Inflammation

Components and evolution of the inflammatory process

Adaia Valls Ontañón

Sorin Mocanu

G E N E R A L M E D I C A L & S U R G I C A L PAT H O L O G Y
 INFLAMMATION
definition
• response triggered by damage to living tissues
induced by any agent
• defence mechanism to protect the organism from
injuries and infections

• Purposes :
- to localize and eliminate the injurious agent
- to remove the damaged tissue components -> the
body can start the healing process
 INFLAMMATION
aetiology
EXOGENOUS causes
• physical-mechanic agents
• thermal agents
• chemical agents
• biological agents

ENDOGENOUS causes
• circulation disorders (thrombosis, infarction, haemorrhage, …)
• enzymes activation (pancreatitis, …)
• metabolic products (uric acid, …)
 INFLAMMATION
signs of inflammation
CELSUS in 1st century AD named the famous 4 cardinal signs of
inflammation:
• rubor -> redness
• tumor -> swelling
• calor -> heat
• dolor -> pain

VIRCHOW added the 5th sign:

• functio laesa -> loss of function
INFLAMMATION
pathogenesis of inflammation

VASCULAR EVENTS CELLULAR EVENTS

•haemodynamic •exudation of
changes leukocytes
•vascular •phagocytosis
permeability

• increased blood flow : redness,

warmth
• increased vascular permeability :
swelling, pain, loss of function
VASODILATION -> EXUDATION/EDEMA -> CELLS MIGRATION -> CHEMOTAXIS
 INFLAMMATION
pathogenesis of inflammation

PLASMA EXUDATE

• Hydrostatic pressure increases water filtration

and solutes of low molecular weight

• Protein exudation due to increased vascular

permeability (widening of the gaps between
endothelial cells)
 INFLAMMATION
types of inflammation
- according to duration -
Acute Chronic

• Rapid onset • Slow onset (>48h)

• Short course
• Mediated by neutrophils
• Exudate (fluid + plasma proteins)
• Followed by repair
• May follow acute
• Mediated by lymphocytes and macrophages
• Neoangiogenesis
• Tissue destruction
• Simultaneous inflammation and repair (but
healing is poor or absent)
Acute inflammation outcomes
 INFLAMMATION
types of inflammation
- according to morphology -

• Alterative

• Exudative

• Productive
 INFLAMMATION
types of inflammation
- according to morphology -

• Alterative

• Exudative

• Productive
 INFLAMMATION
types of inflammation
- according to morphology -

ALTERATIVE
• Relatively rare
• Cell necrosis predominates as a result of the
direct action of the harmful agent
• Usually caused by :
- Toxins (diphtheria)
- Viruses (poliomyelitis, hepatitis, encephalitis)
 Hepatic necrosis due to drug toxicity
(central area – pink – showing extensive necrosis)
 INFLAMMATION
types of inflammation
- according to morphology -

• Alterative

• Exudative

• Productive
 INFLAMMATION
types of inflammation
- according to morphology -

EXUDATIVE
• Most frequent
• Exudate = fluid and blood cells leak in the
interstitial space as a result of:
1.Vasodilation
2.Increased blood flow
3.Increased vascular permeability
 INFLAMMATION
types of inflammation
- according to morphology -
EXUDATIVE
 INFLAMMATION
types of inflammation
- according to morphology -

Types of EXUDATIVE inflammation

1.Catarrhal (liquid exudate)

a. Serous – plasma exudate is predominant
b. Purulent (suppurative)
c. Hemorrhagic

2.Fibrinous (semisolid exudate)

 INFLAMMATION
types of inflammation
- according to morphology -

Serous inflammation
• Components
1.Plasma
2.Low amount of fibrin
3.Few leucocytes
 INFLAMMATION
types of inflammation
- according to morphology -

Purulent (suppurative) inflammation

• Exudate dominated by degenerated
leukocytes with only a small amount
of fibrin (pus)
• Tendency to liquefaction with tissue
destruction
 INFLAMMATION
types of inflammation
- according to morphology -

Purulent (suppurative) inflammation

• Pus may accumulate in:
1. Cavities – forms empyema (pleura, meningeal space,
synovial space, cavitary organs eg., gallbladder)
2. Interstitial space
a. Phlegmon – diffuse purulent inflammation not
delimited by a membrane
b. Abscess – purulent exudate well delimited by a
membrane; may slowly enlarge.
Empyema
Phlegmon
Abscess
 INFLAMMATION
types of inflammation
- according to morphology -
Purulent (suppurative) inflammation ->
Ludwig’s Angina

• Cellulitis of the floor of the mouth -> 2

compartments: sublingual +
uni/bilateral submaxillary space/s.
• Life-threatening -> airway obstruction,
mediastinitis, …
 INFLAMMATION
types of inflammation
- according to morphology -

Hemorrhagic inflammation
• Exudate very rich in
erythrocytes due to severe
impairment of capillary
walls

Hemorrhagic cystitis Hemorrhagic gastritis

 INFLAMMATION
types of inflammation
- according to morphology -

Fibrinous inflammation
• Exudate rich in fibrin -> activation of
coagulation cascade
• Usually affects:
1. Serous surfaces (pleurisy, pericarditis)
2. Mucous membranes (pneumonia)
 INFLAMMATION
types of inflammation
- according to morphology -

• Alterative

• Exudative

• Productive
 INFLAMMATION
types of inflammation
- according to morphology -

PRODUCTIVE

• Characterized by:
- proliferation of fibroblasts and endothelial cells
- collagen fibre deposition with tendency to scar
formation
 INFLAMMATION
types of inflammation
- according to morphology -

TYPES OF PRODUCTIVE INFLAMMATION

• Inflammation with formation of polyps

• Interstitial inflammation

• Granulomatous inflammation
 INFLAMMATION
types of inflammation
- according to morphology -
Productive inflammation
- granulating inflammation with formation of polyps -
• Predominantly vascular proliferation
• Occurs on mucous membranes
 INFLAMMATION
types of inflammation
- according to morphology -
Productive inflammation
- interstitial -
• Lymphoplasmocytic • Fibroblasts proliferation
infiltrate in stromal with collagen
tissue (heart, kidney, …) deposition and fibrosis
 INFLAMMATION
types of inflammation
- according to morphology -

Productive inflammation
- granulomatous inflammation -
• Granulomatogenic factors -> poorly degradable
materials
• Granulomas -> focal lesions formed by cells of
the mononuclear phagocyte system – activated
macrophages
 INFLAMMATION
types of inflammation
- according to morphology -

Types of granulomas
• Foreign body granuloma • Epitheloid (hypersensitivity) granuloma
 INFLAMMATION
types of inflammation
- according to morphology -

Granulomatous diseases
1. Infectious
tuberculosis, leprosy, histoplasmosis, cat-scratch disease

2. Non-infectious
asbestosis, silicosis, lipogranuloma

3. Unknown origin
Crohn´s disease, sarcoidosis, Wegener`s disease
Tuberculous granuloma
Crohn’s Disease granulomatosis
 a

thanks for your kind attention

avalls@uic.es