1. Chronic Inflammation Dr. Raid Jastania

2. Chronic Inflammation: Chronic inflammation is a prolonged inflammation with continuous: 1.Cell injury 2.Active inflammation 3.Ongoing healing (repair) process It is characterized by: 1.Mononulcear cells (lymphocytes, macrophages, plasma cells) 2.Tissue destruction 3.Repair process (including new vessel formation and fibrosis)

5. Cellular Events in Chronic Inflammation: Monocyte – histiocyte – macrophage – giant mutincleated cell Tissue macrophages: eg. Kupffer cell in liver, alveolar macrophage in lung… Macrophage is responsible for: 1.Mononuclear phagocytic system, and hence 2.Alert the Immune system.

6. Cellular Events in Chronic Inflammation: Macrophages also produce: 1.Acid and neutral proteases to break down extracellular components 2.Complement components and coagulation factors. 3.Oxygen-free radicals and NO 4.AA metabolites 5.Cytokines (eg. IL-1, TNF)

7. Cellular Events in Chronic Inflammation: Lymphocytes and Plasma cells: Other cells: –Mast cells –Eosinophils

8. Granulomatous Inflammation Collection of activated macrophages with or without giant cells Rimmed by lymphocytes May be surrounded by fibrosis

10. Granulomatous Inflammation Granuloma can be divided (morphologically) into Necrotizing granuloma and Non-necrotizing granuloma. Necrotizing granuloma is seen in infections. In tuberculosis the granuloma shows central necrosis “Caseating Necrosis”

11. Granulomatous Inflammation Causes: –The causes of granuloma can be divided in: a.Infectious a.mycobacterium (like tuberculosis), and syphilis. b.Fungal infections commonly result in granuloma (candida, aspergillous, mucor, histoplasma, blastomycosis….) c.Parasitic infections may result in granuloma (Schistosomiasis). b.Non-infectious a.immune mediated (like sarcoidosis) b.foreign body granuloma ( like suture material, pigments….)

12. Lymphatic and Lymph Nodes

13. What are the Causes of Acute Inflammation? And, What are the Causes of Chronic Inflammation?