Inflammation - 1

Introduction &
Definition :

Inflammation in a
response of vascularized tissues to

infections &
damaged tissues that brings cells and
molecules
from circulation where they needed in are ,
order

to eliminate the
offending agents
.

Typical inflammatory reaction

develops through of
•

a series

sequential steps :

(a)
Offending agent is
recognised by
host cells
(b)
leukocytes
are recruited
& Plasma proteins

activated
(c)
leukocytes & Proteins are

and work
together to
destroy
& eliminate
offending subs .

(d) The Reaction is controlled 9

terminated

(e)
Damaged tissue is
repaired .

Divided into :

in Acute Inflammation
121 Chronic
Inflammation .
 Causes of Inflammation :

Infection ( Bacterial
Fungal Parasitic )
Ci > .
Viral .
&
,

Microbial toxins .

Iii , Tissue Necrosis -

(a) Ischemia
(b) Trauma

(c)
Physical / chemical
Injury .

( iiis Foreign Bodies ( Splinters dirt sutures ) , ,

( in Immune Reaction ( Hypersensitivity ) Autoimmune - disease

Acute Inflammation
Principle :

Characterized Edema
Neutrophils tissue
by
&
of in
•

presence
.

tissue
•
Arise in
response
to
infection or necrosis .

Immediate Response limited

with
specificity
•

•
Acute Inflammation has three
major components :

Dilation Vessels to
in
of small
leading A Blood Flow

(2) Increased
Permeability ( enabling plasma proteins 4

circulation
leukocytes to leave )

(3)
Emigration y
leukocytes to eliminate the
offending
agents .

Vascular Reactions in Acute Inflammation :

Vasodilation induced mediators

is
by chemical such
•
as

histamine & stasis blood

& is the came
g Erythema g

flow .
 Increased vascular
permeability is induced
by histamine
•

kénins and other mediators that between

,
produces gap
endothelial cells .

Vascular
permeability
• A

allow
plasma proteins &

leukocytes to reach site g

infection .

Lymphatic vessels &

lymph
nodes are also involved

in
inflammation ,
and

often show Redness &

Swelling -
 Cardinal
signs of AI :

Rubor ( Redmen ) & Calor ( neat ) -

Due to Histamine

•
Tumor ( swelling ) -
Histamine mediated

•
Dolor ( Pain )

• Functio laesa ( loss of function )

Cellular Events in AI :

ii.
Neutrophils are 1°
leukocytes in AI .

Liii
Margination of Neutrophils
In AI RBCs
aggregate into Rouleau
•

,
n in venules .

Rondeaux neutrophils the central

mechanically forces out
•

axis stream and them to

pushes periphery ( called Marginate )
ion

( iiii
Rolling of Neutrophils
9T and in due to
in venules
expression of
•
occurs

selectin adhesion molecules on

neutrophils and
✗ enular endothelial cells .

•
Selections are
carbohydrates binding - adhesion molecules .

L Selectin located
• -
is on
leukocytes ( Neutrophils) ;
whereas E- Selectin & P -
selectin are located on the

surface of Venue ar Endothelial cells .

• Interleukin ( Il -

1) and tumor necrosis

factor ( TNF )

stimulate the selectin

expression of ligands on the
 selectin )
surface of Neutrophils ( of
L &
expression
-

selectin molecules on the

surface of Venue an

endothelial cells ( E & P - selectin ) .

selectin
Binding of circulating Neutrophil to E P
•
&

endothelial cells in
weak & transient thus
on .

causing
them to Rod .

rim Firm adhesion Venules

in in due to
Neutrophil
expression of Pz -

integrins and venue ar endothelial cell

expression of Integrin adhesion molecules .

Activation of Neutrophil
•

Pz -

integrin (cotta :c ☐ Is )
adhesion molecules .

Activation of Endothelial cells

integrin adhesion
•

molecules (ligands ) .
( in
Transmigration ( Diapedesis ) of Neutrophils :

•
Neutrophils moving along the xenular endothelium
dissolve the venular basement membrane (release type in

collagen one
) exposed by previous
histamine - mediated

endothelial cell contraction & enter interstitial tissue .

Exudate ( Plasma derived Proteins &

•
-

fluid Rich in cells )

accumulates in interstitial feisue .

• Function 7 Exudate :

ii. Dilute bacterial toxins

Provide assist
(
iis
opsonin ( IgG ,
C 3 b) to in

Phagocytosis .

in Chemotaxis of Neutrophils :

Neutrophils follow chemical gradients that lead to

infection site .
 •
Chemotactic mediators bind to
neutrophil receptors .

Mediators include bacterial

.
c-ba.LT Bq , products
and Il - 8 .

Binding causes Release of Ca .

which increases
Neutrophil
motility .

( in Neutrophil Phagocytosis :

hagocytosis multistep
☐
in a
process ,
consisting of
ionization
ops ,
ingestion and
killing .

(a)
Neutrophil opsonization :

Opsonin s
( IgG ,
c3b
,
c- Reactive
proteins) attach to

bacteria ( bodies )
or
foreign
-

Neutrophils have Receptors for IgG & costs .

0ps ionization enhances

neutrophil recognition and
attachment to bacteria
( foreign bodies )
&

( b ,
Neutrophil Ingestion :

Neutrophil engulf and then

trap bacteria in

phagocytic vacuoles .

into
Primary lysosomes empty hydrolytic enzymes
-

phagocytic vacuoles
producing phago lysosomes .
(c)
Neutrophil killing of Bacteria :

-
via Oz -

dependent myelo peroxidase ( MPO )

system .

in Oz dependent myelo peroxidase system in

only
present in
Neutrophils &
Monocytes ( Not
macrophages)
radicals
4) Production
of superoxide free ,
peroxide ,

bacteria
bleach ( ) which
fungi
.

Hou
,
kill & .

Microbicide
131
Deficiency of NADPH
produces a

96¥
defect .
(
deficiency )

☒ Patients with GGPD

deficiency
*

susceptible Bacterial
More to & some
fungal
infection due to Oz -

dependent MPO
system in

dysfunctional .
owe

Types of Acute Inflammation :

i Purulent ( Suppurative ) Inflammation :

• Localised
proliferation of pm forming organisms ,

such as S .
aureus .

contains
S aureus
coagulase
•
.

which cleanses
fibrinogen into
and bacteria
fibrin traps &

neutrophils ,
and
therefore
keeps the lesion localised .
 (2) Fibrinous inflammation :

•
Inflammation due to increased vessel
permeability ,

with deposition of a
fibrin - rich exudate on
surface g
tissue .

Commonly occurs in Serosal

lining .

of pericardium peritoneum ,
or

pleura .

e-

(3) Serous Inflammation :

Inflammation with thin watery exudate that a ,

has

an
insufficient amount y fibrinogen to produce
fibrin .

Example : Blister in second

degree burn .

Viral Neuritis .
 141 Pseudo membranous
inflammation :

•
Bacterial toxin -
induced
damage of
Mucosal
lining ,

produce a
Shaggy membrane

Necrotic
composed of
tissue .

•
Associated with :

ii , Clostridium difficile
( pseudo membranous colitis)

( Iis
Corynebacterium diphtheria e
,
which produces
membrane
a toxin
causing pseudo formation
trachea
in
pharynx & .

Fever
Role of in AI :

Oz
binding is
Right shifted
•
curve
-

•
More Oz in available
for Oz -

dependent MPO

system .

Hostile environment Bacterial

•

for & Viral

Reproduction

Consequences of 1-1 :
(
Any one or some y them ) :

in Complete resolution ☐ AI

(2) Tissue distraction & Scar

formation
(3) Formation Abscesses
of
(4)
Progression of AI to chronic inflammation .
-

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