Inflammation is the first response of the immune systemto infectionor irritation and may be referred to as the innate cascade. Inflammation is characterised by the following quintet: redness (rubor), heat (calor), swelling(tumor), pain(dolor) and dysfunction of the organs involved (functio laesa). The first four characteristics have been known since ancient times and are attributed to Celsus; functio laesa was added to the definition of inflammation by Rudolf Virchowin 1858.
- 1 Characteristics
- 2 Leukocytes and cytokines
- 3 Outcomes
- 4 Systemic inflammation
- 5 Inflammation examples
Inflammation has two main components - cellularand exudative.
The exudative component involves the movement of fluid, usually containing many important proteinssuch as fibrinand immunoglobulins(antibodies). Blood vesselsare dilated upstream of an infection (causing redness and heat) and constricted downstream while capillarypermeability to the affected tissueis increased, resulting in a net loss of blood plasmainto the tissue - giving rise to edemaor swelling. The swelling distends the tissues, compresses nerveendings, and thus causes pain.
The cellular component involves the movement of white blood cellsfrom blood vessels into the inflamed tissue. The white blood cellsor leukocytes take on an important role in inflammation; they extravasate (filter out) from the capillariesinto tissue, and act as phagocytes, picking up bacteriaand cellular debris. They may also aid by walling off an infection and preventing its spread.
If inflammation of the affected site persists, released cytokinesIL-1and TNFwill activate endothelial cells to upregulate receptors VCAM-1, ICAM-1, E-selectin, and L-selectin for various immune cells. Receptor upregulation increases extravasation of neutrophils, monocytes, activated T-helperand T-cytotoxic, and memory T and B cellsto the infected site.
Neutrophilsare characteristic of inflammation - they are the first cells to appear in an infected area, and any section of inflamed tissue viewed under a microscope will appear packed with them. They are easily identified by their multilobed nuclei and granular cytoplasm and perform many important functions, including phagocytosisand the release of extracellularchemical messengers.
Leukocytes and cytokines
Various leukocytesare involved in the initiation and maintenance of inflammation. These cells can be further stimulated to maintain inflammation through the action of adaptive cascade through lymphocytes: T cells, B cells, and antibodies. These inflammation cells are:
- Mast cellswhich release histamineand prostaglandinin response to activation of stretch receptors. This is especially important in cases of trauma.
- Macrophageswhich release TNF-α, IL-1 in response to activation of toll-like receptors.
The outcome in a particular circumstance will be determined by the tissue in which the injury has occurred, and the injurious agent that is causing it.
There are three possible results to inflammation:
- Resolution, the complete reconstitution of damaged tissue, does not usually occur in the body.
- Connective tissue scarring. Some 24 hours after inflammation in a woundfirst occurs, the wound healingresponse will commence. This response involves the formation of connective tissue to bridge the gap caused by injury, and the process of angiogenesis, the formation of new bloodvessels, to provide nutrientsto the newly formed tissue. Often healingcan not occur completely and a scarwill form; for example after lacerationto the skin, a connective tissue scar results which does not contain any specialised structures such as hairor sweat glands.
- Ongoing or chronic inflammation. If the injurious agent continues, chronic inflammationwill ensue. This process, marked by inflammation lasting many days, months or even years, may lead to the formation of a chronic wound. Chronic inflammation is characterised by a dominating presence of macrophages in the injured tissue, which extravasate via the same methods discussed above (ICAM-1 VCAM-1). These cells are powerful defensive agents of the body, but the toxinsthey release (including reactive oxygen species) are injurious to the organism's own tissues as well as invading agents. This is why chronic inflammation is almost always accompanied by tissue destruction. Finally, an abscess, or a collection of pus, can form in chronic inflammation.
When inflammation overwhelms the whole organism, systemic inflammatory response syndrome(SIRS) is diagnosed. When it is due to infection, the term sepsisis applied. Vasodilationand organ dysfunction are serious problems that may lead to septic shockand death.
With the discovery of interleukins, another concept of systemic inflammation developed. Although the processes involved are identical, this form of inflammation is not confined to a particular tissue but involves the endothelium(lining of blood vessels) and many other organ systems. High levels of several inflammation-related markers such as IL-6, IL-8, and TNF-αare associated with obesity. These levels are reduced in association with increased levels of antiinflammatory molecules within four weeks after patients begin a very low calorie diet . The role of systemic inflammation as a cause and/or result of insulin resistanceand atherosclerosisis the subject of intense research. It has little direct bearing on clinical care.
Inflammation is usually indicated by adding the suffix "-itis", as shown below. However, some conditions such as asthmado not follow this convention.
- appendicitis: appendix
- gastritis: stomach
- laryngitis: larynx
- meningitis: meninges(the membrane covering the brain)
- otitis: ear
- pancreatitis: pancreas
More examples are available at list of types of inflammation.da:Betændelse
Categories: Pathology| Animal physiology| Symptoms
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It uses material from the http://en.wikipedia.org/wiki/Inflammation Wikipedia article Inflammation.