inflammation laboratory 1people.upei.ca/smartinson/inflammation_lab_1.pdfacute inflammation –...
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Inflammation – Laboratory 1
Shannon Martinson: http://people.upei.ca/smartinson
VPM 152: February 2012
Lab1 Emphasis: • The exudates of
acute inflammation • Descriptions • Morphologic
Diagnoses
Describing Lesions – tell me what’s abnormal!
IMP
OR
TAN
CE
• This is simply stating what you see that is abnormal • When you describe something - I should be able to
make a morphologic diagnosis without ever seeing the sample!
Distribution Spatial arrangement of the lesions : random, focal, multifocal, coalescing, diffuse, symmetrical, etc
Contour and shape Raised, depressed, round, square, irregular
Colour
I’m pretty sure you know what these are…
Size Size of the lesions, increases/decreases in organ size
Texture / Consistency What does the surface look like and how does it feel (soft, firm, hard, friable, fluctuant, crepitous)
Describing Lesions – tell me what’s abnormal!
Creating a Morphologic Diagnosis for Inflammatory Lesions
Organ and Process Generally speaking = Organ + itis Egs: Hepatitis, Pleuritis, Nephritis, Gastritis…..
Exudate Serous, Fibrinous, Suppurative, Necrotizing, Hemorrhagic, Granulomatous
Distribution Focal, multifocal, locally extensive, coalescing, diffuse
Duration Peracute, Acute, Subacute, Chronic, Chronic-active
Severity Mild, Moderate, Severe
Fibrinous VS Fibrous!
• They are different – and represent two ends of a spectrum of change
• Acute inflammation
• Blood vessels become hyperemic and permeable
• FIBRIN leaks out
• Forms strands, sheets, loose adhesions
• Fibroblasts migrate out – organization
• New blood vessels form –granulation tissue
• Organizes into dense FIBROUS connective tissue (scar)
Fibrinous adhesions = ACUTE
• Delicate and friable strands of yellow material form loose adhesions between the parietal and visceral pleura
• Abundant clear yellow fluid fills the thorax
Fibrin
Serous fluid
This is a serofibrinous exudate
Fibrous adhesions = CHRONIC
• Sheets of pale tan to white material form firm adhesions between the visceral and parietal pleura and the diaphragm
Fibrous connective tissue
This is scarring and it is always chronic
Acute Inflammation – Exudates
Suppurative exudate = pus (made of neutrophils) It’s yellow-tinged, often smells bad, and can be watery , viscous, or crumbly
Acute Inflammation – Exudates
Hemorrhagic exudate = bloody Fibrinous exudate = friable tan-yellow material You can combine the 2: fibrinohemorrhagic
Acute Inflammation – Exudates
Mucoid exudate = gelatinous clear exudate This is typical in mild forms of inflammation
www.cfsph.iastate.edu/DiseaseInfo/ImageDB/MCF/MCF_008.jpg
Acute Inflammation – Exudates
Necrotizing - not an exudate per say Fibrinonecrotizing
Acute Inflammation – Exudates
Erosive - not an exudate per say
• Adult , MC, Lab • Limping , swelling and pain affecting the right front leg • Skin turned black and ulcerated • Swelling became marked and the dog became systemically ill
Acute Inflammation – Example
Inflammation – Example
• Upon incision and reflection of the skin, abundant viscous yellow opaque fluid exudes from the subcutis and connective tissues of the right front limb
Description?
Inflammation – Example
• Cellulitis, suppurative, locally extensive, acute, severe
Morphologic Diagnosis?
Additional Info: Disease name = Necrotizing fasciitis Etiology: Streptococcus sp (Lancefield G)
Inflammation – Case 1
• Liver from a calf • History of an umbilical abscess and swollen joints
Inflammation – Case 1
• Sheets and tags of friable tan material are loosely adhered to the hepatic capsular surface covering a large portion of the diaphragmatic surface
Description?
Inflammation – Case 1
• Hepatitis, fibrinous, locally extensive, acute, severe
Morphologic Diagnosis?
Technically speaking this is peri-hepatitis, a form of peritonitis, because the liver itself is not inflamed – common finding in sepsis!
Inflammation – Case 2
• Heart from a calf • History of an umbilical abscess and swollen joints
Inflammation – Case 2
Description?
• Sheets and tags of friable tan material are loosely (to firmly) adhered to the entire epicardial surface
Inflammation – Case 2
Morphologic Diagnosis?
• Pericarditis (epicarditis), fibrinous, diffuse, (sub)acute, severe
Inflammation – Case 3
• Limb (joint) from a lamb • The syringe contains material collected from the joint
Inflammation – Case 3
Description?
• The stifle joint is distended containing friable tan-yellow material and viscous yellow fluid (in the syringe). Similar material dissects the surrounding soft tissues.
• Fibrosis expands the joint capsule and surrounds the exudate
Inflammation – Case 3
Morphologic Diagnosis?
• Arthritis and periarthritis, fibrinosuppurative, diffuse (stifle), chronic, severe
Inflammation – Case 4
• Abomasum from a calf
Inflammation – Case 4
Description?
• Scattered multifocally within the abomasal mucosa are round to irregular, slightly depressed areas of pale discolouration and mucosal roughening (erosions/ulcers) with a surrounding thin dark rim (hemorrhage).
Inflammation – Case 4
• Abomasitis, erosive/ulcerative, multifocal to coalescing , acute, severe
Morphologic Diagnosis?
Inflammation – Case 5
• Liver and umbilicus from a calf • The syringe contains material collected from umbilical vein
Inflammation – Case 5
Description?
• Near the umbilicus, the umbilical vein is markedly distended and contains yellow tinged viscous opaque fluid
• The wall of the umbilical vein is thickened
Inflammation – Case 5
• Omphalophlebitis, suppurative, segmental, acute /subacute severe
Morphologic Diagnosis?
Inflammation – Case 6
• Small intestine from a snake
Inflammation – Case 6
Description?
• Throughout the length of this segment of SI, there is thickening of the wall, roughening of the serosal surface and replacement of the mucosa by an adherent layer of friable tan material. When removed, this leaves a raw ulcerated mucosa. Deeper in the wall, hemorrhage and edema are present.
Inflammation – Case 6
• Enteritis, fibrinonecrotizing, segmental, acute, severe
Morphologic Diagnosis?
Inflammation – Case 7
• Stomach from an adult cat
Inflammation – Case 7
Description?
• In the body of the stomach, near the pylorus, the mucosal surface is locally bright red with a roughened granular appearance. The affected area measures ~ 4 x 4 cm.
Inflammation – Case 7
• Gastritis, hemorrhagic, locally extensive, acute severe
Morphologic Diagnosis?
Inflammation – Case 8
• Uterus from a dog
Inflammation – Case 8
Description?
• The walls of the uterine horns are diffusely thickened and the lumen is distended containing viscous yellow tinged opaque fluid.
Inflammation – Case 8
• Pyometra, (Suppurative endometritis), diffuse, acute, severe
Morphologic Diagnosis?
Inflammation – Case 9
• Lungs from a cow
Inflammation – Case 9
Description?
• Covering the lungs, especially the cranioventral lung fields, is a thin layer of friable yellow material
• The underlying lung is dark red to green-tinged, firm and consolidated
Inflammation – Case 9
Description?
• On cut section the lung lobules are pale and dry and the interlobular septa are mildly expanded by pale yellow-tan material
Inflammation – Case 9
• Pleuritis, fibrinous, locally extensive, acute, severe • Necrotizing bronchopneumonia, locally extensive, acute,
severe
Morphologic Diagnosis?
Questions?