Inflammation Laboratory 1 Lab1 Emphasis: The exudates of acute inflammation Descriptions Morphologic Diagnoses Shannon Martinson: http://people.upei.ca/smartinson VPM 152: March 2013
Describing Lesions tell me what s abnormal! This is simply stating what you see that is abnormal When you describe something - I should be able to make a morphologic diagnosis without ever seeing the sample! IMPORTANCE
Describing Lesions tell me what s abnormal! Distribution Spatial arrangement of the lesions : random, focal, multifocal, coalescing, diffuse, symmetrical, etc Contour and shape Raised, depressed, round, square, irregular Colour I m pretty sure you know what these are Size Texture / Consistency Size of the lesions, increases/decreases in organ size What does the surface look like and how does it feel (soft, firm, hard, friable, fluctuant, crepitous)
Creating a Morphologic Diagnosis for Inflammatory Lesions Organ and Process Exudate Distribution Duration Severity Generally speaking = Organ + itis Egs: Hepatitis, Pleuritis, Nephritis, Gastritis.. Serous, Fibrinous, Suppurative, Necrotizing, Hemorrhagic, Granulomatous Focal, multifocal, locally extensive, coalescing, diffuse Peracute, Acute, Subacute, Chronic, Chronic-active Mild, Moderate, Severe
Fibrinous VS Fibrous! They are different and represent two ends of a spectrum of change Acute inflammation Blood vessels become hyperemic and permeable FIBRIN leaks out Forms strands, sheets, loose adhesions Fibroblasts migrate out organization New blood vessels form granulation tissue Organizes into dense FIBROUS connective tissue (scar)
Fibrinous adhesions = ACUTE This is a serofibrinous exudate Delicate and friable strands of yellow material form loose adhesions between the parietal and visceral pleura Abundant clear yellow fluid fills the thorax Fibrin Serous fluid
Fibrous adhesions = CHRONIC This is scarring and it is always chronic Tough sheets of pale tan to white material form firm adhesions between the visceral and parietal pleura and the diaphragm Fibrous connective tissue
Acute Inflammation Exudates Suppurative exudate = pus (made of neutrophils) It s yellow-tinged, often smells bad, and can be watery, viscous, or crumbly
Acute Inflammation Exudates Hemorrhagic exudate = bloody Fibrinous exudate = friable tan-yellow material You can combine the 2: fibrinohemorrhagic
Acute Inflammation Exudates www.cfsph.iastate.edu/diseaseinfo/imagedb/mcf/mcf_008.jpg Mucoid exudate = gelatinous clear exudate This is typical in mild forms of inflammation
Acute Inflammation Exudates Necrotizing - not an exudate per say Fibrinonecrotizing
Acute Inflammation Exudates Erosive (erosions) - not an exudate per say
Acute Inflammation Example Adult, MC, Lab Limping, swelling and pain affecting the right front leg Skin turned black and ulcerated Swelling became marked and the dog became systemically ill
Inflammation Example Description? Upon incision and reflection of the skin, abundant viscous yellow opaque fluid exudes from the subcutis and connective tissues of the right front limb
Inflammation Example Morphologic Diagnosis? Cellulitis, suppurative, locally extensive, acute, severe Additional Info: Disease name = Necrotizing fasciitis Etiology: Streptococcus sp (Lancefield G)
Lungs from a 2 day old calf Inflammation Case 1
Lungs from a 2 day old calf Inflammation Case 1
Inflammation Case 1 Description? Loosely adhered to the pleura, especially the cranioventral lung fields, is a thin layer of friable yellow material The underlying lung is bright red, firm and consolidated
Inflammation Case 1 Description? On cut section the parenchyma is mottled dark red and bright red
Inflammation Case 1 Morphologic Diagnosis? Pleuritis, fibrinous, locally extensive, acute, severe Bronchopneumonia, hemorrhagic, locally extensive, acute, severe When the distribution in the lung is cranioventral = Bronchopneumonia
Abomasum from a calf Inflammation Case 2
Inflammation Case 2 Description? Scattered multifocally within the abomasal mucosa are round to irregular, slightly depressed areas of pale discolouration and mucosal roughening (erosions/ulcers) with a surrounding thin dark rim (hemorrhage).
Inflammation Case 2 Morphologic Diagnosis? Additional info: This was caused by a fungal infection Etiologic Diagnosis = Fungal abomasitis Abomasitis, erosive/ulcerative, multifocal to coalescing, acute, severe
Small intestine from a snake Inflammation Case 3
Inflammation Case 3 Description? Throughout the length of this segment of SI, there is thickening of the wall, roughening of the serosal surface and replacement of the mucosa by an adherent layer of friable tan material. When removed, this leaves a raw ulcerated mucosa. Deeper in the wall, hemorrhage and edema are present.
Inflammation Case 3 Morphologic Diagnosis? Additional info: In snakes these lesions can be caused by bacteria (Salmonella) and by parasites (Entamoeba invadens) Enteritis, fibrinonecrotizing, segmental, acute, severe
Uterus from a dog Inflammation Case 4
Inflammation Case 4 Description? The uterine horns are dilated and the organ is fluctuant The content is viscous yellow tinged opaque fluid.
Inflammation Case 4 Morphologic Diagnosis? Pyometra, (or suppurative endometritis), diffuse, acute, severe
Liver from a lamb Found dead Inflammation Case 5
Inflammation Case 5 Description? Numerous, multifocal to coalescing pale, tan, discrete, 0.5-1 cm in greatest diameter foci are scattered randomly throughout the liver. These areas extend deep into the parenchyma on cut surface.
Inflammation Case 5 Morphologic Diagnosis? Additional info: This was caused by Fusobacterium necrophorum Disease name = Necobacillosis Hepatitis, necrotizing, multifocal to coalescing, acute, severe
Heart from a cow Inflammation Case 6
Heart from a cow Inflammation Case 6
Inflammation Case 6 Description? The epicardium is thickened and rough with friable to firm, tanyellow sheets and tags covering the entire surface
Inflammation Case 6 This is a good example of how fibrin becomes organized with Morphologic time this step precedes fibrosis Diagnosis? Pericarditis, fibrinous, diffuse, subacute (or chronic-active), severe
Inflammation Case 6 Additional info: This may occur as a result of ingestion of a nail/wire perforation of the reticulum and penetration of the diaphragm pericardium = Traumatic reticulopericarditis
Inflammation Case 7 Kidneys from a cull dairy cow at slaughter Enlarged kidneys noted during processing
Inflammation Case 7 Kidneys from a cull dairy cow at slaughter Enlarged kidneys noted during processing
Inflammation Case 7 Description? On the capsular surface there are multifocal to coalescing slightly raised rough tan foci. The capsule is firmly adhered in areas
Inflammation Case 7 Description? On section, there is dilation and roughening of the renal pelvis with yellow cloudy fluid, and firm yellow material (exudate and stones (uroliths) in the lumen. Fibrosis surrounds these areas
Inflammation Case 7 Morphologic Diagnosis? (Pyelo) nephritis, suppurative, bilateral (diffuse), chronic (because of the fibrosis!) Also nephrolithiasis!
Questions?