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-Morphologic patterns
Kusum Kapila
September 2006
CLASSIFICATION OF
INFLAMMATION
Extent Exudate
Mild Suppurative
Moderate Fibrinous
Severe Serofibrinous
Duration Fibrino-purulent
Peracute Necrotizing
Acute Granulomatous,
Subacute Anatomic Modifiers
Chronic Interstitial
Chronic-active Broncho-interstital
Distribution Glomerulonephritis
Focal Submandibular
Multifocal Organ
Coalescent Nephritis
Locally Extensive Hepatitis
Diffuse Enteritis
Etc
FOCAL
Definition: Single
abnormality or
inflamed area within
a tissue
Size: Varies from 1
mm to several
centimetres in
diameter
MULTIFOCAL
1- Serous Inflammation
Marked by a thin fluid that derived from blood serum or
mesothelial cells
2- Fibrinous Inflammation
A fibrinous exudate develops with large vascular leak
Characteristic of inflammation in body cavities
(pericardium and pleura)
3- Suppurative or Purulent Inflammation
Characterized by large amounts of purulent exudate (pus)
Pus consists of neutrophils, necrotic cells, and edema
4- Ulcers
A local defect or excavation of the surface of epithelial
covering
Sites: Skin, gastro-intestinal tract, urinary bladder, etc.
Morphologic Patterns – Serous
Inflammation
Definition: Inflammatory
process characterized by
accumulation of fluid
relatively rich in protein on
body surfaces with little
cellular infiltrate.
Time: Usually acute
Causes: May be a dominant
pattern of exudation for a
wide variety of mild injuries.
Example: Traumatic blisters,
sunburn, within body cavities.
Gross : Yellow, straw-like
colour fluid, commonly seen
in very early stages of many
kinds of inflam responses.
Morphologic Patterns –
fibrinous Inflammation
2-Fibrinous Inflam
A fibrinous exudate
develops with large
vascular leak
Characteristic of
inflammation in body
cavities
Sites:
a- pericardium
b- pleura
Example: Fibrinous
pericarditis secondary
to rheumatic fever
(rheumatic pericarditis)
EXUDATE: The inflammatory process can be
classified according to the predominant type of
inflammatory cells, plasma protein content, and
amount of fluid present.
A transudate has a specific gravity of less
than 1.012, a low protein content, and few if
any cells.
An exudate has a specific gravity of greater
than 1.020, a high protein content, and
usually contains leukocytes.
Morphologic Patterns –
suppurative Inflammation
3- Suppurative or Purulent
Inflammation
Characterized by formation
of a large amounts of
purulent exudate (pus)
Usually caused by pyogenic
bacteria (pus-forming)
PUS consists of: PMNLs,
Necrotic cells, and Edema
fluid
-Appearance: yellow-white to
gray-white and varies from
watery to viscous
Suppuration - Abscess
formation
Abscess:
A localized area of
tissue loss leading to
formation of a cavity
filled with pus /
purulent exudate
Morphologic Patterns in Acute
and Chronic Inflammation
Suppurative
inflammation could take
the form of:
2- Empyema:
Suppurative exudate
within a natural anatomic
cavity
e.g. Pleural/pericardial
empyema of gallbladder
etc
Spectrum of Inflammatory Responses
to Infection
Suppurative ( Polymorphonuclear )
Inflammation - aetiology
1. Pneumococci Acute lobar pneumonia
2. Staphylococci Abscess formation
3. Klebsiella Pneumonia
Definition:
Granulomatous
response characterized
by the presence of
lymphocytes,macropha
ges, and plasma cells
.Macrophages can be
clustered around the
foreign matter and be
as "epithelioid,"
or"multinucleated "
Spectrum of Inflammatory Responses
to Infection
III a. Cytopathic-
Inflammation :
Viral-mediated damage
to host cells in the
absence of host
inflammatory response
Formation of viral
inclusions within cells
Examples
Cytomegalovirus CMV
Herpes Simplex
Spectrum of
Inflammatory
Responses to
Infection
III b. Cytoproliferative Inflammation
Human Papilloma Virus HPV
Over 60 distinct types
produces proliferative
lesions of squamous
epithelium
condyloma
accuminatum
(6,10,11)
common warts
(1,2,4)
flat warts
Condyloma acuminatum-HPV 6,10,11
Viral Inclusions
Healing
Mediators Regeneration
Persistent infection
Chronic inflammation Scarring
Persistent toxins
Autoimmune diseases
Resolution
Means complete restoration of the tissues to normal
Favouring factors
Minimal cell death and tissue damage
Occurrence in an organ or tissue which has
regenerative capacity (eg the liver) rather than in one
which cannot regenerate (eg. the central nervous
system)
Rapid destruction of the causal agent
(eg. phagocytosis of bacteria)
Rapid removal of fluid and debris by good local
vascular drainage
Sequence of events leading to
resolution of pneumonia
Phagocytosis of bacteria
(eg pneumococci) by
neutrophils and
intracellular killing
Fibrinolysis
Phagocytosis of debris, by
macrophages and carriage
to lymphatics and lymph
nodes
Disappearance of vascular
dilatation
Abscess Formation
1- Abscess:
A localized area of
tissue loss leading to
formation of a cavity
filled with pus /
purulent exudate
Organisation
cavity
Replacement by
granulation tissue
Increased fibrin
which cannot be
removed
Organisation - organ
Substantial necrotic
tissue not easily
digested
Exudate and debris
cannot be removed
or discharged
Outcome of Acute
Inflammation:
Fibrosis – Repair by
Connective Tissue
Replacement’
a. Substantial tissue
destruction
b. Occurs when
affected tissue can
not degenerate
c. Occurs when fibrin
exudation is abundant
as in effusions
following pneumonias
Outcome of Acute
Inflammation:
Chronic
Inflammation
a. Persistent stimuli
progression of
inflammatory process
b. Primary purpose is
to contain and
remove pathologic
agents or processes.
ANATOMIC MODIFIERS:
Terms used to describe a specific area within an
organ that may be affected by inflammation or
degenerative conditions.
Example: Cardiac Inflammation
Endocardium - Endocarditis
valvular/mural
Myocardium - Cardiomyopathy/myocarditis
Pericardium - Pericardial effusion,
pericarditis
Pancarditis - Involves all layers
Effects of acute
inflammation
Beneficial Harmful
Dilution of toxins Digestion of normal
Entry of antibodies tissue
Transport of drugs Swelling
Fibrin formation Raised Intracranial
Delivery of nutrients pressure
and oxygen acute epiglottitis
Stimulation of Allergic
immune response inflammatory
response
Local Clinical Effects of Acute And
Chronic Inflammation