scientific team - humsc

SCIENTIFIC TEAM 1 –الفريق العلمي

م بسم الله الرحمن الرحي

Chronic Inflammation

❖ Inflammation of prolonged duration (weeks, months to years) in which active

inflammation, tissue injury, & healing proceed simultaneously.

بأنه بكون مدته طويله acuteهو التهاب بتميز بشكل اساسي عن chronic inflammationطيب شو هو ال

prolonged duration اسابيع اشهر او ايام

: مراحل اساسيه الي همه ٣بتميز بحدوث

1) Active inflammation

Infiltration هاد بصير فيه

( inflammatory cells) للخلايا الاساسيه الي بتميز هاد الالتهاب بوجودهم الي همه

1. Plasma cell

2. Lymphocyte

3. Macrophages

وطبعا في خلايا اخرى بس هدول الأساس

يعني يطلعوا من داخل الاوعيه الدمويه ويروحوا ل مكان الالتهاب infiltrationطيب شو يعني

2) Tissue damage

inflammatory cellبشكل اساسي للمواد الكيميائية الي بتفرزها ال هون بصير موت للخلايا وتحللها نتيجه

ومواد اخري تفرز من البكتيريا الداخله الي سببت الالتهاب مثلا

3) Repair

healingهون لما ترجع خلايا جديده تتكون بدل الي ماتت ويصير في

❖ Chronic inflammation is characterized by:

1. Infiltration with mononuclear chronic inflammatory cells, including

macrophages, lymphocytes, & plasma cells.

2. Tissue destruction, largely directed by the inflammatory cells

Chronic inflammation

الشرحالأسود: ✓

السلايد الأزرق: ✓


3. Repair, involving new vessel proliferation angiogenesis) & fibrosis

هدول الي حكيناهم فوق الأحداث الرئيسيه

A, Chronic lung

inflammation, showing collection

of chronic inflammatory cells

(asterisk) + destruction of

parenchyma (normal alveoli are

replaced by spaces lined by cubical

epithelium, arrowheads), + fibrosis

(arrows).

B, Acute

bronchopneumonia. Showing

neutrophils filling the alveolar

spaces with congested blood

vessels.

Causes of chronic inflammation

1) Progression of acute to chronic inflammation :

طيب متى بصير هاد الاشي chronicالى acuteيعني يتطور من

Occurs when the acute response cannot be resolved

a) because of the persistence of the injurious agent

وما يقدر الجسم يدمره زي بكتيريا مثلا acute. لما يضل العامل المسسب للالتهاب ال ١

b) because of interference in the normal process of healing

بحيث انو healingمرات متتاليه وما نعطي فرصه انو الجسم يعمل acute.او لما يتكرر الاصابه بالتهاب ٢

بمراحله كامله وبس يجي يبلش ينشفى يرجع ينصاب مره تانيه وكهذا مثلا :قرحة المعده ال acuteينصاب ب

peptic ulcer


For example, a peptic ulcer of the stomach or duodenum initially shows acute

inflammation followed by the beginning stages of resolution and healing process.

However, recurrent attacks of duodenal epithelial injury interrupt this process, &

result in chronic peptic Ulcer.

2) Viral infections:

Intracellular infections of any kind typically require a response that involves

chronic inflammatory cells (lymphocytes & macrophages) from the onset in

order to identify, & eradicate infected cells, as in viral hepatitis ..

خلايا مناعيه معينه الي هي بتتواجد viralهاد بتطلب حتى نقتل هاد ال viral infectionsفي حالة الاصابه ب

عشان هاد مسبب المرض قوي ف بقابله مناعيه قويه chronicال في حالة

.عشان نقدر نكشفه ونقتله viralيعني من لحظة دخول ال chronicمهم نعرف انه هون من البدايه بكون

3) Persistent infections by microbes that are difficult to eradicate, e.g.,

tubercle bacilli of T.B.; Treponema pallidum of syphilis, certain viruses, &

fungi; all of which tend to established persistent infections & elicit a T

lymphocyte-mediated immune response, called ( delayed hypersensitivity

reaction ) i.e. Type IV.

ما عرفت اوضحها بطريقه مناسبه

طيب نكمل

4) Immune-mediated inflammatory diseases or hypersensitivity diseases.

Immune reactions may develop against the individual's own tissues,

leading to autoimmune diseases, resulting in chronic tissue damage&

inflammation e.g., rheumatoid arthritis.

Immune responses against common environmental substances are the

cause of allergic diseases, such as bronchial asthma.

هاي الامراض بكون الجسم يتعرف ع اجزاء منه autoimmune diseasesطيب هلأ في امراض اسمها

وببلش يعمل عليها antigenيعني خلايا منه مواد طبيعه موجوده بجسمه عادي على انها مسببات للامراض

وكذلك chronicهاد الالتهاب الناتج من المناعه الي صارت يعتبر antibodyاستجابه مناعيه ويفرز


وهي نفس المبدأ بس بكون يتعرف على مواد من البيئه زي الغبار مثلا وبصير التهاب بجسمه نتيجة allergiesال

chronicحدوث تفاعل الحساسيه برضه هاد الالتهاب هو

(5) Prolonged exposure to potentially toxic agents.

e.g., non-degradable exogenous material such as inhaled silica &

asbestos, which can induce a chronic inflammatory responses in the lungs called

silicosis & asbestosis respectively.

حاطط مثال مواد chronic inflammationمواد سامه غير قابه للتحلل بتدخل ع جسمي وبتحفز حدوث

lungالاسبست والسيليكا الي بعملوا التهاب بال

Chronic Inflammatory cells and Mediators

Macrophages:

The most important cell of chronic inflammation, they are tissue cells that

are derived from circulating blood monocytes after leaving the blood.

Macrophages, scattered diffusely in most connective tissues normally, but

found in increased numbers in certain organs: Liver (Kupffer cells), CNS

(microglial cells), Lungs (alveolar macrophages), Spleen &lymph nodes (sinus

histiocytes) , or called dendritic cells ..

هي خلايا يتمشي في الدم اسمها macrophagesطيب نحكي عن اول خليه في هاد الالتهاب وهي الأهم

monocytes لما تطلع من الدم وتدخل على الانسجه المختلفه بصير اسمهاmacrophage هي بتتوزع بشكل

liverعشوائي بين انسجة الجسم بس بتتركز بأماكن معينه وبكل مكان الها اسم معين زي مثلا الي موجودين بال

و……….. kupffer cellبسميهم

اطول وقدرتها half lifeالها Macrophage ؟؟ macrophagesو ال monocytesشو الفرق بين ال

phagocytosisعلى البلمعه

Macrophages act as filters for particulate matter, microbes, & senescent

cells and control specific components of the immune system (i.e., T& B

lymphocytes) to injurious stimulation

《《 دورها بشكل عام لأنو رح نحكيه بالتفصيل تحت

بتعمل مسح للخلايا عشان تشوف شو في اشي اتدمره زي مسببات امراض مثلا وبتعمل تنظيم للالتهاب بشكل عام


The half-life of circulating blood monocytes is 1 day. Under the influence of

adhesion molecules & chemotactic factors, they begin to emigrate following the

neutrophils) to the site of injury within the first 24 to 48 hours after onset of acute

inflammation.

هلأ متى بتطلع هاي الخلايا ؟؟

بالدوره الدمويه حتى توصل لمكان تهاجر وتمشي monocytesساعه من بدايه الالتهاب بتبلش ال ٤٨ل ٢٤بعد

macrophageالالتهاب بعدين بتطلع وبتصير

When monocytes reach the extravascular interstitial tissue, they undergo

transformation into the larger tissue macrophages, which have longer half-lives &

a greater capacity for phagocytosis.

هاي حكيناها فوق

Macrophages may also become activated a process resulting in more

active metabolism increase of cell size increase content of lysosomal enzymes

with increased ability to kill ingested organisms.

The activated macrophages appear large ,flat pink, this appearance is

similar to that of squamous cells & therefore, these cells are called epithelioid

macrophages (epithelial like) .

Focal aggregates of these cells called granuloma.

بتكون لسا مش جاهزه تدخل وتعمل دورها بالالتهاب لازم اعملها macrophageبس تطلع هاي ال

activation - عشان –وعندي طريقيتن هلأ رح نشرحهم

. يزيد حجمها ١

الموجوده فيها وبالتالي تكون اكثر قدره على القتل والقيام بوظيفتها lysosomal enzymes. ازيد ال ٢

epithelial cellsهلأ هاد الشكل النهائي الها بكون بشبه ال

. epithelioid macrophages (epithelial like)عشان هيك سميناها

granulomaوالتجمع من هاي الخلايا بسميه

Activation of macrophages:

Tissue macrophages are activated by diverse stimuli to perform a range of

functions:

1- Classical pathway.

2- Alternative pathway.


I. The classical pathway or classical macrophage activation: Which is

induced by microbial byproducts such as bacterial endotoxins , by cell-

derived signals like cytokines Ifγ ( interferon gamma) , and by foreign

substances including crystals & foreign-bodies .

Classically activated macrophages produce lysosomal enzymes , NO , &

ROS ( free radicals ) . All enhance their ability to kill ingested organisms &

secrete cytokines that stimulate inflammation.

These macrophages are important in host defense against ingested

microbes & in many chronic inflammatory reactions .

الاول pathwayال

مواد ٣هون يحدث تحفيز لل خليه ب

1) microbial byproducts such as bacterial endotoxins

يعني سموم موواد معينه بتفرزها نفس البكتيريا الي دخلت وسببت الالتهاب

2) by cell-derived signals like cytokines Ifγ ( interferon gamma

interferonزي ماده Lymphocyteزي other inflammatory cellاو عن طريق مواد تفرزها

gamma

. and by foreign substances including crystals & foreign-bodies او عن طريق .٣

:خليه شو بدها تعمل عندها وظيفتينطيب هلأ بس تتحفز ال

lysosomal enzymes , NO , & ROS ( freeافراز مواد عشان تدمر مسبب الالتهاب .1

radicals )

secrete cytokines thatبتفرز مواد بتنظم الانفلاميشن يعني بتحفز مثلا خلايا اخرى وهكذا .2

stimulate inflammation

II. Alternative pathway: Is induced by cytokines other than IFN-γ such as IL-4

& IL-13 produced by T-lymphocytes & other cells like mast cells &

eosinophils. The activity is not antimicrobial, its principle role is tissue

repair.

They secrete growth factors that promote angiogenesis بناء اوعيه دمويه

.active fibroblasts & collagen synthesis, جديده


Macrophages secrete mediators of inflammation such as cytokines IL-1,

TNF , chemokines & others. Also they display antigens to T-cells as well

respond to signals from T-cells

Lymphocyte هاد هلأ رح نشرحه بال

T-lymphocytes & other cells like mast cells & eosinophilsالخليه بتتحفز بمادتين بنفرزوا من

IL-4 & IL-13ااي همه

tissue repair وهون الدور الأساسي هو اعاده بناء الخلايا الي ماتت

IFN-γ induces macrophage fusion into multinucleate giant cells.

Roles of macrophages in

chronic inflammation


Macrophages: the section shows mainly very large activated

macrophages, each with a single vesicular nucleus & abundant

granular & vacuolated cytoplasm. Some macrophages contain

ingested RBC, polymorphs & cell fragments (Thick arrow).

Neutrophils seen ( thin arrow) .


Lymphocytes: Both T & B lymphocytes migrate into inflammatory sites using

some of the same adhesion molecule pairs & chemokines that recruit

monocytes. Macrophages: present antigens (Ag) to T cells & express

membrane molecules produce interleukins which stimulate & activate T-

lymphocytes to produce IFN- γ, which is a powerful activator of macrophages,

promoting more Ag presentation

هاي الخلايا بتكون T و B هاي الخلايا الها نوعين Lymphocyte هلأ نحكي عن النوع التاني من الخلايا

وخلتها تروح ع مكان الالتهاب طيب monocytes س العوامل الي حفزت البتمشي بعدين بتتحفز بتتجند بنف

بتكون تستناها عشان تحفزها بشغلتين macrophage هلأ بس اوصل للانسجه الملتهبه بتلاقيها هناك ال

1. Present antigens (Ag) to T cells

Antigen مطلعه على سطحها بتكون Macrophage

وبتتحفز T بتتعرف عليه

2. Produce interleukins

بتفرز مواد كيميائيه معينه macrophage او

macrophage الي برجع بحفز كمان ,IFN- γ تتحفز بتفرز T هلأ لما ال

بتحفز ال Lymphocyte فبتروح ال Lymphocyte بتحفز ال macrophage يعني ال

macrophage

وا بعض يعني زي عمليه تبادليه بضلوا يحفز

(By directional way)

Plasma cells : Are the terminally differentiated end -product of B cell

activation; they can produce antibodies directed either:

1. Against persistent Antigens in the inflammatory site, or

2. Altered tissue components.

B Lymphocyte تتحول الى 》》plasma cell》》 antibody تفرز

ضد شيئين :

. الماده الي دخلت وسببتلي الالتهاب وصارت كل هاي الاحداث عشانها ١

. المواد الي تغيرت من خلايا وانسجه اثناء تفاعل الالتهاب وصار بدها تدمير ٢


Lymphocytes (Red & blue arrows). Histiocyte (macrophage) (Green

arrow)

Chronic colitis: showing dense chronic inflammatory cells infiltrate

mainly lymphocytes & plasma cells.


Plasma cells Eosinophils Characteristically found in inflammatory sites around:

(1) Parasitic infections: eosinophil-specific granules contain major basic

protein that is toxic to parasites.

(2) As part of Allergic immune reactions: Emigration of eosinophils is

driven by adhesion molecules similar to those used by neutrophils & by

specific chemokines (exotoxin) derived from WBC or epithelial cells.

هاي الخلايا بتكون موجود يشكل ميمز في حالتين :

1) Parasitic infections

ال هاد قتل على قادره سامه مواد على بتحتوي انها سُمية parasitesبحيث وبتزداد تقتتله عشان فبتفرزهم

المكان

(2) As part of Allergic immune reactions

epithelialو ال WBCبتيجي بتحفيز من مواد بتفرزها ال

Mast cells

Are widely distributed in connective tissues throughout the body & can

participate in both acute & chronic responses. In atopic individuals (prone to

allergic reactions), mast cells are “armed” with IgE antibody (Ab) specific for

certain Antigens (Ag).


IgE-armed mast cells are important in allergic reactions including Asthma &

anaphylactic shock, & can elaborate cytokines such as TNF & chemokines.

**found in both acute and chronic inflammation

كأنه الخليه الها ايد هاي الخلاياه الها دور بيجي بمسك فيها فبصير زي IgEلل receptorهلأ هاي الخليه عندها

بتفرزه( ، طيب هلأ mast cellمهم في تفاعلات الحساسيه ) نتزكر انو الهستامين هو ماده مسببه للحساسيه و

& TNFومعين و بتفرز مواد زي antigenبتصير كل وحده تتعرف على IgE-armed mast cellsهاي

chemokines.

**note》》

Atopic: genetic tendency to develop allergic reactions

IgE: immunoglobulin E

Blood Eosinophil


Eosinophils in an inflamed tissue

Granulomatous inflammation

Is a distinctive pattern of chronic inflammation characterized by aggregates of

activated macrophages called epitheliod cells.

الي حكينا قلل activated macrophageبس يتميز بتجمع عدد كبير من ال chronicيعني هو عباره عن

epitheliodعشان هيك بنسميهم epithelial cellsانهم بشبهوا ال

Granulomatous Inflammation is caused by:

1. Bacterial infection: Tuberculosis, Leprosy, Syphilitic gumma & Cat-scratch

disease.

2. Parasitic infections: Schistosomiasis.

3. Fungal infections: Histoplasma capsulatum & Blastomycosis.

4. Inorganic metals or dusts: Silicosis & Berylliosis.

5. Foreign body: Suture, breast prosthesis. 6. Unknown: Sarcoidosis.


Microscopically the granuloma consist s of :

(1) A central aggregate of epitheliod cells or activated macrophages, (large, &

flat with pink granular cytoplasm & indistinct cell boundaries), surrounded by

(2) A collar of lymphocytes secreting cytokines responsible for ongoing

macrophage activation.

(3) A surrounding rim of fibroblasts & connective tissue (scarring), due to

cytokines elaborated by the activated macrophages; this rim is useful in

containing the causative injurious agent, But it may cause harmful tissue injury!

(4) A multinucleated giant cell (s) measuring 40 to 50 microns in diameter

may be found in some granulomas, with two or more nuclei {e.g., Langhans giant

cell in TB granuloma}.

(5) Sometimes, caseous necrosis is seen, especially in TB granulomas due to

combine effects of hypoxia & FR injury. Identification of T.B. bacilli in such

granuloma, using special ZN stain is necessary to confirm the diagnosis of TB.

ي( بس هون بحكي عن تركيبها و شو بشوف تحت الميكروسكوب )حفظ اكتر يعن

هي رسمه صغيره للتوضيح

الاسهم السوداء بتمثل الخلايا الي بحفزوا بعض **


Microscopic view of granulomatous inflammation ,showing rounded aggregates of epithelioid cells ,giant cells (arrows) & surrounding

lymphocytes with fibrosis

Microscopic view of foreign-body giant cell granuloma, surrounding s particles of suture material


Caseating tuberculous granuloma showing central caseous necrosis (pink) with peripheral epithelioid cells & Langhans giant

cells (arrows), with lymphocytes & fibrosis

طب هلأ رح نحكي بعض التعريفات للامور مرت علينا قبل :

Definitions:

Transudate:

Is a clear serous fluid that has low protein content , low specific gravity

less than 1020 , and a low cellular content.

It accumulates in tissue spaces & in serous cavities , when increased

intravascular fluid escapes from intravascular compartment due to increased

hydrostatic pressure or increased vascular permeability as in serous

inflammation or in heart failure .

Transudateاول اشي ال

عند حدوث الالتهاب حكينا من الاحداث الرئيسيه الي بتصير هو

١. Increase vascular permeability

2. Increase hydrostatic pressure by vaso dilation

الي بسبب interstitial compartmentsيؤدي الى حدوث ارتشاح او خروج السؤال بكميات كبيرالى مما

swelling


زي ما حكينا قبل هلأ هاد السائل الي طلع وبكون تركيز البروتينات ومكونات الخلايا فيه قليل وهو خفيف

low specific gravity less than 1020

Transudateيعني زي كأنه أقرب للمي ،كميه البروتين فيه قليله جدا بسميه

serious inflammationوبكون cavitiesوبصير يتجمع في ال

Exudate:

A thick fluid of high protein content, high specific gravity more than 1020,

and high cellular content mainly neutrophils, accumulate in tissue spaces, seen

in acute suppurative inflammation due to escape of plasma protein and

leukocytes due to increased vascular permeability.

Exudate

هو نفس السائل الي حكينا انو طلع فوق بس لأنه النفاذيه زادت فصار يطلع مواد حجمها ووزنها كبير

يعني سائل بس بكون تقيل مش زي المي neutrophilو leukocytesو plasma proteinزي

suppurative inflammation acuteوبصير فيه

Pus:

A thick creamy yellowish , greenish or blood – stained fluid consisting of

neutrophils , necrotic debris , with high protein content and high specific gravity

more than 1020.

It accumulates in sever suppurative inflammation.

Pus

او خلايا مكونات كمان يطلع وضل السائل نفس برضه زي هلأ neutrophils , necroticحطامها

debris , وبروتينات وخلايا ميته فهاد السائل ثقل كتير وصار اقرب ما يكون للكريمه او اللبنه

pusهاد هو ال

suppurative inflammation. severويحدث في

Abscess:

A localized collection of pus caused by suppurative inflammation.

The central part of the abscess consists of a mass of acidophilic (pinkish)

amorphous semi fluid debris composed of dead tissue cells ,and dead

leukocytes.

This in turn is surrounded by a zone of viable neutrophils, which is

surrounded by a highly vascularized connective tissue called granulation tissue


and fibrosis which act as a barrier for further spread of the inflammatory process

to the surrounding tissues.

ال وتراكيب pusهاد بعده خلايا وبتحوط بمكان محصور This in turn is surrounded by a)بتجمع

zone of viable neutrophils, which is surrounded by a highly vascularized

connective tissue called granulation tissue and fibrosis which act a) زي بتعمل الي

حاجز بمنع انتشاره وبخليه محبوس بمكان واحد زي الحبوب البيضاء الي بتطلع على الجلد

Figure: Chronic brain abscess, its inner wall of is covered with grayish-

green pus. The abscess is enclosed by a fibrous capsule, the brownish rim

is a granulation tissue (arrows).

Ulcer:

Is a local defect or excavation of the surface of the skin , or the lining of a

viscous organ ( gastrointestinal , respiratory or genitor-urinary tracts). It is

produced by sloughing of inflammatory necrotic tissue.

In other words it is a localized loss of the continuity of an epithelial surface

يعني زي كشط او حفر بسطح معين من الجسم فبصير في فجوات بين الخلايا الي كانت عامله زي شبكه ومغطيه

العضو زي الجلد او في بطانات التجاويف زي المعده و الامعاء….


Gross appearance of

aphthous ulcers in the tongue,

caused by viral infections.

Gummatous ulcer

(syphilis): Skin. A

large deep ulcer of

the abdominal wall.

The ulcer base is

covered by a necrotic

slough.


TB ulcer: ileum : A circumferential ulcer . Contraction of the ulcer scar

tissue may produce a localized stricture, with intestinal obstruction, and

dilatation of the proximal segment (right of the figure).

Morphology of an ulcer.

A, gross appearance of

chronic duodenal ulcer.

B, Low power view of the ulcer

crater (pit) with an acute

inflammatory exudate in the

base.


Figur: Microscopic view of Chronic gastric ulcer ,showing loss of epithelial

lining with acute inflammation & vascular granulation tissue at the ulcer

floor

Effects of inflammation:

عن اثار هاد الالتهاب الي صار طيب هلأ رح نحكي

المفروض والأساس انو هاد كله صار عشان نقتل البكتيربا او الماده الضاره الي دخلت ع الجسم ونقلل من تأثيرها

والضرر الي ح تعلمه على الأنسجه بس برضه بصاحب هدول التأثيرات الايجابيه اثار سلبيه برضه

يعني صح الجسم قتل البكتيريا بس برضه رح يضر حاله وما بنقدر نهرب من هاي الأثار الجانبيه 《

يعني هي عمليه ذات وجهين

A- Beneficial effects:

These act partly through the flow of exudates into the tissue & partly by the

phagocytic & microbial effects of migrated WBCs:

اسباب ٣النتائج الايجابيه هي ناتجه عن

. عن طريق الإفرازات من مختلف الخلايا الي ذكرناهم ١

( phagocytosis. عمليه البلعمه) ٢

٣. WBC


(1) Dilution of toxins: Exudate dilutes chemical and bacterial toxins & enhances

their carriage by lymphatics.

عن يكون منه والتخلص دخل الي المرض مسبب او البكتيريا افرزتهم الي السموم من والتخلص وتكسير اذابه

Lymphatic systemطريق

(2) Protective antibodies: The proteins present in the exudates include

antibodies, which have been already present in the plasma as a result of

previous infection or immunization. These antibodies attack injurious agents in an

attempt to destroy them immunologically

مناعيه anti-bodyانتاج استجابه بنسميه وهاد تدميرها وبالتالي دخلت او...الي البكتيريا ضد

immunologically

(3) Fibrin formation : Fibrinogen of the blood is included in the exudates which is

transformed into fibrin . A network of the deposited fibrin is seen in the inflamed

tissue forming a mechanical barrier that precludes the movement & spread of

bacteria, it may also aid in their phagocytosis.

هو من المواد التي تفرز اثناء الالتهاب Fibrinogenال

mechanicalعمل زي يعني بصير خيوط وبتراكمه فوق بعض هاد ب fibrinبطلع من الدم وبتراكم على شكل

barrier يعني بعمل حاجز بمنع انتشار وحركه البكتيريا وبحاصرها

((Note : هاد ال fibrin بدخل بتكون الblood clot وبالتالي هو عنده زي هاد القوام الي بعملblocking

وهيك ف نفس المبدأ تقريبا((

(4) Promotion of immunity : Bacteria in the inflammatory exudates , whether free

or phagocytosed , are carried to the lymph nodes by lymphatics. There they

mount an immune response, which provides antibodies & cellular mechanisms

that may appear after few days and may remain for years. These immunological

mechanisms help destroy microbial agents

وبالتالي تعرف جسمي antibodyتقوية المناعه عن طريق حدوث الاستجابه المناعيه الي حكينا عنها قبل وتكون

على هاي البكتيريا الي دخلت وبالتالي لما تدخل مره تانيه جسمي عارفها وكاسب مناعه ضدها

)المناعه هاي بتصير لما ننقل البكتيريا سواء هي او على شكل انها تكون مُبلعه داخل الخلايا(


B- Harmful effects :

ال اساسي يصير harmful effectsبشكل لما الدمويه الاوعيه من السوائل خروج عن ناتجه هي

vasodilation و زيادة الpermeability

1- Swelling: of acutely inflamed tissue may have serious mechanical effects e.g.

in acute laryngitis causes suffocation in children

التنفس مجرى تسكير الى يؤدي رح الاشي هاد فيها التهاب نتيجة الحنجره في والورم الانتفاخ حدوث حال في

وبالتالي حدوث اختناق خاصه عند الاطفال

2- Rise in tissue pressure: Inflammation when is confined within a restricted

space cannot expand, the result is an increase in tissue pressure and this

interferes with cell function and the blood flow, the latter leads to ischemic

injury ,e.g. encephalitis and meningitis both cause increased intra cranial

pressure and even death. Similarly osteomyelitis leads to bone necrosis due to

ischemia caused by pressure on blood vessels.

د ااسوائل عم تطلع وتتراكم وبنتفخ بالنسيج طيب لو كان النسيج قاسي وصعب انه يتمد

الي بالنسيج وبالتالي بقل الدم الواصل اله فبصير capillaryبصير زي ضغط فبتصير الخلايا تضغط على ال

injuryوبصير ischemiaفيه

وكمان بصير في زياده بالضغط جوا النسيج زي في الدماغ مثلا

اencephalitis and meningitisفي حال حدوث التهاب بالسحايا او الدماغ intracranialلى زياده يؤدي

pressure

الي له مضاعفات كثيره قد تؤدي للوفاه

3- Sever allergic reaction: e.g. to pollen may cause sever asthma & dyspnoea ,

this may sometimes be so sever as to cause death due to asphyxia caused by

laryngeal edema.

وهاد هوب بسببلي الحساسيه histamineالي بتفرز mast cellلتهاب بتيجي ال حكينا انو بالا

كيف؟؟

وبالتالي بتصير الاحداث الي بنعرفها الي vasodilationبالاوعيه الدمويه وبالتالي relaxationهلأ هو بعمل

بالأخر بتأدي للانتفاخ والتورم

)الي هو من اعراض الحساسيه زي مثلا لما ينفخ الوجه وحوالين العين ولما يضيق مجرى التنفس ووو(

وبالتالي اعراض الحساسيه هاي هي عباره عن ناتج خطير ومضر من الالتهاب الي صار


SYSTEMIC EFFECTS OF INFLAMMATION

These effects are collectively called acute-phase reaction .

They include fever, malaise (feeling of being sick), anorexia (loss of

apatite), insomnia, hypotension الي بصير تمدد الاوعيه accelerated degradation ,عشان

of skeletal muscle proteins عشان عيك بنحس بتعب عام ووجع بالعضلات لما يصيبنا التهاب

,increased hepatic synthesis of a variety of proteins (e.g., complement &

coagulation proteins), & alteration in the circulating WBC as leukocytosis.

coagulation proteinsليش بزيد هاد البروتين ؟؟؟؟

بالاوعيه حوالين مكان الالتهاب وبالتالي نمنع انتشاره اكتر بالجسم ونحاصر البكتيريا clotsعشان يعمل

The most important mediators of the acute-phase reaction are the

cytokines TNF, IL-1, & IL-6, produced mainly by WBC in response to infection, or

to immune & toxic injury, & are released systemically, frequently in a cascade.

TNF & IL-1 both act on the thermoregulatory center of the hypothalamus-

via local PGE production to induce fever .

؟؟ feverكيف بتصير ال

TNF & IL-1 》》PGE بتنتج 》》

لدرجه الحراره زي ما اخدنا بالفسيو stepointوبتغير ال hypothalamusبتروح على

PGE= prostaglandin

IL-6 stimulates the hepatic synthesis of several plasma proteins,

(1) Fibrinogen; elevated fibrinogen levels cause RBC to agglutinate more

readily, explaining why inflammation is associated with a higher ESR .

ببعضها فبصير وزنها اكثر وتترسب اسرع ف لما بخليها تتجمع وتمسك RBCبعمل زي لاصق لل fibrinال

ESR :Erythrocyte sedimentation rateاعمل فحص

رح الاقيه أعلى RBCالي هو سرعة ترسب اال


(2) C-reactive protein (CRP) & serum amyloid A (SAA) proteins, both bind to

microbial cell walls, & they may act as opsonins & fix complement, thus

promoting the elimination of the microbes.

fix complement

Complement fixation systems take advantage of the fact that complement

proteins bind, or “fix,” to antigen-antibody complexes during the host immune

response to a foreign antigen. If this antigen is cell localized, then the deposition

of complement elements will cause cell lysis.( كلام منقول من جوجل لأني ما فهمت الفكره منيح

( ممكن تقرأوه او خلص سكيب عنه

❖ Leukocytosis (increased, mature, white blood cell count in blood) is a common

feature of inflammatory reactions, especially those induced by bacterial

infection. WBC count typically increases from a normal 4,000 to 10,000 to

15,000 - 20,000 cells per micro liter, but may climb as high as 40,000 to

100,000, a so-called Leukemoid (leukemia-like) reaction .

طبعلا اكيد زياده عدد خلايا الدم البيضاء لأنو هلأ هو دورها وعم تشتغل

ومعروف لما نعمل فحص لدم شخص ونلاقيهم مرتفعين بنعرف انو عندو التهاب معين

Most bacterial infections induce selective increase in polymorphonuclear

cells called (neutrophilia),

• while parasitic infections & allergic responses characteristically induce

eosinophilia.

• Certain viruses,like infectious mononucleosis, mumps, & rubella cause

selective↑ in lymphocytes (lymphocytosis).

• However, most viral infections, rickettsial, protozoal, & certain types of

bacterial infections (e.g., typhoid fever), are associated with a decreased

number of circulating WBC called (leucopenia).

Severe bacterial infections (sepsis), especially by gramnegative

bacteria stimulate the production of huge quantities of several cytokoines,

notably TNF, IL-1, IL-6, & IL-8, resulting in septic shock, which is usually

fatal.

ي بتتجمع في نوع محدد من الالتهاب هون ذكر يعني نوع للخلايا ال


او كل التهاب وشو بميزه

بالتوفيق ..

النقاط الي فوق للفهم وتوضيحلينكات لفيديوهات اعتمدت عليها **

١. https://youtu.be/7LS4B4Pms2I مفيد جدا

٢. https://youtu.be/-a1AxBvhKWU

٣. https://youtu.be/hMm6i0x4V6c

٤.https://youtu.be/1QUPxCft-B0

٥. https://youtu.be/W8JH3lV9ZWs

٦. https://youtu.be/O4KlpnzX-8k

https://youtu.be/7LS4B4Pms2I

https://youtu.be/-a1AxBvhKWU

https://youtu.be/hMm6i0x4V6c

https://youtu.be/1QUPxCft-B0

https://youtu.be/W8JH3lV9ZWs

https://youtu.be/O4KlpnzX-8k

scientific team - humsc

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