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5. PATHOPHYSIOLOGY OF INFLAMMATION

Questions to prepare for classes and examination

•  Definition and significance of inflammation. General features of acute and chronic inflammation. Causes of inflammation.

•  Primary and secondary alteration in the focus of acute inflammation: causes, mechanisms of development, manifestation. Physico-chemical changes in the focus of inflammation.

•  Exudation. Definitions of exudate and transudate.

•  Sequence and mechanisms of vascular changes in acute inflammation.

•  Mechanisms of vascular leakage in acute inflammation.

•  Stages of extravasation. Mechanisms of margination, rolling, firm adhesion and transmigration. Inflammatory mediators that influence on these processes.

•  Chemotaxis: definition, exogenous and endogenous chemoattractants, regulatory (receptor) mechanisms of chemotaxis.

•  Phagocytosis: stages, major opsonins, opsonic and nonopsonic phagocytosis, mechanisms of bacterial killing (oxygen free radicals, products of secondary and lysosomal granules). Regurgitated and frustrated phagocytosis.

•  Defects in leukocyte function. Defects in leukocyte adhesion and intracellular digestion.

•  Local and systemic signs of inflammation.

•  Definition of inflammatory mediators and their classification.

•  Sources, nature and effects of inflammatory mediators: vasoactive amines, complement, kinin, and clotting systems, arachidonic acid metabolites, platelet-derived factor, cytokines and chemokines, nitric oxide, lysosomal constituents.

N 22

A 46-year-old patient B. suffers from gastric ulcer. He has been admitted as an emergency into the surgery department with a preliminary diagnosis of gastric perforation. On admission: acute pain in the epigastrial region, rigid abdomen, tenderness, signs of peritoneal irritation; body temperature 38,5 °C; the absence of bowel sounds; marked leukocytosis; an increased erythrocyte sedimentation rate. Analysis of the aspirated fluid (400 ml of opalescent fluid was evacuated during the needle drainage of the abdomen) showed the presence of a large amount of leukocytes, protein 4%, various types of bacteria including anaerobic. A plain radiograph of the abdomen demonstrated the presence of air under the diaphragm. The patient was transported to the operation room.

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