中国医科大学病理学英文课件7.ppt

2 Mediatorsfromplasma ComplementS kininS ClottingS 1 kininsystem releaseofthevasoactivenonapeptidebradykinin IncreasesvascularpermeabilityCausescontractionofSMexceptBVSMVasodilationPain 2 ComplementSystem 1 Consistsof20componentproteintogetherwiththeircleavageproducts presentasinactiveforms C1 C9 2 Functions Increasevasopermeability C3a C5a Causevasodilation C3a C5a Chemotaxist C5a Opsonization C3b C3a 5aincreasevascularpermeabilitycausevasodilationbyreleasinghistaminefrommastcellsC5aApowerfulchemotacticagentforneutrophilsbasophils eosinophils monocytesActivatesthelipoxygenasepathwayofAAmetabolisminmonocytes neutrophils releaseofmediators 3 Clottingandfibrinolyticsystem Activatedclottingsystem i Thrombinandfibrinopeptide ThrombinpromotesleukocyteadhesionfibroblastproliferationFibrinopeptideincreasedVpermeabilitychemotacticactivityforleukocytes ii FactorXaincreasedVpermeabilityleukocyteexudation ActivatedfibrinolyticsystemC3C3aincreasevpermeabilityvasodilationFibrintofibrinproducts increasevpermeability Sourcesofmediators 3 Summaryofinflammatorymediators FunctionMajormediatorsVasodilationhistamine bradykinin PGI2 PGE2 NOPermeabilityhistamine bradykinin LTB4 C3a C5a PAFChemotaxisLTB4 C5a cytokins cationicproteinFeverIL 1 IL 2 TNFa PGE2PainPGE2 bradykininTissuedamageoxyradical Lysosomalenzymes NO V Typesandmorphologyofacuteinflammation AlterativeinflammationDegradation necrosisAcuteseverehepatitis encephalitisb toxicmyocarditisExudativeinflammationSerous Fibrinous Purulent Hemorrhagic Proliferousinflammation Chronicinflammation Serousinflammation1 CommonsiteslooseCT serosamucosaandskin2 Lesions Serousexudationbloodserum main secretionofmesothelialCLMalbumin 3 5 fibrin neutrophils epithelialcell 3 Commoncauses Rheumatism TBinvolveserosaBurn cold catarrh4 Consequence absorptionHarmfulseveredemainthroat stiflethoraciccavitypericardialcavity dysfunction Serousinflammationofskin Serousinflammation Low powerviewofacross sectionofaskinblistershowingtheepidermisseparatedfromthedermisbyafocalcollectionofserouseffusion Theskinblisterresultingfromaburnorviralinfectionrepresentsalargeaccumulationofserousfluid eitherwithinorimmediatelybeneaththeepidermisoftheskin Fibrinousinflammation 1 Lesions ExudateswithalargeamountoffibrineosinophilicmeshworkofthreadsoramorphouscoagulumNecroticdebrisneutrophils2 Causesbacterial virusinfectionintoxication urea mercury 3 Favorsitesandfeatures 1 Mucosafibrinousinflammation Sitesupperrespiratorytractgastrointestinaltract Feature pseudomembranousinflammationFibrin necrotictissue neutrophils gray white membrane shaped Common bacillarydysentery diphtheria Diphtheriaoftrachea LarynxandTreacheaallrevealaroughcongestedmucosacoveredbyalayerofpseudomembrane Adheretightlyonlaryngealregions whilelooselyconnectedwiththesubmucosaoftrachea Mucosaofcoloniscoveredbyexudates Bran likesubstancessurfacethemucosalfoldsMucosaappearsthickenedduetoedemaConstitutesofthemixtureoffibrin mucus injuredtissue neutrophils RBCs bacilli 2 Serosafibrinousinflammation Sites pleura pericardium Feature fibrinouspericarditis corvillosumHairyheart epicardiumiscoveredwithfibrinousexudateandformaheavyshaggycoatwithadhesionbetweenthelayersofthepericardium Fibrinouspericarditis Pericardialcavityhasbeenopenedtorevealafibriouspericarditiswithstrandsofstringypalefibrinbetweenviseralandparietalpericardium Depositsoffibrinonthepericardium Finevilloseformheavyshaggycoatonthsurface Fibrinouspericarditis Apinkmeshworkoffibrinexudateoverliesthepericardialsurface 3 Lung lobarpneumonia thealveolarcapillariesappearcompressedalveolarspaces progressivedisintegrationofneutrophilsalongwiththecontinuedaccumulationoffibrin 4 Consequences Resolutionandabsorption Organization lung carnificationheart constrictivepericarditisTheprocessofresolutionmayrestorenormaltissuestructure butwhenthefibrinisnotremoved itmaystimulatetheingrowthoffibroblastsandbloodvesselsandthusleadtoscarring Conversionofthefibrinousexudatetoscartissue organization Suppurativeorpurulentinflammation 1 Concept productionoflargeamountsofpusorpurulentexudateconsistingofneutrophilsnecrosiscellsandedemafluid Pus apurulentexudate isaninflammatoryexudaterichinleukocytes mostlyneutrophils thedebrisofdeadcellsand inmanycases microbes 2 Causes Staphylococcus streptococcus 3 Types 1 Surfacepurulenceandempyema Concept purulentinflammationoccurringinmucosaandserosa Features surfacepurulence superficalinfiltrationofneutrophil purulentcatarrh empyema pusdepositinthecavities gallbladder appendix Purulentmeningitis Athicklayerofsuppurativeexudatecoversthesurfaceofthebrainandthickenstheleptomeninges Themeningealvesselsareengorgedandstandoutprominently Purulentmeningitis Inflammatoryexudatesinthewidensubarachnoidspace Composedofplentyofnutrophils puscells afewmonocyteandfibrin BVareengorgedextensively 2 Phlegmonousinflammation Concept diffusepurulentinflammationoccurringinlooseconnectivetissue Pathogen hemolyticstreptococcus Sites skin muscles appendix Lesionfeature neutrophils diffuseinfiltration Phlegmonousappendicitis Appendixisswollen withyellow whitetotanexudatesandhyperemia ratherthanasmooth glisteringpaletanserosasuface Phlegmonousappendicitis Mucosashowsulcerationandunderminingbyanextensiveneutrophilexudate Thewallisthickenedbycongestion edema Phlegmonousappendicitis Neutrophilextendintoandthroughthewalloftheappendix 3 Abscess Concept localizedpurulentinflammationaccompaniedwithlocaltissuenecrosisandformingthecavityfullofpus Sites Skin furuncle carbuncleOrgans lung brain liver kidney Pathogen Staphylococcus toxin necrosis Results Smallabscess absorptionLargeabscess becomewalledoffandultimatelyreplacedbyconnectivetissueChronicabscess Abscessofliver Onthecutsufaceoftheliver anabscesswithpusinthecenteriswalledoffbyproliferatedgrayish whitefibroustissue Abscessofkidney Yellowabscessscatteredonthesurfaceofkidney Theinfectioncanreachthekidneyby ascendinguptheurinarytracthematogenousspreadwithsepsis Abscessofkidney Focalrenaltissuearenecrotic neutrophilsaccumulates Renalmesenchymaengorgementandedematakeplaceatperiphery Ulcer 1 Concept Inflammationofskinandmucosaaccompaniedwithsuperficialnecrosisanddetachmenttoformlocaldefect 2 Causesintoxication traumavascularobstructionSinusasacorcavityinanorganortissueFistulaabnomalconnectionorpassagewaybetweentwoEC linedorgansthatnormallydonotconnect Hemorrhagicinflammation 1 Ininflammatoryfoci vascularwallssevereinjuredwithexudatescontainlargeamountsofRBC2 Causes causedbyhighlyvirulentorganismssuchasWaterhouse FriederichsenSEpidemichemorrhagicfeverLeptospirosisanthrax Section3 Chronicinflammation I Etiologyandfeatures1 Features Prolongedduration1 Followacuteinflammation2 FrequentlybeginsinsidiouslyoftenasymptomaticresponseRheumatoidarthritis AS TBChroniclungdisease 2 Causes 1 PersistentinfectionsbycertainmicroorganismswithlowertoxicityTuberclebacilli TB Helicobacterpylori chronicgastritis 2 ProlongedexposuretotoxicagentsExogenous Particulatesilicainhaledforprolongedperiod silicosisEndogenous ToxicplasmalipidcomponentsAtherosclerosis3 AutoimmunitycausedbyautoantigensRheumatoidarthritis lupuserythematosus II Classification Chronicnon specificinflammationInflammatorypolypInflammatorypseudotumorChronicspecificinflammation Granulomatousinflammation InfectiousgranulomaForeignbodygranuloma 1 Chronicnon specificinflammation 1 Morphologicfeatures 1 Infiltrativecells LC PC MC 2 ProliferationFibroblast ECParenchymalcell 3 Milddegenerationnecrosis exudation 4 Tissuedestruction inducedbyoffendingagentorinflammatorycells 2 Chronicinflammatorycells 1 Mononuclearphagocytesystem BloodmonocyteTissuemacrophageConnectivetissueLiver KupffercellsSpleen LN sinushistocyte Lung alveolarmacrophage Consistof Organs Maturationofmononuclearphagocytes Theageofinflammation i Acute neutrophilspredominateduringthefirst6 24hs arereplacedbymonocytein24 48hsii Chronic LC PC monocyte Chemotacticfactors C3a PDGF Fibronectin FunctionsPhagocytosisTissuedamageFibrosis Therolesofactivatedmacrophagesinchronicinflammation Macrophagesareactivatedbycytokinesorbynonimmunologicstimuli Theproductsmadebyactivatedmacrophagesthatcausetissueinjuryandfibrosisareindicated 2 Lymphocyte Chemotacticfactors I V CAM lymphotactin Functions Producelymphokines IFN 3 Mastcell DistributedinCT Functionsproducecytokinescontributetofibrosisanaphylacticreactiontodrugs 4 Eosinophils parasiteinfection 3 Somecharacteristicchanges 1 Inflammatorypolyp Concept underthestimulationofinflammatoryagentslocalmucosalepithelium glands GTproliferateformprotrudentmass Commonsitesnasalpolypcervicalpolypintestinalpolyp Smoothmassoftissue polyp withstalksprotrudesoutwardsfromthesurfaceofintestinemucosa Mucosalepithelium gland granulationproliferate andtherearelymphocyte plasmacellinfiltration Nasalpolyp 2 Inflammatorypseudotumor Concept aclearedge tumor likemassformedbytissueinflammatoryproliferationoftenoccurineyesandlung Lesions Ineyes largeamountsofLCproliferationInlung GT proliferativealveolarepi M foamC infiltrativeLC PC 2 ChronicspecificinflammationGranulomatousinflammation 1 Granulomatousinflammation adistinctivechronicinflammationcharacterizedbyformationofgranuloma Granuloma ininflammatoryfocimacrophagesproliferateformclearnodularfocus 2 Types 1 Infectious immune granuloma Concept causedbyinsolubleparticlesthatarecapableofinducingacell mediatedimmunereaction Formation M engulfinsolubleparticlespresentsomeofittoTCcytokines IL 2 IFN r transformingM intoepithelioidCandmultinucleategiantC Thecommondiseases TB leprosy rheumatismtyphoidfever syphilis Forexample TuberculosisCentral caseousnecrosisPeripheryEpithelioidcellsLanghansgiantcellsLC fibroblast Tubercle Tubercle Thegranulomaisreferredtoasatubercle centralcaseousnecrosisappearsaspink amorphousgranlardebris lossofallcellulardetail Theepitheliodcellshavepalepinkgranularcytoplasmwithdistinctcellboundaries Nucleilongandstringy EpitheliodcellsfusetoformLGCcontain10ormorenucleiarrangedperipherally 2 Foreignbodygranuloma Causes foreignbody talc suture LesionsForeignbodyEpithelioidcellForeignbodygiantcell Foreignbodygranuloma Foreignbodygaintcellsareseenwherethereischolesterolcrystal thereralsoMC fibroblasts Section4 Localmanifestationandgeneralreactions I Localmanifestation1 Redness BVdilating hyperemia rubor 2 Swelling congestion edema exudationchronicinflammation proliferation tumor 3 Heat hyperemia metabolism producingheat calor 4 Painswelling Nendingpressedinflammatorymediator dolor 5 Lossoffunctionreleasetoxicmetabolitesandproteases II Generalreactions 1 FeverExogenousF toxin virus Ag AbcomplexEndogenousF cytokines IL 1 TNF PGbeneficialandharmful2 Leukocytosis Acutepurulentinfla neutrophils Chronicorvirusinfection LC Allergicdiseaseorparasite eosinophils left shift SLE typhoidfever virusinfection 3 OthersM proliferation liver spleen LN lesionsofmesenc