Inflammations
assistant-professor Volodymyr
Voloshyn
(in accordance with Ya.Ya. Bodnar et al., Rubin & Farber, Serov et al.;
Frank Netter’s illustrations)
1
• Inflammation is a typical
pathological process which arises up
as a reflex to the destroing agent
action. It was made in the
phylogenesis process and has the
protection & adaptation value.
2
Etiology.
• exogenous:
– biological
– physical
– chemical
• endogenous:
- the structures of own tissue
and cells
- the metabolism’s products
- immune complexes
3
hystion:
• morphofunktional unit of connecting
tissue, which includes cellular
elements, fibers, basic matter,
nerves and their completions,
haemomicrocirculation channel and
lymphatic ways
4
Inflammation Indications
(markers)
• Clinical:
–
–
–
–
–
temperature;
tumor;
hyperaemia;
pain;
function lose.
• Morphological:
– Alterations (A):
(primary, secondary);
– Exudation (B);
– Proliferation (C).
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A
B
C
Pathogeny of
inflammation
Exudation
Alteration
Dystrophy
Microcirculati
on changes
Spasm
Paresis
Plasma
infiltration
Endoteliocells
activation
Necrosis
Blood cells
immigration
Leucodiapedesis
Phagocytosis
Completed
Uncompleted
Marginal
leucocells
placing
Mitosis
Plasmorrhagy
Proliferation
Утворення
ексудату
Erythrodiapedesis
Amitosis
Endocytobiosis
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A
B
C
Pathogeny of
inflammation
Alteration
Dystrophy
Necrosis
Exudation
Microcirculation
changes
Spasm
Paresis
Plasma
infiltration
Endoteliocells
activation
Blood cells
emigration
Leucodiapedesis
Phagocytosis
Completed
Uncompleted
Marginal
leucocells
placing
Mitosis
Plasmorrhagy
Proliferation
Утворення ексудату
Erythrodiapedesis
Amitosis
Endocytobiosis
7
Reasons of exudation:
• a) an increasing of pressure at arterial and
venous hyperemia;
• b) increase of vascular wall permeability
under neurohumors act of inflammation,
hydrogen and potassium ions, ATP acid, milk
and other acids;
• c) oncotic pressure growthing outside
vessels as a result of disintegration of
albuminous molecules and output of albumin.
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Types of exudates inflammation:
• serosal (2 % protein)
• fibrinoid (crouposis or diphtheritic)
• purulent (festered): (acute or chronic)
(abscess, phlegmon, empyema)
• putrid
• hemorrhagic
• catarrhal:
– acute: serosal, mucus, festering, putrid, hemorrhagic;
– chronic: atrophic, hypertrophic;
• mixed.
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A
B
C
Pathogeny of
inflammation
Alteration
Dystrophy
Necrosis
Exudation
Microcirculati
on changes
Spasm
Paresis
Plasma
infiltration
Blood cells
emigration
Endoteliocells
activation
Leucodiapedesis
Phagocytosis
Completed
Uncompleted
Marginal
leucocells
placing
Mitosis
Plasmorrhagy
Proliferation
Утворення ексудату
Erythrodiapedesis
Amitosis
Endocytobiosis
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Periods of Emigration
• marginate
• penetration is through a vascular wall
• motion is in tissue
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Infiltration types
•
•
•
•
by polymorphonuclear leucocytes
roundcells
macrophage
(pale-gray infiltration)
eosinofilic
• hemorrhagic
:
(and signs)
(gray-green tint)
(erythrocytes infiltration)
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A
B
C
Pathogeny of
inflammation
Alteration
Dystrophy
Necrosis
Exudation
Microcirculati
on changes
Spasm
Paresis
Plasma
infiltration
Endoteliocells
activation
Blood cells
immigration
Leucodiapedesis
Phagocytosis
Completed
Uncompleted
Marginal
leucocells
placing
Mitosis
Plasmorrhagy
Proliferation
Утворення ексудату
Erythrodiapedesis
Amitosis
Endocytobiosis
13
Stages of phagocytosis:
approaching
adhesion
absorption
digestion
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A
B
C
Pathogeny of
inflammation
Alteration
Dystrophy
Necrosis
Exudation
Microcirculati
on changes
Spasm
Paresis
Plasma
infiltration
Endoteliocells
activation
Blood cells
immigration
Leucodiapedesis
Phagocytosis
Completed
Uncompleted
Marginal
leucocells
placing
Mitosis
Plasmorrhagy
Proliferation
Утворення ексудату
Erythrodiapedesis
Amitosis
Endocytobiosis
15
Consequences of
inflammation:
•
•
•
•
a) complete restore;
b) scarring formed;
c) chronic form;
d) death.
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Classifications of
inflammation:
• Etiology: a) banal; b) specific;
• Process rate: a) lightning; b) subacute;
c) acute; d) chronic
• Process predominance of banal inflamation:
a) exsudative; b) productive.
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• Acute inflammation ---1) hyperemia, peristasis and stasis)
2) edema, fibrinous exudates
Suppurative inflammation
abscesses
Endotoxemia
circulatory shock.
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Types of exudates inflammation:
• serosal (2 % protein)
• fibrinoid (crouposis or diphtheritic)
• purulent (festered): (acute or chronic)
(phlegmon, abscess, empyema)
• putrid
• hemorrhagic
• catarrhal:
– acute: serosal, mucus, festering, putrid,
hemorrhagic;
– chronic: atrophic, hypertrophic;
• mixed.
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20
Serous rhinitis in allergic
nasal polyp
Pseudomembranous enteritis
Serous rhinitis in allergic nasal polyp; note the severe edematous swelling of the stroma (arrow).
Pseudomembranous enteritis (serofibrinous exudate) in small intestine of baby with staphylococcal food poisoning; note the loose
yellowish membranes covering the mucosa (arrow).
a
b
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• Suppurative microcarditis with abscess formation
and bacterial colonies, gross (left) and microscopic
(right).
note the well-circumscribed yellow necroses (arrow) and fine granular bacterial colonies (arrow).
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Bronchopneumonia
(hemorrhagic)
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Bronchopneumonia
(hemorrhagic)
• the prominent
extravasation
of
erythrocytes
(arrow)
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Necrotizing pneumonia,
microscopic view;
note the pale granular destruction of lung
tissue (arrow).
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Chronic
Inflammation
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Types of productive
(proliferative) inflammation
• interstitial (acute or chronic)
• with polypus and pointed
kondilom formation
• granulomatosic (acute or
chronic)
• hyperplastic of lymphoid tissue
• Around animal parasites
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Phases of granulomes
organizing:
• Accumulation young
mononuclear;
• their transformation into
macrophages;
• formation of mature
granulomaes.
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Granulamatosis inflammation
Unspecific
Specific
Acute
Chronic
Tuberculosis
Syphilis (Luis)
Rheumatism
Syphilis (Luis)
Brucellosis
Leprosy
Tularemia
Rinoscleroma
Sarcoidosis
Glanders
Typhus, spotted fever
Typhoid (fever)
Hydrophobia
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Granulomatous (fungal)
pneumonitis, gross (left) and
microscopic (right)
with fungal organisms {histoplasma sp.
red in PAS stain) in giant cells (arrows).
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• Chronic (lymphocytic)
gastritis
microscopic (right) with fungal
organisms {histoplasma sp. red
in PAS stain) in giant cells
(arrows).
• Severe chronic fibrosing
pneumonitis
("carnification"), gross
appearance
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• Granulation
tissue
Granulation tissue (skin wound) preceding repair with fibrosis; note the edematous
stroma with mixed inflammatory infiltration and proliferation of capillaries
(arrow).
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• Fibrosing granulomatous
pneumonitis in
autoimmune disease
(Wegener
granulomatosis)
note the fibrosing granulomas and the
surrounding interstitial lymphocytic infiltration
with progressive fibrosis (arrow).
• Chronic atrophic
enteritis (Crohn's)
with mucosal atrophy in a
patient with Crohn's
disease; note the fibrous
thickening of the
terminal ileum with loss
of mucosal structure
(arrow).
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•
Type I (allergic) reaction,
bronchial asthma with
prominent bullous emphysema
of the lung
Type II (toxic) reaction, necrotizing
glomerulus and vasculitis with
fibrinoid necrosis in patient with
panarteritis nodosa,
33
• type II reactive
• necrotic
the homogeneous red necroses of
glomerular vessels and arteries
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Type I (allergic) reaction, bronchial asthma with prominent bullous
emphysema of the lung (left), and typical eosinophilic bronchitis with
sclerosis of epithelial basement membrane
Type I (allergic)
reaction (bronchial
asthma): typical
eozinophilic
bronchitis with
sclerosis of
epithelial basement
membrane (arrow).
35
Type III (immune complex) reaction, membranous glomerulus
with immune complex deposits.
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Type III (immune complex)
reaction (membranous glomerulus)
note the prominent thickening of glomerular capillary basement
membranes (arrow).
37
Kidney transplant rejection (lymphocytic), gross appearance of
kidney (left), interstitial lymphocytic infiltration with tubular
damage (right, arrow).
•
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Granulomatous pneumonitis showing gross (left) and
microscopic (right) features of pulmonary tuberculosis;
note the well-circumscribed granulomas with giant cells and
• (caseous) necrosis (arrow).
central
•
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Morphological markers of specific granulomaes
Tuberculosis
Syphilis
Leprosy
Necrosis
Vasculites
Epitelioid
cells
Necrosis
Epitelioid
cells
Lymphocytes
Epitelioid
cells
Virkhov;s
cells
Fibroblastes
Solitary
plasmocytes
Gigantic
cells of
Pirohov’ &
Langans’
Lymphocytes
Plasmocytes
Multitude
plasmocytes
Gigantic cells
of Pirohov’ &
Langans’
Lymphocytes
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Morphological markers of specific granulomaes
Rinoscleroma
Glanders
Epitelioid
cells
Granulation
tissue
Plasmocytes
Neutrophyles
Leucocytes
Mikulch’
cells
necrosis with
kariorexis
Hyaline
globes
Microabscesses
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AIDS
(acquired immune deficiency syndrome).
Periods:
• incubate (asymptomatic carrier)
• limphadenopathic syndrome (LAS)
• pre – AIDS (syndrome which is
associative with AIDS)
• acquired immune deficiency syndrome
(AIDS).
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AIDS Syndromes:
• lymphatic nodes defeat
• injury, which formed at
opportunistic infections
• development of malignant tumors.
43
AIDS
stages
• Follicular hyperplasia
• Diffuse hyperplasia by
angioimmunoblastic lymphadenopatic
type
• Lymphoid emaciation
(виснаження)
.
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and
there is
the
end…
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Thank you
for
attention!
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