Definition

a protective tissue response to injury or destruction of tissues

cardinal signs

these 5 cardinal signes are due to the reaction of the vascularized mesenchyme, blood cells and
circulatory pathways

they don't have to be detectable at the same time

Acute Inflammation

pathogenesis - biological mechanism that leads to the disease state

acute inflammation, vascular response

After transient vasoconstriction (lasting only for seconds), arteriolar vasodilation

occurs, resulting in locally increased blood flow and engorgement
(berfllung) of the down-stream capillary beds.

This vascular expansion is the cause of the redness (erythema) and warmth
characteristic of acute inflammation.

The microvasculature becomes more permeable, and protein-rich fluid

moves into the extravascular tissues.
This causes the red cells in the flowing blood to become more concentrated,
thereby increasing blood viscosity and slowing the circulation.
microscopically there are numerous dilated small vessels packed with red
blood cells, called stasis.

As stasis develops, accumulation of leucocytes along the vascular

endothelial surface appears - called margination.

increased permeability
non mediated mechanism - toxic and physical agents (e.g. burns) can
cause necrosis of endothelial cells resulting in abnormal leakage

mediated mechanism - Increased vascular permeability is induced by
histamine, kinins, and other mediators that produce gaps between
endothelial cells; by direct or leukocyte-induced endothe- lial injury; and
by increased passage of uids through the endothelium
 Results in leakage of fluid and proteins forming edema

acute inflammation, vascular permeability

. movement of protein-rich fluid and even blood cells into the extravascular
tissues. This in turn increases the osmotic pressure of the interstitial fluid,
leading to more out flow of water from the blood into the tissues. The
resulting protein- rich fluid accumulation is called an exudate.
(transudates, which are interstitial uid accumulations caused by increased
hydrostatic pres- sure, usually a consequence of reduced venous return )

producing edema

margination and rolling

Leukocytes bigger than RBCs, so they are pushed outward in the blood
stream due to faster movement of RBCs - leukocyte accumulation at
periphery of vessel is called margination

If the endothelial cells are activated by cytokines and other mediators, they
express adhesion molecules to which the leukocytes attach loosely. These
cells bind and detach and thus begin roll on the endothelial surface, a
process called rolling.

The endothelial selectins are typically expressed at low levels or are not
present at all on unactivated endothelium, and are up-regulated after
stimulation by cytokines and other mediators.

Adhesion. The rolling leukocytes are able to sense changes in the
endothelium that initiate the next step in the reaction of leukocytes, which
is firm adhesion to endothelial surfaces. This adhesion is mediated by
integrins expressed on leukocyte cell surfaces interacting with their ligands
on endothelial cells.
They are normally expressed on leukocyte plasma membranes in a low-
affinity form and do not adhere to their specific ligands until the leukocytes
are activated by chemokines.

 Transmigration. After being arrested on the endothelial surface,
leukocytes migrate through the vessel wall primarily by squeezing between
cells at intercellular junctions. This extravasation of leukocytes, called
diapedesis, occurs mainly in the venules of the systemic vasculature. After
passing through the endothelium, leukocytes secrete collagenases that
enable them to pass through the vascular basement membrane.

chemotaxis

These mediators are produced in response to infections and tissue damage

and during immunologic reactions.

neutrophils predominate in the inflammatory infiltrate during the first 6 to

24 hours and are replaced by monocytes in 24 to 48 hours

Phagocytosis

+ picture

1. Leukocytes bind and ingest most microorganisms and dead cells by means
of specific surface receptors. Some of these receptors recognize components
of the microbes and dead cells and other receptors recognize host proteins,
called opsonins, that coat microbes and target them for phagocytosis

The most important opsonins are antibodies of IgG class.

Leukocytes express receptors for opsonins that facilitate rapid phagocytosis

of the coated microbes.

2. The key steps in this reaction are the production of microbicidal substances
such as reactive oxygen species within lysosomes and fusion of the
lysosomes with phagosomes, thus exposing the ingested particles to the
destructive mechanisms of the leukocytes

3. The dead microorganisms are then degraded by the action of lysosomal

acid hydrolases.

Types of cells

neutrophils:

24h diagnostic hallmark

eosinophils:
erscheinen.. predominant in allergic reactions and parasitic infections
hives - Nesselsucht
 Polyarthritis nodosa - Entzndung der Blutgefe
Hodgkin lymphoma - ist ein bsartiger Tumor des Lymphsystems

Macrophages:
derived from monocytes in circulating blood which migrate into damage tissue area after
neutrophils
numbers slowly increase to facilitate elimination of dead material after 2-3 days of
neutrophils
secret growth factors and cytokines - mediate some events of inflammatory response

Inflammatory mediators
Vasoactive amineshistamine, serotonin Their main effects are vasodilation
and increased vascular permeability.
Prostaglandins and leukotrienes ?????
Chemotactic factors such as complement fragments and cytokines - these proteins,
produced by many cell types, usually act at short range; they mediate multiple
effects, mainly in leukocyte recruitment and migration

complement -

Plasma proteases that can activate complement and components of the clotting
system
ROS: Roles include microbial killing and tissue injury
NO: Effects are vasodilation and microbial killing
Lysosomal enzymes: Roles include microbial killing and tissue injury

Injured tissues can be repaired by regeneration of the injured tissue cells with:
cells of the same tissue of parenchymal type, (e.g, skin, liver) or
by connective repair processes in which scar tissue is used to effect healing

generalized malaise - overall weakness

Der Begriff Pneumonitis steht fr eine entzndliche Vernderung der Lunge. Im

Gegensatz zur Pneumonie sind die Auslser jedoch keine
Mikroorganismen wie Bakterien oder Pilze, sondern in der Regel
pneumotoxisch wirkende Einflsse wie hochenergetische Strahlung oder
Medikamente, also Noxen physikalischer und chemischer Art.