What is granulomatous inflammation characterised by?
Presence of granulomas in tissues and organs
What is granulomatous inflammation stimulated by?
What can the cause of granulomatous inflammation be described as?
Idiopathic (no known cause)
What does idiopathic mean?
No known cause
What are granulomas composed of?
Aggregates of epitheloid macrophages in tissue
May contain giant cells
May be surrounded by lymphocytes
Contains neutrophils and eosinophils
What may granulomas surround?
What are granulomas the response to?
What kinds of hypersensitive reaction are many granulomas?
What are giant cells?
Fusion of macrophages to form larger cells (larger cytoplasms and multinucleated)
What are different kinds of granulomas?
Foreign body type
Where are Langhans type granulomas commonly found?
What are properties of Langhams type granulomas?
Peripheral rim of nuclei
Large eosinophillic cytoplasm
What do foreign body type granulomas contain?
How are the nuclei arranged in foreign body type granulomas?
Scattered around the cytoplasm
What are silicone associated granulomas due to?
Rupture of silicone implants, vacouls contain leaked silicone
Where are Wartin-Finkeldy type granulomas found?
How are the nuclei arranged in Warthin-Finkeldy granuloma?
Clustered in the centre
What are examples of infectious granulomatous diseases?
Tuberculosis (mycobacterium tuberculosis)
Leprosy (mycrobacteria leprae)
Syphilis (treponema pallidum)
What is tuberculosis caused by?
What is leprosy caused by?
What is syphilis caused by?
What are examples of non-infective granulomas?
Rheumatoid disease (tissue specific autoimmune disease, targets synovial fluid in joints)
Crohn's disease (chronic inflammatory bowel disease)
What is Rheumatoid disease?
Tissue specific autoimmune disease, targets synovial fluid in joints
What is Crohn's disease?
Chronic inflammatory bowel disease
What is the process of wound healing?
1) Phase of acute inflammation
2) Granulation tissue formation
3) Local angiogenesis (new vessels grow)
4) Fibrosis and scar formation
What does ideal surgical wound healing involve?
Healing by primary intention
Small amount of granulation tissue
Small linear scar
What does healing of larger defects lead to?
Healing by secondary intention
Lots of granulation tissue ingrowth
Contraction and scarring
What is the detailed process of healing?
1) Injury, blood clot, acute inflammation, fibrin formation
2) Many growth factors and cytokines involved
3) Granulation tissue growth - angiogenesis
4) Phagocytosis of fibrin
5) Mycofibroblasts move in and lay down collagen
6) Contraction of scar
What are factors that help wound healing?
Apposition of edges (no haemotoma)
Metabolic stability and normality
Normal inflammatory and coagulation mechanisms
What are things that would impair wound healing?
Dirty, gaping wound, large haematoma
Poorly nourished, lack of vitamines A and C
Abnormal metabolism, diabetes
Inhibition of angiogenesis