1. Chapter 3 Inflammation, the Inflammatory Response, and Fever

2. Pre lecture quiz true/false
Acute inflammation is the immediate and early response to an injurious agent and occurs in two phases; the vascular phase and the cellular phase.
Chronic inflammation is self-perpetuating and may last for weeks, months, or even years.
Erythrocytes play a central role in the physiology of inflammation.
Vasoconstriction occurs during the vascular stage of inflammation.
Fever is a pathologic response to bacterial and viral infection with and has no positive outcome on illness. T F

3. Pre lecture Quiz
The ______________ signs of inflammation are known as redness, swelling, heat, pain, and loss of function.
Histamine, serotonin, cytokines, bradykinin, arachidonic acid, and platelet-activating factor are _____________ of inflammation.
Body temperature is regulated by the thermoregulatory center in the ________________.
____________, or pyrexia, represents an increase in body temperature due to resetting of the hypothalamic thermoregulatory set point as the result of endogenous pyrogens released from host macrophages or endothelial cells.
_____________ refers to heat transfer through the circulation of air currents.
cardinal
Convection
Fever
hypothalamus
mediators

4. Inflammation
Inflammation is an automatic response to cell injury that:
Neutralizes harmful agents
Removes dead tissue

5. Inflammation Damaged cells release inflammatory mediators.
These compounds stimulate inflammation.

6. Damaged cells
release
inflammatory
mediators
local
responses
vascular
stage
cellular
systemic (whole-
body) responses
white blood
cell response
acute-phase
response

7. Acute Inflammation Vascular stage
Prostaglandins and leukotrienes affect blood vessels.
Arterioles and venules dilate.
Increasing blood flow to injured area
Redness and warmth result
Capillaries become more permeable.
Allowing exudate to escape into the tissues
Swelling and pain result

8. Question
What mechanism causes the redness (erythema) associated with the inflammatory process?
Prostaglandins
Leukotrienes
Arachidonic acid
All of the above
a and b

9. Answer
a and b
Prostaglandins and leukotrienes cause vasodilation, which brings more blood to the injured/affected area. The symptoms caused by this vasodilation are redness/erythema and warmth.

10. Kinds of Exudate
Serous
Hemorrhagic
Fibrinous
Membranous
Purulent

11. A woman has peritonitis …
Scenario:
A woman has peritonitis …
She has a distended abdomen, low blood pressure, and fluid in her abdominal cavity.
After surgery, she is told to report any GI distress as it may indicate fibrous adhesions.
Question:
What kinds of exudate are involved? What useful purposes do they serve? What complications may they cause?

12. Cellular Stage White blood cells enter the injured tissue:
Destroying infective organisms
Removing damaged cells
Releasing more inflammatory mediators to control further inflammation and healing

13. White Blood Cells Involved in Inflammation
Granulocytes
Neutrophils
Eosinophils
Basophils
Mast cells
Monocytes
Monocytes  Macrophages

14. Leukocytes Leukocytes enter the injured area
Leukocytes express adhesive proteins
Attach to the blood vessel lining
Squeeze between the cells
Follow the inflammatory mediators to the injured area

15. Leukocytes (cont.)

16. Leukocytes release many inflammatory mediators at the injured area:
Leukocytes (cont.)
Leukocytes release many inflammatory mediators at the injured area:
Histamine and serotonin
Platelet-activating factor
Cytokines
Colony-stimulating factors
Interleukins
Interferons
Tumor necrosis factor
Nitric oxide

17. Question
Which leukocytes participate in the acute inflammatory response?
Eosinophils
Monocytes
Neutrophils
All of the above
a and c

18. Answer
All of the above
Granulocytes and monocytes play a role in the acute phase of the immune response. Eosinophils and neutrophils are granulocytes, so all of the leukocytes listed participate.

19. Other Inflammatory Mediators
Other inflammatory mediators travel in the plasma:
Kinins
Coagulation and fibrinolysis proteins
Complement system
C-reactive protein

20. damaged cells
release
inflammatory
mediators
local
responses
vascular
stage
cellular
systemic (whole-
body) responses
white blood
cell response
acute-phase
response

21. Leukocytes release interleukins and tumor necrosis factor
Acute-Phase Response
Leukocytes release interleukins and tumor necrosis factor
Affect thermoregulatory center  fever
Affect central nervous system  lethargy
Skeletal muscle breakdown
Liver makes fibrinogen and C-reactive protein
Facilitate clotting
Bind to pathogens
Moderate inflammatory responses

22. Fever

23. Author: Title needed here?

24. Question
Tell whether the following statement is true or false: Body temperature is controlled through negative feedback loops.

25. Answer
True When the body senses a change out of the norm (as illustrated in the previous slides), it activates mechanisms that oppose that change (vasodilation and sweating with increased temperatures; vasoconstriction and shivering with decreased temperatures). This is known as negative feedback. Positive feedback, on the other hand, senses a change but activates a mechanism that exaggerates the change.

26. Mr. X says he has “chills and fever”…
Scenario:
Mr. X says he has “chills and fever”…
His daughter wants you to explain how he could have both at the same time and from the same disease
Question:
Should she be keeping him warmer or helping him cool off?

27. White Blood Cell Response
Inflammatory mediators cause WBC production
WBC count rises
Immature neutrophils (bands) released into blood

28. Nonspecific chronic inflammation
Macrophages accumulate in the damaged area and keep releasing inflammatory mediators.
Nonspecific chronic inflammation
Fibroblasts proliferate
Scar tissue forms
Granulomatous inflammation
Macrophages mass together around foreign bodies
Connective tissue surrounds and isolates the mass

29. Scenario:
A man had tuberculosis (TB) long ago, and when he first had the disease, he had a fever, productive cough, and bloody sputum.
Later, he had trouble breathing and the doctor said his lungs were “consolidated” with fibrous proteins.
He recovered and his fever went down; he thought he was cured.
Three years later, an x-ray showed nodules in his lungs and he was told they contained the TB bacteria.
Question:
Identify inflammatory events in his case.

30. Growth factors stimulate local cells to divide.
Tissue Repair
Growth factors stimulate local cells to divide.
Tissue organization is controlled by the extracellular matrix.
New cells are laid down on the extracellular matrix.
Tissue regeneration: injured tissue is replaced by the same kind of cells
Fibrous tissue repair: injured tissue is replaced by connective tissue
Granulation tissue  scar tissue

31. Question
Tell whether the following statement is true or false: If you get a paper cut, epithelial tissue will be replaced with connective tissue.

32. Answer
False The surface epithelial cells of the skin are most likely to be damaged in this instance. Surface epithelial tissue has the ability to regenerate, replacing the damaged tissue with the same type (epithelial).

33. Wound Healing
Inflammatory phase
Proliferative phase
Remodeling phase