Acute and Chronic Inflammation Lec-1 PDF

Debarment of Anesthesia Tech - Acute and Chronic Inflammation No.1 Overview Inflammation: A fundamental immune response to injury and infection. Inflammation can be classified into two main types: Acute and Chronic. 1. Acute inflammation is a rapid and self-limited response. 2. Chronic inflam...

Debarment of Anesthesia Tech - Acute and Chronic Inflammation No.1 Overview Inflammation: A fundamental immune response to injury and infection. Inflammation can be classified into two main types: Acute and Chronic. 1. Acute inflammation is a rapid and self-limited response. 2. Chronic inflammation is a persistent and long-lasting process. In this lecture, we will explore the characteristics, causes, and key differences between acute and chronic inflammation. Acute Inflammation Acute inflammation is a tightly regulated and highly coordinated response that occurs rapidly after tissue injury or infection. The duration of acute inflammation is usually brief, ranging from minutes to days. Acute inflammation is generally a beneficial response that helps to: o Eliminate pathogens. o Clear debris. o Initiate the healing process. Local Signs and Symptoms of acute inflammation include: 1. Pain 2. heat 3. redness 4. swelling 5. loss of function Dr. Hisham Hammodat Causes of Acute Inflammation 1. Infections: Bacterial, viral, fungal, or parasitic infections can trigger acute inflammation. 2. Tissue injury: Physical trauma, burns, cuts, or chemical exposure can induce acute inflammation. 3. Immune reactions: Hypersensitivity responses, such as allergies, can lead to acute inflammation. 4. Ischemia: Lack of blood supply to tissues can cause acute inflammation. Steps of Acute Inflammation 1. Vasodilation and increased vascular permeability: Blood vessels dilate, allowing increased blood flow to the affected area. Increased permeability allows fluid, proteins, and immune cells to enter the tissue. This results in redness, heat, and swelling. 2. Migration and activation of immune cells: Neutrophils are the first immune cells to arrive at the site of inflammation. They are the predominant cells in acute inflammation. They engulf and destroy pathogens through phagocytosis. Macrophages are recruited later, play a crucial role in tissue clean up, and repair. 3. Release of chemical mediators: Chemical mediators, such as histamine, bradykinin, and prostaglandins, are released. They enhance vascular permeability, attract immune cells, and promote the inflammatory response. 4. Tissue repair: Once the injurious stimulus is eliminated, the inflammatory response subsides. Fibroblasts and other cells are activated to repair and regenerate damaged tissue Dr. Hisham Hammodat Systemic Effects of Acute Inflammation 1. Systemic Signs and Symptoms: o Fever o Chills o Malaise o Anorexia (loss of appetite) o Increased pulse and blood pressure 2. Leukocytosis: o Neutrophilia in bacterial infection o Lymphocytosis in viral infection o Eosinophilia in allergy and parasitic infection 3. Acute phase protein production in liver: o C-reactive protein (CRP): The elevation is often proportional to the intensity and severity of the inflammatory response. o Fibrinogen o Leads to increased Erythrocyte Sedimentation Rate (ESR) Systemic Inflammatory Response Syndrome (SIRS) SIRS is a clinical syndrome characterized by an exaggerated defense response of the body to a noxious stressor to localize and then eliminate the endogenous or exogenous source of the insult. It can occur in response to various triggers, including infectious and non-infectious causes (e.g. trauma, surgery, acute inflammation, or malignancy). SIRS, Sepsis, and Septic Shock When SIRS is associated with a confirmed or suspected infection, it is termed “sepsis”. Septic shock: refers to sepsis with persistent hypotension despite adequate fluid resuscitation, along with the presence of organ dysfunction. Dr. Hisham Hammodat  Sepsis and septic shock represent more severe manifestations of the systemic inflammatory response and require immediate medical intervention Diagnostic Criteria for SIRS The criteria include the presence of at least two of the following: 1. Abnormal body temperature: Fever (>38°C) or hypothermia (12,000 cells/mm³) or leukopenia ( shrinkage and tightening of once-elastic tissues (contracture) > a narrowing of a luminal space (stricture), or > Attachment of structures, which normally do not attach (adhesions). Systemic Effects of Chronic Inflammation 1. Symptoms: o Fever (usually mild) o Fatigue o Weight loss o Disease specific symptoms 2. Elevated eosinophil counts (eosinophilia): e.g. asthma, allergic rhinitis, eosinophilic esophagitis, or parasitic infections. Dr. Hisham Hammodat 3. Impaired Kidney Function: leading to elevated blood tests such as blood urea nitrogen (BUN) and creatinine levels 4. Impaired Liver Function: leading to elevated blood tests such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) 5. Serum Amyloid A (SAA): SAA is an acute-phase protein that is produced by the liver in response to inflammation. 6. Raised Inflammatory Markers in Specific Conditions: Depending on the specific chronic inflammatory condition, additional markers may be assessed. For example, fecal calprotectin or C-reactive protein (CRP) in inflammatory bowel disease (IBD). 7. Immunoglobulins: e.g., an increase in immunoglobulin G (IgG) levels may be seen in autoimmune disorders such as rheumatoid arthritis or systemic lupus erythematosus. 8. Raised Autoantibodies: e.g., rheumatoid factor (RF) in rheumatoid arthritis. Complications of Chronic Inflammation 1. Cardiovascular diseases 2. Cancer 3. Diabetes 4. Rheumatoid arthritis 5. Allergic asthma 6. Chronic obstructive pulmonary disease (COPD) 7. Alzheimer's disease 8. Chronic kidney disease (CKD) 9. Inflammatory Bowel Disease (IBD) 10. Metabolic Syndrome 11. Multiple Autoimmune Syndrome Dr. Hisham Hammodat Key Differences between Acute and Chronic Inflammation Conclusion Acute and chronic inflammation are two distinct types of immune responses. Acute inflammation is a rapid and self-limited process aimed at eliminating the injurious stimulus and promoting tissue repair. Chronic inflammation is a persistent and prolonged response that can lead to tissue damage and scarring. Dr. Hisham Hammodat  Understanding the characteristics and causes of acute and chronic inflammation is vital for diagnosing, managing, and treating various inflammatory conditions. MCQ’s 1. What is the primary purpose of inflammation? o A) To inhibit immune responses o B) To promote tissue growth o C) To act as a fundamental immune response to injury and infection o D) To decrease blood flow to affected areas o E) To reduce body temperature 2. Which of the following is NOT a characteristic of acute inflammation? o A) Rapid onset o B) Long-lasting process o C) Self-limited response o D) Involves neutrophils o E) Helps clear debris 3. What type of cells are predominantly involved in acute inflammation? o A) Lymphocytes o B) Eosinophils o C) Neutrophils o D) Basophils o E) Fibroblasts 4. Which of the following is NOT a local sign of acute inflammation? o A) Pain o B) Redness o C) Swelling o D) Fever o E) Loss of function 5. Which of the following is a key difference between acute and chronic inflammation? o A) Acute inflammation involves lymphocyte infiltration, while chronic does not o B) Chronic inflammation is short-term, while acute is long-term o C) Granuloma formation is common in acute inflammation, but not in chronic o D) Acute inflammation often involves neutrophils, while chronic involves fibroblasts o E) Acute inflammation shows significant tissue remodeling, while chronic does not Dr. Hisham Hammodat 6. Which of the following is NOT a cause of acute inflammation? o A) Bacterial infections o B) Tissue injury o C) Genetic disorders o D) Immune reactions o E) Ischemia 7. What is "SIRS" an acronym for? o A) Systemic Infection Response Syndrome o B) Systemic Immunological Reaction Syndrome o C) Systemic Inflammatory Response Syndrome o D) Severe Interstitial Reaction Syndrome o E) Serious Inflammatory Reaction Syndrome 8. Which of the following conditions is NOT associated with chronic inflammation? o A) Rheumatoid arthritis o B) Asthma o C) Acute appendicitis o D) Chronic obstructive pulmonary disease (COPD) o E) Tuberculosis 9. What is the role of fibroblasts in chronic inflammation? o A) Initiating the inflammatory response o B) Destroying pathogens o C) Phagocytosing debris o D) Producing fibrous connective tissue 10. SIRS is a clinical syndrome characterized by a systemic inflammatory response involving multiple organs and systems in the body. What are the diagnostic criteria for SIRS? o A) Abnormal body temperature, tachycardia, tachypnea, abnormal white blood cell count o B) Elevated erythrocyte sedimentation rate, leukocytosis, fever, hypotension o C) Malaise, anorexia, increased blood pressure, leukopenia o D) Granuloma formation, fibrosis, angiogenesis, tissue remodeling o E) Pain, fever, weight loss, elevated C-reactive protein Dr. Hisham Hammodat