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CHRONIC INFLAMMATION
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Chronic Inflammation
An immune reaction to "mild" but
persistent antigen producing a
proliferation of lymphocytes and plasma
cells.
There is usually no pain, redness,
swelling, or warmth. Scarr ing and persistence of et io logic
agent is common .
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Causes of chronic inflammation Prolonged exposure to non-degradable:
Partially toxic substances are either endogenous lipidcomponents which result in atherosclerosis or
exogenoussubstances such as silica, asbestos.
Progression from acute inflammation:
Persistent suppuration is result from un-collapsed
abscess cavities, foreign body materials (dirt, cloth,
wool, etc), sequesterum in osteomylitis, or a
sinus/fistulafrom chronic abscesses.
Autoimmuniy:
Autoimmune diseases such as rheumatoid arthritis and
systemic lupus erythematosis are chronic
inflammations
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Chronic Inflammation
Time course:
Greater than 48 hours (weeks, months, years)
Cell type
Mononuclear cells (Primarily Macrophages,
Lymphocytes, Plasma cells), giant cells &fibroblast.
Chronic inflammation classified into:
Diffuse
Focal (granuloma)
Other cells in chronic inflammation:
Lymphocytes: Plasma cells: Eosinophils:
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Cells of chronic inflammation
(1) Monocytes and Macrophages
Monocytes and Macrophages are the prima Dona
(primary cells) in chronic inflammation.
Macrophages are phagocytic Cs, derived from
circulating blood monocytes or tissue histocyte).
Macrophagesarise from the common precursor cells in
the bone marrow, which give rise to blood monocytes.
These cells are then diffusely scattered in various parts
of the body, in the liver (Kupffer cells), spleen, lymph
nodes (sinus histiocytes), lungs (alveolar macrophages),
brain (microglia), skin (Langerhanscells), etc.
Macrophages are scavenger cells of the body.
(2) i
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(2) giant cell Inflammatory giant cells are
multinucleated cells that result from:
1- The fusion of macrophages.
2-Giant cells may form by mitotic
division of the macrophages nuclei
without division of the cytoplasm. i -Langhansgiant cell type: it is large
cells with multiple nuclei (arranged
peripherally). It is situated specially
in tuberculous lesions.
ii- Foreign body giant cell type:
large cells with multiple nuclei are
placed centrally or scattered in thec to lasm as F.B ranulomas
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(3) Other cells in chronic inflammation
1. T-Lymphocytes are primarily involved in cellular
immunity with lymphokine production, and they arethe key regulator and effector cells of the immune
system.
2. B-lymphocytes and Plasma cells produce antibody
directed either against persistent antigen in the
inflammatory site or against altered tissue components.
3.Mast cells and eosinophils appear predominantly in
response to parasitic infestations & allergic reactions.
4. Fibroblast is cell of connective tissue origin synthesis
the collagen fibers in case of fibrosis or cirrhosis
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Classification of chronic inflammation
Chronic inflammation can be classified into the following
two types based on histologic features:
1) Non specific chronic inflammation:
This involves a diffuse accumulation of macrophages and
lymphocytesat site of injury that is usually productive withnew fibrous tissue formations. E.g. Chronic cholecystitis.
2) Specific inflammation (granulomatous inflammation):.
Granulomatous inflammation is characterized by the
presence of granuloma. A granuloma is a microscopic
aggregate of epithelioid cells.
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1- non specific chronic inflammation Different irritants can produce inflammatory
reactions of the same microscopic picture. So
etiology cantbe identified from reaction. Follows acute inflammation e.g. chronic abscess
Gross
Decrease of organ size
Pale in color .Hard inconsistency
Microscopic picture
Lymphocytes, plasma cells, and macrophagesinfiltration
Proliferation of fibroblasts collagen fibers
Thickening of blood vessels wall
Tissue necrosis
Complications of Chronic Inflammation Fibrosis and scarrin .Persistence of etiolo ic
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2- Specific inflammation
(granulomatous inflammation)
Foreign body Tuberculosis (Tb)
Fungal infections
Schitosomiasis
Granulomas
Each irritant produces a specific inflammatory reaction& so etiologycan be identified from reaction e.g.
tuberculosis, bilharziasis
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Granulomatous Inflammation
Factors necessary for granuloma formation:
Presence of indigestible organisms or particles(T.B, mineral oil, etc)
Cell mediated immunity (T cells)
Microscopic Features of granulomatousinflammation
Lymphocytes
Fibroblasts
Collagen
Macrophages
Plasma cells, giant cells, eosinophils
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Foreign Body Granuloma Tuberculosis (Tubercle)
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