Lp5_Inflamatii nespecifice+specifice
-
Upload
alexandra-tuvene -
Category
Documents
-
view
77 -
download
0
description
Transcript of Lp5_Inflamatii nespecifice+specifice
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 1/33
INFLAMATII
NESPECIFICE
Asist. Luminita MitracheDepartamentul Anatomie Patologica, UMF “Carol Davila”
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 2/33
APENDICITA ACUTA
FLEGMONOASA
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 3/33
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 4/33
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 5/33
= infam eu!ativa purulenta ce in"ltrea#a !i$u# pereteleapen!icular %caracter fegmonos&
A!olescenti, a!ulti tineri %mai $recvent&, !ar poate saapara la orice varsta
• 'tiologie( coli)acili, sta"lococi, streptococi, germ.anaero)i !in fora comensala a colonului* !evin patogeniin con!itii !e o)structie a lumenului apen!icular%$ecaloame, calculi, tumori, para#iti, sam)uri&
• Mecanisme patogenice( o)structie + acumulareasecretiei mucoasei in lumen + p intraluminal + -!rena vv + sta#a / hipoie + inva#ie )acteriana + procesinfamator
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 6/33
Macroscopic
0 la sectionare(
1 perete ingrosat,
$ria)il
1 ulceratii alemucoasei, picheteurihemoragice
1 in lumen( puroi
2 3, e!ematiat %turgescent&,
hiperemiat %!esen vascularaccentuat&, $ria)il
0 seroasa mata, !epo#ite al)0
cenusiu !e ")rina
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 7/33
icMucoasa(
0 #one ulcerate0 esu!at ")rinoleucocitar
4estul peretelui(
0 PM5 , esu!at
0 hiperemie, hemoragie
6eroasa( ")rina / PM5
Lumen( !opulmucopurulent
2 PM5
0 piocite
0 !etritus necrotic
0 ")rina
0 hematii, mucus
0 resturi alim
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 8/33
Forme !e apen!icita7. Apen!icita acuta catarala %limitata la
mucoasa&
8. Apen!icita acuta fegmonoasa %!iseminareaprocesului infamator !incolo !e mucoasa&
9. A)cesul apen!icular %trans$ormareaapen!icelui intr0o colectie purulenta
!elimitata !e seroasa apen!icelui&:. Apen!icita gangrenoasa %necro#a
gangrenoasa a apen!icelui !atorat inva#iei!e germeni anaero)i&
;. Apen!icita per$orata %$ormarea !e traiecte
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 9/33
ENTERITA ULCERO-NECROTICA
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 10/33
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 11/33
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 12/33
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 13/33
= infam alterativa a intestinului su)tire in ca!rul careia tesutulnecro#at este in!epartat + ulceratia %=lipsa !e su)stanta la
nivelul peretelui intestinal&
• Frecvent la prematuri, persoane cu imuno!e"ciente %fora
comensala&
•
La sugari, copii %$recvent 4otavirus* A!enovirus&• >acterii inva#ive ( Camp?lo)acter euni, 6almonella, 6higella
• >acterii toigene( Clostri!ii, 6ta"lococ auriu, 'scherichia coli
Patogenic( 0 )acterii enteroinva#ive( !etermina le#iuni ale peretelui
intestinal %ulceratii&
0 )acterii enterotoigene( !etermina sin!rom !iareic care#ultat al actiunii en!otoinelor* )acteriile nu au capacitate
inva#iva si nu !etermina ulceratii
l i i ti
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 14/33
Macroscopicle#iuni @ #one necrotice
1 !epresiuni<ecavatii1 contur regulat<nereg
1 !imensiuni varia)ile
1 unice<multiple 1 a$ectare seroasa
%esu!at seros, ")rinos,hemoragic&
mucoasa e!ematiata,
hiperemiata
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 15/33
MicroscopicMucoasa (
2 pier!eri !e su)stanta muscularis mucosae
%= eulceratii&
0 in"ltrat infamator( PM5
6u)mucoasa(
2 hiperemie /<0 hemoragie
0 e!em
0 in"ltrat infamator( PM5
B /<0 in"ltrat infamator la
nivelul seroasei
Lumen(
0 !etritus necrotic
0 eu!at ")rino0leucocitar
0 hematii
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 16/33
Alte $orme !e enterite
'nterita catarala %!escuamari epiteliale, $araulceratii&
'nterita $oliculara a nou0nascutului%hipertro"a $ormatiunilor lim$oi!e&
'nterita purulenta %PM5 &
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 17/33
ABCESUL HEPATIC
i f ! ti l t i t
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 18/33
= infam eu!ativa purulenta ce se pre#inta ca o$ormatiune )ine
circumscrisaMacro(
0 $ormat. )ine circumscr.
% fegmon( in"ltrareatesutului
este !i$u#a&
0 unice<multiple %mai$recvent&
0 cavitatea a)cesului(continut
purulent %culoarea puroi !i$
$ctie!e germene&
0 mem)rana piogena( !elim
procesul supurativ
0 tesutul !in ur( hiperemiat
• 'volutie(
0 a)cesele mici se re#or)
0 a)cesele mari( puroiul se !eshi!ratea#a + cicatrice
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 19/33
Clasi"careFctie !e calea !e vehiculare a germenilor patogeni(
A. Pioemic %cale arteriala& 2 in septicemii
2 multiple
0 mici % 90: mm&
0 rotun!0ovalare
>. Pilefe)itic %cale venoasa& 2 multiple
0 mari % ;E0E mm&
0 rotun!e<neregulate
B A)cesul ChauGar! %$u#ionarea mai multor cavitati
purulente&
C. Colangitic %cale )iliara& 2 puroi !e culoare ver#uie
0 F @ “)urete im)i)at cu puroiH
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 20/33
MicroscopicIn centrul a)cesului(
PU4JIUL
2 PM5
0 piocite %PM5 alterate&
0 ")rina
0 sero#itate
0 hepatocite!egenerate
0 germeni patogeni%colonii )act. al)astru0
violet&
• Mem)rana piogena(tesut !e granulatie
0 ")ro)laste, ")rocite
0 vase !e neo$ormatie
0 in"ltrat infamator
• Kesutul !in ur (
2 hepatocite !istro"ce
0 cap. sinusoi!e !ilatate, pline cuhematii %= reactia !e hiperemie!in urul $ocarului infamator &
0 in"ltrat infamator, e!em
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 21/33
INFLAMATII
SPECIFICE
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 22/33
6IALAD'5IKA CUCIKJM'ALJ3I4U6
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 23/33
= infam acuta esu!ativa speci"ca, !at CM3 %$orma locali#ata a )oliicu inclu#ii citomegalice&
CM3 %herpes virus& = agent in$ectios ce !iseminea#a (
0 picaturi Plgger
0 intrauterin
0 perinatal
0 lapte matern 0 transplant, trans$u#ii
0 transmisie veneriana
9 perioa!e optime pt contractare vir (
2 3IU %incompati)ila cu viata, a$ectare 65C&
0 in primul an !e la nastere 0 !upa 7; ani
Clinic 0 Nsmegalie
0 pneumonie interstitiala
0 enterocolita
'volutia( !epen!enta !e imunocompetenta ga#!ei %severa laimuno!eprimati si la nou0nascuti&
Macro glan!a paroti!a 3
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 24/33
Macro 2 glan!a paroti!a 3
0 hiperemica, e!ematiata
0 usor !ureroasa
0 temperatura locala
Micro (
interstitiul ce separa acinii secretori
0 in"ltrat infamator L0P
0 vase hiperemiate, esu!at
celule para#itate cu CM3 %la nivelul !uctelor ecretorii&
2 mari
0 nucleu mare, pleomor"c !at inclu#iei nucleare virale
0 inclu#ia @ O !in nucleu, inconurata !e un halou clar,
)ine!emarcat !e mem)rana nucleara net trasata
0 /<0 mici inclu#ii )a#o"le in citoplasma
BBB Celula cu aspect !e “ in ochi !e )u$nita”<”ochi !e”
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 25/33
PI'LJ5'F4IKAMICJKICA
= infam acuta<su)acuta speci"ca pro! !e Can!i!a al)icans
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 26/33
= infam acuta<su)acuta speci"ca pro! !e Can!i!a al)icans%can!i!omico#a<monilia#a&
Can!i!a al)icans = $ung ce se gaseste in fora sapro"ta<comensala
!e la nivelul pielii, cavitatii )ucale, tract gastrointestinal, vagin
Microfora )acteriana are infuenta inhi)itorie asupra cresteriican!i!ei
Patogenic( proli$erarea $ungilor $avori#ata !e supresia microforei)acteriene %e( anti)ioticoterapie&, mo!i"cari !e ph, con!itii !eimunosupresie a ga#!ei
9 mo!uri !e im)olnavire(
0 proli$erare super"ciala %in locali#arile o)isnuite ale can!i!ei&
0 inva#ie pro$un!a %$recvent in con!itii !e imunosupresie& +
!iseminare sistemica
0 inoculare !irecta in circuitul sanguin %catetere, !iali#a, proce!uri
chirurgicale, a!ministrare !roguri intravenoase&
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 27/33
Macroscopic
microa)cese%corticala,
me!ulara,)a#inet&
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 28/33
Microscopic
PM5 / L
colonii !e can!i!a
hi$e %str tu)ulare ingrame#i, !ispo#itie
plei$orma&
spori %$ormatiunirotun!0ovoi!e, !im mici : Q&
BBB Coloratia PA6 + rosu0violaceu
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 29/33
ACKI5JMICJRAPULMJ5A4A
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 30/33
= inflam specifica a parench pulm det de Actinomyces Israelii (bacil G+, anaerob)
Actinom?ces = )acterie comensala in cavitatea )ucala, tract !igestiv,vagin
Determina in$ectii in con!itii $avori#ante( anaero)io#a, traumatisme,imunosupresii
Forme clinice(
0 Cervico$aciala( !e)utea#a !e la nivelul gingiei + tume$actii lemnoase,
!ureroase + etin!ere la piele prin traiecte "stuloase<sinusuri !e !rena
0 A)!ominala( inva#ia mucoasei intestinale + penetrarea peretelui
intestinal + a)cese peritoneale, retroperitoneale, perete a)!ominalanterior + "stuli#ea#a la tegument.
Pot !isemina hematogen sau prin contiguitate in F + a)cese hepatice,su)!ia$ragmatic + a)cese intratoracice.
BBB Contraceptivele mecanice %sterilete& + $orme pelvice
0 Koracica
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 31/33
Macroscopic Apare in ca!rul actinomico#ei toracice
Patogenic(
0 aspiratie %!e la nivelul cavitatii)ucale&
0 etensie su)!ia$ragmatica
0 hematogen
A)cese cu un continut @ “granulelor!e sul$ur”
Kin! sa "stuli#e#e in pleura + empiem%acumulare !e puroi intre $oitelepleurei&
'ro!area coaste, stern, coloanaverte)rala
Poate "stuli#a spre pericar!
Le#iunile !istrictive locale suntasociate cu stare generala )una tuse hemopti#ie
Kratament( anti)iotice
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 32/33
Microscopic 4A5ULJM
0 in centru( colonia )act“in soare care ar!e”
$orma si !im !i$
"lamente !ispusera!iar<stelat “in spite
!e roata”
0 PM5
0 macro$age
0 rare celule gigante
multinucleate
7/21/2019 Lp5_Inflamatii nespecifice+specifice
http://slidepdf.com/reader/full/lp5inflamatii-nespecificespecifice 33/33