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Inflammation - Coggle Diagram

- - - - Neurogenic vasoconstriction > limit blood loss
      - Arteriolar dilation > Incr vol blood to affected site & incr perm = localised
    - - Direct > trauma/WBC dependent damage
      - Indirect
        
        1st phase incr perm > histamines, PAF + leukotrienes
        
        2nd phase incr perm > WBC migration > vasoactive mediatiors
  - - - Margination
        
        How = vasodilation + decr speed blood flow + adhesion molecules on leukocytes/endothelia surfs
        
        endothelia stimulated > P-selectins + leukocyte receptors > weak bond
        
        Endothelial strongly stim (active inflam) > E-selectins + leukocyte receptors > strong bond
        
        Leukocytes stim > Up-regulate B-integrins + endothelia receptors (ICAM 1-3) > strong bond
      - Pavementing
        
        Multiple WBCs marginated & tightly packed on endothelia
    - - WBCs crawl > chemotactic stimulus until inter-endothelial jxn detected (space widened by histamine)
      - CD31 adhesion mol binds to endothelium + leukocyte
      - Leukocyte > jxn > secrete proteinases to pass BM
    - - Directional migration in resp gradient of chemoattractant
      - Chemotactic factors
        
        Chemokines = cytokine w/ chemotactic fxn
        
        Selective attraction & activation almost all WBCs
        
        Repair
        
        Tumorigenesis
        
        Disease
        
        Endotoxin > released as gram neg bacteria multiply or die > indirectly potent chemoattractant > induces resident tiss cells to produce chemokines
        
        Cytokines > polypep mediators secr by all cell types in resp to stim
    - - Phagosome formation
      - Engulfment
      - Surf att of particle to WBC
      - Specific memb recognition events
      - Fusion w/ lysosome = phagolysosome
      - Optimal @ high temps
      - Opsonisation > C3b/antibody/fibronectin coats bacteria = more susceptible to phagocytosis
      - Microbiocidal mechanisms
        
        O2 dependent syst
        
        O2 radical system > O2- & H2O2 > OH = oxidant damage & perioxidation of memb lipids
        
        During phago respiratory burst = neurophils incr O2 consumption & incr glucose metab = O2- & H2O2
        
        Surf of phagosome
        
        H2O2 myeloperoxidase-halide system > in lysosome H2O2 + azurophil granules = potent bactericidal blend (HOCl)
        
        Risks (if outside WBC)
        
        Oxygen scavenger mechanisms > superoxide, dismutase, catalse & glutathione
        
        O2 indep syst
        
        Defensins - anti-microb peptides
        
        Cathepsin G - proteinase microbicidal to gram pos & some fungi
        
        Risks
        
        Lysosomal suicide
        
        Regurgitation during feeding
        
        Frustrated phagocytosis
        
        Anti-proteinases > prevents excessive tissue injury from above events
        
        Lactoferrin - binds iron = no bacterial growth
        
        Lysozyme - attacks bacterial cell wall
        
        Lysosomes
    - - Polymorphonuclear/granular
        
        Eosinophils
        
        Mast cells
        
        Banded & segmented neutrophils
        
        Basophils
      - Mononuclear/agranular
        
        Lymphocytes
        
        Plasma cells
        
        Monocytes
      - Other
        
        Endothelial cells
        
        Fibroblasts
        
        Platelets
  - - - Exogenous vs Endogenous
      - Pre-formed vs synthesised upon stimulation
    - - Kinins - Bradykinin
        
        Bronchial constrxn
        
        Incr vasc perm
        
        Stim histamine release
        
        Peripheral bv vasodilation/constriction
        
        Activate AA-cascade
        
        Stim nerve endings
      - Arachidonic acid (AA) metabolites
        
        Vascular leakage
        
        Haemostasis
        
        Vasodilation
        
        Pain
        
        Pathophys
        
        COX-1 pway & COX-2 pway
      - Vasoactive amines - Histamine
        
        Dilates arterioles
        
        Brochial consrtxn
        
        Incr perm via venule endothelial contrxn
        
        Anaphylaxis
      - Hagenab factor (XII) - dep pways
        
        Fibrinolysis
        
        Kinin generation
        
        Clotting cascade
        
        Complement cascade
      - Complement system
        
        Bio membrane perf > cytolysis
        
        C5a + C3a (anaphylatoxins)
        
        C3b > opsonisation
      - Nitric oxide
        
        Vascular tone
        
        Effector molecule against certain pathogens
        
        Signaling molecule in NS
  - - - Amyloid (SAA + SAP)
      - Coag proteins (fibrinogen)
      - C-reactive protein
      - LPS binding protein
      - Complement
      - Anti-proteases
    - - Albumin
      - Factor XII
      - Transferrin
- - - - Mediating tissue destruciton
      - Neovascularisation
      - Fibrosis
      - Produce when activated
        
        Reactive O2 radicles & NO
        
        Complement & coag factors
        
        Cytokines
        
        Proteases
  - - - Foreign body granulome
        
        Macrophages (incl giant cells) + granuloma surrounded by fibroproliferative CT
        
        Materials perceived as forgein but not antigenic
      - Immune (hypersensitivity granuloma)
        
        Macrophages (incl giant cells) + lymphocytes
        
        Cause = antigenic agents
- - - - Microscopic
        
        Lymphocytic / Lymphoplasmacytic / Plasmacytic /
        Non-suppurative
        
        Lymphcytes/plasma cells predom inflam cells > viral infxns
        
        Eosinophilic
        
        Eosinophils predom inflam cells > parasites & allergic rxn
        
        Granulomatous
        
        Epithelioid macrophages predom inflam cells
        
        Pyogranulomatous = + neutrophils
        
        CHRONIC
        
        Necrotizing/necrotic
        
        Necrotic tissue debris
        
        Fibrinonecrotic = + vascular feats
        
        Necropurulent = + WBCs
        
        Pseudomembranous
      - Macroscopic
        
        Purulent
        
        Pyogenic bacteria (staphylococcus & streptococcus) = exudation of neutrophils
        
        Pus = neutrophils + necrotic debris
        
        Abscess = localized purulent exudation w/ fibrous caps
        
        Fibrinous
        
        Incr vascular perm > ACUTE inflam = fibrinogen exudate
        
        Serofibrinous
        
        Fibrinopurulent
        
        Fibrosis = fibroblasts + collagen = chronic
        
        Catarrhal/mucoid = serous + mucus (+ neutrophils > mucopurulent)
        
        Haemorrhagic > acute/peracute lesions in well vasc tissues
        
        Serous - proteinaceous fluid
- - - - Parenchymal cells must have ability to regenerate
        
        Stable cells
        
        Labile cells
        
        Permanent cells
      - CT framework of tissue must be intact
    - - Granulation tissue
        
        Middle zone = angiogenesis & fibroblast proliferation
        
        Deep zone = Mature CT
        
        Superficial zone = serocellular crust or scab w/ underlying necrotic debris, neutrophuls & poss fibrin
      - Angiogenesis = migration, proliferation & differentiation new BVs
        
        Migration, proliferation & differentiation of fibroblasts
        
        Deposition ECM
        
        Remodelling/Scar formation = maturation & reorg of fibrous tissue