1. CHRONIC INFLAMMATION

2. CHRONIC INFLAMMATION-DEFENSE AT
A PRICE
 PROLONGED DURATION
 WKS TO MONTHS
 ACTIVE INFLAMMATION,
 TISSUE DESTRUCTION AND
 REPAIR
ALL occurs SIMULTANEOUSLY

3. CAUSES
 PERSISTENT INFECTION
 Eg:TB,SYPHILIS
 LOW TOXICITY
 EVOKE DELAYED HYPERSENSITIVITY REACTION
 PROLONGED EXPOSURE TO TOXIC AGENTS
 ENDO-TOXIC LIPIDS IN ATHEROMA
 EXO-SILICOSIS,
 AUTOIMMUNE:caused by excessive and
inappropriate activation of the immune system
 Eg. RA,MS,IBD, Br. Asthma

4. FEATURES
 MONONUCLEAR INFILTRATIION-
MACROPHAGES,LYMPHOS,PLASMA CELLS
 TISSUE DESTRUCTION
 ATTEMPTS AT HEALING:
angiogenesis+ fibrosis

5. Chronic infl. Acute infl.
collection of chronic inflammatory cells (*) alveolar spaces filled with neutrophils
destruction of parenchyma Congested blood vessels
fibrosis, (arrows)

6. CELLS-MACROPHAGES
 KEY ROLE
 PART OF MONOCYTE PHAGOCYTE SYSTEM
 ORIGIN IN BM BLOOD MONOCYTES
TISSUE MACROPHAGES
 TISSUE MACROPHAGES-MICROGLIA,KUPFFER
CELLS,ALVEOLAR MACROPHAGES,OSTEOCLASTS

8. CELLS-MACROPHAGES
 AFTER 48 HRS EMIGRATE INTO SITE OF
INFLAMMATION
 ACTIVATION
 BY CYTOKINES(IFN GAMMA), ENDOTOXINS
 INCREASE IN SIZE, MORE LYSOSOMAL ENZYMES,
INCREASED METABOLIC ACTIVITY
 WIDE VARIETY OF BIOLOGICALLY ACTIVE SUB

11. CELLS-MACROPHAGES
IF IRRITANT PERSISTS MACROS ACCUMULATE
RECRUITMENT LOCAL PROLIF IMMOBILIZATION

12. CELLS-MACROPHAGES
 PRODUCTS OF MACROPHAGES
 ELIMINATION OF MICROBES
 TISSUE INJURY-PROTEASES,NO,AA METABOLITES
 FIBROSIS

13. CELLS-OTHERS
 LYMPHOCYTES
 BOTH IN IMMUNE AND NON IMMUNE
 TWO WAY INTERACTION WITH MACRO
 PLASMA CELLS
 FROM ACTIVATED B-LYMPHOS
 tertiary lymphoid organs: long standing R.A.
 EOSINOPHILS
 IMMUNE,PARASITIC d/t MBP
 EOTAXIN

15. GRANULOMATOUS INFLAMMATION
It is a cellular attempt to contain an offending agent
that is difficult to eradicate.
A granuloma is a focus of chronic inflammation consisting
of a microscopic aggregation of macrophages that are
transformed into epithelium-like cells, surrounded by a
collar of mononuclear leukocytes, principally
lymphocytes and occasionally plasma cells.

16. GRANULOMATOUS INFLAMMATION-
EXAMPLES
 TB
 SARCOID
 SYPHILIS(GUMMA)
 CAT SCRATCH DISEASE
 LEPROSY
 BERYLLIOSIS
 HISTOPLASMA
 FOREIGN BODY

17. GRANULOMA
 EPITHELIOID CELLS
 ACTIVATED/MODIFIED MACROPHAGES
 INDISTINCT CELL BORDERS
 PALE PINK CYTOPLASM
 VESICULAR NUCLEUS-SLIPPER SOLE SHAPED
 LYMPHOCYTES
 USUALLY FORM A CUFF AROUND EP CELLS
 MAY BE ADMIXED WITH PLASMA CELLS

18. GRANULOMA
 GIANT CELLS
 FUSION OF EPITHELIOID CELLS
 LANGHANS G.C-NUCLEUS IN PERIPHERY-HORSE SHOE MANNER
 FOREIGN BODY-HAPHAZARD ARRANGEMENT
 NO SP SIGNIFICANCE ABOUT UNDERLYING CAUSE
 FIBROSIS
 SURROUNDING LYMPHOS
 BURNT OUT-SCARRING

19. GRANULOMA
 TWO MAIN TYPES BASED ON PATHOGENESIS- FB
(SUTURE,TALC) AND IMMUNE (TB)
 IMMUNE
 POORLY DEGRADABLE AGENT
 CELL MEDIATED IMMUNITY

20. GRANULOMA
 CENTRAL NECROSIS IS SEEN IN SOME
GRANULOMAS
 PROTOTYPE-TB
 CASEOUS NECROSIS
 GROSSLY-CHEESE LIKE
 MICRO-EOSINOPHILIC,AMORPHOUS GRANULAR DEBRIS

21. Granuloma

22. A granuloma: a collection of
epithelioid histiocytes

25. SYSTEMIC EFFECTS OF INFLAMMATION
 ACUTE PHASE RESPONSE OR SYSTEMIC
INFLAMMATORY RESPONSE(SIRS)
 DUE TO CYTOKINES-TNF,IL-1

26. SYSTEMIC EFFECTS OF INFLAMMATION
FEVER
 IL-1 AND TNF ACT ON HYPOTHALAMUS
 PRODUCE PGs
 RESET TEMP AT HIGHER LEVEL
 HOW USEFUL??????

27. OSLER
“HUMANITY HAS BUT 3 GREAT
ENEMIES-FEVER ,FAMINE AND
WAR,OF THESE BY FAR THE
GREATEST ,THE MOST TERRIBLE IS
FEVER”

28. SYSTEMIC EFFECTS OF INFLAMMATION
ACUTE PHASE PROTEINS
 SYN IN LIVER,CIRCULATE IN PLASMA
 MANY FOLD INCREASE IN INFLAMMATION
 CRP,FIBRINOGEN,SAA
 POSSIBLE ROLE AS OPSONINS
 INCREASED ESR-DUE TO FIBRINOGEN

29. SYSTEMIC EFFECTS OF INFLAMMATION
LEUCOCYTOSIS
 INCREASED RELEASE FROM BM
 INCREASED PROLIFERATION FROM PRECUSORS
 NEUTROPHILIA-MOST BACTERIA
 LYMPHOCYTOSIS-VIRAL
 EOS-PARASITIC,ALLERGIC

30. SYSTEMIC EFFECTS OF INFLAMMATION
ANOREXIA,SOMNOLENCE,DECREASED APPETITE
SEV BACTERIAL INFECTION-SEPTIC SHOCK

31. IMPT TOPICS
 ESSAY
 CHEMICAL MEDIATORS OF INFLAMMATION
 CELLULAR EVENTS OF INFLAMMATION
 SHORT TOPICS
 ADHESION MOLECULES
 PHAGOCYTOSIS
 GRANULOMAS
 SYSTEMIC EFFECTS OF INFLAMMATION
 CELLULAR EVENTS OF INFLAMMATION
 VASCULAR EVENTS OF INFLAMMATION
 KILLING AND DEGRADATION