Transcript 13 Inflamm 2 - Univerzita Karlova v Praze

General Pathology
Inflammation II
Healing processes
Classification
Jaroslava Dušková
Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague
Inflammation
Definition:
complex reaction of
organism to damage
(aim: homeostasis maintenance)
Inflammation
Sense
defensive – agent elimination
reparative – damage
reparation
Inflammation
Celsus´ features:





rubor
tumor
calor
dolor
functio laesa
Inflammation -
Classification:
Time view



acute
(days)
subacute
(weeks)
chronic (months-years)
Phases of Inflammatory
Response
Proliferation
Alteration
Exsudation
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

Metaplasia
 Adaptation
– enlargement of the organ through
cell multiplication
– transformation of one differentiated
tissue into another differentiated tissue
-
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., platellets
causes: 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
 necrosis
 foreign bodis
 patient´s motility
 arterial perfusion
 venous drainage
Inflammation -
Classification:
According to the dominant
phase:
 alterative
 EXSUDATIVE
 proliferative
Inflammation 
superficial
mucous
membranes
 serous
membranes
 skin


localisation
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