Today we are going to talk about “INFLAMMATION”, which comes after we have talked about
with Dr.Mohammad and Dr.Samir, cell injury..
Inflammation is divided into two types (Acute and Chronic), Dr.Najlaa is going to cover the first
type.
2-Inflammation eliminates the necrotic cells( that have resulted from the inflammatory
response ).
3-Inflammation paves the way for repair; replacing normal cells, including epithelial cells
and leukocytes, that have been lost in the process.
So inflammation is a bridge between our immunity and the injurious agent, for example :a heart
which contains necrotic cells,will eliminate this necrotic cells by elimination, “necrosis will not
remain forever”, and these necrotic cells will be replaced with epithelial cells, leukocytes…
Sometimes it might happen as a wrong response (autoimmune diseases) , or it might get out of
control and cause harmful effects(no negative feedback stopped it), so we can describe
inflammation as a “Double-edged sword”.
Nomenclature
In medical terminology inflammation is easily known by the suffix –i tis , it reflects the
inflamed organ.
Examples:
• Appendix Appendicitis
• Dermis Dermatitis
• Gallbladder Cholecystitis
• Duodenum Duodenitis
• Meninges Meningitis
*Asthma: inhaling certain allergens initiates a local reaction and leads to bronchospasm;
which is an inflammatory response.
The participants in Inflammation:
“inflammation is a war between my body and cellular injury,, the Soldiers are the
participants”
-Plasma proteins are proteins that are synthesized in the liver, but their inactive form is
found in the serum, and once stimulated by inflammation, they are activated, producing
other proteins and chemical mediators (we will talk about them in details in the future
InshaaAllah), each of these proteins will give active byproducts that have a specific role
in the inflammatory process.
-Endothelial cells and smooth muscles of vessels (needs chemical regulators) *epithelial
cells surround the smooth muscles in blood vessels anatomy*
Acute Chronic
Duration: starts instantly; within minutes Duration:days to years
and lasts for days *early response* ( starts after days and lasts for years)
Fluid & plasma protein exudation (more Vascular proliferation and fibrosis
fluids)
More swollen.
Notes:
-If the acute inflammation failed to eliminate the injurious agent it will change to the
chronic inflammation type.
-Certain diseases are based on inflammation; a patient may live his life with an ongoing
inflammatory process.
-Presence of neutrophils is a very important indicator of acute inflammation.
Acute Inflammation:
When any type of injury that causes inflammation happens there will be two events or
components occurring:
1- Vascular change (In the area of injury we would have: Vasodilatation followed by
increased blood flow then increased vascular permeability(extravasation of fluids)
and lastly stasis.
Stasis: Normal blood is composed of cells and plasma, but as an inflammatory response the fluid
leaks out of the vessel and the cells stay inside, this slows the flow and increases the viscosity
inside the vessels.
* A student asked about the defense mechanism which is driven by the leukocytes, how is it
accomplished if the cells stay inside the vessels? The doctor said that the leukocytes emigrate
out of the cells after the exudation of fluids.
2- Cellular events; Emigration of cells from microvessels *this is a very complicated event
that needs chemical mediators* and accumulation at sites of injury).
• Heat.
• Redness.
• Pain.
Vascular changes
Arteriolar dilatation follows:
1-transient vasoconstriction (the doctor said it is not important as it occurs so fast)
2-vasodilation and after that there will be an increase in the vascular permeability.
3-Increased vascular permeability and stasis:
• Early phase Arteriolar vasodilatation → ↑hydrostatic pressure, resulting
in transudate.
● Late phase: Leaky vessels results in the loss of proteins ( due to the
difference in oncotic pressure)→ exudate (protein rich fluid) and stasis.
# The protein-poor fluid ( due to the increase of hydrostatic pressure across blood
vessels) is called transudate (inside the vessels).
#The protein-rich liquid due to the increase of oncotic pressure is called exudate
(outside the vessels).
4-Margination of leukocytes; the process by which leukocytes migrate from inside the
blood vessel to the outside.
{ In summary : when an injury occurs, the small blood vessels in the area constrict
(vasoconstriction) very momentarily. The blood vessels then dilate, causing an increase in blood
flow into the area. Blood vessels walls that normally allow only water and salts to pass through
become more permeable. Increasing the hydrostatic pressure results in transudate in the early
phase, followed by the late phase which creates exudate as a result of increasing oncotic
pressure. The final step is the migration of leukocytes from inside of blood vessel to site of
injury. }
The 3rd
mechanism
The 4th
mechanism
● *Delayed prolonged response“Delayed” reflects that it needs time to occur
which is 2-12 hours, however it lasts for hours or days. .
• Many types of injury could lead to this response but mostly is caused by thermal
injury, UV radiation and bacterial toxins; injuries that are not severe enough to
destroy all vessels.
The 5th
mechanism
As a general rule; any newly formed blood vessel will be leaky, because the tight
junctions between the endothelial cells and the supportive tissue surrounding it are not
yet formed properly.
*A student asked, do any RBCs leak out of the vessels? The doctor said yes in a small
amount but the plasma is more in volume, and when the leakage of RBCs increase its
called a hemorrhage, not leakage.*
*A student asked: Is the exudate fluid sterile or not?
The doctor answered:
It depends on the cause of the leakage, for example if it was a
burn it is sterile,
unless a secondary infection occurs, but if it was due to a
bacterial infection for example, it isn’t sterile. *
TRANSUDATE EXUDATE
• Fluid of low protein content • Fluid of high protein content (>3g/dl)
(ultrafiltrate of blood plasma). & increased cellular debris.
*Notes:
-Transudate does not contain microorganisms.
-Specific gravity: measured by a machine, it reflects the amount of protein in the
fluid
0
Cellular Events
Neutrophil migration
- This was the first time for me to publish a sheet to the whole batch, so please forgive me for any
unintentional mistakes, if you have any question do not hesitate to ask and I will try my best to help,
Your colleague Malak Khasawneh