44. Inflammation stages, main signs and types.

Main signs:

1. oedema – tumor; 2) reddish (rubor); 3) heat, ardour, fever –calor; 4) pain – dolor; 5) dysfunction – functio laesa. These features are known as pentade of Cels-Galen.

Stages:

1. alteration;

2. microcirculation disorders with exsudation and emigration;

3. proliferation.

Doctor must remember that these stages are not always consequent and can interfere one another.

Inflammation types (continuation).

I. Dependently on exsudate character:

1. haemorhagic;

2. purulent;

3. decoy;

4. serose et al.

II. Dependently on sepsis development:

1. septic;

2. aseptic.

45. Primary and secondary alteration.

Primary alteration – tissue injury due to flogogenic agents direct action.

Secondary alteration – tissue injury which occurs due to action of factors being formed as primary alteration result.

Secondary alteration developmental factors:

1. Inflammation mediators (lyzosomal factors, activated complement, lymphokines-lymphotoxins).

2. Free radicals and peroxides.

3. Hypoxy occurring as a result of circulation local disorders.

4. Local acidosis.

5. Osmotic and oncotic pressure increasing in inflammation locus (as a result of protein level increasing, its dispersity and hydrophyly).

6. Hyperiony – accumulation such ions as K⁺, Cl^-, HPO₄^-, Na⁺.

7. Dysiony.

46. Mediators and antimediators.

According to the source:

1. Cellular:

3. From polymorphic-nuclear leucocytes, mainly neutrophils and basophils:

   1. highly-active lysosomal hydrolases;

   2. cationic proteins;

   3. prostaglandines;

   4. leucotriens;

   5. interleukines;

   6. biogenic amines.

Eosinophils participate in oxidants and leucotriens detoxication. They play essential role in inflammation allergy component.

2. From mononuclears (lymphocytes, monocytes, tissular macrophags):

   1. lymphokines;

   2. monokines;

   3. neutral proteases;

   4. estherases;

   5. acid phosphatases and others.

3. From platelets:

   1. adhesive proteins;

   2. ADP;

   3. serotonine;

   4. lysosomal enzymes;

   5. Willebrand’s factor.

4. From labrocytes (adipocytes):

   1. biogenic amines;

   2. platelet activation factor;

   3. leucotriens (C4 and D4) are compounds of anaphylaxy slow-reacting substance (ASRS);

   4. eosinophilic chemotactic factor;

   5. neutrophilic chemotactic factor;

   6. heparine and others.

5. Other cells of injured tissue:

   1. lysosomal enzymes;

   2. prostaglandines;

   3. lipids peroxidative oxidation products et al.

2. Plasmic – from blood:

   1. complement system components;

   2. kinines;

   3. blood coagulation system factors.

According to mediators nature:

1. Biogenic amines:

   1. histamine;

   2. serotonine and others.

2. Active polypeptides and proteins:

   1. kinines (bradykinine, kallydine, methyonyl-lysyl-bradykinine);

   2. complement system components;

   3. enzymes (mainly lysosomal);

   4. leucocytic proteinic factors (cationic proteins, interleukine-1, monokines, lymphokines).

3. Polysaturated fatty acids (arahidonic, linolic) derivates:

   1. prostaglandines (E, I₂ or prostacycline);

   2. thromboxanes;

   3. leucotrienes;

   4. lipids free-radical peroxidative oxidation products.

Antimediators – 1) glucocorticoids decrease alteration, arachidonic acid and its derivation synthesis (decreasing of exsudation and leucocytes emigration, microcirculation disorders weakening); cellular division and protein biosynthesis inhibiting by glucocorticoids leads to proliferation decreasing in inflammation focus;

2. proteases inhibitors;

3. histaminase – it is in eosinophils (it decomposes histamine released from basophils)…