P athology

Inflammation III 2024

Associate Prof. Manal Ismail Abd-Elghany

MSC, MD (Minia, Egypt), PhD (Liverpool, UK)

For Faculty of Medicine Students

ILOs
By the end of the lecture, the student should be ale to:
⚫Classify types of acute inflammation.
⚫Classify types of acute suppurative inflammation.
⚫Describe pathology of abscess formation, enumerate fate &
describe its complications.
⚫Describe pathology of biol & carbuncle.
⚫Describe pathology of cellulitis.
⚫Compare between abscess & cellulitis.
⚫ Classify types of non-suppurative inflammation & outline
each type in brief.
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 Classification of inflammation

• Acute inflammation is characterised by Rapid onset &

short duration (minutes to days).
Acute

It lies between acute & chronic types

Subacute

• Chronic inflammation is characterized by gradual onset

Chronic and long duration.
 Types of Acute
inflammation

A. Acute Suppurative
Severe acute B. Acute Non-
inflammation Suppurative
Characterised by
Pus formation

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A. Types of Acute Suppurative
inflammation

Suppurative
inflammation

Localised Diffuse

1. 2. 3.
Cellulitis
Abscess Furuncle Carbuncle

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 1. Abscess (Localised Acute
Suppurative Inflammation)

⚫ Definition: A type of localized suppurative

acute inflammation. characterized by a
cavity containing pus
⚫ Cause: Commonly caused by
Staphylococcus aureus bacteria
⚫ Site: Commonly in subcutaneous tissue but
can occur in any tissue or organ e.g. lung,
brain, liver

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⚫ Pathogenesis of abscess:
➢ The pyogenic organism cause severe necrosis leading
to attraction of large number of neutrophils. The killed
neutrophils are called “pus cells” which release
proteolytic lysosomal enzymes leading to
liquefaction of the central necrotic tissue and fibrin
A. Abscess starts as 2 zones:
1- Central necrosis
2- Peripheral inflammation.
B. Partial Liquefaction of the necrotic material leads to
formation of 3 zones:
1- Central necrosis
2- Mid zone of pus
3- Peripheral inflammation.
C. When liquefaction of necrotic zone is complete,
the abscess looks as a cavity filled with pus.
D. Then the abscess become surrounded by fibrosis
⚫ Fate of abscess:
1. Small abscess; healing after pus
absorption
2. Large abscess; surgical incision or
pointing and evacuation
 Abscess
3. Peripheral Zone
2. Second zone: of inflammation
peripheral
1. Central
inflammation necrosis

2. Mid zone of Pus

1. First zone: Abscess is formed of
Central a cavity containing
necrosis Pus &
Is surrounded by 9
fibrosis
 Characters and composition of Pus

➢ Definition of Pus: It is a non-coagulable (no fibrinogen)

purulent inflammatory fluid exudate. It is thick (creamy),
turbid, alkaline and looks yellowish or yellowish green.

➢ Pus is composed of:

1- Fluid exudate without fibrin (liquefied by fibrinolysin).

2- Inflammatory Cells: A large number of pus cells (dead neutrophils),

PMNs, some macrophages and some erythrocytes (RBCs).

3- Liquefied necrotic tissue and little necrotic fragments (sloughs).

4- Bacteria and bacterial pigments which may be yellowish or greenish.

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 Abscess
(Localised Acute Suppurative Inflammation)

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 Abscess
(Localised Acute Suppurative Inflammation)
 Subcutaneous Abscess
(Localised Acute Suppurative Inflammation)

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 Complications of Abscess
1- Complications of evacuation and healing:
a) Ulcer: It is a local defect or discontinuity of the surface.
It is due to separation of inflammatory necrotic tissue
and defective healing.
b) Sinus: It is a blind ended tract between a deep abscess
and the surface, e.g. a peritoneal abscess may cause
sinuses on the abdominal wall.
c) Fistula: It occurs if evacuation of a deep abscess results
in a tract with two openings, communicating between
one hollow organ and external surface or between two
hollow organs e.g. ano-rectal fistula complicating a peri-
anal abscess.
d) Keloid: It is a large bulging scar (due to excess collagen
formation) which is covered by thin stretched epidermis.
Complications of Abscess continued

2- Haemorrhage e.g. haemoptysis when a lunge

abscess opens into a bronchus.
3- Putrefaction: e.g. putrefaction of a lung abscess
by saprophytes (a type of bacteria) leading to
gangrene.
4- Spread of infection:
a) Direct spread leads to abscess enlargement.
b) Lymphatic spread leads to lymphangitis and
lymphadenitis.
c) Blood spread may lead to;
❑ Toxaemia: Bacterial toxins circulating in the
blood.
 Complications of Abscess continued

❑ Septicaemia: large numbers of virulent bacteria

& their toxins circulating in blood. Commonly fatal.
❑ Pyaemia: Multiple small abscesses caused by
septic emboli derived from septic thrombi due to
septic inflammation of veins near the abscess
(septic thrombophlebitis).
5-Compression effects: e.g. in case of brain
abscess and liver abscess.
6-Chronicity: If the abscess is neither evacuated
spontaneously nor surgically, it gets surrounded by
fibrosis and becomes a chronic abscess. Pus dries
and dystrophic calcification may occur. Examples:
a) Chronic breast abscess b) Chronic lung abscess.
 Ulcer

Note large gab between edges

Ulcer: Gross (A) & microscopic (B) picture of ulcer. Ulcer is a

local defect or discontinuity of the surface. It is due to separation of
inflammatory necrotic tissue and defective healing.
 (a) Sinus (b) Fistula

Sinus: It is a blind ended Fistula: It is a tract with two

tract between a deep openings, communicating
abscess and the surface, between one hollow organ and
e.g. a peritoneal abscess external surface or between two
may cause sinuses on the hollow organs.
abdominal wall.
 Keloid

Keloid: It is a
bulging scar (due to
formation of excess
collagen i.e. fibrosis).
It is covered by thin
stretched epidermis.
2. Boil “Furuncle” (Localised Acute Suppurative
inflammation)
⚫ Definition: Is a
small abscess
related to hair
follicle. May be
single or
multiple
⚫ Caused by…
⚫ Pathogenesis..

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 Boil “Furuncle”
(Localised Acute Suppurative Inflammation)

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 3. Carbuncle (Localised Acute Suppurative
inflammation)

⚫ Definition; localised suppurative inflammation.

characterised by multiple communicating deep
abscesses, opening on the skin by multiple
openings or sinuses
⚫ Cause & pathogenesis: …….
⚫ Site; in thick skin as scalp and skin of the back
⚫ It occurs more common in diabetics

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 Carbuncle
(Localised Acute Suppurative Inflammation)

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Carbuncle (Localised Acute Suppurative
inflammation)

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 2. Cellulitis (Diffuse Acute
Suppurative Inflammation)

⚫ Definition: A type of an acute diffuse

suppurative inflammation, more common
in diabetics
⚫ Cause: Commonly caused by
Streptococcus haemolyticus bacteria
⚫ Site: Commonly in loose connective
tissue such as subcutaneous tissues and
areolar tissue of orbit and pelvis.

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 Cellulitis (Diffuse Acute
Suppurative Inflammation)

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 Cellulitis (Diffuse Acute
Suppurative Inflammation)

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 Abscess
1. Definition: Localized acute
suppurative inflammation
2. Causative organism:
staphelococous aureus
3. Bacteria secretes coagulase
4. Occurs commonly in
subcutaneous tissue but can occur
in any tissue or organ
5. Pus is characterized
by being:
a. Thick due to the presence of large
amount of liquefied fibrin
b. Few RBCs
c. Contains few sloughs (less
necrosis).
6. Spread of infection is less
common
Cellulitis
Diffuse acute suppurative inflammation
Caused by Streptococcous haemolyticus
Bacteria secretes Fibrinolysin &
hyaluronidase
Occurs commonly in loose connective
tissue such as subcutaneous tissues,
areolar tissue of orbit and pelvis.
Pus characterized by
a. Thin, because fibrinolysin antagonizes
fibrin deposition; thus the amount of liquefied
fibrin within pus is absent or very small.
b. Sanguineous i.e. contains numerous
RBCs.
c. Contains many sloughs due to extensive
necrosis.
Spread is more common (direct, lymphatic
& blood spread).
B. Types of Acute Non-
Suppurative inflammation
1. Serous

8.Haemorrhagic 2. Fibrinous

Non- 3.Serofibrinous
7.Necrotizing Suppurative

6.Allergic
4.Membranous

5.Catarrhal

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 1. Serous Inflammation
⚫ It is characterized by excessive serous
fluid poor in fibrin. This fluid is either
derived from blood (exudate) or from
secretions of the mesothelial cells (in case of
inflammation of serous membranes).
⚫ Examples:
a. Skin blisters due to skin burns.
b. Epidermal vesicles due to herpes simplex viral
infection.
c. Inflammation of serous membranes (e.g.
pleura, pericardium and peritoneum).
 Serous Inflammation

Skin blister (a small bubble on skin filled with serous

fluid. It occurs in case of burn). 31
 2. Fibrinous inflammation

➢ Fibrinous inflammation is characterized by an

exudate which is rich in fibrin with little fluid
component.

➢Examples:
❖ a. Adult hyaline membrane disease (adult
respiratory distress syndrome): which is
characterized by diffuse alveolar damage and
formation of alveolar hyaline membranes
predominantly composed of fibrin.
❖ b. Inflammation of serous membranes
❖ C. Lobar pneumonia

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 Fibrinous inflammation:
Fibrinous pericarditis

Pericardium

Fibrin
Pericardium
Heart

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 3. Sero-fibrinous inflammation
➢As previously
discussed,
inflammation of
serous membranes
may be of the serous
type or fibrinous
type.
➢Sero-fibrinous
inflammation is rich
in Both Fluid exudate
& Fibrin.
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 4. Membranous inflammation (or Pseudo-membranous)
⚫ A severe form of acute
inflammation of mucous
membranes caused by
bacteria that produce
exotoxins leading to
mucosal necrosis and
marked submucosal
inflammation resulting
in formation of false
membrane (i.e.
pseudo-membrane)
composed of:
1. Necrotic mucosa
2. Acute inflammatory cells
3. Excess fibrin
⚫ Examples: diphtheria 35
and bacillary dysentery
 5. Catarrhal inflammation
⚫ Mild form of acute inflammation of
mucous membranes characterized by
an exudate mixed with excess mucous
secreted by the irritated mucous membrane.
⚫ Examples: In Catarrhal
rhinitis (common cold).

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 Other Types of Acute
Non Suppurative Inflammation
6- Haemorrhagic Inflammation:
➢ Characterized by excessive erythrocytes within the
exudate due to associated vascular damage.
➢ Example: Small pox.

7- Necrotizing Inflammation:
➢ Characterized by extensive (severe) necrosis in
association with inflammation.
➢ Example: Cancrum oris (infective gangrene).

8- Allergic Inflammation:
➢ Hypersensitivity is the underlying cause of inflammation.
There are usually many eosinophils.
➢ Examples: Urticaria, allergic rhinitis and bronchial
asthma.
 Summary of Types of
Acute Inflammation

I. Acute Suppurative
II. Acute Non-
Severe acute inflammation
Suppurative
Characterised by
Pus formation

1. Serous
A. Localised B. Diffuse 2. Fibrinous
3. Sero-fibrinous
4. Membranous
2. 3. 5. Catarrhal
1. Abscess Cellulitis
Furuncle Carbuncle 6. Allergic
7. Necrotizing
8. Hemorrhagic
References
⚫ Robbin’s Basic pathology, 10th edition.

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 Thank You

Good Luck