INFLAMMATION AND REPAIR Acute and chronic inflammation
- The initial, rapid response to infections and tissue damage is
Inflammation is a response of vascularized tissues to infections and called acute inflammation. It typically develops within
damaged tissues that brings cells and molecules of host defense from the minutes or hours and is of short duration, lasting for several
circulation to the sites where they are needed, in order to eliminate the hours or a few days; its main characteristics are the exudation
offending agents. of fluid and plasma proteins (edema) and the emigration of
It serves to rid the host of both the initial cause of cell injury (e.g., leukocytes, predominantly neutro-phils. When acute
microbes, toxins) and the consequences of such injury. inflammation achieves its desired goal of eliminating the
Without inflammation, infections would go unchecked, wounds would offenders, the reaction subsides, but if the response fails to
never heal, and injured tissues might remain permanent festering sores. clear the stimulus, the reaction can progress to a protracted
phase that is called chronic inflammation. Chronic
The typical inflammatory reaction develops through a series of inflammation is of longer duration and is associated with more
sequential steps: tissue destruction, the presence of lymphocytes and
1. The offending agent, which is located in extravascular tissues, is macrophages, the proliferation of blood vessels, and the
recognized by host cells and molecules. deposition of connective tissue. Acute inflammation is one of
2. Leukocytes and plasma proteins are recruited from the circulation the reactions of the type of host defense known as innate
to the site where the offending agent is located. immunity, and chronic inflammation is more prominent in the
3. The leukocytes and proteins are activated and work together to reactions of adaptive immunity
destroy and eliminate the offending substance.
4. The reaction is controlled and terminated. Termination of inflammation and initiation of tissue repair.
5. The damaged tissue is repaired. - Inflammation is terminated when the offending agent is
eliminated. The reaction resolves because mediators are broken
Fundamental Properties of Inflammation down and dissipated, and leukocytes have short life spans in
Components of the inflammatory response tissues. In addition, anti-inflammatory mechanisms are
- The major participants in the inflammatory reaction in tissues activated, serving to control the response and prevent it from
are blood vessels and leukocytes. Blood vessels dilate to slow causing excessive damage to the host. Once inflammation has
down blood flow, and by increasing their permeability, they achieved its goal of eliminating the offending agents, it also
enable selected circulating proteins to enter the site of infection sets into motion the process of tissue repair. Repair consists of
or tissue damage. Characteristics of the endothelium lining a series of events that heal damaged tissue. In this process, the
blood vessels also change, such that circulating leukocytes first injured tissue is replaced through regeneration of surviving
come to a halt and then migrate into the tissues. Leukocytes, cells and filling of residual defects with connective tissue
once recruited, are activated and acquire the ability to ingest (scarring).
and destroy microbes and dead cells, as well as foreign bodies
and other unwanted materials in the tissues. Acute vs Chronic Inflammation
Harmful consequences of inflammation.
- Protective inflammatory reactions to infections are often
accompanied by local tissue damage and its associated signs
and symptoms (e.g., pain and functional impairment).
Typically, however, these harmful consequences are self-
-limited and resolve as the inflammation abates, leaving little
or no permanent damage.
Local and systemic inflammation.
- Much of this discussion of inflammation focuses on the tissue
reaction that is a local response to an infection or to localized Cardinal Signs of Inflammation
damage. Although even such local reactions can have some o Rubor – Redness of the site of inflammation
systemic manifestations (e.g., fever in the setting of bacterial o Dolor – Pain due to the compressed nerves on the site of the
or viral pharyngitis), the reaction is largely confined to the site infection
of infection or damage. In rare situations, such as some o Calor – Heat
disseminated bacterial infections, the inflammatory reaction is o Tumor – Swelling due to the increased intestitial fluid
systemic and causes widespread pathologic abnormalities. This o Funtio laesa – Loss of function
reaction has been called sepsis, which is one form of the
systemic inflammatory response syndrome. *Celsus, a Roman writer of the first century AD, first listed the four
cardinal signs of inflammation. A fifth clinical sign, loss of function
Mediators of inflammation (functio laesa), was added by Rudolf Virchow in the 19th century.
- The vascular and cellular reactions of inflammation are
triggered by soluble factors that are produced by various cells Causes of Inflammation
or derived from plasma proteins and are generated or activated Infections The toxins that are created or expelled by these
in response to the inflammatory stimulus. Microbes, necrotic microorganisms are one of the causes of inflammation. These toxins and
cells, and even hypoxia can trigger the elaboration of damaged cells trigger or give-off chemotactic elements that attracts
inflammatory mediators and thus elicit inflammation. Such leukocytes in the site of infection.
mediators initiate and amplify the inflammatory response and Tissue necrosis -elicits inflammatory response regardless of the cause
determine its pattern, severity, and clinical and pathologic of cell death.
manifestations. Foreign bodies elicit inflammation because of the traumatic tissue
injury it caused and the potential microbes the foreign body
possesses/has. Even endogenous substances can trigger inflammation with bacteria that cause liquefactive tissue necrosis, such as
like urate crystals in gout and cholesterol crystals in atherosclerosis. staphylococci; these pathogens are referred to as pyogenic
Immune Reactions or hypersensitivity-this includes allergies and (pus--producing) bacteria. A common example of an acute
autoimmune diseases wherein our body attacks itself due to a perceived suppurative inflammation is acute appendicitis. Abscesses are
foreign body kahit wala naman. localized collections of purulent inflammatory tissue caused by
suppuration buried in a tissue, an organ, or a confined space.
Acute Inflammation
Acute inflammation has three major components: Ulcers
- Dilation of small vessels leading to an increase in blood flow, - An ulcer is a local defect, or excavation, of the surface of an
- Increased permeability of the micro-vasculature enabling organ or tissue that is produced by the sloughing (shedding) of
plasma proteins and leukocytes to leave the circulation inflamed necrotic tissue. Ulceration can occur only when
- Emigration of the leukocytes from the microcirculation, their tissue necrosis and resultant inflammation exist on or near a
accumulation in the focus of injury, and their activation to surface. It is most commonly encountered in (1) the mucosa of
eliminate the offending agents the mouth, stomach, intestines, or genitourinary tract, and (2)
the skin and subcutaneous tissue of the lower extremities in
Increased Permeability of Blood Vessels older persons who have circulatory disturbances that
- The escape of fluid, proteins, and blood cells from the predispose to extensive ischemic necrosis.
vascular system into the interstitial tissue or body cavities is
known as exudation. An exudate is an extravascular fluid that Chronic Inflammation
has a high protein concentration and contains cellular debris. Its Chronic inflammation is a response of prolonged duration (weeks or
presence implies that there is an increase in the permeability of months) in which inflammation, tissue injury and attempts at repair
small blood vessels triggered by some sort of tissue injury and coexist, in varying combinations. It may follow acute inflammation, as
an ongoing inflammatory reaction. In contrast, a transudate is described earlier, or chronic inflammation may begin insidiously, as a
a fluid with low protein content, little or no cellular material, low-grade, smoldering response without any manifestations of a
and low specific gravity. It is essentially an ultrafiltrate of preceding acute reaction.
blood plasma that is produced as a result of osmotic or
hydrostatic imbalance across the vessel wall without an Causes of Chronic Inflammation
increase in vascular permeability. Edema denotes an excess of o Persistent Infections
fluid in the interstitial tissue or serous cavities; it can be either o Hypersensitivity diseases
an exudate or a transudate. Pus, a purulent exudate, is an o Prolonged exposure to toxic agents
inflammatory exudate rich in leukocytes (mostly neutrophils),
the debris of dead cells and, in many cases, microbes. Morphologic Features of Chronic Inflammation
o Infiltration of mononuclear cells
Morphologic Patterns of Acute Inflammation o Tissue destruction
o Attempts at healing
Serous Inflammation
- Serous inflammation is marked by the exudation of cell-poor
fluid into spaces created by cell injury or into body cavities
lined by the peritoneum, pleura, or pericardium. Typically,
the fluid in serous inflammation is not infected by destructive
organisms and does not contain large numbers of leukocytes
(which tend to produce purulent inflammation).
*accumulation of fluid in these cavities is called an effusions.
Effusions also occur in noninflammatory conditions, such as reduced
blood outflow in heart failure, or reduced plasma protein levels in some
kidney and liver diseases
Fibrinous Inflammation
- With greater increase in vascular permeability, large molecules
such as fibrinogen pass out of the blood, and fibrin is formed
and deposited in the extracellular space. A fibrinous exudate
develops when the vascular leaks are large or there is a local
procoagulant stimulus (e.g., cancer cells). A fibrinous
exudate is characteristic of inflammation in the lining of body
cavities, such as the meninges, peri-cardium, and pleura.
Fibrinogen (factor I) is a glycoprotein complex, made in the liver,
that circulates in the blood of all vertebrates. During tissue and vascular
injury, it is converted enzymatically by thrombin to fibrin and then to a
fibrinbased blood clot. Fibrin clots function primarily to occlude
blood vessels to stop bleeding.
Purulent (Suppurative) Inflammation, Abscess
- Purulent inflammation is characterized by the production of pus,
an exudate consisting of neutrophils, the liquefied debris of
necrotic cells, and edema fluid. The most frequent cause of
purulent (also called suppurative) inflammation is infection
