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EXUDATIVE

INFLAMMATION
№6

Tania Petkova m.d.


EXUDATIVE INFLAMMATION
1.PNEUMONIA LOBULARIS
2.PNEUMONIA LOBARIS
3.PERICARDITIS FIBRINOSA
4.LEPTOMENINGITIS PURULENTA
5.NEPHRITIS PURULENTA

Tania Petkova m.d.


INFLAMMATION

Inflammation is a protective response intended to


eliminate the initial cause of cell injury as well as the
necrotic cells and tissues resulting from the original
insult

Tania Petkova m.d.


SIGNS OF INFLAMMATION
Cardinal signs are
1.Heat (calor)
2.Redness (rubor)
3.Swelling (tumor)
4.Pain (dolor)
5.Loss of function
(function laesa)

Originally recorded by the Roman encyclopedist Celsus in the 1st century A.D.
TYPES OF INFLAMMATION:
Acute inflammation = exudative inflammation
1. rapid in onset and of short duration, lasting up to few days
2. characterized by fluid and plasma protein exudation and
predominantly neutrophilic leukocyte accumulation
Chronic inflammation = productive inflammation
1. longer duration (days to years)
2. characterized by lymphocytes and macrophages influx and
vascular proliferation and fibrosis (scarring)
Tania Petkova m.d.
Tania Petkova m.d.
TYPES OF INFLAMMATION:

1. Exudative (acute) – serous/catarrhal, fibrinous


(surface and deep), purulent (localized and diffuse),
haemorrhagic and gangrenous
2. Chronic – non-specific and specific/granulomatous
(TBC, lues/syphilis, sarcoidosis, cat scratch disease,
leprosy, Crohn’s disease, rheumatoid arthritis etc.)

Tania Petkova m.d.


STIMULI
1.Infections
2.Trauma
3.Physical & chemical agents
4.Foreign bodies
5.Immune reactions
Tania Petkova m.d.
ACUTE INFLAMMATION HAS TWO MAJOR
COMPONENTS

• Vascular changes
• Cellular events

Tania Petkova m.d.


VASCULAR CHANGES

• Changes in Vascular Caliber and Flow


• Increased Vascular Permeability

Tania Petkova m.d.


Vasoconstriction

arteriolar vasodilation

increased viscosity & slowing of circulation

Stasis

migration Tania Petkova m.d.


Tania Petkova m.d.
CELLULAR EVENTS

Аn important function of the


inflammatory response is to
deliver leukocytes to the site of
injury and to activate them

Tania Petkova m.d.


LEUKOCYTE RECRUITMENT
Sequence consists of:
1. margination, adhesion to endothelium & rolling along the vessel
wall
2. firm adhesion to endothelium
3. transmigration between endothelial cells;
4. migration in interstitial tissues toward a chemotactic stimulus

Neutrophils are the classic hallmarks of acute inflammation

Tania Petkova m.d.


Tania Petkova m.d.
LEUKOCYTE ACTIVATION
Once leukocytes have been recruited to the site
of infection or tissue necrosis, they must be
activated to perform their functions

Stimuli for activation include microbes,


products of necrotic cells, and several mediators
Tania Petkova m.d.
PHAGOCYTOSIS
1. Movement
2. Adhesion to micro-organisms
3. Phagocytosis
4. Intracellular killing of microorganisms

Tania Petkova m.d.


Tania Petkova m.d.
EXUDATIVE (ACUTE) INFLAMMATION

I. Serous exudate – contains predominantly fluids; usually caused by


viruses.
еxamples of serous inflammation that can be lethal –cholera, burns,
rotavirus enteritis in children
EXUDATIVE (ACUTE) INFLAMMATION
II. Fibrinous exudate – resulting in greater vascular permeability
that allows large molecules (such as fibrinogen) to pass the endothelial
barrier
1. surface fibrinous infl – seen in tubular organs covered by single-layered
epithelium; e.g. croup
2. deep fibrinous infl – seen in organs with stratified squamous epithelium;
e.g. diphtheria (tonsillar pseudomembranes)
- PNEUMONIA LOBARIS
- PERICARDITIS FIBRINOSA
EXUDATIVE (ACUTE) INFLAMMATION
III. Purulent exudate – characterized by the presence of large amounts of
purulent exudate (pus) consisting of neutrophils, macrophages, necrotic cells,
and edema fluid
• yellowish colour to grey
• diffuse = flegmone
• localized = abscess
• empyema – in cavities, gall bladder, pleura
1. PNEUMONIA LOBULARIS
2. LEPTOMENINGITIS PURULENTA
3. NEPHRITIS PURULENTA
EXUDATIVE (ACUTE) INFLAMMATION
IV. Haemorrhagic exudate – rich in red blood cells examples of
potentially lethal haemorrhagic infl – the flu, anthrax, plague, viral
hemorrhagic fevers
V. Gangrenous inflammation = anaerobic bacterial infection +
necrosis

Tania Petkova m.d.


Tania Petkova m.d.
EXUDATIVE INFLAMMATION
1.PNEUMONIA LOBULARIS
2.PNEUMONIA LOBARIS
3.PERICARDITIS FIBRINOSA
4.LEPTOMENINGITIS PURULENTA
5.NEPHRITIS PURULENTA

Tania Petkova m.d.


PNEUMONIA LOBULARIS

PNEUMONIA LOBARIS
PNEUMONIA LOBULARIS

• Acute localized purulent inflammation of the terminal parts of the


respiratory tree (alveolar ducts and alveolar sacks), usually due to
bacterial infection (Streptococcus, Staphylococcus, Haemophilus
influenzae, Proteus…).

Tania Petkova m.d.


PNEUMONIA LOBULARIS
Histo/
1. acute leucocytic alveolitis
- some alveoli are filled with purulent
exudate (Neu),
- some have oedema,
- some appear unaffected (filled with air)
2. acute bronchiolitis – purulent exudate in
lumen, erosions or ulceration of the
respiratory epithelium
could merge – confluent

Tania Petkova m.d.


PNEUMONIA LOBARIS (CROUPOSA)
Acute surface fibrinous inflammation of a whole lobe of the lung
due to pneumococcal infection.
4 stages:
• 1. active hyperemia – vasodilation
• 2. red hepatization – exudate turns fibrinous and rich in Ery
• 3. grey hepatization – Leu↑ in alveoli and interstitium
• 4. resolution/resorption – if incomplete -> fibrosis (carnification –
because it resembles meat – reddish and tough)

Tania Petkova m.d.


PNEUMONIA LOBARIS (CROUPOSA)

Histo/
- all alveoli are affected
- interstitium is also filled with Neu
- the exudate filling the alveoli may
look detached from the alveolar walls
due to the retraction of fibrin

Tania Petkova m.d.


PERICARDITIS FIBRINOSA (COR
VILLOSUM)
Acute fibrinous inflammation of the epicardium and subepicardial fat tissue.
Both parietal and visceral pericardial sheets are covered in a fibrinous exudate.

E/
diffuse pericarditis localised pericarditis
uremia transmural acute MI
autoimmune diseases croupose pneumonia
TBC
PERICARDITIS FIBRINOSA (COR
VILLOSUM)

Gross/ dull white coating of the


heart surface forming crests and
strings (cor villosum/hairy heart)

Tania Petkova m.d.


PERICARDITIS FIBRINOSA (COR
VILLOSUM)
Histo/
- fibrinous exudate on the surface
of the epicardium that is rich in
fibrin;
- some Neu under the fibrinous
exudate;
• underlying adipose tissue
contains dilated blood vessels
and perivascular Neu infiltrates;
Tania Petkova m.d.
LEPTOMENINGITIS PURULENTA
Е:
- Acute diffuse purulent inflammation of the leptomeninges (arachnoi
and pia mater).
- Newborns, babies and young children suffering from acute otitis
media or a tooth abscess.

Tania Petkova m.d.


LEPTOMENINGITIS PURULENTA
Gross/ purulent yellow
exudate covering the brain
convexity – purulent “cap”.
Underlying brain tissue is
oedematous.

Tania Petkova m.d.


LEPTOMENINGITIS PURULENTA
Histo/
- the leptomeninges are covered
by a purulent exudate –
abundant Neu, fibrin, cell and
tissue debris
- underlying brain tissue –
perivascular and pericellular
oedema
- blood vessels are dilated,
congested, with Neu margination
Tania Petkova m.d.
NEPHRITIS PURULENTA
E/ usually microbial;
1. hematogenous (thgough the blood stream) ->
multiple small abscesses all over the kidney
cortex
2. ascending (via urine retention, infection and
reflux from the bladder) -> large abscess at one
of the kidney poles
Tania Petkova m.d.
NEPHRITIS PURULENTA

Gross/ multiple small


round soft yellow
abscesses

Tania Petkova m.d.


NEPHRITIS PURULENTA

Histo/
- numerous acute abscesses –
roundish structureless collections of
dead renal tissue (cell and tissue
debris) surrounded by a Neu infiltrate
• Neu in tubules

Tania Petkova m.d.