General Pathology Inflammation II Healing processes Classification Jaroslava

General Pathology Inflammation II Healing processes Classification Jaroslava Dušková Inst. Pathol. , 1 st 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: v v v rubor tumor calor dolor functio laesa

Inflammation - Classification: Time view v v v acute (days) subacute (weeks) chronic (months-years)

Phases of Inflammatory Response Proliferation Alteration Exsudation

Healing of Inflammation

Progressive Changes Def. : processes leading to v lost or damaged tissue substitution or v adaptation to the organism or environment changed conditions

Progressive Changes Regeneration (restitution) v Reparation (substitution) v Hypertrophy v Hyperplasia v Metaplasia v Adaptation v

Progressive changes 1. u Regeneration - restitution of former status u Reparation – substitution with a less specialised tissue u Hypertrophy – enlargement of the organ through cell enlargement

Angiogenesis Endogenous Promotors u VEGF - A, B, C, D u Angiopoietins u Angiogenin u basic FGF b. FGF u Hepatocyte Growth Factor HGF u Interleukin-8 u PDGF u Transformation Growth Factor ß TGF ß u TNF

Angiogenesis Endogenous Inhibitors u Angiostatin u Brain Angiogenesis Inhibitor 1 BAI 1 u Endostatin u Interferons u Platelet factor-4 cleavage products u Prolactin fragment (16 kd) u Thrombospondin-1 u VEGI u Vasostatin

Progressive changes 2. u Hyperplasia u Metaplasia u 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. u wounds – per primam intentionen (wounds without infection, dislocation, foreign bodies) – u u per secundam intentionen hematoma organisation thrombus organisation (possible recanalisation)

Proliferation - steps v dissolution of exsudate & v granulation tissue necrotic tissue fibronectin formation, fibroblasts & endothelia organisation collagen production v scar maturation v scar contraction myofibroblasts v

Wound Healing - steps Day 0: fibrin – fibronectin gel Day 1: neutrophils Day 1 -2: macrophages Day 2 -4: fibroblasts, myofibroblasts, capillaries

Granulation Tissue Growth v PDGF from: mf, endoth. , platellets causes: fbl proliferation, proteosynthesis v Transforming GF from: mf, epithelia causes: fbl proliferation, angiogenesis v IL- 1 from: mf, epithelia causes: fbl proliferation, endogenous pyrogen v TNF α from: mf causes: endothelial growth, killing bacteria, cachexia

Healing Processes 2. u ischemic and traumatic necroses u foreign bodies healing u bone fractures

Factors Influencing Wound Healing v v v age nutrition status – protein deficit vitamins A, C – collagen, epithelisation Zinc – enzyme function steroids local factors v infection v necrosis v foreign bodis v patient´s motility v arterial perfusion v venous drainage

Inflammation - Classification: According to the dominant phase: v alterative v EXSUDATIVE v proliferative

Inflammation u superficial mucous membranes v serous membranes v skin v u localisation interstitial

Inflammation - Classification: Type of exsudate: v v v serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous

Inflammation - Classification: Type of exsudate: v v v serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous

Inflammation - Classification: Type of exsudate: v v v serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous

Inflammation - Classification: Type of exsudate: v v v serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous

Inflammation - Classification: Type of exsudate: v v v serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous

Inflammation - Classification: Type of exsudate: v v v serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous

Interstitial fibrinose inflammation u fibrin exsudation & fibrinoid change of the collagen containing connective tissue

Fibrinoid Change of Collagen vessels and connective tissue damage u plasmorrhagia (leakage of plasma) u deposits of Ag-AB complexes u staining characteristics fibrin - like u

Significance of Fibrinoid Change diminished quality of the collagen u ( firmness, permeability) tendency to thrombosis in the vessels, aneurysms formation u

Inflammation - Classification: Type of exsudate: v v v serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous

Gangrenous Inflammation u u u tends to be interstitial putrefactive bacteria severe alteration