JOLEJOLE, Kristina R.

2B - 7

September 18, 2015

INFLAMMATION AND REPAIR

1. Identify and describe.
This is an Inflamed Appendix.
Edema and hyperemia can be seen in
the specimen.
2. Discuss the pathogenesis including
the biomolecular aspects of each
event
o Vasodilation (primarily mediated
by Histamine) and increased
blood flow
o Increased permeability (due to contraction of endothelial cells) with
outpouring of protein-rich fluid into the extravascular tissues
o Stasis seen as vascular congestion
o Leukocytes (neutrophils) accumulate along the vascular endothelium.
2. Clinical manifestation of each phase.
Calor - increased blood flow
Rubor - vascular congestion
Tumor - edema
Dolor - swelling and production of chemical mediators

margination and
adhesion

margination and
adhesion

rollin
g

chemota
xis

Magination happens in the presence of stasis, wall shear stress decreases

and more white cells assume a peripheral positon along the endothelial
surface. Leukocytes adhere loosely to the endothelium, detach and bind
again, thus rolling on the vessel wall (Selectins). At some point, cells finally
adhere firmly (Integrins). Then the leukocytes will transmigrate throuh the
endothelium or diapedesis (PECAM-1). After exiting the circulation,
leukocytes move in the tissues toward the sute of injury by a process called
chemotaxis (chemoattractants).

Chronic inflammation:
- plasma cells, monocytes, and fibroblasts
with spindle cells. Plasma cells can be
differentiated by having eccentric
nucleus.
- small, round, dark-blue lymphocytes in
the submucosa
- there is also hemorrhage

- liver with chronic hepatitis

- portal triad is expanded by mainly
mononuclear
inflammatory cell infiltrates
- extension of the inflammation into
adjacent hepatic parenchyma

- fibroblast proliferation
- numerous blood vessels
- edema
- loose extracellular matrix with occasional
inflammatory cells

Granuloma:
Epithelioid
cells - activated
macropahges
pink granular
cytoplasm.
Located in the
center
Langhans
giant cells large mass of cytoplasm, many nuclei. Derived from fusion of
multiple macrophages. Located in the periphery
Fibroblast - rims older granulomas
Lymphocytes - collars aggregates of epithelioid cells
Caseous necrosis - grossly, granular cheesy apperance; microscopically amorphous, structureless, eosinophilic, granular debris with complete loss of
cellular details.
Regenerative nodules of hepatocytes ringed by
thick bands of collagenous fibrosis. Within the
fibrous bands are lymphocytic infiltrates and a
proliferation of bile ductules. Liver injury leads to
Kupffer cell activation with
release of cytokines, such as platelet-derived
growth factor and tumor necrosis factor (TNF), which stimulate stellate cells

in the space of Disse to proliferate into myofibroblastic cells that contribute

to the fibrogenesis.