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Inflammation is a complex process that involves several responses that tell the body that something is going wrong. Often the response occurs on a tissue level with swelling, redness, skin warmth, and other symptoms.

This process is defined as a response to Damage, Infection, Irritation, and results in an Immune Process.

An increase of blood flows to the particular area is observed. A foreign object, pathogen, irritant, or damage may be seen. It is both a protective measure as well as a factor that begins the healing process.

Without Inflammation, it would be virtually impossible for a wound to heal. But when the condition becomes chronic, this can lead to serious consequences and complications.

The body will typically closely monitor and control the process through molecules, markers, and hormones. The body attempts to ensure that the process starts on time and stops before the situation becomes worse and Chronic Inflammation sets in.

Classification

1.  Acute Process

–  Cellular response of monocytes and macrophages
–  Immediate response to cause
–  Few days is expected for response
–  Often will be resolved shortly
–  May turn into chronic inflammation

2.)  Chronic Process

–  Cellular response of monocytes, macrophages, fibroblast, lymphocytes, plasma cells and other.
–  Response is typically delayed and may occur a time amount after involvement.
–  Duration can be weeks to months to years.
–  If severe enough tissue can be damaged.

Possible Causes of inflammation

–  Physical injury
–  Virus infection
–  Other infections
–  Bacteria infection
–  Hypersensitivity
–  Burns
–  Frostbite
–  Chemical irritants
–  Foreign bodies
–  Arthritis
–  many others

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5 main signs

1.) Rubor (redness)
2.) Calor  (increased heat)
3.) Tumor  (swelling)
4.) Dolor  (pain)
5.) Functio laesa  (loss of function)

Swelling

–  Caused by molecules such as protein, fibrin, and immunoglobulins into tissue.
–  Dilation and increased permeability of the blood vessels is seen.
–  Fluid enters the tissue causing swelling.

Vascular changes

1.) Vasodilation
2.) Slowing of blood flow

–  The result of these changes include redness and heat around the inflammation.
–  Both are more often seen than not.
–  Stasis occurs– this allows cell that help fight infection to cross from the passage way of the arteries to the targeted tissues where the infection or trauma has occurred.

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Classifications or Types of Inflammation:

1.) Purulent 

–  Results in a large amount of “pus”
–  Pus consists of large amount of neutrophils, dead cells, fluid and other molecules.
–  Typical infection is staphylococci
–  Abscess or boils can be seen in the surrounding tissues

2.) Serous

–  Results in a minimal to large amount of clear to cloudy colored fluid
–  Not as far along as having “pus”
–  Produced by mesothelial cells
–  May be caused by blood plasma
–  Blisters are an example

3.)  Granulomatous 

–  Formation of granulomas
–  Is a collection of immune cells such as macrophages
–  The body attempts to wall off the area
–  Typically is a small nodule
–  Pathology report will differentiate between this and other disease processes
–  Is seen in a variety of diseases

4.) Fibrinous 

–  Large amount of the molecule fibrin enters that inflammation area
–  Results in a cavity formation
–  Fibrin is deposited in the area

5.)  Ulcerative 

–  Damage or ulceration of the tissue involved
–  The top lay over the epithelium is damaged
–  This exposes the lower layers
–  Ulcers are formed

Many Cells, proteins, or molecules are involved in inflammation:

 1.)  Bradykinin 

–  A protein that helps with vasodilation and smooth muscle contraction.
–  Often results in pain

2.)  Plasmin 

–  Helps break down clots and activates Factor XII

3.)  Thrombin

–  Breaks down fibrinogen molecule
–  Helps form blood clots

4.)  C3 

–  Produces C3a and C3b
–  Causes histamine response
–  Causes target control of bacteria which leads to an attack on the bacteria

5.)  C5a 

–  Causes histamine response

6.)  Factor XII 

–  Protein that activates the plasma systems

Factors involved in mediating inflammation

1.)  Histamines

–  Are released by certain cells (Mast cells, Basophils and platelets)
–  This releases often causes the inflammation process to begin

2.)  Lysosome granules 

–  Enzyme action that causes breakdown of substances.
–  Helps mediate inflammation

3.)  Nitric Oxide 

–  Released from Macrophages and Endothelial cells
–  Relaxes smooth muscles
–  Causes a decrease in platelet aggregation  (grouping)
–  Help increase the recruitment of Leukocytes
–  Increases vasodilation

4.)  Prostaglandins 

–  Arise from Mast Cells
–  Can cause pain
–  Can result in fever
–  Increases vasodilation

5.) TNF-alpha 

–  Released from Macrophages
–  Can result in fever
–  Increases production of cytokines
–  Causes Leukocyte adherence
–  May increase heart rate
–  May decrease appetite

6.)  IL-1 

–  Released from Macrophages
–  Can result in fever
–  Increases production of cytokines
–  Causes Leukocyte adherence
–  May increase heart rate
–  May decrease appetite

7.)  IL-8

–  Released from Macrophages
–  Causes attraction of Neutrophils

8.)  IFN-Y

–  Complicated response
–  Helps in the maintenance of chronic inflammation
–  Has antiviral properties
–  Has anti-tumor properties

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Cells involved in inflammation

1.)  Leukocytes

–  Must get from the blood circulation to the site of inflammation
–  This process is known as “Extravasation”

1.) Localization and Recruitment  –  become attached to the side of arterial wall
2.) Migration –  the movement between the blood vessel wall and into the adjacent tissue
3.) Chemotaxis within the tissue  –  Attraction allows this cell to move within the tissue to
the source of inflammation

2.)  Phagocytosis

–  Cells that take bacteria, viruses, dead or damaged cells, debris, parasites and other particles/molecules and destroyed them.
–  Several cells, acids, factors, processes are involved

3.)  Monocytes

–  Type of white blood cell
–  They replenish macrophages and dendritic cells
–  Help with immune response at the site of inflammation

4.)  Termination of inflammation

–  This process must be turned off in order to end properly
–  When this does not occur the result is often chronic inflammation along with the potential for tissue damage

5.)  TGF-beta

– Released by macrophages

6.)  Anti-inflammatory Lipoxins

7.)  Prostaglandins

8.)  Leukotrines

Several disorders associated with Inflammation exist

Allergic reactions and immune system disorders are seen in this category

Is a rather broad category

Types:

–  Asthma
–  Allergies
–  Autoimmune disorders
–  Artherosclerosis
–  Cancers
–  Chronic prostatitis
–  Crohn’s Disease
–  Pelvic Inflammatory Disease
–  Rheumatoid
–  Arthritis
–  Ulcerative Colitis
–  others

Anti-Inflammatory medication

Treatment options that reduce inflammation include:

–  Rest
–  Ice
–  Elevation
–  Ace Wrap

Medications

1.)  Steroids

2.)  Non-Steroidal Anti-Inflammatory Drugs

–  Also referred to as NSAIDs
–  Method of Action:  –  affecting cyclooxygenase (COX) enzymes
–  Prevents the synthesis of prostaglandins
–  Cox-I and Cox-II are affected

.   Ibuprofen (IBU, Motrin)
.   Naproxen
.   Diclofenac
.   Sulindac

3.)  COX-2 Inhibitiors

.   Celecoxib  (Celebrex)  –  FDA alert

4.)  Cancelled medications

.   Etoricoxib  [Withddrawn by FDA]
.   Valdecoxib (Bextra)  [Withddrawn by FDA]
.   Rofecoxib  (Vioxx) [Withddrawn by FDA]

5.)  Aspirin

.   Affects Cox-1
.   Stops platelet aggregation  (grouping)

6.)  Herbs

.   Ginger
.   Willow bark
.   Arnica montana
.   Turmeric

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