#4

Edited by ABDALLAH RIYALAT &WAFA’ AL-HUSAMI

date 21/11

Here is a purulent exudate

in which the exuded fluid

also contains a large

number of acute

inflammatory cells. Thus,

the yellowish fluid in this

opened pericardial cavity is

a purulent exudate.

Fluid in the pericardial cavity اص ب منتج :م pus جد خ الت

Yellowish fluid in the pericardial

A purulent exudate is seen beneath the meninges in the brain of this

patient with acute meningitis from Streptococcus pneumoniae infection. The exudate obscures the sulci.

The abdominal

cavity is opened

at autopsy here

to reveal an

extensive

purulent

peritonitis that

resulted from

rupture of the colon.

A thick yellow exudate coats the peritoneal surfaces. A paracentesis yielded fluid with the properties of an

exudate: high protein content with many cells (mostly PMN's). Intestine ف بعض ال ء ف امع ف البطن د تج loops abnormal ه

with dark color may result from inflammation

The PMN's seen here are in alveoli, indicative of an acute

bronchopneumonia of the lung. The PMN's form an exudate in

the alveoli. This patient had a "productive" cough because

large amounts of purulent sputum were produced. The source, the neutrophilic alveolar exudate, is seen here.

whenever there is a blood in a tissues that mean there is an

e tra asatio s …here there is a o gested dilated apillaries… e a see the congested & dilated RBCs so it is an acute inflammation

بع دت السابل ال

This radiograph demonstrates patchy infiltrates consistent with a

bronchopneumonia from a bacterial infection. Typical organisms include Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas

aeruginosa, Hemophilus influenzae, Klebsiella pneumoniae, among

others.

The neutrophils are seen infiltrating the mucosa and submucosa of

the gallbladder in this patient with acute cholecystitis and right

upper quadrant abdominal pain with tenderness on palpation.

Is there a i fla atio a ute or hro i … h ? There is a large u er of neutrophiles in mucosa and sub mucosa so it is an acute and this type of

inflammation called cholecystitis

At medium power magnification, numerous neutrophils fill the

alveoli in this case of acute bronchopneumonia in a patient with a

high fever. Pseudomonas aeruginosa was cultured from sputum.

Note the dilated capillaries in the alveolar walls from vasodilation

with the acute inflammatory process.

The normal manifestations of the alveoli is to be with an empty space within it here

there is o e pt spa e ithi it so fro this e k o it is a or al ase… its filled with neuotrophiles and there is dilated congestive blood vessels here we have an acute

inflammation

The white arrows mark areas

of abscess formation in the

upper lobe of this lung. The

liquefactive necrosis of an

abscess is apparent, because

the purulent contents are

draining out to leave a cavity. On a chest radiograph, the

liquefied central contents of

an abscess can appear as an

"air-fluid level".

Here we have lung within cavities because

of the e rosis …the i rophage a d different WBCs come to the inflammatory

site do its work and these cavities will be

produced after all of that ن بعد ب ل سب ااص تز ع لم تعمل الخا المن

ب رح تنتج ن ااص ن هتنظف مك تك ل زااشك اثر بعد عم

Much smaller abscesses are seen here. These could be

termed "microabscesses" due to their small size.

Abscesses can come in a variety of sizes. Perhaps the most common abscess is the pimple on the face of a teenager.

ن شك ح زبكالشب ف مرح المراه

ن ه للكن ه ع

An abscess is a localized collection of PMN's. Here is a

microabscess in the myocardium. The irregular dark

purple center is a collection of bacteria that are the cause

for this abscess.

س ح نالشب ال

ه ن لش ع

Collection of

bacteria

made an

abscess

around it

This abscessing

bronchopneumonia has

numerous areas of raised,

lighter tan appearance

which are the areas

containing the extensive

neutrophilic infiltrates.

Microscopically, the extensive neutrophilic exudate of an acute

abscessing pneumonia is seen here. Normal tissues are destroyed

in the region of the abscess.

There is a ede a …. o gesti e lood o the left side essels…neutrophiles …extravasated blood

cells د ح ف الحد ض عد ج نس جد تخر ل

Destruction of the normal tissues

Here is another more focal abscess in the lung. The alveoli in that area have been destroyed.

Necrotic debris in

the center with an

inflammotery cells

compound with

the abscess

One consequence of acute inflammation is ulceration. This occurs

on epithelial surfaces. Here the gastric mucosa has been lost, or

ulcerated. A larger ulcer and several adjacent smaller ones with

surrounding erythema appear at the left of center.

This is a larger ulceration. The cause for the

ulceration in this case was an underlying

neoplasm.

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 on skin over

bony prominences in persons

who are bedridden for an

extended time.

Two ulcers underneath the

vocal cord

An esophageal acute ulcer is shown here in which the

squamous mucosa has been lost. In the ulcer base

are inflammatory cells and fibrin.

Celluar de ris a d fi ri …………………….. .………………….. ul eratio

ال تخر .sequamous

epithelium

ال أمتداد

sequemous

epithelium

راح إذن هن ulcerجد

we see squamous epithelium In left, cellular debris , fibrin necrotic tissue

Ulcernation :

د ع م ن cells للبس مض تح tissuesكم ط ه غ ت المخ فجزء من ط رح ممكن تعمل collagenالمخ ه ببعض ال ر ف ص ممكن

perfuration تعمل بتضل ج تحت حت تث جدار كل النس بت

perfuration هone of the most serious complication of

peptic ulcers perfuration and penetration بسب االت ال الذر ف المعدة أ ص ر ف duodenumممكن ص ulcernation ر ص

necrosis and inflammation ه ر ف ص .inflammantory response in surrounding tissueراح

ر ص رح adhesion التصفممكن د ج ط بسب ء المح مع اأعضن تعمل necrosis and inflammation Orderly deform ulcerف مك

طع ط هن م د المخ ع م رح epitheliumغ esophagusض هذه

This patient had diabetes mellitus for many years. This

with arterial atherosclerosisdisease leads to marked

narrowing.

When peripheral arteries to the legs are involved, then ischemia of

soft tissues and bone occurs. Even minor trauma leads to ulceration that heals poorly and often

becomes secondarily infected. A transmetatarsal amputation has

already been performed in this patient because of the severity of

peripheral vascular disease.

ض عنده د عند مر amputationرح ع الج

مشط بسب ر DM (diabetes mellitusل ص لب غه ر عنده انسداد atherosclerosis مع ل ص لت ب

د ن ذا الشر ن أ تض ل جزئ أ ت ف الشرث ischemiaإل ا إل حد ص ل لت ulcerب

ر .اضح بشكل ulcerصر ص ض السكر أنه عرف مر حس أ م ن م بد

اعتال أعص peripheral neuropathyعنده ل ص ب ط سكر المنش خ sensory nervousمح

Chronic

inflammation

is more

difficult to

understand,

because it is

so variable.

Seen here is chronic endometritis with lymphocytes as

well as plasma cells in the endometrial stroma. In

general, the inflammatory infiltrate of chronic

inflammation consists mainly of mononuclear cells

("round cells"): lymphocytes, plasma cells, and

macrophages.

ج chronic <...م نس

lymphocyteبسب plasma cell

macrophage

monocyte ف ممكن نش

neutrophiles ع ض مد ده مش أك ج ب أ غ

ل حدة chronicب نجد ك

ع نت

Pus ...> acute Fibrin , scar formation ,collagen ....>

chronic

ه ن ف ك repeated inflammationمثا ممكن

chronicف pusنرى

Here is chronic cervicitis. Prolonged acute inflammation or repeated bouts of acute

inflammation may lead to the appearance of more mononuclear

cells, and chronic inflammation. In this case the inflammation is

severe enough to produce mucosal damage with hemorrhage.

Squamous epithelium

ن ن كم م ر إن squamousع ال ز thinnerبس ال redالمنظر المم

blood cells ه hemorrhageبكثرة ف....> bleeding Chronic hemorrhage

connective tissueنحك عن lymphocyteمع red blood cellsجد

with bleeding Severe cervicitis ن مع ك لب بسب bleedingغInflammation

Inflammation ...> extra vasation

Trauma can avoid the bleeding due to chronic inflammation

Chronic inflammation can go on for a long time: weeks to months

to years. Seen here in the synovium from the joint of a patient with

rheumatoid arthritis are collections of dark blue lymphocytes.

ج in lowصع معرف النسmagnification

ب تجمع الخا االتChronic inflammation in

synovium Synovium found in joints

Certain etiologic agents

such as viruses are

more likely to lead to

chronic inflammation,

as seen here in the lung

of a patient with

influenza A.

Note also that the inflammatory infiltrates

of chronic inflammation are more likely to

be interstitial (within tissues) rather than

exudative (above surfaces or in spaces) like

acute inflammation.

ج ف الرئ نس Alveolar space اضح extra vasation

Red blood vessels even

within lumen Lymphocyte So it chronic

inflammation

Microscopically,

this abscess has a

mixture of

inflammatory

cells, but the wall

of the abscess is

"organizing" with

ingrowth of

capillaries (filled

with red blood

cells) and

fibroblasts.

As organization continues there is resolution with decreasing size of

the abscess, until only a scar remains. If the body's defensive systems

cannot contain the agent causing the abscess, then the process may

continue and even spread.

ف abscessهذا ه نش mixture of inflammatory cells ...ف , necrotic tissue , red blood cells ,cellular debris

The cell wall is organized that mean newly formed of

capillaries and blood vessels (angiogenesis) and Fibrosis

In red ...> Red blood vessels with scrated blood vessels

extra vasationإذن vesselsا نرى جدار

رج red blood cellsنرى lumenخ

اضح angiogenesisنرى جدار

Healing of inflammation often involves ingrowth of capillaries and

fibroblasts. This forms granulation tissue. Here, an acute myocardial

infarction is seen healing. There are numerous capillaries, and

collagen is being laid down to form a scar.

Non-infarcted

myocardium

ف لب نرى غمرح م ف العاج

angiogenesis

طع لم ل مثا ب الدلع ا نراه الطب

مبعثرة ف ذه الكث بح ضمن المس

Myocardial infarction / ischemia

ض خا ر ن خا ح الم ك ض ر تمش الم ل متم angiogenesis طع بعد فترة راح أخذن الم تخت scar ه ن ف ك راح

regeneration of blood vessels حدث ف ال ا ط حدث ف repair *

Regeneration حدث ر ال أ ش غجد ف stem cells لللكن بنس مخت كل اأنسج regeneration

ث ده ف الع الحد ك هذا م ت ت

Superficial wound ...> healing in few days . Maturation and remolding means

synthesis of new collagen and removing the old one

Deep wound ....> for months or years

ا تخت ن scarأح

أن

process very slow

حدث س أنه ا ل

regeneration