Medicine is a dynamic area of human knowledge but nevertheless,

it is based on strong tradition.

Traditionally, medical students start the studies of inflammation from its components,

signs, and stages, and that is the topic of the next part of my talk.

Traditionally,

all books write about components of inflammation,

and traditionally, three components of inflammation are delineated,

alteration, exudation and proliferation.

Let me emphasize that the components of inflammation are not stages.

In some old texts,

they are called stages but stage is something which must end,

and only after that next stage will come.

And if you really look at this picture,

you can see that through the whole dynamic of inflammatory process,

these three components can be observed in parallels.

So these are not stages because they go in

parallel through the major duration of the process.

But, of course, it would be correct to say that inflammation

always starts with alteration with cell damage.

And if we will take the final period of inflammation,

there is always predominance and

the preponderance of proliferation and reparative process.

Although cell proliferation takes place at the periphery

of inflammatory focus from the very beginning of process.

So three components: alteration,

which is starting component, exsudation,

which prevails in first period of inflammation, and proliferation,

which is a banner of reparative process in the end of acute inflammation.

Also, it is traditional to to

name five major signs of inflammation.

You can see them in this joke picture taken from Willoughby and Spector pathology as

five antique outlets supporting the fronton of Inflammation Temple.

And these are calor or local heat,

rubor or local redness,

tumor or local edema,

dolor or local pain and final manifestation added to these four in the 19th century,

functio laesa, or functional disorder.

Four first manifestations were a point

by antique Greek-Roman physicians,

Andreas Vesalius and Claudius Galen,

and the fifth one was added by Willoughby Sometimes,

if the location of inflammation is superficial,

you can observe all five manifestations very brightly like dermatitis,

in stomatitis, in well, ophthalmitis and so on.

But you know,

many inflammatory diseases are located deep inside the body in inner organs.

For example, pituitary is quite properly hidden and protected by nature.

It is in the skull,

in the depth of the brain,

covered with hemisphere area,

and it is very difficult to have access to pituitary even in neurosurgery.

And, of course, pituitary is not observable visually, externally.

So, for the organs like pituitary,

adrenals with longer Hans islets,

which are deep inside,

these calor, rubor, dolor,

tumor maybe not very actual and not very informative,

but functio laesa, disorder or function,

may be a single manifestation of inflammation for

small inner organs in clinical medicine.

They are clinically displayed.

I mean, inflammation of the organs like hypophysitis, adrenalitis, insulitis.

They may be manifested only and exclusively in functio laesa like in adrenalitis.

You have hypocortisolism and Addison's Disease.

In insulitis, you have lack of insulin and the sugar diabetes.

In the hypophysitis, you may have multi-hormonal disorder and,

you know, it can be a single clinical manifestation.

So always expect inflammation,

always take into account its possibility.

Even if you cannot see redness,

if you cannot see tumor,

percept calor, even if a patient has not complained

of dolor because functio laesa may be a single manifestation.

Many things in pathology do not seem to be inflammation,

and they have no typical names,

but nevertheless, they actually belong to inflammation.

As a rule in Latin medical terminology,

inflammation is designated as is it.

It is bronchitis, alveolitis-

Stomatitis, dermatitis, gastritis, everyone will agree that it is inflammation.

But you know mechanical injury, burn, frostbite, abscesses,

all these are also all forte of inflammation although they

have no that "itis" in their names.

So, even if you read in case historic bronchial asthma,

you must understand that it is just conventional name,

traditional name, for a process which is

chronic relapsing, distal, eosinophilic bronchiolitis.

Medical doctors are lazy.

It is too long, chronic,

distant relapsing, eosinophilic bronchitis.

They just write in case here as bronchial asthma period.

It does not mean that bronchial asthma is inflammation

although it has not this "itis" in the name.

So, very many things with different names like nephrotic syndrome,

like lupus erythematosus, like scleroderma,

like phlegmon, like toxidermia.

All their diseases are inflammations although they have not that famous "itis".

"Itis" is familiar to many first year students.

So, inflammation always accompany very many processes.

For example, it always surrounds the forte of infraction,

the forte of stroke.

Although infarction and stroke have different names,

please do not let the name to deceive you.

Every type of shock is accompanied with

excessive production of inflammatory mediators in perishing cells.

And these inflammatory mediators penetrate into

systemic circulation and that's why in every shock patient,

in fact, we have systemic action of inflammatory mediators.

No one does not use the term organismitis or inflammation of the whole body.

It sounds funny but if you will look on

the manifestations in different organs of a shock patient,

you may relate mechanisms of

circulatory shock with systemic action of inflammatory mediators.

Such various phenomena as graft rejection in

transplantology or a placentogenesis in normal,

healthy pregnant lady, they belong to inflammation.

In fact, specific kind of inflammation is a basis for placentogenesis.

So, their domain of inflammation is much broader than common people think.

Not only "itis" is inflammation but

many pathological and even some normal phenomena depend on inflammation.

Any allergic reaction is nothing but hyperallergic,

poorly regulated, or misaimed inflammation.

There is no special process in pathology called allergy.

Allergy is not typical pathological process of separate kind.

It is just exaggerated hyperallergic harming

inflammation caused by poorly regulated immune response.

So, please understand the broad meaning of inflammation.

There is a complex of symptoms displayed in many severely critically ill patients.

It is called general intoxication.

For example, you can see these manifestations of severe character in sepsis patient,

in patient with severe combined trauma.

But in fact, intoxication is always concrete.

It depends on concrete poison.

There is no general intoxication.

And now, this old term is substituted in medicine by the term

systemic inflammatory response syndrome.

So, we understood finally that all that severe general symptoms,

they depend on systemic action of the same inflammatory mediators.

That's why you should be ready that very many diseases are

inflammatory although it is not

obvious from the first glance from the sounding of their names.

For example, atherosclerosis.

You have no "itis" in that name, but in fact,

atherosclerosis has much common with

chronic arthritis caused by pathological lipoproteins.

Even metabolic syndrome, the disease

invasion in the world in the beginning of 21st century,

metabolic syndrome, which sounds as not related to inflammation.

In fact, many aspects of pathogenesis of

chronic metabolic syndrome depend on the action of inflammatory mediators.

That's why very broad term but not endlessly broad, there are limits,

and sometimes in medicine vice versa,

the processes which are irrelated to inflammation are misnamed under inflammatory names.

A good example is so called myelitis.

Myelitis is a term from neurology.

And for a long time,

it was called myelitis because neurologists believe

that the syndrome is a result of inflammation of spine.

But in fact, it is a result of

ischemia and stroke in spine.

In cosmetology, in the field or cosmetics,

sometimes they use the term cellulitis,

and patient believes that it is inflammation because it sounds like inflammation.

But in reality, cellulitis is absolutely irrelated with any inflammations.

It is a result of hypothyroid dermopathy, non-inflammatory metabolic process.

So, sometimes, you learn the things far from inflammation

are called or misled in inflammatory terms.

That's why you need to be correct.

Sometimes, as you can see from my examples,

many pathological phenomena irrelate to

inflammation but misnamed with inflammatory terms.

You should be careful in your medical thesaurus.

Like William Shakespeare mentioned,

a rose, what's in a name?

A rose, by any other name,

would smell as sweet but first of all,

modern medicine is a science of correct terms.

5_2 "Components of Inflammation"

General Pathophysiology

Meet the Instructors