1. Inflammation & Repair

2. Chronic Inflammation

4. Cell Types in Chronic Inflammation Macrophages Types of Macrophages (fixed) – Kupffer cells - liver –Pulmonary alveolar macrophages –Histiocytes - connective tissue –Microglia - brain –Osteoclasts - bone –Spleen/lymph nodes –Langerhans cells - epidermis

6. Other Cell Types Lymphocytes Plasma cells Eosinophils –IgE mediated, parasitic infections Mast Cells

7. Granulomatous Inflammation Granulomatous inflammation –focal accumulations of activated macrophages with an epithelial-like (epithelioid) appearance. Granuloma –microscopic aggregation of epitheliod macrophages surrounded by a collar of lymphocytes and occasionally plasma cells.

9. Granulomatous Inflammation - TB

14. Healing and Repair

15. Cell Types with Different Regenerative Capacities

17. Resolution vs Repair

18. Granulation Tissue Proliferation of new blood vessels and fibroblasts Fibroblasts  myofibroblasts

20. Granulation Tissue

22. Wound Healing Primary union (healing by 1 st intention) –healing of a clean surgical incision –very little tissue damage is present Secondary union (healing by 2 nd intention) –healing of a large tissue defect

23. Healing by First IntentionHealing by Second Intention 24 Hours

24. Healing by First IntentionHealing by Second Intention 3 to 7 Days

25. Healing by First IntentionHealing by Second Intention Weeks

26. Aberrations of Wound Healing Inadequate granulation tissue/healing Excessive repair –Hypertrophic scar –Keloid Contractures

27. Hypertrophic Scar

28. Keloid

29. Conditions Inhibiting/Delaying Wound Healing Poor local vascular supply –Poor oxygenation, decreased bacterial resistance, low temperature, and an acid pH Deficiencies of vitamin C, protein, zinc Infection Tissue necrosis –Foreign material delay healing and acts as a nidus for bacterial infection Excessive movement

30. Extracellular Matrix - Collagen - Tropocollagen is the basic unit Intracellular –procollagen Extracellular –procollagen cleavage & lysine oxidation  cross-linking –  tensile strength

31. Wound Healing Replacement of Type III collagen by Type I in wound healing will have a maximal tensile strength of 70-80% of normal (takes about 3 months)

33. Outcomes of Acute Inflammation

34. The End Chronic Inflammation & Repair