Inflammation & Healing PDF

INFLAMMATION AND HEALING N111 Pathopharmacology 1 Samuel Merritt University  IMMUNITY 1st line of defense Innate immunity 2nd line of defense Inflammation 3rd line of defense Adaptive/acquired immunity 2  INFLAMMATION IN...

INFLAMMATION AND HEALING N111 Pathopharmacology 1 Samuel Merritt University  IMMUNITY 1st line of defense Innate immunity 2nd line of defense Inflammation 3rd line of defense Adaptive/acquired immunity 2  INFLAMMATION IN RELATION TO IMMUNITY Wall off/confine pathogens/foreign bodies to minimize damage/infection Stimulate immune response Promote healing 3  PATHOGENESIS: LEUKOCYTES (WBCS) Neutrophils: phagocytosis  release free radicals Purulent exudate Macrophages: phagocytosis  release of cytokines Eosinophils: degranulate Basophils & Mast cells 4 PHAGOCYTOSIS  BASOPHILS & MAST CELLS Degranulate  release Histamine  vascular permeability Dilated blood vessels Chemotactic factor Proteolytic enzyme and heparin Leukotrienes Prostaglandins Platelet activating factor 6  MAST CELL DEGRANULATION  A LOOK AT THE TISSUE LEVEL ↑ vascular permeability Dilated blood vessels Emigration of leukocytes  PLASMA PROTEINS Complement Chemotaxis Target cell lysis Kinins Vasodilation Clotting cascade  vascular permeability Pain 9  PLASMA PROTEINS Coagulation Clotting factors Form fibrinous mesh at an injured or inflamed site Prevents infection spread Stop bleeding 10  CYTOKINES Interleukins IL-1: proinflammatory cytokine IL-10: anti-inflammatory cytokine Interferon (IFN) Protects against viral IFN-alpha and IFN-beta IFN-gamma Tumor necrosis factor (TNF) Endogenous pyrogen  synthesis of plasma proteins 11 CYTOKINES (CONT’D)  3 EVENTS OF INFLAMMATION 13  PATHOGENESIS: LENGTH OF ILLNESS Acute Chronic Localized More diffuse Self limiting Scar tissue Discrete events formation or deformity < 2 weeks > 2 weeks 14 4 CARDINAL SIGNS OF INFLAMMATION 15  LOCALIZED CLINICAL MANIFESTATIONS Redness Swelling Heat Pain Loss of function Exudative fluids 16  EXUDATES Late/most severe inflammation Hemorrhagic Purulent Fibrinous Serous Early/least severe inflammation 17 SYSTEMIC CLINICAL MANIFESTATIONS Fever  leukocytes circulating Lethargy Muscle catabolism   plasma proteins C reactive protein,TNF α, IL-1, IL-6   inflammation  erythrocyte sedimentation rate (ESR) 18  GOALS OF INFLAMMATION 1. Limit and control the inflammatory process 2. Prevent and limit infection and further damage 3. Initiate adaptive immune response 4. Initiate healing 19  TREATMENT IMPLICATIONS To intervene or not? This is the question Antihistamines Systemic corticosteroids/glucocoritcoids Fever reducers Elevation of the extremity Heat? Infectious processes Antibiotics/antifungals I&D 20  END RESULT OF INFLAMMATION Regeneration: return to original structure/function Repair: scar tissue 21  HEALING Primary intention Minimal tissue loss Secondary intention Great deal of tissue loss = open wound 22  WOUND HEALING Phases: Coagulation Inflammatory Proliferation Remodeling Maturation 24  DYSFUNCTION DURING HEALING Scarring Keloid Impaired epithelialization Corticosteroids Hypoxemia Nutritional deficiencies Wound disruption Dehiscence (increases risk of infection) 25 DYSFUNCTIONAL WOUND HEALING (CONT’D) THE MATURE WHITE BLOOD CELL IS CALLED A: A.Platelet B. Monocyte C.Neutrophil D.T lymphocyte  28 THE SYSTEMIC MANIFESTATIONS OF INFLAMMATION INCLUDE (SELECT ALL THAT APPLY) A.Fever B. Muscle catabolism C.Decreased respiratory rate & rhythm D.Lethargy E. Polyuria INTERLEUKIN-1, INTERLEUKIN-6, 29 AND TUMOR NECROSIS FACTOR ALPHA ARE INFLAMMATORY CYTOKINES SECRETED BY A.Plasma cells B. Neutrophils C.Lymphocytes D.Macrophages