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INFLAMATII

NESPECIFICE

Asist. Luminita MitracheDepartamentul Anatomie Patologica, UMF “Carol Davila”

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APENDICITA ACUTA

FLEGMONOASA

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= 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

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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

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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

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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

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ENTERITA ULCERO-NECROTICA

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= 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

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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

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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 

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Alte $orme !e enterite

'nterita catarala %!escuamari epiteliale, $araulceratii&

'nterita $oliculara a nou0nascutului%hipertro"a $ormatiunilor lim$oi!e&

'nterita purulenta %PM5 &

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ABCESUL HEPATIC

i f ! ti l t i t

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 = 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

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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

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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

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INFLAMATII

SPECIFICE

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6IALAD'5IKA CUCIKJM'ALJ3I4U6

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= 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

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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”

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PI'LJ5'F4IKAMICJKICA

= infam acuta<su)acuta speci"ca pro! !e Can!i!a al)icans

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= 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&

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Macroscopic

 microa)cese%corticala,

me!ulara,)a#inet&

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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

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ACKI5JMICJRAPULMJ5A4A

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 = 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 

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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

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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

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