inflammation 6

Inflammation

and Repair - 6

Dr.CSBR.Prasad, M.D.

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Out comes of Acute Inflammation

May have one of three outcomes:

1. Complete resolution

2. Healing by fibrosis

3. Chronic inflammation

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Out comes of Acute Inflammation May have one of three outcomes:

1. Complete resolution

Restoration of inflamed tissue to normal

No loss of cells

No architectural loss

Seen when:

Inflammation is short lived

There is little tissue destruction

The tissue can regenerate – eg: liver

It involves:

Removal of cellular debris and microbes by macrophages and

Resorption of edema fluid by lymphatics v3-CSBRP-May-2012

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Fulminant fatal acute viral hepatitis

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Out comes of Acute Inflammation

May have one of three outcomes:

1. Complete resolution

2. Healing by fibrosis:

It occurs: – When there is substantial tissue loss

– When inflammation occurs in tissue incapable of regeneration

– When there is excessive fibrin exudation which can not be cleared

In these conditions connective tissue grows into the area of destruction - ORGANIZATION

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Out comes of Acute Inflammation

May have one of three outcomes:

1. Complete resolution

2. Healing by fibrosis

3. Chronic inflammation

This occurs when:

• There is persistence of injurious agent

• There is interference with normal healing

process

Eg: Peptic ulcer, Complicated pneumonia

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Morphologic Patterns of Acute

Inflammation

The morphologic hallmarks of all acute inflammatory reactions are:

• dilation of small blood vessels

• slowing of blood flow, and accumulation of leukocytes and fluid in the extravascular tissue

• However, special morphologic patterns are often superimposed on these general features, depending on the severity of the reaction, its specific cause, and the particular tissue and site involved

• The importance of recognizing the gross and microscopic patterns is that they often provide valuable clues about the underlying cause

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Morphologic Patterns of Acute

Inflammation

SEROUS INFLAMMATION

FIBRINOUS INFLAMMATION

SUPPURATIVE INFLAMMATION

ULCERATIVE INFLAMMATION

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Morphologic Patterns of Acute

Inflammation

SEROUS INFLAMMATION

• marked by the outpouring of a thin fluid

• The skin blister resulting from a burn or

viral infection represents a large

accumulation of serous fluid

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SEROUS INFLAMMATION

Catarrh

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Vesicular and Bullous Lesions of Poison Ivy v3-CSBRP-May-2012

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Serous inflammation

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Morphologic Patterns of Acute Inflammation 1. SEROUS INFLAMMATION

2. FIBRINOUS INFLAMMATION

A fibrinous exudate develops when:

Vascular leaks are large or Local procoagulant stimulus (e.g., cancer cells)

Fibrinogen will be converted to fibrin

Occurs in inflammations involving the body cavities

Histology of fibrin: Eosinophilic meshwork of threads

or amorphous coagulum

Presence of fibrin stimulate the fibroblasts and blood vessels resulting in scarring

Scarring (organization) may result in functional impairment eg: cardiac encasemnt v3-CSBRP-May-2012

The typical “bread and butter” appearance of fibrinous pericarditis. v3-CSBRP-May-2012

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FIGURE 2-19 Fibrinous pericarditis. A, Deposits of fibrin on the

pericardium. B, A pink meshwork of fibrin exudate (F) overlies the

pericardial surface (P).

Fibrinous inflammation

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Morphologic Patterns of Acute Inflammation 1. SEROUS INFLAMMATION

2. FIBRINOUS INFLAMMATION 3. Suppurative inflammation: Abscess

Characterized by large amounts of PUS:

PMNs, Necrotic tissue Edema fluid Bacteria

Abscess: Localized collections of purulent

inflammatory tissue

Histologically: Central core of necrotic tissue Viable leucocytes at the periphery Wall composed of granulation tissue

Walled off by fibrocollagenous tissue

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FIGURE 2-20 Purulent inflammation. A, Multiple bacterial

abscesses in the lung, in a case of bronchopneumonia. B, The

abscess contains neutrophils and cellular debris, and is surrounded

by congested blood vessels.

Suppurative inflammation

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Morphologic Patterns of Acute Inflammation 1. SEROUS INFLAMMATION

2. FIBRINOUS INFLAMMATION 3. Suppurative inflammation: Abscess

4. ULCERATIVE INFLAMMATION:

Def: An ulcer is a discontinuity in the surface epithelial lining or tissue due to sloughing of necrotic cells

Commonly encountered in

Lining epithelia Skin and subcutaneous tissue

Eg: Peptic ulcer, Ophthus ulcers Histologically:

PMN infiltrates at the margins Granulation tissue formation Fibrosis with chronicity v3-CSBRP-May-2012

FIGURE 2-21 The morphology of an ulcer. A, A chronic duodenal

ulcer. B, Low-power cross-section of a duodenal ulcer crater with an

acute inflammatory exudate in the base.

Ulcerative inflammation

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Gastric ulcer v3-CSBRP-May-2012

Gastric

ulcer

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E N D

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