Inflammation Chapter 2

Ms. Harris

Pathophysiology

Fall 2009

Body’s Defenses

1) What is the body’s FIRST line of defense?– Mechanical barriers like the skin and mucous

membranes! (non-specific)

2) 2nd line of defense?– Phagocytosis and inflammation (non-specific)

• Phagocytosis uses neutrophils (leukocytes) and macrophages to “gobble up” foreign matter.

Body’s Defenses

3. 3rd line of defense?– The immune system! (specific)

• Produces antibodies following exposure.

Inflammation

• Serves as a warning of a problem, which may be hidden in the body.

• What’s the difference between infection and inflammation?

Inflammation Definition

• the body’s non-specific response to tissue injury– Localize it and remove it!

What does inflammation look like?

• Redness

• Swelling

• Warmth

• Pain

• Loss of function

What causes inflammation?

• Cuts

• Sprains

• Ischemia

• Allergic reactions

• Burns

• Foreign bodies (like a splinter)

• infection

-itis = inflammation of

• Appendicitis = ???

• Gastroenteritis = ???

• Senioritis = ???

Acute Inflammation- Inflammatory Response

1. Injury Occurs2. Damaged cells release chemical messengers

in to the blood and interstitial fluid– Histamines, leukotrienes, prostaglandins, etc. (see

Table 2-1 and know these 3!!!!)

3. These chemicals affect blood vessels and nerves in the affected area.

4. Body naturally inactivates these chemicals when inflammatory response is no longer necessary.

Histamines• Released immediately to cause vasodilation and

increase capillary permeability.

Leukotrienes• Prolong inflammation; cause vasodilation,

increase capillary permeability, chemotaxis

Prostaglandins• Prolong inflammation; cause vasodilation,

increase capillary permeability, pain, and fever

What commonalities did you notice?– Vasodilation - ??? (hyperemia)

– Increased capillary permeability - ???• Dilute toxins, deliver antibodies and fibrinogen (to

cover the area)

= “the vascular response”

Chemotaxis

• Leukocytes are attracted to the area to destroy and remove foreign material– Bacteria, dead cells, etc.

• These leukocytes then die and lysosomal enzymes break them and nearby cells down, prolonging inflammation. (edema)

Local Effects – why?

• Redness and warmth

• Swelling or edema

• Pain

• Loss of function

Interstitial Fluid = Exudate

• Serous- watery; allergic rxns. and burns

• Fibrinous- thick and sticky

• Purulent- (a.k.a. pus) thick, yellow/ greenish color; contains more leukocytes, microorganisms, debris. Indicates bacterial infection

• Abcess- localized pocket of purulent exudate

• Hemorrhagic- bloody exudate (blood vessels have been damaged

???

Systemic Effects

• Fever (a.k.a. pyrexia)

• Malaise

• Fatigue

• Headache

• anorexia

Fever… good or bad???

• Also called pyrexia.

• Can be low grade or high, depending on the pathogenic organism.

• Caused by the release of pyrogens which also cause shivering, cutaneous vasoconstriction (feeling “clammy”)

Diagnosis

• Almost always a blood test– Increased leukocytes– Increased # enzymes– Differential counts (# for each of the types of

WBCs)– Eo counts (if allergies are suspected)

Course of Inflammation

• If caused by brief exposure (like a burn), inflammation will reside within 48 hours.

• Otherwise, inflammation will persist until the harmful agent is removed.– If too long, extensive necrosis may occur

• Ulcers, perforations

Chronic Inflammation

• Ex: Arthritis

• Less swelling and exudate, but more lymphocytes and macrophages

• More necrosis

Treatment

• Acetylsalicylic acid (Aspirin or ASA)– Decreases prostaglandins– Pros: antipyretic, analgesic, anti inflammatory– Cons: Acidic (tummy issues), can inhibit

platelet adhesion, reducing the blood’s ability to clot.

• Acetominophen: (Tylenol)– Pros: Analgesic, Antipyretic– Cons: Not anti-inflammatory, in high doses it

can cause kidney or liver damage

• NSAIDs: (Advil, Motrin, Celebrex) non-steroidal anti-inflammatory drugs

– Decreases prostaglandins– Pros: Anti-Inflammatory, analgesic,

antipyretic• Typically used to treat inflammation of the

muscular and skeletal systems

– Cons: same as aspirin but less severe

• Prednisone (a steroid)– Extremely valuable in short-term relief of

inflammation• Blocks immune response• Decreases capillary permeability

– REALLY bad long term affects:• Causes atrophy• Increases blood pressure• Kidney and liver damage