Inflammation

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1 Inflammation 炎症 ( 三 ) 白求恩医学院病理学系李伟

2 Major events in inflammation 纤维素性炎浆液性炎化脓性炎出血性炎慢性炎症

3 Morphologic types of inflammation Serous inflammation 浆液性炎 accumulation of excessive serous fluid (clear watery fluid) with variable protein content (plasma) Locus: mucous membrane, serosa, loose connective tissue, skin Manifestation: inflammatory edema, blister, cavity effusion, serous catarrh Sequel: absorption

4 Serous inflammation a friction blister of the skin

5 Serous inflammation right pleural effusion in a baby serous effusion clear, pale yellow appearance of the fluid

6 Morphologic types of inflammation Fibrinous inflammation 纤维素性炎以纤维蛋白原渗出为主, 继而形成纤维蛋白, 即纤维素 Definition : The inflammation exudate contains plentiful fibrinogen, then forms fibrin. Cause: severe vascular injury bacterial toxin,hg, urea Locus: mucous membrane, serosa, lung Manifestation: Pseudo-membranous inflammation--dysentery, diphtheria rheumatic pericarditis---hairy heart( 绒毛心 ) lobar pneumonia

7 Fibrinous inflammation 纤维素性炎伪膜性炎 Pseudo-membranous inflammation 纤维素性炎发生于粘膜时, 渗出的纤维蛋白坏死组织和中性粒细胞共同形成伪膜 Diphtheria 白喉

8 Fibrinous inflammation 纤维素性炎 bacillary Dysentery 细菌性痢疾

9 Fibrinous inflammation 纤维素性炎 serous pericarditis fibrinous pericarditis

10 Fibrinous inflammation 纤维素性炎绒毛心 Hairy heart Shaggy heart Cor villosum

11 Fibrinous inflammation 纤维素性炎绒毛心 Hairy heart

12 normal fibrinous pericarditis 纤维素性心包炎

13 Fibrinous inflammation 纤维素性炎 lobar pneumonia 大叶性肺炎

14 Fibrinous inflammation 纤维素性炎 Outcome Absorption: lobar pneumonia Organization and adherence -- pericarditis--armored heart( 盔甲心 ) --Pulmonary Carnification( 肺肉质变 ) Pseudo-membrane: detach ulcer, bleeding trachea diphtheria asphyxia

15 Fibrinous inflammation 纤维素性炎 Pulmonary Carnification 肺肉质变心包腔闭锁心包壁层和脏层发生纤维性粘连

16 Morphologic types of inflammation Suppurative inflammation 化脓性炎以中性粒细胞渗出为主, 伴不同程度组织坏死和脓液形成 The presence of large number of neutrophils and varying degrees of tissue necrosis and pus formation. Pus purulent exudation Purulent cells degenerated and necrotic neutrophils Causes: pyogenic bacteria superficial suppuration and Empyema( 表面化脓和积脓 ) Phlegmonous inflammation( 蜂窝织炎 ) Abscess ( 脓肿 )

17 Types of suppurative inflammation Superficial Suppuration and Empyema 表面化脓和积脓 Superficial Suppuration Location: mucosal or serosa surface Features: Pus formation,, Suppurative Catarrh Empyema a collection of pus in a hollow viscus, e. g. in the gallbladder or fallopian tube, serous cavity

18 Superficial Suppuration Superficial Suppuration 表面化脓性炎化脓性脑膜炎 acute meningitis

19 Superficial Suppuration Superficial Suppuration 表面化脓性炎化脓性腹膜炎 purulent peritonitis

20 Empyema 积脓输卵管积脓 pyosalpinx 心包腔积脓 purulent exudate in pericardial cavity

21 Types of suppurative inflammation Phlegmonous inflammation 蜂窝织炎疏松结缔组织的弥漫的化脓性炎 Definition: wide-spread purulent inflammation in loose tissue Locus: skin, muscle and appendix Causes: hemolytic streptococci 溶血性链球菌 : 透明质酸酶, 链激酶

22 Phlegmonous inflammation 蜂窝织炎 Phlegmonous inflammation: in loose tissue

23 Phlegmonous inflammation 蜂窝织炎 acute appendicitis 急性阑尾炎

localized inflammation and fever Also called: Saint Anthony's fire 丹毒是皮肤及其网状淋巴管的急性化脓性真皮炎

24 Types of suppurative inflammation Erysipelas( 丹毒 ) An acute disease of the skin and subcutaneous tissue caused by a species of hemolytic streptococcus and marked by localized inflammation and fever Also called: Saint Anthony's fire 丹毒是皮肤及其网状淋巴管的急性化脓性真皮炎病原菌是 A 族乙型溶血性链球菌, 好发于下肢和面部其临床表现为起病急, 局部出现界限清楚之片状红疹, 颜色鲜红, 并稍隆起, 压之褪色皮肤表面紧张炽热, 迅速向四周蔓延, 有烧灼样痛伴高热畏寒等

25 Types of suppurative inflammation Abscess 脓肿局限性化脓性炎症, 其主要特征是组织发生溶解坏死, 形成充满脓液的腔 Definition--Focal localized collections of purulent inflammatory tissues caused by suppuration buried in a tissue, an organ, or a confined space. Locus--skin, lung, brain, liver, kidney Causes Staphylococcus aureus金黄色葡萄球菌毒素组织坏死 PMN 浸润 PMN 崩解释放蛋白水解酶坏死组织液化血浆凝固酶纤维蛋白原转变为纤维素病变局限层粘连蛋白受体迁徙性脓肿

26 Abscess 脓肿 Liver abscess

27 Abscess 脓肿 Renal abscess

28 Lung abscess

29 疖 Furuncle Localized suppurative inflammation of haircyst, sebaceous gland & surrounding tissues. 痈 Carbuncle: Fusion of quite a few furuncles. 疖 Furuncle 痈 Carbuncle

30 Haemorrhage inflammation 出血性炎 Inflammation associated with conspicuous haemorrhage as a result of vascular damage. 血管损伤重, 大量红细胞漏出流行性出血热 (epidemic hemorrhagic fever) 钩端螺旋体病 (leptospirosis) 鼠疫 (plague) 炭疽 (anthrax)

31 outcome of acute Inflammation 损伤与抗损伤斗争结果既为炎症的结局 : 抗损伤 > 损伤炎症痊愈 ( 大多数 ) 损伤 > 抗损伤炎症蔓延扩散 ( 极少数 ) 抗损伤 = 损伤炎症迁延不愈, 转为慢性 ( 少数 ) 痊愈 Healing 迁延为慢性 Delay and Persistence 蔓延扩散 Spreading 局部蔓延 local 淋巴道蔓延 Lymphatic 血道蔓延 Blood vessels

32 Events in the complete resolution of inflammation 1. Return to normal vascular permeability 2. Removal of fluid and protein 3. Macrophage pinocytosis 4. Phagocytosis by neutrophils 5. Necrotic debris by macrophages 6. Eventual exodus by macrophages

33 炎症局部蔓延 (local spreading) 溃疡 Ulcer 皮肤或粘膜深在的组织坏死脱落后所留下的组织缺损 Local spreading 空洞 cavity 窦道 Sinus 空腔脏器的组织坏死随自然管道排出体外后留下的腔洞深部脓肿如向体表或自然管道穿破, 在组织内形成一个有盲端的病理性管道瘘管 Fistula 深部脓肿一端穿破皮肤, 另一端穿破自然管道或有腔脏器, 在组织内形成两端相通的病理性管道

34 炎症局部蔓延 (local spreading) 溃疡 Ulcer

35 炎症局部蔓延 (local spreading) Sinus and Fistula 肛门直肠周围脓肿伴窦道瘘管形成

36 Course & outcome of Inflammation Local spreading Lymphatic spreading: 淋巴管炎 lymphangitis, 淋巴结炎 lymphnoditis Blood spreading 菌血症 Bacteremia: organisms blood 毒血症 Toxemia: toxin blood 败血症 Septicemia: 1+2 脓毒败血症 Pyaemia: pyogenic organisms

37 炎症血道蔓延的后果 ** 栓塞性脓肿 ( 迁徙性脓肿, 转移性脓肿 ) 脓肿中央或毛细血管小血管内有细菌菌落, 由栓塞于毛细血管的化脓菌引起

38 血道蔓延 -- 脓毒败血症 Pyaemia 肾栓塞性小脓肿

39 Example--- 肺结核病的结局好转 1. 吸收消散 2. 纤维化纤维包裹或钙化恶化进展 1. 浸润进展 2. 溶解播散 1 经血道全身或肺粟粒性结核 2 经淋巴道淋巴结结核 3 经自然管道

40 Lymphatic spreading: 淋巴管炎 lymphangitis, 淋巴结炎 lymphnoditis 结核性淋巴管炎肺结核原发综合征结核性淋巴结炎原发灶

41 原发性肺结核扩散途径

42 病例摘要 -1 女,23 岁,20 天前鼻旁粉刺, 后红肿, 头部变黄, 挤压后红肿, 并扩大至面部,14 天前开始发热 (38.5 ),8 天前因出现头痛, 呕吐而入院查体 : 神志尚清楚, 嗜睡体温 39.2,P92 次 / 分, 血压 10.6/13.6kpa, 皮肤粘膜多数小出血点, 表浅淋巴结轻度肿大, 脾左肋缘下 2cm, 救治无效死亡 1 病变诊断 :14 天前,8 天前, 死亡时 2 尸检所见 : 脸脾肝脑

43 病理诊断 : 1 疖痈菌血症 ( 粉刺感染疖, 上唇周围和鼻部是危险三角区, 疖如被挤压或挑刺, 炎症蔓延, 经静脉入血沿内眦静脉和眼静脉进入颅内, 引起化脓性脑膜炎 2 化脓性脑膜炎 3 败血症尸检所见 : 皮下脓肿, 化脓性脑膜炎病原菌毒素可引起组织器官发生水肿变性和坏死病菌引起的迁徙性脓肿可见于肺肝肾等毛细血管损伤造成皮肤和粘膜淤点和皮疹单核吞噬细胞增生活跃, 肝脾淋巴结可肿大

44 Course & outcome of Inflammation Chronic inflammation Injury Acute inflammation healing regional spread Lymphatic Blood vessel

45 Section 3 chronic inflammation

46 Causes of chronic inflammation supervening on acute 继发于急性炎症之后 due to repeated bouts of an acute 急性炎症反复发作 at beginning: persistent infection by intracellular microorganisms (tubercule bacilli-- Granulomatous inflammation ) Prolonged exposure to nondegradable but potentially toxic substances (silicosis in the lung) Immune reactions perpetuated against the individual s own tissues (rheumatoid arthritis,sle)

47 Types of Chronic inflammation Non specific chronic inflammation 一般慢性炎症 Chronic Granulomatous inflammation 慢性肉芽肿性炎症

Pathologic features of general chronic inflammation Non-special chronic inflammation Exudation: manifest of active inflammation Inflammatory cells: macrophage,

48 Pathologic features of general chronic inflammation Non-special chronic inflammation Exudation: manifest of active inflammation Inflammatory cells: macrophage, lymphocytes, and plasma cells. Alteration: Tissue destruction-- mainly caused by inflammatory cells Proliferation: parenchymal cells, vessels and connective tissues

49 Non-special chronic inflammation Chronic bronchitis 慢性支气管炎

50 Non-special chronic inflammation Here is chronic cervicitis.appearance of more mononuclear cells. In this case the inflammation is severe enough to produce mucosal damage with hemorrhage.

inflammation composed of mucosal glands, granulation tissue, and

51 Chronic inflammation 炎性息肉 (inflammatory polyp) : 由局部粘膜上皮腺体及肉芽组织增生所致常见于鼻子宫颈肠 Polypoid lesion of mucosa result from Chronic inflammation composed of mucosal glands, granulation tissue, and inflammatory cells. Commonly seen in nasal, cervical & colorectal mucosa. 炎性息肉鼻息肉

(parenchymal, stromal, even inflammatory cells) resulting from chronic

52 Chronic inflammation 炎性假瘤 (inflammatory pseudotumor): 炎性增生形成的肉眼和 Ⅹ 线观察上与肿瘤相似的团块常见于眼眶肺 Tumor-like proliferation of local tissues (parenchymal, stromal, even inflammatory cells) resulting from chronic inflammation It is not a real tumor Occur in the orbit, lung, liver and spleen 炎性假瘤

53 Chronic granulomatous inflammation 慢性肉芽肿性炎 A form of chronic inflammation is characterized by granulomas-small nodular collections of activated macrophages. 慢性肉芽肿性炎是以肉芽肿形成为特点的特殊慢性炎症肉芽肿是由巨噬细胞及其衍生细胞局部增生构成的境界清楚的结节状病灶 Special type of chronic inflammation Distinctive pattern (granuloma) Aggregation of macrophages (derived cell) Diameter 0.5-2mm

54 causes of granulomas Infective granuloma Bacteria 结核, 麻风 treponema 螺旋体梅毒 fungi 真菌 parasite 寄生虫 Foreign body s granuloma Agnogenic:

55 Conditions of granulomas formation Two conditions : 1. Durable chronic stimulation 异物肉芽肿 2. Cellular immune response 结核

56 Infective granuloma Tuberculosis Caseous necrosis Epitheloid cells and Langhans giant cell Lymphocytes fibrosis

57 Infective granuloma Langhans giant cells and epitheloid cells

58 Foreign body s granuloma Features: foreign bodies Foreign body giant cells: seen in association with particulate insoluble material. Nuclei scattered throughout cytoplasm.

59 Foreign body s granuloma Here is a foreign body type giant cell at the upper left of center adjacent to a segment of vegetable material aspirated into the lung

60 Foreign body s granuloma Two foreign body giant cells are seen just to the right of center where there is a bluish strand of suture material from a previous operation

61 Two types of granulomas Infection granulomas Foreign body granulomas

62 Causes and outcomes of acute and chronic inflammation

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