8年制病理學英文課件（2版）：04炎癥

Chapter4：InflammationDepartmentofPathologyPekingUniversityHealthScienceCenterZhengJieSkinblisterresultfromburningSerouseffusionaccumulatedwithinandunderneaththeepidermisofskinFuruncle（癤）Carbuncle（癰)OutlinesofinflammationGeneralConsiderationsDefinition;Inflammatoryagents;Basicpathologicalchangesofinflammation;LocalandsystemicmanifestationsofInflammation

AcuteinflammationTheprocessofvascularandcellulareventsininflammation,InflammatorymediatorsTheclassificationandoutcomesofacuteinflammationChronicinflammationPart1

GeneralConsiderations

DefinitionInflammationisaprotective

responseintendedtoeliminatetheinitialcauseofcellinjuryaswellasthenecroticcellsandtissuesresultingfromtheoriginalinsult.ComponentsofacuteandchronicinflammationInflammatoryagentsInfections(bacterial,viral,parasitic)andmicrobialtoxinsPhysicalagents(e.g.,irradiation,burns)andTrauma(bluntandpenetrating)Chemicalagents(someenvironmentalchemicals)IschemicandnecrotictissuesForeignparticle(dirt,sutures)AllergicreactionsThebasicpathologicalchangesAlteration(degeneration,necrosis)Exudation(hallmark,vascularchange,leukocytereaction,inflammatorymediators)Proliferation(parenchymalandstrmalcells)ExudationofplasmaproteinsExudateandtransudateCauseinflammationnon-inflammationGrosscloudyclearGravity>1.018<1.018Protein>30g/L<30g/LCellno.>100/mm3<100/mm3Coagulation+-Mucoprotein+-LocalmanifestationsofInflammation

rubor(redness)tumor(swelling)calor(heat)dolor(pain)FeverIncreasedacute-phaseproteinsLeukocytosisOthers:increasedpulseandbloodpressure;decreasedsweating;rigors;anorexiaSystemicmanifestationsofinflammation

Part2

Acuteinflammation

Theprocessofacuteinflammation

VasculareventsCellulareventsMoleculareventsVascularEventsChangesinvascularcaliberandflowTransientvasoconstrictionofarteriolesatthesiteofinjuryVasodilationofprecapillaryarteriolesthenincreasesbloodflowtothetissueIncreasedvascularpermeabilityThemajorlocalmanifestationsofacuteinflammation:(1)vasculardilation;(2)extravasationofplasmafluidandprotein;(3)leukocyteemigrationandaccumulationinthesiteofinjury1)Recruitmentofleukocytestositesofinfectionandinjury2)Recognitionofmicrobesanddeadtissues3)Removaloftheoffendingagents4)Releaseofleukocyteproductsandleukocyte-mediatedtissueinjuryCellularEventsMargination,rollingandadhesiontoendotheliumLeukocytemigrationthroughendotheliumChemotaxisandactivation1)RecruitmentofleukocytestositesofinfectionandinjuryThemultipleprocessofleukocytemigrationthroughbloodvessels.RobbinsandCotranPathologicBasisofDisease7thedition

ChemotaxisAfterextravasatingfromtheblood,leukocytesmigratetowardsitesofinjuryalongachemicalgradientinaprocesscalledChemotaxis.ChemotacticFactorsincludingbacterialproducts,chemokines,C5a,leukotrieneB42)RecognitionofmicrobesLeukocytereceptorsandresponses3)RemovaloftheoffendingagentsPhagocytosisEngulfmentKillinganddegradationRobbinsBasicPathologyA.Phagocytosis:AttachmentEngulfmentFusionwithlysosomesB.oxygen-dependentbactericidalmechanism4)Releaseofleukocyteproductsandleukocyte-mediatedtissueinjury

Acuteinflammation:e.g.,acuterespiratorydistresssyndrome;acutetransplantrejection;reperfusioninjuryChronicinflammation:e.g.,arthritis;asthma;chroniclungdiseaseInflammatoryMediatorFunctionofchemicalmediators:directingthevascularandcellulareventsininflammationCell-derivedorPlasma-derivedmediatorsActasacomplicatednetworkMediatorsSourcesActionsHistamineMastcells,basophils,plateletsVasodilation,increasedvascularpermeability,endothelialactivationSerotoninPlateletsVasodilation,increasedvascularpermeabilityProstaglandinsMastcells,leukocytesVasodilation,pain,feverLeukotrienesMastcells,leukocytesIncreasedvascularpermeability,chemotaxis,leukocyteadhesionandactivationPlatelet-activatingfactorLeukocytes,mastcellsVasodilation,increasedvascularpermeability,leukocyteadhesion,chemotaxis,degranulation,oxidativeburstReactiveoxygenspeciesLeukocytesKillingofmicrobes,tissuedamageNitricoxideEndothelium,macrophagesVascularsmoothmusclerelaxation,killingofmicrobesCytokines(TNF,IL-1)Macrophages,endothelialcells,mastcellsLocalendothelialactivation(expressionofadhesionmolecules),fever/pain/anorexia/hypotension,decreasedvascularresistance(shock)ChemokinesLeukocytes,activatedmacrophagesChemotaxis,leukocyteactivationCell-derivedmediatorsGenerationofarachidonicacidmetabolitesandtheirrolesininflammation

RobbinsandCotranPathologicBasisofDisease7theditionRobbinsBasicPathologyMajoreffects

ofIL-1

andTNF

MediatorsSourcesActionsComplementproducts(C5a,C3a,C4a)Plasma(producedinliver)Leukocytechemotaxisandactivation,vasodilation(mastcellstimulation)KininsPlasma(producedinliver)Increasedvascularpermeability,smoothmusclecontraction,vasodilation,painProteasesactivatedduringcoagulationPlasma(producedinliver)Endothelialactivation,leukocyterecruitmentplasmaprotein-derivedmediatorsInterrelationshipsbetweenthefourplasmamediatorsRoleinInflammationMediatorsVasodilationProstaglandins,Nitricoxide,HistamineIncreasedvascularpermeabilityHistamineandserotonin,C3aandC5a,Bradykinin

LeukotrienesC4,D4,E4,PAF,SubstancePChemotaxis,leukocyterecruitmentandactivationTNF,IL-1,Chemokines,C3a,C5a,LeukotrieneB4

FeverIL-1,TNF,ProstaglandinsPainProstaglandins,BradykininTissuedamageLysosomalenzymesofleukocytes,Reactiveoxygenspecies

NitricoxideRoleofMediatorsinInflammationInflammatoryMediatorVasodilatationVascularpermeabilityEDEMAVESOACTIVE

MEDIATORSHistamineBradykininC3aC5aLTPGPAFNOTISUEINJURYTraumaIschemiaNeoplasmInfectiousagentsForeignparticlePRODUCTIONOFINFLAMMATORYMEDIATORSCHEMOTACTICFACTORSC5aLTB4IL-8,TNFinflammatorycellsACUTEINFLAMMATION

Neutrophils,Platelets,MastcellCHRONICINFLAMMATIONMacrophages,Lymphocytes,Platelets

ClassificationofinflammationClinicalclassificationPathologicalclassificationClinicalClassification

AcuteinflammationChronicinflammationCharacteristicsofAcuteInflammationShortduration:daystomonthsAcuteinjuriesinducedbyinflammatoryagentsExudation:fluid,plasmaproteins,neutrophilsAbscessformationCompleteresolutioncanbereachediftheinjuryislimitedorshort-livedSevereinjuryhealingbyscarformationSpreading:septicemia,pyemia,(metastaticabscess)Progressiontochronicinflammation

CharacteristicsofChronicInflammation

Longduration:monthstoyearsPersistentinfection,prolongedexposuretoharmfulagents

Prolongedtissuedestruction,lossofnormalstructureandfunction

chronicinflammatorycell

Infiltration:Macrophages,Lymphocytes,Plasmacellspersistentnewvesselregenerationandfibroblastproliferation:ResultinginfibrosisPathologicalClassificationAlterationInflammation(acute)ExudationInflammation(acute)ProliferationInflammation(chronic)Viralhepatitis(hepatocytenecrosis)EpidemicTypeBEncephalitis(neuronalnecrosis)Poliomyelitis(neuronalnecrosis)AlterationInflammationAlterationinflammation----ViralhepatitisExudationInflammationSerousInflammationFibrinousInflammaionSuppurativeInflammationPhlegnomousInflammationSuperficialSuppurationAbscessHemorrhagicInflammationSerousInflammationFeatures:Outpouringofawatery,relativelyprotein-poorfluid(effusion,with3%-5%plasmaproteins,Albumin)Location:Mucosa,bodycavities(peritoneal,pleural&pericardialcavities),LooseconnectivetissuesPathologicchanges:Inflammatoryedema,blister,hydrops,CatarrhOutcome:completeresolutionSerousInflammationFibrinousInflammationCauses:Moresevereinjuriescanresultingreatervascularpermeability.

Largermolecules(esp.fibrinogen)comeoutthroughtheendothelialcells.Pathologicchanges:Eosinophilicmeshworkofthreadsorsometimesasanamorphouscoagulum.Location:Mucosa,pericardium,peritonium,bodycavities,LungExudationInflammationFibrinousInflammationPathologicchanges:

Mucosa:PseudomembraneousPericardium:ShaggyheartLung:lobarpneumonia

Outcome:Resolution:RestorenormaltissuestructureOrganization:scarformationExudationInflammation

FibrinousInflammationofLarynx&Tracheaduetodiphtheria

FibrinousInflammationofIntestine

Pseudomembrane(BacillaryDysentery)FibrinousInflammationofPericardialCavityPulmonaryCarnificationAdhesivePleuritisSuppurativeorPurulentInflammationFeatures:Thepresenceoflargenumberofneutrophilsandvaryingdegreesoftissuenecrosisandpusformation.Causes:Pyogenic(pus-producing)bacteriasubclass:SuperficialSuppuration,Abscess,PhlegmonousInflammationExudationInflammationAbscessDefinition:Focallocalizedcollectionsofpurulentinflammatorytissuescausedbysuppurationburiedinatissue,anorgan,oraconfinedspace.Reason:adeepseedingofpyogenicbacteriaintoatissueFeatures:Massofnecroticneutrophilsandtissuecells(pus)inthecentralpart,surroundingiscellularproliferation.ExudationInflammation

AbscessofLungAbscessofliver

AbscessofcerebrumExudationInflammationAbscessofSkinFuruncle：thelocalizedsuppurativeinflammationofhaircyst,sebaceousgland&surroundingtissues.Carbuncle：Fusionofquiteafewfuruncles.CausedbyStaphylococciExudationInflammationSuperficialSuppurationLocation:Mucosa,SerosalMembrane.

Features:Pusformation,SuppurativeCatarrh,Empyema(積膿)Examples:Gallbladder,Fallopiantube,Suppurativemeningitis.ExudationInflammationEmpyemaofFallopianTubeSuppurativemeningitis

(subarachnoidempyema)PhlegmonousInflammationLocation:Looseconnectivetissues:Appendix,Skin.Examples:PhlegmonousappendicitisFeatures:largenumbersofneutrophilsinfiltration.Outcome:healwithoutsequelaeExudationInflammationAcutephlegmonousappendicitisExudationInflammationErysipelasAnacutediseaseoftheskinandsubcutaneoustissuecausedbyaspeciesofhemolyticstreptococcusandmarkedbylocalizedinflammationandfever.Alsocalled:SaintAnthony'sfireExudationInflammationHemorrhagicInflammation

Features:largenumbersofRBCintheexudation.

Generally:It’snotanindependentinflammation

Insomeinstances:epidemichemorrhagicfever、leptospirosis(鉤端螺旋體病)andplague(鼠疫)ExudationInflammationTheOutcomesofAcuteInflammationResolutionProgressiontochronicinflammationDisseminationLocalspreadLymphaticspreadHematogenousspread

EventsinthecompleteresolutionofinflammationReturntonormalvascularpermeabilityRemovaloffluidandproteinMacrophagepinocytosisPhagocytosisbyneutrophilsNecroticdebrisbymacrophagesEventualexodusbymacrophagesSinusUlcerFistulaOutcomesofSuppurativeInflammationulcerHematogenousSpreadofAcuteInflammationBacteremia:bacteriaentersystemiccirculationToxemia：

ToxinsentersystemiccirculationSepticemia:bacteriareproduceinsystemiccirculation,releaseendotoxin,inducesystemicmanifestrationsPyemia：sepicemiaresultsfrompyegenicbacteria,embolicabscessesoccurinmultipleorgansMultipleEmbolicAbscessesofKidneyPart3Chronicinflammation

ProliferationinflammationCharacterizedbycellularproliferationparenchymalcellproliferationmesenchymalcellproliferationlymphoidtissueproliferationgranulomatoueinflammationproliferationofmacrophageanditsderivativesInflammatorypseudotumorInflammatorypolypChronicinflammationinlungGranulomatousInflammationDefinition:Distinctivepatternofchronicinflammationcharacterizedbyaggregatesofactivatedmacophagesthatassumeasquamouscell-likeappearance(epithelioidcell)Macrophagederivatives:Foamycell,epithelioidcell,typhoidcell,Aschoffcell,multinucleargiantcell(Langhans’giantcell,foreignbodygiantcell)GranulomatousInflammationTuberculosisTubercleLeparosyTu