granulomatousinflammation1-180106181542 (1).pptx

It's regarding the acute, chronic inflammation and the definition of granulomatouS inflammation occur n what's it's type s.

1. INFLAMMATION

2. Inflammation is a response of vascularised tissue to infections and damaged tissues It brings out cells and molecules of host defence from the circulation to the sites where they are needed To eliminate the offending agent

3. ACUTE INFLAMMATION Onset is sudden and the course of the disease is short CLINICALLY: Classical signs of inflammation are present with associated constitutional symptoms MICROSCOPY : Vascular changes Exudation of fibrous fluid Presence of large number of neutrophils Cells like Fibroblasts, Histiocytes and Plasma cells are present at the stage of repair

4. CHRONIC INFLAMMATION It is a response of prolonged duration In which inflammation, tissue injury and attempts to repair co exist in varying combinations CAUSES: Persistent infections Hypersensitivity diseases Prolonged exposure to toxic agents

5. MACROSCOPIC APPEARENCES 1. Chronic ulcer: Chronic peptic ulcer of stomach 2. Chronic Abscess cavity: Osteomyelitis 3. Thickening of wall of a hollow viscus: Crohns disease, chronic cholecystitis Granulomatous inflammation Fibrosis

6. MICROSCOPY: Characterised by the proliferation of connective tissue and blood vessels Presence of lymphocytes,plasma cells and macrophages In many cases small areas of necrosis may be present along with process of repair marked by fibrosis Neutrophils are scarce

7. GRANULOMATOUS INFLAMMATION

8. Granuloma formation is a protective response to chronic infection or presence of foreign material. It isolates a persistent offending agent, prevents it from dissemination and restricting the inflammation This protects the host

9. Granuloma is defined as a circumscribed lesion of about 1mm in diameter composed predominantly Modified macrophages Rimmed at the periphery by lymphoid cells With a collar of fibroblast proliferation

10. Granulomatous Diseases BACTERIAL Tuberculosis Leprosy Brucellosis Salmonellosis Listeriosis Syphilis Q fever

11. FUNGAL Histoplasmosis Blastomycosis Cocc i diomyc o sis Hypersensitivity Pneumonitis

12. HELMINTHIC Schistosomiasis Trichinosis FOREIGN BODY TYPES Silica granulomatosis Foreign body pneumonitis

13. VIRAL, CHLAMYDIAL Cat-scratch disease Lymphogranuloma venerum METAL INDUCED Berylliosis Zirconium Granulomatosis

14. UNKNOWN CAUSES Sarcoidosis Crohns disease Wegeners granulomatosis Giant cell arteritis Rheumatoid arthritis

15. FORMATION OF GRANULOMA

16. Cell injury Failure to digest agent Weak acute inflammatory response Engulfment by macrophages Persistence of injurious agents T cell mediated response Poorly digestible agent Activation of CD4 T cells Monocyte chemotactic factor Macrophages are activated by IFN-Y Accumulation of tissue macrophages Epitheloid giant cells Fibroblastic proliferating cytokines GRANULOMA

17. CYTOKINES: Cytokines are formed by activated CD4 T cells and also by activated macrophages IL-1 and IL-2: proliferation of T cells Interferon Y: activation of macrophages TNF-alfa: fibroblast proliferation, activates endothelium Growth factors: TGF

18. COMPOSITION OF GRANULOMA

19. EPITHELOID CELLS Macrophages become large and polygonal with pale, oval nuclei and abundantly cloudy eosinophilic cytoplasm Called epitheloid cells due to resemblance to epithelial cells Apposing cell membranes of epitheloid cells exhibit a high degree of inter digitation Macrophages become epitheloid cells

20. GIANT CELLS Giant cells are large, mullti - nucleated cells that are formed when multiple cells fuse together. When macrophages encounter insoluble material they coalesce to form giant cells Mostly non proliferating macrophages fuse in this manner FOREIGN BODY: Large number of nuclei: 50-100 Regular in size Scattered in the cytoplasm Site of : Suture Haemorrhage Atheroma

21. LANGHANS TYPE: The nucleus are arranged around the periphery like a horse shoe EXAMPLES: Tuberculosis • L e pr o sy • Syphilis TOUTON GIANT CELLS: The cytoplasm has a foamy or vacoulated appearance Typically seen in : Xanthomas

22. Giant cells(GC) Found in Aschoff GC Rheumatic heart Warthin – Finkeley GC Measles Touton GC Xanthomas , juvenile xathogranuloma Reed – sternberg GC Hodgkin’s lymphoma Physiological GC Bone marrow( osteoclast cells and megakaryocytes ), syncytotrophoblasts (placenta).

23. LYMPHOID CELLS Cell mediated immunity reaction to antigen Lymphocytes are an integral composition of granuloma Plasma cells are indicative of accelerated immune response NECROSIS: Feature of some granulomatous conditions FIBROSIS: Feature of healing by proliferating fibroblasts at periphery of granuloma

24. TYPES OF GRANUL O MAS

25. FOREIGN BODY Talc, Suture material NECROTISING GRANULOMAS Mycobacterium Tuberculosis, Histoplasma Capsulatum, Granuloma Annulare NON NECROTISING GRANULOMAS M.Leprae, Sarcoidosis, SLE, SUPPURATIVE GRANULOMAS Actinomyces, Chlamydia Trachomatis HISTIOCYTIC RESPONSE, NO GRANULOMAS Listeria Monocytogenes,Mycosis Fungoides

26. FOREIGN BODY GRANULOMA: Relatively inert foreign bodies Absence of T cell mediated immune response Found around materials such as Talc ( I/V drug abuses) , Sutures etc They do not incite any specific inflammation or immune response Foreign material can be identified in the centre of granuloma Viewed with polarised light- REFRACTILE

27. IMMUNE GRANULOMAS Variety of agents inducing persistent T cell mediated immune response . It can be caseous and non caseous necrosis. It is usually seen when the inciting agent is difficult to eradicat e. Diseases like: Tuberculosis Syphilis Leprosy Sarcodosis Cat scratch disease are seen.

28. THANK YOU