Morphology of-acute-inflammation

pathology inflammation

1. MORPHOLOGICAL PATTERNS,
SYSTEMIC EFFECTS & FATE OF
ACUTE INFLAMMATION
DR. DUSSA VAMSHIKRISHNA MD(H)

2. •Inflammationofanorganisusuallynamedby
addingthesuffix-itistoitsLatin/Greekname.
•E.g.
-Appendix-Appendicitis,
-Liver(Hepar)-Hepatitis,
-Gallbladder(Cholecyst)-Cholecystitis,
-Meninges-Meningitis.

3. Morphologicvarietiesofacuteinflammation
aredescribedbelow:
1.Serous Inflammation
2.Fibrinous Inflammation
3.Suppurative or Purulent Inflammation: Abscess
4.Hemorrhagic Inflammation
5.Catarrhal Inflammation
6.Membranous Inflammation

4. MORPHOLOGICAL TYPES OF
ACUTE INFLAMMATION:
1.SerousInflammation:
•Characterizedbymarkedoutpouringofathin
serousfluid.
•Serousexudateoreffusionisyellow,straw-likein
colorandmicroscopicallyshowseitherfeworno
cells.
•Example:Pleuraleffusionasacomplicationof
lobarpneumonia.

6. 2.FibrinousInflammation:
•Marked increasein
vascularpermeability
leadstoescapeoflarge
moleculeslikefibrinogen
fromthelumenofthe
vessel into the
extravascularspaceand
formsfibrin.
MORPHOLOGICAL TYPES OF
ACUTE INFLAMMATION:

7. •Theexudaterichin
fibriniscalledfibrinous
exudate.
•Forexample,fibrinous
pericarditisisseenin
rheumaticfeverand
classicallyknownas
“breadandbutter”
pericarditis.
MORPHOLOGICAL TYPES OF
ACUTE INFLAMMATION:

8. “bread and butter”
pericarditis.

9. 3.SuppurativeorPurulentInflammation:Abscess
•Itischaracterizedbytheproductionoflarge
amountsofpusorpurulentexudate.
•Microscopically,showsneutrophils,liquefactive
necrosis,andedemafluid.
MORPHOLOGICAL TYPES OF
ACUTE INFLAMMATION:

10. •Bacteria(e.g.staphylococci)whichproduce
localizedsuppurationandarecalledaspyogenic
(pus-producing)bacteria.
Forexample,acuteappendicitis.
•Abscesses:Itisthelocalizedcollectionsof
purulentinflammatoryexudatesinatissue,an
organ,oraconfinedspace.
MORPHOLOGICAL TYPES OF
ACUTE INFLAMMATION:

11. ABSCESSES

12. 4. Hemorrhagic Inflammation:
•Wheninflammationisassociatedwithsevere
vascularinjuryordeficiencyofcoagulationfactors,
itcauseshemorrhagicinflammation,
•e.g.Acutepancreatitisduetoproteolytic
destructionofvascularwalls.
MORPHOLOGICAL TYPES OF
ACUTE INFLAMMATION:

14. 5. Catarrhal Inflammation:
•Acuteinflammationofamucousmembraneis
accompaniedbyexcessivesecretionofmucusand
theappearanceisdescribedascatarrhal.
•e.g.commoncold.
MORPHOLOGICAL TYPES OF
ACUTE INFLAMMATION:

16. 6.MembranousInflammation:
•Inthistype,epitheliumiscoveredbymembrane
consistingoffibrin,desquamatedepithelialcells
andinflammatorycells
•e.g.pharyngitisorlaryngitisdueto
Corynebacteriumdiphtheria.
MORPHOLOGICAL TYPES OF
ACUTE INFLAMMATION:

18. 7.Necrotizing(Gangrenous)Inflammation:
•Thecombinationofnecrosisandbacterial
putrefactionisgangrene
•e.g.gangrenousFOOT.
MORPHOLOGICAL TYPES OF
ACUTE INFLAMMATION:

20. •Systemicchangesinacuteinflammationare
collectivelyknownasacute-phaseresponse,or
theSystemicInflammatoryResponseSyndrome
(SIRS).
•Causes:Duetocytokinesproducedbyleukocytes,
inresponsetoinfectionsorimmunereactions.
•MostimportantcytokinesareTNF,IL-1,andIL-6.
SYSTEMIC EFFECTS OF
ACUTE INFLAMMATION

21. •TheClinicalandPathologicchangesofacute-phase
responseare:
1.Fever:
•Pyrogens:Thesearemoleculesthatcausefever.Itmay
beexogenous(bacterialproducts,likeLPS),which
stimulateleukocytestoreleaseendogenouspyrogens
(cytokinessuchasIL-1andTNF).
•Thecytokinesincreasetheenzymescyclooxygenases
resultinginconversionofAAintoprostaglandins.
SYSTEMIC EFFECTS OF
ACUTE INFLAMMATION

23. 2.Raisedplasmalevelsofacute-phaseproteins:
•Theseareplasmaproteinssynthesizedintheliverand
maybemarkedlyraisedinresponsetoinflammatory
stimuli.
Typesofacute-phaseproteins:
•(1)C-reactiveprotein(CRP)
•(2)fibrinogen
•(3)serumamyloidA(SAA)protein.
SYSTEMIC EFFECTS OF
ACUTE INFLAMMATION

24. 3.Changesintheleukocytes:
A.Leukocytosis
•Totalleukocytecountmorethan11,000/μLare
termedasleukocytosis.
•Commonininflammatoryreactions,especially
thosecausedbybacterialinfections.
SYSTEMIC EFFECTS OF
ACUTE INFLAMMATION

25. B.Lymphocytosis:
•Itisseeninviralinfections(e.g.Infectious
mononucleosis,mumps,andGermanmeasles).
SYSTEMIC EFFECTS OF
ACUTE INFLAMMATION

26. SYSTEMIC EFFECTS OF
INFLAMMATION
C.Eosinophilia:
•Itisseeninbronchialasthma,allergy,and
parasiticinfestations.
D.Leukopenia:
•Decreasednumberofcirculatingwhitecellsis
associatedwithfewinfectionsliketyphoidfever
andsomeviruses,rickettsia,andcertain
protozoa.
SYSTEMIC EFFECTS OF
ACUTE INFLAMMATION

27. SYSTEMIC EFFECTS OF
INFLAMMATION
E.Shockmayoccurinseverecases.
•MassivereleaseofcytokineTNF,amediatorof
inflammation,inresponsetoseveretissueinjuryor
infectionresultsinprofusesystemicvasodilatation,
increasedvascularpermeabilityandintravascular
volumeloss.
•Theneteffectofthesechangesishypotensionand
shock.
SYSTEMIC EFFECTS OF
ACUTE INFLAMMATION

28. SYSTEMIC EFFECTS OF
INFLAMMATION
Otherfeaturesoftheacute-phaseresponse:
Itincludes:
•Increasedpulseandbloodpressure.
•Anorexiaandmalaise,probablyduetocytokinesacting
onbraincells.
•Inseverebacterialinfections(sepsis)cytokines(mainly
TNFandIL-1)maybeproducedinlargequantitiesand
canresultindisseminatedintravascularcoagulationand
cardiovascularfailure.
SYSTEMIC EFFECTS OF
ACUTE INFLAMMATION

29. FATE OF ACUTE
INFLAMMATION
•Acuteinflammatoryprocesscanculminateinone
ofthefollowingoutcomes:
•1.Resolution
•2.Healing
•3.Suppuration
•4.Chronicinflammation

30. 1. Resolution
•Completereturntonormaltissuefollowingacute
inflammation.-RESOLUTION
•Occurswhentissuedamageisless&Reversible
cellinjuryisseen.
•e.g. resolution in lobar pneumonia.

31. 2. Healing
•Ifthetissuelossinacuteinflammationis
superficial,healingtakesplacebyregeneration.
•Whenthetissuedestructionisextensive,then
healingoccursbyfibrosis.

32. 3. Suppuration
•Whenthepyogenicbacteriacausingacute
inflammationresultinseveretissuenecrosis,the
processprogressestosuppuration.
•Initially,thereisintenseneutrophilicinfiltration.
Subsequently,mixtureofneutrophils,bacteria,
fragmentsofnecrotictissue,celldebrisandfibrin
comprisepuswhichiscontainedinacavitytoform
anabscess.

33. 4. Chronic inflammation
•Persistingorrecurrentacuteinflammationmay
progresstochronicinflammationinwhichthe
processesofinflammationandhealingproceedside
byside.