Download Hematogenic tuberculosis

Pathological anatomy of
TUBERCULOSIS
As.-prof. V.Voloshyn
According prof Ya. Bodnar
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Tuberculosis
Tuberculosis is the chronic specific
infectious disease which is caused
by tuberculosis mіkobacterias and
characterized by the defeat of all
human’s
organs,
but
more
frequent lungs. This disease has
undulating motion with the duty of
acute condition and remission.
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Etiology
Mіkobacteria of
tuberculosis, which was
opened by Koch in 1882
year, is the exciter of
illness.
Distinguish four its varieties:
human;
bovine;
bird;
cold-blooded.
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Pathogeny
Overwhelming ways of infection:
Air-drop (through respiratory way)
Alimentary (through mouth &
stomach way)
Origin, course (перебіг) and
consequence (result) of illness
depends from organism reactivity.
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Clinic–morphologic forms of
tuberculosis
Basic
morphological
forms:
Primary;
Secondary;
Haematogenic
Basic clinical
forms:
Tubercular
intoxication in
children and
teenagers;
Tuberculosis of
breathing organs;
Tuberculosis of
other organs and
systems.
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Description of tubercular
process
Localization and
prevalence
(поширеність):
In lungs in the lobules;
In other systems
according to localization;
Phases:
Infiltration, disintegration,
insemination, dissolving,
scarring, calciphication.
Selection (excretion) of
bacteria:
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BK+, BK-
Primary tuberculosis
A
primary
tubercular complex
is a morphological
expression
of
primary
tuberculosis
and
consists of primary
tubercular
affect,
lymphangitis
and
specific
lymphadenitis.
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Variants of course (перебіг) of
primary tubercular complex:
1. healing;
2. progress;
3. chronic motion.
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Healing of primary tubercular
complex
Healing
of
primary
complex
regardless (independently) of its
localization begins from dissolving of
perifocal
inflammation.
The
calciphicated and ossiphicated healed
origins of primary affects have name
the focus of Ghon’s. Sclerosis along
the lymphangitis and sclerosis of the
primary destroyed lymphatic nodes
be going on at the same time.
Mіkobacterias is saved in the Ghon’s
focuses many years (tens of years)
and predetermine unsterile immunity
.
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Forms of progress of primary
tuberculosis
growth of primary affect;
haematogenic spreading
(generalization);
lymphogenic spreading
(generalization);
intracanalicular spreading
(generalization);
mixed spreading.
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Charts of progress forms of
primary tuberculosis
Growth of
primary
affect
Lymphglandular
generalization.
Tubercular
bronchadenitis.
Hematogenic
generalization.
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Chronic flowing of primary
tuberculosis
It is observed in those cases, when a
primary affect heals over, but in a
lymphglandular complex processes of
cicatrization change with acutening. It
cause sensibilisation of organism. In
reply to it there are the paraspecific
displays in the inner organs.
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Morphology of paraspecific
displays of tuberculosis
Diffuse or knot proliferation of
lymphocytes
and
macrophages,
hyperplasia of hemopoetic organs,
fibrinoid changes of connecting tissue,
arterioles, dysproteinosis amyloidosis
sometimes. The paraspecific reaction
in joints at the chronic flowing of
primary tuberculosis is known as the
rheumatism of Ponsie.
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Causes of death
Death at progress of primary
tuberculosis
mainly
comes
from
tubercular meningitis, peritonitis, or
generality defeat of internal organs. At
timely
treatment
the
focuses
encapsulate, but they can be the
source of development of hematogenic
tuberculosis
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Secondary tuberculosis
Tuberculosis which arises up after
past primary tuberculosis with a some
immunity, although can be unstable
immunity. Reason of him is repeated
superinfection, or reactivation of
process in the place of selection in the
lungs after primary tuberculosis.
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Features of the secondary
tuberculosis
it is localized only in lungs;
has intracanalicular distribution from
an apex to basis;
specific inflammation is absent in
lymphatic nodes;
the changing of clinico-morphologic
phases is its clinico-morphologic forms
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Morphogeny of the secondary
tuberculosis
Ghon’s focus
Simon's focus
Ashoff-Pool's focus
Abrikosov's focus
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Clinico-morphologic forms
Acute focus TB
Fibrotic-focus
TB
Infiltraticpneumonitic 18of
Assman-Redeker
Clinico-morphologic forms
Tuberculoma
Lobitis.
Caseous
pneumonia
Acute
cavernous.
Fibrotic
cavern.
Cirrotic TB
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Morphology of chronic cavity
(cavern)
The wall of cavity is
dense. Morphologically
distinguish three layers
in it's wall:
necrotizing (piogenic),
is rich by leucocytes;
tubercular granulation
tissue;
connective tissue.
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Hematogenic tuberculosis
Hematogenic tuberculosis arises up
in persons which clinically got better
(recovered) from primary tuberculosis,
but there is an infection source in fully
healed
wound,
enhanceable
sensitiveness to the tuberculin is saved
at
a
formed
immunity
to
mycobacterium
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Forms of hematogenic
tuberculosis
Generalized (Quick as lightning
tubercular sepsis of Landuze);
Dissimilar, with predominance of
lungs defeat;
Dissimilar, with predominance of
extralungs damages
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Generalized hematogenic
tuberculosis
Most heavy form. This one
arises out from focuses of
selection, which got in different
organs in the period of progress
of primary tuberculosis and did
not manifestation long time.
Inflammation shows up by the
origin in the internalss of plural
humps with predominance of
necrosis above exudation &
proliferation (quick as lightning
tubercular sepsis), or by like
millet humps with predominance
of productive reaction (acute
general miliary tuberculosis).
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Hematogenic tuberculosis with
the primary defeat of lungs
This one arises up as
a
result
of
lung
infecting
from
the
focuses of selection,
which localized mainly
in
genitals
or
lymphatic
nodes.
Mycobacteriums come
in the lungs with the
blood current that is
why the defeat of
lungs
are
bilateral
mirror always.
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Forms of hematogenic tuberculosis
with the primary lungs defeat
Distinguish an acute and a chronic
forms. Miliary tuberculosis is the
presence of shallow (small) humps, at
presence of large – large niduses. At
the chronic flowing the scarring of
humps, development of emphysema,
cavity and as a result hypertension of
pulmonary circle of blood circulation is
possible
with
development
of
pulmonary heart.
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Hematogenic tuberculosis with
the primary defeat of lungs
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Hematogenic tuberculosis with
predominance of extralungs
damages
Develops
from
focuses of selection,
by carrying of exciter
into any organ by a
hematogenic way in
the period of the
primary infecting. It
can be acute and
chronic.
Bones,
urinary system, skin
are damaged mainly.
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Hematogenic tuberculosis with
predominance of extralungs
damages
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Complication of tuberculosis
Complications of tuberculosis
are numerous: so meningitis,
pleuritis, pericarditis, abscesses,
perifocal inflammations can
develop at primary tuberculosis;
at secondary TB – is bleeding,
pneumothorax, empyema of
pleura, amyloidosis.
Death mainly comes from the
indicated complications, chronic
insufficiency of pulmonary heart,
uremia.
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Thank you for attention!
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