Inflammation – Laboratory 1

Shannon Martinson: http://people.upei.ca/smartinson

VPM 152: February 2012

Lab1 Emphasis: • The exudates of

acute inflammation • Descriptions • Morphologic

Diagnoses

Describing Lesions – tell me what’s abnormal!

IMP

OR

TAN

CE

• This is simply stating what you see that is abnormal • When you describe something - I should be able to

make a morphologic diagnosis without ever seeing the sample!

Distribution Spatial arrangement of the lesions : random, focal, multifocal, coalescing, diffuse, symmetrical, etc

Contour and shape Raised, depressed, round, square, irregular

Colour

I’m pretty sure you know what these are…

Size Size of the lesions, increases/decreases in organ size

Texture / Consistency What does the surface look like and how does it feel (soft, firm, hard, friable, fluctuant, crepitous)

Describing Lesions – tell me what’s abnormal!

Creating a Morphologic Diagnosis for Inflammatory Lesions

Organ and Process Generally speaking = Organ + itis Egs: Hepatitis, Pleuritis, Nephritis, Gastritis…..

Exudate Serous, Fibrinous, Suppurative, Necrotizing, Hemorrhagic, Granulomatous

Distribution Focal, multifocal, locally extensive, coalescing, diffuse

Duration Peracute, Acute, Subacute, Chronic, Chronic-active

Severity Mild, Moderate, Severe

Fibrinous VS Fibrous!

• They are different – and represent two ends of a spectrum of change

• Acute inflammation

• Blood vessels become hyperemic and permeable

• FIBRIN leaks out

• Forms strands, sheets, loose adhesions

• Fibroblasts migrate out – organization

• New blood vessels form –granulation tissue

• Organizes into dense FIBROUS connective tissue (scar)

Fibrinous adhesions = ACUTE

• Delicate and friable strands of yellow material form loose adhesions between the parietal and visceral pleura

• Abundant clear yellow fluid fills the thorax

Fibrin

Serous fluid

This is a serofibrinous exudate

Fibrous adhesions = CHRONIC

• Sheets of pale tan to white material form firm adhesions between the visceral and parietal pleura and the diaphragm

Fibrous connective tissue

This is scarring and it is always chronic

Acute Inflammation – Exudates

Suppurative exudate = pus (made of neutrophils) It’s yellow-tinged, often smells bad, and can be watery , viscous, or crumbly

Acute Inflammation – Exudates

Hemorrhagic exudate = bloody Fibrinous exudate = friable tan-yellow material You can combine the 2: fibrinohemorrhagic

Acute Inflammation – Exudates

Mucoid exudate = gelatinous clear exudate This is typical in mild forms of inflammation

www.cfsph.iastate.edu/DiseaseInfo/ImageDB/MCF/MCF_008.jpg

Acute Inflammation – Exudates

Necrotizing - not an exudate per say Fibrinonecrotizing

Acute Inflammation – Exudates

Erosive - not an exudate per say

• Adult , MC, Lab • Limping , swelling and pain affecting the right front leg • Skin turned black and ulcerated • Swelling became marked and the dog became systemically ill

Acute Inflammation – Example

Inflammation – Example

• Upon incision and reflection of the skin, abundant viscous yellow opaque fluid exudes from the subcutis and connective tissues of the right front limb

Description?

Inflammation – Example

• Cellulitis, suppurative, locally extensive, acute, severe

Morphologic Diagnosis?

Additional Info: Disease name = Necrotizing fasciitis Etiology: Streptococcus sp (Lancefield G)

Inflammation – Case 1

• Liver from a calf • History of an umbilical abscess and swollen joints

Inflammation – Case 1

• Sheets and tags of friable tan material are loosely adhered to the hepatic capsular surface covering a large portion of the diaphragmatic surface

Description?

Inflammation – Case 1

• Hepatitis, fibrinous, locally extensive, acute, severe

Morphologic Diagnosis?

Technically speaking this is peri-hepatitis, a form of peritonitis, because the liver itself is not inflamed – common finding in sepsis!

Inflammation – Case 2

• Heart from a calf • History of an umbilical abscess and swollen joints

Inflammation – Case 2

Description?

• Sheets and tags of friable tan material are loosely (to firmly) adhered to the entire epicardial surface

Inflammation – Case 2

Morphologic Diagnosis?

• Pericarditis (epicarditis), fibrinous, diffuse, (sub)acute, severe

Inflammation – Case 3

• Limb (joint) from a lamb • The syringe contains material collected from the joint

Inflammation – Case 3

Description?

• The stifle joint is distended containing friable tan-yellow material and viscous yellow fluid (in the syringe). Similar material dissects the surrounding soft tissues.

• Fibrosis expands the joint capsule and surrounds the exudate

Inflammation – Case 3

Morphologic Diagnosis?

• Arthritis and periarthritis, fibrinosuppurative, diffuse (stifle), chronic, severe

Inflammation – Case 4

• Abomasum from a calf

Inflammation – Case 4

Description?

• Scattered multifocally within the abomasal mucosa are round to irregular, slightly depressed areas of pale discolouration and mucosal roughening (erosions/ulcers) with a surrounding thin dark rim (hemorrhage).

Inflammation – Case 4

• Abomasitis, erosive/ulcerative, multifocal to coalescing , acute, severe

Morphologic Diagnosis?

Inflammation – Case 5

• Liver and umbilicus from a calf • The syringe contains material collected from umbilical vein

Inflammation – Case 5

Description?

• Near the umbilicus, the umbilical vein is markedly distended and contains yellow tinged viscous opaque fluid

• The wall of the umbilical vein is thickened

Inflammation – Case 5

• Omphalophlebitis, suppurative, segmental, acute /subacute severe

Morphologic Diagnosis?

Inflammation – Case 6

• Small intestine from a snake

Inflammation – Case 6

Description?

• Throughout the length of this segment of SI, there is thickening of the wall, roughening of the serosal surface and replacement of the mucosa by an adherent layer of friable tan material. When removed, this leaves a raw ulcerated mucosa. Deeper in the wall, hemorrhage and edema are present.

Inflammation – Case 6

• Enteritis, fibrinonecrotizing, segmental, acute, severe

Morphologic Diagnosis?

Inflammation – Case 7

• Stomach from an adult cat

Inflammation – Case 7

Description?

• In the body of the stomach, near the pylorus, the mucosal surface is locally bright red with a roughened granular appearance. The affected area measures ~ 4 x 4 cm.

Inflammation – Case 7

• Gastritis, hemorrhagic, locally extensive, acute severe

Morphologic Diagnosis?

Inflammation – Case 8

• Uterus from a dog

Inflammation – Case 8

Description?

• The walls of the uterine horns are diffusely thickened and the lumen is distended containing viscous yellow tinged opaque fluid.

Inflammation – Case 8

• Pyometra, (Suppurative endometritis), diffuse, acute, severe

Morphologic Diagnosis?

Inflammation – Case 9

• Lungs from a cow

Inflammation – Case 9

Description?

• Covering the lungs, especially the cranioventral lung fields, is a thin layer of friable yellow material

• The underlying lung is dark red to green-tinged, firm and consolidated

Inflammation – Case 9

Description?

• On cut section the lung lobules are pale and dry and the interlobular septa are mildly expanded by pale yellow-tan material

Inflammation – Case 9

• Pleuritis, fibrinous, locally extensive, acute, severe • Necrotizing bronchopneumonia, locally extensive, acute,

severe

Morphologic Diagnosis?

Questions?