Pathological anatomy of peptic ulcer. Macropreparation of multiple erosions of the stomach Micropreparation of chronic gastric ulcer in the period of exacerbation

Read: C. Chronic insufficiency of preganglionic autonomic nerve fibers. Long-term mechanisms of metabolic acidosis compensation are implemented mainly by the kidneys and to a much lesser extent with the participation of bone tissue buffers, liver and stomach. Acid and pepsin of the stomach. Chopping and mixing food Contrast radiography - the release of a contrast agent outside the contour of the stomach. GROUND PREPARATION № 16. Chronic aneurysm of the left ventricle of the heart Acute gastritis is an acute inflammatory disease of the stomach.

This macropreparation is the stomach. The masses and dimensions of the organ are normal, the shape is preserved. The organ is light gray in color, the relief is intensely developed. On the lesser curvature of the stomach in the pyloric section, there is a significant depression in the wall of the stomach 2x3.5 cm. Its limiting surface of the organ is devoid of characteristic folding. The folds converge towards the borders of the formation. In the area of ​​the pathological process, there are no mucous, submucosal and muscular layers of the stomach wall. The bottom is smooth, made serosa. The edges are raised like a roller, dense, have a different configuration: the edge facing the pylorus is gentle (due to gastric peristalsis).

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, which lead to local disorders: hyperplasia of the glandular apparatus, increased activity of the acid-peptic factor, increased motility, increased number of gastrin-producing cells; and a general disorder: excitation of the subcortical centers and the hypothalamic-pituitary region, increased tone vagus nerve, increase and subsequent depletion of the production of ACTH and glucocarticoids). Influencing the gastric mucosa, these disorders lead to the formation of a mucosal defect - erosion. Against the background of non-healing erosion, an acute peptic ulcer develops, which, with continued pathogenic influences, 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, superimposed on 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 through fibrinoid changes in the walls of blood vessels and disruption of the trophism of the ulcer tissues).

1) favorable: remission, ulcer healing by scarring followed by epithelialization.

2) unfavorable:

a) bleeding

b) perforation;

c) penetration;

d) malignancy;

e) inflammation and ulcer-cicatricial processes.

Conclusion: these morphological changes indicate a destructive process in the stomach wall, which leads to the formation of a defect in the mucous, submucosal and muscular membranes - ulcers.

Diagnosis: Chronic peptic ulcer of the stomach.

• 1 Causes of pain
• 2Gastritis
• 3 Peptic ulcer
• 5Food poisoning
• 6Duodenitis and pancreatitis
• 7Diagnosis and treatment

1 Causes of pain

If you feel severe discomfort, you should consult a specialist. An important aspect of diagnosis is to clarify the nature of the pathology. Pain in the stomach is most often concentrated in the projection of the organ on the abdominal wall. This region is called the epigastric region. Pain in the stomach area can be localized, diffuse, radiating, acute, dull, paroxysmal, burning and cutting.

To establish the cause of its occurrence, it is necessary to identify the intensity of the syndrome. In this case, the main characteristics of pain are determined:

• character;
• appearance time;
• duration;
• localization;
• connection with food intake;
• weakening or strengthening during movement, after defecation or when changing posture;
• combination with other symptoms (nausea, loss of appetite, vomiting, bloating).

The sensation of pain in the stomach in most cases is associated with damage to the organ. The most common reasons are:

• sharp and chronic gastritis;
• stomach ulcer;
• the presence of polyps;
• damage to the mucous membrane of an organ during food poisoning (intoxication or toxic infection);
• damage due to abdominal trauma;
• severe stress;
• intolerance to certain products;
• injury to the mucosa by accidentally swallowed objects.

Pain in the stomach area can be due to other reasons. These include pancreatitis, peptic ulcer of the 12th intestine, colitis, enterocolitis, cholecystitis, dyskinesia biliary tract, irritable bowel syndrome, appendicitis, heart disease.

2Gastritis

The most common causes of stomach pain are acute or chronic gastritis. These forms of the disease are characterized by inflammation of the mucous layer of the organ against the background of exposure to irritating factors. Quite often, gastritis has an infectious nature. In this case, the starting moment is Helicobacter bacteria pylori. The disease occurs in children, young and old people. When it hurts in the stomach, in this case there is an acute gastritis, which is divided into simple, catarrhal, erosive, fibrinous and phlegmonous. If the disease becomes chronic, organ atrophy often develops. The main provoking factors for the occurrence of gastritis are:

• abuse of spicy, fried, hot or cold foods;
• alcohol consumption;
• smoking;
• infection with Helicobacter bacteria;
• accidental or intentional use of acids or alkalis;
• uncontrolled intake of medications (drugs of the NSAID group).

The symptoms of gastritis are varied. In children and adults, discomfort in the stomach is the main symptom of the disease. Most often worried Blunt pain. Sharp manifestations are typical for acute inflammation of the mucosa. With gastritis, the pain syndrome can be paroxysmal or constant. There is a clear connection with food intake (spasm appears after eating and when a person is hungry). Additional symptoms of the disease may include belching, nausea, loose stools, bloating, and a feeling of acid in the mouth. not pronounced It's a dull pain characteristic of chronic gastritis with normal acidity.

3 Peptic ulcer

Acute pain in the stomach associated with eating may indicate the presence of peptic ulcer. It proceeds in a chronic form. The pain syndrome is most pronounced during the period of exacerbation. Ulcers form on the background of stress, gastritis, the use of certain drugs, endocrine diseases. The pathogenesis of the formation of this defect is associated with the suppression defense mechanisms(violation of the synthesis of mucus covering the stomach), as well as an increase in the acidity of gastric juice. The symptoms of stomach ulcers are similar to those of gastritis. The main signs of the disease include:

• severe pain in the epigastric region;
• nausea and vomiting after eating;
• weight loss;
• loss of appetite.

With ulcerative lesions, the stomach hurts after eating. This is the main difference from the pathology of the 12th intestine. Pain syndrome occurs almost immediately after eating (within one and a half hours). There is a certain connection of exacerbation with the time of year. Most often, a person suffers from attacks of pain in the fall and spring. In the case of complications (perforation, bleeding), symptoms can increase dramatically. This condition requires urgent care. The processes occurring in the stomach, the causes of which may be different, are often reversible.

4Cancer

If the stomach hurts, the cause may lie in oncology. This is one of the most common malignant pathologies. Nearly a million people worldwide die from stomach cancer every year. For a long time, the disease may not manifest itself. Quite often, cancer is detected already at stage 3 or 4, when treatment is ineffective. Men suffer from this disease more often than women. Cancer is dangerous because the tumor in the later stages is capable of metastasizing to other organs, which is why patients die. The exact cause of the disease is still unknown. Possible etiological factors are: the presence of atrophic gastritis, infection of the organ with Helicobacter bacteria, exposure to toxic and carcinogenic substances, poor nutrition, intake medicines, alcoholism, aggravated heredity, Menetrier's disease.

Symptoms of cancer in the early stages are represented by a decrease in appetite, an aversion to meat, nausea, bloating, weight loss, malaise, weakness, and swallowing disorders. In the later stages, patients may be disturbed by aching pain. In most cases, it is due to the germination of the tumor in neighboring organs. Persistent shingles pains appear when the neoplasm is introduced into the pancreas. Operative treatment should be started as soon as possible. Acute pain, resembling an angina attack, is characteristic of a tumor that has grown into the diaphragm. If the pain syndrome is combined with a transfusion in the abdomen, a violation of the stool by the type of constipation, this may indicate the involvement of the transverse colon in the process.

5Food poisoning

Sharp pain in the stomach may be a sign food poisoning. This is a disease that develops when eating poor-quality food containing pathogenic microorganisms, their decay products, or various toxic compounds. All food poisonings are divided into the following forms:

• microbial;
• non-microbial etiology;
• mixed.

The first group includes food toxic infections and intoxications. In this situation, the pathogens are bacteria (clostridia, E. coli, Proteus, streptococci), fungi, toxins. Poisoning is also possible with poisonous plants, mushrooms, berries, fish caviar, seafood, salts of heavy metals, pesticides, pesticides. Symptoms in this pathology are caused by inflammation of the stomach against the background of exposure to toxins.

In most cases, there are signs of gastroenteritis. These include constant pain in the muscles, head, nausea, vomiting, fever, weakness, frequent stools. Often there are symptoms of dehydration. Diagnostic features food poisoning are:

• acute, sudden onset;
• connection of pain with food intake;
• simultaneous onset of symptoms in a group of individuals;
• the speed of the disease.

6Duodenitis and pancreatitis

Pain in the epigastric region may be a symptom of duodenitis (inflammation of the mucous membrane of the 12th intestine). It can occur in acute and chronic form. This is the most common pathology of this organ. Quite often, this disease is combined with enteritis and gastritis. The main causes of inflammation of the 12th intestine are:

• nutritional errors;
• the use of alcoholic beverages;
• bacterial infection;
• the presence of an ulcer or gastritis;
• violation of blood supply;
• chronic pathology of the liver and pancreas.

The main symptoms of the disease depend on its form. Duodenitis, which arose against the background of an ulcer or infectious gastritis, is characterized by pain on an empty stomach, at night and a few hours after eating. Strong manifestations are characteristic of the acute type of pathology. When combined with inflammation of other departments small intestine symptoms may include malabsorption syndrome, dyspeptic disorders. In case of stagnation of the secret of the 12th intestine, there are paroxysmal pains, belching, nausea, vomiting, bloating, rumbling. With duodenitis, the outflow of bile can be disturbed. In this situation, pain appears in the epigastric region. Clinical picture resembles biliary dyskinesia.

If something hurts in the stomach, the cause may be pancreatitis, the symptoms of which, as a rule, are quite pronounced. The pain syndrome is most pronounced in acute inflammation pancreas. The latter is located next to the stomach. This pathology is characterized by the appearance of pain in the upper abdomen. It can last from several minutes to several days. The pain is intense, constant and disturbs the patient. It can give to the left or right half of the body, depending on which part of the organ is affected (head, body or tail). The pain syndrome intensifies during meals and requires treatment. Often it takes on a shingling character. Additional signs of the disease include nausea, vomiting, bloating, tenderness on palpation, and an increase in general body temperature.

7Diagnosis and treatment

If the stomach is sick, then you should not put off a visit to the doctor on the back burner, because the consequences can be dangerous. Treatment is carried out only after the cause is established. pain syndrome. Diagnostics includes:

• a detailed survey of the patient;
• physical examination (palpation of the abdomen, auscultation of the lungs and heart);
• general and biochemical blood test;
• conducting FGDS;
• determination of the acidity of gastric juice;
• a blood test for the presence of Helicobacter pylori;
• Ultrasound of the abdominal organs;
• laparoscopy;
• study of feces;
• contrast radiography;
• CT or MRI;
• duodenal sounding;
• Analysis of urine.

Colonoscopy may be done if colitis is suspected. A biopsy is done to rule out stomach cancer. How to get rid of stomach pain? Therapy should be aimed at eliminating the underlying cause. If the stomach is inflamed, what to do in this situation? Treatment of gastritis involves adherence to a strict diet, the use of drugs (antacids, proton pump blockers, gastroprotectors). The use of Almagel, Phosphalugel and Omez is indicated for the form of the disease with high acidity. If Helicobacter bacterium is detected, antibiotics and Metronidazole are used.

Therapy for acute pancreatitis includes temporary fasting, application of cold to the abdomen, the use of antispasmodics, omeprazole, diuretics, infusion therapy.

With purulent pancreatitis, treatment necessarily includes antibiotics. If vomiting is present, antiemetics (metoclopramide) are used. With the development of peritonitis and necrosis of the organ, an operation is indicated. The chronic form of pancreatitis involves dieting, taking enzyme preparations (Panzinorma, Pancreatin, Mezima). In case of gastric cancer, surgical treatment (resection of the organ or its removal). Thus, the causes of abdominal pain can be very different. If any, you should consult your doctor.

What to do in case of exacerbation of peptic ulcer of the stomach?

If a patient has an acute critical condition associated with perforation of a stomach ulcer, then it is necessary emergency treatment, since peritonitis in this case is rapidly progressing. The symptoms of perforation are:

• the appearance of a sharp pain, rapidly spreading throughout the abdomen;
• muscle tension of the walls of the peritoneum;
• phenomena preceding fainting (dizziness, ringing in the ears, weakness);
• chills;
• nausea;
• dry mouth.

Traditional Therapies

Therapeutic care in the phase of exacerbation of gastric ulcer is determined based on the patient's condition, his age, the nature of clinical symptoms. However, the treatment of uncomplicated forms is almost always based on the use of bactericidal agents, for example, Amoxicillin, Metranidazole, Clarithromycin. Due to these drugs and some others, also belonging to the group of antibiotics, it becomes possible to cure the pathology of the gastric mucosa, since they eliminate main reason – pathogen Helicobacter pylori.

In addition to antibacterial drugs in the treatment of acute ulcers, the following can be used:

1. means that normalize the level of acidity of the digestive juice (Omeprazole, Ranitidine);

2. drugs with a gastroprotective (protective) property (De-nol and other bismuth-containing medicines);

3. dopamine central receptor blockers (Primperan, Reglan, Cerucal);

4. drugs with a psychotropic effect, if the patient suffers from irritability, insomnia, a feeling of constant anxiety (Tazepam, Elenium);

5. adrenergic agents that have antisecretory and suppressive gastrin release action (Obzidan, Inderal).

In the treatment of exacerbation of gastric ulcer, certain physiotherapeutic methods have also proven themselves: ozocerite and paraffin applications, magnetic and hydrotherapy, sessions of modulated sinusoidal currents.

Carrying out all activities in combination with a diet in 80-90% of cases allows you to achieve a stable remission of the pathology. However, conservative treatment does not always help, and then the patient is shown surgical intervention in various ways depending on the circumstances (method of selective proximal vagotomy, resection, endoscopy).

Indications for gastric surgery:

• perforation ulceration;
• an ulcer complicated by bleeding of a profuse nature (bleeding leading to hypovolemia);
• pyloric stenosis;
• defect penetration.

Folk recipes for treatment

Experts do not recommend using folk methods to cure an ulcer because of the risk of aggravating the situation. Such treatment is especially prohibited in complicated acute forms. But in order to prevent exacerbation, doctors allow, for example, a remedy to use some non-traditional recipes:

1. from birch leaves (1 teaspoon of crushed fresh leaves of this tree is poured with a glass of boiling water, infused for 1-2 hours);

2. from coltsfoot (the infusion is prepared similarly to the previous method with one difference that not only the leaves of the plant, but also the flowers themselves can be used); besides this folk recipe helps to treat both the stomach and bronchi;

3. out marshmallow(1 large spoonful of its ground rhizome is poured with 250 ml of boiling water, everything simmers for 30 seconds on low heat, and then infused for about half an hour).

All of the listed traditional medicine should be drunk before meals 3 times a day.

Diet for ulcers

Compliance with dietary nutrition is equally important during an exacerbation of the inflammatory process, and in the stage of its remission, and in case of complications with stenosis, bleeding and other life threatening factors. Therefore, the doctor prescribes a personal diet to the patient, based on:

• sparing of the gastroduodenal mucosa with the elimination of all chemical, thermal and mechanical stimuli;
• fractional nutrition (the patient is recommended to eat and drink in small portions, but every 3-4 hours);
• correction of fats in the direction of increase;
• increasing the protein quota;
• reducing the proportion of carbohydrates in the daily diet.

Diet in the treatment of stomach ulcers should be observed for at least 6-9 months. When the disease recedes, going into a remission phase, and food does not cause discomfort to the stomach, you can gradually return to the usual type of dishes (not pureed and not very boiled), but you still have to completely abandon coarse and harmful industrial products.

In addition to diet, an important role in the prevention and treatment of acute ulcers is played by the exclusion of alcohol and energy drinks because they cause bleeding and the growth of erosive inflammation.

Ulcer of the duodenal bulb

One of the most common types of erosive formations of the gastrointestinal tract is the ulcer of the duodenal bulb. The disease is widespread. According to official data, up to 10% of the world's population is ill. Deformation develops due to a failure in chemical treatment food. The anatomy of erosive formations is different, but more often they form on a bulb that has the shape of a ball. The bulb of the duodenum is located at the very beginning of the intestine, at the exit from the stomach. Treatment is long and difficult.

It can be deformed on the front and back wall(kissing sores). The duodenal ulcer also has a special location - at the end or at the beginning (mirror). Mirror erosions are treated like other forms. Negative factors that affect the work of the stomach and intestines, provoke the appearance of ulcers various shapes. The risk group includes middle-aged people and those who are forced to work the night shift.

If there is a failure in the processing of food by the stomach, an ulcer of the duodenal bulb may occur.

Causes of duodenal ulcer

Most often, inflammation of the duodenum occurs due to the aggressive action of acid. In the absence of therapy, the development of perforated ulcers and bleeding is possible. There can be a number of reasons:

• disturbed diet (a lot of fatty, spicy, diet abuse, carbonated drinks);
• bacterium Helicobacter - the cause of ulcerative formations in most cases;
• smoking, alcohol;
• severe stress or systematic stay in a state of emotional stress;
• hereditary predisposition;
• long-term use of certain anti-inflammatory drugs;
• inappropriate treatment for initial stage illness.

Kissing ulcers in the intestines can appear due to concomitant causes: HIV infection, liver cancer, hypercalcemia, kidney failure, Crohn's disease, etc.

Symptoms

Symptoms of a duodenal ulcer are also characteristic of other types of gastrointestinal ulcers, and they appear depending on the stage of the disease:

• heartburn;
• nausea in the morning or after eating;
• pain in the epigastric region;
• pain in the stomach at night;
• flatulence;
• the appearance of a feeling of hunger after a short period of time after eating;
• if the disease is in advanced form, bleeding may open;
• vomit;
• pain localized in the lumbar region, or retrosternal part.

The inflammatory lymphofollicular form of the duodenum has a different nature of pain: stabbing pain, sharp or aching. Sometimes it goes away after the person has eaten. Hunger pains usually occur at night, and to eliminate discomfort, it is recommended to drink a glass of milk or eat a little. Night pain is caused by a sharp increase in acidity.

stages

The intestinal healing process is divided into 4 main stages:

• Stage 1 - initial healing, the creeping of layers of the epithelium is characteristic;
• stage 2 - proliferative healing, in which protrusions in the form of papillomas appear on the surface; these formations are covered with regenerating epithelium;
• Stage 3 - the appearance of a polysade scar - an ulcer on the mucous membrane is no longer visible; a more detailed study shows many new capillaries;
• Stage 4 - scar formation - the bottom of the ulcer is completely covered with new epithelium.

Erosive kissing formations on the duodenum 12 heal after therapy. Many ulcers in a small area of ​​the intestine leads to the formation of several scars. The result of such healing is cicatricial and ulcerative deformity of the duodenal bulb. The appearance of fresh scars leads to a narrowing of the lumen of the bulbous sector. Inflammatory cicatricial deformity of the duodenal bulb has Negative consequences, for example, stagnation of food and malfunctions of the entire gastrointestinal tract.

There is also a distribution by stage: exacerbation, scarring, remission.

One of the forms of intestinal ulcers is lymphoid hyperplasia of the duodenal bulb, which is characterized by inflammation due to a violation in the outflow of lymph. The causes of occurrence are exactly the same as those of a duodenal ulcer. Also have similar symptoms. Lymphofollicular dysplasia is a pathology in the mucous membrane of the intestine or stomach. It is characterized by the appearance of rounded formations on a wide base. Lymphofollicular dysplasia is deformed and has a dense texture and punctate dimensions. The lymphofollicular mucosa is infiltrated. Development stages:

1. acute;
2. chronic.

Diagnosis of the disease

Accurately diagnose the presence of a duodenal ulcer will help FGDS method(fibrogastroduodenoscopy). Using a special probe with a camera, the surface of the intestine is examined. It is this diagnostic method that will determine the location of the ulcer, its size and stage of the disease. Usually inflammation is observed, or the surface is hyperemic, covered with dotted erosions of a dark red color. The area of ​​the intestine is inflamed in the region of the mouth, and the mucosa is hyperemic.

Be sure to appoint tests to determine the bacterium Helicobacter. As a material for testing, not only blood and feces are used, but also vomit, material after a biopsy. Auxiliary diagnostic methods include x-ray, palpation in the stomach area, general analysis blood.

Treatment

After the diagnosis of "inflammation of the duodenal bulb" is made, treatment should be started immediately, since serious complications may develop. Kissing ulcers are treated mainly with medication. During an exacerbation, hospitalization is necessary.

The doctor selects drugs and physiotherapy individually for each patient, taking into account the characteristics of the body and stage. For example, the chronic or lymphofollicular stage is treated differently than during an exacerbation. This scheme usually includes such medicines:

• bismuth-based drugs, in case of detection of Helicobacter bacteria; such drugs have a depressing effect on pathogenic microflora;
• drugs that reduce the amount of gastric juice produced: blockers, inhibitors, anticholinergics;
• prokinetics - improve intestinal motility;
• unpleasant pain is eliminated with the help of antacids;
• antibiotics are prescribed to combat the bacterial cause of the appearance of a lymphofollicular ulcer;
• prevent negative impact of hydrochloric acid gastroprotectors will help on the affected area;
• inflammation is relieved by analgesics and antispasmodics.

The combination of medication and physiotherapy contributes to a faster recovery of the body. These techniques include: electrophoresis, ultrasonic exposure, the use of microwaves, modulated current therapy for pain relief. Special physiotherapy exercises will help normalize the motility of the stomach. Gymnastics is good prophylactic from congestion in the intestines and stomach.

In addition to the generally accepted methods of healing intestinal ulcers, traditional medicine has long proven its effectiveness. In the first place with ulcerative lesions is freshly squeezed potato juice. It must be drunk three times a day, and only freshly squeezed. Pre-peel the potatoes, rub on a grater, and squeeze through gauze. The first few days, the dosage is one tablespoon. Gradually, it can be increased to half a glass. It is necessary to drink before eating.

To others, no less effective means, include honey, medicinal herbs (calendula, St. John's wort, plantain), olive and sea buckthorn oils.

During the period acute form obligatory observance of a bed rest. After the aggravation has passed, you can take short walks. Heavy physical activity and exercise are prohibited. The army is contraindicated for those who have an ulcer. In order not to provoke new attacks, it is important to avoid stress and protect the nervous system.

Compliance with the diet is one of the important factors on the way to recovery and reduction of inflammatory processes. General recommendations to diet food the following:

• small portions;
• chew each piece thoroughly;
• temporarily exclude foods that provoke the active production of gastric juice (vegetable soups, fish and meat broths);
• in order not to additionally irritate the mucous membrane, the food should be frayed;
• fruit juices should be diluted with water;
• consume milk more often;
• do not use spices in dishes;
• cook grated cereals;
• eat food at the optimum temperature, not too hot and not too cold;
• fractional meals, up to 5 times a day.

Cooking food should be steamed or in the oven. The diet must include non-acidic fruits, kefir, milk, cottage cheese, boiled or steamed vegetables. It is necessary to stop drinking alcohol and smoking, as this can lead to the development of serious complications.

Forecast

A favorable prognosis for recovery can be if the treatment was carried out on time and the correct diet was observed. In case of untimely access to a doctor or incorrectly prescribed drugs, serious complications can develop: lymphofollicular ulcer, bleeding (vomiting blood), perforation of the ulcer (acute pain under the sternum) and penetration (due to adhesions, intestinal contents enter neighboring organs). In each of these cases, the only option is surgery.

Duodenal stenosis is a complication. After healing, there are cicatricial changes which can later cause swelling and spasm. Stenosis usually manifests itself during the acute form or after therapy. Stenosis occurs in those patients who have an ulcer long time does not heal. Stenosis is accompanied by impaired motility of the intestines and stomach.

9. Toxic dystrophy of the liver.

This macropreparation is the liver. The shape is preserved, the weight and dimensions are reduced. Liver yellow color.

These pathological changes could develop as a result of intoxication, allergic or viral liver damage. Fatty (yellow) degeneration develops in the organ, the morphogenetic mechanism of which is decompensation. Dystrophy spreads from the center to the periphery of the lobules. It is replaced by necrosis and autolytic disintegration of hepatocytes. central departments. Fat-protein detritus is phagocytosed, while the reticular stroma with dilated vessels is exposed (red dystrophy). Due to necrosis of hepatocytes, the liver shrinks and decreases in size.

1) favorable: transition to a chronic form.

2) unfavorable:

a) death from liver or kidney failure;

b) post-necrotic cirrhosis of the liver;

c) damage to other organs (kidneys, pancreas, myocardium, central nervous system) as a result of intoxication.

Conclusion: these morphological changes indicate fatty degeneration of hepatocytes and their progressive necrosis.

Diagnosis: Toxic dystrophy of the liver. Stage of yellow dystrophy.

^ 10. Gastric cancer.

This macropreparation is the stomach. The shape and dimensions of the organ are changed due to the growth of a whitish-yellow tissue that has grown through the wall of the stomach and significantly thickens it (up to 10 cm or more). Reliefs of the mucosa are not expressed. In the central part of the growth, depressions, loosening and hanging areas - ulcerations are visible.

Description of pathological changes:

These pathological changes could develop as a result of precancerous conditions and precancerous changes (intestinal metaplasia and severe dysplasia).

In the foci of changes in the epithelium, malignancy of cells and the development of tumors occur (or cancer develops de novo). Based on the macroscopic picture, we can say that this is a cancer with predominantly endophytic infiltrating growth - infiltrative-ulcerative cancer (this is evidenced by tumor ulceration). Histologically, it can be either adenocarcinoma or undifferentiated cancer. Progression, the tumor grows into the wall of the stomach and thickens it significantly.

1) favorable:

a) slow growth of cancer;

b) highly differentiated adenocarcinoma;

c) late metastasis;

2) unfavorable: death from exhaustion, intoxication, matastases; the spread of cancer outside the stomach and germination in other organs and tissues, secondary necrotic changes and the breakdown of carcinoma; dysfunction of the stomach.

Conclusion: these morphological changes indicate a mutational transformation of epithelial cells with their malignancy and subsequent tumor progression, which, with infiltrating growth, led to the germination of the stomach wall with ulcers, which may represent secondary necrotic changes and tumor decay.

Diagnosis: Infiltrative-ulcerative cancer of the stomach.

^ 11. Erosions and acute stomach ulcers.

This macropreparation is the stomach. The shape and dimensions of the organ are preserved, the mass is not changed. Body whitish. The mucosa is strewn with black formations of a dense consistency. Among numerous small diameter 1-5 mm. there are also larger ones with a diameter of 7 mm, as well as conglomerates 8x1 cm, 3x0.5 cm, consisting of merged formations with a diameter of 5 mm. Near one of them we see the formation of a triangular shape, the boundaries of which have pronounced differences from the gastric mucosa, since they are formed by connective tissue.

These morphological changes could develop as a result of exogenous and endogenous influences: malnutrition, bad habits and harmful agents, as well as autoinfections, chronic autointoxication, reflux, neuroendocrine, vascular allergic lesions. Since the lesions are localized in the fundus, we can talk about an autoimmune process with damage to the parietal cells, which led to dystrophic and necrobiotic changes in the epithelium, a violation of its regeneration and atrophy. Probably, in this case, chronic atrophic gastritis developed with atrophy of the mucosa and its glands. Mucosal defects lead to erosion, which is formed after hemorrhage and rejection of dead tissue. The black pigment in the bottom of the erosion is hydrochloric acid hematin. The restructuring of the epithelium joins these changes. Education, the border of which is formed by the mucosa and is the healing of an acute gastric ulcer by scarring and epithelialization.

1) favorable:

a) healing of an acute ulcer by scarring or epithelialization;

b) inactive chronic gastritis (remission);

c) mild or moderate changes;

d) epithelialization of erosions;

2) unfavorable:

a) development of chronic peptic ulcer;

b) malignancy of epithelial cells;

c) pronounced changes;

d) active expressed gastritis.

Conclusion: these morphological changes indicate long-term dystrophic and necrobiotic changes in the mucosal epithelium with a violation of its regeneration and structural restructuring of the mucosa.

Diagnosis: chronic atrophic gastritis, erosion and acute stomach ulcer.

^ 12. Chronic stomach ulcer.

This macropreparation is the stomach. The masses and dimensions of the organ are normal, the shape is preserved. The organ is light gray in color, the relief is intensely developed. On the lesser curvature of the stomach in the pyloric section, there is a significant depression in the wall of the stomach 2x3.5 cm. Its limiting surface of the organ is devoid of characteristic folding. The folds converge towards the borders of the formation. In the area of ​​the pathological process, there are no mucous, submucosal and muscular layers of the stomach wall. The bottom is smooth, made by a serous membrane. The edges are raised like a roller, dense, have a different configuration: the edge facing the pylorus is gentle (due to gastric peristalsis).

Description of pathological changes:

These pathological changes could develop as a result of general and local factors (general: stressful situations, hormonal disorders; drugs; bad habits that lead to local disorders: hyperplasia of the glandular apparatus, increased activity of the acid-peptic factor, increased motility, increased 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). Influencing the gastric mucosa, these disorders lead to the formation of a mucosal defect - erosion. Against the background of non-healing erosion, an acute peptic ulcer develops, which, with continued pathogenic influences, 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, superimposed on 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 through fibrinoid changes in the walls of blood vessels and disruption of the trophism of the ulcer tissues).

1) favorable: remission, ulcer healing by scarring followed by epithelialization.

2) unfavorable:

a) bleeding

b) perforation;

c) penetration;

d) malignancy;

e) inflammation and ulcer-cicatricial processes.

Conclusion: these morphological changes indicate a destructive process in the stomach wall, which leads to the formation of a defect in the mucous, submucosal and muscular membranes - ulcers.

Diagnosis: Chronic peptic ulcer of the stomach.

^ 13. Hyalinosis of the spleen capsule. Glazed spleen.

This macropreparation is the spleen. The masses and dimensions of the organ are not increased, the shape is preserved. The color of the capsule is white, it is large-tuberous, and the tuberosity is more pronounced in front. The recesses are more or less large. There is a noticeable area with a diameter of 0.5 cm on the anterior surface of the yellow organ. Behind and from the side with the capsule, areas of yellowish tissue are soldered.

Descriptions of pathological changes.

These pathological changes could develop as a result of the destruction of fibrous structures and an increase in tissue-vascular permeability (plasmorrhagia) due to angioedema, metabolic and immunopathological processes. Plasmorrhagia - tissue impregnation with plasma proteins, their absorption on fibrous structures, precipitation and formation of hyaline. Hyalinosis can develop as a result of plasma impregnation, fibroid swelling, inflammation, necrosis, sclerosis. In the capsule of the spleen, hyalinosis develops as an outcome of sclerosis. The connective tissue swells, loses fibrillarity, its bundles merge into a homogeneous dense, cartilaginous mass, the cells are compressed, atrophy. The fabric becomes dense, whitish, translucent. Along with hyalinosis of the connective tissue in the spleen, local hyalinosis of arterioles may be present as a physiological phenomenon. In this case, a simple hyaline is formed (due to sweating of unchanged or slightly changed blood plasma components).

1) favorable:

a) was possible only as a stage of the process during its stabilization and resorption of hyaline masses;

b) unfavorable - the most frequent: dysfunction of the organ, limitation of its functionality.

Conclusion: the data of morphological changes indicate degenerative processes in the capsule of the spleen, which led to its hyalinosis.

Diagnosis: Hyalinosis of the spleen capsule.

^ 14. Dysentery colitis.

This macropreparation is the large intestine. The shape of the organ is preserved, the mass and dimensions are increased due to the thickening of the wall. The mucosa is dirty-gray, at the top of the folds and between them, the film overlays of brown-green color covering the mucous mass are necrotic, ulcerated, in many places hang freely into the lumen of the intestine (which is narrowed).

Description of pathological changes:

These pathological changes could develop as a result of an acute intestinal disease with a predominant lesion of the large intestine, which was caused by the penetration, development and reproduction of Shigella bacteria and their species in the epithelium of the mucous membrane. This group of bacteria has a cytoplasmic effect on these cells, which is accompanied by destruction and desquamation of the latter, the development of desquamative catarrh. Bacterial enterotoxin exerts a vasoneuroparalytic action, which is associated with paralysis blood vessels> increased exudation and damage to intramural nerve ganglia, which leads to the progression of processes and the development of fibrinoid inflammation (as a result of increased sweating of fibrinogen from dilated vessels). If in the first stage we find only superficial necrosis and hemorrhage, then in the second stage a fibrinoid film appears at the top and between the folds. Necrotic masses of the mucosa are permeated with fibrin. Dystrophic and necrotic changes in the nerve plexuses are combined with leukocyte infiltration of the mucosa and submucosa, its edema, and hemorrhages. With the further development of the disease, due to the rejection of fibrin films and necrotic masses, ulcers are formed, which at 3-4 weeks of the disease are filled with granulation tissue, which matures and leads to the regeneration of ulcers.

1) favorable:

a) complete regeneration with minor defects;

b) abortive form;

2) unfavorable:

a) incomplete regeneration with the formation of scars > narrowing of the intestinal lumen;

b) chronic dysentery;

c) lymphadenitis;

d) follicular, polycular ulcerative colitis;

e) severe general changes (necrosis of the epithelial tubules of the kidneys, fatty degeneration of the heart and liver, impaired mineral metabolism). Complications:

a) ulcer perforation: peritonitis; paraproctitis;

b) phlegmon;

c) intra-intestinal bleeding.

Extra-intestinal complications - bronchopneumonia, pylonephritis, serous arthritis, liver abscesses, ameloidosis, intoxication, exhaustion.

Conclusion: these morphological changes indicate diphtheric colitis of the colon associated with toxic effects shigella.

Diagnosis: Dysentery and colitis. Stage of diphtheria colitis.

^ 15. Typhoid fever.

This macropreparation is the ileum. The shape of the organ is preserved, the weight and dimensions are normal. The intestine is whitish in color, the folding of the mucous membrane is pronounced, on which formations of 4x2.5 cm and 1x1.5 cm are noticeable, which protrude above the surface of the mucous membrane. Furrows and convolutions are noticeable on them, the surface itself is uneven, loosened. These formations are dirty gray in color. A formation with a diameter of 0.5 cm is noticeable, with a loss of characteristic folding, a whitish color, slightly deepened and compacted.

Description of pathological changes:

These pathological changes could develop as a result of infection (parenteral) with typhoid bacillus and their multiplication in the lower part of the small intestine (with the release of endotoxin). Along the lymphatic pathways -> into Peyer's patches -> salitary follicles -> regional lymph nodes -> blood -> bacteremia and bacteriocholia

-\u003e into the intestinal lumen -\u003e hyperergic reaction in the follicles, which leads to an increase and swelling of the follicles, tortuosity of their surface. This occurs as a result of the proliferation of monocytes, histiocytes, reticulocytes, which extend beyond the follicles into the underlying layers. Monocytes turn into macrophages (typhoid cells) and form clusters - typhoid granulomas. Catarrhal enteritis joins these changes. With further progression of the process, typhoid granulomas become necrotic and are surrounded by a zone of demarcation inflammation; sequestration and rejection of necrotic masses leads to the formation of "dirty ulcers" (as a result of soaking with bile), which change their appearance over time: they are cleared of necrotic masses, the edges are rounded. overgrowth granulation tissue and its maturation leads to the formation of delicate scars in their place. Lymphoid tissue is restored. Exodus:

1. favorable:

Complete regeneration of lymphoid tissue and healing of ulcers;

2. unfavorable:

Death as a result of intestinal (bleeding, perforation of ulcers, peritonitis) and extraintestinal complications (pneumonia, osteomyelitis, intramuscular abscesses, sepsis, waxy necrosis of the rectus abdominis muscles);

dystrophic changes in parenchymal organs, the formation of typhoid granulomas in them.

Conclusion: these morphological changes indicate an acute infectious disease with local changes in the small intestine - ileolitis.

Diagnosis: Ileolitis.

^ 16. Gangrene of the small intestine.

This macropreparation is a section of the small intestine. Its dimensions and weight have not been changed. The bowel loops are enlarged, the consistency of one part is loose, the second is not changed. The surface is smooth. The serous membrane is dull and dull. Between the loops is a sticky, viscous, stretching liquid in the form of threads. On the section of the intestine, the walls are enlarged, the lumen is narrowed.

Possible causes: violation of the blood supply as a result of strongomecian necrochodemonia of the mesenteric arteries.

Morphogenesis: ischemia, dystrophy, atrophy, necrosis of an organ in contact with the external environment - gangrene.

1) unfavorable - putrefactive melting, will overtake.

Conclusion: indirect vascular necrosis.

Diagnosis: Wet gangrene of the small intestine.

MACRO PREPARATION №1 FATTY LIVER

In the preparation, sections of the liver are visible.

The liver is small, as it is the liver of a child. But still, the size of the liver is increased, since its capsule is tense, and the corners are rounded.

The color of the liver on the cut is yellow.

The consistency of the liver is flabby.

When cutting such a liver 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, and chronic alcoholism.

In the outcome of parenchymal fatty degeneration, portal, small-nodular cirrhosis of the liver may develop over time.

MACRO PREPARATION №2 BLEEDING IN THE BRAIN

The preparation shows a horizontal section of brain tissue. 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 center of dark brown color due to the fact that we see clotted blood in the focus of hemorrhage. This is a focus of hemorrhage into dead brain tissue, with fairly clear boundaries - a hematoma. In the center of the hematoma, under anaerobic conditions, the hematoidin pigment is formed, and along the periphery, at the border with healthy tissues, hemosiderin is formed. Blood from the focus of hemorrhage broke into the anterior horn of the right lateral ventricle, into the third ventricle of the diencephalon, the Sylvius aqueduct of the mesencephalon, and into the fourth ventricle of the rhomboid brain.

Hematoma is one of the varieties of hemorrhagic stroke.

Clinically 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 at the site of the hemorrhage a cyst would have formed with walls rusty from hemosiderin.

MACRO PREPARATION №3 CEPHALOHEMATOMA

The preparation shows the integumentary bone of the skull of a newborn. On the upper - the lateral surface of the bone, under its periosteum there is clotted dark brown, almost black blood - this is a subperiosteal hemorrhage. This is a birth injury of the skull, related to the external cephalohematoma.

MACRO PREPARATION №4"TAMPONAD" OF THE HEART

The preparation shows 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 somehow compressed from the outside. The subepicardial layer of fat, epicardium, pericardium is determined. Gray-brown blood clots are visible in the pericardial cavity. It is due to their presence in the pericardial cavity that the heart turned out to be compressed from all sides, and the cavity of the left ventricle became slit-like. This is bleeding into the pericardial cavity - hemopericardium, for example internal bleeding, figuratively - "tamponade" of the heart. It is also noteworthy that in the region of the posterior - lower wall of the heart, the myocardial tissue is stained with hemosiderin in brown color, due to a rupture of the heart wall in this place and hemorrhage from the damaged vessel. Rupture of the heart wall occurred due to myomalacia in the area of ​​transmural myocardial infarction.

Thus, hemorrhage in the heart shirt was the result of myomalacia and rupture of the heart wall in the area of ​​transmural myocardial infarction.

MACRO PREPARATION №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 a 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 furrows, smoothing the relief of the surface of the brain.

Inflammation of the meninges is meningitis.

Primarily purulent meningitis can occur with meningococcal infection, and secondarily can complicate infectious diseases with generalization of infection (with sepsis).

MACRO PRODUCTS №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 growth of brain tissue with fuzzy contours, fuzzy growth boundaries. The consistency of the node of pathological growth of the brain tissue approaches the consistency of the brain itself. The color is variegated, as there are hemorrhages and necrosis in the focus. It's 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.

MACRO PREPARATION №7 Sarcoma of the Tibia

The preparation shows the bones that form the knee joint. In the region of the upper part of the diaphysis of the tibia, there is a pathological growth of tissue that destroys the posterior surface of the bone, which has fuzzy growth boundaries. This is a tumor. It is white, layered, reminiscent of fish meat. The vagueness of the boundaries of growth 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.

MACRO PREPARATION №8 ABSCESSES OF THE BRAIN IN SEPTICOPIEMIA

The preparation presents sections of the brain. In each section, there are multiple foci of irregular round shape, clearly delimited from the brain tissue by a thick wall. Filled with contents of white-yellowish or white-greenish color, the consistency of thick sour cream. This is a purulent exudate.

Focal accumulations of pus, delimited from the brain tissue by a wall, are abscesses.

The wall of an acute abscess consists of two layers: 1) the inner layer - the pyogenic membrane and 2) the outer layer - nonspecific granulation tissue.

Three layers are distinguished in the wall of a chronic abscess: 1) inner - pyogenic membrane, 2) middle - nonspecific granulation tissue and 3) outer - rough fibrous connective tissue.

Abscesses of the brain develop with generalization purulent inflammation in the lungs, intestines and other organs, that is, with sepsis, septicopyemia.

MACRO PREPARATION №9 STENOSIS OF THE MITRAL HOLE (RHEUMATIC HEART DEFECT)

The preparation shows a transverse section of the heart, made above the level of the atrio-ventricular openings, so that the leaflets of the bicuspid, mitral and tricuspid valves are clearly visible.

sashes mitral valve deformed. They are sharply thickened, with a bumpy surface, opaque, rigid due to the growth 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 disease - insufficiency and stenosis of the mitral valve.

Such acquired heart defects are most often formed during rheumatic valve 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 cardio - vascular insufficiency caused by decompensated rheumatic heart disease.

MACRO PREPARATION №10 CHORIONEPITHELIoma OF THE UTERINE

The preparation has 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 does not contain connective tissue at all.

The color of the tumor tissue in the preparation is gray with dark brown patches. In a fresh preparation, it is dark red, variegated, since the tumor has cavities, gaps filled with blood.

Based on the nature of 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 from two types of cells - large mononuclear cells with a light cytoplasm, or Langhans cells, derivatives of cytotrophoblast, and large ugly multinuclear cells, derivatives of synticiotrophoblast. The tumor is hormonally active. Tumor cells secrete the hormone gonadotropin found in the woman's urine; due to the hormone, the uterus is enlarged in size.

The tumor developed in connection with pregnancy. This is a differentiated tumor.

It metastasizes predominantly hematogenously to the liver, lungs, and vagina.

In this preparation, in the area of ​​the vaginal portion of the cervix and in the wall of the vagina, rounded foci are visible in appearance similar to the primary tumor. These are tumor metastases.

MACRO PREPARATION №11 CHRONIC GASTRIC ULCER WITH PENETRATION INTO THE PANCREAS

The preparation shows a fragment of the stomach wall from the mucosal side and the pancreas located behind the stomach.

The wall of the stomach contains ulcer defect with towering dense, callused, callous edges and a sloping bottom. One edge of the defect, facing the esophagus, proximal - undermined, with an overhanging mucous membrane. The other edge, opposite, distal, is gently sloping or terraced. The difference between the edges is due to the presence of a peristaltic wave.

A defect in the wall of the stomach is a chronic ulcer, since there was an overgrowth of connective tissue in its edges, which caused a change in the edges of the defect.

In the bottom of the ulcer, it is not the tissue of the stomach wall that is determined, but the lobed, 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 diffuse pritonitis.

MACRO PREPARATION №12 NUTLE LIVER

The preparation shows a frontal section of the liver.

The size of the liver is enlarged.

The color of the liver tissue on the cut is variegated: areas of gray-black color (these are areas with gore) are interspersed with areas of gray-brown color (the color of hepatocytes).

Areas of gray - black color, and in a fresh preparation - red, due to plethora and expansion of the central veins and the central 2/3 sinusoids of the liver lobules flowing into them.

In view of the similarity of the appearance of the surface of the cut of the liver to the surface of the cross section of nutmeg, the drug got its name.

It occurs during the development in the body of chronic venous plethora, which occurs in conditions of chronic cardiovascular insufficiency, which is a complication chronic diseases heart, such as mitral valve disease, myocarditis with an outcome in cardiosclerosis, chronic coronary heart disease.

MACRO PREPARATION №13 PROSTATE ADENOMA WITH URETEROHYDRONEPHROSIS

The preparation presents 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 led to compensatory - adaptive changes in the structure of the overlying organs.

Prostate increased in size, due to the growth in one of its lobes of the tumor node, rounded in shape, 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 calices of the kidney expanded due to a violation of the outflow of urine - hydroureteronephrosis.

In the parenchyma of the kidney, a kind of local pathological atrophy developed - pressure atrophy.

MACRO PREPARATION №14 CENTRAL LUNG CANCER

The preparation shows 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.

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, of a dense consistency, in the form of a node with fuzzy 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 of irregular round shape - cancer metastases to the lungs.

Since cancer grows from the main bronchus, it is central in localization.

Since tumor growth is represented by a node, the macroscopic form of cancer is nodular.

Most often, central lung cancer in its histological form is squamous, the development of which is preceded by metaplasia of the glandular epithelium of the bronchi into a stratified squamous non-keratinizing epithelium during 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 compression of its tumor in the adjacent to the bronchus lung tissue complications such as atelectasis, abscess, pneumonia, bronchiectasis may develop.

Lung cancer is an epithelial organ-specific tumor.

Metastasizes predominantly by the lymphogenous route. The first lymphogenous metastases are found in regional lymph nodes - peribronchial, paratracheal, bifurcation.

MACRO PREPARATION №15 POLYPOSIS-ULCER ENDOCARDITIS OF THE AORTIC VALVE

We see the preparation of the heart 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 myocardium of the left ventricle of the heart and tonogenic dilation.

The crescents of the aortic valve are changed, they are thickened, tuberous, rigid, opaque. On two of the three crescents, an ulcerative defect is clearly visible, on the surface of which thrombotic deposits in the form of polyps have formed. Such changes in the crescents of the aortic valve are called polyposis - ulcerative endocarditis, which is one of the clinical - morphological forms sepsis.

Microscopically, in the thickness of these thrombotic overlays, colonies of microbes and deposits of lime salts can be detected.

Thrombobacterial embolism and the formation of aortic heart disease can become complications of this process.

Since polyposis-ulcerative endocarditis has developed on the already altered crescents of the aortic valve, this is secondary endocarditis.

MACRO PREPARATION №16 STOMACH CANCER (SAUCTOR-SHAPED)

The preparation shows a fragment of the stomach from the mucosal side. The stomach is cut along the greater curvature.

In the region of the lesser curvature of the body of the stomach, there is a pathological growth of the tumor tissue into the lumen of the stomach with loose raised edges and a flat bottom. The boundaries of tumor growth are indistinct in places. At the bottom of the tumor growth there are foci of white necrosis.

Fuzzy 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 gastric cancer.

According to localization, this is a cancer of the body of the stomach.

By the nature of growth, it is an ecophyte-expansive cancer.

Macroscopically, it is a saucer-shaped cancer.

Microscopically, it will most often be represented by a differentiated form of cancer - adenocarcinoma.

Since gastric cancer, according to the international classification of tumors, belongs to the group of epithelial organ-specific tumors, the predominant route of its metastasis will be lymphogenous. The first lymphogenous metastases may appear in regional lymph nodes - four collectors of lymph nodes located along the lesser and greater curvatures of the stomach.

Since the stomach is an unpaired organ of the abdominal cavity, the first hematogenous metastases are found in the liver.

MACRO PREPARATION №17 ABSCEDING PNEUMONIA IN SEPTICOPIEMIA

We see a cross section of the right lung, since it contains three lobes.

In each lobe, against the background of an airy tissue of a light beige color, there are multiple foci of round and irregular shape, the size of a match head, in places merging with each other, of a 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 forms around some foci, and the contents of the foci become the consistency of thick sour cream. A complication of pneumonia develops - abscess formation.

Abscessing pneumonia can develop with septicopyemia, one of the clinical and morphological forms of sepsis.

MACRO PREPARATION №18 croupous pneumonia (with abscess formation)

The preparation shows a longitudinal section of the right lung, as three lobes are visible.

The lower lobe is entirely gray, airless. Its cut surface is fine-grained.

The consistency of the lobe of the lung corresponds to the hepatic density.

The interlobar pleura is thickened with gray-beige membranous overlays.

This is lobar pneumonia, hepatization stage, gray hepatization variant.

In the lower segments of the lobe, cavities are defined, delimited from the lung tissue by a wall. These are abscess cavities.

There is one of pulmonary complications pneumonia - abscess formation. The reason for it is the addition of a secondary purulent infection due to a decrease in immunity and increased fibrinolytic activity of neutrophilic leukocytes.

MACRO PREPARATION №19 SMALL-NODULATE LIVER CIRRHOSIS

The preparation shows a section of the liver.

The liver is reduced in size, as its corners are pointed, and the capsule is wrinkled.

On the outer surface of the liver, multiple nodes of regenerates, up to 1 cm in size, are determined, making the surface of the liver uneven.

On the surface of the incision, the boundaries of the false lobules are clearly visible (whereas the boundaries of the hepatic lobules are not visualized normally) due to the growth of fibrous tissue in the region of the portal tracts.

This is cirrhosis of the liver.

In macroscopic appearance, it is small-nodular. By microscopic view- monolobular, since the size of the false lobules corresponds to the size of the nodes - regenerates.

According to pathogenesis, this is portal cirrhosis of the liver, in which portal hypertension develops primarily, and secondarily - hepatic cell failure.

Such cirrhosis can develop as a result of fatty hepatosis, chronic form of viral hepatitis B and chronic course alcoholic hepatitis.

MACRO PREPARATION №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 ulcerations, with fuzzy 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 of the epithelium - cancer of the body of the uterus.

Histologically, it is represented by a differentiated form of cancer - adenocarcinoma.

The nature of the growth of the tumor in relation to the lumen of the uterus is exophytic, in relation to the surrounding tissues - infiltrating.

May develop as a result of atypical glandular hyperplasia of the endometrium.

It is an epithelial organ-specific tumor. It metastasizes predominantly by the lymphogenous route. The first lymphogenous metastases are found in regional lymph nodes.

MACRO PREPARATION №21 PURULENT - FIBRINOUS ENDOMYOMETRITIS

A longitudinal section of the uterus with appendages is seen.

The uterus is sharply increased in size, its cavity is sharply expanded, the wall is thickened.

The endometrium is dirty-gray, dull, covered with membranous overlays of beige color, in places hanging down into the uterine cavity. The endometrium has inflammatory process- purulent - fibrinous endometritis.

In addition, inflammation has spread to muscular layer uterus, as the myometrium is dull, dirty gray.

Thus, in the presented preparation there is purulent-fibrinous endomyometritis, which could arise as a result of a criminal abortion and cause uterine sepsis.

MACRO PREPARATION №22 MULTIPLE UTERINE FIBROMIOMAS

A transverse section of the uterus is shown.

In the wall of the uterus, tumor tissue grows in the form of nodes, of different sizes, round and oval, with clear growth boundaries, surrounded by a thick-walled capsule, which is a reflection of the expansive growth of the tumor.

Nodes located inside the wall of the uterus - intramural, lying under the endometrium - submucosal, lying under the serous membrane - subserous.

The nodes are built from two types of fibrous structures - some beige fibers are smooth muscle fibers, other fibers are gray-white in color - connective tissue fibers. Fibrous structures have different thicknesses and go in different directions, which are manifestations of tissue atypism.

Since 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 a fibromyoma.

Based on the international classification of tumors, it belongs to mesenchymal tumors.

MACRO PREPARATION №23 BUBBLE SKID

The drug is represented by a cluster of thin-walled vesicles linked to each other and filled with a clear liquid. This is a cystic drift, a benign organ-specific tumor that develops during and after pregnancy from the epithelium of the chorionic villi.

Hydropic dystrophy of epithelial cells is the basis for the development of cystic drift.

The cystic drift 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 hydatidiform mole, a malignant organ-specific tumor of chorionepithelioma may develop.

MACRO PREPARATION №24 THROMBOEMBOLISM OF THE PULMONARY ARTERY

The drug is represented by an organocomplex: the heart and fragments of both lungs.

The heart is cut 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 the vessels. These are thromboemboli. The source of such massive thromboembolism could most likely be the veins lower extremities.

Located in the lumen of the trunk pulmonary artery and its bifurcation, the thromboembolus irritates the receptors of the reflexogenic zone located in the intima of the above vessels and causes the development of a pulmo - coronary reflex, which consists in an instant spasm of the small bronchi and bronchioles and coronary arteries of the heart, with the development of acute cardio - vascular insufficiency and the onset of instant death.

MACRO PREPARATION №25 ATHEROSCLEROSIS OF THE AORTIC WITH ATHEROMATOSIS AND PARTILEAL THROMBOSIS

The abdominal aorta is shown in a longitudinal section and the area of ​​aortic bifurcation into the common iliac arteries.

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 aortic lumen, 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 atherosclerosis, a clinical and morphological form of aortic atherosclerosis.

The described changes in plaques correspond to the macroscopic stage of complicated lesions.

Damage to the intima of the aorta was one of the local prerequisites for thrombosis. In the lumen of the abdominal aorta and in the lumens iliac arteries parietal and even obturating thrombi were formed, which disrupted the passage of blood through the aorta to the lower extremities.

MACRO PREPARATION №26 SMALL INTESTINAL DEFECT IN TYPHOSIS

The preparation shows the small intestine in a longitudinal section from the mucosal side.

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 furrows 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 submucosal layer of the intestine. Due to the proliferation of macrophage and histiocytic elements, the follicles increased in volume and size and began to rise above the mucosal surface.

Due to the presence of furrows and convolutions on the surface of the follicles, the first stage of typhoid fever is called cerebral swelling.

MACRO PREPARATION №27 FIBROUS-CAVERNOUS PULMONARY TUBERCULOSIS

The preparation is represented by a longitudinal section of the right lung, since it has 3 lobes. In each of the lobes there are cavities, large caverns 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, tuberculosis intoxication and cachexia, from which he dies.

MACRO PREPARATION №28 LYMPHOGRANULOMATOSIS OF PARAORTAL LYMPHONODES

The specimen shows the aorta in longitudinal section.

Atherosclerotic plaques are determined in the intima of the aorta.

On both sides of the abdominal aorta, above the bifurcation, lymph nodes are sharply enlarged and, because of this, soldered to each other, forming "packages" of lymph nodes.

The consistency of the lymph nodes is densely elastic, the surface is smooth, the color on the section is gray-pink.

Lymph nodes lying on the sides of the aorta are called para-aortic.

Enlargement of the para-aortic lymph nodes and their merging into packets occurs with lymphogranulomatosis, malignant Hodgkin's lymphoma.

MACRO PREPARATION №29 ARTERIOLOSCLEROTIC NEPHROSCLEROSIS

Two intact 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 type has a primary - wrinkled kidney due to the benign course of primary arterial hypertension. The wrinkling is based on hyalinosis and sclerosis of the capillaries of the renal glomeruli - arteriolosclerotic nephrosclerosis.

The same appearance has a secondary - wrinkled kidney, which develops as a result of chronic glomerulonephritis.

Clinically, against the background of primary and secondary shrunken kidneys, chronic renal failure develops, accompanied by the development of azotamic uremia, which can be treated with chronic hemodialysis or kidney transplantation.

MACRO PREPARATION №30 MILARY PULMONARY TUBERCULOSIS

A longitudinal section of an enlarged lung is shown.

It is clearly seen that the entire surface of the lung tissue is diffusely dotted with small, the size of a millet grain, dense tubercles, light yellow in color.

This type of lung has miliary tuberculosis, which develops with 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, plasmocytes and single multinuclear Pirogov-Langhans cells.

According to the classification of granulomas, tuberculous granulomas are infectious, specific. Specific cells of tuberculous granuloma are epithelioid cells of hematogenous, monocytic origin, which are the most in the granuloma.

MACRO PREPARATION №31 NODAL GOITER

The preparation shows the thyroid gland in section.

Its dimensions are sharply 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.

Persistent increase in size thyroid gland, not associated with inflammation, swelling or circulatory disorders in it, is called a goiter.

By appearance is a nodular goiter.

According to the internal structure - colloid goiter.

Most often occurs with endemic goiter, the occurrence of which is associated with a lack of exogenous iodine.

Despite the compensatory increase in the size of the gland, its function is reduced.

MACRO PREPARATION №32 TUBE PREGNANCY

The fallopian tube is seen in cross section.

The tube is sharply expanded. Its wall is thinned in places, thickened in places. In places of thickening of the pipe wall, the fabrics have a dark Brown color omnipresence of 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 fetal membranes.

This is an ectopic, tubal pregnancy, complicated by incomplete tubal abortion.

fertilized egg detached from the walls fallopian tube, as evidenced by hemorrhage, but remained in the tube.

MACRO PREPARATION №33 RENAL CELL CANCER

It is represented by a section of the kidney, in the upper pole of which the 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, epithelial organ-specific, developing from the epithelium of the tubules of the kidney.

Occurs in adults.

MACRO PREPARATION №34 DRY GANGRENE OF THE FOOT

The foot of the right lower limb is visible in the preparation.

In the region of the dorsal surface of the metatarsus, at the base of the fingers, the skin is absent, and the soft tissues are dry, mummified, gray-black in color.

This is dry gangrene of the foot, one of the clinical and morphological forms of necrosis.

Gangrene is the necrosis of tissues in contact with the external environment.

soft tissues with gangrene, they are stained gray-black with pseudomelanin pigment, or iron sulfide.

Foot gangrene 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.

MACRO PREPARATION №35 EMBRYONAL RENAL CANCER

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 growth boundaries, 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, indicating that the kidney belongs to a small child.

Despite the nature of the growth of the tumor - 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 over time is replaced by invasive.

The tumor is epithelial organ-specific.

It metastasizes predominantly hematogenously to the opposite kidney, lungs, bones, brain.

MACRO PREPARATION №36 MAMMARY CANCER

The drug is presented by the mammary gland.

In one of the quadrants of the mammary gland, a pathological proliferation of tumor tissue occurred, emanating from the epithelium of the ducts of the mammary gland, and sprouting onto the surface of the skin, which indicates invasive tumor growth.

This is a malignant, epithelial organ-specific tumor - breast cancer.