1. Inflammation and Infection

2. Defense Mechanisms Nonspecific Skin
650,000 microbes/square inch; 100 trillion/ person (acts as a place holder)
Sebaceous (oil) and odoriferous (sweat) secrete antibacterial acids and enzymes
Mucous membranes trap invaders

3. Defense Mechanisms Nonspecific Specific
Inflammatory response- isolate invader, destroy it, and clean up debris
Specific
much slower
All cells have protein or saccharide markers called ANTIGENS

4. Defense Mechanisms Specific
when an antigen of the invader is identified, lymphocytes produce ANTIBODIES
This defense has ability to remember the invader and to produce more antibodies if the invader returns

6. Inflammation
Nonspecific cellular and vascular response to tissue TRAUMA
Only occurs where blood supply exists (no gangrene)
May be so intense that it harms the tissues
Anaphylactic shock
Autoimmune diseases

7. Inflammatory Process
When any trauma happens, including injury, microbial infection, ischemia (decreased oxygen in cells), freezing, burning, electrocution, radiation, and chemical irritation

8. Inflammatory Process MAST CELLS (histocytes) are in all cells
When injured, they produce HISTAMINE that causes blood vessels to dilate and increase blood flow
HYPEREMIA causes increased redness and heat in area
Hyperemia brings increased white blood cells (neutrophils also called polymorphonuclear cells- PMNs)

9. Inflammatory Process
These cells also line the endothelium of the vessels (capillaries become permeable)
Blood fluid called EXCUDATE leaks into tissue
Leaking causes swelling (edema)
With edema, pressure is put on nerve endings causing pain

10. 5 Cardinal Signs of Inflammation
Inflammatory Process
5 Cardinal Signs of Inflammation

11. Inflammatory Process
Vascular permeability also allows neutrophils to escape into tissues (DIAPEDESIS)
Neutrophils arrive in great numbers and readily move into action by a process called CHEMOTAXIS
Neutrophils detect chemicals released by bacteria, injured tissue, and proteins and they are then drawn to the area

12. Inflammatory Process Begin phagocytosis (cell eating)
Neutrophils life is short and they die and then are mixed with blood fluid to make PUS

13. Inflammatory Process
In 3-4 days, large numbers of monocytes (large eater) arrive
More killing power and are on clean up crew
This INFLAMMATION is considered acute

14. Inflammatory Process
After 7-10 days if the inflammation is still present, then the lymphocytes are brought in
They use a slower, more specific attack

15. Chronic Inflammation Last mare than 2 weeks
Microscope shows large amounts of macrophages and fewer neutrophils
If macrophage cannot help, a granuloma might be formed
These are fibrous deposits of collagen and may calcify
Ex: Tuberculosis or foreign object like a splinter

16. Inflammatory Exudates
LEISIONS can be external or internal
They can often be identified from fluid
Serous exudate- clear, serum-like (Ex: blisters)
Fibrinous exudate- fluid and large amounts of fibrinogen (Ex: strep throat or if dried, a scab)
Purulent exudate- full of dead neutrophils, tissue debris, and pyogenic (pus forming) bacteria. If localized, it is called an abscess. If in a body cavity, it is called an empyema

17. Inflammatory Lesions
Include wounds, ulcers, wheals, blisters, vesicles, pustules, tumors, etc.
Abscesses
Caused by streptococcal or staphylococcal bacteria
Body tries to keep it contained
If a large abscess ruptures, it forms a tract or opening in skin called a sinus
If the tract connects two organs, it is called a fistula

18. Inflammatory Lesions Ulcers Deep loss of tissue, crater-like lesion
Pressure sores or decubitus ulcers are common problems in health care

19. Inflammatory Lesions Cellulitis widespread, acute inflammatory process
General edema and redness
Caused by streptococcus or staphylococcus

20. Inflammation Videos
(Khan Academy)
(animated)
(cartoon)

21. Tissue Repair and Healing
Tissue Repair *Cellular proliferation or division categories * mitotic- continually divide (Ex: skin and mucosa of internal organs) * facultative mitotic- cells do not divide regularly but can be stimulated to do so when needed (Ex: liver and kidney, but some tissue needs to be there) * non-dividing cells- don’t divide EVER! (Ex: brain cells, heart muscle cells- repair is only scarring)

22. Tissue Repair Methods of repair Regeneration
Involves mitotic cell division (bone, skin, bone marrow)
Fibrous Connective Tissue Repair
Scar formation – bridge between normal tissue and the wound, but DOES NOT restore function
Examples: brain tissue, heart muscle

23. Tissue Healing http://www.youtube.com/watch?v=IYL6vg89uds
Primary Union (First Intention)
*Wound edges are clean
* Steps
1. line fills with serum, forming a scab
2. in 1-2 days, new capillaries bridge the gap between the edges
3. in a few days fibroblasts grow across the deeper wound layers and begin to deposit collagen in fibrous network (granulation tissue)
4. collagen begins to contract pulling edges together and forming a scar
**In a few weeks, incision will look healed but deep layers may not be for a month or more

24. Tissue Healing Secondary Union (Secondary Intention)
When dirty, or deeper degree of tissue damage or cannot be pulled together
Same process but with much more inflammation to resolve
Large numbers of capillaries, fibroblasts, and collagen must be produced
After a week, new soft tissue called granulation tissue is formed and later replaced with collagen
Collagen contracts, pulling the wound edges together
Healing depends on size of wound- may need skin graph

25. Delayed Wound Healing
Increased levels of dirt, bacteria, dead leukocytes, etc might make the body take months to eat up.
Wounds must be cleaned or DEBRIDED
Other factors effecting healing time
Age, size of wound, location of wound, nutrition, immobility, and circulation
Organism virulence (strength)
steroids

26. Complications of Wound Healing
Prolonged wound healing
Poor or excessive scar formation
DEHISCENSE- scar does not have enough strength and separates at margin
Excessive collagen formation results in a raised scar called a keloid (more common in African- Americans)
ADHESIONS form scar tissue that adheres to a nearby organ (often after surgery)

27. Complications or Wound Healing

28. Testing for Infection Symptoms Fever Tachycardia Malaise Leukocytosis
Septicemia
Tests
Cutures- organism grown in agar, often with sheep’s blood
Culture and sensitivity tests- microorganisms smeared on agar and small antibiotic-permeated disks are placed on the agar- killing zones are identified
Antigen-antibody (reactive tests or serologic tests)
Skin testing (TB- Mantoux test) for induration (positive test)
Xpert test for MRSA- DNA testing