If You Fail to Plan,

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The investment you make in yourself must receive
Top Priority. When you GROW your entire world
Expands...when you do not grow your whole world
starts to become Very Small...that smallness
reflects in all areas of life including your
income."Bob ProctorAuthor and Personal Coach
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Pathology of Inflammation
Dr. Venkatesh M. Shashidhar. Associate Professor
of Pathology Fiji School of Medicine
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Introduction

• In-flame to set fire. (red, hot, pain)
• Inflammation is dynamic response of vascularised
  tissue to injury.
• It is physiologic, protective response.
• Serves to bring defense healing mechanisms to
  the site of injury.

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INFLAMMATION
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Inflammation Causes ..Injury

• Physical agents Trauma, radiation,
• Infection microbial agents
• Chemicals acid, alkali, toxins
• Ischemia / Infarction lack of blood..
• Immune reaction

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Appearance of Inflammation

• Flush Red spot - capillary dilatation.
• Flare Red area - arteriolar dilatation.
• Weal Swelling - exudation, edema.

Lewis Triple Response - old!
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Cardinal Signs of Inflammation

• Calor Warm Hyperaemia.
• Rubor Redness Hyperaemia.
• Dolor Pain Nerve, Chemical med.
• Tumor Swelling Exudation
• Functio laesa Loss of function (Virchow 1902)

Celsus, 30 BC - Latin
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Calor, Rubor, Dolor, Tumor, Loss of function.
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Surgical wound inflammation
Calor, Rubor, Dolor, Tumor, Loss of function.
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Inflammation - Mechanism

• Vaso dilatation
• Exudation - Edema
• Emigration of cells
• Chemotaxis
• Phagocytosis

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Mechanism of Inflammation
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Mouth Aphthus ulcer
Calor, Rubor, Dolor, Tumor, Loss of function.
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Laryngitis
Calor, Rubor, Dolor, Tumor, Loss of function.
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Acute Enteritis
Calor, Rubor, Dolor, Tumor, Loss of function.
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PneumoniaInflammation of lung
Calor, Rubor, Dolor, Tumor, Loss of function..!
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(No Transcript)
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Emigration of Leucocytes
Diapedesis ?
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Neutrophil Margination
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Lung Normal / Pneumonia
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Pneumonia - Exudation
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Normal - Meningitis
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The 5 Cardinal Signs of
Heat Redness Swelling Pain
Loss Of Func.
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Chemical Mediators of Inflammation

• Cellular hormones cytokines.
• Released by cells act on same or nearby cells
• Each phase of Inflammation is orchestrated by
  several chemical mediators cytokines.
• Modifying these modifies inflammation drugs
• Endogenous Exogenous.
• Locally produced Plasma factors.

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Chemical Mediators of Inflammation

• Plasma derived
• Kinins
• Complements
• Coagulation system
• Plasminolysis system
• Others H2O2, NO, O2rad.

• Locally produced
• Histamine
• Seratonin/5HT
• Interleukins.
• Prostaglandins
• Leukotrienes

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Chemical Mediators of Inflammation

• Vasodilatation Histamine, Pgs, Nitric oxide
• BV permeability Hist, bradykinin, C5a, LB4
• Leukocyte adhes IL8, LB4, C5a, TNFa
• Chemotaxis LB4, IL8, bacterial toxins, C3, C5.
• Pain Prostaglandins Bradykinin.

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Chemical Mediators of Inflammation

• Vasoactive amines - Histamine, Seratonin vaso
  dil.
• Complement system C1-9 cytolysis, opsonins.
• Kinin System Kallikreins ? Bradykinin
• Clotting system FXII, FX, Fibrin, Plasmin
• Arachidonic acid metabolites
• Prostaglandins - (cyclooxigenase) - Pyretic
• Leukotrienes (Lipoxigenase) -
• Lipoxins anti-inflammatory action also.
• Others
• H2O2, Nitric Oxide, Lysozymes,O2 free radicals

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Chemical mediators in inflam.
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5-LO inhibitors
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Types of Inflammation

• Time
• Acute Chronic
• Predominant process
• Suppurative neutrophils - bacterial
• Fibrinous - fibrin - immune
• Serous fluid - viral
• Granulomatous chronic TB/fungus/Foreign body.
• Eosinophilic parasite, immune.

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Inflammation Types

• Acute upto days.
• Vascular changes Hyperemia exudation.
• PMNs Neutrophils, Pus/suppuration.
• Chronic - Weeks to Months or Years
• No Vascular changes.
• Fibrosis Scarring.
• MNs - Lymphocytes and macrophages

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Inflammation Outcome
Injury
Acute Inflammation
Healing
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"It gives me great pleasure to converse with the
aged. They have been over the road that all of us
must travel and know where it is rough and where
it is level and easy...!" Plato