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CHRONIC INFLAMMATION

CHRONIC INFLAMMATION. DR RABIA RATHORE ASSISTANT PROFESSOR WEST MEDICAL WARD MAYO HOSPITAL/K.E.M.U. DEFINITION. An inflammation that may begin with a relatively rapid onset or in a slow, insidious, and even unnoticed manner, and that tends to persist for several weeks, months, or years.

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CHRONIC INFLAMMATION

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  1. CHRONIC INFLAMMATION DR RABIA RATHORE ASSISTANT PROFESSOR WEST MEDICAL WARD MAYO HOSPITAL/K.E.M.U

  2. DEFINITION • An inflammation that may begin with a relatively rapid onset or in a slow, insidious, and even unnoticed manner, and that tends to persist for several weeks, months, or years.

  3. PATHOPHYSIOLOGY: • Chronic inflammation has a vague and indefinite termination; occurs when the injuring agent persists in the lesion, and the host's tissues respond in a manner that is not sufficient to overcome completely the continuing effects of the injuring agent.

  4. It is characterized histopathologically by infiltrates of lymphocytes, plasma cells, and histiocytes; fibrosis; and granuloma formation.

  5. CAUSES OF CHRONIC INFLAMMATION • PERSISTANT INFECTION: • Trepenoma Pallidum infection(Syphilis) • Mycobacterium tuberculosis(Tuberculosis) • PROLONGED EXPOSURE TO TOXIC AGENTS: • Exogenous(Silicosis) • Endogenous(Atherosclerosis)

  6. AUTOIMMUNITY: • Autoimmune disorders(SLE)

  7. TYPES OF CHRONIC INFLAMMATION • Non Specific Inflammation • Granulomatous Inflammation

  8. NONSPECIFIC INFLAMMATION • A diffuse accumulation of macrophages and lymphocytes at the site of injury.Fibroblasts proliferate with subsequent scar formation that may replace functional connective tissue or the parenchymal tissues .

  9. GRANULMATOUS INFLAMMATION • A cluster of T cell activated modified macrophages (epithelioid cells) that engulf and surround indigestible foreign bodies.*Epithelioid cells may coalesce to form a large, multinucleated giant cell that attempts to surround the foreign agent and eventually becomes encapsulated by dense connective tissue.

  10. GRANULMATOUS INFLAMMATION • *These clusters of macrophage "epithelioid cells" are surrounded by lymphocytes*Clumping of the epithelioid cells (macrophages) into a mass produce a granuloma.

  11. OUTCOME OF CHRONIC INFLAMMATION • The destruction of tissue. • Thickening and scarring of connective tissue (fibrosis). • Death of cells or tissues (necrosis).

  12. CLINICAL PRESENTATION

  13. CASE SCENARIO NO:1 • A 35 years female comes to OPD with complaints of pain and symmetric swelling of multiple joints especially the proximal interphalangeal joints and wrists for more than 6 months.There is morning stiffness persisting for > 30 minutes, stiffness may recur after daytime inactivity . She also complains of small rounded swellings over the extensor surface of the forearms.

  14. What is the diagnosis?

  15. RHEUMATOID ARTHRITIS

  16. How will you investigate her?

  17. ESR • C-REACTIVE PROTEINS • RA FACTOR • ANTI CCP ANTIBODIES( anti-cyclic citrullinated peptide antibody)

  18. CASE SCENARIO NO:2 • A College student seeks medical advice due to off and on cramps, abdominal pain, fecal urgency, and tenesmus for the last 4-5 months and now complaining of bloody diarrhea 7-8 episodes/day for 2 days.He had similar episode of bloody diarrhea 2 months back. • What is the differential diagnosis?

  19. DIFFERENTIAL DIAGNOSIS • Inflammatory Bowel disease • Infectious colitis • Amebic colitis • Diverticulitis • Psuedomembranous colitis • Hemorrhoids • Anal fissure Rectal carcinoma/Ca colon.

  20. How will you investigate him?

  21. INVESTIGATIONS • Stool specimens for routine bacterial cultures (to exclude Salmonella,Shigella, and Campylobacter, as well as specific assays for Ecoli O157) • Ova and parasites (to exclude amebiasis) • Stool toxin assay for C difficile. • Per rectal examination and proctoscopy • Colonoscopy • pANCA • Blood complete examination • ESR and C- reactive protein

  22. ULCERATIVE COLITIS AND CHRONIC INFLAMMATION

  23. CASE SCENARIO NO.3 • A woman brings her maid to hospital as she was having hemoptysis for one day. On inquiring her it was found that the maid was having fatigue, weight loss, fever with evening rise, night sweats, and productive cough since 3 months for which she has been taking off and on medication from the local doctor. On physical examination, the patient appears chronically ill and malnourished. Chest examination revealed posttussive apical rales and few pan inspiratory coarse crepts.

  24. What could be the cause of hemoptysis?

  25. CAUSES OF HEMOPTYSIS • COMMON CAUSES: • Pulmonary Tuberculosis • Bronchiectasis • Chronic Bronchitis • Bronchogenic Carcinoma • Pneumonia (Acute)

  26. LESS COMMON CAUSES: • Idiopathic pulmonary haemosiderosis, • Goodpasture’s syndrome, • Microscopic polyangiitis, • Wegner ,s Granulomatosis • Trauma • Blood disorders • Benign tumours.

  27. How will you investigate her?

  28. Blood Examination :To assess both the hematocrit, the platelet count as well as coagulation studies. • ESR • Sputum Examination for AFB/Gram staining ,culture • Chest X-RAY • CT Scan Chest

  29. Renal Fuction test • Antineutrophil cytoplasmic antibody Antiglomerular basement membrane antibody .

  30. CASE SCENARIO NO:4 • A 55 years old diabetic ,hypertensive smoker suddenly developed severe crushing chest pain while he was working at his office.This pain was radiating to the left arm ,neck and jaw.He also complained of palpitation,cold sweating and 1 episode of vomiting. • What could be the cause of his chest pain.?

  31. Unstable angina • Non ST Segment elevation Myocardial Infarction. • ST Segment elevation Myocardial Infarction .

  32. How will you investigate him?

  33. Electrocardiogram • Biochemical markers: • Cardiac troponin • Creatine-kinase-MB • SGOT • LDH • Angiogram • Echocardiogram

  34. Fasting Lipid profile • Blood sugar(Fasting-Random) • HbA1C

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