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Keywords: an inflammation, an alteration, an exudation, a proliferation, an englobement, mediators of an inflammation, physiopathology of an inflammation, sample pathological process

PHYSIOPATHOLOGY OF THE INFLAMMATION.
the Alteration, a dystrophia, a proliferation. Circulatory disturbances and flows of lymph in a tissue at an inflammation. An englobement

Key concepts

1. the Inflammation (inflammatio - to ignite) - the sample pathological process described by development of aboriginal alterative - dystrophic, vascular and proliferative reactions of an organism on pathogenic influences.
2. the Alteration (alterare - to variate) - damage of frame of cells, tissues and the organs, accompanying with infringement of their vital activity.
3. the Dystrophia (dystrophya - distress of a feeding) - distress of a metabolism in tissues.
4. Mediators of an inflammation (mediator - the messenger) - biologically awake materials liberated in a tissue at an inflammation.
5. the Exudation (exudatio - to sweat) - an output of fluid of a blood from fine pots through their wall in a tissue or serous lumens at an inflammation.
6. the Exudate (exsudatio - to sweat) - an inflammatory exudate: left at an inflammation through a wall of fine blood vessels (capillars, venul) fluid which collects in tissues or serous lumens (pleural, pericardiac, belly, articulate, etc.).
7. the Proliferation (proliferatio - to frame brooding) - a neoplasm of cells by their fissiparity for completion of a damaged tissue.
8. Vascular reactions at an inflammation - pathophysiological changes of microcirculation (a circulation and a flow of lymph) in a tissue, showing an ischemia, an arterial and venous hyperemia, an exudation, emigration of leucocytes, a stasis.
9. Emigration (emigratio - to be relocated, moved) - an output of leucocytes from a blood through a wall of fine pots in a tissue or serous lumens at an inflammation.
10. the Englobement (phagocytosis - activity of phagocytes) - absorption, digestion and neutralization of the microbes, damaged cells and alien particles phagocytes.

the General pathological value

The inflammation concerns to fundamental pathological processes which compound a pathophysiological basis of many diseases of the person (for example: an encephalitis, a myocarditis, a pneumonia, a stomatitis, a flu, a diphtheria, etc.). Classical attributes of an inflammation - a pain (dolor), an erythema (rubor), fever (calor), a swelling (tumor) and the broken function of a tissue and an organ (functio laesa). Mechanisms of inflammatory process are universal, and laws of development are the general irrespective of structurally functional differences of tissues.

Inflammatory process is characterized by development of three phylums of sosudisto-histic reactions: alterative - dystrophic, vascular and proliferative. Alterative - dystrophic reactions show aboriginal damage (alteration) of a tissue and distress of a histic metabolism (dystrophia). The initial alteration results from direct morbid influence on cellular frames of an organ. In reply to a boring and damage the permeability of cellular and subcellular membranes raises. Mast cells excrete mediators of an inflammation (Histaminum, a serotonin, Heparinum, etc.). From various cells are liberated lizosomalnye (glikoliticheskie, lipolytic and proteolytic) the enzymes which are making active in a tissue of reaction of a glycolysis, a lipolysis and a proteolysis. Biologically awake materials (mediators, enzymes) render pathogenic influence and invokes the further destruction (a secondary alteration) cells.

The alteration comes to the end with a necrosis of the inflamed tissue with formation of necrosises, ulcers, wounds, etc. Alterative - dystrophic changes show appreciable physical and chemical infringements in the inflamed tissue. The most expressed dystrophic changes are accompanied by development of an acidosis of damage (H⁺-гипериония), hyperosmias and overhydratations of the inflamed tissue. The inflammation is shaped as automatically adjusting process of damage of frame, infringement of a metabolism and function of a tissue. At the same time development and diffusion of an inflammation in the form of aboriginal process is in dependence from the general reactivity of an organism.

The exudative inflammation shows the expressed infringements of an aboriginal circulation (an ischemia, an arterial and venous hyperemia, a stasis) and flows of lymph the phenomena of an exudation (intensifying of a filtration, a diffusion and mikrovezikuljatsii blood plasmas through a wall of micropots) in a tissue and serous lumens with formation of infiltrates and different kinds of exudates, an output (emigration) of leucocytes in a tissue and an englobement in the inflamed tissue.

Among protective - adaptive reactions the important role is played with a hyperemia of a tissue, an englobement, a compensator reparation and the neogenesis (proliferation) having the big anti-inflammatory value.

The productive (proliferative) inflammation is characterized by a pathological reparation and neogenesis (a reclaiming hypertrophy, a granulomatosis with formation of polyps, a sclerosis and a cirrhosis).

Treatment of an inflammation is based on pathophysiological principles of elimination of pathological alterative - dystrophic, ekssudativno-vascular and proliferative reactions by regeneration of a neurohumoral regulation of vital activity of a tissue.

At early stages of evolutionary development (phylogenesis) the inflammation shows cytophagous reaction (I.I.Mechnikov).

In the early season of an ontogenesis or on a background of immunobiological failure inflammatory process quite often accepts generalized diffusion (sepsis).

Educational elements

I. Aboriginal and general attributes of an inflammation

• mechanisms of development of a pain (dolor), erythemas (rubor), fever (calor), swellings (tumor), infringements of function of a tissue, an organ (functio laesa)
• concept about a functional element in the inflamed tissue
• a boring the inflammatory agent
• damage by the inflammatory agent

II. An alteration of a tissue

• an initial alteration
• a direct injury of a tissue the inflammatory agent
• rising of a permeability of membranes of cells and cellular organellas
• a secondary alteration
• damage of cellular and subcellular frames by products of a metabolism, mediators of an inflammation
• an autolysis, paranekroz, a necrobiosis, a necrosis (anabrosis, a ulcer, a wound)

III. A dystrophia of a tissue: nervous, inflammatory

• infringement of a histic metabolism (intensifying and oppression of a metabolism), change of redoxreactions
• rising of activity lizosomalnyh enzymes (a glycolysis, a lipolysis, a proteolysis)
• an acidosis of damage (H⁺-гипериония)
• a hyperosmia, giperionija, a hydration of tissues

IV. Mediators of an inflammation

• liberation of biologically awake materials
• biogenic amines (Histaminum, a serotonin)
• polypeptides (a bradykinin, kallidin)
• proteins (a necrosin, globulinovyj the factor of a permeability)
• Acetylcholinum, system of a complement, Prostaglandinums
• anti-inflammatory mediators (an epinephrine, Noradrenalinum, Heparinum)

V. A role of a reactivity of an organism in development of an inflammation

• a role of a functional state of nervous system in development of an inflammation
• Hormonums promoting development of an inflammation (Somatotropinum, mineralocorticoids, Hormonums of a thyroid gland)
• Hormonums handicapping development of an inflammation (corticotropin, glucocorticoids, an insulin, sexual Hormonums)
• connection of the general and aboriginal phenomena at an inflammation
• value of immune responses in inflammatory process
• an inflammation and an allergy
• features of an inflammation, vascular reactions, emigrations, an englobement in the season of a neonatality
• features of inflammatory processes in maxillofacial range

VI. A proliferation. Reparativnaja a stage of an inflammation

• mechanisms of a proliferation
• a compensator reparation and neogenesis (granuljatsionnaja a tissue, cicatrix)
• a pathological reparation and neogenesis at a productive, proliferative inflammation (a granulomatosis, polyps, a sclerosis and a cirrhosis)
• stimulators and inhibitors of a proliferation

VII. Distresses of a neurohumoral regulation of a circulation and a flow of lymph in a tissue at an inflammation

• neurogenic mechanisms of vascular tone
• nejrotonichesky, nejroparalitichesky
• myogenetic mechanisms of vascular tone
• miotonichesky, mioparalitichesky

VIII. Reactions of pots mikrotsirkuljatornogo channels in the inflamed tissue

• change of a blood-groove, mechanisms, stages
• mechanisms of development of an ischemia, an arterial, venous hyperemia
• change reologicheskih properties of a blood in the locus of an inflammation, albuminous structure and physical and chemical properties of proteins of plasma
• change of a permeability of walls of micropots
• intravascular factors
• extravascular factors
• mioparalitichesky the mechanism
• the phenomenon "slajdzha" in capillars
• a clottage of micropots
• a stasis

IX. An exudation: intensifying of a filtration, a diffusion and mikrovezikuljatsii (tsitopempsis) blood plasmas

• mechanisms of formation of exudates
• physical and chemical alterations in the locus of an inflammation
• kinds of exudates: serous, fibrinous, purulent and hemorrhagic

X. An output of leucocytes in the inflamed tissue

• regional standing of leucocytes
• mechanisms of emigration of leucocytes, formation of an inflammatory infiltrate
• hemotaksis: tsitotaksigeny and tsitotaksiny

XI. An englobement in the inflamed tissue

• kinds, stages and mechanisms
• stages of an approaching, an adherence, dipping, digestion
• failure of an englobement

XII. Pathophysiological principles of anti-inflammatory treatment

XIII. Features of flow of inflammatory process in an ontogenesis and phylogenesis, features of an inflammation in the season of a neonatality; features of vascular reaction, emigration, an englobement

XIV. Biological value of an inflammation

• dialectic interrelation of damage and protective - adaptive reactions in inflammatory process
• outcomes of an inflammation

Uchebno-research work of students

An anesthetized frog fix on a pith plate a backrest up so that the first line of a mandible adjoined to a foramen. Tongue of a frog straighten above a foramen. Under small augmentation of a microscope find a field of tongue with a good microcirculation. This field damage an argentum nitricum (within 1-2 seconds), wash off water and paint over 1 % solution metilenovoj sini during 1-2-O minutes. Observe of change of a circulation and colouring of a tissue of tongue in range of an inflammation. Pay attention that the damaged tissue is imbued more intensively. Results write down in the report and analyze.

Experience 2. Preparation, colouring and a cytologic evaluation of Unguentums of an inflammatory exudate

A drop of an exudate render on the slide plate and with the help of a glass with shlifom do Unguentum. Dried up Unguentum above the pan fill in solution of a paint May - Grjunvalda on 5 mines, then on a preparation add approximately peer amount of distilled water and Unguentum paint within 3-5 minutes. Further a preparation wash off water water and accurately dry up on air. Unguentum study under a microscope; pay attention to cellular structure: presence of neutrophils, lymphocytes, monocytes and macrophages specifies inflammatory process of different gravity.

A principle of a method: the method is based on change of electrode potential. If in solution to lower an electrode on border "electrode - solution" there will be an electrical potential which depends on awake concentration of hydrogen ions in solution.

Work with the device: in an alveole pour distilled water and flush an electrode twice. Then establish pH distilled water. For this purpose the tumbler " a limen of gaugings " put on risk "2-14" and on the inferior (basic) scale determine rough pH. Then put the tumbler on risk of digit above which a limen of gaugings pH in narrower range and include roughly certain pH. After that in an alveole consistently pour purulent and serous exudates in amount of 50 ml and carry out gauging pH on the above-stated procedure. After the terminal of work it is necessary to wash out electrodes and to leave them in distilled water.

Prepare for a preparation of a mesentery of an intestine of an anesthetized frog (experience Kongejma). Under small augmentation observe a circulation in fine pots (arterias, arterioles, capillars, venulah). Pay attention to change of a lumen of various pots, amount of functioning capillars, rate of a blood-groove, majatnikoobraznoe locomotion of a blood, an interrelation of the central (axial) blood-groove keeping uniform elements of a blood, and a peripheric plasmatic layer. Mark (considering from the beginning of observation) time of appearance in plasmatic pristenochnom a layer of leucocytes as numerous transparent silvery globules moving along a vascular wall. Determine phylum of pots in which the given phenomenon earlier is found out. Fix also time when in any pots of their wall become covered by a layer of fixed leucocytes. Mark change of a blood-groove and time through which the output of leucocytes in extravascular space will be distinctly observed.

On painted Unguentum of an inflammatory exudate is found with various stages of an englobement: an approaching, an adherence, dipping, digestion. Sketch. Then count up amount of phagocytes in last stage of an englobement from 100 in sight and the phagocytic coefficient (index), i.e. interest of englobing cells in which there are in a stage of digestion microbes or alien particles (jadrosoderzhashchie chicken erythrocytes) determine. This parameter quantitatively characterizes activity of an englobement.

The note: the quantitative characteristic of an englobement the cytophagous number and a parameter opsonofagotsitarnoj give reaction.

Pathophysiological problems

The alteration at an inflammation shows an aboriginal boring and the damage of a tissue accompanying with distress of a histic metabolism (dystrophia). Distinguish the initial alteration starting inflammatory process, and the secondary alteration determining character, intensity of inflammatory process.

1. Characterize classical attributes of an inflammation and mechanisms of their development.
2. Give concept about initial and secondary damage of a tissue at an inflammation.
3. Open mechanisms of infringement of a histic exchange at development of an inflammation.
4. Tell about a role of mediators of an inflammation.
5. What role of stimulators and inhibitors of a proliferation?

Studying an exudate gives the important information on the inflammatory process, necessary for purpose by the doctor of anti-inflammatory treatment. The albuminous, cellular structure and physical and chemical properties of an inflammatory exudate have the big value.

1. As it is cytologic gravity of inflammatory process on Unguentum of an inflammatory exudate estimates?
2. Lead relative analysis of physical and chemical properties and cytologic given different kinds of an inflammatory exudate and a transudate.
3. How to differentiate on pH various exudates (purulent, putrefactive, serous)?

Circulatory disturbances in the inflamed tissue are characterized by consecutive development of an ischemia, arterial, then a venous hyperemia and a stasis. These circulatory disturbances are caused by damage of tissues and action of mediators of an inflammation.

1. Characterize the general laws of infringement of a circulation and a flow of lymph in a tissue at an inflammation.
2. mikrotsirkuljatornogo channels in the locus of an inflammation you can name What reactions of pots? Give the explanatory.
3. Open mechanisms of an exudation, emigration of leucocytes and an englobement.
4. Explain a role of a reactivity of an organism in development of an inflammation.
5. Explain features of an inflammation in ontogenetic and phylogenetic aspect.
6. Open biological value of an inflammation.
7. Characterize stages of an englobement.

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Keywords: an inflammation, an alteration, an exudation, a proliferation, an englobement, mediators of an inflammation, distress of microcirculation, physiopathology of an inflammation, sample pathological process

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