Transcript CHRONIC INFLAMMATION

CHRONIC INFLAMMATION
DR RABIA RATHORE
ASSISTANT PROFESSOR
WEST MEDICAL WARD
MAYO HOSPITAL/K.E.M.U
DEFINITION
• An inflammation that may begin with a
relatively rapid onset or in a slow,
insidious, and even unnoticed manner,
and that tends to persist for several
weeks, months, or years.
• PATHOPHYSIOLOGY:
• Chronic inflammation has a vague and
indefinite termination; occurs when the
injuring agent persists in the lesion, and
the host's tissues respond in a manner
that is not sufficient to overcome
completely the continuing effects of the
injuring agent.
• It is characterized histopathologically by
infiltrates of lymphocytes, plasma cells,
and histiocytes; fibrosis; and granuloma
formation.
CAUSES OF CHRONIC
INFLAMMATION
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PERSISTANT INFECTION:
Trepenoma Pallidum infection(Syphilis)
Mycobacterium tuberculosis(Tuberculosis)
PROLONGED EXPOSURE TO TOXIC
AGENTS:
• Exogenous(Silicosis)
• Endogenous(Atherosclerosis)
• AUTOIMMUNITY:
• Autoimmune disorders(SLE)
TYPES OF CHRONIC
INFLAMMATION
• Non Specific Inflammation
• Granulomatous Inflammation
NONSPECIFIC
INFLAMMATION
• A diffuse accumulation of macrophages
and lymphocytes at the site of injury.
Fibroblasts proliferate with subsequent
scar formation that may replace functional
connective tissue or the parenchymal
tissues .
GRANULMATOUS
INFLAMMATION
• A cluster of T cell activated modified
macrophages (epithelioid cells) that engulf
and surround indigestible foreign bodies.
*Epithelioid cells may coalesce to form a
large, multinucleated giant cell that
attempts to surround the foreign agent and
eventually becomes encapsulated by
dense connective tissue.
GRANULMATOUS
INFLAMMATION
• *These clusters of macrophage "epithelioid
cells" are surrounded by lymphocytes
*Clumping of the epithelioid cells
(macrophages) into a mass produce a
granuloma.
OUTCOME OF CHRONIC
INFLAMMATION
• The destruction of tissue.
• Thickening and scarring of connective
tissue (fibrosis).
• Death of cells or tissues (necrosis).
CLINICAL PRESENTATION
CASE SCENARIO NO:1
• A 35 years female comes to OPD with
complaints of pain and symmetric swelling of
multiple joints especially the proximal
interphalangeal joints and wrists for more than 6
months.There is morning stiffness persisting
for > 30 minutes, stiffness may recur after
daytime inactivity . She also complains of small
rounded swellings over the extensor surface of
the forearms.
• What is the diagnosis?
• RHEUMATOID ARTHRITIS
• How will you investigate her?
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ESR
C-REACTIVE PROTEINS
RA FACTOR
ANTI CCP ANTIBODIES( anti-cyclic
citrullinated peptide antibody)
CASE SCENARIO NO:2
• A College student seeks medical advice
due to off and on cramps, abdominal pain,
fecal urgency, and tenesmus for the last 45 months and now complaining of bloody
diarrhea 7-8 episodes/day for 2 days.He
had similar episode of bloody diarrhea 2
months back.
• What is the differential diagnosis?
DIFFERENTIAL DIAGNOSIS
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Inflammatory Bowel disease
Infectious colitis
Amebic colitis
Diverticulitis
Psuedomembranous colitis
Hemorrhoids
Anal fissure
Rectal carcinoma/Ca colon.
• How will you investigate him?
INVESTIGATIONS
• Stool specimens for routine bacterial cultures (to
exclude Salmonella,Shigella, and
Campylobacter, as well as specific assays for
Ecoli O157)
• Ova and parasites (to exclude amebiasis)
• Stool toxin assay for C difficile.
• Per rectal examination and proctoscopy
• Colonoscopy
• pANCA
• Blood complete examination
• ESR and C- reactive protein
ULCERATIVE COLITIS AND
CHRONIC INFLAMMATION
CASE SCENARIO NO.3
• A woman brings her maid to hospital as she was
having hemoptysis for one day. On inquiring her
it was found that the maid was having fatigue,
weight loss, fever with evening rise, night
sweats, and productive cough since 3 months
for which she has been taking off and on
medication from the local doctor. On physical
examination, the patient appears chronically ill
and malnourished. Chest examination revealed
posttussive apical rales and few pan inspiratory
coarse crepts.
• What could be the cause of hemoptysis?
CAUSES OF HEMOPTYSIS
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COMMON CAUSES:
Pulmonary Tuberculosis
Bronchiectasis
Chronic Bronchitis
Bronchogenic Carcinoma
Pneumonia (Acute)
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LESS COMMON CAUSES:
Idiopathic pulmonary haemosiderosis,
Goodpasture’s syndrome,
Microscopic polyangiitis,
Wegner ,s Granulomatosis
Trauma
Blood disorders
Benign tumours.
• How will you investigate her?
• BLOOD EXAMINATION :To assess
both the hematocrit, the platelet count as
well as coagulation studies.
• ESR
• Sputum Examination for AFB/Gram
staining ,culture
• Chest X-RAY
• CT Scan Chest
• Renal Fuction test
• Antineutrophil cytoplasmic antibody
Antiglomerular basement membrane
antibody
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CASE SCENARIO NO:4
• A 55 years old diabetic ,hypertensive
smoker suddenly developed severe
crushing chest pain while he was working
at his office.This pain was radiating to the
left arm ,neck and jaw.He also complained
of palpitation,cold sweating and 1 episode
of vomiting.
• What could be the cause of his chest
pain.?
• Unstable angina
• Non ST Segment elevation Myocardial
Infarction.
• ST Segment elevation Myocardial
Infarction .
How will you investigate him?
• Electrocardiogram
• Biochemical markers:
1. Cardiac troponin
2. Creatine-kinase-MB
3. SGOT
4. LDH
• Angiogram
• Echocardiogram
• Fasting Lipid profile
• Blood sugar(Fasting-Random)
• HbA1C
• FINAL DIAGNOSIS:
• Inferior Wall Myocardial Infarction
CASE SCENARIO NO:5
• The patient is a 56-year-old man with
chronic hepatitis C infection diagnosed 15
years back. He had never had an
evaluation of his HCV. He was diagnosed
as a case of chronic liver disease 1 year
back, now complains of worsening right
upper quadrant abdominal pain of
approximately 1 week's duration,
increased abdominal distension and
jaundice.
• What complication might have occurred in this
patient?
• HEPATO-CELLULAR CARCINOMA
• How will you investigate him?
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LFTS
PT/APTT
ULTRASOUND ABDOMEN
ALPHA-FETOPROTEIN
TRIPHASHIC CT –SCAN ABDOMEN