MACROPREPARATION # 1 FAT LIVER DYSTROPHY
Liver incisions are visible in the specimen.
The liver is small, as it is the liver of a child. But nevertheless, the size of the liver is increased, since its capsule is tense, and the corners are rounded.
The color of the liver is yellow on the cut.
The consistency of the liver is flabby.
When such a liver is cut with a knife, droplets of fat remain on its blade.
This is parenchymal fatty degeneration of the liver, or "goose" liver.
It can develop in people suffering from chronic cardiovascular diseases, chronic lung diseases, diseases of the blood system, chronic alcoholism.
As a result of parenchymal fatty degeneration, portal, small-nodular cirrhosis of the liver may develop over time.
MACROPREPARATION # 2 BLEEDING IN THE BRAIN
A horizontal section of the brain tissue is visible in the specimen. The cerebellum is visible below and behind the brain.
In the right hemisphere of the brain, in the region of the subcortical nuclei, there is a focus of dark brown color due to the fact that in the focus of hemorrhage we see caked blood. This is a focus of hemorrhage in the necrotic tissue of the brain, with fairly clear boundaries - a hematoma. In the center of the hematoma under anaerobic conditions, the pigment hematoidin is formed, and along the periphery, on the border with healthy tissues, hemosiderin. Blood from the focus of hemorrhage broke into the anterior horn of the right lateral ventricle, into the third ventricle of the diencephalon, the Silvian aqueduct of the midbrain and into the fourth ventricle of the rhomboid brain.
Hematoma is a type of hemorrhagic stroke.
Clinically it was accompanied by the development of focal symptoms on the opposite side of the body - left-sided paresthesia, hemiplegia, hemiparesis, paralysis.
If the patient had not died, then a cyst with walls rusty from hemosiderin would have formed at the site of the hemorrhage.
MACROPREPARATION No. 3 KEPHALOGEMATOM
The preparation contains the integumentary bone of the newborn's skull. On the upper - lateral surface of the bone, under its periosteum there is caked blood of a dark brown, almost black color - this is a subperiosteal hemorrhage. This is a birth injury to the skull related to external cephalohematoma.
MACROPREPARATION No. 4 "TAMPONADA" OF THE HEART
The preparation presents a longitudinal section of the heart from the side of the left ventricle, since the thickness of the ventricular myocardium is more than 1 cm. It is noteworthy that the cavity of the left ventricle is slit-like, that is, the heart is compressed by something from the outside. The subepicardial fat layer, epicardium, pericardium are determined. In the pericardial cavity, gray-brown blood clots are visible. It is due to their presence in the pericardial cavity that the heart was compressed from all sides, and the cavity of the left ventricle became slit-like. This is bleeding into the pericardial cavity - hemopericardium, an example of internal bleeding, figuratively - "tamponade" of the heart. Attention is also drawn to the fact that in the region of the posterior - lower wall of the heart, the myocardial tissue is stained with hemosiderin in a brown color, due to the rupture of the heart wall in this place and hemorrhage from the damaged vessel. The rupture of the heart wall occurred due to myomalacia in the area of transmural myocardial infarction.
Thus, the hemorrhage in the cardiac shirt was a consequence of myomalacia and rupture of the heart wall in the area of transmural myocardial infarction.
MACROPREPARATION №5 PURULENT MENINGITIS
In the preparation, the brain is visible from the side of its upper - lateral surfaces. Under the pia mater, an accumulation of exudate is determined white - yellow color, the consistency of thick sour cream. This is a purulent exudate. The exudate lies on the surface of the convolutions, enters the grooves, smoothing the relief of the surface of the brain.
Inflammation of the soft meninges Is meningitis.
Primary purulent meningitis can occur when meningococcal infection, and secondarily it can complicate infectious diseases during the generalization of the infection (with sepsis).
MACROPREPARATIONS No. 6 BRAIN TUMOR
The preparation shows a horizontal section of the brain. In one of the hemispheres (in the left), in the white matter, there is a focus of pathological proliferation of brain tissue with indistinct contours, indistinct growth boundaries. The consistency of the node of pathological growth of brain tissue approaches the consistency of the brain itself. The color is variegated, since there are hemorrhages and necrosis in the focus. This is a brain tumor. Since the boundaries of tumor growth are indistinct, there is malignant tumor... It can be assumed that this is glioblastoma, the most common malignant tumor in adults.
MACROPREPARATION №7 OF TIBLE BONE SARCOMA
The preparation contains the bones that form the knee joint. In the area of the upper part of the diaphysis of the tibia, there is a pathological proliferation of tissue that destroys the posterior surface of the bone, which has indistinct growth boundaries. This is a tumor. It is white, layered, reminiscent of fish meat. The indistinctness of the growth boundaries indicates the malignant nature of the tumor. Malignant tumor from bone tissue- osteosarcoma. Since the process of bone destruction prevails over the process of bone formation, this is osteolytic osteosarcoma.
MACROPREPARATION №8 OF THE BRAIN ABSCESS IN SEPTICOPYEMIA
The preparation contains sections of the brain. In each section, there are multiple foci of irregular rounded shape, clearly delimited from the brain tissue by a thick wall. Filled with contents of white - yellowish or white - greenish color, consistency of thick sour cream. This is a purulent exudate.
Focal accumulations of pus, separated from the brain tissue by a wall, are abscesses.
The wall of an acute abscess consists of two layers: 1) an inner layer - a pyogenic membrane and 2) an outer layer - a nonspecific granulation tissue.
In the wall of a chronic abscess, three layers are distinguished: 1) inner - pyogenic membrane, 2) middle - nonspecific granulation tissue and 3) outer - coarse fibrous connective tissue.
Brain abscesses develop with generalization purulent inflammation in the lungs, intestines and other organs, that is, with sepsis, septicopyemia.
MACROPREPARATION No. 9 STENOSIS OF THE MITRAL OPENING (RHEUMATIC HEART DEFECTION)
The specimen presents a cross-section of the heart, produced above the level of the atrio-ventricular foramen, so that the cusps of the bicuspid, mitral and tricuspid valves are clearly visible.
The leaflets of the mitral valve are deformed. They are sharply thickened, with a tuberous surface, opaque, rigid due to the proliferation of connective tissue in them. There is a gap between the closed valve leaflets, that is, mitral valve insufficiency has developed.
In addition, there is a narrowing of the left atrio-ventricular opening.
Thus, in the area of the mitral valve there is a combined heart defect - insufficiency and stenosis of the mitral valve.
Such acquired heart defects most often form in the course of rheumatic valvular endocarditis.
The described changes in the mitral valve correspond to the stage of fibroplastic endocarditis.
It can be assumed that the patient died of progressive chronic cardiovascular failure due to decompensated rheumatic heart disease.
MACROPREPARATION No. 10 UTERINE CHORIONEPITELIOMA
The preparation contains a longitudinal section of the uterus with appendages.
The size of the uterus is increased (normally the height of the poppy is 6 - 8 cm, the width is 3 - 4 cm and the thickness is 2 - 3 cm). In the uterine cavity, the growth of tumor tissue is visualized, which grows into the myometrium, that is, invasive tumor growth takes place.
The consistency of the tumor is soft, porous, since the tumor contains absolutely no connective tissue.
The color of the tumor tissue in the preparation is gray with dark brown blotches. In a fresh preparation, it is dark red, variegated, since the tumor has cavities, lacunae filled with blood.
Based on the nature of the growth, the tumor is malignant. It develops from the epithelium of the chorionic villi (placenta). This is chorionepithelioma.
It is an organ-specific tumor. It is built of two types of cells - large mononuclear cells with light cytoplasm, or Langhans cells, derived from cytotrophoblast, and large ugly multinucleated cells, derived from synticyotrophoblast. The tumor is hormonally active. Tumor cells secrete the hormone gonadotropin found in a woman's urine; thanks to the hormone, the uterus is enlarged.
The tumor developed in connection with pregnancy. This is a differentiated tumor.
Metastasizes mainly by hematogenous route to the liver, lungs, vagina.
In the present preparation, in the area of the vaginal portion of the cervix and in the wall of the vagina, rounded foci similar in appearance to the primary tumor are visible. These are tumor metastases.
MACROPREPARATION №11 CHRONIC STOMACH ULTRA WITH PENETRATION INTO THE PANCREAS
The preparation shows a fragment of the stomach wall from the side of the mucous membrane and the pancreas located behind the stomach.
In the wall of the stomach there is an ulcerative defect with raised dense, callous, callous edges and a shallow bottom. One edge of the defect facing the esophagus, the proximal one is subdued, with an overhanging mucous membrane. The other edge, opposite, distal, is gently sloping or terraced. The difference in edges is due to the presence of a peristaltic wave.
A defect in the wall of the stomach is a chronic ulcer, since at the edges of it there was an overgrowth of connective tissue, which caused a change in the edges of the defect.
At the bottom of the ulcer, it is not the tissue of the stomach wall that is determined, but the lobular, white tissue of the pancreas.
Thus, there is an ulcerative - destructive complication of chronic gastric ulcer - penetration into the pancreas.
It can be assumed that the patient died from a spilled den.
MACROPREPARATION No. 12MUSKATNAYA LIVER
A frontal section of the liver is visible in the specimen.
The liver is enlarged.
The color of the liver tissue on the cut is variegated: areas of gray - black color (these are areas with clotted blood) interspersed with areas of gray - brown color (color of hepatocytes).
Areas of gray-black color, and in a fresh preparation - red, are caused by plethora and expansion of the central veins and the central 2/3 of the sinusoids of the liver lobules flowing into them.
Due to the similarity of the surface of the liver incision to the surface of the cross section of nutmeg, the drug got its name.
It occurs with the development of chronic venous plethora in the body, which occurs in conditions of chronic cardiovascular insufficiency, which is a complication of chronic diseases of the heart, such as mitral valve disease, myocarditis with an outcome in cardiosclerosis, chronic ischemic heart disease.
MACROPREPARATION No. 13 PROSTATE ADENOMA WITH URETEROHYDRONEPHROSIS
The preparation contains an organocomplex consisting of a longitudinal section of the kidney with a ureter, longitudinal sections of the urinary bladder and prostate.
Changes in the structure of the prostate gland entailed compensatory - adaptive changes in the structure of the overlying organs.
The prostate gland is enlarged, due to the proliferation of a tumor node in one of its lobes, rounded, with clear boundaries of growth, delimited from the prostate tissue by a connective tissue capsule. This is a benign tumor - prostate adenoma.
Due to the presence of an adenoma, the prostatic part of the urethra narrowed sharply, which led to a violation of the outflow of urine.
Working hypertrophy developed in the bladder wall. Along with wall hypertrophy, the bladder cavity expanded, that is, eccentric decompensated bladder hypertrophy developed.
The ureter, pelvis and cups of the kidney have dilated due to impaired outflow of urine - hydroureteronephrosis.
In the parenchyma of the kidney, a type of local pathological atrophy has developed - atrophy from pressure.
MACROPREPARATION №14 CENTRAL LUNG CANCER
The trachea with cartilaginous half-rings located on its front surface, the main bronchi, a part of the left lung adjacent to the left main bronchus are visible in the preparation.
The lumen of the left main bronchus is sharply narrowed due to the fact that around the bronchus in the lung tissue there is a pathological proliferation of gray - beige tissue, dense consistency, in the form of a node with indistinct growth boundaries. This is a malignant tumor growing from the epithelium of the main bronchus - lung cancer... Outside the main node of the tumor, there are multiple foci, irregularly rounded, - cancer metastases to the lungs.
Since cancer grows from the main bronchus, it is central in localization.
Since tumor growth is represented by a nodule, the macroscopic form of cancer is nodular.
Most often, the histological form of central lung cancer is squamous, the development of which is preceded by metaplasia of the glandular epithelium of the bronchi into stratified squamous non-keratinizing epithelium in the course of chronic bronchitis.
In relation to the surrounding tissues, cancer grows infiltratively.
In relation to the lumen of the main bronchus - into its wall, that is, endophytic, compressing the lumen of the bronchus.
Due to a violation of the patency of the bronchus due to its compression by a tumor in the lung tissue adjacent to the bronchus, such diseases as atelectasis, abscess, pneumonia, bronchiectasis can develop.
Lung cancer is an organ-specific epithelial tumor.
Metastasizes mainly by the lymphogenous pathway. The first lymphogenous metastases are found in the regional lymph nodes- peribronchial, paratracheal, bifurcation.
MACROPREPARATION №15 POLIPOSO - ULTRAINER ENDOCARDITIS OF THE AORTIC VALVE
We see the heart preparation in a longitudinal section from the side of the left ventricle, since its myocardium has a thickness of more than 1 cm. The cavity of the left ventricle is expanded. There is eccentric decompensated working hypertrophy of the left ventricular myocardium and tonogenic dilation.
The crescent moon of the aortic valve is changed, they are thickened, tuberous, rigid, opaque. On two of the three half-moon, an ulcerative defect is clearly visible, on the surface of which thrombotic overlays in the form of polyps have formed. Such changes I in the aortic valve crescent are called polypoid - ulcerative endocarditis, which is one of the clinical and morphological forms of sepsis.
Microscopically, microbial colonies and lime scale deposits can be detected in the thickness of these thrombotic deposits.
Complications of this process can be thrombobacterial embolism and the formation of aortic heart disease.
Since polypoid - ulcerative endocarditis has developed on the already changed aortic valve crescents, this is secondary endocarditis.
MACROPREPARATION №16 GASTRIC CANCER (Saucer-shaped form)
The preparation contains a fragment of the stomach from the side of the mucous membrane. The stomach is cut along the greater curvature.
In the area of the lesser curvature of the body of the stomach, there is a pathological proliferation of tumor tissue into the lumen of the stomach with loose raised edges and a shallow bottom. The boundaries of tumor growth are indistinct in places. At the bottom of the tumor growth, there are foci of white necrosis.
The indistinct boundaries of tumor growth and the presence of secondary changes in it in the form of foci of necrosis indicate the malignancy of the tumor.
A malignant tumor growing from the epithelium of the stomach is stomach cancer.
By localization, it is a cancer of the body of the stomach.
By the nature of its growth, it is an ecophytic - expansive cancer.
On a macroscopic basis, it is a saucer-shaped cancer.
Microscopically, it will most often be represented by a differentiated form of cancer - adenocarcinoma.
Since stomach cancer, according to the international classification of tumors, belongs to the group of organ-specific epithelial tumors, the predominant route of its metastasis will be lymphogenous. The first lymphogenous metastases can appear in the regional lymph nodes - four collectors of lymph nodes located along the lesser and greater curvatures of the stomach.
Since the stomach is an unpaired abdominal organ, the first hematogenous metastases are found in the liver.
MACROPREPARATION No. 17 ABSCEDING PNEUMONIA IN SEPTICOPYEMIA
We see a cross section of the right lung, as it contains three lobes.
In each lobe, against the background of an airy tissue of a light beige color, there are multiple foci of a rounded and irregular shape, the size of a match head, in places merging with each other, dense consistency, airless or low-air, with a smooth cut surface, white - gray. These are foci of inflammation in the lung tissue - foci of pneumonia.
A white wall is formed around some foci, and the contents of the foci become the consistency of thick sour cream. A complication of pneumonia, abscess formation, develops.
Absolute pneumonia can develop with septicopyemia, one of the clinico-morphological forms of sepsis.
MACROPREPARATION No. 18 LARGE PNEUMONIA (WITH ABSCEDING)
The preparation shows a longitudinal section of the right lung, as three lobes are visible.
The lower lobe is entirely gray, airless. The surface of its section is fine-grained.
The consistency of the lung lobe corresponds to the hepatic density.
The interlobar pleura is thickened with gray-beige filmy overlays.
it lobar pneumonia, stage of hepatization, a variant of gray hepatization.
In the lower segments of the lobe, cavities are determined, delimited from the lung tissue by the wall. These are abscess cavities.
There is one of the pulmonary complications of pneumonia - abscess formation. Its cause is the addition of a secondary purulent infection due to decreased immunity and increased fibrinolytic activity of neutrophilic leukocytes.
MACROPREPARATION # 19 SMALL-NODED LIVER CIRROSIS
A section of the liver is presented in the preparation.
The liver is reduced in size, since its corners are pointed, and the capsule is wrinkled.
On the outer surface of the liver, multiple nodes of regenerates are determined, up to 1 cm in size, making the surface of the liver non-smooth.
On the surface of the incision, the boundaries of the false lobules are clearly visible (whereas in the norm the boundaries of the hepatic lobules are not visualized) due to the proliferation of fibrous tissue in the area of the portal tracts.
This is cirrhosis of the liver.
In macroscopic form, it is small-knot. In microscopic form, it is monolobular, since the size of the false lobules corresponds to the size of the nodes - regenerates.
By pathogenesis, it is portal cirrhosis liver, in which portal hypertension develops primarily, and secondarily - hepatic - cellular insufficiency.
Such cirrhosis can develop as a result of fatty hepatosis, chronic viral hepatitis B and chronic course of alcoholic hepatitis.
MACROPREPARATION №20 UTERINE BODY CANCER
A longitudinal section of the uterus is shown.
The uterus is enlarged. It can be seen that in the uterine cavity there is a pathological proliferation of tissue with a non-smooth, papillary surface, in places with ulceration, with indistinct growth boundaries. This is a tumor growth.
The tumor develops from the endometrium, it can be seen that it grows into the wall of the uterus. This is a malignant tumor from the epithelium - cancer of the body of the uterus.
Histologically, it is represented by a differentiated form of cancer - adenocarcinoma.
The nature of tumor growth in relation to the lumen of the uterus is exophytic, in relation to the surrounding tissues - infiltrating.
It can develop as a result of atypical glandular hyperplasia of the endometrium.
It is an organ-specific epithelial tumor. Metastasizes mainly by the lymphogenous pathway. The first lymphogenous metastases are found in the regional lymph nodes.
MACROPREPARATION №21 PURULENT - FIBRINOUS ENDOMYOMETRITIS
A longitudinal section of the uterus with appendages is visible.
The uterus is sharply increased in size, its cavity is sharply expanded, the wall is thickened.
The endometrium is dirty gray in color, dull, covered with filmy beige overlays, hanging in places into the uterine cavity. In the endometrium there is an inflammatory process - purulent - fibrinous endometritis.
In addition, the inflammation has spread to the muscular membrane of the uterus, since the myometrium is dull, dirty gray in color.
Thus, in the presented preparation there is purulent - fibrinous endomyometritis, which could arise as a result of a criminal abortion and cause uterine sepsis.
MACROPREPARATION No. 22 MULTIPLE FIBROMIOMAS OF THE UTERUS
A cross section of the uterus is shown.
In the wall of the uterus, the growth of tumor tissue in the form of nodes, of different sizes, round and oval, with clear boundaries of growth, surrounded by a thick-walled capsule, is visible, which is a reflection of the expansive growth of the tumor.
The nodes located inside the wall of the uterus - intramural, lying under the endometrium - submucous, lying under the serous membrane - subserous.
The nodes are built of two types of fibrous structures - some beige fibers are smooth muscle fibers, the other gray-white fibers are connective tissue fibers. Fibrous structures have different thicknesses and go in different directions, which are manifestations of tissue atypism.
Since the tumor nodes contain a large number of connective tissue fibers, their consistency is dense.
Due to the fact that the tumor grows expansively and has only signs of tissue atypism, it is benign. A benign tumor of smooth muscle with an admixture of fibrous tissue is called fibroids.
Based on the international classification of tumors, it belongs to mesenchymal tumors.
MACROPREPARATOR No. 23 BUBBLE
The drug is represented by an uviform cluster of thin-walled vesicles adhered to each other and filled with a transparent liquid. This is a cystic mole, a benign organ-specific tumor that develops during and after pregnancy from the epithelium of the chorionic villi.
The development of cystic drift is based on hydropic degeneration of epithelial cells.
A vesicular mole is benign until it begins to grow into the wall of the uterus, into the veins. After that, it becomes malignant, or destructive. Against the background of a malignant cystic drift, a malignant organ-specific tumor of chorionepithelioma may develop.
MACROPREPARATION # 24 THROMBOEMBOLIA OF THE PULMONARY ARTERY
The drug is represented by an organocomplex: the heart and fragments of both lungs.
The heart is clipped from the side of the right ventricle, since the thickness of its myocardium is approximately 0.2 cm. The pulmonary trunk emerges from the right ventricle, which is divided into two pulmonary arteries, respectively, to the right and left lungs.
In the lumen of the pulmonary trunk and its bifurcation there are massive, heavy, dense, crumbling masses with a corrugated surface that are not attached to the walls of blood vessels. These are thromboemboli. The source of such massive thromboemboli could most likely be the veins of the lower extremities.
Located in the lumen of the trunk pulmonary artery and its bifurcation thromboembolus irritates the reflexogenic zone receptors located in the intima of the above vessels and causes the development of a pulmo - coronary reflex, which consists in an instant spasm of small bronchi and bronchioles and coronary arteries of the heart, with the development of acute cardiovascular failure and the onset of instant death.
MACROPREPARATION # 25 AORTIC ATHEROSCLEROSIS WITH ATHEROMATOSIS AND PARALLEL THROMBOSIS
The abdominal aorta in a longitudinal section and the area of bifurcation of the aorta to the common iliac arteries are presented.
The intima of the aorta is changed. It defines multiple round-longitudinal spots of white-yellow color, which are lipid deposits and proliferation of fibrous tissue. These are atherosclerotic plaques. They bulge into the lumen of the aorta, making it narrower. Below the opening of the inferior mesenteric artery, the plaques are ulcerated, atheromatous (necrotic) masses have formed on their surface, and hemorrhages have occurred.
The appearance of atherosclerotic plaques in the intima of the aorta indicates the presence of a disease of atherosclerosis, a clinical and morphological form of atherosclerosis of the aorta.
The described plaque changes correspond to the macroscopic stage of complicated lesions.
Damage to the aortic intima was one of the local prerequisites for thrombus formation. In the lumen of the abdominal aorta and in the lumen of the iliac arteries, parietal and even obstructing blood clots formed, disrupting the passage of blood through the aorta to the lower extremities.
MACROPREPARATION # 26 Small intestine lesion in case of abdominal typhus
The specimen presents the small intestine in a longitudinal section from the side of the mucous membrane.
On the mucous membrane, longitudinal oval-shaped formations are visible, protruding above the surface of the mucous membrane and having on their surface a kind of grooves and convolutions, as in the brain. These formations are pathognomonic for typhoid fever. They arose as a result of acute productive inflammation in the area of lymphatic follicles located in the submucosa of the intestine. Due to the proliferation of macrophage and histiocytic elements, the follicles increased in volume, size and began to rise above the mucosal surface.
Due to the presence of grooves and convolutions on the surface of the follicles, the first stage of typhoid fever is called cerebral swelling.
MACROPREPARATION №27 FIBROZO - CAvernous pulmonary tuberculosis
The specimen is represented by a longitudinal section of the right lung, since it has 3 lobes. Each of the lobes has cavities, large cavities with thick, non-collapsing walls. Since the walls of the cavities do not collapse, these are old, chronic cavities inherent in fibrous-cavernous pulmonary tuberculosis, one of the phases of forms of secondary pulmonary tuberculosis.
The wall of the old cavity consists of 3 layers: 1) internal - caseous necrosis; 2) medium - specific granulation tissue; 3) external - fibrous tissue.
The patient develops cor pulmonale, chronic pulmonary heart failure, tuberculous intoxication and cachexia, from which he dies.
MACROPREPARATION No. 28 LYMPHOGRANULEMATOSIS OF PARA-AORTIC LYMPHONOSES
The specimen shows the aorta in longitudinal section.
In the intima of the aorta, atherosclerotic plaques are determined.
On both sides of the abdominal aorta, above the bifurcation, sharply enlarged and because of this lymph nodes welded to each other are determined, forming "packets" of lymph nodes.
The consistency of the lymph nodes is densely elastic, the surface is smooth, the color on the cut is gray-pink.
The lymph nodes that lie on the sides of the aorta are called paraaortic.
Enlargement of the paraaortic lymph nodes and their fusion into packets occurs in lymphogranulomatosis, malignant Hodgkin's lymphoma.
MACROPREPARATION №29 ARTERIOLOSCLEROTIC NEPHROSCLEROSIS
Two whole kidneys are visible in the preparation.
Their size and weight are sharply reduced (both kidneys in humans weigh 300 - 350 g). The surface of the kidneys is wrinkled, fine-grained. The consistency of the kidneys is very dense.
This is primarily a wrinkled kidney due to the benign course of primary arterial hypertension. At the heart of wrinkling is hyalinosis and sclerosis of the capillaries of the renal glomeruli - arteriolosclerotic nephrosclerosis.
The same appearance is secondary - a wrinkled kidney, which develops as a result of chronic glomerulonephritis.
Clinically, against the background of primary and secondary contracted kidneys, chronic renal failure develops, accompanied by the development of azotemic uremia, which can be treated with chronic hemodialysis or kidney transplantation.
MACROPREPARATION №30 MILLIARY PULMONARY TUBERCULOSIS
An enlarged longitudinal section of the lung is presented.
It is clearly seen that the entire surface of the lung tissue is diffusely dotted with small, millet-sized grain, dense tubercles, light yellow in color.
The lung has this type in miliary tuberculosis, which develops in hematogenous generalized and hematogenous tuberculosis with a predominant lesion of the lungs.
Each tubercle has the following structure: in the center there is a focus of caseous necrosis, the severity of which depends on the state of the patient's immunity; it is surrounded by a cell wall of epithelioid cells, lymphocytes, plasma cells and single multinucleated cells of Pirogov-Langhans.
According to the classification of granulomas, tuberculous granulomas are infectious, specific. Specific cells of a tuberculous granuloma are epithelioid cells of hematogenous, monocytic origin, which are the most in the granuloma.
MACROPREPARATION No. 31 NODULAR GOITER
The cutaway of the thyroid gland is presented in the preparation.
Its dimensions are dramatically increased (normally weighs 25 g).
Outside surface bumpy.
On the surface of the incision, the lobular structure of the gland is distinguished, and in the lobules there are follicles of different sizes filled with a brown colloid.
Persistent increase in size thyroid gland not associated with inflammation, swelling or poor circulation in it is called goiter.
In appearance, it is a nodular goiter.
Internal structure - colloid goiter.
Most often occurs with endemic goiter, the occurrence of which is associated with a deficiency of exogenous iodine.
Despite the compensatory increase in the size of the gland, its function is reduced.
MACROPREPARATION No. 32 PIPE PREGNANCY
The fallopian tube is visible in cross section.
The pipe is sharply expanded. Its wall is thinned in places, thickened in places. In places of thickening of the wall of the tube, the tissues have a dark brown color due to hemorrhage. In the center of the tube is a human embryo, in which the head, torso, hands and fingers are clearly distinguishable. The embryo is surrounded by membranes.
This is an ectopic, tubal pregnancy, complicated by an incomplete tubal abortion.
The fertilized egg has separated from the walls fallopian tube, as evidenced by hemorrhage, but remained in the tube.
MACROPREPARATION №33 RENAL - CELLULAR CANCER
It is represented by a section of the kidney, in the upper pole of which tumor tissue grows in the form of a node with clear growth boundaries, forming a pseudocapsule around itself, which indicates the expansive growth of the tumor.
The tumor node is light yellow in color, since the tumor cells contain a large amount of lipids; motley, since the tumor is characterized by the development of necrosis and hemorrhage; soft consistency, since the tumor contains little fibrous tissue.
Despite the nature of growth, the tumor is malignant, differentiated, organ-specific epithelial, developing from the epithelium of the kidney tubules.
It occurs in adults.
MACROPREPARATION No. 34 DRY GANGRENA FOOT
The foot of the right lower limb is visible in the specimen.
In the area of the dorsum of the metatarsus of the foot, at the base of the toes, there is no skin, and the soft tissues are dry, mummified, gray-black.
This is dry gangrene of the foot, one of the clinical and morphological forms of necrosis.
Gangrene is called necrosis of tissues in contact with the external environment.
With gangrene, soft tissues are stained in a gray-black color with a pigment pseudomelanin, or iron sulfide.
Gangrene of the foot can develop as a result of atherosclerotic damage to the vessels of the lower extremities, which occurs primarily or as a result of diabetes mellitus due to the development of macroangiopathy.
MACROPREPARATION №35 EMBRYONIC KIDNEY CANCER
It is represented by a kidney in longitudinal section.
In the upper pole of the kidney there is an overgrowth of tumor tissue, large in size, with clear boundaries of growth, forming a pseudocapsule around itself. In the center of the tumor node there is a large cavity due to necrosis of the tumor tissue.
The lower pole of the kidney is small, which indicates that the kidney belongs to a small child.
Despite the nature of tumor growth - expansive and given the presence of secondary changes in the tumor - it is a malignant, undifferentiated tumor that develops from metanephrogenic tissue and affects children from two to six years old.
Expansive growth gives way to invasive growth over time.
The tumor is organ-specific epithelial.
Metastasizes mainly by hematogenous route to the opposite kidney, lungs, bones, brain.
MACROPREPARATION №36 BREAST CANCER
The drug is represented by the mammary gland.
In one of the quadrants of the mammary gland, a pathological growth of tumor tissue occurred, emanating from the epithelium of the mammary gland ducts, and grown to the surface of the skin, which indicates the invasive growth of the tumor.
This is a malignant, epithelial organ-specific tumor - breast cancer.
megaobuchalka.ru
MACROPREPARATIONS (to lay down)
Chronic aneurysm of the heart
Brown myocardial atrophy
wet gangrene of the small intestine
reasons - syphilis
abdominal aorta
aortic aneurysm with thrombosis
Brain
spleen
ischemic splenic infarction
Lobe of the lung
Hemorrhagic lung infarction
MACROPREPARATION No. 53.
apex of the lung
emphysema
Congenital heart defect
appendix
phlegmonous appendicitis
Chronic stomach ulcer
Child's liver
part of the liver
nutmeg liver
Cancer of the body and cervix
Reasons - polyetiological
part of the fallopian tube
tubal pregnancy
Complications:
Complete tubal abortion
Incomplete tubal abortion
Pipe rupture
Mummification of the fetus
Calcification of the fetus
Bleeding
saucer-shaped stomach cancer
the reasons are polyetiological
uterus (pregnant)
uterine fibroma and pregnancy
the reason is polyetiological
bladder
Papilloma of the urinary bladder
reasons - polyetiological
adipose tissue (tumor tissue)
the reasons are polyetiological
MACROPREPARATION No. 172. Lipoma
femur in section
the reason is polyetiological
part of the lung
central lung cancer
reasons - polyetiological
large intestine fragment
colon cancer
the reason is polyetiological
reasons - septicemia
micronodular nephrocirrhosis
subacute glomerulonephritis
unfavorable outcome - renal failure, uremia
reasons - infectious and allergic diseases
part of the large intestine
colitis with dysentery
organocomplex
meningococcal infection
spleen
The heart is slightly enlarged, the papillary muscles and chords are not changed, the walls of the mitral valve are dull, the chords are thin, along the free edge of the valves facing the atria, small gray-pink, loose, easily removable thrombotic overlays - warts are visible on the surface
Acute warty mitral endocarditis
the outcome is unfavorable. thromboembolism in a large circle. Complications: the formation of acquired heart disease, kidney infarction, intestinal gangrene
reasons - rheumatism, infections, intoxication, infectious and allergic diseases
the organ is enlarged, ulceration and polypoid-ulcerative overlays on them are visible on the semilunar valves of the aorta.
Polypoid-ulcerative endocarditis of the semilunar aortic valves
an unfavorable outcome - the formation of aortic valve insufficiency and thromboembolism of the CCB vessels.
reasons - infectious and allergic diseases
The heart is sharply increased in size and mass, the papillary muscles and chords are thickened and sclerosed. The LV wall is thickened to 2 cm, the mitral valve leaflets are sharply thickened, represented by dense, opaque tissue, sclerosed, narrowing the left atrioventricular opening, which looks like a gap. The left atrial cavity is expanded
Fibroplastic endocarditis, mitral stenosis.
The outcome is unfavorable. Complications - chronic heart failure, acquired heart defects
reasons - viral and infectious diseases, rheumatism
the heart is enlarged. on the preparation - saccular protrusions of the wall of the left ventricle in the apex area - an aneurysm with a diameter of 7 cm, the wall in its area is thinned to 0.3 cm, represented by connective tissue.
Chronic aneurysm of the heart
The outcome is unfavorable. Complications - ruptured aneurysm, bleeding, chronic heart failure, parietal thrombosis thromboembolism
causes - myocardial infarction (postinfarction cardiosclerosis)
the organ is enlarged, on the outer layer of the pericardium there is an exudate of a loose consistency. The pericardium is dull, covered with rough, greyish-yellow filaments and very distantly resembles a hairline. Overlays are easy to remove.
Fibrinous pericarditis (hairy heart)
the outcome is unfavorable. Due to the proliferation of deposited fibrin masses by fibroblasts, adhesions are formed between the pericardial layers, which leads to obliteration of the pericardial cavity. Sometimes the sclerosed membranes are petrified with the formation of a carapace heart, which leads to impaired contractility.
reasons - infectious agents, mercuric chloride poisoning, uremia, inflammation, myocardial infarction
heart (cross section through the ventricles)
the size of the organ is almost not increased. The wall of the left ventricle is thickened due to the concentric narrowing of the cavity. The swollen papillary muscles are clearly visible
Heart hypertrophy (compensatory, working (tonogenic), concentric)
the outcome is favorable (heart function is compensated) complications - many cells die, dilated hypertrophy (decompensation) develops - chronic heart failure, hemodynamic disturbances, stagnation in the CCB, the development of a bovine heart
Cardiac forms of hypertension, aortic valve insufficiency, excessive long-term and emotional stress
the organ is reduced in size, there is no subepicardial fatty tissue, the coronary vessels have a pronounced convoluted course, the color of the heart muscle on the cut is yellow-brown
Brown myocardial atrophy
Unfavorable outcome - chronic heart failure
reasons - cachexia, vitamin E deficiency, drug intoxication, increased functional loads, debilitating diseases
abdominal aorta
there is a saccular protrusion of the wall of a rounded shape with a diameter of 5 -8 cm with the formation of a cavity - a saccular aortic aneurysm. In the cavity of the aneurysm - ribbed, dark red dryish masses, which are tightly welded to the wall of the saccular protrusion in the aorta
aortic aneurysm with thrombosis
the outcome depends on the complications. Favorable - replacement for connective tissue, wall thickening. Unfavorable - septic fusion, blockage of the lumen, impaired blood flow, rupture of the aneurysm wall, bleeding, hemorrhage, separation of a thrombus (thromboembolism)
causes - ulceration of atherosclerotic plaques, damage to a vessel, slowing blood flow, changes in hemostasis, thrombosis
Brain
in the temporal region of the right hemisphere in the region of the base, lamellar hemorrhage 7 x 5 cm with clear maroon borders. The grooves and grooves are smoothed.
Subarachnoid hemorrhage
relatively unfavorable outcome: development of edema, compression, dislocation of the brain hypoxia death of the cortex
Hypertension, atherosclerosis, leukemia, trauma, aneurysm
spleen
2 lesions of a triangular shape (the base is directed to the capsule): the lower one is white, the upper one is white with a hemorrhagic corolla. The spleen is slightly enlarged, the consistency is dense. The area of necrosis bulges out from under the capsule. The surface of the capsule in the infarction area is rough with overlays of fibrinoid exudate
ischemic splenic infarction
outcome: favorable - scar formation, ossification, cyst formation, encapsulation, petrification. Unfavorable - death, purulent fusion, adhesion formation
circulatory disorders of the spleen - thrombosis, embolism
Lobe of the lung
in the lung tissue - a triangular necrosis focus, dark red, the base of the infarction (red) facing the pleura, the apex towards the root of the lung. On the surface of the pleura corresponding to the base of the infarction - fibrinous overlays
Hemorrhagic lung infarction
The outcome is favorable - scar formation, ossification, cyst formation, encapsulation, petrification. Unfavorable - purulent fusion, passing to the pleura; pneumonia, death
causes - thromboembolism of the middle and small branches of the pulmonary artery
apex of the lung
in the upper part of the lung, there is a subpleural thin-walled bladder filled with air, with a diameter of about 5 cm (bulla)
emphysema
outcome: unfavorable - respiratory distress, stagnation in the ICC, cor pulmonale, possible pneumothorax with rupture of the bladder
reasons - around scars after tuberculosis, age-related changes in lung tissue, with chronic bronchitis, occupational diseases (glass blowers), impaired protein synthesis in surfactant
the organ is enlarged, in the posterior wall of the left ventricle there is an infarction focus measuring 2 x 3.5 cm white, represented by dense fibrous tissue (primary infarction). Above it - a secondary focus of irregular shape, clay-yellow color, soft consistency measuring 5 x 6 cm (secondary infarction, later in time)
repeated transmural myocardial infarction
outcome - favorable - organization and formation of a scar (chronic heart failure); unfavorable - death. Complications - asystole, ventricular fibrillation, acute heart failure, development of aneurysm with rupture of the heart
cause - thrombosis, spasm, thromboembolism of the coronary artery, atherosclerosis, functional overstrain in conditions of insufficient blood supply
organocomplex of a stillborn child
in the upper part of the interventricular septum - a round defect with a diameter of 0.5 cm (non-closure of the interventricular septum). A common arterial trunk departs from the right heart, giving a branch to left lung and giving rise to the carotid arteries. 2 general departs carotid arteries... The mouth of the right pulmonary artery is missing. Light bluish, airless, collapsed
Congenital heart defect
the outcome is unfavorable, the defect is incompatible with life
exposure to adverse factors during 3-11 weeks of intrauterine development
the stomach is enlarged, the wall is thickened, the presence of thick folds, thickened mucous membrane
hypertrophic gastritis (Minetrie disease)
outcome - impaired digestive processes, precancerous condition
reasons - the etiology is not clear; predisposing factors: overnutrition, heredity, national character
appendix
the process is enlarged, the serous membrane is dull, full-blooded, fibrinous plaque is noted on its surface. The mesentery is edematous, hyperemic. The cut shows 2 full-blooded vessels.
phlegmonous appendicitis
the outcome is favorable - surgical intervention; unfavorable - perforation of the wall peritonitis. If there is a closure of the proximal process stretching of the distal empyema of the process. Periapendicitis, perityphlitis, purulent thrombophlebitis of the mesenteric vessels
reasons - autoinfection, E. coli, enterococcus
on the lesser curvature in the pyloric section, a deep defect in the stomach wall is visible, extending to the mucous and muscular membranes. The defect has an oval-rounded shape, with a diameter of about 0.5 cm, high density, calcified, ridged, raised edges. The edge facing the esophagus overhangs, and the edge facing the pyloric section is terraced, shallow (due to peristaltic contractions of the muscular membrane). The bottom of the ulcer is represented by dense, whitish scar tissue.
Chronic stomach ulcer
complications: ulcerative and destructive (perforation, bleeding, penetration); inflammatory (gastritis, perigastritis, duodenitis, perideodenitis); ulcerative cicatricial (stenosis of the inlet and outlet, deformity of the stomach, stenosis and deformation of the duodenal bulb); ulcer malignancy, combined complications. The outcome is favorable - scarring of the defect
causes - recurrent acute gastritis, Helicobacter pillory, stress, psychoemotional stress, alimentary factors, bad habits, hereditary predisposition
Child's liver
the organ is enlarged, the surface is smooth, clay-yellow in color, the parenchyma has a flabby consistency. The cut has a characteristic oily sheen
fatty liver disease (goose liver)
poor prognosis. Complications - necrosis, cirrhosis, chronic liver failure, hepatic coma, death
reasons - intoxication, infection, hypoxia, vitamin deficiency, protein starvation, transfusion of an incompatible blood group
part of the liver
the liver is enlarged. Dense consistency, smooth. The surface, in the section, has a variegated color, there are foci of gray-yellow with alternating brown-red color. Gray-yellow - peripheral hepatocytes with fatty degeneration. Brown-yellow - venous hyperemia of the central vein
nutmeg liver
unfavorable, because muscat fibrosis develops cirrhosis portal hypertension ascites, intoxication
chronic heart failure, impaired outflow of venous blood, general and chronic venous congestion
the organ is reduced in size, dense, reddish-brown in color. The surface is bumpy due to the formation of regenerate nodes, between them dense connective tissue partitions (more than 1 cm - macronodular, less than 1 cm - micronodular)
macronodular cirrhosis
poor outcome - liver failure, portal hypertension, ascites, heart failure
reasons - viral hepatitis, hepatosis, toxic liver dystrophy
Organocomplex - uterus, ovaries, fallopian tubes
The uterus is enlarged, in the cavity - growing into the cavity and into the wall from the epithelium of the mucous membrane, gray-red ovoid formations, on the surface - multiple ulcerations. No capsule. The wall is thickened, especially in the cervical region
Cancer of the body and cervix
The outcome is unfavorable. Complications - lymphogenous metastases, necrosis, hemorrhage
Reasons - polyetiological
the lower third of the esophagus and the cardiac part of the stomach
The mucous membrane of the esophagus is thinned, in the submucosa of the lower and middle third of the esophagus, swollen, cyanotic, sinuous, sinuous varicose veins of the esophagus are visible, which have become a source of bleeding
Varicose veins of the esophagus with rupture of the vessel wall
Unfavorable outcome - death due to massive bleeding
Liver cirrhosis in the stage of decompensation of portal hypertension with the development of porto-caval internal anastomoses. If a vein is damaged by a food lump - bleeding
part of the fallopian tube
the fallopian tube is dilated, deformed, saturated with blood, the fimbrial section is expanded to 7 cm with a rupture of the wall, in the lumen the fetus with membranes and placenta. In the enlarged area - traces of massive hemorrhages
tubal pregnancy
the outcome is favorable in case of surgery and stopping bleeding.
on the lesser curvature, the formation grows into the lumen and into the wall, with a diameter of about 10 cm. It looks like a gray-pink saucer. Raised edges, depression in the center
saucer-shaped stomach cancer
unfavorable outcome: metastases, dyspepsia, intoxication
the reasons are polyetiological
uterus (pregnant)
the uterus is enlarged, in section, in the thickness of the myometrium - a tumor node in the capsule, gray, fibrous structure, dense consistency, with a diameter of about 8 cm.The fibers of the tumor node have a fibrous structure, the fibers are randomly arranged, have swirls
uterine fibroma and pregnancy
the outcomes are different. Complications - obstruction of pregnancy, malignancy
the reason is polyetiological
bladder
on the SS of the bladder, a spherical formation, soft, elastic consistency, 3 cm in diameter, growing into the lumen of the bladder, is visible. The wall under it is not thickened. On the surface, the tumor resembles a cauliflower.
Papilloma of the urinary bladder
The outcome is favorable, with surgery. Depends on localization. If it grows at the orifice of the ureter, the opening of the urethra is unfavorable. In case of injury, bleeding. Complication - malignancy, tissue compression, recurrence of operations
reasons - polyetiological
adipose tissue (tumor tissue)
tumor node of dense-elastic consistency in a capsule, with a diameter of about 10 cm, has a lobular structure in the cut, yellow, greasy
outcomes are different, more often favorable. Complications: malignancy, compression of the surrounding tissue
the reasons are polyetiological
femur in section
the bone canal was opened: from the bone and around it, the growth of a tumor node of large sizes without clear boundaries is visible, it does not have a capsule, on the cut it is gray in color, reminiscent of fish meat, of soft consistency. Diameter - 15 x 20 cm
osteoblastic osteosarcoma of the hip
the outcome is unfavorable. Complication: hematogenous metastasis
the reason is polyetiological
part of the lung
in the root zone of the lung - a tumor node of a whitish-pink color with unequal contours. SB of the lobar bronchus in the area of the tumor is tuberous. No capsule. Grows from the epithelium through the bronchial wall
central lung cancer
the outcome is unfavorable. Complications - respiratory failure (respiratory failure, metastases, necrosis, hemorrhage, ulceration)
reasons - polyetiological
large intestine fragment
in the central part - the growth of the tumor into the lumen and the intestinal wall, circularly covering the intestinal wall. The intestinal lumen is narrowed here. Grows from the epithelium. The surface of the tumor is bumpy. The growth boundary is indistinct. From the side of the mesentery - an increase in the LU. On the cut, tumor tissue (metastases)
colon cancer
unfavorable outcome. Complications - metastasis, peritoneal carcinomatosis, obstruction of the lumen, obstruction
the reason is polyetiological
The organ is enlarged, under the capsule in the thickness of the tissues there are multiple foci of purulent inflammation of a gray-yellow color, prone to fusion, measuring from 0.2 to 2 cm.On the cut, the parenchyma is decrepit, the pattern of the organ is erased
Embolic purulent interstitial nephritis
Outcome - unfavorable, acute renal failure, uremia
reasons - septicemia
the organ is sharply reduced in size, gray in color, the surface is small-knobby. On the cut, all tissue was replaced with connective tissue. There is no border between cortical and medulla
micronodular nephrocirrhosis
unfavorable outcome - renal failure, uremia
causes - hypertension, atherosclerosis, amyloidosis, glomerulonephritis
the organ is enlarged, the surface is coarse. Decubitus ulcers are visible on the surface. Under the capsule there are lesions of black-gray color of various shapes. In the cavity of the calyx and pelvis there are stones of irregular shape, about 2 cm in diameter, with a layered structure of white and light brown color. There are no boundaries between the cortical and medulla. The parenchyma is severely thinned due to atrophy. Cavities filled with urine are visible.
urolithiasis, hydronephrosis
the outcome is unfavorable. Complications - pyelonephritis, pyonephrosis, renal bedsores, perinephritis, paranephritis.
violation of mineral metabolism, stagnation of secretions, inflammation of the kidneys, compression by a tumor
the upper kidney is small, gray, tuberous, dense - congenital hypoplasia. The second kidney is sharply increased in size, the surface is smooth - vicarious hypertrophy
vicarious hypertrophy and renal hypoplasia
the outcome is favorable - the second kidney takes over the function of the first. Complications - Acute Renal Failure
reasons - underdevelopment of one of the kidneys - congenital hypoplasia, inflammation, nephrosis, glomerulonephritis, surgical removal of the second kidney. Hypertrophy - vicarious
kidneys are enlarged, flabby consistency. On the cut, the cortical layer is expanded, swollen, yellow-gray in color, dull with red specks. It is clearly demarcated from the dark red medulla.
subacute glomerulonephritis
unfavorable outcome - renal failure, uremia
reasons - infectious and allergic diseases
part of the large intestine
the wall of the colon is sharply thickened, CO is covered with a grayish-yellow film of purulent exudate, consisting of numerous dead enterocytes and polymorphonuclear leukocytes, colonocytes and thickened mucus.
colitis with dysentery
unfavorable outcome - ulceration, perforation, fistulas, transition to adjacent tissues, peritonitis, bleeding
dysentery (shigella infectious agents)
a fragment of the large intestine (ileum)
The mucous membrane of the distal ileum is thickened and swollen. Lymphatic follicles are enlarged, protrude above the CO surface. A group of lymphatic follicles is necrotic. The surface resembles the surface of the brain - cerebral swelling. V proximal- ulceration, exfoliation of necrotic masses
cerebral swelling and necrosis of Peyer's patches in typhoid fever
favorable outcome - scarring, healing. Unfavorable - the development of complications. Intestinal complications - intraintestinal bleeding, perforation of the ulcer. Extraintestinal - pneumonia, purulent perichondritis of the larynx, waxy necrosis of the rectus abdominis muscles, osteomyelitis, intramuscular abscesses
Ebert-Gaffka's wand (Salm. Typhi)
organocomplex
the tonsils are enlarged, edematous. At the bottom, 1 x 0.5 cm ulcers are visible, made with necrotic masses
ulcerative necrotizing tonsillitis
a favorable outcome is recovery. Unfavorable - retropharyngeal abscess, otitis media, osteomyelitis of the temporal bone, phlegmon of the neck, brain abscess, meningitis, septicopyemia, severe intoxication, glomerulonephritis, serous arthritis, vasculitis
beta-hemolytic streptococcus A virus
part of the brain with a pia mater
on the outside, the gyrus and grooves are smoothed. Under the soft shell, gray-white exudate overlays are visible. The dilated full-blooded vessels are clearly visible. The soft shell is thickened, dull, saturated with a thick yellowish mass of exudate
purulent leptomeningitis (meningitis of the pia mater)
the outcome is favorable in the organization. Unfavorable - impaired outflow of cerebrospinal fluid, edema, dislocation of the brain, formation of abscesses, encephalitis, sepsis, hydrocephalus
meningococcal infection
spleen
the organ is enlarged, the capsule is tense. The spleen pulp is flabby, has a red color, when carried out with a knife, it gives an abundant scraping of the substance.
splenic hyperplasia with sepsis
in segment III, under the pleura, a focus of caseous pneumonia with a diameter of about 1.5 cm of yellow-gray color, dense (primary affect) is visible. From affect to the root of the lung, a path is traced of small, millet-sized grain, yellowish tubercles (lymphangitis). Regional lymph nodes are enlarged, dryish in the cut, yellow-gray in color (caseous lymphadenitis). All the fields of the lung tissue are small, the size of a millet grain, yellowish foci.
Primary pulmonary tuberculosis complex with miliary generalization.
3 options for the course are possible: attenuation of primary tuberculosis and healing of foci of the primary complex; progression of primary tuberculosis with generalization of the process; chronic course
reasons - mycobacterium tuberculosis
studfiles.net
Patan_MAKROPRYePARAT
MACROPREPARATION №1. Verrucous mitral endocarditis
MACROPREPARATION № 6. Polypoid-ulcerative endocarditis of the semilunar aortic valves
MACROPREPARATION No. 9. Fibroplastic endocarditis of the mitral valve
MACROPREPARATION No. 16. Chronic aneurysm of the left ventricle of the heart
MACROPREPARATION No. 18. Fibrinous pericarditis
MACROPREPARATION No. 21. Heart hypertrophy
MACROPREPARATION No. 26. Brown myocardial atrophy
MACROPREPARATION № 28. Gangrene of the small intestine
part of the small intestine with mesentery
the wall is edematous, thickened, dark brown in color, the intestinal lumen is sharply narrowed. In the lumen of the mesenteric vessels - thrombotic masses
wet gangrene of the small intestine
the outcome is favorable if a small section of the intestine is damaged resection. But more often unfavorable perforation with peritonitis
causes - thrombosis of the mesenteric arteries and their embolism
MACROPREPARATION No. 31. Aneurysm of the aortic arch in syphilis
on the intima of the aorta, whitish tuberosities with wrinkles and cicatricial retractions are visible, giving the aorta the appearance of pebbled skin. There is an inflammatory process in the aortic wall.
syphilitic aneurysm of the ascending aortic arch
the outcome is unfavorable. Complications - a decrease in the strength of the aortic wall - its rupture; development of syphilitic aortic disease.
reasons - syphilis
heart, site of bifurcation of the pulmonary trunk
In the main trunk of the pulmonary artery, worm-like dryish gray-red masses are visible. They fill the lumen of the vessel, but are not associated with the intima.
the outcome is unfavorable; sudden death due to the development of pulmo-cardiac and pulmocoronary reflex spasm of the coronary arteries; pulmonary-pulmonary reflex spasm of pulmonary arteries and bronchi respiratory and heart failure death
causes - thrombosis of the veins of the lower extremities, small pelvis, hemorrhoidal plexus, thrombus formation in the right half of the heart and from the vena cava system
MACROPREPARATION No. 35. Atherosclerosis with aneurysm and parietal thrombus
MACROPREPARATION No. 48. Subarachnoid bleeding
MACROPREPARATION No. 50. Ischemic spleen infarction
MACROPREPARATION No. 70. Bullous emphysema of the lung
MACROPREPARATION No. 74. Repeated myocardial infarction
MACROPREPARATION № 84. Complicated congenital heart disease and blood vessels
MACROPREPARATION No. 90. Hypertrophic gastritis
MACROPREPARATION No. 97. Phlegmonous appendicitis
MACROPREPARATION No. 98. Chronic stomach ulcer
MACROPREPARATION № 104. Fatty degeneration of the liver
MACROPREPARATION No. 110. Nutmeg liver
MACROPREPARATION No. 115. Macronodullary cirrhosis of the liver
MACROPREPARATION No. 116. Cancer of the body of the uterus
MACROPREPARATION No. 118. Varicose veins of the esophagus with rupture of the vessel wall
MACROPREPARATION No. 125. Tubal pregnancy
Complications:
Complete tubal abortion
Incomplete tubal abortion
Pipe rupture
Secondary peritoneal pregnancy
Mummification of the fetus
Calcification of the fetus
Bleeding
Causes - changes in the fallopian tubes violation of the advancement of the fertilized egg ( chronic inflammation, congenital anomalies, tumor)
MACROPREPARATION No. 131. Saucer-shaped stomach cancer
MACROPREPARATION № 154. Uterine fibroids, pregnancy
MACROPREPARATION No. 165. Urinary bladder papilloma
MACROPREPARATION No. 172. Lipoma
MACROPREPARATION No. 175. Osteosarcoma of the femur
MACROPREPARATION № 178. Lung cancer
MACROPREPARATION No. 179. Colon cancer
MACROPREPARATION No. 191. Embolic purulent nephritis
MACROPREPARATION No. 199. Nephrocyrosis
MACROPREPARATION № 207. Kidney stones and hydronephrosis.
MACROPREPARATION № 208. Hypoplasia and vicarious hypertrophy of the kidneys.
MACROPREPARATION № 223. Subacute glomerulonephritis (large variegated kidney).
MACROPREPARATION № 232. Colitis with dysentery.
MACROPREPARATION № 236. Brain swelling and necrosis of Peyer's patches in typhoid fever.
MACROPREPARATION № 237. Necrotizing ulcers.
MACROPREPARATION № 238. Purulent leptomeningitis.
MACROPREPARATION № 240. Septic spleen.
MACROPREPARATE № 242. Primary pulmonary tuberculosis complex with miliary generalization.
studfiles.net
Determination of the properties of diseases (Acute stomach ulcer. Interstitial pneumonitis. Chronic stomach ulcer. Bronchopneumonia)
O-88 Acute stomach ulcer
1) necroses of the mucous membrane alternate with the preserved areas of the mucous membrane of the pyloric stomach,
2) foci of necrosis reach the muscle plate and submucosa,
3) necrotic mucosa is impregnated with hydrochloric acid hematin,
4) leukocyte infiltration of areas of necrosis and submucosal layer.
O-124 Interstitial pneumonitis
1) the state of the interalveolar septa (thickened, lymphohistiocytic infiltration)
2) the cellular composition of the inflammatory infiltrate (lymphocytes, histiocytes)
3) the contents of the alveoli and bronchioles (protein exudate)
4) the primary is inflammation of the walls of the alpha
5) complications of interstitial pneumonitis: respiratory failure
Ch-26 Microdrug Ch / 26-diphtheritic colitis
1) necrosis and ulceration of the mucosa,
2) the bottom of the ulcer is represented by the submucosa,
3) the surface of the ulcer is covered with necrotic mucosa with fibrin (fragments of a diphtheria film) and leukocytes,
4) under the film leukocyte infiltration of the entire submucous layer,
5) expansion and plethora of blood vessels (paresis).
Ch-32 Microdrug Ch / 32 - Idiopathic ulcerative colitis (acute)
1) an ulcer in the intestinal wall reaching the muscle layer,
2) at the bottom there are necrotic masses infiltrated with leukocytes,
3) preserved mucosal tissue (pseudopolyp) hangs over the ulcer,
4) inflammatory infiltration in all layers of the intestinal wall,
5) the serous membrane is thickened, impregnated with fibrin,
6) a gap (pocket) between the lamina propria of the mucosa and the muscular membrane.
Ch-35 Chronic stomach ulcer
1) a deep defect in the stomach wall in the pylorus region (mucous membrane of the antrum and duodenal bulb),
2) at the bottom of the ulcer there is a zone of fibrinoid necrosis, preserved at the edges of the ulcer, under it is granulation tissue with leukocytes,
3) in the center of the bottom of the ulcer, granulation tissue impregnated with fibrin,
4) coarse-fibrous scar tissue that has replaced all layers of the stomach to the serous membrane,
5) plethora of vessels of the serous membrane,
6) stage of chronic ulcer - period of exacerbation
Ch-36 Bronchopneumonia
1) the condition of the wall of small bronchi (damage and desquamation of the ciliated epithelium, plethora of the vessels of the lamina propria, inflammatory infiltration),
2) the lumen of the small bronchi is filled with purulent exudate,
3) the alveoli around the bronchi are filled with various exudates
4) the state of blood vessels in the focus of inflammation (erythrocyte sludge) and outside the focus (plethora),
5) the condition of the alveoli around the focus of inflammation (compressed, desquamated alveocytes in the lumen of the alveoli, plethora of capillaries in the interalveolar septa.
Ch-39 Microdrug Ch / 39-Phlegmonous appendicitis
1) purulent-hemorrhagic exudate in the lumen of the appendix,
2) diffuse infiltration of all layers of the appendix with leukocytes,
3) hyperplasia of lymphoid follicles,
4) the imposition of fibrin in the serous membrane,
5) which of the described signs is the main one for phlegmonous appendicitis. - diffuse infiltration of all layers of the appendix with leukocytes,
Ch-58 Microdrug Ch / 58-Portal liver cirrhosis
1) regeneration nodes (false lobules) surrounded by connective tissue septa of various thicknesses,
2) there are no central veins in the nodes, the radial orientation of the beams is impaired,
3) fatty degeneration in hepatocytes, and bile thrombi in individual hepatocytes,
4) in the connective tissue layers - inflammatory infiltration,
5) indicate the possible outcomes of portal liver cirrhosis. - renal coma, bleeding from varicose veins of the esophagus and stomach, ascites, peritonitis, portal vein thrombosis, hepatocellular carcinoma.
Ch-60 Microdrug Ch / 60 - chronic hepatitis
1) complete violation of the beam structure of the liver lobules,
2) pronounced (severe) diffuse fibrosis (pericellular, perivascular, portal),
3) polymorphism of hepatocytes,
4) a combination of vacuole and fatty degeneration of hepatocytes,
5) cholestasis and staining of cells with bile,
6) inflammatory infiltration with a predominance of leukocytes,
7) name the possible etiology of this hepatitis. - viral, autoimmune, alcoholic, hereditary
Ch-61 Croupous pneumonia
1) the prevalence of damage to the alveoli (lobe of the lung)
2) the nature and composition of the exudate filling the dilated alveoli (many leukocytes, macrophages, fibrin)
3) thinning of the interalveolar septa impregnated with fibrin,
4) a sharp thickening of the interlobar pleura due to edema and fibrin overlays
5) stage of gray hepatization
6) Complications:
a) Pulmonary (carnification, formation of acute abscesses, lung gangrene, pleural empyema)
b) Extrapulmonary (purulent mediastitis, pericarditis, metastatic abscesses in the brain, bacterial endocarditis, purulent meningitis, peritonitis, purulent arthritis)
Ch-62 Fibrosing alveolitis (early stage)
1) foci with thickening and sclerosis of the interalveolar septa
2) plethora of interalveolar capillaries,
3) thickening and sclerosis of the vascular wall,
4) in the lumen of various alveoli desquamated alveocytes, protein fluid,
5) which of the detected signs is stereotypical for ELISA (1)
Ch-63 Fbronchoalveolar adenocarcinoma
1) multiple small tumor nodules,
2) the borders of the nodules are indistinct,
3) polymorphic cells with hyperchromic nuclei grow along the walls of the preceding alveoli,
4) cancer cells form papillae,
5) the lumens of many alveoli around the main tumor nodes are filled with desquamated papillae,
6) the stroma in tumor nodes is well expressed,
7) vessels surrounded by a tumor are full-blooded, foci of collapsed alveoli alternate with vicar emphysema.
Ch-72 Undifferentiated stomach cancer
vunivere.ru
Read:
|
This macro-preparation is the stomach. The masses and sizes of the organ are normal, the shape is preserved. The organ is light gray in color, the relief is strongly developed. On the lesser curvature of the stomach in the pyloric section, there is a significant depression in the stomach wall 2x3.5 cm. Its limiting surface of the organ is devoid of characteristic folding. The folds converge to the boundaries of the formation. In the area of the pathological process, there are no mucous, submucous and muscular layers of the stomach wall. The bottom is smooth, filled with a serous membrane. The edges are ridge-like raised, dense, have a different configuration: the edge facing the gatekeeper is shallow (due to gastric motility).
Description of pathological changes:
These pathological changes could develop as a result of general and local factors (general: stressful situations, hormonal disorders; medicinal; bad habits that lead to local disorders: hyperplasia of the glandular apparatus, increased activity of the acid-peptic factor, increased motility, an increase in the number of gastrin-producing cells; and a general disorder: excitation of the subcortical centers and the hypothalamic-pituitary region, an increase in the tone of the vagus nerve, an increase and subsequent depletion of the production of ACTH and glucocarticoids). Acting on the gastric mucosa, these violations lead to the formation of a defect in the mucous membrane - erosion. Against the background of non-healing erosion, an acute peptic ulcer develops, which, with continued pathogenic effects, turns into a chronic ulcer, which goes through periods of exacerbation and remission. During the period of remission, the bottom of the ulcer can be covered with a thin layer of epithelium, layering on the scar tissue. But during the period of exacerbation, "healing" is leveled as a result of fibrinoid necrosis (which leads to damage not only directly, but also by fibrinoid changes in the walls of blood vessels and disruption of the trophism of the ulcer tissues).
1) favorable: remission, healing of the ulcer by scarring, followed by epithelialization.
2) unfavorable:
a) bleeding;
b) perforation;
c) penetration;
d) malignancy;
e) inflammation and ulcerative cicatricial processes.
Conclusion: these morphological changes indicate a destructive process in the stomach wall, which leads to the formation of a defect in the mucosa, submucosa and muscular membrane - ulcers.
Diagnosis: Chronic gastric ulcer.
Time: 2 hours.
Motivational characteristics of the topic: knowledge of the topic is necessary for further study of stomach diseases, stomach cancer at clinical departments of general and private courses of pathological anatomy, in the practical work of a doctor it is necessary for the clinical and anatomical analysis of sectional observations and comparison of clinical data with the results of biopsy studies.
General learning objective: to study the etiology, pathogenesis and pathological anatomy esophagitis, gastric ulcer and duodenal ulcer, stomach cancer; be able to distinguish between them, guided by morphological characteristics.
Specific objectives of the lesson:
1. To be able to define gastritis, explain its classification, characterize the morphology of various forms of gastritis;
2. To be able to give a definition of peptic ulcer disease, explain its classification;
3. To be able to characterize the morphology of gastric ulcer and duodenal ulcer, depending on the stage of the course, to be able to name its complications;
4. To be able to name the macroscopic forms and histological types of stomach cancer, to explain the features of their growth and metastasis;
5. To be able to name the complications and causes of death in stomach cancer. Required initial level of knowledge: the student must remember the anatomical and histological structure esophagus, stomach, intestines, physiology of their activity, types and morphology of inflammation and regeneration.
Questions for self-study (initial level of knowledge):
1. Etiology, pathogenesis, morphological characteristics of acute and chronic esophagitis and gastritis;
2. Etiology, pathogenesis, morphological characteristics of peptic ulcer disease, its complications and outcomes;
3. Risk factors for developing stomach cancer. Classification of stomach cancer. Morphological characteristics, features of metastasis.
Terminology
Callous (callus - corn) - callous, dense.
Penetration - (penetratio - penetration) - the penetration of an ulcer through the wall of the stomach or duodenum 12 into a neighboring organ (for example, into the pancreas), fused with it due to the organization of fibrinous overlays during perigastritis (periduodenitis). Perforation (perforatio - perforation) - through perforation of the wall of a hollow organ.
Ulceration (ulcus - ulcer) - ulceration.
1. To study gastritis using the example of the macropreparations "Chronic hypertrophic gastritis", "Chronic atrophic gastritis" and micropreparations "Chronic superficial gastritis", "Chronic atrophic gastritis with epithelial restructuring".
2. To study the morphology of the stages and complications of gastric ulcer and duodenal ulcer on the example of macro-preparations "Multiple erosions and acute gastric ulcers", "Chronic stomach ulcer", "Ulcer-stomach cancer" and micro-preparations "Chronic stomach ulcer in the period of exacerbation."
3. To study precancerous processes in the stomach, macroscopic forms and histological types of cancer of the stomach and esophagus using the example of macro-preparations "Polyposis of the stomach", "Squamous cell carcinoma of the esophagus", "Fungal cancer of the stomach", "Saucer-shaped cancer of the stomach", "Ulcer-stomach cancer", "Diffuse gastric cancer" and micropreparation "Adenocarcinoma of the stomach".
Equipment of the lesson, characteristics of the studied drugs Micropreparations
1. Chronic superficial gastritis (staining with hematoxylin and eosin) - mucous membrane of normal thickness, integumentary fossa epithelium with moderate dystrophic changes. In the lamina propria of the mucous membrane at the level of the ridges, there is moderate lymphoplasmacytic infiltration with an admixture of a small amount of polymorphonuclear leukocytes. The fundic glands are not changed.
2. Chronic atrophic gastritis with restructuring of the epithelium (staining with hematoxylin and eosin) - the gastric mucosa is thinned, lined in places with integumentary epithelium, in places with limp and goblet cells. The main parietal and mucous cells in the fundic glands are displaced by large cells with a foamy cytoplasm characteristic of the pyloric glands. The number of glands is small, they are replaced by growths of connective tissue. In the lamina propria of the mucous membrane, lymphohistiocytic infiltration is noted.
3. Chronic stomach ulcer (staining according to Van Gieson) - in the wall of the stomach, the defect captures the mucous and muscular membranes, while the muscle fibers in the bottom of the ulcer are not detected, their break is visible at the edges of the ulcer. One edge of the ulcer is undermined, the other is shallow. At the bottom of the ulcer, 4 layers are distinguishable: fibrinous-purulent exudate, fibrinoid necrosis, granulation tissue and scar tissue. In the last zone, vessels with thickened sclerosed walls (endovasculitis) and destroyed nerve trunks are visible, which have grown like amputation neuromas.
4. Squamous cell carcinoma of the esophagus (stained with hematoxylin and eosin) - in the wall of the esophagus, cords and complexes of atypical squamous epithelium cells are visible. In the center of the complexes, there is an excessive formation of the horny substance in the form of layered structures called "cancer pearls". The tumor stroma is well expressed, represented by coarse fibrous connective tissue infiltrated with lymphocytes.
5. Adenocarcinoma of the stomach (staining with hematoxylin and eosin) - growths of bizarre, atypical glands are visible in all layers of the stomach wall. The cells that form these glands are of various sizes and shapes, with hyperchromic nuclei and figures of pathological mitoses
Macro preparations
1. Erosions and acute stomach ulcers. In the gastric mucosa, numerous small (0.2-0.5 cm) conical defects are visible, the bottom and edges of which are dark brown colored with hematin hydrochloric acid. Several deeper rounded defects with soft edges are visible.
2. Chronic stomach ulcer. On the lesser curvature, a deep defect of the stomach wall is visible, capturing the mucous and muscular membranes, oval-round in shape with very dense, callous, roller-like raised edges. The edge facing the esophagus is undermined, the edge facing the pyloric section is flat, looks like a terrace formed by the mucous membrane, submucosa and the muscular layer of the stomach. The bottom of the ulcer is represented by a dense whitish tissue.
3. Chronic hypertrophic gastritis. The mucous membrane of the stomach is thickened, edematous, with high hypertrophied folds covered with thick viscous mucus, a few small punctate hemorrhages are visible.
4. Chronic atrophic gastritis. The gastric mucosa is sharply thinned, in fact smooth, with single atrophied folds, numerous small punctate hemorrhages and erosions are visible.
5. Polyposis of the stomach. On the gastric mucosa, many rounded outgrowths on the pedicle are visible, grayish in color, with an uneven surface. Histologically, a polyp of the stomach often has an adenomatous structure.
6. Fungal stomach cancer. On the lesser curvature of the stomach, a nodular, broad-based formation resembling a fungus is visible. It is grayish red in color. On the periphery of the tumor, the mucous membrane is thinned, its folds are smoothed (signs of atrophic gastritis). Ulceration of mushroom stomach cancer leads to its transition to a saucer shape.
7. Saucer-shaped stomach cancer. The tumor has the appearance of a rounded formation on a broad base with raised roller-like edges, which gives the tumor some resemblance to a saucer. The bottom of the ulcer is covered with dirty gray decaying masses.
8. Ulcer-stomach cancer. It occurs with the malignancy of a chronic stomach ulcer. In the wall of the stomach (more often on the lesser curvature) - a deep round defect. At the bottom of the ulcer there is a dense grayish tissue. One of the edges of the ulcer is raised in a roller-like manner, represented by gray-pink tissue, which invades the surrounding mucous membrane. There are histological differences between saucer carcinoma and ulcer-carcinoma. With ulcerated stomach cancer, complications such as bleeding, perforation are frequent; development of stomach phlegmon is possible.
9. Diffuse stomach cancer. The wall of the stomach (especially the mucous membrane and submucosal layer) is sharply thickened throughout, whitish on the cut. The mucous membrane is uneven, folds of varying thickness; the serous membrane is thickened, dense, tuberous. The lumen of the stomach is narrowed (stomach of the "pistol holster" type). With diffuse cancer, complications are frequent due to germination in the surrounding organs (intestinal obstruction, jaundice, ascites, etc.).
Gastritis is an inflammatory disease of the stomach lining. Acute and chronic gastritis are distinguished along the course.
Acute gastritis develops as a result of irritation of the gastric mucosa by alimentary, toxic and microbial agents. Morphologically acute gastritis is characterized by a combination of alterative, exudative and proliferative processes.
Depending on the features of morphological changes in the mucous membrane, the following forms of acute gastritis are distinguished: catarrhal (simple), fibrinous, purulent (phlegmonous), necrotic (corrosive).
Chronic gastritis can develop in connection with relapses of acute gastritis or not associated with it. Chronic gastritis is characterized by long-term dystrophic and necrobiotic changes in the epithelium, as a result of which there is a violation of its regeneration and restructuring. Changes in the mucous membrane in chronic gastritis go through certain stages (phases), well studied with the help of repeated gastrobiopsies.
The appearance of intestinal epithelium in the stomach is called enterolization, or intestinal metaplasia, and the presence of pyloric glands in the body of the stomach, called pseudopyloric, is called pyloric restructuring. Both of these processes reflect the perverse regeneration of the epithelium.
Peptic ulcer is a chronic, cyclically current disease, the main clinical and morphological expression of which is a recurrent ulcer of the stomach or duodenum. Depending on the localization of the ulcer and the characteristics of the pathogenesis of the disease, peptic ulcer disease is distinguished with the localization of the ulcer in the pyloroduodenal zone and in the body of the stomach. Among the pathogenetic factors of peptic ulcer disease, there are general (violations of the nervous and hormonal regulation of the stomach and duodenum) and local factors (violations of the acid-septic factor, mucous barrier, motility and morphological changes in the gastroduodenal mucosa). The significance of these factors in the pathogenesis of pyloroduodenal and fundic ulcers is not the same.
The morphological substrate of peptic ulcer disease is a chronic recurrent ulcer, which initially goes through the stages of erosion and acute ulcer. Erosion is a defect in the stomach lining. An acute ulcer is a defect not only of the mucous membrane, but also of other membranes of the stomach wall. The presence of necrosis in the bottom of the ulcer and fibrinoid changes in the vessel walls indicates an exacerbation of the pathological process. In the period of remission, the bottom of the ulcer is usually scar tissue, sometimes epithelialization of the ulcer is noted.
The period of exacerbation of the ulcer is dangerous with complications of an ulcerative-destructive nature: perforation, bleeding and penetration of the ulcer. In addition, complications of an ulcerative-cicatricial nature are distinguished: deformity, stenosis of the inlet and outlet of the stomach and an inflammatory nature: gastritis, perigastritis, duodenitis, periduodenitis. Malignancy of a chronic ulcer is possible.
Precancerous processes in the stomach include chronic gastritis, chronic ulcers, and gastric polyposis. The clinical and anatomical classification of stomach cancer takes into account the localization of the tumor, the nature of growth, macroscopic forms, histological types, the presence and nature of metastases, complications. Most often, stomach cancer is localized in the pyloric region (up to 50%) and on the lesser curvature (up to 27%), most rarely in the fundic region (2%). Depending on the nature of growth, the following clinical and anatomical forms are distinguished:
I. Cancer with predominantly exophytic expansive growth: plaque-like; polypous; fungal (mushroom); ulcerated cancer (primary ulcerative, saucer-shaped, cancer from a chronic ulcer, or ulcer-cancer);
II. Cancer with predominantly endophytic infiltrative growth: infiltrative-ulcerative, diffuse (limited and total);
III. Cancer with exoendophytic, mixed growth.
These types of gastric cancer can be phases of the development of carcinoma at the same time.
The following histological types of stomach cancer are distinguished: adenocarcinoma, solid cancer, undifferentiated cancer (mucous, fibrous, small cell), squamous cell carcinoma. Adenocarcinoma, as a more differentiated form of cancer, occurs more often in forms with predominantly exophytic expansive growth. Fibrous cancer (skyr), as a type of undifferentiated, occurs very often in forms with predominantly endophytic infiltrating growth. The first metastases of gastric cancer are found in the regional lymph nodes. The liver is the main target organ for hematogenous metastasis.
GASTRITIS (gastritis; Greek, gaster stomach + -itis) - damage to the gastric mucosa with predominantly inflammatory changes in the acute development of the process and the phenomena of dysregeneration, structural restructuring with progressive atrophy during hron, course, accompanied by dysfunction of the stomach and other body systems.
Representations about G. changed depending on the level of development of honey. science. References to functional and organic disorders of the stomach can be found in the works of Hippocrates, Galen, Razi, Ibn-Sina, and others. The beginning of the study of G. is associated with the name of French. doctor F. Brouss (1803), who considered G. the most common disease and associated with it the development of diseases of the heart, brain, and lungs. Since introduction into a wedge, practice of a method of sounding of a stomach [A. Kussmaul, 1867] G. was considered as a functional disease. However, this point of view was revised in the second half of the 19th century. - the beginning of the 20th century. on the basis of new data patol, anatomy, surgery of the abdominal cavity, rentgenol. method, research by I.P. Pavlov and his school in the field of physiology of the digestive tract.
Introduction into a wedge, practice of methods of gastroscopy and especially aspiration gastrobiopsy led to the expansion of ideas about G. A great contribution to the development of the doctrine of G. was made by Soviet scientists Yu. M. Lazovsky, N. I. Leporsky, O. L. Gordon, I. P Razenkov, S. M. Ryss.
Distinguish between acute and hron. G.
Acute gastritis
There are the following forms of acute G.: simple (banal, catarrhal), corrosive, fibrinous, phlegmonous.
Pathogenesis of acute gastritis
The pathogenesis of acute gastritis is reduced to the development of an inflammatory process of varying severity - from superficial changes to deep inflammatory-necrotic. The pathogenesis of a wedge, signs is caused, on the one hand, by a violation of the secretory and motor function of the stomach (vomiting, spastic pain, etc.), by the depth and severity inflammatory changes in the stomach (leukocytosis, accelerated ROE, increased body temperature, pain as a result of irritation of nerve endings in the wall of the stomach), on the other hand, the involvement of other organs, body systems and some aspects of metabolism in the patol process (collapse, dehydration of the body, blood clotting, etc.) etc.).
Pathological anatomy of acute gastritis
The pathological anatomy of acute gastritis is characterized by inflammatory changes in the gastric mucosa. Distinguish between catarrhal, corrosive, phlegmonous and fibrinous G.
Fig. 10. The mucous membrane of the stomach with phlegmonous gastritis (pronounced sharp thickening of the folds); on the cut - purulent infiltration.
At catarrhal G. the mucous membrane is infiltrated with leukocytes (color, table. Fig. 1-3), which are also located between the cells of the epithelium, there is inflammatory hyperemia, dystrophic and necrobiotic changes in the epithelium.
At corrosive G. there are necrotic-inflammatory changes in the wall of the stomach (printing. Fig. 9).
At phlegmonous G. (tsvetn. Fig. 10) diffuse leukocytic infiltration of all layers of the stomach wall is observed, but hl. arr. submucosa. Phlegmonous G. is accompanied by perigastritis (see) and can end with peritonitis.
Fibrinous G. is characterized by diphtheria inflammation of the mucous membrane.
Simple gastritis
Simple gastritis (commonplace, catarrhal)- the most common form. Occurs at all ages and regardless of gender. A common cause of simple G. is errors in nutrition, infections, especially foodborne toxicoinfections (see. Food toxicoinfections). The irritating effect of some drugs is known (salicylates, butadion, bromides, iodine, digitalis, antibiotics, sulfonamides, etc.). G.'s development from taking small amounts of drugs and under the influence of certain types of food (eggs, strawberries, crabs, etc.) may indicate an allergic mechanism of damage to the gastric mucosa.
Wedge, picture of a simple G.(caused by the most common causes - errors in nutrition and foodborne diseases) usually develops after 4-8 hours. after exposure to etiol, factor. Patients note pain, a feeling of heaviness and fullness in the epigastric region, nausea, weakness, dizziness, vomiting, sometimes diarrhea, salivation, or, conversely, severe dry mouth. The tongue is coated with a grayish-white bloom. On palpation of the abdominal wall - pain in the epigastric region. The pulse is usually fast, the blood pressure is slightly reduced. An increase in body temperature is possible, in the peripheral blood - neutrophilic leukocytosis. In the urine there may be albuminuria, oliguria, cylindruria, i.e., changes characteristic of toxic renal damage. There is a lot of mucus in the stomach contents; secretory and acid-forming functions can be suppressed or enhanced. Motor disorders are manifested by pylorospasm (see), hypotension and even atony of the stomach (see). The duration of the acute period of the disease with timely initiation of treatment is 2-3 days.
Complications at simple G. are rare. General intoxication, disorders in the cardiovascular system may develop.
Diagnosis simple G. is based on a wedge, a picture. With an increase in temperature and a disorder of intestinal activity, it is possible to assume gastroenterocolitis (see), it is also necessary to differentiate G. with salmonellosis (see). In this case, bacteriol, and serol, research is of decisive importance.
Treatment simple G. must begin with cleansing the stomach and intestines and prescribing antibacterial drugs(enteroseptol 0.25-0.5 g 3 times a day, chloramphenicol up to 2 g per day, etc.) and absorbent substances ( Activated carbon, clay, etc.). In case of severe pain syndrome, atropine (0.5-1 ml of 0.1% solution subcutaneously), platifillin (1 ml of 0.2% solution subcutaneously), papaverine (1 ml of 2% solution subcutaneously) are injected. With the development of dehydration, physiol, solution, 5% glucose solution is injected subcutaneously. In acute cardiovascular failure - caffeine, mezaton, norepinephrine. It is necessary to prescribe to lay down. nutrition. The first 1 - 2 days should refrain from eating, drinking is allowed in small portions (strong tea, borzhom). On the 2-3rd day - low-fat broth, slimy soup, semolina and mashed rice porridge, jelly. On the 4th day - meat and fish broth, boiled chicken, fish, steamed cutlets, mashed potatoes, crackers, dried white bread. Then the patient is assigned a table number 1 (see. Therapeutic nutrition), and after 6-8 days - the usual food.
Forecast at simple G. in case of timely started treatment is favorable. If the action of etiol, factors is repeated, then acute G. can go to hron.
Prophylaxis simple G. is reduced to rational nutrition, observance a dignity. - gigabyte. events in everyday life and at catering establishments, dignity. - skylight, work.
Corrosive gastritis
Corrosive gastritis develops as a result of the ingestion of substances such as strong to-you, alkalis, salts of heavy metals, highly concentrated alcohol into the stomach.
Wedge, painting by the corrosive G. depends on the degree of damage to the mucous membrane of the mouth, esophagus and stomach, the nature and resorptive action of the substances that caused the corrosive G, Patients usually complain of pain in the mouth, behind the sternum and in the epigastric region, repeated excruciating vomiting; in vomit - blood, mucus, sometimes tissue fragments. On the lips, mucous membrane of the mouth, pharynx and larynx there are traces of burns - edema, hyperemia, ulceration. Sometimes, by the nature of the changes in the mucous membranes, it is possible to establish the cause of the burn: from sulfuric and hydrochloric acid grayish-white spots appear, from nitrogen - yellow and greenish-yellow scabs, from chrome - brownish-red scabs, from carbolic - a bright white bloom resembling lime, from acetic - superficial whitish-gray burns. In severe cases, a collapse may develop (see). The abdomen is usually swollen, painful on palpation in the epigastric region, sometimes there are signs of irritation of the peritoneum. In some patients, in the first hours after poisoning, acute perforation of the stomach wall occurs, signs of toxic damage to the kidneys (in the urine - protein, cylinders) are noted up to the development of acute renal failure.
Complication with corrosive G., it can occur in the first hours from the moment of exposure to etiol, factor and is manifested by perforation of the stomach wall with the development of peritonitis (see) and penetration into neighboring organs.
Diagnosis corrosive G. is based on anamnesis data, a wedge, signs (including the nature of changes in the mucous membrane of the mouth, pharynx and larynx).
Treatment you should start with gastric lavage with plenty of water through a tube lubricated with vegetable oil. Contraindications to the introduction of the probe are collapse and, obviously, severe destruction of the esophagus.
In case of poisoning with to-tami add milk, lime water or burnt magnesia to the water; in case of damage with alkalis - diluted lemon and acetic to - you, antidotes are introduced. At severe pain morphine, promedol, fentanyl, droperidol are administered; in case of collapse, in addition, caffeine, cordiamine, mezaton, norepinephrine, strophanthin (subcutaneously or intravenously with blood substitute fluids, glucose, physiological solution, etc.). During the first days, fasting, parenteral administration of fiziol, solution and 5% of glucose solution are necessary. If it is impossible to feed by mouth for several days - parenteral administration of plasma and protein hydrolysates. With perforation of the stomach, urgent surgical treatment is indicated.
Forecast corrosive G. depends on the severity of inflammatory and destructive changes and therapeutic tactics in the first hours and days of the disease; death can result from shock, bleeding, or peritonitis. Corrosive G.'s outcome is usually cicatricial changes in the stomach, more often in the pyloric and cardiac departments.
Fibrinous gastritis
Fibrinous gastritis is rare, develops in severe infectious diseases (smallpox, scarlet fever, sepsis, etc.), as well as poisoning with mercuric chloride, acids, etc., which determines the wedge, picture, treatment and prognosis.
Phlegmonous gastritis
Phlegmonous gastritis occurs, as a rule, primarily as a result of infection directly into the stomach wall. It is caused by streptococcus, more often hemolytic, often in combination with colibacillus, less often staphylococcus, pneumococcus, proteus, etc. Sometimes it develops as a complication of an ulcer or disintegrating stomach cancer, with abdominal trauma due to damage to the gastric mucosa. Phlegmonous G. can develop a second time with some infections - sepsis, typhoid fever, etc.
Wedge, picture of phlegmonous G. characterized by an acute onset, fever, chills, severe adynamia and pain in the upper abdomen, usually aggravated by palpation, nausea and vomiting. The general condition deteriorates sharply. Patients refuse to eat and drink; exhaustion quickly sets in. In peripheral blood - neutrophilic leukocytosis, toxigenic granularity in granulocytes, accelerated erythrocyte sedimentation, change in the ratio of protein fractions and other reactions.
Complications with phlegmonous G.: purulent diseases of the chest - mediastinitis (see), purulent pleurisy (see) and abdominal cavity - subphrenic abscess (see), thrombophlebitis of large vessels (see Thrombophlebitis), liver abscess (see), etc. ...
Diagnosis phlegmonous G. before operation is placed very rarely.
It is often recognized on the operating table or at autopsy.
Treatment phlegmonous G. consists mainly in parenteral administration of broad-spectrum antibiotics in large doses. With inefficiency conservative treatment surgical intervention is indicated.
Forecast phlegmonous G. is serious. After healing, persistent organic changes may remain in the stomach.
Chronic gastritis
Chron. G. makes up most of the diseases of the stomach. It is often combined with other diseases of the digestive system.
Chron. G. - the concept of wedge. - morfol., It is shown by a wedge, signs, functional and morfol, changes in various combinations and can proceed with various disorders of secretion, but a decrease in gastric juice secretion is more characteristic. Function of acid formation at hron. G. is disturbed earlier and more often than enzyme-forming and excretory.
There are many different classifications of cron. D. The classification according to Ryss (1966) is given.
I. By etiological basis
1. Exogenous gastritis: long-term violations of the diet - the qualitative and quantitative composition of food; alcohol and nicotine abuse; action of thermal, chemical, fur. and other agents; the influence of professional hazards - systematic tasting of raw meat seasoned with spices (canning industry), ingestion of alkaline vapors and fatty acids (soap, margarine and candle factories), inhalation of cotton, coal, metal dust, work in hot shops, etc.
2. Endogenous gastritis: neuro-reflex (patol, reflex action from other affected organs - intestines, gall bladder, pancreas); G., associated with violations in Article. n. with. and endocrine organs; hematogenous G. (hron, infections, metabolic disorders); hypoxemic G. (hron, circulatory failure, pneumosclerosis, pulmonary emphysema, pulmonary heart); allergic G. (allergic diseases).
II. By morphological characteristics
1. Superficial.
2. Gastritis with glandular involvement without atrophy.
3. Atrophic: a) moderate; b) pronounced; c) with the phenomena of restructuring of the epithelium; d) atrophic-hyperplastic; others rare forms atrophic (the phenomenon of fatty degeneration, the absence of the submucosa, the formation of cysts).
4. Hypertrophic.
5. Antral.
6. Erosive.
III. Functionally
1.With normal secretory function.
2. With moderately expressed secretory insufficiency: absence of free salt to - you on an empty stomach (or a decrease in its concentration after a test stimulus below 20 titers, units); a decrease in the concentration of pepsin after a test stimulus to 1 g%, a concentration of mucoprotein below 23%, a positive reaction to the introduction of histamine, a normal content of uropepsinogen.
3. With a pronounced secretory insufficiency: the absence of free hydrochloric acid in all portions of gastric juice, a decrease in the concentration of pepsin (or its complete absence), the absence (or traces) of mucoprotein, a histamine refractory reaction; decrease in the content of uropepsinogen.
IV. According to the clinical course
1. Compensated (or remission phase): absence of a wedge, symptoms, normal secretory function or moderately expressed secretory insufficiency.
2. Decompensated (or exacerbation phase): the presence of a distinct wedge. symptoms (with a tendency to progression), persistent, difficult to treat, pronounced secretory insufficiency.
V. Special forms of chronic gastritis
1. Rigid.
2. Giant hypertrophic (Menetrie's disease).
3. Polyposis.
Vi. Chronic gastritis concomitant with other diseases
1. With Addison-Birmer anemia.
2. With stomach ulcers.
3. With cancer.
Chron, gastritis is a polyetiologic disease, is a consequence of untimely and insufficient treatment of acute G., as well as prolonged malnutrition, eating foods that irritate the gastric mucosa (spices, onions, garlic, pepper), addiction to hot food and drink, bad chewing food, eating dry food, frequent consumption alcoholic beverages, malnutrition, especially with a lack of protein, vitamins and iron. The reason may be long-term intake of certain medications (quinine, atophan, digitalis, salicylates, butadion, prednisolone, sulfa drugs, potassium chloride, antibiotics, etc.), the influence of factors such as inhalation of cotton, metal, coal dust, alkali vapors, etc. T. Disorders in the endocrine system (diabetes, gout) can cause the development of structural changes in the gastric mucosa. The release through the gastric mucosa of metabolic products such as acetone, indole, skatole, like toxins in infectious diseases and local foci of infection, causes the development of the so-called. elimination G. Chron, diseases of the digestive system (appendicitis, cholecystitis, colitis, etc.) are especially important in development hron. G. Often hron. G. develops in diseases causing tissue hypoxia (hron, circulatory failure, pneumosclerosis, anemia).
From the blood serum of sick hron. G. isolated antibodies, with the help of which the model of autoimmune lesions of the stomach is reproduced. However, the pathogenetic nature of circulating gastric antibodies has not yet been clarified. There is evidence of the role of genetic factors in the emergence of hron. D. In patients with a severe form of atrophic G., relatives of the first degree of relationship are predisposed to this disease, which manifests itself early (in young age) G.'s emergence and its rapid transformation into a severe form.
The pathogenesis is complex and not the same at various forms hron. G. At hron. G., which developed from acute, progresses primary inflammatory changes in the stroma and the development of secondary degenerative-regenerative changes in the glandular apparatus (atrophy, hyperplasia, metaplasia, etc.). The mechanism of development of separate forms hron. G., etiologically associated with various nutritional disorders and neuroreflex effects on the stomach, is reduced to functional secretory motor disorders of the stomach (see) with subsequent structural changes in its glandular apparatus and the development of an inflammatory process in the stroma. Changes in the secretory activity of the stomach and neuroreflex influences from the affected organ are, in turn, the cause of disruption of the activity of other organs of the digestive apparatus.
According to morfol, superficial G. is distinguished by signs, various stages of atrophy of the mucous membrane. Ts. G. Masevich (1967) allocates G. with defeat of the glands of the bey of atrophy of the mucous membrane and G. is atrophic. Schindler (R. Schindler, 1968) and Elster (K. Elster, 1970) distinguish hypertrophic G.
The results of histochemical, and electron microscopic research of biopsy material allow us to consider that the forms hron. G. are phases of violation fiziol, regeneration of the gastric mucosa. According to M. Siurala et al. (1963, 1966), Ts. G. Masevich (1967) and others, superficial G. passes into G. with defeat of the glands, and then into atrophic. Syurala et al. (1968) believe that this process takes approx. 17 years.
Chronic superficial gastritis characterized by a picture of mucus hypersecretion, sometimes with a predominance of the excretion phase over the phase of secretion accumulation: there are no neutral mucopolysaccharides in the apical section of the cells, and a large amount of mucus on the cell surface. The presence of CHIK positive granules over the nuclei indicates increased mucus synthesis (see CHIC response). Sometimes the epithelium lining the gastric fields and dimples looks flattened, with a narrow strip of mucoid, rare supranuclear granules, and a high content of RNA. Revealed granular and vacuolar degeneration of the epithelium, infiltration with lymphoid and plasma cells own shell rollers (color, table., Fig. 4). Accessory cells normally located in the isthmus gastric glands, often spread to their middle third.
For chronic gastritis with glandular involvement the surface epithelium of the mucous membrane is flattened, there is a deepening of the gastric pits, additional glandulocytes are hyperplastic.
In the main glandulocytes, vacuoles are detected (Fig. 1) containing neutral mucopolysaccharides (color, table. Fig. 5). In the cytoplasm of these cells, among the zymogen granules, shapeless masses are found, in places surrounded by a membrane. These masses are similar to "immature" or "mature" mucoid. In the supranuclear zone, a developed lamellar complex (Golgi) with dilated cisterns is revealed (Fig. 2). Thus, these cells contain elements of both the main (zymogen, RNA, ergastoplasm) and additional glandulocytes (neutral mucopolysaccharides, a well-developed lamellar complex). These cells are, apparently, the immature main glandulocytes of the isthmus of the gastric glands. As a result of slowing down their differentiation, they occupy the territory of mature main glandulocytes. Accessory glandulocytes are also "immature", with a developed lamellar complex and ergastoplasm; they are found in those parts of the glands where they are usually not observed.
Chronic atrophic gastritis characterized by a decrease (sometimes significant) in the number of main and accessory glandulocytes, deepening of the gastric dimples (color. Fig. 7 and color, table. Fig. 6 and 7), which often have a corkscrew-like appearance (Fig. 3), hyperplasia of accessory glandulocytes. The epithelium covering the gastric fields and dimples is often flattened, contains a lot of RNA and little neutral mucopolysaccharides, in places it is replaced by intestinal epithelium (color table. Fig. 8) with typical enterocytes, goblet cells and Paneth cells (intestinal metaplasia). The stomach glands are often replaced by mucous membranes (pyloric metaplasia). The remaining main glandulocytes are vacuolated; in the obstructive glandulocytes, a rarefaction of the cytoplasm in the perinuclear zone and around the intracellular tubules is revealed, as well as a decrease in the number of microvilli and tubulovesicles; there is a reduction in the mitochondrial cristae of the parietal glandulocytes.
Wolf (G. Wolf, 1968) distinguishes three stages of atrophy of the gastric mucosa: incipient atrophy, with a cut the glands are not yet shortened, but look as if squeezed; partial atrophy (of glands), with a cut preserved groups of glands containing the main and parietal (lining) glandulocytes; total atrophy of the glands (atrophy of the mucous membrane), when the main and parietal (parietal) glandulocytes are not detected, the glands are lined only with mucus-forming epithelium.
Chronic hypertrophic gastritis- thickening of the mucous membrane and increased proliferation of the epithelium (color. Fig. 6, color. Table Fig. 9 and Fig. 7).
There are three forms of hron, hypertrophic G.: interstitial, proliferative, glandular. The interstitial form is characterized by abundant lymphoplasmacytic infiltration, which occurs at the edges of ulcers; for proliferative - the growth of the superficial epithelium, deepening of the dimples, the glandular apparatus unchanged; with a glandular form, the mucous membrane is thickened 2-7 times due to glandular hyperplasia; this form is hron. G. meets with duodenal ulcer (see Peptic ulcer), Zollinger-Ellison syndrome (see Zollinger-Ellison syndrome) and how independent disease... Some authors refer hron to the glandular form. G. and Menetrie's disease, designating it as gastritis hypertrophica gigantea, although Menetrie himself considered this condition of the mucous membrane not as hypertrophic G., but as a "creeping adenoma." Most authors (Yu. N. Sokolov, PV Vlasov, and others) deny the connection of Menetrie's disease with G., considering it as an anomaly in the development of the gastric mucosa.
The clinical picture. Depending on the state of the secretory function of the stomach, hron is distinguished. G. with normal and increased secretion and hron. G. with secretory insufficiency.
Chronic gastritis with normal and increased secretion usually occurs at a young age, more often in men. The main symptoms are dyspeptic disorders and pain, which usually appear during an exacerbation of the disease, after errors in the diet, the use of alcoholic beverages, including table wines and beer. Patients complain of heartburn, sour belching, a feeling of pressure, burning and distention in the epigastric region, constipation (sometimes diarrhea), rarely vomiting. The pains are usually dull, aching, without a certain irradiation, localized in the epigastric region, their occurrence, as a rule, is associated with food intake. But the pains can be "hungry" and "night", and subside after eating.
Early complications are movement disorders of the intestines and biliary tract (hyper- and hypomotor dyskinesias). In the future, functional disorders are replaced by organic changes, and then hron, cholecystitis (see), hron develop. pancreatitis (see), hron, enterocolitis with metabolic disorders - hypovitaminosis, iron deficiency anemia, etc. (see. Enteritis, enterocolitis).
Massive bleeding from the gastric mucosa is possible, which on average accounts for half of non-ulcer bleeding. In this case, they talk about the so-called. hemorrhagic gastritis. Hemorrhagic gastritis - the concept of a wedge; morfol, its picture may be different. Bleeding at G. is most often associated with the development of erosions, but sometimes the mechanism of bleeding remains unclear even after gistol, research of the resected part of the stomach. A certain value in the occurrence of gastric bleeding is attributed to the acidity of gastric juice (the higher the acidity, the more often bleeding). Abundant gastric bleeding usually develops in patients with minor wedge, manifestations, in which, as it is believed, increased permeability of the blood vessels of the stomach. Allergic reactions can also be the cause of the development of massive gastric bleeding (see Gastrointestinal bleeding).
Special wedge-morfol. form hron. G. with normal and increased secretion is gastroduodenitis (synonym: pyloroduodenitis, hypertrophic glandular G., hypertrophic hypersecretory gastropathy), which occurs mainly at a young age. It is similar in wedge, manifestations with duodenal ulcer, although not identical to it. IM Fleckel (1958) considered gastroduodenitis to be the pre-stage of peptic ulcer disease or a form of "peptic ulcer disease without an ulcer." The frequency of the disease (during the day and year) is less pronounced than with peptic ulcer disease. Of the wedge, the most characteristic symptoms are pain ("painful gastritis"), which are usually localized under the xiphoid process or to the right of it. Often there is a combination of pain immediately after eating with "hungry" and "night" pains.
The secretory and acid-forming functions of the stomach are usually enhanced, but less than in duodenal ulcers: the amount of basal secretion is up to 10 meq / hour, and the maximum is 35 meq / hour (Yu. I. Fishzon-Ryss, 1972). Abundant gastric secretion is often observed at night.
Chronic gastritis with secretory insufficiency more common in people of mature and old age. In patients, weight usually decreases, weakness appears, symptoms of multivitamin deficiency are revealed - dry skin, loosening and bleeding of the gums, changes in the tongue (thickening, redness, flattened papillae, the presence of dental prints), cracks on the lips, in particular in the corners of the mouth. Of the gastric symptoms, a violation of appetite and a desire to eat spicy and spicy food outside the period of exacerbation are noted. Some patients cannot take solid food without liquid, which they drink before and during the meal. Patients note an unpleasant taste in the mouth, especially in the morning, nausea, a feeling of fullness and distention in the epigastric region, belching with air. The stool is unstable, with a tendency to diarrhea. Dyspeptic symptoms usually occur soon after eating, especially poorly patients tolerate milk. In some cases, nausea and salivation are persistent and painful for patients, and they seek to alleviate their condition with frequent meals. Sometimes there is pain in the epigastric region.
Complications - hypermotor dysmnesia of the intestine or involvement in patol, the process of the pancreas and gallbladder. Gastric bleeding is rare. Some patients show allergic reactions to certain food and medicinal substances.
Sometimes (more often in women) iron deficiency anemia develops (see). Changes in the intestines are often noted, the exocrine function of the pancreas decreases, dysbiosis develops (see), manifested by fermentation or putrefactive dyspepsia.
Special forms hron. G. (rigid, polypous and giant hypertrophic) differ in originality a wedge, manifestations and morfol, features. Some researchers attribute these forms to complications hron. G.
Rigid gastritis first described by A. N. Ryzhikh and Yu. N. Sokolov (1947). It is manifested by persistent dyspepsia (see) and achlorhydria (see). The diagnosis is established with rentgenol. research and based on gastroscopy data. The outlet section of the stomach is mainly affected, which, due to hypertrophic changes, edema and spastic contraction of the muscles, is deformed, turning into a narrow tubular canal with dense rigid walls.
Polypoid gastritis(tsvetn. fig. 8) usually develops against the background of atrophic G. with histamine refractory achlorhydria, it can be considered as further progression hron. G. (dysregenerative hyperplasia of the mucous membrane).
Giant hypertrophic gastritis, or rather excessive development of the mucous membrane, described by P. Menetrier (1886), is relatively rare disease, manifested by metabolic disorders (more often protein) and very rarely by the development of iron deficiency anemia. The change in the acid-forming function of the stomach is different (see also table).
The diagnosis is based on the analysis of a wedge, manifestations of the disease, the results of a study of gastric secretion (see. Stomach, research methods), rentgenol, research, gastroscopy data (see) and gastrobiopsy.
In the assessment of morfol, the picture of the gastric mucosa, gastrobiopsy data should be preferred. Exfoliative cytodiagnostics, determination of the absorption and excretory functions of the stomach are of secondary importance.
Certain difficulties arise in differential diagnosis with functional disorders of the stomach, stomach cancer (see. Stomach, tumors) and peptic ulcer disease (see).
With functional disorders of the stomach, there are usually no sharp morfol, changes. In addition, they have a relatively short-term (up to 1 year) course, less dependence of the occurrence of pain on food intake, greater variability of the wedge. manifestations, which is associated with neuropsychic influences, atypical localization of pain on palpation of the abdomen and, finally, a sharp fluctuation in acidity in individual studies.
X-ray diagnostics is based on a thorough rentgenol, examination of the stomach. At the same time, changes in the relief of the gastric mucosa and other X-ray functional and morfol, symptoms are determined. These include: excessive fasting secretion, rapid growth of secretory fluid, changes in tone, persistent deformation of the pyloric part of the stomach, impaired peristalsis, etc. The most constant symptom of increased fasting secretion, sometimes manifested by a horizontal fluid level against the background of the gastric bladder before taking barium suspension. The first one or two sips of barium suspension confirm the presence of excess liquid. By the nature of the mixing of barium with a liquid, one can, to a certain extent, judge the amount of mucus contained in it: slow mixing with the formation of shapeless flakes indicates the presence of mucus. Another symptom of the presence of mucus (the phenomenon of mucus) is small-point enlightenment in the layer of barium suspension - the smallest droplets of mucus suspended in a suspension of barium. The mucus phenomenon is indistinguishable when translucent and can only be ascertained on images with compression. Chron. G. is often accompanied by a decrease in stomach tone. The increase in tone is often local in nature; at antral G. it is manifested by spastic conditions or motor excitation of the output part of the stomach. Violation of the peristaltic function is not always detected. In about half of the cases hron. G. superficial and rare peristalsis is observed. Pronounced disorders of peristalsis up to the appearance of the aperistaltic zone are observed with the so-called. rigid antral G. Evacuation of barium from the stomach usually occurs within normal periods, although occasionally it can be slowed down.
Forms hron. G. radiographically differ hl. arr. by the nature of the relief of the mucous membrane. According to Schindler's classification - Gutzeit, there are: hypertrophic G., atrophic G., mixed G., superficial hron, mucous catarrh. In turn, hypertrophic G. has subspecies: polypous, warty, ulcerative, or erosive. However, this classification is outdated and needs to be revised, since the inaccuracy of rentgenol has been proven. criteria for mucosal hypertrophy and atrophy; besides, at hron. G., as a rule, atrophic processes progress.
Based on the capabilities of rentgenol. the method is distinguished: hron, universal G., hron, antral G. and its wedge, and rentgenol, varieties (including rigid antral G.); hron, polypous (warty) G .; hron, granular G .; erosive G .; so called. accompanying gastritis (concomitant), for example, with peptic ulcer.
Rentgenol, data cron. G. can be taken into account only at the corresponding wedge, picture, anamnesis, etc. Numerous facts are known when expressed rentgenol, G.'s symptomatology was not confirmed by biopsy data and, conversely, morphologically proven G. did not appear radiologically.
At hron, universal G. the area of the rebuilt relief is usually very extensive (the body of the stomach is also captured). As a result of edema, hyperemia and inflammatory cell infiltration, mainly of the submucosal layer and connective tissue stroma, the folds of the mucous membrane swell unevenly (Fig. 4 and 5), sometimes so significantly that their number decreases. In places, the folds form polyp-like thickenings and have a distinct appearance (Fig. 6). Along the greater curvature, the oblique and transversely located bridges between the folds thicken, therefore the contour of the large curvature, Ch. arr. the lower half of the body of the stomach and sinus, becomes serrated and fringed. With severe edema, the mucous membrane loses its plasticity, which is accompanied by a symptom of relief rigidity. Inflammatory restructuring of the relief of the mucous membrane at hron. G. is sometimes so disordered and chaotic that it is difficult to distinguish it from the atypical relief in stomach cancer. Only a series of sighting images of the relief of the mucous membrane help to establish the still preserved variability of its pattern. In difficult cases, it is useful to resort to pharmacol, stimulation of peristalsis (morphine).
The described changes in the relief of the mucous membrane are not specific for G. Similar pictures can occur with allergic edema of the mucous membrane, with systemic diseases, etc.
Chron, antral G. refers to the most often found varieties hron. D. It has a bright, diverse, and most importantly the most convincing roentgenosemiotics. Rentgenol, the picture is characterized by signs of hypersecretion, the phenomenon of mucus, patol, restructuring of the relief of the mucous membrane. In addition, a deformation of the antrum and a violation of its peristalsis are found. The relief pattern varies: more often sharply swollen, widened folds, but retaining the usual longitudinal direction, their number is reduced. With pronounced edema, they form shapeless, pillow-like defects in the relief, the grooves between the folds disappear, the relief is smoothed out. A classic example of a relief at hron. G. of the antrum are rather persistently persistent thickened transverse folds of the mucous membrane (Fig. 7), along the greater curvature of the stomach - an irregularity of the contour in the form of uniform serration. With a long flowing hron. G. with secretory insufficiency, the relief is disordered and consists of shapeless bulges (defects) and spots and strips of barium chaotically located between them. In some cases, atypism of the relief occurs due to the increased mobility of the swollen mucous membrane of a relatively loose, inflammatory altered submucosa. With a wide pyloric canal, partial prolapse of the mucous membrane into the duodenal bulb is possible. With a normal lumen of the pylorus, the gastric mucosa does not fall out. However, periodically "sliding" mucous membrane, accumulating in front of the gatekeeper, here forms a kind of defect, reminiscent of a tumor lesion (Fig. 8). This "phenomenon of crawling" of the mucous membrane was first explained and described by Yu. N. Sokolov and VK Gasmaeva (1969).
Due to the thickening of the circular and longitudinal muscles, the antrum of the stomach is deformed: it narrows and shortens, in contrast to the deformity in infiltrating cancer, when the lumen of the pyloric part of the stomach only narrows, but does not shorten. As the process progresses, the walls of the antrum become thicker, lose elasticity, and the deformation becomes persistent. As a result of inflammatory submucosal sclerosis (the so-called sclerosing G.) peristalsis disappears and rigid antral G. arises, which, undoubtedly, is a late stage hron, antral G. with secretory insufficiency. At these patients quite often on the basis of a wedge, data suspect stomach cancer, which is often difficult to refute at rentgenol, research. The deformation of the antrum is very pronounced and persistent. Attention is drawn to the circular narrowing of the pyloric part of the stomach, while its simultaneous shortening often remains unnoticed (Fig. 9). On palpation, a feeling of a dense and painful tumor is created. The presence of cancer is indicated by a symptom of the aperistaltic zone, usually covering the entire antrum. The observation of at least short-term peristalsis testifies against cancer, edges can also be caused with the help of morphine.
At polypous (warty) G. patol, changes are often localized in the antrum. They represent multiple, uniform in size, rounded, blurred defects to dia. 3-5 mm, sometimes in the form of elevations on the crests of the folds, but more often forming a disorderly or honeycomb pattern (Fig. 10). With true polyps, even multiple ones, the relief of the gastric mucosa is usually not changed. At polypous G., as a rule, other rentgenol, symptoms are also found. At smaller growths G. is called warty, or verrucous; small defects are usually recognized only on sighting images with compression.
Granular gastritis is recognized by the symptom of "granularity" of the relief (Fig. 11). This symptom was studied by W. Frik using photographs of the relief of a sharp-focus X-ray tube at short exposures (no more than 0.1 sec.). This creates the impression of a granular surface of the mucous membrane with the smallest elevations - the so-called. gastric fields. Comparison of the data of the study of "fine relief" with the results of gastrobiopsy revealed a parallelism between the picture of the gastric fields and the presence of inflammatory changes in the mucous membrane. If under normal conditions the diameters of the fields are 0.5-1.5 mm, then with chron. G. gastric fields become more convex - "granular" type, and in advanced cases - and larger (dia. 3 mm and more), uneven, reminiscent of a warty surface. Along with this symptom, it is necessary to detect other rentgenol described above, G.'s signs.
Erosive G. is rarely recognized roentgenologically, since the possibilities of identifying erosions rentgenol are very limited by the research method.
The so-called. accompanying (accompanying) G. is radiologically constantly found in case of peptic ulcer disease (the exception is the so-called senile stomach ulcers) and less often in case of stomach cancer.
The expressed pictures of accompanying G. are observed with duodenal ulcer, after gastroenterostomy operation. At accompanying G. the outlet part of the stomach is more often amazed. All of the above-described rentgenol are also observed. G.'s symptoms. Often there is a rough drawing of the relief of the mucous membrane, disorder and swelling of the folds. Dynamic wedge. - rentgenol, observations of accompanying G.'s course at peptic ulcer show that if under the influence of conservative treatment the ulcer "niche" disappears, and other rentgenol, G.'s symptoms remain unchanged, then, as a rule, patients do not notice improvement.
At rentgenol, research, the recognition of polyposis G., which should be differentiated with true polyps of the stomach, can present known difficulties. When diagnosing hron. antral G. it is necessary to keep in mind also pernicious anemia, at a cut polymorphic changes in the relief of the mucous membrane of the pyloric part of the stomach can be observed.
In addition to rigid antral gastritis, it is necessary to take into account other types of antral G. with a sharp restructuring of the relief of the mucous membrane, which is sometimes indistinguishable from the atypical relief in cancer. Of particular importance in this sense is the "mucosal crawling phenomenon" described above. In case of difficulties, a series of images or X-ray cinematography, fibroscopy and gastrobiopsy are used. With the so-called. systemic diseases only a thorough analysis of the entire wedge, pictures allows you to come to the correct diagnosis.
See also Stomach, X-ray diagnostics.
Treatment complex and differentiated. Usually, treatment is carried out in outpatient; patients are hospitalized with exacerbations, especially those occurring with complications and severe general disorders.
Health food v complex therapy G. is of leading importance. During an exacerbation hron. G., regardless of the nature of secretory disorders, observe the principle of sparing the gastric mucosa and its functions. Food should be well cooked and chopped. Products and dishes that have a strong sokogonny effect, as well as causing mechanical, thermal and chemical, are excluded from the diet. irritation of the gastric mucosa. Prescribe a diet 1A (see Nutritional Medicine). Food is fractional, 5-6 times a day. As the exacerbation subsides, diet therapy is carried out in accordance with secretory disorders.
In case of secretory insufficiency of the stomach (outside exacerbations), the diet should be complete with a sufficient amount of proteins (110-115 g), fats (80-90 g), carbohydrates, vitamins; it should correspond to the calorie content of work and the patient's lifestyle. Prescribe diet number 2. Food must be taken 4-5 times a day. The diet includes a normal amount table salt and extractives. With persistent remission, extended nutrition can be prescribed. Fresh bread and other fresh dough products, fried (including boneless in breadcrumbs) meat and fish, fatty meats and fish, spicy, salty dishes, canned fish, cold drinks, ice cream are prohibited.
With normal and increased secretion, they begin with the appointment of table 1A, after 7-10 days they switch to table 1B, and after the next 7-10 days - to diet No. 1. The diet should be complete, but with restriction of table salt, carbohydrates and extractives, especially with increased acidity. Dairy laxatives (fresh kefir, yogurt) are recommended at night. Cabbage soup, borscht, fatty meat are prohibited, Fried fish, salted, smoked, pickled vegetables, not grated. Alcohol, beer, carbonated water, fruit water are strictly contraindicated.
Medical treatment of sick hron. G. provides for the impact on pathogenetic links patol, process. To normalize the functional state of the higher sections of the c. n. with. recommend valerian preparations, small tranquilizers, sleeping pills.
With an increased secretory and motor-evacuation function of the stomach, anticholinergic drugs (atropine, platifillin, spasmolitin, benzohexonium) in combination with antacids (vicalin, almagel, etc.) and agents that stimulate regenerative processes (methyluracil, pentoxil, licorice preparations, etc.) should be prescribed. ).
With secretory insufficiency, anticholinergic drugs are prescribed, similar to quateron and gangleron, which cause a pronounced antispasmodic effect, but have relatively little effect on the secretory function of the stomach. A good wedge, the effect is achieved with the use of Caucasian dioscorea, plantain juice, plantaglucide, which cause a slight increase in secretion, enhance the motor function of the stomach and have anti-inflammatory and antispasmodic effects. In order to influence the secretory function of the stomach, vitamins PP, C, B 6 and B 12 are also prescribed.
Outside the period of exacerbation, apply substitution therapy- gastric juice, abomin, betacid, pancreatin, etc.
Physical methods of treatment are also included in the complex to lay down. activities: heating pads, mud therapy, diathermy, electro- and hydrotherapy.
Sanatorium treatment of patients with chronic gastritis is carried out without exacerbation of the disease. Shown are resorts with mineral waters for drinking treatment: Arzni, Arshan, Berezovsky mineral waters, Borjomi, Izhevsk, Jalal-Abad, Jermuk, Druskininkai, Essentuki, Zheleznovodsk, Pyatigorsk, Sairme, Feodosia, Shira, etc. conditions: in case of secretory insufficiency, it is preferable to use chloride, chloride-bicarbonate waters for 15-20 minutes. before meals, and with normal and increased secretory function - bicarbonate waters 1 hour before meals.
Treatment hron. G. is possible in local sanatoriums, as well as in the usual regime, subject to dietary conditions.
The prognosis for life is favorable. Under the influence of treatment, the well-being of patients relatively quickly improves. But the main morfol, changes characteristic of hron. G., like the secretory function of the stomach, does not normalize under the influence of treatment. At massive bleeding in patients hron. G. with normal and increased secretion, the prognosis is more serious, as well as in patients with insufficient secretory function when they develop anemia, gastritis enterocolitis with impaired absorption processes and involvement in patol, the process of other organs of the digestive apparatus (hron, pancreatitis, hron, cholecystitis, etc.). With special forms hron. G. (rigid, polypous, giant hypertrophic) there is a danger of malignancy.
Prevention hron. G. consists in rational nutrition and observance of food hygiene rules, as well as in the fight against the consumption of alcoholic beverages and smoking. It is necessary to monitor the state of the oral cavity, timely treat diseases of other organs of the abdominal cavity, eliminate occupational hazards and helminthic-protozoal invasions. Dispensary examination of patients G. is of great importance.
Gastritis in children
Acute gastritis in children occurs as a result of infection, the consumption of infected, difficult to digest food, overeating and as a manifestation of allergies. Its etiology, clinic and treatment methods are similar to acute gastritis in adults.
Chronic gastritis occurs mainly in preschool and school age; its prevalence in school-age children is higher.
The causes of occurrence hron. G. are irrational nutrition and regimen, various diseases of the digestive and other systems, infection, allergies, as well as congenital features of the neuro-endocrine system and a violation of the synthesis of hydrochloric acid, which is confirmed by the presence of persistent achilia (in practically healthy and sick children of G.), to -It can not be explained by any illness or nutritional deficiencies.
At children with long-term diseases and disorders went. - kish. path hron. G. as an independent disease is rarely observed. At the same time, the study of the gastric mucosa by the gastrobiopsy method changed the idea of G.'s prevalence in children: a wedge, G.'s diagnosis is confirmed only in half of the cases. Children of senior school age and adolescents have hron. G. becomes a fairly frequent disease.
Morphologically, superficial G. and gastritis with defeat of glands without atrophy prevails in children, atrophic G. is less often observed (some authors do not find it in children).
The disease usually occurs gradually, has relatively little effect on the development of the child, has more easy current than in adults and is easier to treat; sometimes there is a persistent course.
There are two forms of hron. G. in children - malosymptomatic and a form with severe symptoms, often similar to peptic ulcer disease. The asymptomatic course of G.
Malosymptomatic form hron. G. is less common than a form with severe symptoms; often occurs in younger children: pain usually appears after eating, is of low intensity, localized in the epigastrium or diffused. Dyspeptic symptoms are absent in some children. The acid-forming function of the stomach is reduced or histamine reflex achilia is determined.
With hron. G. with severe symptoms, the pain symptom is intense, can occur immediately after a meal, after 1 - 2 hours or at night. Dyspeptic symptoms are persistent. Acid-forming function in most sick children is increased during long-term follow-up. In some children, peptic ulcer disease comes to light in the future, in this case G. is essentially a pre-ulcer state.
G.'s diagnosis is established on the basis of anamnesis data set, a wedge, manifestations and laboratory tests.
Differential diagnosis hron. G. at children is carried out with peptic ulcer (see), liver diseases (see), bile ducts (see Bile ducts) and diseases of the nervous system. Taking into account the exceptional rarity of malignant neoplasms of the stomach in children and an easier course of hron than in adults. G., there are no sufficient grounds for widespread use in pediatric practice of the gastrobiopsy method for diagnostic purposes. It is used only for strict indications and necessarily in a specialized clinic in order to exclude possible complications.
Treatment of gastritis in children is basically the same as in adults (taking into account the age and form of the disease).
At G., similar in clinic to peptic ulcer, treatment is carried out as antiulcer, including seasonal preventive courses.
Prevention hron. G. in children has the same principles as in adults.
Constitutionally weakened children with signs of dysfunction demanded special attention went. - kish. tract (increased acid-forming function, achilia, etc.), with residual effects after past diseases digestive and other systems.
Sick hron. D. children are subject to supervision by a pediatrician in order to prevent exacerbations of the disease, to carry out prophylactic anti-relapse courses of treatment and recreational activities.
Gastritis in old and old age
Features of G.'s course are caused by age-related changes in the digestive system and a decrease in general reactivity. Wedge, G.'s manifestations in elderly and senile patients are less pronounced than in young ones. Dyspeptic symptoms and pain are relatively little expressed, and a decrease in appetite is rarely observed. The digestive ability of gastric juice and the content of gastromucoproteins in it are reduced, as is the acid-forming function of the stomach. The electropherogram of gastric juice proteins in comparison with the electropherogram of young patients has a more "compressed" appearance, the debit of the protein component is lower in both fractions of gastric mucus, and the carbohydrate component is increased in insoluble mucus. A vitreous basal secret is often found - a jelly-like mass with a large number of desquamated cells of the mucous membrane. Atrophic changes in the gastric mucosa (according to aspiration biopsy) and secretory insufficiency occur in patients with hron. G. over the age of 60 is 2-3 times more often than among 30-40-year-olds. After 60 years, atrophic G. is more often observed in women, while at a younger age - more often in men. The great prevalence of atrophic G. in old age is connected, apparently, with the frequent development at this age hron, diseases of the liver, pancreas, intestines, promoting development hron. G.
Treatment and prevention are based on the accompanying hron, diseases and characteristics of the reaction of the elderly organism to the introduction of medicinal substances. When determining the forecast, one should bear in mind the possibility of cancer on the background of hron, atrophic G.
Experimental gastritis
In order to study the patterns of activity and mechanisms of regulation of the digestive system in conditions of pathology, as well as to develop issues of therapy, G. on animals reproduce G.
There are two groups of models of experimental G., which are used depending on the objectives of the study: a) G. caused by local action of various damaging agents on the gastric mucosa; b) G. caused by unusual conditions of contact of normal acidopeptic factors with the gastric mucosa.
To damage the gastric mucosa of animals, hot and cold water is used, as well as chemical. substances (1 - 10% silver nitrate solution, 1% acetic acid and 10% hydrochloric acid, alcohol solutions, infusion of mustard, red pepper, etc.), which are injected once or repeatedly into the stomach cavity. With such an effect of a damaging agent, it cannot be ruled out that it gets into the initial section of the duodenum, which complicates the picture of functional and morfol, disorders and cannot always be taken into account. There are techniques of limited damage to the gastric mucosa, which reproduce focal G., usually acute. At repeated damages, experimental acute G. can pass into hron, form. Of practical interest in the models of this group is experimental gastritis caused by the introduction into the stomach of various volumes of alcohol of different concentrations.
IP Pavlov created models of experimental G., directly damaging the stomach and observing the work of an isolated ventricle. He established the compensatory ability of the preserved mucous membrane, analyzed in detail the complex complex of intrasystemic and extrasystemic reactions in the body in response to damage to the stomach. IP Pavlov initiated the classification of types of gastric secretion disorders, which is used in the clinic.
G.'s model caused by the creation of nephysiol. the conditions of contact of normal secretion products of the gastric glands (acidopeptic factors) with the mucous membrane, is achieved by prolonged repeated imaginary feeding (gastric juice remains in the stomach cavity), adding salt to food or gastric juice in excess. Experimental violation fiziol. the ratio between free and bound hydrochloric acid in the stomach also has a damaging effect on the mucous membrane.
Experimental G. can also be caused by a change in the spectrum of proteolytic enzymes or the introduction of histamine or pilocarpine. This G.'s model develops gradually against the background of microcirculation disturbances and trophic processes in the mucous membrane, has hron, current.
Clinical and diagnostic characteristics of some clinical forms of chronic gastritis
|
chronic gastritis |
The main Clinical signs |
Gastric secretion study data |
radiological research |
Gastroscopy data |
Biopsy data |
|
Antral |
Pains in the epigastric region are hungry, nocturnal, sometimes subsiding after eating; heartburn, sour belching, often vomiting at the height of pain. Constipation tendency |
Increased |
The relief of the mucous membrane in the antrum is changed: thickening of the longitudinal folds, patol. restructuring, granular formations, the presence of the phenomenon of mucus. Increased tone and weakening of the peristalsis of the antrum. Signs of hypersecretion. Often, deformity of the antrum |
In the pyloric part of the stomach, redness of the mucous membrane, swelling of the folds, erosion and hemorrhage in the submucous layer are found. The tone of the pyloric part is enhanced, sometimes there is a prolonged pyloric spasm. Signs of hypersecretion |
Gistol, the picture of the mucous membrane is normal or has signs of hron, gastritis of varying severity. In the antrum - signs of hyperplasia, often a rare location of the pyloric glands, pronounced cellular infiltration of its own layer, areas of intestinal metaplasia |
|
Giant hypertrophic gastritis (Menetrie's disease) |
Weight loss, signs of hypoproteinemia, iron deficiency anemia. Obstinate gastric dyspepsia. Patients report a feeling of spasm and pressure in the epigastric region. The pains sometimes resemble those of a peptic ulcer; vomiting may be mixed with blood |
Decreased, normal or increased |
Pronounced changes in the relief of the mucous membrane along the greater curvature (in the sinus and the lower half or third of the body of the stomach) in the form of overly spaced, elastic thickened folds hanging down into the lumen of the stomach, and sometimes into the duodenum |
The mucous membrane is swollen, with wide winding folds covered with mucus, sometimes with warty, polypoid growths |
Hyperplasia of all elements of the mucous membrane |
|
Gastritis with normal and increased secretory function |
The general state does not change. Pain in the epigastric region occurs immediately after eating, combined with a feeling of heaviness, overflow. The pains are diffuse, dull, aching, usually moderate, less often intense, last 1 - 11/2 hours. Heartburn, often belching with air, intermittent vomiting |
Basal secretion increases to 10 meq / hour, maximum histamine secretion - up to 35 meq / hour. Abundant gastric secretion is often observed at night |
Widespread restructuring of the relief of the mucous membrane with thickening of the folds (sometimes their pillow-like bulging) until the grooves disappear; smoothness of the relief in the antrum. Violation of tone and peristalsis. Signs of hypersecretion |
Redness, hypertrophy of folds, edema, the presence of mucus, single erosion and hemorrhage in the submucosa, signs of hypersecretion. With severe hypertrophy, the mucous membrane has a velvety appearance without the usual shine |
Flattening of the mucous membrane due to hyperplasia of the superficial epithelium, less often interstitial tissue. The epithelium is often flattened, with a basal arrangement of nuclei of various sizes; hypersecretion with flour yes, signs of granular and vacuolar degeneration; abundant cellular infiltration of its own layer |
|
Polypoid |
Reminds clinic hron, gastritis with secretory insufficiency; can be asymptomatic. The prolapse of polyps into the duodenum and their infringement is clinically manifested by a pronounced pain syndrome. Bleeding may occur |
More often reduced |
Typical changes are more often localized in the antrum - typical small uniform rounded filling defects, sometimes on the crests of the folds, but usually they form a disorderly or honeycomb pattern. With true polyps, even multiple ones, the relief of the mucous membrane is usually not changed. |
Found multiple polyps, the same or different in shape and size, which are often located in the pylorus. The mucous membrane is pale, thinned, its folds are smoothed, blood vessels are visible (atrophic gastritis) |
Outside the localization of the polyp, the picture of atrophic gastritis |
|
Rigid |
Prolonged persistent dyspepsia. In the epigastric region, patients note diffuse moderate pain, often a feeling of heaviness and pressure. There is a tendency to diarrhea and the development of anemia |
Sharply reduced |
Deformation (narrowing, shortening) of the antrum, restructuring of its internal relief; weakening or disappearance of peristalsis |
Deformity, rigidity and narrowing of the pyloric stomach, edema of the mucous membrane |
In the output section, there is a picture of atrophic and hyperplastic hron, gastritis. In other departments, atrophy of the glandular apparatus of varying severity |
|
Gastritis with secretory insufficiency |
Weight loss and decreased appetite, feeling of heaviness and pressure in the epigastric region after eating. Moderate and intermittent pain, nausea, rarely vomiting. Tendency to diarrhea, flatulence; poor milk tolerance, without exacerbation - addiction to sour and salty foods. Often anemia |
Basal secretion approx. 0.8 meq / hour, maximum histamine secretion up to 10 meq / hour |
The relief of the mucous membrane is smoothed, tone and peristalsis are often weakened, the evacuation of stomach contents is accelerated |
Diffuse or focal thinning of the mucous membrane, its color is pale, dilated blood vessels of the submucosa are clearly visible. The folds of the mucous membrane are small, in places covered with mucus, when the stomach is inflated with air, the folds are easily smoothed out. Erosions and punctate hemorrhages are sometimes observed |
Various degrees of glandular atrophy (decrease in the main and parietal glandulocytes), flattening of the epithelium of the mucous membrane, deepening of the fossae, intestinal and pyloric metaplasia |
|
Erosive gastritis(hemorrhagic) |
Pain in the epigastric region: early, fasting and late; acidic heartburn, sometimes vomiting mixed with blood (from traces to clots). The higher the acidity, the more often bleeding Tendency to constipation |
Normal or elevated |
The relief of the mucous membrane is changed more often in the pylorus of the stomach. Erosion detection capabilities are very limited |
Multiple erosions of a round or stellate shape are determined, mainly in the outlet of the stomach, against the background of the phenomena of superficial gastritis - edema, infiltration, hyperemia of the mucous membrane |
Gistol, the picture of the mucous membrane is more often similar to the picture of hron, gastritis with increased secretion. Erosions are more often detected with targeted biopsy |
Bibliography: Aruin LI Morphological study of biopsies of the gastric mucosa, Arkh. patol., t. 31, No. 3, p. And, 1969; Aruin L. I. and Sh and -r about in V.G. To the question of the morphogenesis of chronic gastritis, in the same place, t. 33, No. 10, p. 21, 1971; Belousov AS Essays on functional diagnostics of diseases of the esophagus and stomach, M., 1969, bibliogr .; Gordon OL Chronic gastritis and so-called functional diseases of the stomach, M., 1959, bibliogr .; Gubar V. L. Physiology and experimental pathology of the stomach and duodenum, M., 1970; Kanishchev P. A. Methods of diagnosis of diseases of the stomach, L., 1964; Lazovsky Yu. M. Functional morphology of the stomach in norm and pathology, M., 1947; Levin GL Sketches of gastric pathology, M., 1968; L and with about h to and B. G. N., Ultrast ^ structure of the glands of the stomach and its change in conditions of chronic gastritis, Arkh. patol., t. 34, No. 10, p. 11, 1972; Masevich Ts. G. Aspiration biopsy of the mucous membranes of the stomach, duodenum and small intestine, L., 1967; about N e, Pre-tumor diseases of the stomach, L., 1969, bibliogr .; Menshikov FK Diet therapy, M., 1972, bibliogr .; Pavlov I.P. Complete Works, vol. 2, book. 2, M.-L., 1951; Peleschuk A. P. Diseases of the system and digestive organs, in the book: Fundamentals of gerontol., Ed. D.F. Chebotareva and others, p. 322, M., 1969; Rachvelishvi-l and B. X. Gastrobiopsy in clinical practice, Tbilisi, 1969; P y with with SM Diseases of the digestive system, L., 1966; Tugolukov VN Modern methods of functional diagnostics of the state of the gastric mucosa and their clinical significance, L., 1965; F and sh-z about N-P y with Yu. I. Modern methods of research of gastric secretion, L., 1972, bibliogr .; about N e, Gastritis, L., 1974, bibliogr .; In about with k u s H. Gastroenterology, at. 1-3, Philadelphia-L. * 1963-1965; Gastritis, hrsg. v. G. Clemenson, Basel, 1973; HafterE. Praktische Gastroenterologie, Stuttgart, 1962, Bibliogr .; M o r s o n B. C. a. Davson I. M. P. Gastrointestinal pathology, p. 80, Oxford, 1972, bibliogr .; Peleschtschuk A. P. u. a. Funktionelle und morphologische Veranderungen des Magens bei Pa-tienten mil umunischer Gastritis im hohe-ren Lebensalter, Z. Alternsforsch., Bd 25, S. 271, 1972; Schindler R. Gastritis, N. Y., 1947, bibliogr .; Spiro H. M. Clinical gastroenterology, p. 155, L., 1970; Wolff G. Chronische Gastritis, Lpz., 197 4.
X-ray diagnostics G.- Ryzhikh AN and Sokolov Yu. H. Rigid antral gastritis as a precancerous disease of the stomach, Surgery, No. 4, p. 34, 1947; Saghatelyan G. M. X-ray diagnostics of diseases of the esophagus, stomach and gastroscopy, Yerevan, 1966, bibliogr .; Smirnova NV Diagnostics of gastritis of the distal stomach, Wedge, medical, t. 49, No. 1, p. 69, 1971; With about to about l about in Yu. N. and V l and with about in P. V. Relief of the mucous membrane of the stomach is normal and pathological, M., 1968, bibliogr .; Sokolov Yu. N. and Gasmaev VK About the phenomenon of "crawling" of the gastric mucosa, Vestn, rentgenol, and radiol., No. 2, p. 66, 1969; Sokolov Yu.N. id r. Our experience in the study of the fine relief of the stomach in chronic gastritis, ibid., No. 5, p. 3, 19 73, bibliogr .; Tikhonov KB and Pruchansky VS Microrelief of the gastric mucosa and its significance in the diagnosis of chronic gastritis, ibid., No. 2, p. 82, 1970, bibliogr .; F and N and r d-sh I V. A. N. Radiodiagnosis of diseases of the digestive tract, t. 1, Yerevan, 1961; Sh l and f er I. G. Relief of the mucous membrane of the stomach and duodenum, Gastritis, ulcer, carcinoma, b. m., 1935, bibliogr .; Cummack D.H. Gastrointestinal X-ray diagnosis, Edinburgh - L., 1969; Pr £ v6t R. u. L a s r i c h M. Rontgendiagnostik des Magen-Darmka-nals, Stuttgart, 1959, Bibliogr.
G. in children- Balashova TF Enzyme-forming function of the stomach in chronic gastritis in children, Pediatrics, No. 5, p. 14, 1971; And in scarlet about in SM, etc. Endocrine cells of the gastric mucosa in children, in the same place, No. 3, p. 12, 1975, bibliogr .; Queen R. I. and Bialik V. L. O diagnostic value aspiration biopsy of the gastric mucosa in chronic gastritis in children, ibid., JNft 12, p. 22, 1966; Cossure M. B. Diseases of the stomach in children, M., 1968, bibliogr .; Lukyanova EM, Korole-z in and RI and Shly to about in IA Endoscopic studies of the stomach in chronic gastritis in children, Pediatrics, No. 3, p. 17, 1975; Multivolume Guide to Pediatrics, ed. Yu. F. Dombrovskaya, vol. 4, p. 191 and others, M., 1963; About s tr about polo-lets S. S. and others. Morphological day-n1st of small gastritis with normal i shdvshtsenoy secretory function of the shlun-ka at d1tey, Ped1at., Obstetrician. i gshek., no. 4, p. 3, 1975; Samarina G. Ya. Clinical features of antral gastritis in children, Vopr. okhr. mat. and children., v. 18, no. 6, p. 23, 1973; Smirnov H. M. Chronic gastritis in children, Minsk, 1967, bibliogr .; Sandberg D. N. Hypertrophic gastropathy (Menetrier's disease) in childhood, J. Pediat., V. 78, p. 866, 1971; Sedl & ckov & M. a. Bedn £ r B. Chronic gastritis in childhood, Gastroenterologia (Basel), v. 107, p. 251, 1967.
F. I. Komarov; L. I. Aruin (pat.an.), M. B. Cossyura (ped.), H. N. Lebedev (pat. Phys.), A. P. Peleschuk (geront.), Yu. N. Sokolov ( rent.), the compiler of the table F.I.Komarov.
MACROPREPARATION No. 1 FATTY LIVER DYSTROPHY
Liver incisions are visible in the specimen.
The liver is small, as it is the liver of a child. But nevertheless, the size of the liver is increased, since its capsule is tense, and the corners are rounded.
The color of the liver is yellow on the cut.
The consistency of the liver is flabby.
When such a liver is cut with a knife, droplets of fat remain on its blade.
This is parenchymal fatty degeneration of the liver, or "goose" liver.
It can develop in people suffering from chronic cardiovascular diseases, chronic lung diseases, diseases of the blood system, chronic alcoholism.
As a result of parenchymal fatty degeneration, portal, small-nodular cirrhosis of the liver may develop over time.
MACROPREPARATION No. 2 BLEEDING IN THE BRAIN
A horizontal section of the brain tissue is visible in the specimen. The cerebellum is visible below and behind the brain.
In the right hemisphere of the brain, in the region of the subcortical nuclei, there is a focus of dark brown color due to the fact that in the focus of hemorrhage we see caked blood. This is a focus of hemorrhage in the necrotic tissue of the brain, with fairly clear boundaries - a hematoma. In the center of the hematoma under anaerobic conditions, the pigment hematoidin is formed, and along the periphery, on the border with healthy tissues, hemosiderin. Blood from the focus of hemorrhage broke into the anterior horn of the right lateral ventricle, into the third ventricle of the diencephalon, the Silvian aqueduct of the midbrain and into the fourth ventricle of the rhomboid brain.
Hematoma is a type of hemorrhagic stroke.
Clinically it was accompanied by the development of focal symptoms on the opposite side of the body - left-sided paresthesia, hemiplegia, hemiparesis, paralysis.
If the patient had not died, then a cyst with walls rusty from hemosiderin would have formed at the site of the hemorrhage.
MACROPREPARATION No. 3 KEPHALOGEMATOMA
The preparation contains the integumentary bone of the newborn's skull. On the upper - lateral surface of the bone, under its periosteum there is caked blood of a dark brown, almost black color - this is a subperiosteal hemorrhage. This is a birth injury to the skull related to external cephalohematoma.
MACROPREPARATION No. 4"TAMPONADA" OF THE HEART
The preparation presents a longitudinal section of the heart from the side of the left ventricle, since the thickness of the ventricular myocardium is more than 1 cm. It is noteworthy that the cavity of the left ventricle is slit-like, that is, the heart is compressed by something from the outside. The subepicardial fat layer, epicardium, pericardium are determined. In the pericardial cavity, gray-brown blood clots are visible. It is due to their presence in the pericardial cavity that the heart was compressed from all sides, and the cavity of the left ventricle became slit-like. This is bleeding into the pericardial cavity - hemopericardium, an example of internal bleeding, figuratively - "tamponade" of the heart. Attention is also drawn to the fact that in the region of the posterior - lower wall of the heart, the myocardial tissue is stained with hemosiderin in a brown color, due to the rupture of the heart wall in this place and hemorrhage from the damaged vessel. The rupture of the heart wall occurred due to myomalacia in the area of transmural myocardial infarction.
Thus, the hemorrhage in the cardiac shirt was a consequence of myomalacia and rupture of the heart wall in the area of transmural myocardial infarction.
MACROPREPARATION No. 5 Purulent Meningitis
In the preparation, the brain is visible from the side of its upper - lateral surfaces. Under the pia mater, an accumulation of exudate of white-yellow color, the consistency of thick sour cream, is determined. This is a purulent exudate. The exudate lies on the surface of the convolutions, enters the grooves, smoothing the relief of the surface of the brain.
Inflammation of the pia mater is meningitis.
Primarily purulent meningitis can occur with meningococcal infection, and secondarily, it can complicate infectious diseases with generalization of the infection (with sepsis).
MACROPREPARAI No. 6 A BRAIN TUMOR
The preparation shows a horizontal section of the brain. In one of the hemispheres (in the left), in the white matter, there is a focus of pathological proliferation of brain tissue with indistinct contours, indistinct growth boundaries. The consistency of the node of pathological growth of brain tissue approaches the consistency of the brain itself. The color is variegated, since there are hemorrhages and necrosis in the focus. This is a brain tumor. Since the boundaries of tumor growth are indistinct, a malignant tumor occurs. It can be assumed that this is glioblastoma, the most common malignant tumor in adults.
MACROPREPARATION No. 7 Tibial sarcoma
The preparation contains the bones that form the knee joint. In the area of the upper part of the diaphysis of the tibia, there is a pathological proliferation of tissue that destroys the posterior surface of the bone, which has indistinct growth boundaries. This is a tumor. It is white, layered, reminiscent of fish meat. The indistinctness of the growth boundaries indicates the malignant nature of the tumor. Malignant tumor from bone tissue - osteosarcoma. Since the process of bone destruction prevails over the process of bone formation, this is osteolytic osteosarcoma.
MACROPREPARATE No. 8 BRAIN ABSCESSES IN SEPTICOPYEMIA
The preparation contains sections of the brain. In each section, there are multiple foci of irregular rounded shape, clearly delimited from the brain tissue by a thick wall. Filled with contents of white - yellowish or white - greenish color, consistency of thick sour cream. This is a purulent exudate.
Focal accumulations of pus, separated from the brain tissue by a wall, are abscesses.
The wall of an acute abscess consists of two layers: 1) an inner layer - a pyogenic membrane and 2) an outer layer - a nonspecific granulation tissue.
In the wall of a chronic abscess, three layers are distinguished: 1) inner - pyogenic membrane, 2) middle - nonspecific granulation tissue and 3) outer - coarse fibrous connective tissue.
Brain abscesses develop with the generalization of purulent inflammation in the lungs, intestines and other organs, that is, with sepsis, septicopyemia.
MACROPREPARATE No. 9 Stenosis of the mitral orifice (rheumatic heart disease)
The specimen presents a cross-section of the heart, produced above the level of the atrio-ventricular foramen, so that the cusps of the bicuspid, mitral and tricuspid valves are clearly visible.
The leaflets of the mitral valve are deformed. They are sharply thickened, with a tuberous surface, opaque, rigid due to the proliferation of connective tissue in them. There is a gap between the closed valve leaflets, that is, mitral valve insufficiency has developed.
In addition, there is a narrowing of the left atrio-ventricular opening.
Thus, in the area of the mitral valve there is a combined heart defect - insufficiency and stenosis of the mitral valve.
Such acquired heart defects most often form in the course of rheumatic valvular endocarditis.
The described changes in the mitral valve correspond to the stage of fibroplastic endocarditis.
It can be assumed that the patient died of progressive chronic cardiovascular failure due to decompensated rheumatic heart disease.
MACROPREPARATE No. 10 UTERINE CHORIONEPITELIOMA
The preparation contains a longitudinal section of the uterus with appendages.
The size of the uterus is increased (normally the height of the poppy is 6 - 8 cm, the width is 3 - 4 cm and the thickness is 2 - 3 cm). In the uterine cavity, the growth of tumor tissue is visualized, which grows into the myometrium, that is, invasive tumor growth takes place.
The consistency of the tumor is soft, porous, since the tumor contains absolutely no connective tissue.
The color of the tumor tissue in the preparation is gray with dark brown blotches. In a fresh preparation, it is dark red, variegated, since the tumor has cavities, lacunae filled with blood.
Based on the nature of the growth, the tumor is malignant. It develops from the epithelium of the chorionic villi (placenta). This is chorionepithelioma.
It is an organ-specific tumor. It is built of two types of cells - large mononuclear cells with light cytoplasm, or Langhans cells, derived from cytotrophoblast, and large ugly multinucleated cells, derived from synticyotrophoblast. The tumor is hormonally active. Tumor cells secrete the hormone gonadotropin found in a woman's urine; thanks to the hormone, the uterus is enlarged.
The tumor developed in connection with pregnancy. This is a differentiated tumor.
Metastasizes mainly by hematogenous route to the liver, lungs, vagina.
In the present preparation, in the area of the vaginal portion of the cervix and in the wall of the vagina, rounded foci similar in appearance to the primary tumor are visible. These are tumor metastases.
MACROPREPARATE No. 11 CHRONIC STOMACH ULTRA WITH PENETRATION INTO THE PANCREAS
The preparation shows a fragment of the stomach wall from the side of the mucous membrane and the pancreas located behind the stomach.
In the wall of the stomach there is an ulcerative defect with raised dense, callous, callous edges and a shallow bottom. One edge of the defect facing the esophagus, the proximal one is subdued, with an overhanging mucous membrane. The other edge, opposite, distal, is gently sloping or terraced. The difference in edges is due to the presence of a peristaltic wave.
A defect in the wall of the stomach is a chronic ulcer, since at the edges of it there was an overgrowth of connective tissue, which caused a change in the edges of the defect.
At the bottom of the ulcer, it is not the tissue of the stomach wall that is determined, but the lobular, white tissue of the pancreas.
Thus, there is an ulcerative - destructive complication of chronic gastric ulcer - penetration into the pancreas.
It can be assumed that the patient died from a spilled den.
MACROPREPARATE No. 12 MUSKATIC LIVER
A frontal section of the liver is visible in the specimen.
The liver is enlarged.
The color of the liver tissue on the cut is variegated: areas of gray - black color (these are areas with clotted blood) interspersed with areas of gray - brown color (color of hepatocytes).
Areas of gray-black color, and in a fresh preparation - red, are caused by plethora and expansion of the central veins and the central 2/3 of the sinusoids of the liver lobules flowing into them.
Due to the similarity of the surface of the liver incision to the surface of the cross section of nutmeg, the drug got its name.
It occurs with the development of chronic venous plethora in the body, which occurs in conditions of chronic cardiovascular insufficiency, which is a complication of chronic diseases of the heart, such as mitral valve disease, myocarditis with an outcome in cardiosclerosis, chronic ischemic heart disease.
MACROPREPARATION No. 13 Adenoma of the prostate gland with ureterohydronephrosis
The preparation contains an organocomplex consisting of a longitudinal section of the kidney with the ureter, longitudinal sections of the bladder and prostate gland.
Changes in the structure of the prostate gland entailed compensatory - adaptive changes in the structure of the overlying organs.
The prostate gland is enlarged, due to the proliferation of a tumor node in one of its lobes, rounded, with clear boundaries of growth, delimited from the prostate tissue by a connective tissue capsule. This is a benign tumor - prostate adenoma.
Due to the presence of an adenoma, the prostatic part of the urethra narrowed sharply, which led to a violation of the outflow of urine.
Working hypertrophy developed in the bladder wall. Along with wall hypertrophy, the bladder cavity expanded, that is, eccentric decompensated bladder hypertrophy developed.
The ureter, pelvis and cups of the kidney have dilated due to impaired outflow of urine - hydroureteronephrosis.
In the parenchyma of the kidney, a type of local pathological atrophy has developed - atrophy from pressure.
MACROPREPARATE No. 14 CENTRAL LUNG CANCER
The trachea with cartilaginous half-rings located on its front surface, the main bronchi, a part of the left lung adjacent to the left main bronchus are visible in the preparation.
The lumen of the left main bronchus is sharply narrowed due to the fact that around the bronchus in the lung tissue there is a pathological proliferation of gray - beige tissue, dense consistency, in the form of a node with indistinct growth boundaries. This is a malignant tumor growing from the epithelium of the main bronchus - lung cancer. Outside the main node of the tumor, there are multiple foci, irregularly rounded, - cancer metastases to the lungs.
Since cancer grows from the main bronchus, it is central in localization.
Since tumor growth is represented by a nodule, the macroscopic form of cancer is nodular.
Most often, the histological form of central lung cancer is squamous, the development of which is preceded by metaplasia of the glandular epithelium of the bronchi into stratified squamous non-keratinizing epithelium in the course of chronic bronchitis.
In relation to the surrounding tissues, cancer grows infiltratively.
In relation to the lumen of the main bronchus - into its wall, that is, endophytic, compressing the lumen of the bronchus.
Due to a violation of the patency of the bronchus due to its compression by a tumor in the lung tissue adjacent to the bronchus, such diseases as atelectasis, abscess, pneumonia, bronchiectasis can develop.
Lung cancer is an organ-specific epithelial tumor.
Metastasizes mainly by the lymphogenous pathway. The first lymphogenous metastases are found in the regional lymph nodes - peribronchial, paratracheal, bifurcation.
MACROPREPARATION No. 15 POLIPOSO - ULCER AORTIC VALVE ENDOCARDITIS
We see the heart preparation in a longitudinal section from the side of the left ventricle, since its myocardium has a thickness of more than 1 cm. The cavity of the left ventricle is expanded. There is eccentric decompensated working hypertrophy of the left ventricular myocardium and tonogenic dilation.
The crescent moon of the aortic valve is changed, they are thickened, tuberous, rigid, opaque. On two of the three half-moon, an ulcerative defect is clearly visible, on the surface of which thrombotic overlays in the form of polyps have formed. Such changes I in the aortic valve crescent are called polypoid - ulcerative endocarditis, which is one of the clinical and morphological forms of sepsis.
Microscopically, microbial colonies and lime scale deposits can be detected in the thickness of these thrombotic deposits.
Complications of this process can be thrombobacterial embolism and the formation of aortic heart disease.
Since polypoid - ulcerative endocarditis has developed on the already changed aortic valve crescents, this is secondary endocarditis.
MACROPREPARATE No. 16 STOMACH CANCER (Saucer-shaped)
The preparation contains a fragment of the stomach from the side of the mucous membrane. The stomach is cut along the greater curvature.
In the area of the lesser curvature of the body of the stomach, there is a pathological proliferation of tumor tissue into the lumen of the stomach with loose raised edges and a shallow bottom. The boundaries of tumor growth are indistinct in places. At the bottom of the tumor growth, there are foci of white necrosis.
The indistinct boundaries of tumor growth and the presence of secondary changes in it in the form of foci of necrosis indicate the malignancy of the tumor.
A malignant tumor growing from the epithelium of the stomach is stomach cancer.
By localization, it is a cancer of the body of the stomach.
By the nature of its growth, it is an ecophytic - expansive cancer.
On a macroscopic basis, it is a saucer-shaped cancer.
Microscopically, it will most often be represented by a differentiated form of cancer - adenocarcinoma.
Since stomach cancer, according to the international classification of tumors, belongs to the group of organ-specific epithelial tumors, the predominant route of its metastasis will be lymphogenous. The first lymphogenous metastases can appear in the regional lymph nodes - four collectors of lymph nodes located along the lesser and greater curvatures of the stomach.
Since the stomach is an unpaired abdominal organ, the first hematogenous metastases are found in the liver.
MACROPREPARATION No. 17 ABSCEDING PNEUMONIA IN SEPTICOPYEMIA
We see a cross section of the right lung, as it contains three lobes.
In each lobe, against the background of an airy tissue of a light beige color, there are multiple foci of a round and irregular shape, the size of a match head, in places merging with each other, dense consistency, airless or low-air, with a smooth cut surface, white-gray. These are foci of inflammation in the lung tissue - foci of pneumonia.
A white wall is formed around some foci, and the contents of the foci become the consistency of thick sour cream. A complication of pneumonia, abscess formation, develops.
Absolute pneumonia can develop with septicopyemia, one of the clinico-morphological forms of sepsis.
MACROPREPARATE No. 18 LARGE PNEUMONIA (WITH ABSCEDING)
The preparation shows a longitudinal section of the right lung, as three lobes are visible.
The lower lobe is entirely gray, airless. The surface of its section is fine-grained.
The consistency of the lung lobe corresponds to the hepatic density.
The interlobar pleura is thickened with gray-beige filmy overlays.
This is croupous pneumonia, hepatization stage, a variant of gray hepatization.
In the lower segments of the lobe, cavities are determined, delimited from the lung tissue by the wall. These are abscess cavities.
There is one of the pulmonary complications of pneumonia - abscess formation. Its cause is the addition of a secondary purulent infection due to decreased immunity and increased fibrinolytic activity of neutrophilic leukocytes.
MACROPREPARATE No. 19 SMALL-NODED LIVER CIRROSIS
A section of the liver is presented in the preparation.
The liver is reduced in size, since its corners are pointed, and the capsule is wrinkled.
On the outer surface of the liver, multiple nodes of regenerates are determined, up to 1 cm in size, making the surface of the liver non-smooth.
On the surface of the incision, the boundaries of the false lobules are clearly visible (whereas in the norm the boundaries of the hepatic lobules are not visualized) due to the proliferation of fibrous tissue in the area of the portal tracts.
This is cirrhosis of the liver.
In macroscopic form, it is small-knot. In microscopic form, it is monolobular, since the size of the false lobules corresponds to the size of the nodes - regenerates.
According to its pathogenesis, it is portal cirrhosis of the liver, in which portal hypertension develops primarily, and hepatocellular failure secondarily.
Such cirrhosis can develop as a result of fatty hepatosis, chronic viral hepatitis B and chronic course of alcoholic hepatitis.
MACROPREPARATE No. 20 UTERINE BODY CANCER
A longitudinal section of the uterus is shown.
The uterus is enlarged. It can be seen that in the uterine cavity there is a pathological proliferation of tissue with a non-smooth, papillary surface, in places with ulceration, with indistinct growth boundaries. This is a tumor growth.
The tumor develops from the endometrium, it can be seen that it grows into the wall of the uterus. This is a malignant tumor from the epithelium - cancer of the body of the uterus.
Histologically, it is represented by a differentiated form of cancer - adenocarcinoma.
The nature of tumor growth in relation to the lumen of the uterus is exophytic, in relation to the surrounding tissues - infiltrating.
It can develop as a result of atypical glandular hyperplasia of the endometrium.
It is an organ-specific epithelial tumor. Metastasizes mainly by the lymphogenous pathway. The first lymphogenous metastases are found in the regional lymph nodes.
MACROPREPARATION No. 21 PURULENT - FIBRINOUS ENDOMYOMETRITIS
A longitudinal section of the uterus with appendages is visible.
The uterus is sharply increased in size, its cavity is sharply expanded, the wall is thickened.
The endometrium is dirty gray in color, dull, covered with filmy beige overlays, hanging in places into the uterine cavity. In the endometrium there is an inflammatory process - purulent - fibrinous endometritis.
In addition, the inflammation has spread to the muscular membrane of the uterus, since the myometrium is dull, dirty gray in color.
Thus, in the presented preparation there is purulent - fibrinous endomyometritis, which could arise as a result of a criminal abortion and cause uterine sepsis.
MACROPREPARATE No. 22 MULTIPLE UTERINE FIBROMIOMAS
A cross section of the uterus is shown.
In the wall of the uterus, the growth of tumor tissue in the form of nodes, of different sizes, round and oval, with clear boundaries of growth, surrounded by a thick-walled capsule, is visible, which is a reflection of the expansive growth of the tumor.
The nodes located inside the wall of the uterus - intramural, lying under the endometrium - submucous, lying under the serous membrane - subserous.
The nodes are built of two types of fibrous structures - some beige fibers are smooth muscle fibers, the other gray-white fibers are connective tissue fibers. Fibrous structures have different thicknesses and go in different directions, which are manifestations of tissue atypism.
Since the tumor nodes contain a large number of connective tissue fibers, their consistency is dense.
Due to the fact that the tumor grows expansively and has only signs of tissue atypism, it is benign. A benign tumor of smooth muscle with an admixture of fibrous tissue is called fibroids.
Based on the international classification of tumors, it belongs to mesenchymal tumors.
MACROPREPARATE No. 23 BUBBLE FAN
The drug is represented by an uviform cluster of thin-walled vesicles adhered to each other and filled with a transparent liquid. This is a cystic mole, a benign organ-specific tumor that develops during and after pregnancy from the epithelium of the chorionic villi.
The development of cystic drift is based on hydropic degeneration of epithelial cells.
A vesicular mole is benign until it begins to grow into the wall of the uterus, into the veins. After that, it becomes malignant, or destructive. Against the background of a malignant cystic drift, a malignant organ-specific tumor of chorionepithelioma may develop.
MACROPREPARATE No. 24 THROMBOEMBOLIA OF THE PULMONARY ARTERY
The drug is represented by an organocomplex: the heart and fragments of both lungs.
The heart is clipped from the side of the right ventricle, since the thickness of its myocardium is approximately 0.2 cm. The pulmonary trunk emerges from the right ventricle, which is divided into two pulmonary arteries, respectively, to the right and left lungs.
In the lumen of the pulmonary trunk and its bifurcation there are massive, heavy, dense, crumbling masses with a corrugated surface that are not attached to the walls of blood vessels. These are thromboemboli. The source of such massive thromboemboli could most likely be the veins of the lower extremities.
The thromboembolus located in the lumen of the pulmonary artery trunk and its bifurcation irritates the reflexogenic zone receptors located in the intima of the above vessels and causes the development of a pulmo - coronary reflex, which consists in an instant spasm of small bronchi and bronchioles and coronary arteries of the heart, with the development of acute cardiovascular failure and the onset instant death.
MACROPREPARATION No. 25 AORTIC ATHEROSCLEROSIS WITH ATHEROMATOSIS AND PARALLEL THROMBOSIS
The abdominal aorta in a longitudinal section and the area of bifurcation of the aorta to the common iliac arteries are presented.
The intima of the aorta is changed. It defines multiple round-longitudinal spots of white-yellow color, which are lipid deposits and proliferation of fibrous tissue. These are atherosclerotic plaques. They bulge into the lumen of the aorta, making it narrower. Below the opening of the inferior mesenteric artery, the plaques are ulcerated, atheromatous (necrotic) masses have formed on their surface, and hemorrhages have occurred.
The appearance of atherosclerotic plaques in the intima of the aorta indicates the presence of a disease of atherosclerosis, a clinical and morphological form of atherosclerosis of the aorta.
The described plaque changes correspond to the macroscopic stage of complicated lesions.
Damage to the aortic intima was one of the local prerequisites for thrombus formation. In the lumen of the abdominal aorta and in the lumen of the iliac arteries, parietal and even obstructing blood clots formed, disrupting the passage of blood through the aorta to the lower extremities.
MACROPREPARATE No. 26 Lesion of the small intestine with abdominal typhus
The specimen presents the small intestine in a longitudinal section from the side of the mucous membrane.
On the mucous membrane, longitudinal oval-shaped formations are visible, protruding above the surface of the mucous membrane and having on their surface a kind of grooves and convolutions, as in the brain. These formations are pathognomonic for typhoid fever. They arose as a result of acute productive inflammation in the area of lymphatic follicles located in the submucosa of the intestine. Due to the proliferation of macrophage and histiocytic elements, the follicles increased in volume, size and began to rise above the mucosal surface.
Due to the presence of grooves and convolutions on the surface of the follicles, the first stage of typhoid fever is called cerebral swelling.
MACROPREPARATE No. 27 FIBROZOUS - CAvernous pulmonary tuberculosis
The specimen is represented by a longitudinal section of the right lung, since it has 3 lobes. Each of the lobes has cavities, large cavities with thick, non-collapsing walls. Since the walls of the cavities do not collapse, these are old, chronic cavities inherent in fibrous-cavernous pulmonary tuberculosis, one of the phases of forms of secondary pulmonary tuberculosis.
The wall of the old cavity consists of 3 layers: 1) internal - caseous necrosis; 2) medium - specific granulation tissue; 3) external - fibrous tissue.
The patient develops cor pulmonale, chronic pulmonary heart failure, tuberculous intoxication and cachexia, from which he dies.
MACROPREPARATE No. 28 PARA-AORTIC LYMPHONULOMATOSIS
The specimen shows the aorta in longitudinal section.
In the intima of the aorta, atherosclerotic plaques are determined.
On both sides of the abdominal aorta, above the bifurcation, sharply enlarged and because of this lymph nodes welded to each other are determined, forming "packets" of lymph nodes.
The consistency of the lymph nodes is densely elastic, the surface is smooth, the color on the cut is gray-pink.
The lymph nodes that lie on the sides of the aorta are called paraaortic.
Enlargement of the paraaortic lymph nodes and their fusion into packets occurs in lymphogranulomatosis, malignant Hodgkin's lymphoma.
MACROPREPARATE No. 29 ARTERIOLOSCLEROTIC NEPHROSCLEROSIS
Two whole kidneys are visible in the preparation.
Their size and weight are sharply reduced (both kidneys in humans weigh 300 - 350 g). The surface of the kidneys is wrinkled, fine-grained. The consistency of the kidneys is very dense.
This is primarily a wrinkled kidney due to the benign course of primary arterial hypertension. At the heart of wrinkling is hyalinosis and sclerosis of the capillaries of the renal glomeruli - arteriolosclerotic nephrosclerosis.
The same appearance is secondary - a wrinkled kidney, which develops as a result of chronic glomerulonephritis.
Clinically, against the background of primary and secondary contracted kidneys, chronic renal failure develops, accompanied by the development of azotemic uremia, which can be treated with chronic hemodialysis or kidney transplantation.
MACROPREPARATE No. 30 MILIARY TUBERCULOSIS OF PULMONARY
An enlarged longitudinal section of the lung is presented.
It is clearly seen that the entire surface of the lung tissue is diffusely dotted with small, millet-sized grain, dense tubercles, light yellow in color.
The lung has this type in miliary tuberculosis, which develops in hematogenous generalized and hematogenous tuberculosis with a predominant lesion of the lungs.
Each tubercle has the following structure: in the center there is a focus of caseous necrosis, the severity of which depends on the state of the patient's immunity; it is surrounded by a cell wall of epithelioid cells, lymphocytes, plasma cells and single multinucleated cells of Pirogov-Langhans.
According to the classification of granulomas, tuberculous granulomas are infectious, specific. Specific cells of a tuberculous granuloma are epithelioid cells of hematogenous, monocytic origin, which are the most in the granuloma.
MACROPREPARATION No. 31 NODULAR GOITER
The cutaway of the thyroid gland is presented in the preparation.
Its dimensions are dramatically increased (normally weighs 25 g).
The outer surface is bumpy.
On the surface of the incision, the lobular structure of the gland is distinguished, and in the lobules there are follicles of different sizes filled with a brown colloid.
A persistent increase in the size of the thyroid gland that is not associated with inflammation, swelling, or poor circulation in it is called a goiter.
In appearance, it is a nodular goiter.
Internal structure - colloid goiter.
Most often occurs with endemic goiter, the occurrence of which is associated with a deficiency of exogenous iodine.
Despite the compensatory increase in the size of the gland, its function is reduced.
MACROPREPARATE No. 32 TUBULAR PREGNANCY
The fallopian tube is visible in cross section.
The pipe is sharply expanded. Its wall is thinned in places, thickened in places. In places of thickening of the wall of the tube, the tissues have a dark brown color due to hemorrhage. In the center of the tube is a human embryo, in which the head, torso, hands and fingers are clearly distinguishable. The embryo is surrounded by membranes.
This is an ectopic, tubal pregnancy, complicated by an incomplete tubal abortion.
The ovum separated from the walls of the fallopian tube, as evidenced by hemorrhage, but remained in the tube.
MACROPREPARATE No. 33 RENAL - CELLULAR CANCER
It is represented by a section of the kidney, in the upper pole of which tumor tissue grows in the form of a node with clear growth boundaries, forming a pseudocapsule around itself, which indicates the expansive growth of the tumor.
The tumor node is light yellow in color, since the tumor cells contain a large amount of lipids; motley, since the tumor is characterized by the development of necrosis and hemorrhage; soft consistency, since the tumor contains little fibrous tissue.
Despite the nature of growth, the tumor is malignant, differentiated, organ-specific epithelial, developing from the epithelium of the kidney tubules.
It occurs in adults.
MACROPREPARATE No. 34 DRY GANGRENA FOOT
The foot of the right lower limb is visible in the specimen.
In the area of the dorsum of the metatarsus of the foot, at the base of the toes, there is no skin, and the soft tissues are dry, mummified, gray-black.
This is dry gangrene of the foot, one of the clinical and morphological forms of necrosis.
Gangrene is called necrosis of tissues in contact with the external environment.
With gangrene, soft tissues are stained in a gray-black color with a pigment pseudomelanin, or iron sulfide.
Gangrene of the foot can develop as a result of atherosclerotic damage to the vessels of the lower extremities, which occurs primarily or as a result of diabetes mellitus due to the development of macroangiopathy.
MACROPREPARATION No. 35 EMBRYONIC KIDNEY CANCER
It is represented by a kidney in longitudinal section.
In the upper pole of the kidney there is an overgrowth of tumor tissue, large in size, with clear boundaries of growth, forming a pseudocapsule around itself. In the center of the tumor node there is a large cavity due to necrosis of the tumor tissue.
The lower pole of the kidney is small, which indicates that the kidney belongs to a small child.
Despite the nature of tumor growth - expansive and given the presence of secondary changes in the tumor - it is a malignant, undifferentiated tumor that develops from metanephrogenic tissue and affects children from two to six years old.
Expansive growth gives way to invasive growth over time.
The tumor is organ-specific epithelial.
Metastasizes mainly by hematogenous route to the opposite kidney, lungs, bones, brain.
MACROPREPARATE No. 36 MAMMARY CANCER
The drug is represented by the mammary gland.
In one of the quadrants of the mammary gland, a pathological growth of tumor tissue occurred, emanating from the epithelium of the mammary gland ducts, and grown to the surface of the skin, which indicates the invasive growth of the tumor.
This is a malignant, epithelial organ-specific tumor - breast cancer.
What is the Android status bar?
How to choose a gift for the new year for yourself
How to choose gifts for the New Year?
Excel status bar options What the status bar is for
Complete Lessons - Knowledge Hypermarket