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Inflammation
Acute and Chronic Inflammation
 A complex reaction to various injurious
agents
 Consists of vascular responses, migration
and activation of leukocytes, and systemic
reactions
 A protective response
◦ Ultimate goal:
 Remove initial cause of injury
 Remove consequences of injury

Inflammation
 Important in tissue repair
◦ Destroy, dilute, wall of infectious process  Tissues and cells are involved in this
◦ Sets in motion tissue repair
 Regeneration
reaction
 scarring ◦ Fluid and plasma proteins, blood vessels, circulating cells (WBCs),
CT cells (mast cells, fibroblasts, macrophages), extracellular
matrix (collagen, elastin), adhesive glycoproteins
 Unique features:
◦ Reaction of blood vessels
◦ Accumulation of fluids and electrolytes in extravascular space

 Components of inflammatory response

◦ Vascular reaction
 Vasodilation
 Increased permeability
◦ Cellular reaction
 Margination
 Rolling
 Adhesion
 Transmigration
 Migration

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Inflammation

Acute inflammation
Chronic inflammation

INFLAMMATION
 Inflammation is terminated when the
inciting agent is eliminated and the
mediators have degenerated.

Acute Inflammation Stimuli for acute inflammation

 Infections
 A rapid response to an injurious agent that aims to rapidly bring  Trauma
mediators of inflammation to the site of injury  Physical and chemical agents
◦ Alterations in blood flow  Tissue necrosis
◦ Increased vascular permeability  Foreign bodies
◦ Emigration, accumulation, and activation of neutrophils  Immune reactions

 Infiltration by polymorphonuclear cells (neutrophils, eosinophils,

basophils)

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Acute Inflammation
Mediators of Acute Inflammation  Hallmark of acute
1. Vasoactive amines (Histamine and serotonin)
inflammation:
2. Kinins (Bradykinin)
◦ Increased vascular
permeability
3. Complement system (C3a and C3a)
4. Clotting system
1. Arachidonic acid metabolites (Prostaglandin, Prostacyclin,
Thromboxane A2, Leukotrienes [B4, C4, D4, E4]
2. Oxygen metabolites
3. Platelet aggregating factor
4. Nitric oxide
5. Cytokines (Interleukins, TNF)

Acute Inflammation
 Terms
Edema
◦ Refers to an excess fluid in  Exudation
the interstitial tissue or ◦ The escape of fluid, proteins, and blood cells from the vascular
serous cavities system into interstitial tissue or body cavities
◦ Two types
 Exudate
 Transudate

Acute Inflammation
Exudate Transudate

Protein content High Low (albumin)

Specific gravity >1.020 <1.020 MORPHOLOGIC

Cellular components Inflammatory None PATTERNS
cells, cellular
debris
Pus
 An exudate rich in inflammatory cells (leukocytes) and
cellular debris

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Acute Inflammation Acute Inflammation

 Serous  Purulent or Suppurative
◦ Plasma-like effusion with no ◦ The terms 'suppurative' and 'purulent' denote the production of
cells
pus
◦ Contains dying and degenerate neutrophils, proteins, tissue
◦ There is abundant protein- debris, infecting organisms
rich fluid exudate with a
relatively low cellular ◦ Caused by pyogenic bacteria
content ◦ The pus may become walled-off by granulation tissue or fibrous
tissue to produce an abscess (a localized collection of pus in a
◦ Vascular dilatation may be tissue)
apparent to the naked eye
◦ Inflammation of the serous
cavities, such as peritonitis,  If a hollow viscus fills with pus, this is called an
and inflammation of a empyema, for example, empyema of the gall bladder or
synovial joint, acute synovitis of the appendix.
◦ Early inflammation, heart
failure, pleural effusions

Acute Inflammation

Acute Inflammation Acute Inflammation

 Fibrinous
◦ Contains large amounts of fibrinogen
◦ Forms thick, sticky meshwork that may cause areas to stick
together
◦ Thick fibrin coating
◦ Often seen in acute pericarditis giving the parietal and visceral
pericardium a 'bread and butter' appearance.

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Acute Inflammation
 Membranous
◦ Contains fibrinous or fibrinopurulent material with necrotic cells
◦ Often found in mucous membranes, some microbial infection

 Serosanguinous
◦ Contains both serous and hemorrhagic materials
◦ Caused by bleeding, serous exudation like injury and burns

Acute Inflammation Acute Inflammation

Exudates in Inflammatory Processes
 Hemorrhagic
◦ Contains large amount of RBCs and other cells
◦ Damaged or vascular injury or permeable blood vessels or depletion of
coagulation factors
◦ Acute pancreatitis due to proteolytic destruction of vascular walls, and
in meningococcal septicemia due to disseminated intravascular
coagulation

 Mucinous or Catarrhal
◦ When mucus hypersecretion accompanies acute inflammation of a
mucous membrane
◦ Contains large amount of mucous and epithelial cells
◦ Inflammatory conditions like allergic rhinitis, common

Acute Inflammation Acute Inflammation

Types of Inflammation According to Location
1. Abscess
 Localized collection of pus in a part of the body, surrounded by an
inflamed area
 The area will most likely look like a giant boil or cyst that can become
extremely red and infected
2. Ulcer
 An open sore of the skin, eyes or mucous membrane, often caused by
an initial abrasion and generally maintained by an inflammation and/or an
infection
3. Catarrhal
 Mucosal surface
 Thick mucous and white blood cells

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Acute Inflammation Acute Inflammation

Types of Inflammation According to Location
4. Membranous
 An epithelium becomes coated by fibrin, desquamated epithelial
cells and inflammatory cells
 An example is the grey membrane seen in pharyngitis or
laryngitis due to Corynebaeterium diphtheriae
5. Pseudomembranous
 Formed by the fibrin and necrotic surface epithelium
 A structure which resembles the luminal surface of the tissue
(looks like the affected tissue is covered by a membrane)

Acute Inflammation Acute Inflammation

Acute Inflammation Acute Inflammation

Types of Inflammation According to Distribution/Location Types of Inflammation According to Distribution/Location
of Lesion in an Organ of Lesion in an Organ
1. Focal 3. Locally Extensive
 Single abnormality or inflamed area within a tissue  Involvement of considerable area within an organ.
 Size varies from 1 mm to several centimetres in diameter  Also known as Focally extensive
2. Multifocal  Possible origin:
 Arising from or pertaining to many foci (several foci separated from 1. Severe local reactions that spread into adjacent tissue
one another) 2. Coalescence of foci in a multifocal reaction
 Size is variable 4. Diffuse
 Each focus of inflammation is separated from the other inflamed  Involve all the tissue or organ in which the inflammation is present
foci by an intervening relatively normal zone of tissue  Variations in severity may exist
 Interstitial pneumonia

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Acute Inflammation Chronic Inflammation

 An inflammation of prolonged duration
Outcome of Acute Inflammation
1. Complete resolution
 Infiltration by mononuclear cells (macrophages,
lymphocytes, plasma cells)
2. Healing (by CT replacement and scarring)
3. Abscess formation
4. Progression to chronic inflammation

Chronic Inflammation Chronic Inflammation

Causes of Chronic Inflammation Morphologic of Chronic Inflammation
1. Follows an acute inflammation 1. Infiltration of mononuclear cells (macrophages, lymphocytes,
plasma cells, mast cells, eosinophils)
2. Repeated bouts of acute inflammation
2. Tissue destruction
A. Persistent infections of intracellular microbes (tubercle bacilli,
viral infections) 3. Attempts at healing by CT replacement (angiogenesis and fibrosis)
B. Prolonged exposure to nondegradable but potentially harmful
substances (silicosis, asbestosis)
C. Immune reactions (autoimmune diseases)

Chronic Inflammation Chronic Inflammation

Granulomatous Inflammation Granulomatous Inflammation
 A distinctive pattern of chronic inflammation  Two types of granuloma
 Characterized by formation of granulomas
1. Foreign body granuloma
 Granuloma
2. Immune granuloma
o Focal aggregation of activated macrophages which are transformed in
an epithelial-like (epithelioid) cells, have an abundant pink cytoplasm,
and are surrounded by numerous lymphocytes and plasma cells

 Tuberculosis, leprosy, syphilis

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1. Foreign body granuloma

o Caused by inert foreign bodies
o Material (talc), sutures
o No inflammatory or immune reactions present

1. Immune granuloma
o Caused by immune T cell-mediated reactions
o Insoluble particles (microbial parts)
o Inflammatory reactions present

Resolution Inflammation (Healing)

 Simple resolution
◦ No destruction of normal tissue
◦ Offending agent is neutralized
◦ Vessels return to their normal permeability state
◦ Excess fluid is reabsorbed
◦ Clearance of mediators and inflammatory cells

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Resolution Inflammation (Healing) Resolution Inflammation (Healing)

 Regeneration  Replacement by a CT scar
◦ Replacement of lost or necrotic tissue with a new tissue that is ◦ Formation of a new type of tissue that causes fibrous scar
structurally and functionally similar to those that were destroyed production with some loss of tissue function
◦ Angiogenesis
◦ The intact, healthy neighboring cells surrounding the dead cells
will proliferate to replace the affected cells ◦ Migration and proliferation of fibroblasts
◦ Deposition of extracellular matrix
 Replacement by a CT scar
◦ Remodeling (reorganization of the fibrous tissue, contraction of
wound edges)
◦ Cicatrization
 Formation of the mature scar
 Cicatrix
 Scar
 Less vascular, pale, contracting scar tissue
◦ Epithelialization

Resolution Inflammation (Healing) Resolution Inflammation (Healing)

Resolution Inflammation (Healing)

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Systemic Effects Inflammation

 Fever, increase in pulse and blood pressure, decreased
in sweating, rigors, chills, anorexia, somnolence,
malaise, lymphadenopathy
 Increase plasma levels of acute phase proteins (CRP,
serum amyliod A protein)
 Leukocytosis
 Sepsis
 Shock

Factors Modifying the Inflammatory-

Reparative Response
Inflammation
 Adequacy of blood supply
 Nutritional status of the patient
 Presence or absence of infection
 Presence or absence of diabetes mellitus
 Presence or absence of immunosuppressive drugs
(e.g. glucocorticosteroids)
 Adequate levels of circulating, normal functioning
WBCs

END of PRESENTATION

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