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TYPES OF ACUTE INFLAMMATION

I. Suppurative inflammation.
II. Non suppurative inflammation:
Includes:
(1) Catarrhal inflammation.
(2) Membranous inflammation.
(3) Sero-fibrinous inflammation.
(4) Fibrinous inflammation.
(5) Serous inflammation.
(6) Haemorrhagic inflammation.
(7) Necrotizing inflammation.
(8) Allergic inflammation.

I.

SUPPURATIVE INFLAMMATION
(Pyogenic or Septic)

Definition: Severe acute inflammation characterized


by pus formation.
Causes: Pyogenic (pus forming) microorganisms
as staphylococcus aureus, streptococcus haemolyticus,
pneumococcus.
Types of Suppurative Inflammation:
(1) Localized: (a) Abscess,
(b) Furuncle,
(c) Carbuncle.
(2) Diffuse: e.g. Cellulitis, suppurative appendicitis,
suppurative peritonitis ... etc.

A-LOCAL SUPPURATIVE INFLAMMATION


1- Abscess
Definition: A localized suppurative
inflammation resulting in the formation
of an irregular cavity containing pus.

Cause:
Commonly
Staphylococcus
aureus.
Site: Commonly the abscess occurs in the
subcutaneous tissue, but occur in any
organ as the lung, brain, liver ... etc.
Composition of Pus:
o (1) Bacteria living and dead and their
toxins.
o (2) Liquefied necrotic tissue.
o (3) Inflammatory cellular exudate in the
form of polymorph- leucocytes, many
pus cells, macrophages and red cells.
o (4) Inflammatory fluid exudate.

Pathogenesis of Abscess Formation


1.Pyogenic microorganisms cause tissue necrosis by its
toxins and exert strong chemotaxis on polymorphnuclear leucocytes.
2.Many leucocytes (neutrophil) are killed during their
struggle bacteria and are called pus cells.
3.The dead leucocytes release proteolytic enzymes which
cause rapid liquefaction of the necrotic tissue.
The resulting fluid material mix with the fluid and
cellular exudate forming the pus (dilution of toxins).
M/E: (zone formation)Early : - central necrotic tissue.
peripheral area of acute inflammation surround it.
Late : - central necrotic tissue. - pus cavity surround it.
area of acute inflammation [ pyogenic membrane]
surround it with excess neutrophils.
N/E : cardinal signs of acute inflammation

opening

A cavity containing pus

subcutaneous fat

pyogenic membrane

ACUTE INFLAMMATION
SUPPURATIVE / PURULENT - ABSCESS

Fate of abscess : pus in body


must be evacuated.
Pus can be evacuated either :
1. Surgical method : healing.
2. Spontaneously

PUS
=
PURULENT
ABSCESS
=
POCKET OF PUS

Complications of Abscess Formation

(1)

Lymphatic spread of infection causes


lymphangitis(inflammation of lymph vessels) and
lymphadenitis (inflammation of L.Ns.

(2) Blood spread of bacteria and its toxins causes


a:bacteraemia ,
b: septicemia (circulation , multiplication of large
number of pathogenic bacteria & their toxins in
blood without localization).
c: toxaemia (toxins in blood).
(3) Inadequate drainage and treatment changes the
abscess to a chronic one. A chronic abscess has a
thick fibrous wall.
(4) Complications of healing in the form of chronic
ulcer, sinus and fistula

Ulcer

Basic description: Loss of the mucosa and


deeper
tissues
including
basement
membrane the correct term is ulcer.
If only the mucosa is lost with intact
basement membrane, the correct term is
an erosion.
Microscopic morphology of an ulcer:
The layers, from superficial to deep, are
fibrin, neutrophils, granulation tissue, and
fibrosis.
Location: Most commonly seen in the
gastrointestinal tract and other tissues.
Complications of an ulcer:

SINUS
blind ended tract open on surface

Fistula
Basic description: A fistula is an
abnormal tunnel connecting two body
cavities (hallow organ) (such as the
rectum and the vagina) or a body
cavity to the skin (like the rectum to the
outside of the body).
Example:
Entero-cutaneous fistula
Biliary fistula: connecting the bile
ducts to the skin surface, often caused
by gallbladder surgery
Rectovaginal fistula: between the
rectum and vagina

2- Furuncle (Boil)
Small abscess related to
a hair follicle or
sebaceous gland caused
by
staphylococcus
aureus.
Common sites are face
and back of the neck in
males and axilla in
females.
Multiple furuncles are
called furunculosis.

3- Carbuncle

Definition:
A type
of
localized
suppuration
forming multiple communicating suppurative foci in the
skin and subcutaneous fat
discharging pus through
several openings.

Cause:
Staphylococcus
aureus. Diabetes mellitus is a
common predisposing factor.
Sites: Areas where the skin
and subcutaneous tissue are
thick and tough as the back
of the neck and buttocks.

B-DIFFUSE SUPPURATIVE INFLAMMATION


Cellulitis (Phlegmonous Inflammation)

Definition: Acute diffuse


suppurative inflammation.
Cause:
Streptococcus
haemolyticus.
The organism produces two
enzymes:
(1)Fibrinolysin
(streptokinase):
Dissolves
fibrin.
(2) Hyaluronidase (spreading
factor): Dissolves hyaluronic
acid of ground substance
helping spread of bacteria and
its toxins.
Sites: Loose connective tissue
as subcutaneous tissue

Pathology of Cellulitis
The basic pathological changes
are similar to those of abscess
with the following differences:
(1) Failure of localization because
of absence of fibrin (No pyogenic
membrane).
(2) The necrosis is extensive
(3) Pus formation is slow. Pus is
thin in consistency and may
contain many red cells i.e.
sanguineous.
Complications:
(1) Acute lymphangitis and
lymphadenitis.
(2) Septicemia.

(3) Neurofibromatosis
A
hereditary
familial
disease transmitted as a
dominant trait. The disease
is characterized by:
(a) Multiple neurofibromas
which appear as small firm
nodules in the skin along
the
course
of
the
cutaneous nerves.
(b) Cafe au lait skin
pigmentation.
(c)
Pigmented
iris
hamartomas called Lisch
nodules.
Malignant
tumours:
Malignant
Schwannoma
(neurofibrosarcoma).

Multiple neurofibromas

Cafe au lait skin

Plexiform Neurofibroma

Malignant Neurofibroma