Download fibrinous inflammation

DR RABIA RATHORE
ASSISTANT PROFESSOR
WEST MEDICAL WARD
MAYO HOSPITAL/K.E.M.U
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DEFINITION OF INFLAMMATION
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Inflammation is a defensive process that a living
body initiates against local tissue damage. It takes the
form of a complex reaction of blood vessels, certain
plasma components and blood cells, and cellular and
structural components of connective tissue.
 Terms ending in the suffix “–itis” denote
inflammation
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ETIOLOGY OF INFLAMMATION
•Physical agents:
 •extreme temperatures, electric shock, radiation,
mechanical injures, etc.
 •Chemical agents:
 •Products of metabolism, acids, alkalis, drugs, tissue
necrosis
 •Biological agents:
 •Microorganisms (bacteria, viruses, fungi), parasites
(helmints, insects), immune cells and complexes.
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ACUTE INFLAMMATION
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 Causative agents - harmful bacteria or injury to tissue
 Major cells involved - mainly neutrophils, basophils (in
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the inflammatory response), and eosinophils (response to
parasites and worms), and mononuclear cells
(macrophages, monocytes)
Primary mediators - eicosanoids, vasoactive amines
Onset (when does the inflammation start) - straight away
Duration - short-lived, only a few days
Outcomes - the inflammation either gets better
(resolution), develops into an abscess, or becomes a
chronic inflammation.
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Terminology used in systemic
inflammation and sepsis
 Infection
 Invasion of normally sterile host tissue by
microorganisms
 Bacteraemia
 Viable bacteria in blood
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Terminology used in systemic
inflammation and sepsis
 Systemic inflammatory response syndrome (SIRS)
 The systemic inflammatory response to a variety of severe
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clinical insults. The response is manifested by two or more
of the following:
Temperature >38°C or <36°C
Heart rate >90 beats/min
Respiratory rate >20 breaths/min or PaCO2 <4.3 kPa
White cell count >12 × 109/L, <4 × 109/L or >10% immature
forms.
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Terminology used in systemic
inflammation and sepsis
 Sepsis
 SIRS resulting from documented infection.
 Severe sepsis
 Sepsis associated with organ dysfunction,
hypoperfusion or hypotensionbut are not limited to,
lactic acidosis, oliguria or an acute alteration in mental
state.
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Terminology used in systemic
inflammation and sepsis
 Septic shock
 Severe sepsis with hypotension (systolic BP <90 mmHg or
a reduction of >40 mmHg from baseline) in the absence of
other causes for hypotension and despite adequate fluid
resuscitation.
 Refractory shock
 Shock unresponsive to conventional therapy (intravenous
fluids and inotropic/vasoactive agents) within 1 h.
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Terminology used in systemic
inflammation and sepsis
 Compensatory anti-inflammatory response
syndrome (CARS)
 Release of anti-inflammatory mediators which
downregulate the inflammatory response. If excessive,
may lead to inappropriate immune
hyporesponsiveness.
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OUT COME OF ACUTE
INFLAMMATION
 Favorable
 •Absorption, tissue repair (the most favorable
outcome)
 •Organization – scar formation
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Unfavorable
•Acute organ insufficiency
•Abscess formation - pyonecrotic cavity
•Persistence of inflammation and chronicity
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DIFFERENCE BETWEEN :
TRANSUDATE
1.Transparent liquid
 2.Origin - congestion
 3.Up to 3% protein
 4.Isolated mesothelial
cells, accidental single
leukocytes and
erythrocytes
EXUDATE
 1.Slightly not quiet clear
liquid
 2.Origin - inflammatory
 3.3-5% protein
 4.A small amount of
leukocytes desquamated
epithelium,
mesothelium
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EXUDATIVE INFLAMMATION
 General definition:
 Inflammations whose principal histologic findings include exudation of
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blood serum and extravasation of blood cells into the inflamed area.
Classification:
may be classified as follows according to the principal components of
the exudate:
•serous
•catarrhal
•mucus, serous, purulent, hemorrhagic
•fibrinous
•croupous and diphtheretic
•purulent
•abscess, phlegmon and empyema
•hemorrhagic
•putrefactive
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SEROUS INFLAMMATION
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SEROUS INFLAMMATION
 Definition: Exudative inflammation with exudate of
fibrin-free serum.
Examples:
 Inflammation of serous membranes such as the
pleura, pericardium, peritoneum, and joints;
 Organ inflammation such as serous hepatitis,
nephritis, myocarditis, encephalitis.
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CASE SCENERIO NO:1
 A 50 years old male presents in OPD with complaints
of gradually increasing abdominal distension and pain
abdomen.On examination the abdomen is
protuberent, umblicus is everted with para umblical
hernia ,prominent striae and veins seen and fluid thrill
is present while shifting dullness cannot be elicited
due to massive ascites.
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 What is the differential diagnosis?
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DIFFERENTIAL DIAGNOSIS
 Chronic liver disease
 Abdominal Tuberculosis
 Hepatocellular carcinoma/Metastatic liver disease
 Congestive cardiac failure
 Chronic kidney disease
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 How will you investigate him?
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 Liver Function Test
 PT/APTT
 Ultrasound abdomen
 Renal Function Test
 ECG
 Alpha Fetoprotein
 Diagnostic Ascitic tap
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CATARRHAL INFLAMMATION
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CATARRHAL INFLAMMATION
 Definition: Exudative inflammation occurring exclusively
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on the mucous membranes of the respiratory and
gastrointestinal tracts and producing a watery exudate of
serum and mucus
Subtypes: mucus (most frequent), serous, purulent,
hemorrhagic
Etiologic factors:
— hypersensitivity reactions;
— bacterial and viral tissue injury;
— physical and chemical tissue injury.
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EXAMPLE
 •Acute rhinitis (common cold);
 •Acute catarrhal bronchitis;
 •Enteritis.
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CASE SCENERIO NO:2
 A young girl is having tiredness, slight pyrexia,
malaise and a sore nose and pharynx. Sneezing and
profuse, watery nasal discharge followed by thick
muco- purulent secretions which is there for a week.
What is your differential diagnosis?
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DIFFERENTIAL DIAGNOSIS
 Seasonal rhinitis
 Perennial rhinitis
 Perennial allergic rhinitis
 Perennial non-allergic rhinitis with eosinophilia.
Vasomotor rhinitis
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FIBRINOUS INFLAMMATION
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FIBRINOUS INFLAMMATION
Definition: Exudative inflammation with exudation of
fibrinogen-containing serum that polymerizes to fibrin
outside the blood vessels .
 Etiologic factors:
 — Infectious toxic tissue injury;
 — Tissue injury from physical trauma;
 — Chemical and toxic tissue injury;
 — Excretion of toxic metabolites (uremic toxins);
 — Ischemic tissue injury.
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TYPES OF FIBRINOUS
INFLAMMATION
 Fibrinous Parenchymal Inflammation
 Fibrinous Serosal Inflammation
 Fibrinous Mucosal Inflammation
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FIBRINOUS PARENCHYMAL
INFLAMMATION
 CASE SCENERIO:NO.3
 A 65 years of male has of high grade fever and
productive cough with copious amount of foul smelling
sputum for 5 days ,now presented with complaints of
hemoptysis.On examination breath sounds are reduced
on left infra scapular region with a patch of broncial
breathing and vocal resonance is increased.
 What is the differential diagnosis?
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DIFFERENTIAL DIAGNOSIS
 Lobar Pneumonia
 Collapse of Peripheral bronchus
 fibrosis (localized)
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 How will you investigate?
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 ESR & BLOOD COMPLETE
 SPUTUM EXAMINATION
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FIBRINOUS SEROSAL
INFLAMMATION
 Definition: Exudative fibrinous inflammations of the
serous membranes may occur as a reaction of the
serosa to other underlying disorders (serositis) or in the
presence of tissue injury occurring in the serosa (such
as infarction).
 Example:
 Fibrinous pericarditis
 Fibrinous pleuritis
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CASE SCENERIO NO:4
 A middle aged school teacher has fever and a sharp
central chest pain exacerbated by movement,
respiration and lying down. It is typically relieved by
sitting forward.Auscultation revealed a frictional
pericardial rub occurring in three phases
corresponding to atrial systole,ventricular systole and
ventricular diastole.
 What is the diagnosis?
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 Acute pericarditis.
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 What are the causes of Acute Pericarditis?
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FIBRINOUS MUCOSAL
INFLAMMATION
 Definition:
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In fibrinous inflammations in the mucosa, the
fibrinous exudation process is usually preceded by
superficial necrosis.
 Types:
 •Croupous Type
 •Diphtheria Type
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 Croupous Type:
 Exudative inflammation in which a wide area of
fibrinous exudate forms an easily removable
pseudomembrane covering the necrosis, which is
limited to the mucosal epithelium.
 Example:
Diphtheric laryngotracheitis
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Diphtheria Type :
Exudative inflammation in which necrosis extending
into the submucosa is covered by a wide area of
fibrinous exudate in the form of an adhesive
pseudomembrane that can only be forcibly removed.
 Example:
 •Antibiotic associated colitis :pseudomembranous
colitis
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CASE SCENERIO NO:5
 A middle aged man whose is taking injectible
Clindamycin for cellulitis presents with bloody
diarrhea for one day.Colonoscopic findings shows the
mucosa is inflamed and ulcerated and was
covered by an adherent membrane-like material.
 What is the likely diagnosis?
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 Pseudomembranous colitis
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 How will you investigate him?
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 Stool examination for Clostridium Difficile Toxin
 Colonoscopy
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PURULENT MUCOSAL
INFLAMMATION
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PURULENT MUCOSAL
INFLAMMATION
Definition:
Inflammation with exudate consisting primarily of
dead neutrophils and cellular debris .
 Example:
 Empyema
 phlegmon
 abscess
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EMPYEMA
 Definition: Suppurative inflammation in a body cavity.
 Pathogenesis: An empyema usually occurs when a
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suppurative inflammation of an organ breaks through into
an adjacent cavity.
Examples:
•Pericardial, peritoneal, and pleural empyema
•Gallbladder and appendiceal empyema;
•Middle ear and nasal sinus empyema;
•Pyosalpinx (pus in the uterine tube);
•Pyocephalus (pus in the cranial cavity);
•Hypopyon (pus in the anterior chamber of the eye).
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CASE SCENARIO NO:6
 A 35 years Immunocompromised male has high grade
fever with purulent sputum. Upon arrival to the
referral center, the patient was in mild respiratory
distress with a respiratory rate of 44, SpO2 94% to 98%
on 2L O2 via nasal cannula .Lung examination revealed
stony dull percussion note ,decreased breath sounds
on right side of the chest ,with decreased vocal
resonance.Fever did not responded to antibiotics for 3
days.Aspiration of the pleural fluid revealed frank pus.
 What is the diagnosis?
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EMPYEMA
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PUTREFACTIVE
INFLAMMATION
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PUTREFACTIVE INFLAMMATION
 Definition:
 Exudative inflammation with putrid smell.
 Etiologic factors – putrefactive anaerobic bacteria:
 •Clostridium perfringens
Morphology: massive necrosis without demarcation.
 Clinical course: severe intoxication, sepsis, death
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 A 60 years diabetic female presented with Local swelling
and a sero sanguineous exudate over the foot. The skin
initially was bronze in color, then progressed to a blueblack color with skin blebs and hemorrhagic bullae. Within
hours, the entire region became markedly
edematous. The Crepitus due to gas production can be
palpated.There is typical putrid smell coming from the
wound.
 What is the diagnosis?
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 Gas Gangrene
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 What is the causative organism?
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 Clostridium perfringens
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COURSES OF ACUTE
INFLAMMATION
 •Dissolution of the exudate
 •Regeneration
 •Secondary postinfectious disorders
 •Chronic inflammation
 •Hematogenous dissemination i.e SEPSIS
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