Primary elements of damage. Pathological processes in the oral cavity
Pathological processes in the oral mucosa can be divided into two groups: inflammatory lesions and tumors.
Inflammation- protective vascular-tissue reaction of the body to the action of an irritant. According to morphology, three phases of inflammation are distinguished: alterative, exudative and proliferative. Inflammation can be acute, sub-acute and chronic. At acute course alterative and exudative changes predominate, and in chronic - proliferative ones.
Alternate phase of inflammation characterized by the predominance of dystrophic and necrotic processes in cells, fibrous structures and in the interstitial substance of the mucosa.
Exudative phase of inflammation characterized by a predominance of hyperemia, edema and infiltration. Following a short-term reflex narrowing of the lumen of the capillaries, their persistent expansion occurs. Slowing of the blood flow leads to stasis and thrombosis of the mucosal vessels. The tone of the vessels decreases and the permeability of their walls is disturbed. Blood plasma (exudation) and blood cells (emigration) go beyond the vessels.
Violation of vascular permeability is caused by the release of a large amount of biologically active substances (acetylcholine, histamine, serotonin, kinins) as a result of cell lysis. In this case, edema and infiltration of the walls of blood vessels and connective tissue of the oral mucosa are observed. The infiltrate can be leukocyte, lymphoid, from plasma cells and with a predominance of erythrocytes.
proliferative phase of inflammation characterized by the processes of reproduction and transformation of cells. Reproduction of connective tissue cells underlies the formation of granulation tissue. In the process of fibroblastic proliferation, a new formation of connective fibers occurs. This is the outcome of an acute process.
chronic inflammation mucous membrane is characterized by the multiplication of connective tissue cells (lymphocytes, plasma cells, fibroblasts, etc.). Then a young, cell-rich granulation tissue is formed. The outcome of productive inflammation is the formation of mature connective tissue, i.e. development of sclerosis and fibrosis.
As a result of neurovascular disorders, focal necrosis often appears in the connective tissue structures of the mucosa. Surface defects - erosion - are formed when integrity is violated only surface layers epithelium. If the connective tissue layer is damaged, then a scar is formed as a result of healing.
With an exacerbation chronic process joins acute disorder vascular permeability with the release of polymorphonuclear leukocytes and erythrocytes into the connective tissue layer of the mucous membrane.
Pathological processes lead to changes in the oral mucosa, in particular to disturbances in the processes of keratinization in the epithelium.
acanthosis- thickening of the epithelial layer of the mucous membrane due to the proliferation of basal and spiny cells. The result of acanthosis is the appearance of a nodule, node, lichenification.
- lichen planus;
- leukoplakia;
- mild leukoplakia;
- hypo- and beriberi;
- lupus erythematosus;
- precancerous cheilitis of Manganotti;
- atopic cheilitis;
- actinomycosis;
- mucosal changes in endocrine disorders.
Parakeratosis- incomplete keratinization of the superficial cells of the spinous layer while maintaining flattened elongated nuclei in them. In this process, the phase of formation of keratohyalin and eleidin falls out, so the granular and shiny layers are absent. The adhesive substance, keratin, disappears from the cells of the stratum corneum, as a result of which pronounced peeling of the epidermis is detected. The resulting scales are easily rejected.
Diseases that accompany this pathological process:
- leukoplakia;
- hypo- and avitaminosis A, C, B;
- lichen planus;
- dry form of exfoliative cheilitis;
- atopic cheilitis;
- lupus erythematosus.
The result of parakeratosis is the appearance of a spot, lichenification, vegetation, node, nodule. Areas of parakeratosis are whitish in color and cannot be scraped off.
Dyskeratosis- a form of irregular keratinization, characterized by pathological keratinization of individual epithelial cells.
Cells become larger, rounded, with granularity in the cytoplasm - “Dariaer bodies”, then turn into homogeneous acidophilic formations with small pictonic nuclei called granules and located in stratum corneum. Dyskeratosis is observed with aging. Malignant dyskeratosis is characteristic of Bowen's disease, a squamous cell carcinoma.
Hyperkeratosis- excessive thickening of the stratum corneum of the epithelium. It can develop as a result of excessive production of keratin or due to a delay in desquamation of the epithelium. Hyperkeratosis is based on the intensive synthesis of keratin as a result of an increase in functional activity epithelial cells (chronic irritation or metabolic disorders).
This process accompanies the following diseases:
- dry form of exfoliative cheilitis;
- leukoplakia;
- lichen planus;
- intoxication with mercury, lead, bismuth, aluminum, zinc, etc.;
- lupus erythematosus;
- actinomycosis.
Papillomatosis- growth of the papillary layer of the lamina propria and its ingrowth into the epithelium. This process is observed in chronic trauma of the mucous membrane of the palate with a lamellar prosthesis and other chronic injuries.
vacuolar dystrophy- intracellular edema of epithelial cells with the appearance in the cytoplasm of vacuoles that destroy cells. Sometimes the vacuole occupies almost the entire cell, pushing the nucleus to the periphery. In this case, the core takes a saddle shape.
- pemphigus vulgaris;
- simple herpes;
- lupus erythematosus;
- mucosal changes in endocrine diseases(gingivitis of pregnant women, Itsenko-Cushing's syndrome, etc.).
Spongiosis- accumulation of fluid between the cells of the spinous layer. At the same time, intercellular spaces are expanded, filled with liquid, cytoplasmic protrusions are elongated. The process begins with the expansion of intercellular tubules, which are filled with exudate coming from the connective tissue. This exudate stretches and then breaks intercellular bonds, forming a cavity. In the resulting cavity, serous contents and epithelial cells that have lost contact with the epithelium are found. The result of this process can be a blister, bubble, bubble.
Spongiosis accompanies the following diseases:
- simple herpes;
- pemphigus vulgaris;
- lichen planus (bullous form);
- multiform exudative erythema;
- chronic relapsing aphthous stomatitis; eczema.
Ballooning dystrophy- violation of the connections between the cells of the spinous layer, which leads to the free location of individual cells or their groups in the exudate of the resulting bubbles in the form of balloons. This is preceded by some thickening of the epithelium, the appearance of giant epithelial cells resulting from amitotic nuclear fission, but the cell itself does not divide. The cell increases in size (ball, balloon) and floats in the liquid. This pathological process is manifested in herpes simplex, eczema, multiform exudative erythema, lichen planus.
Acantholysis- melting of intercellular bridges in the spiny layer, which leads to the loss of connections between epithelial cells. Cracks and intraepithelial bubbles, vesicles are formed in the epithelium. This process is based on immune mechanisms. In this case, the spiny cells are rounded, slightly reduced in size, the nucleus becomes larger. These cells are called Tzanka. Cells float freely in the contents of the bubble, and also line its bottom. This process occurs at pemphigus vulgaris, herpes simplex.
Tumors (blastomas)- pathological proliferation of tissues as a result of potentially limitless cell division. Blastomas are divided into benign (mature) and malignant (immature). They are classified according to their origin. in the following way: tumors from epithelial, connective, vascular, glandular, muscle and nervous tissues, as well as mixed tumors.
Benign tumors of the oral mucosa consist of differentiated cells similar in structure to the original tissue. There is tissue atypia. These tumors grow slowly, are clearly limited, never grow into surrounding tissues, and do not metastasize.
Malignant tumors are built from poorly and undifferentiated cells and bear little resemblance to maternal tissue. Not only tissue, but also cellular atypism is characteristic: a change in the shape of cells, enlargement of the nucleus, polymorphism, the appearance of giant cells. Malignant tumors grow rapidly, are prone to metastasis and recurrence. The criterion for malignancy is classical triad: atypia, polymorphism, invasive growth.
Elements of Defeat
Distinguish primary elements of damage and secondary developing from the primary ones.
TO primary include a spot, a nodule (papule), a node, a tubercle, a vesicle, a bubble, an abscess, a cyst, a blister, an abscess.
secondary elements are erosion, aphtha, ulcer, crack, scar, plaque, scale, crust.
Spot- discoloration of the mucous membrane in a limited area. Distinguish between inflammatory and non-inflammatory spots. Roseola- limited hyperemia up to 1.5 cm in diameter. Erythema- diffuse redness of the mucous membrane. Non-inflammatory spots include hemorrhagic spots: petechiae(pinpoint hemorrhages) and ecchymosis(extensive hemorrhage round shape). Age spots are formations resulting from the deposition of coloring substances of exogenous and endogenous origin (deposits of melanin, taking medications containing bismuth or lead).
Nodule (papule)- a cavityless formation of inflammatory origin up to 5 mm in size, protruding above the level of the mucous membrane and capturing the epithelium and the surface layer of the mucous membrane itself. Morphologically, small cell infiltration, hyperkeratosis and acanthosis are determined. Lichen planus is a typical example of the manifestation of papules on the oral mucosa. With the reverse development of the papule, no trace remains. Plaque- confluent papules.
Knot- dense, slightly painful rounded infiltrate, originating in the submucosa. Much larger than a knot. With actinomycosis, its suppuration with the formation of a fistula is possible. With syphilitic gum, the node may ulcerate. The node is formed as a result of the inflammatory process, tumor growth, etc.
tubercle- infiltrative, cavityless formation 5-7 mm, captures all layers of the oral mucosa and rises above its surface. Tubercles are formed with tuberculosis, tertiary syphilis, leprosy. They quickly disintegrate with the formation of ulcers. After they heal, a scar forms.
bubble- this is a cavity element up to 5 mm in diameter, resulting from a limited accumulation of fluid (exudate, blood). It is located in the spinous layer (intraepithelial), quickly opens, forming erosion. Bubbles occur with viral lesions.
Bubble- a formation that differs from a bubble in larger sizes (more than 5 mm), with serous or hemorrhagic exudate. It can be located intraepithelially (with acantholytic pemphigus as a result of acantholysis) and subepithelially (with erythema multiforme exudative, allergies, etc.).
abscess- abdominal formation with purulent exudate; found on the skin and red border of the lips.
Cyst- cavity formation, having a connective tissue capsule with an epithelial lining.
Blister- a cavityless formation up to 2 cm due to acute limited edema papillary layer. An example is angioedema.
Abscess- limited cavity formation filled with pus; occurs due to the decomposition of pathologically altered tissue or the fusion of pustules.
Erosion- violation of the integrity of the epithelium that occurs at the site of the papule, after opening the bubble, as a result of injury. Heals without a scar. Excoriation- erosion of traumatic origin.
Aphtha- a superficial defect of the epithelium of a rounded shape 3-5 mm, located on a hyperemic area of the mucous membrane, covered with a fibrous coating and surrounded by a bright red rim. Heals without a scar. An example is chronic recurrent aphthous stomatitis.
Ulcer- a defect that captures all layers of the mucous membrane. In the ulcer, the bottom and edges are distinguished. Healing occurs with the formation of a scar. Ulcers occur with trauma, tuberculosis, syphilis, with the decay of the tumor.
Crack- this is a linear defect resulting from the loss of tissue elasticity. Superficial cracks are localized within the epithelium, deep - penetrate into its own plate, heal without a scar.
Scar- replacement of the defect with connective tissue with high content fibrous structures. Hypertrophic (keloid) scars occur after injury, surgical interventions. Atrophic scars are formed after the healing of elements of tuberculosis, syphilis, lupus erythematosus. They are characterized irregular shape and great depth.
Plaque- a formation consisting of microorganisms, a fibrinous film or layers of torn epithelium.
Flake- a falling off thin plate of keratinized epithelial cells, resulting from pathological keratinization, in particular, with some cheilitis.
Crust- shriveled exudate at the site of the bubble, crack, erosion. The color of the crust depends on the nature of the exudate (serous, purulent, hemorrhagic).
The development of each SOTR disease is characterized by the appearance on its surface of peculiar elements of the lesion.
The rashes observed on the skin and SM consist of separate elements that can be combined into several groups: 1) changes in the color of the mucosa, 2) changes in the surface topography, 3) limited fluid accumulations, 4) layering on the surface, 5) SM defects. Damage elements are conditionally divided into primary (which arise on unchanged CO) and secondary (developing as a result of transformation or damage to already existing elements).
The formation of identical primary elements on CO is considered as monoform, and different - as a polymorphic rash. Knowledge of the elements of the rash makes it possible to correctly navigate the numerous diseases of the mucous membranes and lips. And the comparison clinical picture local changes with the state of the whole organism, with environmental factors that adversely affect both the affected area and the whole organism as a whole, allows you to correctly diagnose.
The primary elements of the rash include a spot, a nodule (papule), a node, a tubercle, a vesicle, a bladder, an abscess (pustule), a cyst. Secondary - scale, erosion, excoriation, aphtha, ulcer, crack, crust, scar, etc.
Primary elements of damage. Spot (macula) - a limited change in color of the SOPR. The color of the spot depends on the reasons for its formation. The spots never protrude above the CO level, that is, they do not change its relief. Distinguish between vascular dark spots and spots resulting from the deposition of dyes in CO.
Vascular spots can occur as a result of temporary vasodilation and inflammation. Inflammatory spots have different shades, more often red, less often bluish. When pressed, they disappear, and then, after the cessation of pressure, they reappear.
Erythema- unlimited, without clear contours, reddening of CO.
Roseola- a small rounded erythema, ranging in size from 1.5-2 to 10 mm in diameter with limited contours. Roseola are observed in infectious diseases (measles, scarlet fever, typhoid, syphilis).
Hemorrhages- stains that occur due to a violation of the integrity vascular wall. The color of such spots does not disappear when pressed on them and, depending on the decomposition of the blood pigment, it can be red, bluish-red, greenish, yellow, etc. These spots are of different sizes. Petechiae are pinpoint hemorrhages, large hemorrhages are called ecchymosis. A feature of hemorrhagic spots is that they dissolve and disappear without leaving a trace.
Telangiectasias- spots that occur due to persistent non-inflammatory vasodilation or neoplasms. They are formed by thin tortuous anastomosing vessels. With diascopy, the telangiectasias turn a little pale.
An inflammatory spot on the gum (a), its schematic representation (b).
1 - epithelium; 2 — own plate of a mucous membrane; 3 - dilated vessels.
A nodule (papule) on the buccal mucosa (a), its schematic representation (b).
1 - epithelium, 2 - own plate of the mucous membrane; 3 - elevation of the epithelium.
A node on the mucous membrane of the lip (a), its schematic representation (b).
1 - epithelium; 2 — own plate of a mucous membrane; 3 - proliferation of tissues.
Tubercle on the mucous membrane upper lip(a), its schematic representation (b).
1 - epithelium; 2 — own plate of a mucous membrane; 3 - infiltrate.
Age spots occur due to the deposition of dyes of exogenous and endogenous origin in the CO. They can be congenital and acquired. Congenital pigmentations are called nsvus. Acquired pigmentations are of endocrine origin or develop in infectious diseases.
Exogenous pigmentation occurs when substances that color it penetrate from the external environment into the CO. Such substances are industrial dust, smoke, medications and chemicals. Pigmentation upon penetration of heavy metals and their salts into the body has a clear outlined shape. The color of the spots depends on the type of metal. They are black from mercury, dark gray from lead and bismuth, bluish-black from tin compounds, gray from zinc, greenish from copper, black or slate from silver.
Bubble on the lower lip (a), its schematic representation (b).
1 - epithelium; 2 — own plate of a mucous membrane; 3 - intraepithelial cavity.
Bubble on the mucous membrane of the tongue (a), its schematic representation (6).
1 - epithelium; 2 — own plate of a mucous membrane; 3 - subepithelial cavity.
An abscess on the skin of the face (a), its schematic representation (b).
1 - epithelium; 2 — own plate of a mucous membrane; 3 - cavity filled with purulent exudate.
Cyst of the oral mucosa (a), its schematic representation (b).
1 - cavity; 2 - epithelial lining.
Inflammatory nodes formed due to nonspecific or specific infiltration (with leprosy, scrofuloderma, syphilis, tuberculosis) are characterized by a rapid increase. The reverse development of the nodes depends on the nature of the disease. They can dissolve, necrotic, melt with the formation of ulcers, and in the future - deep scars.
bubble- a cavity element ranging in size from a pinhead to a pea, filled with liquid. A vesicle is formed in the prickly layer of the epithelium, often has a serous, sometimes hemorrhagic content. Rashes of vesicles can be either unchanged or hyperemic and edematous. Due to the fact that the walls of the vesicle are formed by a racing layer of the epithelium, its cover quickly breaks, forming erosion, along the edges of which fragments of the vesicle remain. With the reverse development, the bubble leaves no trace. Often the bubbles are arranged in groups. Bubbles are formed due to vacuolar or ballooning dystrophy, as a rule, with various viral diseases.
Cyst- a cavity formation that has a wall and contents. Cysts are of epithelial origin and retention. The latter are formed due to blockage of the excretory ducts of small mucous or dune glands. Epithelial cysts have a connective tissue wall lined with epithelium. The contents of the cyst are serous, serous-purulent or bloody. Retention cysts are located on the lips, palate and buccal mucosa, filled with transparent contents, which become purulent when infected.
Erosion- a defect in the surface layer of the epithelium, therefore, after healing, it does not leave a trace. Erosion occurs from rupture of the bladder, vesicle, destruction of papules, traumatic injury. When the bubble bursts, erosion follows its contours. At the confluence of erosions, large erosive surfaces with various contours are formed. On CO, erosive surfaces can form without a previous blister, for example, erosive papules in syphilis, erosive and ulcerative form of red lichen planus and lupus erythematosus. The formation of such erosions is a consequence of injury to the easily vulnerable inflamed SO. A superficial mucosal defect that occurs when mechanical damage is called excoriation.
LESSON #3
1. TOPIC: “PATHOLOGICAL PROCESSES OCCURING IN THE RESISTANT. MORPHOLOGICAL ELEMENTS OF DEFEAT".
2. Purpose of the lesson: To study the pathological processes that occur in the oral mucosa in various diseases and the morphological elements for each pathology.3. Lesson plan: to distinguish between individual pathological processes occurring in the OM,
to distinguish between the primary elements of the lesion, to distinguish the secondary elements of the lesion,
to determine the various stages of development of the lesion element, to differentiate the elements of the lesion that are similar to each other, to distinguish the elements of the lesion.
THEORETICAL PART
Pathological processes are expressed in a change in color, integrity and relief of the oral mucosa. It is especially important to be able to distinguish between degenerative processes in the epithelium for the diagnosis of OCM disease.Spongiosis - accumulation of fluid between the cells of the spinous layer. The fluid, accumulating, can open the protoplasmic bridges of cells and, filling the cavities, form bubbles.
Ballooning degeneration - violation of the connection between the cells of the spinous layer, which leads to the free location of individual cells or their groups in the exudate, forming bubbles in the form of balls (baloons).
Acantholysis is a degenerative change in the cells of the spinous layer, which is 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 a violation of the phenomena of desquamation or increased production of keratinized cells.
Parakeratosis is a violation of the process of keratinization, which is expressed in incomplete keratinization of the surface 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 primary ones. 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 - false polymorphism.
PRIMARY MORPHOLOGICAL ELEMENTS:
A. I N F I L T R A T I V N Y E
A stain is a change in the color of the mucous membrane. Spots are small and large, spilled and limited, persistent and unstable. Characteristic of the spots is that they are not felt on palpation. There are vascular, pigmented (dyschromatic) spots resulting from the deposition of dyes in the mucous membrane. Vascular spots may occur as a result of temporary reflex expansion blood vessels and in inflammation. Inflammatory spots can have various shades of red, when pressed on them, they always disappear, and then reappear. Multiple small spots are called roseola large - erythema. Spots resulting from persistent non-inflammatory expansion of superficial vessels or their neoplasms are called telangiectasias. Spots on the skin and mucous membranes can occur 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 hemorrhages of small sizes are called purpura, large hemorrhages are called ecchymosis.
Pigmented (dyschromatic) spots occur as a result of accumulation, or reduction, and sometimes total 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 textures. The size of nodules from millet grain and 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 found on palpation in the form of a dense, painless, rounded infiltrate. As it develops, it increases, rises above the surface of the mucosa. Suppuration or ulceration of the node is possible.
A tubercle is an infiltrative, cavityless formation that captures all layers of the mucous membrane and rises above its surface, as a rule, the tubercles are crowded and quickly disintegrate. In their place, ulcerative surfaces are formed, covered with granulations and vegetations. Heal with scar formation.
B. E X S U D A T I V N Y E
bubble - a cavity element resulting from a limited accumulation of fluid. It is located in the spiny layer, has a bottom, and a thin tire, rises above the surface of the mucosa and is easily opened by mechanical action. Bubble sizes up to 2 mm.
A bubble is a cavity formation that differs from a bubble in larger sizes and the location of the fluid not only inside, but also subepithelially. With an intraepithelial bladder, the tire consists of cells of the spiny layer and opens very quickly. The cover of the subepithelial bladder is strong enough and lasts up to several days.
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 clear 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. They 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 epithelium yellow - gray color round or oval shape, measuring 0.2 - 0.5 cm or more. Surrounded by a bright red inflammatory rim. Heals without a scar.
Ulcer - tissue necrosis, capturing the entire layer of the mucous membrane, has a bottom and edges. Heals with scar formation.
Scar - replacement of differentiated tissues with connective tissue, occurs in place of some primary or secondary elements.
Scales - detached keratinized epithelium plates.
Crust - shriveled exudate from a vesicle, erosion, ulcer. The color depends on the nature of the exudate, usually located on the red border of the lips or near them.
A crack is a linear defect that occurs when the tissue loses elasticity, it is localized more often in the corners of the mouth and on the red border of the lips.
An abscess is a cavity filled with pus.
Atrophy - 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 an important additional factor in making a diagnosis.
New pedagogical technologies used in the practical lesson.
Conducting an interactive game "Spider Web".
Compilation of organizers on the topic “Pathomorphological processes that occur in the oral mucosa. Morphological elements of the lesion.
1. Compilation of the Cluster.
ANALYTICAL PART
Situational task number 1A 66-year-old patient complains of discomfort in the oral cavity after a metal filling was applied to /_6. An objective examination on the buccal mucosa shows a spot at the level /_6
1. Write the WHO tooth formula
Answer: /_26
2. Vascular spots on the oral mucosa are not called
A) empty*
B) pytechia
B) purpura
D) roseola
D) enanthema
3. The primary element of the defeat of the SOPR is
A) papule*
B) erosion
G) crack
4 The primary element of the defeat of the ER is
A) bubble*
B) erosion
G) crack
5 The primary element of the defeat of the ER is
A) blister*
B) erosion
G) crack
Situational task number 2
A 47-year-old patient complains of pain and burning sensation in the oral cavity that appeared 2 days ago d. From the anamnesis it was found out that over the past 2 years, the patient periodically every 5-6 months has aphthae on the tip of the tongue. Healing of aft occurs 10-12 days after the appearance. The patient suffers from chronic gastritis.
1. What is the primary element of the lesion that precedes the aphthae:
g. tubercle
d. blister
2. Histological examination of aphtha does not reveal:
A. vasodilatation
b. perivascular infiltration
v. edema of the spinous layer of the epithelium
g. deep fibrinous-necrotic inflammation
d. acantholytic Tzank cells*
3. What additional methods of examination should be carried out:
A. immunological *
b. cytological*
d. palpation
4. What is the main method of examination to be carried out:
A. palpation*
b. cytological
v. microbiological
g. immunological
d. patient questioning*
Situational task number 3
Patient V., aged 30, complained of very painful aphthae on her cheeks, lips and tongue, and pain when eating. From the anamnesis it turned out that such aphthae are formed in spring and autumn.
Objectively: on the mucous membranes of the cheeks in the area of the left lower 5th and 6th teeth, on the lateral surfaces of the tongue, on the mucosa lower lip there are single aphthae about 0.6-0.8, covered with a tightly seated fibrinous coating against the background of hyperemic mucosal mucosa, painful, soft on palpation.
1. When gastrointestinal pathology aphthae are formed:
A. covered with fibrous plaque.*
b. blood-colored meat
v. covered with necrotic deposits.
g. covered with curd
2. Afta is:
A. dense formation
b. defect in all layers of the epithelium
v. line defect
g. shriveled exudate
d. oval erosion covered with fibrinous plaque *
3. For general treatment as a means of non-specific sensitization use:
A. analgin
b. ciprolet
v. lidocaine
g. mepivocaine
d. histaglobulin*
Situational task number 4
A 34-year-old patient applied to the Tc department. Complaints: a neoplasm in the oral cavity, chronic relapses, general weakness, malaise.
From the anamnesis: the patient has been suffering for 4 years, constant allocation sputum, sometimes with blood, is registered in a tuberculosis dispensary.
Objectively: there are multiple scars on the oral mucosa, some of them have an element of inflammation in the form of a sphere (hemisphere), painless, pinhead size (diameter 1-3 mm), soft consistency, red or yellowish-red color, prone to peripheral growth and merging with neighboring elements, which leads to the formation of different sizes and shapes of plaques.
1. What primary element of the ORM in tuberculosis was described:
g. tubercle*
2. What is the secondary element of the oral mucosa in the patient
A. bubble
v. tubercle
g. plaque.
3. What layers of the mucosal mucosa are captured by the tubercle:
A. epithelium
b. the mucosal lamina proper.
v. submucosal layer
g. muscular
d. a, b, v *
PRACTICAL PART
Manual skill "Methods of examining a patient with diseases of the oral mucosa."Target: Teach student methods of examination of a patient with diseases of the oral mucosa.
Indications: diagnostics of diseases of oral mucosa.
Equipment: goggles, rubber gloves, mask, case patient (volunteer), oral examination instruments
Steps to take:
| № | Steps to take. | Step failed. | The step is complete. |
| 1. | Put on protective equipment | 0 | 20 |
| 2 | Conduct an external examination of the patient | 0 | 20 |
| 3. | Examine the vestibule of the oral cavity (with closed jaws) | 0 | 20 |
| 4. | Examine the actual oral cavity | 0 | 20 |
| 5. | Perform palpation of the salivary glands | 0 | 20 |
| Total: | 0 | 100 |
CONTROL QUESTIONS
1. Name the infiltrated morphological elements of the lesion2. 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 spot, characterize various spots
6. What is ballooning degeneration
7. What is acantholysis.
8 What is hyperkeratosis.
9. What is parakeratosis.
10. What is spongiosis.
Afta (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 the 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-like defect filled with fibrin and necrotic epitheliocytes. Erosion is formed during the opening of cavity primary elements (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 defect of the mucous membrane of a linear shape, a kind of ulcer.
Scar (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 over primary non-cavitary elements.
Crust (crusta) - dried (coagulated) exudate (serous, purulent, hemorrhagic), which lies in the surface layers of the epithelial layer and is rejected along with the damaged epithelium.
Plaque - superficial overlay 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 -
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pathological anatomy
GOU VPO Kemerovo State Medical Academy.. pathological anatomy.. Orofacial area of the head and neck..
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Caries (from gr. сaries - decay) is a widespread disease of teeth after their eruption, manifested by demineralization and softening of their hard tissues with the formation of a defect
Features of some types of dental caries
Circular caries. Caries of milk teeth in children, which develops in upper incisors starting at the neck of the tooth. It spreads circularly around the tooth and rapidly; no transparency
Non-carious lesions of the teeth
Non-carious lesions of the teeth include fluorosis, wedge-shaped defects, dental erosion, acid damage to enamel and dentin, erasure of hard tooth tissues, mechanical damage teeth and legacy
pulpitis
Pulpitis - inflammation in the pulp in response to damage caused by the action of various factors. Damaging factors can be: 1) pathogenic microbes; 2) chemicals
Periodontitis
Periodontitis is an inflammation of the periodontium, predominantly the periodontal ligament. They get sick more often in childhood and adolescence. In the etiology of periodontitis, infection occupies a leading position
Topic Glossary
Dens, dentis - a tooth, an organ of the oral cavity, an integral part of the digestive system. Corona dentis - the crown of the tooth - the part of the tooth covered with enamel.
Test self-control
Choose one or more correct answers. 001. Specify the pathogenesis of dental caries 1) wine fermentation leftover food, 2) lactic acid fermentation of food residues, 3)
Some information about the structure of the gums and periodontium
Anatomical features periodontal structures are great importance in understanding the development and clinical and morphological manifestations of periodontopathies. The periodontium is a complex of tissues
Gingivitis
Gingivitis is a nosological unit, which is based on inflammation of the gums without disturbing the dentogingival connection. Gingivitis can be caused by infection, chemical and
Periodontitis
Periodontitis is an inflammation of the periodontium, accompanied by destruction of the periodontium, bone tissue of the interdental septa and the formation of a periodontal pocket. Periodontitis is more common
Desmodontosis
Desmodontosis or idiopathic periodontal lysis is a dystrophic destruction of periodontal tissues, with predominant damage to the desmodont (ligamentous apparatus of the tooth). Etiology unknown
Periodontoma
The histogenesis of periodontoma has not been elucidated. All tumors and tumor-like growths of periodontal tissues are considered periodontoma. There are periodontoma in the form of epulis (supragingival) and fibromatosis de
Topic Glossary
Parodontopathia - periodontal disease, diseases and pathological processes of the periodontium. Gingivitis (gingiva - gum) acuta, seu chronica -
Test self-control
Choose one or more correct answers. 001. Gingivitis is ... 1) inflammation of the gums without disturbing the dentogingival connection,
Some data of the anatomical and histological structure of the jaws
Bones of the lower and upper jaw form part of the skeletal system maxillofacial region. Lower jaw the only moving bone facial skeleton and with temporal bone forms a joint. Upper
Pathology of the jaws of an inflammatory nature
Osteitis is inflammation of the jaw bone outside the periodontium of the tooth. Infection of the jaw bone occurs when the infection penetrates from root canal along the neurovascular
Odontogenic tumors of the jaws
Odontogenic tumors are rare, grow inside the jaws, leading to their deformation and destruction. According to histogenesis, tumors are distinguished from the odontogenic epithelium, mesenchymal from TC
Odontoma
Odontomas are peculiar tumor-like growths of hard tissues of teeth resulting from irregularities in the process of tooth formation. Distinguish between complex and mixed
Non-odontogenic tumors and tumor-like formations of the jaws
Cemento-ossifying fibroma is a tumor of childhood and young age. It has a capsule and consists of fibrous tissue, including osteoid beams and cementicle-like structures,
Jaw cysts
In the pathology of the jaws, significant specific gravity occupy non-tumor cystic lesions, which are referred to as non-epithelial and epithelial cysts. Non-epithelial cysts
Topic Glossary
Os, ossis (lat); osteon (gr.) – bone. Osteitis acuta, seu chronica - acute or chronic osteitis, acute or chronic inflammation of the bone.
Test self-control
Choose one or more correct answers 001. Osteitis of the jaws is ... 1) dystrophy, 2) dysplasia, 3) inflammation outside the periodontium, 4) inflamed
Major salivary glands
Parotid salivary gland (glandula parotis) - alveolar-tubular structure, protein (serous) type. It has a well-defined connective tissue capsule; characteristic of this gland
Sialadenitis
Sialadenitis is an inflammation salivary glands. With any inflammation that occurs in response to damage, the vascular-stromal organization of the organ or tissue always reacts.
Salivary stone disease
Sialolithiasis is a disease of the salivary glands, which is based on stone formation in the ducts and acini. According to various literary sources illuminating this pathology, salivary stones
Eponymous syndromes of pathology of the salivary glands
Sjogren's syndrome (disease) (dry syndrome, xerodermatosis, Guzhero-Sjogren's syndrome, Predtechensky-Gugerot-Sjogren's syndrome) - the main manifestations: xerostomia, keratoconjunctivitis, p
Tumors of the salivary glands
Tumors of the salivary glands account for only about 2% of all tumors in humans. In accordance with the WHO nomenclature, tumors of the salivary glands are divided into three groups: epithelial, non-epithelial
Salivary gland cysts
Salivary gland cysts are classified as pseudotumor conditions. Separate cysts of small salivary glands (about 56% of all cysts) and large salivary glands. By origin, cysts can be congenital
Test self-control
Choose one or more correct answers 001. Indicate primary sialadenitis 1) tuberculous parotitis, 2) dacryoadenitis, 3) parotitis,
4
Oral mucosa
The mucous membrane of the mouth and tongue is lined with stratified squamous epithelium. mucous membrane alveolar processes, palatine eminence and the anterior third of the hard palate is dense, motionless. He
Morphological signs of the reaction of the epithelium of the oral mucosa to inflammation
Morphological features reactions of the epithelium of the oral mucosa are represented by acatosis, papillomatosis, hyperkeratosis, parakeratosis, dyskeratosis, acantholysis, leukoplakia, vacuolar
Primary morphological elements of lesions of the oral mucosa
Spot (macula) - focal hyperemia inflammatory origin; limited spot (up to 10 mm in diameter) - roseola (rozeola), diffuse hyperemia - erythema (erythaema).
Stomatitis
Diseases of the entire oral mucosa morphological manifestations which inflammation lies, is called stomatitis. In cases of local manifestation of inflammation on the gums, it is called
Viral stomatitis
Spicy herpetic stomatitis- Primary herpetic infection of the oral mucosa. The causative agent is a virus herpes simplex(herpes simplex). Occurs in adults and children
Chronic stomatitis
Chronic recurrent aphthous stomatitis. Has long course with repeated aphthous eruptions. Aphthous rashes are single foci
Mycotic infections
Candidiasis. Caused by pathogenic yeast fungi of the genus Candida. Morphologically, it is manifested by hyperemia of the oral mucosa with the formation of white loose plaques, which can
Changes in the oral cavity in case of poisoning with salts of heavy metals
Heavy metals are potent toxic substances. Enter the body through the respiratory system and gastrointestinal tract in the form of vapors, aerosols, fine dust particles
Changes in the oral cavity with allergies
Behcet's disease. The Turkish doctor Behcet described a disease with a chronic relapsing course, the leading signs of which he singled out recurrent aphthae of the mucous membranes of the oral cavity and
Cheilitis
Cheilitis is an inflammation of the red border, mucous membrane and skin of the lips. It occurs as an independent disease and as a manifestation of other diseases (lichen simplex, lichen planus,
Glossitis
Glossitis is an inflammation of the tongue. It is rare as an independent disease, it usually accompanies other diseases or is a sign of some disease. G
Language changes that are not inflammatory
The black (hairy) tongue (lingua villosa nigra) is represented by hyperkeratosis of the filiform papillae, which, as a result, take the form of a bristle. Altered papillae change over time
Precancerous conditions of the oral mucosa
Precancerous conditions and processes have a different nature (dystrophic, inflammatory) and are conditionally divided into obligate and facultative precancers. Obligate precancer (mandatory
Oral tumors
Tumors and tumor-like formations of the oral cavity differ little from those of any other localization, with the exception of organ-specific tumors of the salivary glands and granular cell myoblastoma
Tumors of the tongue
Rakyazyka almost always occurs superficially, often on the basis of leukoplakia, traumatic ulcer or syphilitic fissure. It develops predominantly in men over 50 years of age. Have
Tumor-like formations and cysts of the oral cavity
Conditions or processes in the mucous membrane and in the soft tissues of the oral cavity, clinically and morphologically manifested as voluminous, are usually considered as tumor-like formations. They include
Topic Glossary
Stomatitis acuta, seu chronica - acute or chronic stomatitis, diffuse inflammation of the oral mucosa. Stomatitis gangraenosa (noma) - gan
Test self-control
Choose one or more correct answers 001. Primary elements of damage to the oral mucosa. 1) macula, 2) papula, nodus, 3
Pathology of the head and neck
Motivational characteristics of the topic. Knowledge of the morphological manifestations of diseases and pathological processes of the soft tissues of the face and neck is necessary for the successful and high-quality assimilation of e
Some data of anatomical and histological properties of the skin
Leather is considered very complex organ which interacts with the body external environment. The skin is made up of the epidermis and the dermis (skin proper). epidermis
Defects of the face and neck
birth defects faces often have the appearance of clefts, which are considered as the result of a violation of the fusion of embryonic tissues. Of all facial clefts, the most common
Inflammatory lesions of the soft tissues of the face and neck
Inflammatory lesions of the soft tissues of the face and neck are conditionally divided into non-odontogenic and odontogenic, taking into account the sources of infection. To non-odontogenic inflammatory lesions soft tissues of the face and sh
Tumors and tumor-like formations of the skin of the face
The most common epidermal skin tumor of the face is basal cell carcinoma(basalioma). It occurs in both sexes in the elderly and old age. Tumor
Soft tissue tumors of the face and neck
Tumors from the soft tissues of the face and neck develop from connective, adipose tissues, muscles, blood and lymphatic vessels and nerves. In structure, they do not differ from tumors of the same name of another l.
Non-tumor and neoplastic lesions of the lymph nodes of the neck
The organs of the neck are supplied with two groups of lymph nodes: a) superficial, located on the outer fascia along the jugular veins; b) deep, lying next to the organs of the neck. Lymph nodes in the neck
Primary tumors of the lymph nodes of the neck
Lymphogranulomatosis (Hodgkin's disease) is a malignant lymphoma with an initial lesion of the superficial lymph nodes of the neck, more often right side. Mostly children and young people are ill.
Tumors and tumor-like formations from melanin-forming tissues
Nevi - tumor-like formations of the skin of the face, as well as other localizations, can be congenital or occur after birth. Nevi develop from epidermal melanocytes
Test self-control
Choose one correct answer. 001. Frequent birth defect face 1) oblique cleft face, 2) direct cleft face, 3) cleft lip,
Rules for sending material for biopsy research
1. Biopsies and surgical material are delivered to the pathoanatomical department immediately after they are taken. 2. If it is impossible to deliver the material on time, it should be placed in fixed
Clinical and anatomical analysis of the results of the study of surgical biopsy material
The pathologist, the examining material gives its macroscopic and microscopic characteristics, using, if necessary, various research methods. For a correct assessment of the result
Solving problems on the clinical and anatomical analysis of a biopsy study
Solve sequentially the proposed tasks, and check your answers with the standards. Task No. 1 (V.V. Serov et al., 1987, p. 270) A 22-year-old patient was admitted to the hospital
Test self-control
Choose one correct answer. 001. Biopsy is the taking of material for intravital histological examination for the purpose of ... 1) treatment, 2) diagnosis,
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 of skin rashes or morphological elements.
There are primary and secondary morphological elements.
Primary- these are skin changes that are a direct, first consequence of exposure to a pathogenic agent.
Secondary- appear after the primary 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 level of the skin, of various shapes with changes in the color of the skin or mucosa. The spots are divided into:
a) vascular - found in syphilis, measles, typhoid, liver diseases, vasculitis.
b) hemorrhagic spots are formed due to the release of blood into the tissues.
c) age spots occur due to an increase or decrease in the content of melanin (leukoderma).
2) Blister (irtica) - is a cavityless formation that rises above the surface of the skin, resulting from a limited acute inflammatory edema of the papillary dermis. This is an element of urticaria.
3) bubble (vesicle) - a cavity formation, slightly elevated above the level of the skin, filled with transparent serous, less often bloody contents. Occurs as a result of inflammation of the epidermis.
4) Bubble (bulla) is a cavity formation above the level of the skin, ranging in size from a pea to a palm, filled with cloudy serous or hemorrhagic contents, where it microscopically finds epithelial cells, ₤ are a manifestation of pemphigus, Dnoring dermatitis.
5) abscess (pustula) - a cavity formation filled with purulent contents, in which a lot of ₤, albumins, globulins are found. An abscess located around the hair follicle is called folliculitis . located around sebaceous glands ulcers are called blackheads with pyoderma.
6) knot (papula) - a cavityless formation that rises above the surface of the skin. This is a manifestation of many skin and veins. diseases.
7) Knot (nodus) - a cavityless infiltrated formation, located deep in the dermis or in the 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 at its level and is sharply delimited. The tubercle heals with a scar. Tubercles are typical for leprosy, leishmaniasis, tuberculosis, tertiary syphilis.
Secondary morphological elements: pigmentation and depigmentation, scale, crust, erosion, crack, abrasion, ulcer, cicatricial atrophy, vegetation.
1) Pigmentation and depigmentation . Hyperpigmented spots occur in places of the greatest deposition of melanin and imosiderin, occur in places of primary or secondary elements. Hypopigmentary spots are located in the places of resolution of spotty-scaly elements and papules.
2) Flake (squama) are loosened horny plates that have lost contact with each other, ready to be torn off or already torn off from the surface of the skin. The division of scales is called peeling .
3) Crust (crusta) - occurs due to the drying of the contents of the vesicles, blisters, abscesses and detachable erosions and ulcers.
4) Erosion (erosion) - a superficial skin defect that occurs most often at the site of a rupture: covering the primary cavity morphological element, repeating its shape and size. After healing of erosion, the scar does not remain.
5) cracks (rhagudes) - are linear damage to the skin in the form of a rupture resulting from a loss of skin elasticity during an inflammatory process or when it is overstretched. Cracks usually appear where the skin is bent. 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, scratching. Abrasions are superficial and deep. prone to infection.
7) Ulcer (ulous) is a deep defect in the skin, subcutaneous tissue, muscles, fascia of bones. Occurs as a result of the breakdown of tissue of nerve elements. Heal by scar formation.
8) Scar (cicatrix) - is a newly formed fibrous connective tissue that replaces the lost property of the skin.
9) cicatricial atrophy - a regressive process resulting from the depletion of all layers of the skin. It develops without prior ulceration by converting the infiltrate into connective tissue.
10) Lichenification - a focus of enhanced skin pattern, accompanied by its thickening and compaction, hyperpigmentation, dryness.
11) vegetation - papillary thickening of the skin, resulting from the growth of the thorn-like layer of the epidermis and papillomatosis of the dermis with a long-term, inflammatory process. Most often formed in the area of papules and ulcers.
