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    Inflammation/peradangan

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    Definitions

    Inflammation is essentially a protective

    response intended to eliminate both theinitial cause of cell injury (e.g., microbes ortoxin) and the necrotic cells and tissuesarising as a consequence of such injury.

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    Acute/Chronic Inflammation

    Acut Inflammation: relatively short duration, lastingfrom a few minutes up to a few days, and ischaracterized by fluid and plasma protein exudation,

    and by a predominatly neutrophil accumulation.

    Chronic Inflammation: longer duration (weeks toyears), is manifested histologically by influx of

    macrophages, lymphocytes and plasma cells,and bytissue destruction and repair, the later is associatedwith vascular proliferation and fibrosis.

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    Acute inflammation

    There are 3 major

    components :

    1. Vasodilatation

    2. Structural changes in

    the microvasculaturethat permit plasmaprotein to leave thecirculation

    3. Neutrophil emigration

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    Heat Red Swelling Pain Loss Of

    Func.

    5 Cardinal Signs

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    Classic Signs of Inflammation

    Rubor: erythema due to capillary dilation

    Calor: warmth due to increased blood flow

    Tumor: edema and accumulation of fluid in theextravascular space and cells migrating intothe tissue

    Dolor: pain due to local pressure andstimulation of nerve endings

    Functio laesa: alteration in function Due tothe physical swelling and the pain present

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    Mouth Aphthous ulcer

    Calor, Rubor, Dolor, Tumor, Loss of function

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    Mediators in vivo of acute inflammation

    *Vasodilatation

    prostaglandins, nitric oxide (NO)

    * Increased vascular permeability

    vasoactive amines, C3a and C5a, bradykinin, Leukotiene, PAF

    Chemotaxis, leucocyte activation

    C5a, Bacterial product, chemokines (IL-8)

    Fever

    IL-1, IL-6, TNF alfa

    Pain

    prostaglandin, bradykinin

    Tissue damage

    Neutrophil & macrophage lysosomal enzymes

    Oxygen metabolites, NO

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    Migration of Leucocytes

    Leucocytes attracted to the area (especially Neutrophils)

    These leave the blood vessel and enter the damaged

    area. This is called DIAPEDESIS

    Leucocytes attracted by CHEMOTAXIS,chemicalsreleased from the damaged tissues

    Leucocytes phagocytose the invading bacteria and dead

    tissue. Antibodies help with this job.

    Fibrin walls the damaged area off preventing further

    damage or extending the infected area

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    These are usually firstto inflammation Bothin serum and mucosal,will function much asmacrophages

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    Granulocytes

    Neutrophils

    Eosinophils

    Basophils

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    Neutrophils

    Polymorphonuclear neutrophils (PMNs)

    First to arrive at the inflamed site

    Phagocytize bacteria, dead cells, cellulardebris.

    Kill living cells

    Digest foreign material

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    Eosinophils

    Functions

    respond to chemical messengers

    phagocytosis

    kill certain microorganisms

    Special functions

    parasite infections

    allergic reactions

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    Basophils

    Functions

    respond to chemical messengers

    release granules containing chemical into the

    injured site

    have functions similar to mast cells

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    Agranulocytes

    Monocytes

    Lymphocytes

    T lymphocytes

    B lymphocytes

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    Monocytes

    Attracted to the area by PMNs

    Blood: Monocytes

    Exudate and RES: Macrophages Skin: Histiocytes

    Respond to the lymphocytes

    produce monokines, interferons, TNF more effective phagocytosis

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    Lymphocytes

    Important in immunity

    Less important in inflammation

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    Mast Cells

    Basophils

    The most important activator of the

    inflammatory response

    Mast cells are cellular bags of granules located

    in loose connective tissue near blood vessels.

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    Outcomes of acute inflammation

    Complete resolution

    little tissue destruction and capable ofregeneration

    Scarring of fibrosis

    do not regenerate

    Abscess formation

    in the setting of certain bacterial or

    fungal infections Progression to chronic inflammation

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    Chronic Inflammation

    Persistent infections

    Tubercle bacilli, Treponema pallidum Prolonged exposure to potentially toxic agents

    inhaled silica, chronically elevated plasma lipid

    Autoimmune diseases

    immune response to self antigens

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    Systemic effects of inflammation

    Fever

    Higher erythrocyte sedimentation rate

    Leukocytosis/leukopenia Neutrophilia, eosinophilia, lymphocytosis

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    Inflammation Cancer

    Arthritis

    Atherosclerosis

    Colitis

    Psoriasis

    Infection

    Diabetes

    Chronic inflammation plays a role inmany disease conditions

    Eczema