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Pathomorph - CREDIT 3 > Inflammation 1 - DONE > Flashcards

Inflammation 1 - DONE Flashcards

1
Q

What is an inflammation?

A

It is a complex reaction in the vascularized tissues which is provoked by the injurious stimuli (infections, trauma, physical and chemical agents etc)

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2
Q

What is unique feature of the inflammatory process?

A

reaction of blood vessels, leading to the accumulation of fluid and leukocytes in extravascular tissues

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3
Q

In the inflammatory response are involved:

A
  • intravascular cells
  • connective tissue cells
  • connective tissue matrix
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4
Q

Intravascular cells:

A
  • neutrophils
  • monocytes
  • eosinophils
  • lymphocytes
  • basophils
  • platelets
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5
Q

Connective tissue cells:

A
  • mast cells
  • fibroblasts
  • resident macrophages
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6
Q

Connective tissue matrix:

A
  • structural proteins (collagen, elastin)
  • glycoproteins (fibronectin, laminin)
  • proteoglycans
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7
Q

What is inflammation divided into?

A

it is divided into acute and chronic patterns

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8
Q

What is the main characteristic of acute inflammation?

A

its main characteristics are the exudation of fluid and plasma proteins (edema) and the emigration of leukocytes, predominantly neutrophils.

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9
Q

Acute inflammation speed:

A

is rapid in onset and is of relatively short duration, lasting minutes, several hours, or a few days

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10
Q

A.i. has three major components:

A
  1. Alteration in vascular caliber that leads to an increase in blood flow
  2. Structural changes in microvasculature that permit the plasma proteins and leukocytes to leave the circulation
  3. Emigration of leukocytes and their accumulation in the
    focus of injury
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11
Q

Morphology of inflammation is classified into 3 categories:

A

I. Damaging (destructive)
II. Exudative
III. Productive (proliferating)

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12
Q

What is the exudative inflammation most commonly?

A

it is most commonly acute inflammation.

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13
Q

Depending upon the character of exudate following types of e.i. are distinguished:

A
  • Serous inflammation
  • Fibrinous inflammation
  • Purulent (suppurative) inflammation
  • Haemorrhagic inflammation
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14
Q

What does the fibrinous inflammation involve?

A

it may involve serous and mucous membranes

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15
Q

What characterizes fibrinous inflammation?

A

it characterized by exudation of large amounts of plasma proteins including fibrinogen, that results in precipitation of fibrin masses

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16
Q

FP =

A

Fibrinous Pericarditis

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17
Q

What may FP accompany

A

FP may accompany myocardial infarct (pericarditis epistenocardiaca) or follow it, myocardial injury due to cardiac surgery or trauma

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18
Q

What is FP seen with

A
  • uraemia
  • rheumatic fever
  • systemic lupus erythematosus
  • pneumonia and pleuritis
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19
Q

Fibrinous pericarditis Ma:

A

fibrin forms grayish white masses which we can see on visceral or parietal pericardium

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20
Q

Fibrinous pericarditis Mi:

A
  • fibrin is seen as a homogenous eosinophilic deposits

- the fibrin- homogenous, eosinophilic (pink) masses

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21
Q

What is “pus”?

A

An exudate rich in leukocytes (mostly neutrophils) is called „pus”.

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22
Q

How is the consistency of pus?

A

thick, viscid, creamy, yellowish.

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23
Q

What does the pus contain?

A

It contains the proteolytic enzymes, bacteria, necrotic cells and remnants of broken-down tissues.

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24
Q

Purulent inflammation may be:

A
  • Superficial

- Profound (Deep)

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25
Q

Superficial:

purulent inflammation

A

– the accumulation of pus in an original (physiological)
space, like serous cavities (e.g. pleural cavity) or in cavitary organs
(gallbladder, uterus ect) is called „empyema”

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26
Q

Profound (Deep) types:

purulent inflammation

A

►Circumscribed (localized) type

►Diffuse type:

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27
Q

►Circumscribed (localized) type:
Profound (Deep)
(purulent inflammation)

A
  • a focus of circumscribed, deep purulent inflammation is called „abscess” or „apostema”.
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28
Q

►Diffuse type:
Profound (Deep)
(purulent inflammation)

A
  • deep diffuse p.i. – „phlegmon”.
  • It develops in loose connective tissue like that of subcutis, retroperitoneal space, mediastinum, wall of vermiform appendix
29
Q

Abscess def #1:

A

Abscess means the accumulation of pus in a pathologic cavity formed by action of proteolytic enzymes of granulocytic origin.

30
Q

Abscess def #2:

A
  • Abscess is a deep localized purulent inflammation.
  • It is defined as a accumulation of pus in a pathological cavity formed by action of enzymes of NEUTROPHILIC or BACTERIAL origin.
31
Q

STUDY THIS:

A
  • At the beginning the pathogens (pyogenic bacteria) cause focal necrosis and attract granulocytes. This action results in an accumulation of neutrophils which is initially hard and painfulimmature abscess. It is solid and we can’t evacuate it by incision or punction.
  • Gradually, the i.a softens - the neutrophils break down and release their lytic enzymes whose action dissolves solid mass and transforms it into fluent pus- mature abscess- cavity is filled with a fluid pus- it can be evacuated- „Ubi pus, ibi evacua” -“where there is pus, there evacuate it”.
32
Q

The pyogenic organisms may reach the liver by:

A
  • the portal vein if focus of infection is present within abdominal cavity (e.g. appendicitis)
  • hepatic artery, in the course of systemic bacteriaemia; source of infection is frequently present in inflamed cardiac valves (bacterial endocarditis)
  • ascending infection in the biliary tract
  • direct invasion of the liver from a nearby source or a penetrating injury.
33
Q

Liver abscesses may occur as……

A

solitary or multiple lesions, ranging in size from mm to massive lesions many cm in diameter.

34
Q

Multiple abscesses of the liver are usually……

A

subsequent to arterial blood infection or severe biliary tract obstruction

35
Q

Multiple hepatic abscess (Ma)

A

numerous, whitish foci

36
Q

Multiple hepatic abscess (Mi)

A

the presence of a number of round accumulations of neutrophils in otherwise unchanged hepatic parenchyma

37
Q

What does „Phlegmon” mean?

A

„Phlegmon” means a diffuse, deeply spread, purulent inflammation which is present in the loose connective or adipose tissue

38
Q

When do people usually get phlegmon?

purulent appendicitis

A

any age, most frequently in second and third decades

39
Q

What causes phlegmon?

A

It results from bacterial infection facilitated by obstruction of the appendiceal lumen (faecalith 80%, gallstones, tumors, worms)

40
Q

What are the clinical signs of phlegmon?

A
  • abdominal pain
  • vomiting
  • fever
  • leucocytosis
41
Q

Purulent appendicitis (Ma):

A
  • appendix is usually distend with serosal surface covered by purulent exudate.
  • the lumen is filled by pus.
  • faecaliths are frequently evident
42
Q

Microscopical examination of purulent appendicitis:

A
  • it reveals abundant infiltration of mucosa, submucosa, muscularis and serosa by neutrophils.
  • Serosa is covered by fibrinosuppurative exudation (fibrin masses with marked admixture of neutrophils).
  • Microabscesses of mucosa may break and leak their content into appendiceal lumen that gives raise to ulcerations of mucosa.
43
Q

Acute inflammation:

A

mainly is manifested by vascular changes, edema and largely neutrophilic infiltration

44
Q

Chronic inflammation:

A

it is inflammation of prolonged duration in which active inflammation, tissue destruction and repair events are proceeding simultanously.

45
Q

Chronic inflammation is characterized by:

A

mononuclear infiltration, tissue destruction and healing by connective tissue replacement of damaged tissue (fibrosis, angiogenesis)

46
Q

Ch.c. =

A

Chronic cholecystitis

47
Q

Who is most commonly affected by chronic cholecystitis (Ch.c.)?

A

middle-aged and elderly obese women

48
Q

What is associated with cholelithiasis in 90% of cases?

A

chronic cholecystitis (Ch.c.)

49
Q

What is associated with 90% of chronic cholecystitis (Ch.c.) cases?

A

cholelithiasis

50
Q

Cause of chronic cholecystitis (Ch.c.):

A

May follow acute cholecystitis but may develop in the

apparent absence of acute attacks.

51
Q

What may develop in the course of chronic cholecystitis?

A

In the course of chronic cholecystitis acute changes for

example empyema, hydrops may develop

52
Q

Chronic cholecystitis (Ch.c.) (Ma):

A
  • gallbladder may be diminished, normal in size or distended.
  • Fibrosis results in thickening and firm consistency of the wall
53
Q

Chronic cholecystitis (Ch.c.) (Mi):

A
  • Infiltration of mononuclear cells (mainly lymphocytes), fibrosis is evident.
  • Sometimes we can see atrophy of mucosa
54
Q

Granulomatous inflammation:

A

It is a distinctive pattern of chronic inflammatory response in which the predominant cell type is an activated macrophage with a modified epithelial-like (epithelioid) appearance.

55
Q

What is granuloma?

A

it is a focal area of granulomatous inflammation

56
Q

G.i. is encountered……

A

in a limited number of infectious and some noninfectious conditions

57
Q

Immune granulomas e.g.:

A
  • tuberculosis (the prototype of the granulomatous diseases)
  • sarcoidosis
  • cat-scratch disease
  • leprosy
  • brucellosis
  • syphilis
  • some mycotic infections
  • berylliosis
  • reactions of irritant lipids
  • some autoimmune diseases (e.g. Crohn disease)
58
Q

Foreign body granulomas:

A
  • are incited by foreign bodies.
  • Typically, foreign body granulomas form around material such as talc, sutures, splinters.
  • The foreign material can usually be identified in the center of the granuloma.
59
Q

What does the granuloma consist of?

A
  • It consists of the aggregation of macrophages that are transformed into epithelial-like cells surrouded by mononuclear leukocytes, principally lymphocytes and occasionally plasma cells.
  • Frequently epithelioid cells fuse to form giant cells in the periphery or in the centre of granuloma. *
  • The giant cells contain 20 or more nuclei arranged peripherally (Langhans-type) or haphazardly (foregin body-type) *
60
Q

Langhans-type giant cell:

A

The giant cells contain 20 or more nuclei arranged peripherally (Langhans-type)

61
Q

Foregin body-type giant cell

A

The giant cells contain 20 or more nuclei arranged haphazardly

62
Q

Where does the epithelioid cells fuse to form giant cells?

A

Frequently epithelioid cells fuse to form giant cells in the periphery or in the centre of granuloma.

63
Q

WITH NECROSIS (Caseating granulomas):

A
  • tuberculosis
  • brucellosis
  • syphilis
64
Q

WITHOUT NECROSIS (Non-caseating granulomas):

A
  • sarcoidosis
  • leprosy
  • Crohn disease
  • berylliosis
65
Q

Haematogenous dissemination of tubercule bacili induces synchronous formation of small focal lesions which in dependence on the host reactivity may have form of:

A
  • Necrotic foci with any reaction

- Typical granulomas with low dosage of microorganisms - Granulomas undergoing caseous necrosis

66
Q

Pulmonary miliary tuberculosis (Ma):

A
  • numerous, small nodules.

- their consistency depends upon the presence of necrosis.

67
Q

Pulmonary miliary tuberculosis (Mi):

A
  • granulomas
  • central part is consisted of areas of caseous necrosis
  • large epithelioid cells with indistinct borders, oval nuclei and abundant cytoplasm
  • Langhans cells: giant cells with multiple nuclei in the periphery
  • Granulomas are surrounded by a rim of lymphocytes.
68
Q

Tuberculosis (text under a picture)

A
  • A characteristic tubercle at low magnification (fig. A) and in detail (fig. B) illustrates central caseation surrounded by epithelioid and multinucleated giant cells.
  • This is the usual response seen in patients who have developed cell mediated immunity to the organism.

Pathomorph - CREDIT 3 (2 decks)

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