2. Acute Inflammation

Question 1

Acute appendicitis

Answer 1

caused by a blockage of the hollow portion of the appendix,most commonly by a calcified “stone” made of feces. However inflamed lymphoid tissue from a viral infection, parasites, gallstone or tumors may also cause the blockage.
This blockage leads to increased pressures within the appendix, decreased blood flow to the tissues of the appendix, and bacterial growth inside the appendix causing inflammation.
The combination of inflammation, reduced blood flow to the appendix and distention of the appendix causes tissue injury and tissue death.

If this process is left untreated, the appendix may burst, releasing bacteria into the abdominal cavity, leading to severe abdominal pain and increased complications.

Question 2

Bacterial meningitis

Causative organisms

Answer 2

The types of bacteria that cause bacterial meningitis vary according to the infected individual’s age group:

In premature babies and newborns up to three months old, common causes are group B streptococci and bacteria that normally inhabit the digestive tract such as Escherichia coli. Listeria monocytogenes (serotype IVb) may affect the newborn and occurs in epidemics.

Older children are more commonly affected by Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae and those under five by Haemophilus influenzae type B (in countries that do not offer vaccination).

In adults, Neisseria meningitidis and Streptococcus pneumoniae together cause 80% of bacterial meningitis cases. Risk of infection with Listeria monocytogenes is increased in persons over 50 years old.

The introduction of pneumococcal vaccine has lowered rates of pneumococcal meningitis in both children and adults.

Question 3

Ascending cholangitis with liver abscess

Answer 3

Ascending cholangitis or acute cholangitis is an infection of the bile duct (cholangitis), usually caused by bacteria ascending from its junction with the duodenum (first part of the small intestine).

It tends to occur if the bile duct is already partially obstructed by gallstones.

Cholangitis can be life-threatening, and is regarded as a medical emergency. Characteristic symptoms include yellow discoloration of the skin or whites of the eyes, fever, abdominal pain, and in severe cases, low blood pressure and confusion.

Initial treatment is with intravenous fluids and antibiotics, but there is often an underlying problem (such as gallstones or narrowing in the bile duct) for which further tests and treatments may be necessary, usually in the form of endoscopy to relieve obstruction of the bile duct.

Question 4

Hereditary angio-oedema

Answer 4

Hereditary angioedema (types I, II and III) (also known as “HAE”) is a rare, autosomal dominantly inherited blood disorder that causes episodic attacks of swelling that may affect the face, extremities, genitals, gastrointestinal tract and upper airways.

Swellings of the intestinal mucosa may lead to vomiting and painful, colic-like intestinal spasms that may mimic intestinal obstruction.

Airway edema may be life-threatening. Episodes may be triggered by trauma, surgery, dental work, menstruation, some medications, viral illness and stress; however, this is not always readily determined.

Question 5

Alpha 1 antitrypsin deficiency

Answer 5

is a genetic disorder that causes defective production of alpha 1-antitrypsin (protease inhibitor; protecting tissues from enzymes of inflammatory cells)

leading to decreased A1AT activity in the blood and lungs, and deposition of excessive abnormal A1AT protein in liver cells.

There are several forms and degrees of deficiency, mainly depending on whether the sufferer has one or two copies of the defective allele because it is a co-dominant trait.

Severe A1AT deficiency causes panacinar emphysema or COPD in adult life in many people with the condition (especially if they are exposed to cigarette smoke). The disorder can also lead to various liver diseases in a minority of children and adults, and occasionally more unusual problems.

It is treated by avoidance of damaging inhalants, and in severe cases by intravenous infusions of the A1AT protein or by transplantation of the liver or lungs. It usually produces some degree of disability and reduced life expectancy.

Question 6

Chronic granulomatous disease

Answer 6

(Bridges–Good syndrome, Chronic granulomatous disorder, and Quie syndrome)
a diverse group of hereditary diseases in which certain cells of the immune system have difficulty forming the reactive oxygen compounds (most importantly, the superoxide radical) used to kill certain ingested pathogens. This leads to the formation of granulomata in many organs.

Question 7

Lobular pneumonia

Answer 7

a form of pneumonia that affects a large and continuous area of the lobe of a lung.
one of the two anatomic classifications of pneumonia (the other being bronchopneumonia).

usually has an acute progression. Classically, the disease has four stages:
Congestion in the first 24 hours
Red hepatization or consolidation 
Grey hepatization 
Resolution (complete recovery)

The most common organisms which cause lobar pneumonia are Streptococcus pneumoniae, also called pneumococcus, Haemophilus influenzae and Moraxella catarrhalis. Mycobacterium tuberculosis, the tubercle bacillus, may also cause lobar pneumonia if pulmonary tuberculosis is not treated promptly.