Chronic Inflammation

dr.reza2006@gmail.comdr.reza2006@gmail.com

Dr Rezaur Rahman

dr.reza2006@gmail.com

Learning objectives for PMDC in Chronic Inflammation

Chronic inflammations/ Granulomatous diseases. The systemic effects of acute and chronic

inflammation and their possible outcomes. Significance of ESR. Examples of induced hypothermia in medicine.

Pathogenesis, clinical features and lab. Diagnosis of Gout.

Management of acute and chronic Gout.

Definition of Chronic Inflammation

Inflammation of prolonged duration (weeks or months) in which active inflammation, tissue destruction and attempts at repair are proceeding simultaneously

Acute Vs Chronic Inflammation

Exudate Vs Transudate

Aetiology: Onset & Causes

A. Chronic inflammation from onset (de novo)1. Persistent infection by certain

microorganism2. Prolonged exposure to toxic/aggressive

agent3. Autoimmunity: RA, SLE, Hashimoto’s

thyroiditis, Chronic gastritis of pernicious anaemia

4. Unknown cause: Sarcoidosis, Crohn disease, ulcerative colitis

B. Chronic inflammation developing from acute inflammation(Acute to Chronic)

A. Chronic inflammation from onset (de novo)

1. Persistent infection by certain microorganism

2. Prolonged exposure to toxic/aggressive agent

3. Autoimmunity: RA, SLE, Hashimoto’s thyroiditis, Chronic gastritis of pernicious anaemia

4. Unknown cause: Sarcoidosis, Crohn disease, ulcerative colitis

1.Persistent infection by certain microorganism

Mycobacterium tuberculosis, Mycobacterium lepri, Treponema pallidum, certain viruses, fungi, parasite- low toxicity, delayed hypersensitivity and granulomatous inflammation

Helicobacter pylori- Chronic gastritis, gastric ulcer, duodenal ulcer

2.Prolonged exposure to toxic/aggressive agent

Aggressive action of acid pepsin in gastric juice causing peptic ulcer

Cigarette smoking causing Chronic bronchitis

Toxic plasma lipid components- atherosclerosis

Talc, suture, other nondegradable material Silica- silicosis of lung

B. Chronic inflammation developing from acute inflammation(Acute to Chronic)

Persistence of injurious agent, eg, organism in abscess

Interference in healing process, eg, sequestrum(dead bone) in chronic suppuratve osteomyelitis

Drainage is delayed or inadequate, eg, lung abscess

Recurrent bouts of acute inflammation, eg, chronic pyelonephritis, chronic cholecystitis, chronic gout.

Histological types of Chronic Inflammation1. Specific Chronic Inflammation:

histologically distinctive. Granulomatous inflammation is specific inflammation

2. Nonspecific Chronic Inflammation: not histologically distinctive

Granuloma:

Granuloma is a microscopic aggregation of macrophages and epitheloid cells which are modified macrophages, surrounded by a collar of mononuclear leucocyte, principally lymphocyte.

Usually giant cells and occasionally plasma cells are present.

Giant cell of Granuloma:Large cell with more than one nucleus.Formed by fusion of macrophages or epitheloid cell. 20 or

more small nuclei are present.Types:1.Langhans’ giant cells- nuclei are arranged in horse-shoe

pattern. Found in tuberculosis and sarcoidosis2.Foreign body giant cells- haphazardly scattered nuclei.

Found in foreign body granuloma.3.Aschoff giant cell- rheumatic lesion4.Giant cell of ‘Giant cell tumor of bone’- osteoclast type5.Tuton giant cell- in Xanthoma6.Giant cell to reaction to sodium urate crystal in gout** Physiological Giant cell- Osteoclast, megakaryocyte

Malignant giant cell:

Found in- Anaplastic tumor Hodgkin’s disease: Reed-Stenberg giant cell Choriocarcinoma Poorly differentiated astrocytoma

Difference between:

Classification of Granulomatous inflammation

Aetiological classification1. Infectious agent- bacteri, helminth, fungi2. Physical & chemical agents- exogenous &

endogenous3. Autoantigen: Wegener’s grnulomatosis, Giant cell

arteritis4. Unknown: Sarcoidosis, Crohn’s diseaseClassification on Pathogenesis1. Immune granuloma2. Foreign body granulomaHistological classification1. Non caseating granuloma2. Caseating granuloma3. Suppurative granulomatous inflammation4. Diffuse granulomatous inflammation

A. Infectious agentBacteria:1. Mycobacterium tuberculosis- tubercle-

noncaseating/hard & caseating/soft2. Mycobactrium lepri- tuberculoid & lepromatous3. Treponema pallidum- GummaHelminth:1. W. bancrfti2. A. lumbricoides3. SchistosomaFungi:Rhinosporidiosis seeberiCryptococcus neoformans, Coccidioido immitis &

Histoplasma capsulatum

Tubercle Vs Gumma

Immune Vs Non-immune granuloma

Histological classification:

Nonspecific chronic Inflammation

Chronic inflammatory ulcer- peptic ulcer Chronic suppuratve inflammation- chronic

abscess, chronic pyelonephritis, chronic osteomyelitis

Chronic fibrinous, serous or serofibrinous inflammation following acute inflammation

Chronic catarrhal inflammation- chronic allergic rhinitis

Chronic necrotizing inflammation- chronic amoebiasis

Systemic effects of Acute Inflammation

Fever: Leucocytosis, specially neutrophilic leucocytosis-

due to stimulation of bone marrow leading to release of immature cells in the circulation(shift to the left)

Synthesis of ‘acute phase protein’- liver synthesizes acute phase protein like C reactive protein(CRP), Fibrinogen and Serum Amyloid A(SAA).

CRP is a marker of activity and very useful prognostic test for active Rheumatic fever and other conditions where there is increased tissue necrosis like MI. As it is not influenced by other factors, so it is more useful than ESR.

Increased Fibrinogen level is responsible for high ESR. SAA is responsible for deposition of amyloid in different tissues

Others- lethargy, anorexia, sweating, tachycardia, hypotension, hypoglycaemia leading to shock due to liberation of different cytokines, particularly IL1, TNF.

Systemic effects of Chronic Inflammation Fever

Anaemia Leucocytosis- lympho or monocytosis ESR- elevated Amyloidosis

Chronic Inflammation

Documents

Transcript of Chronic Inflammation

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