Inflammation and Inflammation and healinghealing

Acute inflammationAcute inflammation

Vascular eventsVascular events Cellular eventsCellular events

Vascular eventsVascular events

Hemodynamic changes Hemodynamic changes Permeability changesPermeability changes

Hemodynamic changesHemodynamic changes

1.1. Transient vasoconstriction of ArteriolesTransient vasoconstriction of Arterioles

2.2. Persistant progressive vasodilatationPersistant progressive vasodilatation

3.3. Elevated local Hydrostatic pressureElevated local Hydrostatic pressure

4.4. Stasis of microcirculationStasis of microcirculation

5.5. WBC migrationWBC migration

Lewis experimentLewis experiment

1.1. Red line Red line vasodilatation vasodilatation

2.2. Flare Flare vasodilatation of surrounding vasodilatation of surrounding vesselsvessels

3.3. Wheal Wheal traqnsudation of fluid into the traqnsudation of fluid into the extra vascular space..extra vascular space..

Vascular permeability changeVascular permeability change

1.1. Endothelial contraction Endothelial contraction immediate immediate transienttransient

2.2. Endothelial retraction Endothelial retraction delayed and delayed and prolongedprolonged

3.3. Direct endothelial injury Direct endothelial injury immediate and immediate and prolonged / delayed and prolongedprolonged / delayed and prolonged

4.4. Injury by WBCInjury by WBC

5.5. NeovascularisationNeovascularisation

Cellular eventsCellular events

1.1. Exudation of WBC Exudation of WBC

2.2. PhagocytosisPhagocytosis

Exudation of WBCExudation of WBC

1.1. Margination( formed elements widen ) and Margination( formed elements widen ) and pavementing( PMN comes in contact woth pavementing( PMN comes in contact woth vessel wall )vessel wall )

2.2. Rolling and adhesionRolling and adhesion

3.3. EmigrationEmigration

4.4. ChemotaxisChemotaxis

RollingRolling

SelectinsSelectins Three typesThree types

1.1. E selectin E selectin in Endothelium in Endothelium

2.2. P selectin P selectin Endo + Platlets Endo + Platlets

3.3. L selectin L selectin WBC WBC

AdhesionAdhesion

ICAM1 ICAM1 LFA 1 ,Mac -1LFA 1 ,Mac -1 Adhesion and Adhesion and TransmigrationTransmigration

VCAM 1 VCAM 1 VLA 4 VLA 4 Adhesion Adhesion PECAM 1 PECAM 1 CD31 CD31 Transmigration Transmigration

ChemotaxisChemotaxis

1.1. Bacterial Products Bacterial Products esp. with N formyl esp. with N formyl methionine terminalsmethionine terminals

2.2. Cytokines of Chemokine family IL 8Cytokines of Chemokine family IL 8

3.3. Complements –C 3a ,C5aComplements –C 3a ,C5a

4.4. LT B4LT B4

Leukocyte activationLeukocyte activation

PhagocytosisPhagocytosis Production of substances that destroys Production of substances that destroys

phagocytosed microbes phagocytosed microbes lysosomal lysosomal enzynes , reactive oxygen and nitrogen speciesenzynes , reactive oxygen and nitrogen species

Production of mediaters that amplify Production of mediaters that amplify inflemmatory reaction inflemmatory reaction AA metabolites and AA metabolites and cytokinescytokines

PhagocytosisPhagocytosis

1.1. Recognition and attachment of particles to Recognition and attachment of particles to WBCWBC

2.2. Formation of phagocytic vacouleFormation of phagocytic vacoule

3.3. Killing and degradation of ingested Killing and degradation of ingested substancesubstance

HealingHealing

Regeneration Regeneration proliferation of parenchymal proliferation of parenchymal cellscells

RepairRepair proliferation of connective tissue proliferation of connective tissue results in fibrosis and scarringresults in fibrosis and scarring

RegenerationRegeneration

Proliferation of the original cells from the Proliferation of the original cells from the margin of the injurymargin of the injury

Migrated cells will differentiates and maturatesMigrated cells will differentiates and maturates

RepairRepair

Granulation tissue formation Granulation tissue formation Contraction of the tissueContraction of the tissue

Granulation tissueGranulation tissue

Slightly granular and pink appearance of the Slightly granular and pink appearance of the tissuetissue

Each granule is a new small blood vesselEach granule is a new small blood vessel there is thin covering of fibroblasts and young there is thin covering of fibroblasts and young collagencollagen

Granulation tissue formationGranulation tissue formation

1.1. Phase of inflammationPhase of inflammation

2.2. Phase of clearancePhase of clearance

3.3. Phase of in growth of granulation tissuePhase of in growth of granulation tissue

Granulation growthGranulation growth

1.1. AngiogenesisAngiogenesis

2.2. FibrogenesisFibrogenesis

HealingHealing

Healing by First intention / Primary UnionHealing by First intention / Primary Union Healing by second intention / secondary unionHealing by second intention / secondary union