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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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