Inflammation II. Healing processes Classification. General Pathology

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1 General Pathology Inflammation II Healing processes Classification Jaroslava Dušková Inst. Pathol.,1st Med. Faculty, Charles Univ. Prague

2 Inflammation II - table of contents Healing of Inflammation Progressive changes healing of wounds Regeneration (restitution) Repair (substitution) Hypertrophy Hyperplasia Metaplasia Adaptation Classification of inflammation superficial skin serous membranes mucous membranes intersticial according to the type of exudate serous non purulent purulent fibrinous gangrenous

3 Inflammation Definition: complex reaction of organism to damage (aim: homeostasis maintenance)

4 Inflammation Sense defensive agent elimination reparative damage reparation

5 Inflammation Celsus features: rubor tumor calor dolor functio laesa

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

7 Phases of Inflammatory Response Alteration Proliferation Exsudation

8 Healing of Inflammation

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

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

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

12 Cell Proliferation in the Gastrointestinal Tract a Oesophagus b Stomach c Sm Bowel d L Bowel e Anus

13

14 Extracellular Matrix Intersticial fbl amorphous gel proteoglycans, hyaluronan, collagens, elastin, fibronectin Basement membrane type 4 collagen, laminin

15 Angiogenesis Endogenous Promotors VEGF - A,B,C,D Angiopoietins Angiogenin Basic fibroblast growth factor bfgf Hepatocyte Growth Factor HGF Interleukin-8 PDGF Transformation Growth Factor ß TGF ß TNF

16 Angiogenesis Endogenous Inhibitors Angiostatin Brain Angiogenesis Inhibitor 1 BAI1 Endostatin Interferons Platelet factor-4 cleavage products Prolactin fragment (16kd) Thrombospondin-1 VEG I Vasostatin

17 Progressive changes 2. Hyperplasia enlargement of the organ through cell multiplication transformation of one differentiated tissue into another differentiated tissue Metaplasia Adaptation - functional adjustment It is done by means of metaplasia, hypertrophy, hyperplasia, metalaxia, (rebuilding)

18

19 Healing Processes wounds by first intention (per primam intentionem) (wounds without infection, dislocation, foreign bodies) by second intention (per secundam intentionem) hematoma organisation thrombus organisation (possible recanalisation)

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

21 Wound Healing Steps-Timing Day 0: Day 1: fibrin fibronectin gel neutrophils Day 1-2: macrophages Day 2-4: fibroblasts, myofibroblasts, capillaries

22

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

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

25

26

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

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

29 Inflammation - localisation superficial mucous membranes serous membranes skin interstitial

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

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

32 Herpes zoster

33 H. zoster

34 Epidermolysis bullosa staphylococcica

35 Pericarditis serosa (CMV)

36

37

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

39

40

41

42

43 Sinusitis chronica

44

45

46

47 Metaplasia intestinalis mucosae ventriculi

48 Urocystitis chronica metaplasia squamocellularis

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

50 Impetigo

51 Acne conglobata

52

53

54

55

56

57

58

59

60

61 Meningitis purulenta CSF

62 Meningitis purulenta CSF

63 Cholelithiasis. Empyema vesicae felleae chronicum.

64

65

66

67

68 Osteomyelitis purulenta

69 Sepsis puerperalis

70

71 Diverticulitis

72

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

74

75

76

77

78 Pericarditis serofibrinosohaemorrhagica Fe

79

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

81 Interstitial fibrinous inflammation fibrin exsudation & fibrinoid change of the collagen containing connective tissue

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

83 Granulomatosis Wegeneri

84 Polyarteritis nodosa

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

86 Rheumatic Heart Disease acute myocarditis Aschoff nodules/bodies

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

88 Gangrenous Inflammation tends to be interstitial putrefactive bacteria severe alteration

89 Appendicitis gangraenosa

90

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