Chapter 4
inflammation
Section 1,General consideration
Inflammation is the reaction of a tissue and its microcirculation to a
pathogenic insult.
It is characterized by the generation
of inflammatory mediators and
movement of fluid and leukocytes
from the blood into extravascular
tissues.
department of pathology
Ⅰ, Definition:
Inflammation is the
response of living tissues
to cellular injury.
‘response’
local physiological response
These include phagocytosis of
the injurious agent;
entrapment to the irritant by
specialized cells(haemocytes);
which then ingest it;
and neutralization of noxious stimuli by hypertrophy of the
cell or one of its organelles,
department of pathology
All these reactions have been
retained in other forms of
life,but what characterizes the
inflammatory process in higher
forms is the reaction of the
blood vessels,leading to the
accumulation of fluid and blood
cells.
department of pathology
Central link to
reaction of the
blood vessels
inflammation
with blood vessels
of organism
department of pathology
The inflammatory response is
closely intertwined with the
process of repair.
injury
irritant
factors inflammation
Anti-
inflammatory
drug
repair
department of pathology
It is not,in itself,a
disease,but is usually a
manifestation of disease,
Inflammation is living
creature war in body.
department of pathology
Ⅱ, Pathogenesis
(1) physiologic factors
(2) chemical factors
(3) biological factors
(4) necrosis tissue
(5) abnormal immunoreactions
department of pathology
physiologic factors inflammation
laryngeal edema → airway narrowed
sulfuric acid → bum inflammation
Tubercle bacillus
Mucor （毛霉菌） Ascaris （蛔虫）
biological
factors
inflammation
infection
department of pathology
inflammation
infection
inflammation
≠
infection inflammation
inflammation infection≠
department of pathology
Infection?
Inflammation?
正确应用
抗生素
Ⅲ, Base change
1,Alteration
2,Exudation
3,proliferation
department of pathology
1,Alteration:
degeneration and
necrosis of local living
tissue alteration
Inflammatory
factors
alteration
inflammation
Living tissue
department of pathology
Acute
pancreatitis
abscess
2.Exudation
(acute inflammation)
This is an important
inflammatory process.
This is an important
process of protecting itself.
department of pathology
Ⅰ, changes in vascular flow
and calibre
Ⅱ, increased vascular
permeability
Ⅲ, leukocytic exudation
and phagocytosis
department of pathology
Ⅰ, changes in vascular flow
and calibre
Ⅱ, increased vascular
permeability
Ⅲ, leukocytic exudation
and phagocytosis
department of pathology
Normal blood flow
department of pathology
fluidarterial end venous end
Normal
venous endarterial end fluid
inflammation
Produce and return of water
In acute inflammation,
however,not only is capillary
hydrostatic pressure increased,
but there is also escape of
plasma proteins into the
extravascular space,increasing
the colloid osmotic pressure
there.
injury
Arterial contraction
Vascular dilatation and
increased blood flow
Blood flow slow-moving
and stasis
P72
Ⅰ, changes in vascular flow
and calibre
Ⅱ, increased vascular
permeability
Ⅲ, leukocytic exudation
and phagocytosis
department of pathology
increased
vascular permeability
1,contraction and transcytosis of endothelial cell
2,injury of endothelial cell
immediate sustained response
delayed prolonged response
3,increased capillary permeability
P72
department of pathology
H2O proteins proteinsproteins
exudate Inflammatory oedema
department of pathology
injury of
endothelial
cell
Contraction and transcytosis
increased
vascular permeability
Fluid exudation
department of pathology
Inflammatory edema
exudate characters of
exudate are…
the exudate and the transudate has what different?
department of pathology
Ⅰ, changes in vascular flow
and calibre
Ⅱ, increased vascular
permeability
Ⅲ, leukocytic exudation
and phagocytosis
department of pathology
slowed blood flow
cellular exudation
department of pathology
slowed blood flow
Leukocytic margination
department of pathology
Slowed blood flow
department of pathology
department of pathology
department of pathology
department of pathology
department of pathology
Tissue injury
Mast cell
coagulation
complement
Cytokines
TNF IL-1
Chemokines IL-8
P-selectin
E-selectin ICAM-1+VCAM-1
C5a
department of pathology
Infiltration of
inflammatory cell
chemotaxsis
department of pathology
department of pathology
Phagocytosis,recognition
internalisation
Digestion
Killing or degradation
①
②
③
Final outcome,Recover
from illness
Depravation
Together
exist
department of pathology
Tissue injury
Category of inflammatory cells
1.monocyte/macrophage
2.polymorphonuclear leukocyte
3.eosinophil
4.basophils(mast cell)
5.lymphocyte/plasma cell
department of pathology
1.monocyte/macrophageRegulates
? inflammatory response
? coagulation/fibrinolytic pathway
? immune response
Inflammatory mediators
cytokines(IL-1,IL-6,TNF)
lysosomal enzymes
Move slow
department of pathology
?Acute inflammation
?Bacterial and foreign body
phagocytosis
?Inflammatory mediators
reactive oxygen metabolites
Lysosomal granule contents
Move quickly
polymorphonuclear leukocyte
polymorphonuclear
leukocyte
polymorphonuclear
leukocyte
department of pathology
polymorphonuclear
leukocyte
department of pathology
3.eosinophil
? Parasite infection
? Associated with:
allergic reactions
parasite-associated
inflammatory reaction
? Modulates mast cell-
mediated reaction
? Reactive oxygen metabolites
? Lysosomal granule enzymes
eosinophil
eosinophil
4.basophils(mast cell)
?Binds IgE molecules
?Contains electron-dense
granules
?Inflammatory mediators
histamine
LTC4,LTD4,LTE4
platelet activating factor
TNF,IL-4
department of pathology
Basophils(mast cell)
Lymphocyte/plasma cell
?Associated chromic
inflammation
antibody synthesis
and secretion
?Key cells in humoral and
cell-mediated immune
responses
?Cytokine production
?Multiple subtypes
Lymphocyte/plasma cell
Lymphocyte
plasma cell
plasma cell
Acute
inflammation
Chronic
inflammation
Parasite
infection
Allergy
Inflammatory mediator:
1,from cell release
2,from plasma
1.dilating vessels
2.increasing permeability
3.chemotaxsis
Function
Source
department of pathology
1.from cell release
(1),Vasoactive amine
(2),AA and PG,LT
(3),Leukocyte release
(4),cytokines
(5),NO and P
department of pathology
2,from plasma
(1),kinin system
(2),Complement system
(3),Clotting system
department of pathology
Types of inflammation
1,Acute inflammation
2,Chronic inflammation
department of pathology
3,Proliferation
Localized tissue
Tissue
macrophages
repair
Granuloma
Persistence of
injurious agent
Acute inflammation
a,change,alteration and exudation
b,inflammatory cell infiltrating,
polymorphonuclear cell
c,duration,few hours to few weeks
d,onset,rapid response
department of pathology
chronic inflammation
a,change,proliferation
b,inflammatory cell infiltrating,
monocyte,lymphocyte,plasma cell
c,duration:
weeks,months or even years
d,onset,slow response
department of pathology
Types of inflammation
1,alterative inflammation
2,exudate inflammation
serous ~ fibrinous ~
suppurative ~ hemorrhagic~
3,proliferatic inflammation
nor-particular ~
granulomatous ~
department of pathology
Virus hepatitis --- alterative inflammation
Virus hepatitis --- alterative inflammation
exudate inflammation
serous ~
fibrinous ~
suppurative ~
hemorrhagic ~
department of pathology
exudate inflammation
serous ~
fibrinous ~
suppurative ~
hemorrhagic ~
department of pathology
Serous inflammation
Serous
inflammation
exudate inflammation
serous ~
fibrinous ~
suppurative ~
hemorrhagic ~
department of pathology
department of pathology
fibrinous inflammation --- heart
This appearance has often been
called a "bread and butter"
pericarditis,
fibrinous inflammation
exudate inflammation
serous ~
fibrinous ~
suppurative ~
hemorrhagic ~
department of pathology
Abscess of brain Abscess of liver
Abscess of lunch
department of pathology
Abscess of muscle
department of pathology
Abscess of brain
department of pathology
department of pathology
Phlegmonous
inflammation
exudate inflammation
serous ~
fibrinous ~
suppurative ~
hemorrhagic ~
department of pathology
department of pathology
Hemorrhagic inflammation of the lung
department of pathology
Hemorrhagic inflammation –viral infection
Types of inflammation
1,alterative inflammation
2,exudate inflammation
serous ~ fibrinous ~
suppurative ~ hemorrhagic~
3,proliferatic inflammation
nor-particular ~
granulomatous ~
department of pathology
department of pathology
nor-particular inflammation
-acute myocardial infarction
department of pathology
granulomatous
inflammation
department of pathology
Epithelioid cells
department of pathology
Epithelioid cells
department of pathology
Granulomatous inflammation of tuberculosis
department of pathology
Foreign body giant cell
department of pathology
Foreign body giant cell
department of pathology
Foreign body giant cell
Langhans giant cell
department of pathology
Granulomatous inflammation:
The principal cells involved in
granulomatous inflammation are
macrophages and lymphocytes.
Nodular collections of epithelioid
cells form granulomas,which are the
morphological hallmark of
granulomatous inflammation
department of pathology
Inflammatory
polyp
Inflammatory pseudotumor
Local express of
inflammation
Systemic express of
inflammation
department of pathology
Local express of inflammation
inflammation
Section 1,General consideration
Inflammation is the reaction of a tissue and its microcirculation to a
pathogenic insult.
It is characterized by the generation
of inflammatory mediators and
movement of fluid and leukocytes
from the blood into extravascular
tissues.
department of pathology
Ⅰ, Definition:
Inflammation is the
response of living tissues
to cellular injury.
‘response’
local physiological response
These include phagocytosis of
the injurious agent;
entrapment to the irritant by
specialized cells(haemocytes);
which then ingest it;
and neutralization of noxious stimuli by hypertrophy of the
cell or one of its organelles,
department of pathology
All these reactions have been
retained in other forms of
life,but what characterizes the
inflammatory process in higher
forms is the reaction of the
blood vessels,leading to the
accumulation of fluid and blood
cells.
department of pathology
Central link to
reaction of the
blood vessels
inflammation
with blood vessels
of organism
department of pathology
The inflammatory response is
closely intertwined with the
process of repair.
injury
irritant
factors inflammation
Anti-
inflammatory
drug
repair
department of pathology
It is not,in itself,a
disease,but is usually a
manifestation of disease,
Inflammation is living
creature war in body.
department of pathology
Ⅱ, Pathogenesis
(1) physiologic factors
(2) chemical factors
(3) biological factors
(4) necrosis tissue
(5) abnormal immunoreactions
department of pathology
physiologic factors inflammation
laryngeal edema → airway narrowed
sulfuric acid → bum inflammation
Tubercle bacillus
Mucor （毛霉菌） Ascaris （蛔虫）
biological
factors
inflammation
infection
department of pathology
inflammation
infection
inflammation
≠
infection inflammation
inflammation infection≠
department of pathology
Infection?
Inflammation?
正确应用
抗生素
Ⅲ, Base change
1,Alteration
2,Exudation
3,proliferation
department of pathology
1,Alteration:
degeneration and
necrosis of local living
tissue alteration
Inflammatory
factors
alteration
inflammation
Living tissue
department of pathology
Acute
pancreatitis
abscess
2.Exudation
(acute inflammation)
This is an important
inflammatory process.
This is an important
process of protecting itself.
department of pathology
Ⅰ, changes in vascular flow
and calibre
Ⅱ, increased vascular
permeability
Ⅲ, leukocytic exudation
and phagocytosis
department of pathology
Ⅰ, changes in vascular flow
and calibre
Ⅱ, increased vascular
permeability
Ⅲ, leukocytic exudation
and phagocytosis
department of pathology
Normal blood flow
department of pathology
fluidarterial end venous end
Normal
venous endarterial end fluid
inflammation
Produce and return of water
In acute inflammation,
however,not only is capillary
hydrostatic pressure increased,
but there is also escape of
plasma proteins into the
extravascular space,increasing
the colloid osmotic pressure
there.
injury
Arterial contraction
Vascular dilatation and
increased blood flow
Blood flow slow-moving
and stasis
P72
Ⅰ, changes in vascular flow
and calibre
Ⅱ, increased vascular
permeability
Ⅲ, leukocytic exudation
and phagocytosis
department of pathology
increased
vascular permeability
1,contraction and transcytosis of endothelial cell
2,injury of endothelial cell
immediate sustained response
delayed prolonged response
3,increased capillary permeability
P72
department of pathology
H2O proteins proteinsproteins
exudate Inflammatory oedema
department of pathology
injury of
endothelial
cell
Contraction and transcytosis
increased
vascular permeability
Fluid exudation
department of pathology
Inflammatory edema
exudate characters of
exudate are…
the exudate and the transudate has what different?
department of pathology
Ⅰ, changes in vascular flow
and calibre
Ⅱ, increased vascular
permeability
Ⅲ, leukocytic exudation
and phagocytosis
department of pathology
slowed blood flow
cellular exudation
department of pathology
slowed blood flow
Leukocytic margination
department of pathology
Slowed blood flow
department of pathology
department of pathology
department of pathology
department of pathology
department of pathology
Tissue injury
Mast cell
coagulation
complement
Cytokines
TNF IL-1
Chemokines IL-8
P-selectin
E-selectin ICAM-1+VCAM-1
C5a
department of pathology
Infiltration of
inflammatory cell
chemotaxsis
department of pathology
department of pathology
Phagocytosis,recognition
internalisation
Digestion
Killing or degradation
①
②
③
Final outcome,Recover
from illness
Depravation
Together
exist
department of pathology
Tissue injury
Category of inflammatory cells
1.monocyte/macrophage
2.polymorphonuclear leukocyte
3.eosinophil
4.basophils(mast cell)
5.lymphocyte/plasma cell
department of pathology
1.monocyte/macrophageRegulates
? inflammatory response
? coagulation/fibrinolytic pathway
? immune response
Inflammatory mediators
cytokines(IL-1,IL-6,TNF)
lysosomal enzymes
Move slow
department of pathology
?Acute inflammation
?Bacterial and foreign body
phagocytosis
?Inflammatory mediators
reactive oxygen metabolites
Lysosomal granule contents
Move quickly
polymorphonuclear leukocyte
polymorphonuclear
leukocyte
polymorphonuclear
leukocyte
department of pathology
polymorphonuclear
leukocyte
department of pathology
3.eosinophil
? Parasite infection
? Associated with:
allergic reactions
parasite-associated
inflammatory reaction
? Modulates mast cell-
mediated reaction
? Reactive oxygen metabolites
? Lysosomal granule enzymes
eosinophil
eosinophil
4.basophils(mast cell)
?Binds IgE molecules
?Contains electron-dense
granules
?Inflammatory mediators
histamine
LTC4,LTD4,LTE4
platelet activating factor
TNF,IL-4
department of pathology
Basophils(mast cell)
Lymphocyte/plasma cell
?Associated chromic
inflammation
antibody synthesis
and secretion
?Key cells in humoral and
cell-mediated immune
responses
?Cytokine production
?Multiple subtypes
Lymphocyte/plasma cell
Lymphocyte
plasma cell
plasma cell
Acute
inflammation
Chronic
inflammation
Parasite
infection
Allergy
Inflammatory mediator:
1,from cell release
2,from plasma
1.dilating vessels
2.increasing permeability
3.chemotaxsis
Function
Source
department of pathology
1.from cell release
(1),Vasoactive amine
(2),AA and PG,LT
(3),Leukocyte release
(4),cytokines
(5),NO and P
department of pathology
2,from plasma
(1),kinin system
(2),Complement system
(3),Clotting system
department of pathology
Types of inflammation
1,Acute inflammation
2,Chronic inflammation
department of pathology
3,Proliferation
Localized tissue
Tissue
macrophages
repair
Granuloma
Persistence of
injurious agent
Acute inflammation
a,change,alteration and exudation
b,inflammatory cell infiltrating,
polymorphonuclear cell
c,duration,few hours to few weeks
d,onset,rapid response
department of pathology
chronic inflammation
a,change,proliferation
b,inflammatory cell infiltrating,
monocyte,lymphocyte,plasma cell
c,duration:
weeks,months or even years
d,onset,slow response
department of pathology
Types of inflammation
1,alterative inflammation
2,exudate inflammation
serous ~ fibrinous ~
suppurative ~ hemorrhagic~
3,proliferatic inflammation
nor-particular ~
granulomatous ~
department of pathology
Virus hepatitis --- alterative inflammation
Virus hepatitis --- alterative inflammation
exudate inflammation
serous ~
fibrinous ~
suppurative ~
hemorrhagic ~
department of pathology
exudate inflammation
serous ~
fibrinous ~
suppurative ~
hemorrhagic ~
department of pathology
Serous inflammation
Serous
inflammation
exudate inflammation
serous ~
fibrinous ~
suppurative ~
hemorrhagic ~
department of pathology
department of pathology
fibrinous inflammation --- heart
This appearance has often been
called a "bread and butter"
pericarditis,
fibrinous inflammation
exudate inflammation
serous ~
fibrinous ~
suppurative ~
hemorrhagic ~
department of pathology
Abscess of brain Abscess of liver
Abscess of lunch
department of pathology
Abscess of muscle
department of pathology
Abscess of brain
department of pathology
department of pathology
Phlegmonous
inflammation
exudate inflammation
serous ~
fibrinous ~
suppurative ~
hemorrhagic ~
department of pathology
department of pathology
Hemorrhagic inflammation of the lung
department of pathology
Hemorrhagic inflammation –viral infection
Types of inflammation
1,alterative inflammation
2,exudate inflammation
serous ~ fibrinous ~
suppurative ~ hemorrhagic~
3,proliferatic inflammation
nor-particular ~
granulomatous ~
department of pathology
department of pathology
nor-particular inflammation
-acute myocardial infarction
department of pathology
granulomatous
inflammation
department of pathology
Epithelioid cells
department of pathology
Epithelioid cells
department of pathology
Granulomatous inflammation of tuberculosis
department of pathology
Foreign body giant cell
department of pathology
Foreign body giant cell
department of pathology
Foreign body giant cell
Langhans giant cell
department of pathology
Granulomatous inflammation:
The principal cells involved in
granulomatous inflammation are
macrophages and lymphocytes.
Nodular collections of epithelioid
cells form granulomas,which are the
morphological hallmark of
granulomatous inflammation
department of pathology
Inflammatory
polyp
Inflammatory pseudotumor
Local express of
inflammation
Systemic express of
inflammation
department of pathology
Local express of inflammation
