General Pathology
Inflammation II
Healing processes
Classification
Jaroslava Dušková
Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague
InflammationDefinition:
complex reaction of organism to damage
(aim: homeostasis maintenance)
InflammationSense
defensive – agent elimination
reparative – damage reparation
Inflammation Celsus´ features:
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Inflammation - Classification:
Time view acute (days)
subacute (weeks)
chronic (months-years)
Phases of Inflammatory Response
Alteration
Exsudation
Proliferation
Healing of Inflammation
Progressive Changes
Def.:processes leading to
lost or damaged tissue substitution
or adaptation to the organism or
environment changed conditions
Progressive Changes Regeneration (restitution) Reparation (substitution) Hypertrophy Hyperplasia Metaplasia Adaptation
Progressive changes 1.
Regeneration - restitution of former status
Reparation – substitution with a less specialised
tissue
Hypertrophy – enlargement of the organ through
cell enlargement
Angiogenesis Endogenous Promotors VEGF - A,B,C,D Angiopoietins Angiogenin basic FGF bFGF Hepatocyte Growth Factor HGF Interleukin-8 PDGF Transformation Growth Factor ß TGF ß TNF
Angiogenesis Endogenous Inhibitors Angiostatin Brain Angiogenesis Inhibitor 1 BAI1 Endostatin Interferons Platelet factor-4 cleavage products Prolactin fragment (16kd) Thrombospondin-1 VEGI Vasostatin
Progressive changes 2.
Hyperplasia – enlargement of the organ through cell multiplication
Metaplasia – transformation of one differentiated tissue into another differentiated tissue
Adaptation - functional adjustment
It is done by means of metaplasia, hypertrophy, hyperplasia, metalaxia, (rebuilding).
Healing Processes 1.
wounds– per primam intentionen (wounds without infection, dislocation, foreign
bodies)
– per secundam intentionen
hematoma organisation thrombus organisation
(possible recanalisation)
Proliferation - steps dissolution of exsudate &
necrotic tissue granulation tissue
fibronectin formation, fibroblasts & endothelia organisation
collagen production scar maturation scar contraction myofibroblasts
Wound Healing - steps
Day 0: fibrin – fibronectin gel
Day 1: neutrophils
Day 1-2: macrophages
Day 2-4: fibroblasts, myofibroblasts,
capillaries
Granulation Tissue Growth PDGF
from: mf, endoth., platelletscauses: fbl proliferation, proteosynthesis
Transforming GF from: mf, epithelia causes: fbl proliferation, angiogenesis
IL- 1 from: mf, epithelia causes: fbl proliferation, endogenous pyrogen
TNF α from: mf
causes: endothelial growth, killing bacteria, cachexia
Healing Processes 2.
ischemic and traumatic
necroses foreign bodies healing bone fractures
Factors Influencing Wound Healing age nutrition status – protein deficit vitamins A,C – collagen, epithelisation Zinc – enzyme function steroids local factors
infection necrosisforeign bodispatient´s motilityarterial perfusionvenous drainage
Inflammation - Classification:
According to the dominant phase:
alterative EXSUDATIVE proliferative
Inflammation - localisation
superficial mucous membranes
serous membranes
skin
interstitial
Inflammation - Classification:
Type of exsudate: serous nonpurulent –
lymphoplasmocellular purulent fibrinous gangrenous
Inflammation - Classification:
Type of exsudate: serous nonpurulent –
lymphoplasmocellular purulent fibrinous gangrenous
Inflammation - Classification:
Type of exsudate: serous nonpurulent –
lymphoplasmocellular purulent fibrinous gangrenous
Inflammation - Classification:
Type of exsudate: serous nonpurulent –
lymphoplasmocellular purulent fibrinous gangrenous
Inflammation - Classification:
Type of exsudate: serous nonpurulent –
lymphoplasmocellular purulent fibrinous gangrenous
Inflammation - Classification:
Type of exsudate: serous nonpurulent –
lymphoplasmocellular purulent fibrinous gangrenous
Interstitial fibrinose inflammation
fibrin exsudation & fibrinoid change of the collagen containing connective tissue
Fibrinoid Change of Collagen
vessels and connective tissue damage plasmorrhagia (leakage of plasma) deposits of Ag-AB complexes staining characteristics fibrin - like
Significance of Fibrinoid Change diminished quality of the collagen
( firmness, permeability) tendency to thrombosis in the
vessels, aneurysms formation
Inflammation - Classification:
Type of exsudate: serous nonpurulent –
lymphoplasmocellular purulent fibrinous gangrenous
Gangrenous Inflammation
tends to be interstitial putrefactive bacteria severe alteration