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General Pathology Inflammation II Healing processes Classification Jaroslava Dušková Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague Inflammation Definition: complex reaction of organism to damage (aim: homeostasis maintenance) Inflammation Sense defensive – agent elimination reparative – damage reparation Inflammation Celsus´ features: rubor tumor calor dolor functio laesa Inflammation - Classification: Time view acute (days) subacute (weeks) chronic (months-years) Phases of Inflammatory Response Proliferation Alteration Exsudation Healing of Inflammation Progressive Changes Def.: processes leading to lost or damaged tissue substitution or adaptation to the organism or environment changed conditions Progressive Changes Regeneration (restitution) Reparation (substitution) Hypertrophy Hyperplasia Metaplasia Adaptation Progressive changes 1. Regeneration - restitution of former status Reparation – substitution with a less specialised tissue Hypertrophy – enlargement of the organ through cell enlargement Angiogenesis Endogenous Promotors VEGF - A,B,C,D Angiopoietins Angiogenin basic FGF bFGF Hepatocyte Growth Factor HGF Interleukin-8 PDGF Transformation Growth Factor ß TGF ß TNF Angiogenesis Endogenous Inhibitors Angiostatin Brain Angiogenesis Inhibitor 1 BAI1 Endostatin Interferons Platelet factor-4 cleavage products Prolactin fragment (16kd) Thrombospondin-1 VEGI Vasostatin Progressive changes 2. Hyperplasia Metaplasia Adaptation – enlargement of the organ through cell multiplication – transformation of one differentiated tissue into another differentiated tissue - functional adjustment It is done by means of metaplasia, hypertrophy, hyperplasia, metalaxia, (rebuilding). Healing Processes 1. wounds – per primam intentionen (wounds without infection, dislocation, foreign bodies) – per secundam intentionen hematoma organisation thrombus organisation (possible recanalisation) Proliferation - steps dissolution of exsudate & necrotic tissue granulation tissue fibronectin formation, fibroblasts & endothelia organisation collagen production scar maturation scar contraction myofibroblasts Wound Healing - steps Day 0: fibrin – fibronectin gel Day 1: neutrophils Day 1-2: macrophages Day 2-4: fibroblasts, myofibroblasts, capillaries Granulation Tissue Growth PDGF from: mf, endoth., platellets causes: fbl proliferation, proteosynthesis Transforming GF from: mf, epithelia causes: fbl proliferation, angiogenesis IL- 1 from: mf, epithelia causes: fbl proliferation, endogenous pyrogen TNF α from: mf causes: endothelial growth, killing bacteria, cachexia Healing Processes 2. ischemic and traumatic necroses foreign bodies healing bone fractures Factors Influencing Wound Healing age nutrition status – protein deficit vitamins A,C – collagen, epithelisation Zinc – enzyme function steroids local factors infection necrosis foreign bodis patient´s motility arterial perfusion venous drainage Inflammation - Classification: According to the dominant phase: alterative EXSUDATIVE proliferative Inflammation superficial mucous membranes serous membranes skin localisation interstitial Inflammation - Classification: Type of exsudate: serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous Inflammation - Classification: Type of exsudate: serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous Inflammation - Classification: Type of exsudate: serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous Inflammation - Classification: Type of exsudate: serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous Inflammation - Classification: Type of exsudate: serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous Inflammation - Classification: Type of exsudate: serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous Interstitial fibrinose inflammation fibrin exsudation & fibrinoid change of the collagen containing connective tissue Fibrinoid Change of Collagen vessels and connective tissue damage plasmorrhagia (leakage of plasma) deposits of Ag-AB complexes staining characteristics fibrin - like Significance of Fibrinoid Change diminished quality of the collagen ( firmness, permeability) tendency to thrombosis in the vessels, aneurysms formation Inflammation - Classification: Type of exsudate: serous nonpurulent – lymphoplasmocellular purulent fibrinous gangrenous Gangrenous Inflammation tends to be interstitial putrefactive bacteria severe alteration