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Case 6: Tuberculosis > Anat Path: Tuberculosis > Flashcards

Anat Path: Tuberculosis Flashcards

1
Q

What is characteristic of tuberculosis

A

Granuloma formation

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2
Q

What is the appearance of a granuloma

A

Localised collection of epitheloid macrophages, central caseous necrosis, Langerhans type giant cells w/ rim of lymphocytes and fibroblast

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3
Q

What is the 2 types of tuberculosis

A

Primary
Secondary

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4
Q

What is primary TB

A

No previous exposure usually at childhood

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5
Q

What is characteristic of primary TB

A

Gohn complex: Ghon focus & lymphadenopathy

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6
Q

Where is the Ghon focus

A

At upper part of lower lobe
At lower part of upper lobe

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7
Q

What is the 5 outcomes of primary TB

A
  1. Healing
  2. Progressive primary pulmonary TB
  3. TB lobar pneumonia
  4. TB lobular/bronchopneumonia
  5. Haematogenous
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8
Q

What happens with healing of primary TB

A

Walled of by fibrosis forming granuloma

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9
Q

What is dystrophic calcification in healing of primary TB

A

Ranke complex formation
Ca deposits in necrotic tissue w/ viable bacteria

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10
Q

What is progressive primary pulmonary TB

A

Progressive infection w/ liquification of content

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11
Q

What causes progressive primary pulmonary TB

A

Superadded infection by other bacteria

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12
Q

2 ways how progressive primary pulmonary TB is spread

A

Content is cough up via bronchus
Extension via pleuritis

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13
Q

What is TB lobar pneumonia

A

Caseous matter erode into small bronchus & disseminate

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14
Q

What is the appearance of TB lobar pneumonia

A

Pyramidal/wedge shaped lesion at the base at the pleural

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15
Q

What is infected in TB lobar pneumonia

A

Whole or segments of lobe

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16
Q

What is infected in TB lobular/bronchopneumonia

A

Multi lobar & can be bilateral

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17
Q

What is TB lobular/bronchopneumonia

A

Erosion of large bronchus at hilum by enlarged lymph nodes & wide dissemination

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18
Q

What is the appearance of TB lobular/bronchopneumonia

A

Numerous small foci of cassation w/ irregular patterns (clover leaf) centered around the bronchi

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19
Q

What primary TB outcome has the highest mortality & morbidity

A

TB lobular/bronchopneumonia

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20
Q

What is the consequences of haematogenous spread

A

Bacteraemia & dissemination due to lymph nodes

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21
Q

3 ways how haematogenous spread occur

A

Erosion into blood vessels
Pulmonary arteries causing widespread via lungs
Pulmonary vein causing spread through body

22
Q

What is the 3 consequences of haematogenous spread

A

Incidental bacteraemia
Miliary TB
Organ TB

23
Q

What is incidental bacteraemia

A

Spread via thoracic duct to high oxygen zones (apex of lungs)

24
Q

What is miliary TB

A

Erosion into blood vessels & widespread haematogenous forming single granuloma with caseation
Can be pulmonary, extra pulmonary & subacute

25
Q

What is organ TB

A

Single organ or organ system involved
Primary site is usually healed

26
Q

What is secondary TB

A

Previous exposure or reactivated/re exposed

27
Q

What is the appearance of secondary TB

A

Extensive caseation & cavity formation at apex of upper lobe & w/ little lymphadenopathy

28
Q

What is 6 secondary pulmonary TB outcomes

A
  1. Healing & fibrosis
  2. Local pulmonary spread
  3. Progressive fibrocaseous disease
  4. Miliary TB
  5. Pericarditis
  6. Swallowed
29
Q

What is 3 local pulmonary spread in secondary pulmonary TB

A

TB pneumonia that erode small bronchus
Bronchiectasis making cavities & obstructions
Extend to pleura causing pleural effusion, empyaema & fibrous pleuritis

30
Q

What is progressive fibrocaseous disease

A

Granuloma w/ surrounding fibrosis

31
Q

What is 3 consequences of swallowed secondary pulmonary TB

A

Laryngeal
Gastric
Intestine

32
Q

What is extra pulmonary TB & how is it spread

A

Multi system disorder
Spread direct, lymphatics, haematogenous or transcoelomic

33
Q

What 3 serous cavities are involved in extra pulmonary TB

A

Pleural
Pericardial
Peritoneal

34
Q

What is 5 types of pleural involvement in extra pulmonary TB

A

Effusion
Empyema
TB/fibrinous pleuritis
Bronchopleural fistula

35
Q

What is 2 types of pericardial cavities extra pulmonary TB & how did it spread

A

Direct content form lymph nodes or lungs
Pericardial effusion
Constrictive pericarditis

36
Q

What is a type of peritoneal cavities extra pulmonary TB & 2 ways it spread

A

Direct contact from lymph node or diaphragm
Transcoelomic
TB ascites

37
Q

What is nodal TB

A

Lymph spread from involved organ or draining region

38
Q

What is the order of lymph node involvement in nodal TB

A

Cervical, inguinal & axillary

39
Q

What is the 2 types of GIT TB

A

Primary due to TB bovis (unpasteurized milk)
Secondary due to swallowing or miliary/subacute TB

40
Q

Where is the GIT TB

A

Terminal ileum causing necrotising granuloma w/i Peyers patches

41
Q

What occur at healing of GIT TB

A

Fibrosis that cause obstruction

42
Q

How is TB spread to the kidneys

A

Due to miliary TB

43
Q

How is TB spread in the kidneys

A

First cortex then medulla & papilla, pelvis & ureters causing pyelonephritis

44
Q

2 ways in which kidneys are involved secondary in extra pulmonary TB

A

Membranous glomerulonephritis
Renal amyloidosis

45
Q

What is the consequences of genital tract being involved in TB

A

Infertility

46
Q

What 3 parts of the genital tract is involved w/ TB

A

Endometrium
Fallopian tubes (fibrosis & tubular damage)
Epididymis & testes that spread to prostate & testes

47
Q

How is TB spread to the brain

A

Haematogenous spread

48
Q

What is it called when TB spreads to vertebrae

A

Potts disease

49
Q

What is the consequenceof TB in the brain

A

Increased intracranial pressure causing endarteritis

50
Q

What is the 3 types of CNS involvement in TB

A

TB meningitis & meningoencephalitis
Tuberculoma
Single or multiple intraparenchymal mass lesions w/ caseous necrosis

Case 6: Tuberculosis (5 decks)

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