pattern of inflammation
TRANSCRIPT
Pathology
Pattern of inflammmation
muhammad koksh sidiqB.Sc. In pharmacy
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Inflammation
• Inflammation is defined as the physiological response of living tissue to injury
• Inflammation is the body's attempt at self-protection; the aim being to remove harmful stimuli, including damaged cells, irritants, or pathogens - and begin the healing process.
• Inflammation does not mean infection, even when an infection causes inflammation. Infection is caused by a bacterium, virus or fungus, while inflammation is the body's response to it.
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Types of inflammation
1. Acute inflammation.
2. Chronic inflammation.
Inflammation is divided into acute inflammation, which occurs over seconds, minutes, hours, and days, and chronic inflammation, which occurs over longer times.
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• Acute inflammation - starts rapidly (rapid onset) and quickly becomes severe. Signs and symptoms are only present for a few days, but in some cases may persist for a few weeks.
• Chronic inflammation - this means long-term inflammation, which can last for several months and even years. It can result from:Failure to eliminate whatever was causing an acute inflammation
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Morphologic Patterns of
Inflammation (exudate)
• Serous Inflammation
• Fibrinous Inflammation
• Suppurative Inflammation
• Ulceration
• pseudomembranous inflammation
• Catarrhal inflammation
• Granulomatous inflammation
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Patterns of inflammation
• 1. Serous inflammation
• abundant watery effusion of fluid (exudate).
• This is characterized by outpouring of thin fluid that is either derived from the blood (serum) or secretions of serous mesothelialcells of pleura, peritoneum, and pericardium or joints spaces. Serous inflammation is seen for example in tuberculous pleurisy.
• Examples: peritonitis, pericarditis, pleuritis, skin burn, viral infections.
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Serous pleural inflammation
Excessive accumulation of clear, thin fluid within pleural cavity. It is
transparent but note the reflection of light in the upper part of the
photograph and lung collapse due to pressure induced by the fluid. 7
BLISTER, “Watery”, i.e., SEROUS8
2. Fibrinous inflammation In this type there is exudation of large amounts of plasma
proteins including fibrinogen with subsequent precipitation of masses of fibrin e.g. in rheumatic pericarditis the pericardial space may become filled with large masses of fibrin; when the epicardium is stripped from the pericardium, the rubbery adherent fibrin coats both surfaces and simulating the appearance of bread & butter . Organization of fibrinous exudates by formation of fibroblasts & capillaries obliterate the cavity. Alternatively there is fibrinolysis & resolution.
Example: trauma, bacterial infections.
may lead to fibrous adhesions. Example: restrictive pericarditis, fibrous adhesion in the peritoneum.
fibrinolysis resolution; organization fibrosis scar
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Fibrinous exudate-pericardium (G)
there is a lot of fibrin
the visceral and parietal
surfaces become stuck
together (by fibrin).
Separation of the two layers
imparts rough irregular
appearance (the so called
bread and butter).
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FIBRINOUS
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3. Suppurative inflammation:
• This is characterized by the production of large amounts of pus or purulent exudates.
• pus accumulation (neutrophils, exudate fluid and cellular debris)
• Staphylococci produce localized suppuration. In suppurative appendicitis, there is pus within the lumen with an intense infiltration of polymorph neutrophils that are present in the mucosa, submucosa, muscularis & serosa.
• Abscess is a localized collection of pus caused by suppurative inflammation.
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Abscess
Furuncle
(boil)
Abscess that involves
the skin is called “Boil”
or “furuncle”.
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PUS
=
PURULENT
ABSCESS
=
OF
PUS
=
NEUTROPHILS15
PURULENT, FIBRINOPURULENT16
4.Ulcer
• it is loss in the continuity of an epithelial surface of the skin, the lining of a viscous organ or tissue (gastrointestinal, respiratory or genitor-urinary tracts), which is produced by sloughing of inflammatory necrotic tissue.
• Ulcer can be acute or chronic.
• Peptic ulcer is a typical example.
• Ulcer may result from physical or chemical injury, or ischemic necrosis.
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Ulceration, larynx, gross
Below the vocal cords in this
larynx are large ulcerations.
Such subglottic ulcers are
produced with prolonged
endotracheal intubation in
which the cuff of the
endotracheal tube fits too
tight. Thus, ulcerations can
be produce by mechanical
forces. In fact, so-called
"pressure ulcers" or
"decubitus ulcers" can form
in the skin over bony
prominences in persons who
are bedridden for an
extended time. 18
ULCERATIVE 19
Appendix: acute suppurative inflammation
ulceration and undermining
by an extensive neutrophilic
exudate
Upper half of excised appendix.
Lt: fibrino-purulent serosal
exudate
Rt: lumen filled with pus
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5. pseudomembranous inflammation
is characterized by the formation of a pseudomembrane,which is usually made up of precipitated fibrin, necrotic epithelium & together with polymorphs, red cells; bacteria produce a false membrane over the inflamed surfaces. This occurs when the inflammation is so severe as to cause epithelial necrosis. An example of this pattern is seen with Diphtheria affecting the larynx & pharynx. It may also affect the large bowel causing pseudomembranous colitis . The latter is caused by Clostridium difficile or Staph. aureus infections.
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Pseudomembranous inflammation
of mucous membranes
• Severe injury extensive epithelial necrosis
large shallow ulcers sloughing
• Fibrin, dead epithelium, neutrophils, red cells
and bacteria mix together false (pseudo-)
membrane (white or cream-colored layer)
• Diphtheria and psudomembranous colitis are
typical examples
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pseudomembrane
Pseudomembranous entercolitis (G)
This yellow-green exudate on the surface of an inflamed, hyperemic
(erythematous) bowel mucosa consists of many neutrophils along with
fibrin and amorphous debris from dying cells.23
6. Catarrhal inflammation:
• This is a mild inflammation of mucosal membranes as is seen in common cold, bacillary dysentery, and food poisoning
• most frequently seen in the respiratory tract, but may occur in any mucous membrane, and is characterized by hyperemia of the mucosal vessels, edema of the interstitial tissue, enlargement of the secretory epithelial cells , as exudation progresses, variable numbers of neutrophils migrate into the affected tissue and are included in the exudate, along with fragments of degenerated and necrotic epithelial cells; such an inflammation may frequently become muco purulent.
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Granulomatous inflammation
• distinctive chronic inflammation type
• cell mediated immune reaction (delayed)
• aggregates of activated macrophages epithelioid cell multinucleated giant cells (of Langhans type x of foreign body type)
• NO agent elimination but walling off
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Granulomatous inflammation
• 1. Bacteria– leprosy
– syphilis
• 2. Parasites + Fungi
• 3. Inorganic metals or dust– silicosis
• 4. Foreign body
- talc powder
• 5. Unknown - sarcoidosis
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Diagram of typical TB granuloma
Caseation
Epithelioid cells
Multinucleated GC
Lymphocytes
fibroblasts
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TB granulomas lung
This is a low power view
showing two, adjacent,
well-defined, rounded
granulomas . From this
power the presence of
multinucleated giant cells
is obvious (arrow).
This is a high power view
showing a portion of
typical TB granuloma.
Note the amorphous,
pinkish central caseation,
which is surrounded by a
rim of epithelioid cells.
caseation
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Langhan’s Vs FB giant cells
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Thank you
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