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Chapter 3

Inflammation, the
Inflammatory Response, and
Fever

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Inflammation

An innate, automatic response to cell injury that:

 Neutralizes harmful agents

 Removes damaged and dead tissue

 Generates new tissue

 Promotes healing

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Inflammation (cont.)

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White Blood Cells in Inflammation

• Granulocytes
– Neutrophils
– Eosinophils
– Basophils
– Mast cells
• Agranulocytes
– Monocytes  macrophages
– T lymphocytes
– B lymphocytes  plasma cells

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Inflammatory Cells

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Question

Which leukocytes participate in the acute inflammatory


response?
A. Eosinophils
B. Monocytes
C. Neutrophils
D. All of the above
E. A and C

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Answer

D. All of the above

Rationale: Granulocytes and monocytes play a role in the


acute phase of the immune response. Eosinophils and
neutrophils are granulocytes, so all of the leukocytes
listed participate.

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Acute Inflammation—Vascular Stage

• Vasodilation:
– Increasing blood flow to the injured area.
– Mediators include histamine and nitric oxide.
– Redness and warmth result.
• Capillaries become more permeable.
– Allowing exudate to escape into the tissues
– Mediators include histamine, bradykinin, and
leukotrienes.
– Swelling, pain, and impaired function result.

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Question

Which causes the redness (erythema) associated with the


inflammatory process?
A. Prostaglandins
B. Leukotrienes
C. Arachidonic acid
D. All of the above
E. A and B

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Answer

E. A and B

Rationale: Prostaglandins and leukotrienes cause


vasodilation, which brings more blood to the
injured/affected area. The symptoms caused by this
vasodilation are redness/erythema and warmth.

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Acute Inflammation—Cellular Stage

• White blood cells enter the injured tissue:


– Destroying infective organisms

– Removing damaged cells

– Releasing more inflammatory mediators to


control further inflammation and healing

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Inflammatory Mediators

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Plasma-Derived Inflammatory Mediators

• Kinins

• Coagulation and fibrinolysis proteins

• Complement system

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Cell-Derived Inflammatory Mediators

• Vasoactive amines: histamine, serotonin

• Eicosanoid family: prostaglandins, leukotrienes

• Omega-3 polyunsaturated fatty acids

• Platelet-activating factor (PAF)

• Cytokines and chemokines: TNF-a, IL-1

• Nitric oxide (NO)

• Reactive oxygen species (ROS)

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Kinds of Exudate

• Serous

• Hemorrhagic

• Fibrinous

• Membranous, pseudomembranous

• Purulent, suppurative

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Scenario

A woman has peritonitis.


• She has a distended abdomen, low blood pressure,
and fluid in her abdominal cavity.
• After surgery, she is told to report any GI distress
as it may indicate fibrous adhesions.

Questions:
• Which kinds of exudate are involved? What useful
purposes do they serve? Which complications may
they cause?

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Question

True or false?

If you get a paper cut, epithelial tissue will be replaced


with connective tissue.

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Answer

False

Rationale: The surface epithelial cells of the skin are most


likely to be damaged in this instance. Surface epithelial
tissue has the ability to regenerate, replacing the
damaged tissue with the same type (epithelial).

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Inflammation

Damaged cells release inflammatory mediators.


 Local responses
 Vascular stage
 Cellular stage
 Systemic (whole-body) responses
 White blood cell response
 Acute-phase response

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Acute-Phase Response

• Leukocytes release interleukins and tumor necrosis


factor.
– Affect thermoregulatory center  fever
– Affect the central nervous system  lethargy
– Skeletal muscle breakdown

• The liver makes fibrinogen, C-reactive protein, serum


amyloid A protein.

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White Blood Cell Response

• Inflammatory mediators cause WBC production.

• WBC count rises  leukocytosis.

• Immature neutrophils released into blood.

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Fever Mechanisms

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Fever Patterns

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Question

True or false?

Body temperature is controlled through negative feedback


loops.

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Answer

True

Rationale: When the body senses a change out of the


norm, it activates mechanisms that oppose that change
(vasodilation and sweating with increased temperatures;
vasoconstriction and shivering with decreased
temperatures). This is known as negative feedback.
Positive feedback, on the other hand, senses a change
but activates a mechanism that exaggerates the change.

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Scenario

Mr. X says he has “chills and fever.”

• His daughter wants you to explain how he could have


both at the same time and from the same disease.

Question:

• Should she be keeping him warmer or helping him


cool off?

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Scenario

• A man had tuberculosis (TB) long ago, and when he


first had the disease, he had a fever, productive cough,
and bloody sputum.
• Later, he had trouble breathing, and the doctor said his
lungs were “consolidated” with fibrous proteins.
• He recovered and his fever went down; he thought he
was cured.
• Three years later, an x-ray showed nodules in his lungs,
and he was told they contained the TB bacteria.
Question:
• Which inflammatory events occurred in this case?

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