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) 2 nd line of defense? –Phagocytosis and inflammation (non-specific) Phagocytosis uses neutrophils (leukocytes) and macrophages to “gobble up” foreign matter.

Body’s Defenses 3.3 rd 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 Occurs 2.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

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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