LESSON No. 3

1. TOPIC: “PATHOLOGICAL PROCESSES ARISING IN COMMITMENT. MORPHOLOGICAL ELEMENTS OF THE LESION.”

3. Lesson plan: distinguish individual pathological processes occurring in the oral mucosa,

distinguish between primary elements of the lesion, distinguish between secondary elements of the lesion,

determine the various stages of development of the lesion element, differentiate the lesion elements that are similar to each other, distinguish the lesion elements.

THEORETICAL PART

Spongiosis - accumulation of fluid between the cells of the spinous layer. The liquid, accumulating, can open the protoplasmic bridges of cells and, filling the cavities, form bubbles.

Ballooning degeneration - disruption of the connection between the cells of the spinous layer, which leads to the free arrangement of individual cells or their groups in the exudate, forming bubbles in the form of balls (balloons).

Acantholysis is a degenerative change in the cells of the spinous layer, expressed in the melting of intercellular protoplasmic bridges.

Acanthosis is a thickening of the cells of the spinous layer, characteristic of inflammation.

Hyperkeratosis is excessive keratinization due to disruption of desquamation phenomena or increased production of keratinized cells.

Parakeratosis is a disorder of the keratinization process, which is expressed in incomplete keratinization of the superficial cells of the spinous layer.

Papillomatosis is the growth of the papillary layer towards the epithelium.

There are primary elements of the lesion, i.e. arising independently, and secondary, developing from the primary. In addition, a monomorphic type of lesion is determined - an accumulation of homogeneous primary elements, and a polymorphic type of lesion - an accumulation of heterogeneous primary elements. Different stages of development of one element are false polymorphism.

PRIMARY MORPHOLOGICAL ELEMENTS:

A. I N F I L T R A T I V N Y E

A spot is a change in the color of the mucous membrane. Spots can be small and large, diffuse and limited, persistent and unstable. A characteristic feature of spots is that they are not felt upon palpation. There are vascular, pigment (dyschromatic) spots that arise as a result of the deposition of dyes in the mucous membrane. Vascular spots may result from temporary reflex expansion blood vessels and with inflammation. Inflammatory spots can have various shades of red; when you press on them, they always disappear and then appear again. Multiple small spots are called roseola large - erythema. Spots resulting from persistent non-inflammatory dilation of superficial vessels or their neoplasm are called telangiectasia. Spots on the skin and mucous membranes can arise as a result of a violation of the integrity of the vascular wall (rupture, increased permeability) - hemorrhagic spots. The color of such spots does not disappear with pressure and, depending on the time elapsed after the hemorrhage, has different shades. Point hemorrhages are called petechiae, multiple small hemorrhages are called purpura, large hemorrhages are called ecchymoses.

Pigmented (dyschromatic) spots arise as a result of accumulation, or reduction, and sometimes complete absence melanin pigment.

A nodule is a cavityless formation in the epithelium due to acanthosis, protruding above the surface of the mucous membrane. The surface of the nodules can be flat, cone-shaped or hemispherical, the outlines are round or polygonal. Nodules can be of different colors and consistency. The size of the nodules is from millet grains or more; they can increase in size and merge, forming plaques. When the nodules heal, no traces remain in their place.

A node is a dense formation originating in the submucosal layer. It is detected upon palpation in the form of a dense, slightly painful, rounded infiltrate. As it develops, it increases in size and rises above the surface of the mucosa. Possible suppuration or ulceration of the node.

A tubercle is an infiltrative, cavity-free formation that covers all layers of the mucous membrane and rises above its surface; as a rule, the tubercles are crowded and quickly undergo decay. In their place, ulcerative surfaces are formed, covered with granulations and vegetations. Heal with the formation of a scar.

B. E X S U D A T I V N E

Bubble - a cavity element resulting from a limited accumulation of fluid. It is located in the spinous layer, has a bottom and a thin cover, rises above the surface of the mucosa and is easily opened under mechanical influence. Bubble sizes up to 2 mm.

A bladder is a cavity formation that differs from a vesicle in its larger size and the location of the fluid not only inside, but also subepithelial. With an intraepithelial bladder, the tegmentum consists of cells of the spinous layer and opens very quickly. The covering of the subepithelial bladder is quite strong and lasts up to several days.

An abscess is a cavity formation filled with purulent exudate.

A cyst is a cavity formation lined with epithelium and having a connective tissue membrane. The contents may be transparent or hemorrhagic.

A blister is a cavityless formation that occurs as a result of acute limited swelling of the papillary layer and protrudes above the mucous membrane, has the shape of a flat hill, can be pale or red in color, sizes from 0.2 to 1.5 cm. Can be of exogenous and endogenous origin .

SECONDARY MORPHOLOGICAL ELEMENTS.

Erosion is a violation of the integrity of the surface layer of the epithelium, heals without a scar.

Afta - a limited area of ​​necrosis of the yellow epithelium gray round or oval shape, measuring 0.2 - 0.5 cm or more. Surrounded by a bright red inflammatory rim. Heals without a scar.

An ulcer is tissue necrosis that covers the entire layer of the mucous membrane, has a bottom and edges. Heals with the formation of a scar.

A scar is the replacement of differentiated tissues with connective tissue; it occurs in place of some primary or secondary elements.

Scales are detachable keratinized plates of epithelium.

Crust - dried exudate from a vesicle, erosion, ulcer. The color depends on the nature of the exudate; they are usually located on the red border of the lips or near them.

A fissure is a linear defect that occurs when tissue loses its elasticity; it is most often localized in the corners of the mouth and on the red border of the lips.

An abscess is a cavity formation filled with pus.

Atrophy is thinning of the mucous membrane.

Pigmentation is a change in tissue color that occurs after inflammation.

It should be remembered that morphological elements are not always pathognomonic, but in the complex of patient studies they serve as important additional factor in making a diagnosis.

New pedagogical technologies used in practical classes.

Carrying out the interactive game “Spider's Web”.

Compilation of organizers on the topic “Pathomorphological processes arising in the oral mucosa. Morphological elements of the lesion."

1. Creation of a Cluster.

ANALYTICAL PART

A 66-year-old patient complains of discomfort in the oral cavity that arose after applying a metal filling to /_6. During an objective examination, a spot is noted on the buccal mucosa at level /_6

1.Write the tooth formula according to WHO

Answer: /_26

2. Vascular spots on the mucous membranes are not called

A) pustule*

B) Pitechia

B) purpura

D) roseola

D) enanthema

3. The primary element of destruction of the oral mucosa is

A) papule*

B) erosion

G) crack

4 The primary element of damage to the oral mucosa is

A) bubble*

B) erosion

G) crack

5 The primary element of damage to the oral mucosa is

A) blister*

B) erosion

G) crack

Situational task No. 2

A 47-year-old patient complains of pain and burning in the oral cavity that appeared 2 days ago. From the anamnesis it was found that over the past 2 years the patient periodically has aphthae on the tip of the tongue every 5-6 months. Healing of aphthae occurs 10-12 days after appearance. The patient suffers from chronic gastritis.

1. What primary element of the lesion precedes aphthae:

g. tubercle

d. blister

2. Histological examination of aphtha does not reveal:

A. vasodilation

b. perivascular infiltration

v. swelling of the spinous layer of the epithelium

g. deep fibrinous-necrotic inflammation

d. acantholytic Tzanck cells*

3.What additional examination methods need to be carried out:

A. immunological *

b. cytological*

d. palpation

4.What is the main method of examination that needs to be carried out:

A. palpation*

b. cytological

v. microbiological

g. immunological

d. patient interview*

Situational task No. 3

Patient V., 30 years old, complained of very painful aphthae on the cheeks, lips and tongue, pain when eating. From the anamnesis it turned out that such aphthae form in spring and autumn.

Objectively: on the mucous membranes of the cheeks in the area of ​​the left lower 5 and 6 teeth, on the lateral surfaces of the tongue, on the mucous membrane lower lip There are single aphthae of about 0.6-0.8, covered with a dense fibrinous plaque against the background of hyperemic mucous membranes, painful, soft on palpation.

1. When gastrointestinal pathology aphthae are formed:

A. covered with fibrous plaque.*

b. meat-bloody color

v. covered with necrotic plaque.

g. covered with a cheesy coating

2. Afta is:

A. dense formation

b. defect in all layers of the epithelium

v. linear defect

g. dried exudate

d. oval erosion covered with fibrinous plaque *

3. For general treatment The following are used as a means of nonspecific sensitization:

A. analgin

b. ciprolet

v. lidocaine

g. mepivocaine

d. histaglobulin*

Situational task No. 4

A 34-year-old patient came to the Tc department. Complaints: tumors in the oral cavity, chronic relapses, general weakness, malaise.

From the anamnesis: the patient has been suffering for 4 years, constant selection sputum, sometimes with blood, is registered at the tuberculosis dispensary.

Objectively: There are multiple scars on the oral mucosa, on some of them there is an element of inflammation in the shape of a sphere (hemisphere), painless, the size of a pinhead (diameter 1-3 mm), soft consistency, red or yellowish-red color, prone to peripheral growth and fusion with neighboring elements, which leads to the formation of plaques of different sizes and shapes.

1. What primary element of the oral mucosa in tuberculosis has been described:

g. tubercle*

2. What secondary element of the oral mucosa does the patient have?

A. bubble

v. tubercle

g. plaque.

3. Which layers of the oral mucosa are covered by the tubercle:

A. epithelium

b. the mucous membrane itself.

v. submucosal layer

g. muscular

d. a, b, v *

PRACTICAL PART

Target: Teach student methods of examining a patient with diseases of the oral mucosa.

Indications: diagnosis of diseases of the oral mucosa.

Equipment: safety glasses, rubber gloves, mask, case patient (volunteer), instruments for examining the oral cavity

Steps to follow:

TEST QUESTIONS

2.Name the exudative elements of the lesion

3.List the primary elements of the lesion

4.List the secondary elements of the lesion

5.What is a stain, describe the various stains

6.What is ballooning degeneration

7.What is acantholysis?

8 What is hyperkeratosis?

9. What is parakeratosis?

10.What is spongiosis.

Aphthae – a superficial defect of the epithelial layer with a diameter of 0.3-0.5 cm, filled with a fibrin film. At the end of inflammation, the defect is epithelialized without the formation of a scar in the lamina propria.

Erosion (erosio) – a superficial defect of the epithelial layer, the lamina propria of which is the bottom of a crater-shaped defect filled with fibrin and necrotic epithelial cells. Erosion is formed when the cavity primary elements are opened (see above).

Ulcer (ulcus) – defect of the epithelial layer and the lamina propria of the mucous membrane. The bottom of the ulcer is covered with fibrinous-purulent exudate. As the ulcer heals, a scar forms.

Crack (rhagades) – deep linear defect of the mucous membrane, a type of ulcer.

Tripe (cicatrix) – incomplete regeneration of the connective tissue of the lamina propria and the submucosal layer of the epithelial layer of the oral mucosa.

Peeling (squama) – rejection of keratinized cells of the epithelial layer in places of hyperkeratosis that has arisen above the primary non-cavitary elements.

crust (crusta) – dried (coagulated) exudate (serous, purulent, hemorrhagic), located in the superficial layers of the epithelial layer and rejected along with the damaged epithelium.

Raid – superficial application fibrinous exudate, containing leukocytes, bacteria, fungi and damaged epithelium. Candidiasis of the mucous membrane of the tongue can be manifested by the formation of a whitish coating, which is called thrush (soor).

End of work -

This topic belongs to the section:

Pathological anatomy

GOU VPO Kemerovo State Medical Academy.. Pathological anatomy.. Orofacial region of the head and neck..

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III. Primary and secondary skin lesions

Pathological phenomena on the skin lead to the formation of changes, which are most often expressed in the occurrence skin rashes or morphological elements.

There are primary and secondary morphological elements.

Primary- these are skin changes that are the immediate, first consequence of exposure to a pathogenic agent.

Secondary– appear after the primary ones due to their further development.

The primary morphological elements include: spot, blister, vesicle, bladder, abscess, nodule, node, tubercle (8 elements).

1) Spot (macnea) – organic, located at the skin level, of various shapes with changes in the color of the skin or mucous membrane. Spots are divided into:

a) vascular – found in syphilis, measles, typhus, liver diseases, vasculitis.

b) hemorrhagic spots are formed due to the release of blood into the tissue.

c) pigment spots occur due to an increase or decrease in the content of melanin (leucoderma).

2) Blister (irtica) - is a cavity-free formation that rises above the surface of the skin, resulting from limited acute inflammatory edema of the papillary dermis. This is an element of urticaria.

3) Bubble (vesicle) - a cavity formation, slightly elevated above the skin level, filled with transparent serous, less often bloody, contents. Occurs as a result of inflammation of the epidermis.

4) Bubble (bulla) is a cavity formation that appears above the skin level, the size of a pea to the palm, filled with turbid serous or hemorrhagic contents, where epithelial cells are microscopically found, ₤ are a manifestation of pemphigus, Dnoring's dermatitis.

5) Pustule (pustula) - a cavity formation filled with purulent contents, in which many ₤, albumins, and globulins are found. An abscess located around the hair follicle is called folliculitis . Located around sebaceous glands ulcers are called acne with pyodermatitis.

6) Nodule (papula) - a cavity-free formation that rises above the surface of the skin. This is a manifestation of many skin and veins. diseases.

7) Knot (nodus) is a cavityless infiltrated formation, located deep in the dermis or subcutaneous fatty tissue and is determined by palpation. An example is morplit. gumma.

8) Tubercle (tuberculum) - is a cavityless formation that rises above the level of healthy skin or is located at its level and is sharply demarcated. The tubercle heals with a scar. The tubercles are typical for leprosy, leishmaniasis, tuberculosis, and tertiary syphilis.

Secondary morphological elements: pigmentation and depigmentation, scale, crust, erosion, crack, abrasion, ulcer, cicatricial atrophy, vegetation.

1) Pigmentation and depigmentation . Hyperpigmented spots appear in places of the greatest deposition of melanin and imosiderin, appear in places of primary or secondary elements. Hypopigment spots are located in areas of resolution of macular-flaky elements and papules.

2) Flake (squama) are loosened horny plates that have lost their connection with each other, ready to be torn off or already torn away from the surface of the skin. The separation of scales is called peeling .

3) Crust (crusta) - occurs due to the drying out of the contents of vesicles, blisters, ulcers and discharge from erosions and ulcers.

4) Erosion (erosion) is a superficial skin defect that most often occurs at the site of a rupture: the covering of the primary cavity morphological element, repeating its shape and size. After the erosion heals, there is no scar left.

5) Cracks (rhagudes) - are linear damage to the skin in the form of a rupture that occurs due to loss of elasticity of the skin during the inflammatory process or when it is overstretched. Cracks usually appear where the skin bends. The cracks are located within the epidermis and dermis. There are superficial and deep.

6) Abrasion (excoriation) – violation of the integrity of the skin due to scratching or scratching. The abrasions are superficial and deep. Prone to infection.

7) Ulcer (ulous) is a deep defect of the skin, subcutaneous tissue, muscles, and bone fascia. Occurs as a result of the breakdown of tissue of nerve elements. They heal by forming a scar.

8) Scar (cicatrix) - is a newly formed fibrous connective tissue that replaces the lost property of the skin.

9) Scar atrophy – a regressive process that occurs as a result of the depletion of all layers of the skin. It develops without previous ulceration by converting the infiltrate into connective tissue.

10) Lichenification - a focus of increased skin pattern, accompanied by thickening and compaction, hyperpigmentation, and dryness.

11) Vegetation – papillary thickening of the skin, resulting from the proliferation of the spinous layer of the epidermis and papillomatosis of the dermis during a long-term inflammatory process. Most often they form in the area of ​​papules and ulcers.