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Inflammation is a complex response that indicates the surrounding tissue that something is going wrong.

Can be a response to damage or an Immune Process.

An increase of blood flows to the particular area is observed.

A foreign object, pathogen, irritant, or damage may be seen.

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 chronic inflammation can lead to serious consequences as well.

Therefore the body will typically closely monitor and control inflammation – to start it on time and
to stop the chronic occurrence as well.

Classification

1.  Acute Inflammation

  • 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 Inflammation

  • 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.

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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Inflammation Classifications:

1.) Purulent Inflammation

  • 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 inflammation

  • 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 Inflammation

  • 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 Inflammation

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

5.)  Ulcerative Inflammation

  • 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 moleucles are involved in inflammation:

  • Bradykinin – A protein that helps with vasodilation and smooth muscle contraction.
    – Often results in pain
  • Plasmin – Helps break down clots and activates Factor XII
  • Thrombin  Breaks down fibrinogen molecule – helps form blood clots
  • C3 – Produces C3a and C3b

Causes histamine response
Causes target control of bacteria which leads to an attack on the bacteria

  • C5a – Causes histamine response
  • Factor XII – Protein that activates the plasma systems

Factors involved in mediating inflammation

  • Histamines – Are released by certain cells (Mast cells, Basophils and platelets)

This releases often causes the inflammation process to begin

  • Lysosome granules – Enzyme action that causes breakdown of substances.

Helps mediate inflammation

  • 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

  • Prostaglandins – Arise from Mast Cells

Can cause pain
Can result in fever
Increases vasodilation

  • TNF-alpha – Released from Macrophages

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

  • IL-1 –  Released from Macrophages

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

  • IL-8 –  Released from Macrophages

Causes attraction of Neutrophils

  • 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

  • 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

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

  • Monocytes

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

  • 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

  • TGF-beta – released by macrophages
  • Anti-inflammatory Lipoxins
  • Prostaglandins
  • Leukotrines

 

Several disorders associated with Inflammation exist

Allergic reactions and immune system disorders are seen in this category

Is a rather broad category

Types:

 

Anti-Inflammatory medication

Treatment options that reduce inflammation include:

  • Rest
  • Ice
  • Elevation
  • Ace Wrap

 

Medications

  • Steroids
  • 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

  • COX-2 Inhibitiors

Celecoxib  (Celebrex)  –  FDA alert

  • Cancelled medications

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

  • Aspirin

Affects Cox-1
Stops platelet aggregation  (grouping)

  • Herbs

Ginger
Willow bark
Arnica montana
Turmeric

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