c2: inflammation

• pain 
• redness
• swelling
• heat
• loss of function

• vasodilation
• constriction of arteriolar smooth muscles
• active hyperemia
• increased hydrostatic pressure
• congestion
• hemodynamic changes: RBC rouleux formation and margination of WBC

• 1. margination of neutrophil
• 2. adhesion of platelets releasing mediators of coagulation
• 3. pavementing of leukocytes to endothelium

adhesion molecules that facilitate leukocytes to adhere to endothelium during inflammation

• 1. increased hydrostatic pressure inside congested blood vessels
• 2. slow circulation reducing oxygen and nutrients to endothelial cells
• 3. adhesion of leukocytes and platelets to endothelial cells
• 4. release of soluble mediators

• plasma derived: circulate inactively in blood, activated during inflammation
• cell derived: stored in granules of platelets and leukocytes

• mast cells and platelets release histamine
• capillary leaks causing increase in vascular permeability
• phagocytes engulf bacteria
• platelets move out of capillary to seal wounded area

• quick reaction/ short action mediator (amine)
• from platelets and mast cells
• increases vascular permeability
• vasodilation
• increase phagocytosis
• pain
• inactivated by histaminase

• from plasma through Hageman factor (coagulation factor)
• similar to histamine function
• incrs. vascular permeability
• pain
• longer lasting

• AKA coagulation factor
• produces: bradykinin, plasmin, fibrin

group of plasma proteins produced in liver that enhances antibodies and phagocytosis to clear damaged cells and promote inflammation. Circulates in inactive form

produce MAC to cause cell lysis

• C3a: anaphylatoxins + opsonin
• C5a: anaphylatoxin + chemotaxis

signaling chemicals that facilitate phagocytosis

• chemicals that release histamine, vasodilation, vascular permeability
• released by C3a and C5a

chemotaxis

attraction of white cells to area of inflammation

derived from membrane phospholipids and metabolized through lipoxygenenase pathway and cyclooxygenase pathway

• leukotrienes: promote chemotaxis and vascular permeability. present in anaphylactic shock, bronchospasm
• lipoxins: inhibit chemotaxis, negative regulator of leukotriene, vasodilation

• prostaglandins: smooth muscle contraction, pain and fever, vascular permeability
• thromboxane: platelet aggregation (clots), vasoconstriction
• prostacyclin: counteracts thromboxane

leakage of plasma fluid into interstitial vessel. result of increased permeability

transudate + proteins + inflammatory cells (WBC)

• inc vascular permeability
• inc hydrostatic pressure, (edema)
• emigration of leukocytes, releasing exudate
• chemotaxis

• 1. adhesion of leukocytes
• 2. insertion of pseudopods between endothelial cells
• 3. passage through basement membrane
• 4. ameboid movement toward chemotactic stimuli

• 1. bacterium opsonized (coated with phagocytic chemicals)
• 2. bacteria is engulfed by PMN
• 3. Degranulation: phagocytic vacuoles and lysosomes digest bacterium

dead leukocytes mixed with tissue debris and lytic enzymes

• polymorphonuclear neutrophils
• eosinophils
• basophils 
• macrophages
• platelets
• lymphocytes
• plasma cells

• first responders to acute inflammation
• cytokine production: interleukin -1 --> hypothalamus --> fever

• 2-3% of WBC
• appears 2-3 days after PMN
• allergy, parasites
• chronic

• <1% of WBC
• allergy
• from mast cells

• derived from blood monocytes
• appears 3 - 4 days after onset
• chronic inflammation
• involved in phagocytosis

fragments of megakaryocytes

• serous inflammation
• fibrinous inflammation
• purulent inflammation
• ulcerative inflammation
• pseudomembranous
• chronic
• granulomatous

• early stage of most inflammation 
• joint swelling in rheumatoid arthritis, herpes, pneumonia
• exudation of serum
• mild

• exudate rich in fibrin
• severe
• strep throat (bacterial infection)

• exudate with pus
• contains dead PMN and necrotic tissue remnants

• abscess: localized collection of pus enclosed in capsule
• sinus: rupture abscess containing a cavity that drains puss
• fistula: a channel connecting two hollow cavities/organs or to the surface of the body

ulcer: loss of epithelial lining in hollow organs

• ulcerative inflammation + fibropurulent
• contain exudate composed of pus, fibrin, cellular debris and mucus

• fibroblast proliferation
• scarring by deposit of collagen
• fibrosis: hardening of tissue, usually associated with lung disease
• occurs after acute

• granulomas
• consists of lymphocytes, macrophages, and multinucleated giant cells
• common in TB

• a type of chronic inflammation with many lymphocyte, macrophages (epithelioid cells), and multinucleated giant cells
• not preceded by acute inflammation
• present in TB patients

• IL-1
• tumor necrosis factor

• 1. leukocytes + macrophages release  IL - 1 and tumor necrosis factor
• 2. IL-1 and TMF enter hypothalamus releasing prostaglandins which cause fever.
• can be inhibited by aspirin

• Go: resting phase
• G1: growth
• S: DNA synthesis
• G2: growth and preparations for division

• cells that do not divide regularly but can be stimulated to proliferate
• ex. parenchymal cells of liver
• stops at G0 phase

• cells that cannot divide
• ex. neurons, myocardial cells

• macrophages
• myofibroblasts
• fibroblasts 
• angioblasts

• myofibroblasts: contract, secret matrix substances
• macrophages: contract, secret matrix
• fibroblasts: extracellular matrix including fibronectin and collagens (III,II,I)
• angioblasts: blood vessel precursors

connective tissue rich in macrophages,

• first intention
• secondary intention

• healing for small wounds
• scar --> leukocytes --> granulation tissue (fibroblast, macrophage) --> small scar

• prolonged wound healing
• exposed granulation tissue delays healing tremendously

• deficient scar formation: slow scar formation usually seen in diabetic pts as a result of ischemia
• wound dehiscence: separation of tissue margins
• excess scar formation
• keloids leftover type III collagen

aspirin

PMN polymorphonuclear neutrophil

• histamine
• coagulation proteins
• cytokines
• growth factors

factor that promotes proliferation of connective tissue

facilitated phagocytosis of bacteria

formation of new blood vessels