炎症医学知识培训培训ppt课件

炎症医学知识培训炎症医学知识培训炎症医学知识培训1SectionIIntroductoryRemarkI.TheConceptofInflammationTheDefinitionandSignificanceofInflammation:Inflammation炎症炎症Inflammationisthelocaldefensiveresponses局部防御反局部防御反应应toinjuryfactorsbylivingorganismspossessofvascularsystem拥有血管系统拥有血管系统.炎症医学知识培训2SectionIIntroductoryRemaAtfirst,weshouldbringoutthegeneralideaoftheinflammation.1.Itisformingstepbysteptofightagainstinjuryduringthecourseofevolutionoforganism.生生物物进进化中产生化中产生UnicellularorganismNon-vascularsystemPinocytosismulticellularorganism(e.g.parasite,invertebrate无脊椎动物无脊椎动物)TheorganismpossessofvascularsystemVasoresponseiscardinalfeatureofdefenseresponseContainofpinocytosis炎症医学知识培训3Atfirst,weshouldbr2.Vasculareventsplaythecentralroleofinflammatoryresponse血管反应为中心血管反应为中心3.Itisamorestereotypednonspecificbiologicaldefensivemechanismagainstanyoftheenvironmentalinvaders反应是反应是定型的定型的.4.Thesearethe3majorpathologicalchangeofinflammation,namely,Alteration,Exudation,&Proliferation变质、渗出、增生变质、渗出、增生5.Itisnot,initself,adisease,butisusuallyamanifestationofdisease,andusuallyaccompaniedwithfeverandleukocytosis是临床表现，如发热、白细胞增多是临床表现，如发热、白细胞增多炎症医学知识培训42.Vasculareventsplaythec6.Instudyingtheprocessofinflammation,weshouldntignoreeitherofthese2sidefortheyareunifiedinonecoin.有益有害两方面有益有害两方面Ontheonehand:Inflammationmayhavebeneficialeffects,suchasthedestructionofinvadingmicro-organismsandwalling-offofanabscesscavity,thuspreventingspreadofinfection.Ontheotherhand:Inflammationmayalsohaveharmfuleffects,forexample:炎症医学知识培训56.InstudyingtheprocessAnabscessinthebrainwouldactasaspace-occupyinglesioncompressingvitalsurroundingstructures.Fibrosis resulting from chronic inflammationmaydistortthetissueandpermanentlyaltertheirfunction(e.g.livercirrhosis).In children the swelling of the epiglottis inacuteepiglottitismayobstructtheairway.炎症医学知识培训6AnabscessinthebrainII.Thecausesofinflammation炎症原因炎症原因Causesofcellulardamagearestillcausesofinflammation.The principal causes of inflammationincluded biological agents,physical agents,chemical agents,immunological reactions andgeneticagentsetc.The biological agents are most importantand common causes of inflammation.(e.g.bacteria,virus,rickettside,fungi,and parasiteetc.)Infection感感染染Itisakindofinflammationduetobiologicalpathogen.炎症医学知识培训7II.Thecausesofinflammaphysicalagents,包括高温、低温、外伤、放射线包括高温、低温、外伤、放射线chemicalagents,强强酸酸、强强硷硷，某某些些毒毒性性化化学学物物质质以以及及体体内内产产生生的的化化学学物物质质（如如坏坏死死组组织织的的崩崩解解产产物物，胆胆囊囊穿穿孔孔，胆胆汁汁流流入入腹腹腔腔、消化液的外溢等）。消化液的外溢等）。immunologicalreactions如各型变态反应如各型变态反应geneticagents如如抗胰蛋白酶缺陷抗胰蛋白酶缺陷炎症医学知识培训8physicalagents,包括高温、低温、外伤、放射线III.TheessentialchangeofinflammationdegenerationAlterationnecrosisfluidexudeExudationleukocyteexudemonocyte-macrophageProliferationendotheliocyte,fibroblastparenchyma(e.g.coverepithelium,glandularepithelium)炎症医学知识培训9III.TheessentialchaIV.TheManifestation,SystemicResponseofInflammation(I).LocalappearanceRedness红红Anacutelyinflamedtissueappears red for example skin affectedbysunburn.Thisisduetodilatationofsmallbloodvesselswithinthedamagedarea.Swelling肿肿Swellingresultfromedema.Heat热热Increaseintemperatureisseenonly in peripheral parts of the body,suchastheskin.Itisduetoincreasedbloodflow(hyperaemia)throughtheregion.炎症医学知识培训10IV.TheManifestation,SystemiPain痛痛Itresultspartlyfromthestretchinganddistortionoftissueduetoinflammatoryedemaand,inparticular,frompusunderpressureinanabscesscavity.Someofthechemicalmediatorsofacuteinflammation,suchasprostaglandins前列腺素前列腺素,areknowntoinducepain.Lossoffunction功能障碍功能障碍Movementofaninflamedareaisconsciouslyandreflexlyinhibitedbypain,whilesevereswellingmayphysicallyimmobilisethetissue.炎症医学知识培训11Pain痛Itresultspartlyfr(II)SystemicresponseFeverSystemicfever,whichresultsfrom:Exogenouspyrogen:e.g.bacterialtoxins,somekindofvirus,IC,etc.Endogenouspyrogen:e.g.cellularfactor(IL-1,TNF)Prostagladin(PG)炎症医学知识培训12(II)Systemicresponse炎症医学LeukocytosisForthepatient,itisoneoftheknownfeaturesofacuteinflammtion.Normal:4-10 109/L类白细胞反应类白细胞反应shifttotheleft核左移核左移:indicativeofsevereinfection炎症医学知识培训13LeukocytosisForthepatieThekindofleukocyteofperipheralblood外周外周血血isinrelationtoinfectivepathogen.AcutesuppurativeinflammationandearlystagesofacuteinflammationincreaseofneutrophilicgranulocyteLatestagesofacuteinflammationincreaseofmonocyte-macrophageChronicinflammationandvirusinfectionincreaseoflymphocyteandmonocyteTheinfectionofparasiteandallergosesincreaseofeosinophilicleukocyte炎症医学知识培训14Thekindofleukocyteoresistanceislow,Leukopeniaindicativeofsevereinfectionsomekindofinfection(e.g.typhoidfever伤寒伤寒,virusinfection)炎症医学知识培训15炎症医学知识培训15Theclinicaltypesofinflammation炎症的临床类型Theclinicaltypesofinflammationareclassifiedaccordingtocourseofdiseaseas:1.Peracuteinflammation:the course persistence of somehoursorafewdays.Itisallergosescommonly.e.g.anaphylaxis过敏过敏duetopenicillin;acutetransplantrejection炎症医学知识培训16Theclinicaltypesofinflam2.Acuteinflammation:thecoursepersistenceofseveraldays,dontexceedamonthcommonly.thepathologicalchangesaremajorofalteration变质变质andexudation渗出渗出,andincreaseofneutrophilicgranulocyte中性中性白细胞白细胞.3.Chronicinflammation:thecoursemaybeprolongedforseveralmonthsorseveralyears.thepathologicalchangearemajorofproliferation增生增生,andincreaseoflymphocyte,plasmocyteandmonocyte淋巴细胞、浆细胞、单核细胞淋巴细胞、浆细胞、单核细胞.4.Subacuteinflammation:Itisintermediatebetweenthatofacuteinflammationandthatofchronicinflammation.e.g.subacutesevereheptitissubacuteinfectiveendocarditis炎症医学知识培训172.Acuteinflammation:炎症医学知识SectionIIAcuteInflammationAcute inflammation is an immediateanddirectdefensiveresponsetoinjuryfactorsbylivingorganismsinitsearlystage.Vascularresponseplayingthecentralroleofchangesaremajorofexudation.Itincludefluid(antibody)andleukocyte(neutrophilicgranulocyte)病程短、起病急病程短、起病急病变以变质和渗出为主病变以变质和渗出为主炎症细胞以中性白细胞为主炎症细胞以中性白细胞为主炎症医学知识培训18SectionIIAcuteInflammatiExudationExudation渗渗 出出 Edema fluid,fibrin andneutrophilpolymorphsaccumulateintheextracellular spaces of the damagedtissue.Exudationofedemafluidandleukocyteisknownasexudate渗出物渗出物.Exudate,especiallyneutrophilpolymorph,isessential forahistologicaldiagnosisofacuteinflammation.Majorcoursesofexudationarechangesinhemodynamics,increasedvascularpermeability血管通透性血管通透性,fluidexudateandcellularexudate.炎症医学知识培训19ExudationExudation渗出EdemI.Changesinhemodynamics1.Microarteriospasm痉挛痉挛:transientvasoconstriction(thecoursespersistenceofafewsecond)2.Vasodilatationandaccelerationofbloodflow:(inflammatoryhyperemia)3.Bloodflowbeginstoslow4.(atleast,occurstasis)炎症医学知识培训20I.Changesinhemodynamics炎症II.Increasedvascularpermeability1.Constrictionofendothelialcell2.Transcytosis3.Endothelialinjury4.Highpermeabilityofnewlyformedcapillarywall炎症医学知识培训21II.IncreasedvascularpermeFluidexudateExudation of fluid rich protein iscalledexudate渗出液渗出液.Inflammatoryedema炎性水肿：炎性水肿：exudateaccumulateintheextracellularspace.Inflammatoryhydrops积液：积液：exudateaccumulateintheserosalcavity.炎症医学知识培训22Fluidexudate炎症医学知识培训22水肿发生简要机制：水肿发生简要机制：体内外液体交换失衡：球管失衡体内外液体交换失衡：球管失衡血管内外液体交换失衡血管内外液体交换失衡毛细血管流体静压毛细血管流体静压血浆胶体渗透压血浆胶体渗透压血管通透性血管通透性淋巴回流淋巴回流炎症医学知识培训23水肿发生简要机制：毛细血管流体静压炎症医学知识培训23Table4-1comparisonofexudateandtransudatetransudateexudatevasopermeabilitynomalincreaseContainofprotein0-1.5g/dl0-1.5g/dlKindsofproteinMajorofalbuminVariousofproteinRivaltatextnegativepositivefibrinwithoutpossessSpecificgravity1.020Thenumberofcells0.5 109/L炎症医学知识培训24Table4-1comparisonofexudatBeneficialeffectsofexudate:a.Dilution of toxins 稀稀 释释 毒毒 素素,such asproduced by bacteria,allows them to becarriedawayinlymphatics.b.Neutralizationoftoxins中中和和毒毒素素entryofantibodies,they may lead either to lysis ofmicro-organisms,throughtheparticipationofcomplement,or to their phagocytosis byopsonization.C.Fibrinformation纤维素纤维素itfromexudedfibrinogenmayimpedethemovementofmicroorganisms,trappingthemandsofacilitatingphagocytosis吞噬作用吞噬作用.炎症医学知识培训25BeneficialeffectsofexudatSurfacephagocytosis表面吞噬作用表面吞噬作用It is thought that phagocytosismaybefacilitatedifthebacteriumcanbe trapped or cornered against asurface,suchasstrandsoffibrin,orin the interstices between two ormorecells.炎症医学知识培训26Surfacephagocytosis表面吞噬作用炎症 Harmfuleffectsofexudate:Edemaoftissuesmayincreaseinseverityoflocaldisturbanceofcirculation.Severe swelling of the epiglottis in acuteepiglottitismayobstructtheairway.Excessive hydrops may have a bed effect onorganfunction.(e.g.hydropericardium心心包包积积水水,hydrothorax胸胸腔积水腔积水)Organizationoffibrinmayleadtopulmonarycarnification肺肉质变肺肉质变andadhesion粘连粘连(e.g.adhesiveperitonitis腹膜炎腹膜炎,adhesivepericarditis心包炎心包炎,adhesivepleurisy胸膜炎胸膜炎).炎症医学知识培训27炎症医学知识培训27III.CellularexudateanditseffectsInflammatorycellinfiltration炎症细胞浸润炎症细胞浸润:The accumulation of leukocyteswithin the extravascular space.It isthe most important aspect of theinflammatoryprocess.炎症医学知识培训28III.CellularexudateanditLeukocytestransmigrationItincludemajorofthreestepsby:1.Marginationandpavementingofleukocytes2.Adhesion3.Transmigration炎症医学知识培训29Leukocytestransmigration炎Redcelldiapedesis红细胞漏出红细胞漏出Itisnegativeprocessofredcelldiapedesis.Thesighofredcelloccuredinextravascularspacesaresuggestiveofsevereinjury.炎症医学知识培训30Redcelldiapedesis红细胞漏出3.LeukocytestransmigrationofinjuredareaandchemotaxisChemotaxis趋化作用趋化作用UnidirectionalmigrationofWBCtothe site of injury is mediated bydiffusiblechemicalattractantsThischemicalattractantis calledchemotacticagents趋化因子趋化因子.炎症医学知识培训313.Leukocytestransmigration2mainsourcesofchemotacticagents:ExogenousbacterialproductsEndogenousderivedfromplasmaproteins(complements,C5a)orleukotreneB4andchemokine(IL-8,MCP,lymphotactin巨噬细胞、巨噬细胞、淋巴细胞趋化蛋白淋巴细胞趋化蛋白).炎症医学知识培训322mainsourcesofchemotacti4.Theeffectsofleukocytes(1).Phagocytosis吞噬杀灭作用吞噬杀灭作用Phagocytosisbyleukocytesinvolvesrecognition识别识别,engulfment吞入吞入,killing杀灭杀灭,anddegradation消化消化ofngestedmaterial.Leukocytepossessionofphagocytosismaybecalledphagocyte.炎症医学知识培训334.Theeffectsofleukocyte1).kinds,structuresandfunctionofphagocytesi.neutrophils(microphages)Around 60%of the total number ofperipheralleukocytesLM:laboidnucleus,Neitrophilicgranules(azurophilicgranules,specificgranules)EM:lysosoma炎症医学知识培训341).kinds,structuresandfuncii.MacrophageMonocyteMacrophageHistocyte(Kupfferscell,sinusoidhistocyte,dustcell,andmicrogliocyte,etc.)炎症医学知识培训35ii.Macrophage炎症医学知识培训35iii.EosinophilicleukocyteItisalittlelargerthanneutrophilrodnucleusorlaboidnucleus,eosinophilicgranulesItsphagocytosisisweakandphagocytosisofIC.炎症医学知识培训36iii.Eosinophilicleukocyte炎症医Kindsandstructuresofphagocytes炎症医学知识培训37KindsandstructuresofThekindsofleukocytesofinfiltrationareinrelationtostagesofinflammation.The early stages of major of acuteinflammationincreaseofneutrophilicgranulocyte(6-24h)Latestagesofacuteinflammationincreaseofmonocyte-macrophage(24-48h)炎症医学知识培训38ThekindsofleukocytesofinThekindsofleukocytesofperipheralbloodarealsoinrelationtoinfectiveinflammatoryfactors.Acutesuppurativeinflammation急性急性化脓性炎、一般细菌感染化脓性炎、一般细菌感染increaseofneutrophilicgranulocyte特殊细菌感染。如结核，特殊细菌感染。如结核，increaseofmonocyteVirusinfection病毒感染病毒感染increaseoflymphocyteandmonocyteTheinfectionofparasiteandallergoses寄生虫和变态反应寄生虫和变态反应increaseofeosinophilicleukocyte炎症医学知识培训39Thekindsofleukocytesofper2).Phagocyticcoursei.Recognitionandattachment(opsonization)(thereceotorofFcandC3b)调理素，调理素，调理素化作用调理素化作用ii.Engulfment,formingphagosome,furtherformingphagolysosome(degranulation)iii.killingordegradation炎症医学知识培训402).Phagocyticcourse炎症医学知识培训Thereare2majorcategoriesofbactericidalmechanisms:a).Oxygen-dependentmechanismsleukocyticoxidaseisactivated(NADPHoxidase还原型辅酶还原型辅酶)H2O2(MPO髓过氧化物酶髓过氧化物酶)HOCl.次氯酸次氯酸b).Oxygen-independentmechanismsLysosomalenzymes溶酶体酶溶酶体酶;lysozyme;arginine-richcationicproteins(phagocytins)Bactericidalpermeabilityincreasingprotein,BPI细菌通透性增高蛋白细菌通透性增高蛋白炎症医学知识培训41Thereare2majorca(2).Immuneeffects免疫作用免疫作用MacrophagesphagocytoseantigenandsendmessageofantigentoT-cellsandB-cellsT-cellsreleasethelymphokine(cellularimmunity)B-cellsproducetheimmunoglobulin(humoralimmunity)NK-cell(naturalkillercell)分泌作用：白细胞介素、干扰素、肿瘤坏死因子分泌作用：白细胞介素、干扰素、肿瘤坏死因子(3).Effectsoftissueinjury组织损伤组织损伤（消极作用，副反应）（消极作用，副反应）炎症医学知识培训42(2).Immuneeffects免疫作用炎症医学IV.InflammatoryMediatorInflammatorymediator炎症介质炎症介质Alotofacuteinflammatoryresponseduetoendogenouschemicalmediators.Thesechemicals,calledinflammatorymediator.炎症医学知识培训43IV.InflammatoryMediatorInThegeneralfeatureofinflammatorymediator1.Inflammatory mediators are from cells andplasma.The former is stored in the cell bygranulesinform;Thelatterispresentinplasmabyprecursorinform.细胞以颗粒形式释放，血浆中以前体激活形式激活细胞以颗粒形式释放，血浆中以前体激活形式激活2.Therelationofinflammatorymediatorandtargetcell(i.specific特异性特异性;ii.secondaryresponse二级二级反应反应;iii.Nonspecific非特异性非特异性)3.Alotofinflammatorymediatorsarepossessedofpotentialdangeroftissue有潜在的危害有潜在的危害.炎症医学知识培训44ThegeneralfeatureofMajorofinflammatorymediatoranditseffects(I)Inflammatorymediatorsarereleasedfromcells1.Vascularamines血管活性胺血管活性胺:includeofhistamine组织胺组织胺and5-hydrooxytryptamine5-羟色胺羟色胺炎症医学知识培训45Majorofinflammatory炎症医学知识培1).Histamine:Itisstoredinmastcells主主细细胞胞,basophil嗜嗜碱碱性性白细胞白细胞andplatelets血小板血小板.Histamine release from these sites(forexample,mast cell degranulation)is stimulatedby complement components补补体体 C3a and C5a,andbylysosomalproteins溶溶酶酶体体酶酶releasedfromneutrophils.Itcausesvasculardilatationandimmediatetransientphaseofincreasedvascularpermeability血管扩张，通透性增高血管扩张，通透性增高.炎症医学知识培训461).Histamine:炎症医学知识培训462).5-hydrooxytryptamine,5-HT:5-羟色胺羟色胺Thisispresentinhighconcertrationinmastcellsandplateles.Italsoincreasevascularpermeability.炎症医学知识培训472).5-hydrooxytryptamine,2.Metaboliteofarachidonicacid,AAphospholipasephospholipidofmembraneAAItincludeprostagladin前列腺素前列腺素(PG),leukotrene白细胞三烯白细胞三烯(LT),andlipoxins脂毒素脂毒素.前列腺素：前列腺素：合成：组织损伤合成：组织损伤溶酶体酶中的磷脂酶释放溶酶体酶中的磷脂酶释放细胞膜磷脂细胞膜磷脂20碳碳脂肪酸脂肪酸前列腺素合成酶前列腺素合成酶前列腺素前列腺素炎症医学知识培训482.MetaboliteofarachidoniProstagladin,PGThese are a group of long-chain fattyacids derived from arachidonic acid andsynthesisedbymanycelltypes.Itcausesvasculardilatation血管扩张血管扩张andincreasesinvascularpermeability通透性增高通透性增高Itmaycausesfever发热发热andpain疼痛疼痛.炎症医学知识培训49Prostagladin,PG炎症医学知识培训493.productofleukocyteandlysosomalcompoundsactiviticproductsofoxygenmetabolism(O2.-,H2O2,OH.)lysosomalcompounds溶酶体成分溶酶体成分炎症医学知识培训503.productofleukocyteand炎4.Cytokineandchemokine细胞因子和趋化性细胞因子细胞因子和趋化性细胞因子Theformer,afamilyofchemicalmessengersreleasedbylymphocytesandmonocytes.(lymphokine,monokine).TheletterincludeIL-8,MCPandlymphotactin.炎症医学知识培训514.Cytokineandchemokine炎症医(II)Plasmafactors:Plasmafactorsincludecomplementsystem,kininsystemandclottingsystem.三个系统：三个系统：补体系统补体系统:C3a、C5a趋化因子、趋化因子、C3b调理素调理素激肽系统：如缓激肽激肽系统：如缓激肽凝血系统：纤维素渗出，限制细菌播散、凝血系统：纤维素渗出，限制细菌播散、利于中性白细胞捕捉细菌利于中性白细胞捕捉细菌炎症医学知识培训52(II)Plasmafactors:炎症医学知识培Kininsystem:Bradykinin缓缓激激肽肽isthemostimportantvascularpermeabilityfactorBradykininisalsoachemicalmediatorofthepainwhichiscardinalfeatureofacuteinflammation.The kinin system is activated by coagulationfactorXIIProductsofthekinin,coagulationandfibrinolyticsystemcanactivatecomplement.炎症医学知识培训53Kininsystem:炎症医学知识培训53V.CommonHistologicPatternsofAcuteInflammationAlterativeinflammation变质性炎变质性炎Majorpathologicalchangesarealteratione.g.a.acuteseverehepatitis;b.amoebiasisc.encephalitisd.myocarditis(duetodiphtheriatoxin白喉毒素白喉毒素)炎症医学知识培训54V.CommonHistologicPatternsProliferativeinflammation增生性炎增生性炎Inearlystagesofacuteinflammation,hemajorpathologicalchangeareproliferatingrightaway.e.g.a.typhoidfeverb.acutediffuseproliferativeglomerulonephritisc.forminggranuloma肉芽肿肉芽肿phaseofrheumatism炎症医学知识培训55Proliferativeinflammation炎症Exudativeinflammation渗出性炎渗出性炎(I)SerousinflammationInserousinflammation,thereisabundantprotein-rich fluid exudate with a relativelylowcellularcontent.Mildinjurytothevascularendothelium浆液渗出为主，预后好。浆液渗出为主，预后好。炎症医学知识培训56Exudativeinflammation渗出性炎炎Thesiteofpredilection:a.areolartissue疏松结缔组织疏松结缔组织(e.g.bebitbythanatophidia)b.serouscavities浆膜腔浆膜腔(e.g.pleuritis,peritonitis胸膜炎、腹膜炎胸膜炎、腹膜炎)c.mucus粘膜粘膜(e.g.earlystageofcommoncold)Catarrhalinflammation卡他性炎卡他性炎:Whenmucushypersecretionaccompaniesacuteinflammationofamucousmembrane,theappearanceisdescribedascatarrhald.synovialmembrane滑膜滑膜(e.g.acutesynovitis)e.skin皮肤皮肤(e.g.IIburn,frictioninjuryofskin)炎症医学知识培训57Thesiteofpredilection:炎症医学知(II)FibrinousinflammationWhen the inflammatory exudate contains plentifulfibrinogen,thispolymerisesintoathickfibrincoating.Withmoresevereinjuries,theresultinggreatervascularleaksarelargeenoughtopermitthepassageoffibrinogenmolecules.Thesiteofpredilection:a.mucosalfibrinousinflammationpseudomembranousinflammation假膜性炎假膜性炎:e.g.diphtheria白喉白喉bacillarydysentery菌痢菌痢b.serosalfibrinousinflammatione.g.pleuritis,peritonitisrheumaticpericarditis(corhirsutum绒毛心绒毛心)c.fibrinousinflammationoflunge.g.lobarpneumonia大叶性肺炎大叶性肺炎炎症医学知识培训58(II)Fibrinousinflammatidiphtheriarheumaticpericarditis(corhirsutum)炎症医学知识培训59diphtheria(III)suppurativeorpurulentinflammationItisitsfeaturethatmajorofneutrophilsexudate中性白细胞渗出中性白细胞渗出accompaniedwithvaryingdegreesonnecrosisoftissue不同程度液化坏死不同程度液化坏死andformingpus形成脓液形成脓液.Pusconsistsoflargeamountsofdyinganddegenerationneutrophils,infectingorganisms,liquefyingnecrosisoftissueandsmallamountsofserum.炎症医学知识培训60(III)suppurativeorpurulenti1.PurulentinflammationofsurfaceandempyemaPurulentinflammationofsurface表面化脓表面化脓PurulentinflammationoccursonmucusorserousItisalsocalledpurulentcatarrh.Empyema积脓积脓ahollowviscusfillswithpuse.g.empyemaofthegallbladderoroftheappendix炎症医学知识培训611.Purulentinflammationof2.Phlegmonousinflammation蜂窝织性炎蜂窝织性炎Diffuse弥漫弥漫formpurulentinflammationoccurstoareolartissue疏松组织疏松组织.3.Abscess脓肿脓肿Abscessisakindoflocalized局限局限purulentinflammationItsmajorfeaturesareliquefyingnecrosisoflocaltissueandformationofacavity脓腔脓腔filledpus.炎症医学知识培训622.Phlegmonousinflammation炎急性阑尾炎总菜单炎症医学知识培训63急性阑尾炎总菜单炎症医学知识培训63炎症医学知识培训培训ppt课件64Table4-1comparisonofphlegmonousinflammationandabscessPhlegmonousinflammationAbscessCommonsiteHypodermis,muscle,appendixSkin,organPathogenicbacteriaHemolyticstreptococcusGoldenstaphylococcusTherangeoflesionDiffuseandspreadingWelllocolizedThedegreeofnecrosisMildSevere炎症医学知识培训65Table4-1comparisonofphlegmmetastaticabscesschronicabscessfuruncle疖疖carbuncle痈痈ulcer溃疡溃疡sinus窦道窦道fistula瘘管瘘管炎症医学知识培训66metastaticabscess炎症医学知识培训6(IV)Hemorrhagicinflammation出血性炎出血性炎Much more severe or very intenseinjurieswouldcausethevascularleakareevenlarge,renderingnotonlythepassageof the largest plasma protein moleculesbut the RBC,such as in certain intenseinfectiousdiseasee.g.plague鼠疫鼠疫,anthrax炭疽炭疽,leptospirosis钩端螺旋体病钩端螺旋体病,andepidemichemorrhagicfever流行性出血热流行性出血热etc.炎症医学知识培训67(IV)Hemorrhagicinflammation出VISequelaeofAcuteInflammation(I)ResolutionandHealing(II)ToDelayRecoverResistanceisloworthoroughtreatmentcannotbemadeSomekindsofacuteinflammationmaytransformationintochronicinflammation.(e.g.chronicappendicitis)Some kinds of chronic inflammationaredelayrecovery.(e.g.chronicbronchitis,chronichepatitis)(III)ToSpread炎症医学知识培训68VISequelaeofAcuteInflamma(III)ToSpread1.Localspreade.g.abscesssinus,fistulanephrotuberculosis肾结核肾结核ureter,bladderTB2.Lymphaticspreade.g.primarycomplex原发综合征原发综合征3.Vascularspread炎症医学知识培训69(III)ToSpread炎症医学知识培训693.Vascularspread(1)bacteremia菌血症菌血症bacteriaenterblood,notoxin(2)toxemia毒血症毒血症toxinabsorbinblood,nobacteria(3)septicemia败血症败血症bacteremia+toxemia(4)pyemia脓毒血症脓毒血症thespecificsepticemiaduetopyococcusformingofmultiplemicroabscess(embolicabscess)炎症医学知识培训703.Vascularspread炎症医学知识培训70SectionIIIChronicInflammationTheCausesandClassificationofChronicInflammation病程长，起病缓；增生为主；淋巴细胞、浆细胞浸润病程长，起病缓；增生为主；淋巴细胞、浆细胞浸润Itmightstartasanacuteonewhichistransformedintochronic,or,itmaybechronicfromtheonset.In the latter instance,it depends mainly on the nature of theinflammatorystimulus.3majoraspectcanbeindicated:i.Persistentlowvirulent毒力低的细菌感染毒力低的细菌感染infections,suchaschronicgastritisduetoHPinfectionandtuberculosisduetotuberclebacillus.ii.Prolongedexposuretonon-degradablematerial,suchassilica硅硅,etc.iii.Autoimmunediseases自身免疫疾病自身免疫疾病andallograftrejection变态反应变态反应炎症医学知识培训71SectionIIIChronicInflammaAccordingtothefeatureofchronicinflammation,itmaybeclassified2typesasnonspecificandspecificchronicinflammation(granulomatousinflammation肉芽肿肉芽肿性炎性炎).炎症医学知识培训72AccordingtothefeTheTypesofChronicInflammationI.Thenonspecificchronicinflammation(I)The morphological characteristicsofnonspecificchronicinflammation:i.Thecellularinfiltrateconsistscharacterist