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1 Author(s): Gerald Abrams, M.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Non-commercial Share Alike 3.0 License: We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
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3 M1 Patients and Populations: Inflammation and Repair IV Outcomes of Acute Inflammation Gerald D. Abrams MD Fall 2008
4 The Inflammatory response 1. vascular response-fluid exudate 2. cellular response-leukocytic exudate 3. macrophages 4. exudates-non-cellular, cellular, mixed 5. granulomas-granulomatous inflammation 6. fate of the inflammatory reaction 7. healing and scar formation 8. healing of cutaneous wounds 9. chronic inflammation
5 Possible Outcomes of Acute Inflammation Resolution Healing with Scar Chronic Inflammation
6 Purulent Pneumonia G.D. Abrams, University of Michigan Medical School
7 Resolution Normal Lung G.D. Abrams, University of Michigan Medical School
8 HEALING SCAR FORMATION REGENERATION
9 GRANULATION TISSUE Loose,young connective tissue with proliferating fibroblasts and endothelial cells. Granulation tissue matures to form scar. The process of granulation tissue ingrowth is termed organizaton.
10 FIBRINOUS EXUDATE G.D. Abrams, University of Michigan Medical School
11 FIBRINOUS EXUDATE EARLY ORGANIZATION G.D. Abrams, University of Michigan Medical School
12 FIBROBLAST PROLIFERATION G.D. Abrams, University of Michigan Medical School
13 ENDOTHELIAL PROIFERATION G.D. Abrams, University of Michigan Medical School
14 GRANULATION TISSUE G.D. Abrams, University of Michigan Medical School
15 GRANULATION TISSUE Day 5-7 G.D. Abrams, University of Michigan Medical School
16 GRANULATION TISSUE Second Week G.D. Abrams, University of Michigan Medical School
17 MATURING SCAR G.D. Abrams, University of Michigan Medical School
18 NECROTIC MYOCARDIUM Day 1-2 G.D. Abrams, University of Michigan Medical School
19 NECROTIC MYOCARDIUM Day 5-6 G.D. Abrams, University of Michigan Medical School
20 NECROTIC MYOCARDIUM Second Week G.D. Abrams, University of Michigan Medical School
21 MYOCARDIAL SCAR G.D. Abrams, University of Michigan Medical School
22 EPITHELIAL REGENERATION G.D. Abrams, University of Michigan Medical School
23 HEALING OF CUTANEOUS WOUNDS Healing by primary or first intentionwound edges in apposition at the start of healing. Healing by secondary or second intention- wound edges apart, wound open.
24 PHASES OF WOUND HEALING Inflammation Organization and Regeneration Deposition of ECM Remodeling
25 HEALING BY PRIMARY INTENTION Department of Pathology, University of Michigan
26 HEALING BY SECONDARY INTENTION Department of Pathology, University of Michigan
27 WOUND CONTRACTION Grillo, Watts and Gross
28 Complications of Wound Healing Deficient scar dehiscence, hernia Excessive scar hypertrophic scar, keloid Excessive granulation tissue proud flesh, adhesions Contracture Traumatic neuroma
29 KELOID Produnis, Wikimedia Commons
30 Department of Pathology, University of Michigan ADHESIONS
31 CHRONIC INFLAMMATION Inflammation sufficiently prolonged that evidence of repair is seen at the same time as evidence of tissue injury and continuing, active inflammation
32 CAUSES OF CHRONIC INFLAMMATION Prolonged or repetitive action of toxic agents Persistent infection Autoimmunity
33 CHRONIC INFLAMMATION G.D. Abrams, University of Michigan Medical School
34 ACUTE PHASE RESPONSE Leukocytosis Fever Synthesis of acute phase proteins Miscellaneous systemic effects
35 What we want you to know and understand The 5 cardinal signs of inflammation their mechanisms Mechanisms of the vascular response and the cellular response and how they relate to one another The cells participating in inflammatory and reparative responses, and their roles Exudates various types, why they form, and their fate. Granulomatous inflammation Organization and scarring Wound healing mechanisms, factors affecting healing, complications
36 Additional Source Information for more information see: Slide 6: G.D. Abrams, University of Michigan Medical School Slide 7: G.D. Abrams, University of Michigan Medical School Slide 10: G.D. Abrams, University of Michigan Medical School Slide 11: G.D. Abrams, University of Michigan Medical School Slide 12: G.D. Abrams, University of Michigan Medical School Slide 13: G.D. Abrams, University of Michigan Medical School Slide 14: G.D. Abrams, University of Michigan Medical School Slide 15: G.D. Abrams, University of Michigan Medical School Slide 16: G.D. Abrams, University of Michigan Medical School Slide 17: G.D. Abrams, University of Michigan Medical School Slide 18: G.D. Abrams, University of Michigan Medical School Slide 19: G.D. Abrams, University of Michigan Medical School Slide 20: G.D. Abrams, University of Michigan Medical School Slide 21: G.D. Abrams, University of Michigan Medical School Slide 22: G.D. Abrams, University of Michigan Medical School Slide 25: Department of Pathology, University of Michigan Slide 26: Department of Pathology, University of Michigan Slide 27: Grillo, Watts and Gross Slide 29: Produnis, Wikimedia, CC:BY-SA 3.0, Slide 30: Department of Pathology, University of Michigan Slide 33: G.D. Abrams, University of Michigan Medical School
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Attribution: University of Michigan Medical School, Department of Microbiology and Immunology
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