marinov - inlammation and fever 2015 [eng] fileastheno-adinamic syndrome loss of appetite, fatigue,...
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Inflammation
Blagoi Marinov, MD, PhD Pathophysiology Dept.
Medcal University of Plovdiv
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Definition
A form of non-specific reactivity, evolutionally developed in multicellular organisms. .
Common pathologic process developing in the vascularized tissues and associated with cellular damage.
Acute inflammation is a self-containing process i.e. it persists till the cause is removed.
“The individuality of the cause “fades” in the uniformity of the response !
Determination
The biologic nature of inflammation is removal and containment of the pathogenic agents which cause it. It develops in three (in)distinct phases.
Alteration
Exudation and emigration
Proliferation
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Inflammation – entity or discreet process
Alteration
Exudation
Proliferation
Alteration
Exudation
Proliferation
Variety of etiologic factors
Exogenous Biologic factors Physical factors Chemical factors Mechanical factors
Endogenous Hypoxia Secretions
Bile Urea Uric acid
Depositions Salts Toxic compounds Immune complexes
Immune reactions
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Alteration
Exudation and emigration
Proliferation
Alteration (damage)
Forced death of cells (tissues)
Cause Reversible damage
(DYSTROPHY)
Irreversible damage
(ALTERATION)
INFLAMMATION
Аpoptosis RECOVERY
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Progression of alteration
Primary Causally determined
Direct injurious action of the pathogenic agent
Secondary Mediators
Metabolites
Damage of lysosomal membranes
Free radicals
Acidosis
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Alteration
Exudation and emigration
Proliferation
Exudation and emigration
Vasomotor changes Transient vasoconstriction of arterioles
Accelerated blood flow in arterioles
Dilation of arterioles
Recruitment of new (non-functioning) capillaries
Obstructed venous flow
Increased vascular permeability with formation of inflammatory secretions - exudate
Leukocyte emigration Marginal position
Extravasation
Activation
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1. Vasodilatation
2. Exudation - Edema
3. Emigration of cells
4. Chemotaxis
5. Phagocytosis
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Biologic significance of exudation
Dilutes the pathogenic agent
Accelerates lymphatic out flow
Increases the quantity of plasma at the site of the damage
Immunoglobulins Complement Coagulation factors
Local signs of inflammation
Celsus през 30 г. пр.н. ера:
Rubor - redness Tumor - edema Calor - warming Dolor - pain
Virchow през 1858 :
Functio laesa – loss of function
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Heat Redness Swelling Pain Loss Of Func.
The 5 Cardinal Signs of
Furunculus
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General signs of inflammation
Fever Astheno-adinamic syndrome
loss of appetite, fatigue, somnolence, prostration
Blood (biochemical) changes
Leuc , CRP , fibrinogen , Fe (anemia)
Endocrine changes Hypothalamo-pituitary axis
Sympathetic nervous system
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Cells involved in the inflammatory response
Neutrophils (24 h)
Macrophages (24-48 h)
Activated lymphocytes
CD8+ T cells
B lymphocytes (PL)
Mediators of inflammation Histamine, serotonin
Calicrein-kinin system (bradikinin)
Complement system
Prostaglandins (Pg) Leucotriens (LT)
PAF
Inflammatory cytokines
(IL-1, TNF)
Degranulation of mastocytes
Increased vascular permeability
Contraction of smooth muscle cells
Pain
Chemotaxis for Neu, Mo
minutes
hours
days
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Alteration
Exudation and emigration
Proliferation
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Proliferation
Debridement phase (Мо, Macrophages) Proliferative phase Fibroblastic reaction Angioblastic reaction Regeneratio ad integrum Cicatrix
Starts from the periphery
Development of inflammation
Local inflammation
Generalized inflammation (Sepsis or polyorgan failure)
Systemic inflammation
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Inflammation Outcome :
Restitutio ad integrum Healing wit consequences Abscess, phlegmon Generalization (disease) Chronification Death
Factors, determining the outcome of inflammation:
Nature of inflammatory agent
Virulence, dose, entry point
Reactivity of the organism
Immunity, age, temper
Site of the process
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Thermoregulation and
FEVER
Range of Human Body Core Temperature
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Processes of heat dissipation
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FEVER
Common pathologic process in homoeothermic animals and man
Fever - characteristics
Temporary reorganization in the thermoregulatory center
The core temperature is not influenced by the environmental temperature but diurnal variations still exist
Fever is caused by pyrogens
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Etiology
Exogenous pyrogens Bacterial
Lipopolisacharide (endotoxins of Gr-)
Non-bacterial Toxic elements (Pb) Synthetic hormones Hypertonic saline
Endogenous pyrogens IL-1, interferon THF
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Fever - stages
Increase in body temperature Stadium incrementi
Increased body temperature Stadium fastigii
Decrease in body temperature Stadium decrementi
Fever stages
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Fever - degrees
Subfebrile – to 38 С
Moderately high – to 39 С
High from 39 С to 40 С
Hyperpyretic above 41 С
Temperature curves Intermittent
Remittent
Sustained
Recurrent
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Decrease of elevated temperature
Lythic – slowly, gradually
Critic – jeopardy of acute failure of the circulation
Metabolism in fever
Increased glycolysis
Hyperlipidemia with increased -oxidation of ketone bodies
Lowering of рН and development of acidosis
Negative N-balance
Electrolyte disturbances
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Systemic effects in fever
Cardio-vascular system (tachycardia: 1оС→15 beats; disturbances of
cardiac rhythm and conductance) Respiratory system (hyperventilation) Digestive system (loss of appetite,
constipation) CNS (insomnia, hallucinations, delirium,
seizures) Skin (redness, dry → moist)
General signs of fever
Headache
Astheno-adynamic syndrome
Безапетитие , умора, сънливост, отпадналост
Blood (biochemical) changes
Leuc , CRP , fibrinogen , Fe (anemia)
Endocrine changes Hypotalamo-pituitary axis
Sympathetic nervous system
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Biologic significance of fever
Derangements of the function of organs and tissues depend on the degree of elevation of body temperature and the main disease.
The fever can be regarded as:
Defensive and adaptive reaction
Pathologic reaction
Defensive and adaptive reaction
Suppression of microbial reproduction
Synthesis of immunoglobulins by the
В-cells and Т-cell proliferation
Stimulation of haemopoesis
Stimulation of hypotalamo-pitutary axis
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Benefits of fever against infection
May inhibit microbial growth (temp sensitive)
Lymphocyte mobility and transformation (Cellular and humoral immunity)
Ion chelating “siderophores” necessary for microbial replication is reduced in higher temp
Pathologic reaction
Derangements in metabolism
Fast exhaustion of compensations
High temperatures suppress immunity
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Treatment Etiologic Symptomatic
NSAIDs – Caution should be applied in case of children under 12 years of age.
Proper feeding and hydration additional 500 ml for every ↑ 1o С
Thank you