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Questions and Answers
What is a distinguishing feature of cellulitis compared to an abscess?
What is a distinguishing feature of cellulitis compared to an abscess?
Which organism is primarily associated with diffuse suppurative inflammation like cellulitis?
Which organism is primarily associated with diffuse suppurative inflammation like cellulitis?
What is the main component found in granulomas?
What is the main component found in granulomas?
Which type of non-suppurative inflammation is characterized by excess watery fluid exudate?
Which type of non-suppurative inflammation is characterized by excess watery fluid exudate?
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Which condition is commonly associated with a risk of carbuncles?
Which condition is commonly associated with a risk of carbuncles?
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What typically leads to chronic inflammation?
What typically leads to chronic inflammation?
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Which type of abscess is directly related to hair follicles or sebaceous glands?
Which type of abscess is directly related to hair follicles or sebaceous glands?
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Which enzyme is associated with the action of Streptococcus haemolyticus in causing diffuse suppurative inflammation?
Which enzyme is associated with the action of Streptococcus haemolyticus in causing diffuse suppurative inflammation?
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What is the primary role of phagocytosis in the inflammatory response?
What is the primary role of phagocytosis in the inflammatory response?
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Which of the following is NOT a chemical mediator of inflammation?
Which of the following is NOT a chemical mediator of inflammation?
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What is the sequence of events in acute inflammation starting from vasodilatation?
What is the sequence of events in acute inflammation starting from vasodilatation?
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Which type of acute inflammation is characterized by the presence of pus?
Which type of acute inflammation is characterized by the presence of pus?
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What defines an abscess in terms of inflammation?
What defines an abscess in terms of inflammation?
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Which of the following best describes the composition of pus?
Which of the following best describes the composition of pus?
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What is the function of opsonins in the phagocytosis process?
What is the function of opsonins in the phagocytosis process?
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What is one potential outcome following an acute inflammation?
What is one potential outcome following an acute inflammation?
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What is the definition of inflammation?
What is the definition of inflammation?
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Which of the following best differentiates acute from chronic inflammation?
Which of the following best differentiates acute from chronic inflammation?
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Which cells are primarily responsible for phagocytosis in acute inflammation?
Which cells are primarily responsible for phagocytosis in acute inflammation?
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What is the primary function of the inflammatory fluid exudate?
What is the primary function of the inflammatory fluid exudate?
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What process describes the movement of neutrophils to the site of inflammation?
What process describes the movement of neutrophils to the site of inflammation?
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Which of the following is a characteristic of chronic inflammation?
Which of the following is a characteristic of chronic inflammation?
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What is one of the main causes of increased permeability during the vascular response?
What is one of the main causes of increased permeability during the vascular response?
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Which characteristic of exudate would indicate a high protein content?
Which characteristic of exudate would indicate a high protein content?
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During extravasation, which step involves neutrophils moving toward the blood vessel wall?
During extravasation, which step involves neutrophils moving toward the blood vessel wall?
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Which of the following describes the role of mast cells in inflammation?
Which of the following describes the role of mast cells in inflammation?
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Study Notes
Introduction to Inflammation
- Inflammation is a local vascular and cellular response of living tissue to an injurious agent.
Objectives
- Define inflammation
- Differentiate between acute and chronic inflammation
- Recognize the steps of extravasation of inflammatory cells
- Recognize the process of chemotaxis and phagocytosis
- Identify different examples of inflammation
Aims of Inflammation
- Fighting bacteria
- Localizing infection
- Removing damaged tissue
Causes of Inflammation
- Allergic reactions
- Chemical irritants
- Infections
- Trauma
- Burns
- Lacerations, cuts, wounds
- Frostbite
- Cardiovascular disease
- Neurological disease
- Autoimmune diseases (e.g., rheumatoid arthritis)
- Cancer
- Lupus
- Fibromyalgia
- Chronic fatigue syndrome
Types of Inflammation
- Acute inflammation
- Chronic inflammation
Cells in Acute and Chronic Inflammation
- Acute: Neutrophils (phagocytosis, pus cells)
- Chronic: Lymphocytes, plasma cells, histiocytes (chronic phagocytosis, monocytes), eosinophils (allergy, parasitic), mast cells (allergy, histamine, serotonin), giant cells (phagocytosis, histiocytes)
Acute vs. Chronic Inflammation (Features)
| Feature | Acute | Chronic |
|---|---|---|
| Onset | Fast (minutes to hours) | Slow (days) |
| Cellular infiltrate | Neutrophils mainly | Monocytes/macrophages & lymphocytes |
| Tissue injury, fibrosis | Usually mild and self-limited | Often severe and progressive |
| Local & Systemic signs | Prominent | Less prominent |
Local Signs of Inflammation
- Heat
- Redness
- Swelling
- Pain
- Loss of function
Systemic Effects of Inflammation
- Fever
- Leukocytosis
- Malaise
- Nausea
- Anorexia
- Lymphoid hyperplasia
- CRP, ESR raised
Main Events of Inflammation
- Vascular response
- Inflammatory fluid exudate
- Inflammatory cellular exudate
Vascular Response
- Changes in vascular flow and caliber (vasodilation, stasis, increased viscosity, swollen end, open capillaries)
- Increased permeability and formation of fluid exudate (histamine, kinins, endothelial gaps, direct endothelial injury)
Inflammatory Fluid Exudate
- Formation: Increased vascular permeability, interstitial osmotic pressure, reduced hydrostatic pressure.
- Function: Dilutes toxins, brings antibodies, supplies nutrients, supplies fibrinogen for localization and movement of inflammatory cells and fibroblasts.
Composition of Exudate
- Appearance: Turbid
- Consistency: Viscous (like pus)
- Protein content: High (4-8 g/dL)
- Specific gravity: High (>1018)
- Cell content: Numerous neutrophils
- On standing: Clots
Cellular Exudate (Extravasation of neutrophils):
- Margination (PMNs toward wall)
- Rolling (tumbling and EAPING) via selectine-glycoprotein and adhesion via integrine-lg
- Transmigration (diapedesis) via PCAM
- Role of activating substances (bacteria, damaged tissues) and mediators (lipopolysaccharides, cytokines).
Chemotaxis
- Movement of neutrophils and macrophages toward inflammatory irritant.
- Mediated by exogenous bacteria products and endogenous mediators (complement, arachidonic acid metabolites, chemokines) leading to actin polymerization.
Leukocyte "Activation"
- Produce eicosanoids
- Undergo degranulation
- Secrete cytokines
Phagocytosis
- Ingestion and destruction of bacteria, necrotic debris, and foreign particles by phagocytic inflammatory cells (e.g., neutrophils, macrophages).
Cellular Responses (Recognition, Engulfment, Killing)
- Recognition: Opsonization (Ig, complement) ,C3b receptor, Fc receptor
- Engulfment: phagocyte ingests the target
- Killing/degradation/digestion: via oxidative burst (reactive oxygen metabolites, lysosomal enzymes).
Chemical Mediators
- Cellular: Histamine, serotonin, eicosanoids, nitric oxide, platelet activating factor (PAF)
- Plasma: Complement, kinins, clotting factors, fibrinolytic factors
Outcome of Acute Inflammation
- Resolution
- Regression & Healing
- Progression & spread
- Progression & chronicity
Summary of Sequence of Events
- Vasodilation → Increased vascular permeability → Leakage of exudate, stasis → Extravasation, margination, rolling, adhesion, transmigration (diapedesis) → Chemotaxis → PMN activation → Phagocytosis (recognition, attachment, engulfment, killing) → Termination → 100% resolution, scar, or chronic inflammation
Types of Acute Inflammation
- Suppurative (pus-forming)
- Localized (e.g., abscess, furuncle, carbuncle)
- Diffuse (e.g., cellulitis, appendicitis, peritonitis)
- Non-suppurative (non-pus-forming)
Characteristics and Composition of Pus
- Non-coagulable, creamy, alkaline, yellowish or yellow-green fluid
- Fluid exudate, without fibrin
- Pus cells (neutrophils, macrophages), RBCs
- Liquified necrotic tissue
- Bacteria and pigments
Abscess
- Localized suppurative inflammation
- Cause: Often Staphylococci, excess fibrin
- Site: Skin, organs
- Microscopically: Central necrotic zone, peripheral inflamed tissue, granulation tissue, fibrosis
- Clinical: Red, hot, swollen
- Fate: Healing or complications
Boil (Furuncle), Carbuncle
- Boil (Furuncle): small abscess around hair follicle or sebaceous gland
- Carbuncle: multiple communicating abscesses, common in diabetics, commonly back of neck
Diffuse Suppurative Inflammation
- Cause: Often Streptococci producing enzymes (fibrinolysin, hyaluronidase, spreading factor).
- Examples: Cellulitis, appendicitis, peritonitis
Comparison of Abscess and Cellulitis
| Feature | Abscess | Cellulitis |
|---|---|---|
| Description | Localized, suppurative | Diffuse, suppurative |
| Causative organism | Staph | Strep |
| Mechanism | Excess fibrin | Fibrinolysin, hyaluronidase, spreading factor |
| Site | Any tissue (e.g., skin) | Loose connective tissue |
| Pus | Thick, yellow | Thin, sanguinous |
| Spread | Less | More common |
Types of Acute Non-Suppurative Inflammation
- Catarrhal (e.g., rhinitis, excess mucous)
- Serous (e.g., pleuritis, excess watery fluid exudate)
- Membranous (e.g., diphtheria, fibrin patches)
Chronic Inflammation
- Causes: Persistence of infection, prolonged exposure to insult
- Types: Non-specific, specific (granuloma)
Granulomas
- Chronic, specific type of inflammation
- Collection of epithelioid cells, lymphocytes, and giant cells (e.g., Langhan's)
- Etiology: Infective (TB, leprosy, syphilis, Bilharzia, Leishmania, fungi like Madura foot), non-infective (foreign bodies, sarcoidosis)
Components of Granuloma
- Epithelioid cells (main component)
- Giant cells (Langhans' type or foreign body type)
- Lymphocytes
- Fibroblasts
- Types of granuloma: granuloma with caseation (tuberculosis), granuloma without caseation (sarcoidosis, Crohn's, silicosis), suppurative granuloma (cat scratch disease), foreign body granuloma.
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Description
Test your knowledge on the distinguishing features of cellulitis compared to abscesses, the organisms involved in inflammation, and the components of granulomas. This quiz covers various types and characteristics of inflammation and tests your understanding of the inflammatory response.
