Patho - Lect 1: Inflammation

What is a complex series of reactions that from injury, immune reactions, ischemic damage?

Inflammation

Which line of defense:

• Mechanical barrier

• Unbroken skin and mucous membranes

• Secretions such as tears and gastric juices

First line of defense (nonspecific)

Which line of defense:

• Phagocytosis

Second line of defense (nonspecific)

Which line of defense:

• Production of specific antibodies or cell-mediated immunity

Third line of defense (inflammation)

Inflammation and Tissue Repair

Injured cells release __.

prostaglandins, proteins, potassium ions.

Inflammation and Tissue Repair

Changes interstitial environment and stimulates __.

mast cells

Inflammation and Tissue Repair

Mast cells release __.

histamine & heparin.

Inflammation and Tissue Repair

__ - causes area to swell, redden, pain, and raises local temperature.

Increased blood flow

Inflammation and Tissue Repair

__ - clean up pathogens and cell debris.

Macrophages

Inflammation and Tissue Repair

__ - form scar tissue.

Fibroblasts

Local Effects of Inflammation

__ - caused by increased blood flow to damaged area.

Redness and warmth

Local Effects of Inflammation

__ - shift of protein and fluid into the interstitial space.

Swelling (edema)

Local Effects of Inflammation

__ - increased pressure of fluid on nerves; release of chemical mediators (e.g., bradykinins).

Pain

Local Effects of Inflammation

__ - may develop if cells lack nutrients; edema may interfere with movement.

Loss of function

Physiology of Inflammation

Disorders are named using the ending __.

-itis.

Physiology of Inflammation

Inflammation is a __.

normal defense mechanism.

Physiology of Inflammation

It is not the same as __. However, is one cause of inflammation.

infection

These are causes of what:

• Direct physical damage

• Infection

• Ischemia or infarction

• Allergic reactions

• Caustic chemicals

• Extremes of heat or cold

• Foreign bodies

Causes of inflammation

Inflammation

Acute response is based on …

• Rapidly occurring vascular changes

• Influx of cells like neutrophils

• If systemic - widespread effect of inflammatory chemicals

Inflammation

Chronic response is based on …

infiltration of cells like macrophages, lymphocytes and fibroblasts.

Inflammation

Outcomes of chronic response are …

• Persistent state of inflammation

• Scarring (fibrosis)

• Necrosis

• Proliferation of blood vessels

Acute inflammation

__ - in connective tissue close to blood vessel - Histamine.

Mast cells

Acute inflammation

__ - Bradykinin - increased vasopermeability and pain

Kinin system

Acute inflammation

__ is the clotting system and __ are vasoconstricts to stop bleeding.

Platelets, serotonin

Acute inflammation

__ - a fluid with protein and cellular debris which has escaped from blood vessels and has been deposited in tissues.

Exudates

Acute inflammation

__ - watery with little protein.

Serous exudate

Acute inflammation

__ - thick, yellow-green, contains leukocytes, cell debris, and microorganisms.

Purulent exudate

Acute inflammation

__ - dead cells, proteins and tissue debris.

Pus

Acute inflammation

__ - a pus-filled cavity resulting from inflammation.

Abscess

Acute inflammation

__ - leak of blood into the tissues.

Hemorrhagic exudates

Acute inflammation

__ - due to the presence of fibrinogen it is a thick, sticky mass.

Fibrinous exudate

Acute inflammation

__ - on mucous membranes, necrotic cells within an thick exudate.

Membranous exudate

What are these effects of:

• Mild fever (pyrexia)

  • Common if inflammation is extensive

  • Release of pyrogens

• Malaise - feeling unwell

• Fatigue

• Headache

• Anorexia - loss of appetite

Systemic effects of inflammation

Which potential complication of inflammation:

• Microorganisms can more easily penetrate edematous tissues.

• Some microbes resist phagocytosis.

• The inflammatory exudate also provide an excellent medium for microorganisms.

Infection

Which potential complication of inflammation:

• May be initiated by inflammation

• Protective response to pain

Skeletal muscle spasm

Potential complication of inflammation:

__ - may result from severe or prolonged inflammation caused by cell necrosis and lack of cell regeneration that causes erosion of the tissue → Can lead to complications such as perforation of viscera.

Deep ulcers

What is chronic inflammation?

Recurrent or persistent inflammation lasting several weeks or longer.

Chronic inflammation is often related __.

to an unsuccess acute inflammatory response.

Chronic Inflammation

__ - wall off foreign bodies like splinters, sutures, silica, asbestos, microorganisms.

Granuloma

What are these cause of:

• Persistent infection like TB

• Prolonged exposure to toxic agents - atherosclerosis

• Autoimmune disease - SLE

• Viral infections - HIV

• Persistent injury

Chronic Inflammation

Which type of healing:

• Infiltration by cells of the immune system

• Angiogenesis - attempt to heal

• Fibrosis

Resolution

Which type of healing:

• Connective tissue replacement

• Returning injured tissue to the original structure and function

Regeneration

Which type of healing:

• Functional tissue replaced by scar tissue

• Loss of function

• Fibrosis, scarring, or granuloma formation

Replacement

Scar formation is the result of normal cells and specialized structures such as __.

hair follicles, nerves, receptors.

Scar Formation

Scar tissue is __ and can restrict range of movement.

non-elastic

Scar Formation

__ - bands of scar tissue joining two surfaces that are normally separated.

Adhesions

Scar Formation

__ - overgrowth of fibrous tissue → leads to hard ridges of scar tissue or keloid formation.

Hypertrophic scar tissue

Scar Formation

__ - blood supply may be impaired around scar → results in further tissue breakdown and ulceration at future time.

Ulceration

What does the R in RICE stands for?

R → Rest

What does the I in RICE stands for?

I → Ice

What does the C in RICE stands for?

C → Compression

What does the E in RICE stands for?

E → Elevation

What are the effects of glucocorticoids?

• Decreased capillary permeability

• Enhanced effectiveness of epinephrine and norepinephrine

• Reduced number of leukocytes and mast cells

• Reduces immune response

What are the adverse effects of glucocorticouds?

• Atrophy of lymphoid tissue; reduced hemopoiesis

• Increased risk of infection

• Catabolic effects - increased tissue breakdown; decreased protein synthesis

• Delayed healing, delayed growth in children

• Retention of sodium and water because of aldosterone affect in the kidney

What are these types of:

• Thermal - caused by flames or hot fluids

• Chemical

• Radiation

• Electricity

• Light

• Friction

Burns

Which classification of burns:

• Involve epidermis and part dermis

• Little, if any, blister formation

Superficial partial-thickness (first-degree) burns

Which classification of burns:

• Epidermis and part of dermis

• Blister formation

Deep partial-thickness (second-degree) burns

Which classification of burns:

• Destruction of all skin layers and often underlying tissues

Full-thickness (third- and fourth-degree) burns

What are effects of burn injury?

• Both local and systemic

• Dehydration and edema

• Shock

• Respiratory problems

• Pain

• Infection

• Increased metabolic needs for healing period