rough and where it is level and easy...!" – Plato Mar-05