Oral Path Chapter 2 Inflammation Part

Leukocytosis causes?

An increase in the number of WBCs circulating in the blood.

Leukocytosis

An increase in the number of WBCs or leukocytes circulating in the blood.

Microcirculation Includes:

Arterioles Capillaries Venules

Leukocytosis occurs in response to?

Biochemical mediators and in an attempt to provide more cells for phagocytosis.

Physical Injury=

Can affect teeth, soft tissue, and bone.

Chemical Injury=

Can occur from the application of caustic substances.

Toxicities=

Causes tissue damage.

Mechanical Defense Examples=

Cillia and Mucus

Abscess=

Collection of purulent exudate that has accumulated in a contained space formed by the surrounding tissue. Can interfere with tissue repair.

Opsonization

Complement proteins can also attach to the surface of bacteria stimulating WBCs to phagocytize them.

The Complement System

Complex series of reactions bw plasma proteins resulting in a cascade of events. Function during inflammation and immunity. Can cause mast cells to release granules from their cytoplasm that contain the biochemical mediator histamine.

Macrophage's Tissue Types

Connective Tissue- Histiocyte Liver- Kupffer Cell Brain- Microglial Cell

Leokopenia

Decrease in the number of WBCs circulating in the blood. Less than 4,000 cells/mm3. Results in a higher risk for life threatening infections.

Giant cells

Digest large matter or destroy resistant organisms such as Candida. Foreign body giant cell is formed in response to a foreign material.

Loss of the usual level of tissue function causes?

Events associated with swelling and pain

Edema=

Extracellular fluid in interstitial space. Clinically manifests as swelling.

Transudate

Extravascular fluid

Pressure on Nerves Caused by?

Exudate formation and release of biochemical mediators.

Inflammation and infection are the same. True or False.

False, not the same as an infection, which implies an inflammatory reaction initiated by invasion of living organisms.

The body can tolerate extremely high fever for a very long time. True or False.

False, the body cannot tolerate it and it could be fatal.

WBCs do not place an important role in inflammation. True or False.

False, they do. Various WBCs appear at different times in the inflammatory process.

As hyperemia in occurring, vascular permeability decreases. True or False.

False, vascular permeability increases.

Acute Onset Speed

Fast: Minutes or Hours

Four Major Systemic Clinical Signs of Inflammation

Fever Leukocytosis Lymphadenopathy Elevated CRP

Increased Body Temperature caused by?

Fever= The production of pyrogens affects the hypothalamus.

Removing Foreign Substances Examples=

Flushing action of tears, saliva, urine, and diarrhea

Clotting Mechanisms

Functions primarily in the clotting of blood, helps to stop bleeding at the site of injury. Products that cause vascular dilation and permeability activate Kinin system. Fibrin meshwork protects tissue.

Inflammation= "-itis" Examples

Gingivitis Periodontitis Pulpitis Appendicitis Hepatitis

WBCs are derived from?

Hematopoietic stem cells

Systemic Diseases that Effect Clotting

Hemophillia Von Willebrand Disease Factor V Leiden Mutation **Affect clotting at various points including within the coagulation cascade.

Inflammation Microscopic Events

Hyperemia Exudate formation Pressure on Nerves Events associated w/ swelling/pain Increased Body Temperature Increase WBCs in blood Hyperplasia/Hypertrophy of Lymphocytes Increases liver proteins

Lymphadenopathy causes?

Hyperplasia and hypertrophy of lymphocytes.

During systemic inflammatory response numbers to what?

Increase to >10,000 mm3 to 30,000/mm3

Redness, erythema, and heat AKA Hyperemia

Increased blood flow to the area. Results from dilation of the microcirculation.

Loss of fluid from blood leads to?

Increased blood viscocity

Physiologic stressors can cause a protective response. Stressors include?

Infection Pregnancy Cancer Hematologic Disorders

Innate Responses to Injury=

Inflammation and White Blood Cells

Fistula/Fistulous Tract=

Injured tissue may allow the excess exudate to drain by formation of a drainage passage that bores through the tissue, allowing draining to the outside. Can result in necrosis.

General Pathology

Injury Inflammation Repair

Oral Path Includes

Injury to Teeth Injury to Oral Soft Tissues

Nod Like Receptors

Intracellular sensors of pathogen-associated molecular patterns of molecules. Cooperated with TLRs and regulare apoptosis.

Microscopic Events in Inflammmation

Involves small blood vessels or microcirculation. Arterioles, venules, and capillaries in the area of injury. Involves biochemical mediators (RBCs, WBCs, and Chemicals)

Three Major Biochemical Mediator Systems

Kinin System Clotting Mechanisms Complement System

Chronic Local and Systemic Signs

Less Prominent Signs compared to Acute

Acute Inflammation

Limited in duration and area

Chronic Inflammation

Long duration and can have systemic complications.

Acute Cellular Infiltrated by?

Mainly Neutrophils (PMNs)

Chronic Tissue Injury Feature, Fibrosis

May be severe and progessive

Severe Injury=

May result in necrosis and extensive damage.

Less Severe Injury=

May result in reversible cellular responses such as hyperplasia, hypertrophy, and atropy.

The Kinin System (Bradykinin)

Mediated inflammation by causing vasodilation and increased vascular permeability. Their role is limited to early phases of inflammation. Causes pain and is Rapidly Degraded.

Infection=

Microorganisms can cause injury by invading orofacial tissue and causing infections.

Chemotaxis=

Migration of leukocytes to the injured tissue mediated by a chemical pathway. Stimulated by leukotrienes, chemokines, and the complement system. Directed movement of WBCs to the tissue. WBCs try to call of the site of the injury.

Macrophages

Monocytes circulate in the bloodstream until they enter a tissue and become macrophages. Respond to chemotactic factors. Capable of phagocytosis/ingestion Have lysosomal enzymes in cytoplasm. Sevel monocytes can join to form a giant cell.

Chronic Cellular Infiltrated by?

Monocytes/Macrophages and Lymphocytes

Leukocytosis increases WBCs primarily with what?

Neutrophils, occurs by increasing their formation and releasing immature forms from the bone marrow into the circulating blood.

Inflammation=

Nonspecific response to injury. Can be local or systemic.

Clinical Correlation for an Abscess

Parulis or gum boil in association with a necrotic tooth.

Swelling

Permeability of the microcirculation leads to exudate formation in the tissue

Injury Innate Defenses=

Physical Barrier Mechanical Defense Killing Microorganisms Removing Foreign Substances Antimicrobial Activity Innate Responses to Injury

Pyrogens

Produce fever by increasing the synthesis and release of prostaglandins in the hypothalamus.

Clinical Features of Inflammation

Redness/Erythema Heat Swelling Pain Loss of Usual Level of Tissue Function Fever Leukocytosis Lymphadenopathy Elevated C Reactive Protein

Drugs reduce high fever by?

Reducing systemic inflammation.

Exudate Types

Serous Purulent/Supperative AKA Pus

Toll Like Receptors

Single, membrane spanning noncatalytic receptors that recognize structurally conserved molecules derived from microbes. Expressed on cells like macrophages and dendritic cells. Activate immune cell response once. icrobes reach physical barriers.

Physical Barrier Examples=

Skin and Mucosa

Chronic Onset Speed

Slow: days

Step 1 of Inflammatory Response

Step 1- Vasoconstriction Immediate constriction of the microcirculation. Controls bleeding, especial in small injuries Coagulation Cascade Injured cells release chemical mediators that start the inflammatory process.

Step 10 of Inflammatory Response

Step 10- Phagocytosis Process in which a WBC eliminates a foreign substance. WBCs try to remove the foreign substance by ingesting and then digesting them. Includes microorganisms or tissue debris. Substances need to removed to the repair tissue.

Step 2 of Inflammatory Response

Step 2- Vasodilation Vessels (capillaries) increase in diameter so more blood (hyperemia) and nutrients can be brought to the area of injury. Clinically manifests as erythema and heat.

Step 3-4 of Inflammatory Response

Step 3-4- Increased Vascular Permeability/Transudate is Formed Plasma fluid with. a low protein content that is without any cells passes between the endothemial cells and enters the tissue.

Step 7 of Inflammatory Response Continued

Step 7 Continued- Pavementing Leukocytes stick to the endothelium of the vessel wall and eventually attach firmly to the endothelial cells.

Step 7 of Inflammatory Response

Step 7- Margination Leukocytes move toward the vessel wall and begin the process of rolling. As Leukocytes move they bounce against the endothelial surface --> rotating and rolling.

Step 8 of Inflammatory Process

Step 8-Emigration Leukocytes squeeze through the gaps in the vessel wall and migrate out of the vessel and into the tissue. Mostly involves neutrophils. Fluid (exudate) is flowing to injury.

Step 9 of Inflammatory Response

Step 9- Exudate Increased vascular permeability allows plasma fluid and WBCs to travel out of the vessels and into the damaged tissue. Can cause pain bc of pressure on small nerves.

Steps 5-6 of Inflammatory Response

Steps 5-6- Vascular Statis Thickening of the blood due to loss of plasma. Allows for more nutrients to be removed from blood and delivered to the injury. Blood becomes stagnant. Slows the removal of waste products.

Killing Microorganisms Examples=

Stomach Acid

Purulent Exudate Description

Thick, white/yellow, contains many PMNs Ex, pustules of acne or perio abscess.

Serous Exudate Description

Thin, clear, few cells. Ex. Blister from a burn.

Exudate contains more cells and higher concentration of protein molecules than transudate. True or False.

True

Slow blood flow allows RBCs to move away from the endothelium and WBCs to move toward the endothelium. True or False.

True

Moderately high fever may be helpful in combating infections bc increased temp slows growth. True or False.

True, bc microorganisms like to live in a narrow temperature window so going above or below the window slows growth or kills the organism.

Presence of either transudate or exudate helps to dilute and neutralize toxic substance. True or False.

True, both dilute toxic substances.

An overwhelming inflammatory response may lead to further injury. True or False.

True, chronic inflammation is a major component of the pathogenesis of common diseases.

Blood and the cells it contains, flows easily through the microcirculation. True or False.

True, exchange of oxygen and nutrients occurs readily through the permeable endothelium.

Leukocytes and Monocytes are the 1st types of WBCs to arrive. True or False.

True, in the book according to Higgins.

Biochemical mediators cause many of the events involved in the inflammatory response. True or False.

True, they are essential to te inflammatory response. They can stimulate or amplify the response.

Hematopoietic stem cells

Undifferentiated multi potent cells produced in the spongy tissue of the bone marrow found in the interior of certain long and flat bones.

Acute Tissue Injury Feature, Fibrosis

Usually mild and self limited

Blood Thinners (Pts need INR, PT, and PTT)

Warfarin Eliquis Xarelto Lovenox

WBCs AKA?

White Blood Cells or Leukocytes

Antimicrobial Activity Examples=

pH and buffering capacity of saliva and tears

Inflammatory Response Sequence of Events After an Injury

1. Constriction of small vessels 2. Dilation of the small vessels 3. Vessels increase permeability 4. Plasma with low protein leaves the micro circulating as transudate 5. Blood increases viscosity 6. Blood flow slows 7. WBC marginate and pave along vessel walls. 8. WBCs emigrate, disrupt the basement membrane of endothelial cells --> increased vascular permeability 9. Plasma with high protein leaves as exudate. 10. WBCs ingest foreign substances

Neutrophils

1st WBC to arrive at the injury. Most common inflammatory cell present during acute inflammation (60-70% of the EBC population). They eliminate and neutralize initial cause of inflammatory process. Mobile phagocytes.

The normal level of leukocytes in the blood is?

4,000 to 10,000 mm3

Fever

A body temperature higher than the normal level of 98.6 F(37 C). Associated with systemic inflammatory response. WBCs and pathogenic microorganisms produce pyrogens.

Elevated C Reactive Protein is?

A non specific protien produced in the liver and elevated in the circulating blood when in the body.

Mobile Phagocytes=

Able to move independently within tissues to phagocytize necessary material. Lysosomal enzymes contained within cytoplasmic vacuoles destroy substances after the cell has engulfed them.

Mast cells

Active during certain inflammatory reactions. When histamine is released from mast cells, it causes an increase in vascular permeability and vasodilation.

Categories of Inflammation

Acute Chronic