CHRONIC INFLAMATION

BAGIAN PATOLOGI ANATOMI FK - UMI

INFECTION

INVATION (M.O) TISSUE DISEASE SUBSEQUENT MULTIPLI CATION OF INVATION M.ORGANISM BACTERIA AND VIRUSES >> FUNGI AND OTHER GROUPS <<

SITE OF CONTAMINATION

SKIN

: - NOSE - ANAL - MOUTH - U.R.T - HANDS - G.I.T COMMENSAL BACTERIA - SKIN, R.T, G.I.T. NON PATHOGEN BENEFICIAL : - PROD.NUTR.CHEMICALS (B12) - COMPETING PATHOGEN

ROUTES OF INFECTION

SKIN / MUCOUS MEMBRANE - DIRECT CONTACT VENERAL DS - CONTAMINATION ABRATION AND WOUND (RABIES) - INOCULATION INSECT BITE (Y.FVR) SYRINGE (HEPIS)

ROUTES OF INFECTION

INGESTION : - CONT. FOOD/WATER E.FVR, INF.HEPTIS (A), POLIT IS, CHOLERA INHALATION : - DUST AND DROPLETS INFLUENZA

PREVENTIVE FACTOR

HOST : - GENERAL - SPECIAL

: - GOOD STATE : - PHYSICAL BARRIERS : * SKIN * FILTRATION - SECRETION : * TEARS * URINE * MUCINE

PREVENTIVE FACTOR
- CHEMICAL ACTION : * ACID SECRETION (GASTER/URINE) * LYSOZYMES ENZYMES (TEARS/ SALIVA) * IgA (TEARS/INTESTINAL SECRT) * NON SPECIFIC INHIBITORY SUBST. (URINE/SWEAT/SEBUM)

PREVENTIVE FACTOR

MICRO ORGANISM : - CAPACITY OF INVASIVE : * DOSES * VIRULENT COURSE OF INFECTION * INFLAMATION * PHAGOSIIS * IMM. RESPONSE * INTERFERON

INFECTION MECHANISM

TOXIN PRODUCTION : (EXO/ENDO) HYPERSENSITIVITY REACTION BLOOD STREAM : - BACTERAEMIA - SEPTICAEMIA - PYEMIA

CHRONIC INFLAMATION
- PMN < LYMPHOCYT & PLASMA (+) - CAP.BAD (+) NEW CAPILARE - FIBROBLASTS + COLLAGEN FIBRO SIS.

CHRONIC INFLAMATION
*GRANULOMA : - TBC - SARCOIDOSIS - TALC GRANULOMA - CROHNS *ENDARTERITIS/ENDOPHLEBITIS T.INTIMA FIBROSIS NECROSIS ULCER

GRANULOMA

CHRONIC INFECTION TUBERCULOSIS. SYPHILIS ACTINOMYCOSIS LEPROSY

TUBERCULOSIS

MYCOBACTERIUM TUBERCULOSIS DISEASE DECLINED : * NUTRITION & HYGIENE * CHEMOTHERAPY * BCG IMMUNISATION. TUBERCLE : 1 2 DAYS PMN 1 WEEK MACROPHAGE 2 WEEK GIANT CELL, LYMPOSITE, EPOID. 3 WEEK + CASEATION.

TUBERCULOSIS

PRIMARY INFECTION. - FIRST CONTAC (CHILDREN) - PERIPHERAL LUNG (GHON) - WITH LYMPH NODE ( GHON COMP) HEALING CALCIFICATION SPREAD BLOOD STREAM MILIARY (GENERALLY) LOCAL (ORGAN) MENING, JOINT, BONE

TUBERCULOSIS

REINFECTION APEX PROGRES. VARIATION FORM : * EXUDATIVE PLEURAL EFFUSION ASCITES (ABDOMEN) COLD ABSCESS SINUS (ABSCESS) FIBROTIC BODY REPARATIVE. ACUTE CASEATING IMPAIRED IMM.

SYPHILIS

VENERAL INFECT. TREPONEMA PALLIDUM FORM : * PRIMARY * SECONDARY * TERTIARY (LATE) - GUMMA - SYPH.AORTITIS - NEUROLOGICAL SYPH.

PRIMARY SIPHYLIS

3 WEEKS SIRCULATION HARD C.

LIMPHOCYTE & PLASMA, PERI & END ARTERITIS. SWELLING LYMPH NODES HARD AND PAINLESS. HARD CHANCRE RAISED BUTTON NODULE.

SECONDARY SYPHILIS

2 OR 3 MONTH SKIN RASH (+), ULCER MUCOUS MEMBRAN, GENERALLY LYMPHADENOPHATY FEVER AND ANAEMIA (+) SPIROCHAETA (>>) + FOCAL INFILTRATION LYMPHOCYTE, PLASMA CELL AND MACROPHAGE, MILD ARTERITIS. TISSUE DESTRUCTION MINIMAL HEALING WITHOUT SCARING.

TERTIARY SYPHILIS

GUMMA

: - LOCAL NECROTIC. - BONE, TESTIS, LIVER. S.AORTITIS : - ARCH & THORACIC - T.MEDIA DESTR. FOCAL DESTRUCTION ( WINDOWING) - PERIARTERITIS - ANEURISMA PRESSURE EFFECT OR RUPTURE

TERTIARY SYPHILIS

NEUROLOGICAL * MENINGOVASCULAR MENINGEAL BLOOD VESSELS NEUROLOGICAL EFFECT * PARENCHYMATOUS : - GENERAL PARALISIS (SEVERE STRUCTION OF CEREBRAL TISSUE). - TABES DORSALISCOL.VERT.POST

CONGENITAL SYPHILIS

TRANSPLACENTAL * ABORTION/STILLBIRTH MANY ORGAN DAMAGE. * MARASMIC INFANT ORGAN AND TISSUE DAMAGE (BIRTH AND LATER CHILDHOOD)

IMMUNITY

ANTIBODY PRODUCTION : - ANTIBODY ACTIVE (COMPLEMENT) WASSERMANN REACTION. - SPECIFIC ANTI-TREPONEMAL A.BODY USED SPESIFIC COMPLEMENT FIXING, IMMOBTION AND FLUORESCENCE TEST

IMMUNITY

CELL MEDIATED DELAYED HYPERSENSI TIVITY ALSO DEVELOPS. SENSITIVITY REACTION ARE IMPORTANT IN THE MECHANISM OF SYPHILITIC DAMAGE TO TISSUE.

ACTINOMYCOSIS

LOCALISED SPREADING (CHRONIC SUPPURATION) SITE OF INFECTION : - LOWER JAW - ILEO-CAECAL - LUNG LOBULATED ABSCES PUS (SULFUR GRANULE), PMN, FOAMY MACROFAGE AND SUROUNDED BY FIBROUS TISSUE.

LEPROSY

SLOW PROGRESIVE DISEASE. DAMAGE PERIPHERAL NERVE. ACQUIRED (CLOSE PROLONG CONTACT) FORM : * LEPROMATOUS * TUBERCULOID.

LEPROMATOUS

NODULE SKIN LEONINE FACIES AFFECTED NERVE (LATE) LESION : - LYMPHOCYTE - PLASMA - MACROFAGE + ORG. - ORG +++ (TISSUE) CELL MEDIATED IMMUNITY (-)

TUBERCULOID

SKIN PALLOR AND ANAESTHESIA INVOLVED NERVE (EARLY) FOLLICULAR GRANULOMA (TUBERCLE) ORGANISM (SCANTY) CELL MEDIATED IMMUNITY (WELL)

HEALING

WOUND HEALING COMPLICATIONS: - CONTRACTURE - GRANULATION - KELOID - FIBROSIS REGENERATION SPECIAL SITUATION.

WOUND HEALING

PRIMARY HEALING : - CLEAN EXISED WOUND - GOOD POSITION (PLANED SURG.INCIS) IMMEDIATELY: - BLOOD CLOT 2-3 HOURS : - INFLAMATION (+) - MILD HYPERAEMIA - FEW POLYMORPHS

WOUND HEALING

2-3 DAYS

: - MACROPHAGE REMOVING CLOT - FIBROBLASTIC 10-14 DAYS: - SCAR LOOSE - EPITHELIAL COVER - FIBROUS UNION

WOUND HEALING

WEEKS

: - SCAR TISSUE SLIGHLY HYPERAEMIA - GOOD FIBROUS UNION MONTHS YEAR: - DEVASCULARISATION - COLLAGEN(-) ENZYME - SCAR MINIMAL.

SECONDARY HEALING

LOSS OF TISSUE >> NECROSIS (+) INFECTION (+) EARLY : BLOOD & FIBRIN CLOT (+) ACUTE INFL. CELLS (+) FEW DAYS : - EPITH.PROLIFERATION - NEW CAPILARY - MACROPHAGE - PMN, FIBROBLAST

SECONDARY HEALING

1 WEEK

: - SURFACE DEBRIS (-) - FIBROBLASTS >> - EPITH.PROLIFTION - CAPILARY >> - GRANULATION

SECONDARY HEALING

2 WEEKS: - EPITH.COVER CMPL - TRANSVERS COLAGEN - DECREASED CAPILARY - FEW CELLS MONTH : - FULL EPITH. COVER - SURFACE DEPRETION - THICK COLLAGEN SCAR - VASCULAR ( < )

REGENERATION

CELL TYPE : * LABILE CELLS: - EPITHELIUM - BONE MARROW - LYMPHOID * STABLE CELLS: - LIVER - ENDOCRINE CELLS * PERMANENT CELLS : - NERVE CELLS