08.21.08: inflammation and repair iv
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Slideshow is from the University of Michigan Medical School's M1 Patients and Populations: Medical Genetics Sequence. View additional course materials on Open.Michigan: openmi.ch/med-M1PatientsPopulationsTRANSCRIPT
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Author(s): Gerald Abrams, M.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution–Non-commercial–Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/
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M1 Patients and Populations:
Inflammation and Repair IV Outcomes of Acute Inflammation
Gerald D. Abrams MD
Fall 2008
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The Inflammatory response 1. vascular response-fluid exudate 2. cellular response-leukocytic exudate 3. macrophages 4. exudates-non-cellular, cellular, mixed 5. granulomas-granulomatous inflammation 6. fate of the inflammatory reaction 7. healing and scar formation 8. healing of cutaneous wounds 9. chronic inflammation
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Possible Outcomes of Acute Inflammation
• Resolution
• Healing with Scar
• Chronic Inflammation
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Purulent Pneumonia
G.D. Abrams, University of Michigan Medical School
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Resolution – Normal Lung
G.D. Abrams, University of Michigan Medical School
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HEALING
• SCAR FORMATION
• REGENERATION
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GRANULATION TISSUE
• Loose,young connective tissue with proliferating fibroblasts and endothelial cells. Granulation tissue “matures” to form scar.
• The process of granulation tissue ingrowth is termed “organizaton”.
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FIBRINOUS EXUDATE
G.D. Abrams, University of Michigan Medical School
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FIBRINOUS EXUDATE EARLY ORGANIZATION
G.D. Abrams, University of Michigan Medical School
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FIBROBLAST PROLIFERATION
G.D. Abrams, University of Michigan Medical School
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ENDOTHELIAL PROIFERATION
G.D. Abrams, University of Michigan Medical School
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GRANULATION TISSUE
G.D. Abrams, University of Michigan Medical School
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GRANULATION TISSUE Day 5-7
G.D. Abrams, University of Michigan Medical School
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GRANULATION TISSUE Second Week
G.D. Abrams, University of Michigan Medical School
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MATURING SCAR
G.D. Abrams, University of Michigan Medical School
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NECROTIC MYOCARDIUM Day 1-2
G.D. Abrams, University of Michigan Medical School
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NECROTIC MYOCARDIUM Day 5-6
G.D. Abrams, University of Michigan Medical School
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NECROTIC MYOCARDIUM Second Week
G.D. Abrams, University of Michigan Medical School
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MYOCARDIAL SCAR
G.D. Abrams, University of Michigan Medical School
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EPITHELIAL REGENERATION
G.D. Abrams, University of Michigan Medical School
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HEALING OF CUTANEOUS WOUNDS
• Healing by primary or first intention- wound edges in apposition at the start of healing.
• Healing by secondary or second intention- wound edges apart, wound open.
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PHASES OF WOUND HEALING
• Inflammation
• Organization and Regeneration
• Deposition of ECM
• Remodeling
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HEALING BY PRIMARY INTENTION
Department of Pathology, University of Michigan
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HEALING BY SECONDARY INTENTION
Department of Pathology, University of Michigan
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WOUND CONTRACTION
Grillo, Watts and Gross
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Complications of Wound Healing • Deficient scar – dehiscence, hernia • Excessive scar – hypertrophic scar, keloid • Excessive granulation tissue – “proud flesh”, adhesions
• Contracture • Traumatic neuroma
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KELOID
Produnis, Wikimedia Commons
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ADHESIONS
Department of Pathology, University of Michigan
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CHRONIC INFLAMMATION
Inflammation sufficiently prolonged that evidence of repair is seen at the same time as evidence of tissue injury and continuing,
active inflammation
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CAUSES OF CHRONIC INFLAMMATION
• Prolonged or repetitive action of toxic agents
• Persistent infection
• Autoimmunity
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CHRONIC INFLAMMATION
G.D. Abrams, University of Michigan Medical School
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ACUTE PHASE RESPONSE
• Leukocytosis
• Fever
• Synthesis of acute phase proteins
• Miscellaneous systemic effects
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What we want you to know and understand
• The 5 cardinal signs of inflammation – their mechanisms
• Mechanisms of the vascular response and the cellular response and how they relate to one another
• The cells participating in inflammatory and reparative responses, and their roles
• Exudates – various types, why they form, and their fate. Granulomatous inflammation
• Organization and scarring • Wound healing – mechanisms, factors affecting
healing, complications
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Slide 6: G.D. Abrams, University of Michigan Medical School Slide 7: G.D. Abrams, University of Michigan Medical School Slide 10: G.D. Abrams, University of Michigan Medical School Slide 11: G.D. Abrams, University of Michigan Medical School Slide 12: G.D. Abrams, University of Michigan Medical School Slide 13: G.D. Abrams, University of Michigan Medical School Slide 14: G.D. Abrams, University of Michigan Medical School Slide 15: G.D. Abrams, University of Michigan Medical School Slide 16: G.D. Abrams, University of Michigan Medical School Slide 17: G.D. Abrams, University of Michigan Medical School Slide 18: G.D. Abrams, University of Michigan Medical School Slide 19: G.D. Abrams, University of Michigan Medical School Slide 20: G.D. Abrams, University of Michigan Medical School Slide 21: G.D. Abrams, University of Michigan Medical School Slide 22: G.D. Abrams, University of Michigan Medical School Slide 25: Department of Pathology, University of Michigan Slide 26: Department of Pathology, University of Michigan Slide 27: Grillo, Watts and Gross Slide 29: Produnis, Wikimedia, http://commons.wikimedia.org/wiki/File:Verbrennungsnarbe_keloid1.jpg, CC:BY-SA 3.0, http://creativecommons.org/licenses/by-sa/3.0/ Slide 30: Department of Pathology, University of Michigan Slide 33: G.D. Abrams, University of Michigan Medical School
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