General Pathology

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General Pathology

• Inflammation II
• Healing processes
• Classification

Jaroslava Dušková Inst. Pathol. ,1st Med.
Faculty, Charles Univ. Prague
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Inflammation

• Definition
• complex reaction of organism to damage
• (aim homeostasis maintenance)

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Inflammation

• Sense
• defensive agent elimination
• reparative damage reparation

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Inflammation Celsus features

• rubor
• tumor
• calor
• dolor
• functio laesa

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Inflammation - Classification

• Time view
• acute (days)
• subacute (weeks)
• chronic (months-years)

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Phases of Inflammatory Response
Proliferation
Alteration

Exsudation
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Healing of Inflammation
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Progressive Changes

• Def.
• processes leading to
• lost or damaged tissue substitution
• or
• adaptation to the organism or environment
  changed conditions

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Progressive Changes

• Regeneration (restitution)
• Reparation (substitution)
• Hypertrophy
• Hyperplasia
• Metaplasia
• Adaptation

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Progressive changes 1.

• Regeneration - restitution of former status
• Reparation substitution with a less
  specialised tissue
• Hypertrophy enlargement of the organ
  through cell enlargement

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Angiogenesis Endogenous Promotors

• VEGF - A,B,C,D
• Angiopoietins
• Angiogenin
• basic FGF bFGF
• Hepatocyte Growth Factor HGF
• Interleukin-8
• PDGF
• Transformation Growth Factor ß TGF ß
• TNF ?

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Angiogenesis Endogenous Inhibitors

• Angiostatin
• Brain Angiogenesis Inhibitor 1 BAI1
• Endostatin
• Interferons
• Platelet factor-4 cleavage products
• Prolactin fragment (16kd)
• Thrombospondin-1
• VEGI
• Vasostatin

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Progressive changes 2.

• Hyperplasia enlargement of the organ through
  cell multiplication
• Metaplasia transformation of one
  differentiated tissue into another
  differentiated tissue
• Adaptation - functional adjustment
• It is done by means of metaplasia,
  hypertrophy, hyperplasia, metalaxia,
  (rebuilding).

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Healing Processes 1.

• wounds
• per primam intentionen
• (wounds without infection, dislocation,
  foreign bodies)
• per secundam intentionen
• hematoma organisation
• thrombus organisation (possible
  recanalisation)

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Proliferation - steps

• dissolution of exsudate necrotic tissue
• granulation tissue
• fibronectin formation, fibroblasts
  endothelia organisation
• collagen production
• scar maturation
• scar contraction myofibroblasts

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Wound Healing - steps

• Day 0 fibrin fibronectin gel
• Day 1 neutrophils
• Day 1-2 macrophages
• Day 2-4 fibroblasts, myofibroblasts,
  capillaries

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Granulation Tissue Growth

• PDGF
• from mf, endoth., platellets
• causes fbl proliferation, proteosynthesis
• Transforming GF
• from mf, epithelia
• causes fbl proliferation, angiogenesis
• IL- 1
• from mf, epithelia
• causes fbl proliferation, endogenous pyrogen
• TNF a
• from mf
• causes endothelial growth, killing bacteria,
  cachexia

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Healing Processes 2.

• ischemic and traumatic necroses
• foreign bodies healing
• bone fractures

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Factors Influencing Wound Healing

• age
• nutrition status protein deficit
• vitamins A,C collagen, epithelisation
• Zinc enzyme function
• steroids
• local factors
• infection
• necrosis
• foreign bodis
• patients motility
• arterial perfusion
• venous drainage

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Inflammation - Classification

• According to the dominant phase
• alterative
• EXSUDATIVE
• proliferative

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Inflammation - localisation

• interstitial

• superficial
• mucous membranes
• serous membranes
• skin

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Inflammation - Classification

• Type of exsudate
• serous
• nonpurulent lymphoplasmocellular
• purulent
• fibrinous
• gangrenous

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Inflammation - Classification

• Type of exsudate
• serous
• nonpurulent lymphoplasmocellular
• purulent
• fibrinous
• gangrenous

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Inflammation - Classification

• Type of exsudate
• serous
• nonpurulent lymphoplasmocellular
• purulent
• fibrinous
• gangrenous

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Inflammation - Classification

• Type of exsudate
• serous
• nonpurulent lymphoplasmocellular
• purulent
• fibrinous
• gangrenous

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Inflammation - Classification

• Type of exsudate
• serous
• nonpurulent lymphoplasmocellular
• purulent
• fibrinous
• gangrenous

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Inflammation - Classification

• Type of exsudate
• serous
• nonpurulent lymphoplasmocellular
• purulent
• fibrinous
• gangrenous

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Interstitial fibrinose inflammation

• fibrin exsudation fibrinoid change of the
  collagen containing connective tissue

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Fibrinoid Change of Collagen

• vessels and connective tissue damage
• plasmorrhagia (leakage of plasma)
• deposits of Ag-AB complexes
• staining characteristics fibrin - like

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Significance of Fibrinoid Change

• diminished quality of the collagen (
  firmness, permeability)
• tendency to thrombosis in the vessels,
  aneurysms formation

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Inflammation - Classification

• Type of exsudate
• serous
• nonpurulent lymphoplasmocellular
• purulent
• fibrinous
• gangrenous

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Gangrenous Inflammation

• tends to be interstitial
• putrefactive bacteria
• severe alteration