Micropreparation nutmeg liver description. disorders of chromoprotein metabolism
MICRO PREPARATIONS. To study, draw and designate the listed morphological features.
1. Acute venous plethora (edema) of the lungs A) dilated, full-blooded blood vessels of the interalveolar septa, b) in the lumen of the alveoli, eosinophilic content (protein transudate) with an admixture of macrophages and desquamated epithelium.
2. Hemorrhage in the brain. Stained with hematoxylin and eosin. A) accumulation of hemolyzed and preserved erythrocytes in the brain tissue, b) there is no brain substance in the center of the hemorrhage (stratification of brain tissue with blood), V) pericellular and perivascular edema.
3. Brown induration of the lungs. Perls reaction. In the lung tissue on the background A) plethora and edema, b) deposits of hemosiderin, which gives a positive reaction to iron and its grains turn bluish-green, there are growths of connective tissue in the alveolar septa, around the bronchi and blood vessels.
4. Chronic venous plethora of the liver (“nutmeg liver”). Stained with hematoxylin and eosin. In the center of the lobules are found A) expansion and plethora of veins and sinusoids, discomplexation of hepatic beams, b) necrosis and atrophy of hepatocytes. On the periphery of the lobules, the blood filling of the sinusoids is normal, the structure of the hepatic beams is preserved, the hepatocytes are in a state of V) fatty degeneration.
MACRO PREPARATIONS.
1. Acute plethora of meninges in influenza. In the preparation of the brain. The pia maters are edematous, gelatinous with dilated full-blooded blood vessels, the convolutions are smoothed.
Causes: flu.
Complications: cerebral edema on the background of serous meningitis. Outcomes: usually full recovery.
2. Nutmeg liver. In the preparation, the liver is enlarged in size, dense in consistency, with a smooth surface and a rounded front edge. The cut surface of the organ is variegated, gray-yellow (fatty degeneration of hepatocytes along the periphery of the lobules) with dark red specks (central stagnant parts of the lobules) and resembles nutmeg.
Causes: chronic heart failure with the development of venous stasis in the systemic circulation: cardiosclerosis of various origins, malformation of the tricuspid valve. Hypertension in the pulmonary circulation, chronic lung diseases resulting in pneumosclerosis.
Complications And outcomes: transition to congestive fibrosis (cirrhosis) of the liver, development of portal hypertension syndrome, ascites, splenomegaly, varicose expansion of porto-caval anastomoses, bleeding, anemia.
3. Brown induration of the lungs. The drug is light, enlarged, brown ("rusty") color, dense consistency. Layers of white dense tissue (pneumosclerosis) are visible around the bronchi, vessels and diffusely in the lung tissue. Changes are more pronounced in the lower and posterior sections of the lung.
Causes: chronic heart failure.
Complications And outcomes: respiratory failure exacerbates chronic heart failure - pulmonary heart failure progresses.
MACRO PREPARATION №1 FATTY LIVER
In the preparation, sections of the liver are visible.
The liver is small, as it is the liver of a child. But still, the size of the liver is increased, since its capsule is tense, and the corners are rounded.
The color of the liver on the cut is yellow.
The consistency of the liver is flabby.
When cutting such a liver with a knife, droplets of fat remain on its blade.
This is parenchymal fatty degeneration of the liver, or goose liver.
It can develop in people suffering from chronic cardiovascular diseases, chronic lung diseases, diseases of the blood system, and chronic alcoholism.
In the outcome of parenchymal fatty degeneration, portal, small-nodular cirrhosis of the liver may develop over time.
MACRO PREPARATION №2 BLEEDING IN THE BRAIN
The preparation shows a horizontal section of brain tissue. The cerebellum is visible below and behind the brain.
In the right hemisphere of the brain in the region of the subcortical nuclei there is a center of dark brown color due to the fact that we see clotted blood in the focus of hemorrhage. This is a focus of hemorrhage into dead brain tissue, with fairly clear boundaries - a hematoma. In the center of the hematoma, under anaerobic conditions, the hematoidin pigment is formed, and along the periphery, at the border with healthy tissues, hemosiderin is formed. Blood from the focus of hemorrhage broke into the anterior horn of the right lateral ventricle, into the third ventricle of the diencephalon, the Sylvius aqueduct of the mesencephalon, and into the fourth ventricle of the rhomboid brain.
Hematoma is one of the varieties of hemorrhagic stroke.
Clinically accompanied by the development of focal symptoms on the opposite side of the body - left-sided paresthesia, hemiplegia, hemiparesis, paralysis.
If the patient had not died, then at the site of the hemorrhage a cyst would have formed with walls rusty from hemosiderin.
MACRO PREPARATION №3 CEPHALOHEMATOMA
The preparation shows the integumentary bone of the skull of a newborn. On the upper - the lateral surface of the bone, under its periosteum there is clotted dark brown, almost black blood - this is a subperiosteal hemorrhage. This is a birth injury of the skull, related to the external cephalohematoma.
MACRO PREPARATION №4"TAMPONAD" OF THE HEART
The preparation shows a longitudinal section of the heart from the side of the left ventricle, since the thickness of the ventricular myocardium is more than 1 cm. It is noteworthy that the cavity of the left ventricle is slit-like, that is, the heart is somehow compressed from the outside. The subepicardial layer of fat, epicardium, pericardium is determined. Gray-brown blood clots are visible in the pericardial cavity. It is due to their presence in the pericardial cavity that the heart turned out to be compressed from all sides, and the cavity of the left ventricle became slit-like. This is bleeding into the pericardial cavity - hemopericardium, an example of internal bleeding, figuratively - "tamponade" of the heart. It is also noteworthy that in the region of the posterior - lower wall of the heart, the myocardial tissue is stained with hemosiderin in brown color, due to a rupture of the heart wall in this place and hemorrhage from the damaged vessel. Rupture of the heart wall occurred due to myomalacia in the area of transmural myocardial infarction.
Thus, hemorrhage in the heart shirt was the result of myomalacia and rupture of the heart wall in the area of transmural myocardial infarction.
MACRO PREPARATION №5 PURULENT MENINGITIS
In the preparation, the brain is visible from the side of its upper - lateral surfaces. Under the pia mater, an accumulation of exudate of a white-yellow color, the consistency of thick sour cream, is determined. This is a purulent exudate. The exudate lies on the surface of the convolutions, enters the furrows, smoothing the relief of the surface of the brain.
Inflammation of the meninges is meningitis.
Primarily purulent meningitis can occur with meningococcal infection, and secondarily it can complicate infectious diseases with generalized infection (with sepsis).
MACRO PRODUCTS №6 A BRAIN TUMOR
The preparation shows a horizontal section of the brain. In one of the hemispheres (in the left), in the white matter, there is a focus of pathological growth of brain tissue with fuzzy contours, fuzzy growth boundaries. The consistency of the node of pathological growth of the brain tissue approaches the consistency of the brain itself. The color is variegated, as there are hemorrhages and necrosis in the focus. It's a brain tumor. Since the boundaries of tumor growth are fuzzy, a malignant tumor occurs. It can be assumed that this is glioblastoma, the most common malignant tumor in adults.
MACRO PREPARATION №7 Sarcoma of the Tibia
The preparation shows the bones that form the knee joint. In the region of the upper part of the diaphysis of the tibia, there is a pathological growth of tissue that destroys the posterior surface of the bone, which has fuzzy growth boundaries. This is a tumor. It is white, layered, reminiscent of fish meat. The vagueness of the boundaries of growth indicates the malignant nature of the tumor. A malignant tumor of bone tissue - osteosarcoma. Since the process of bone destruction prevails over the process of bone formation, this is osteolytic osteosarcoma.
MACRO PREPARATION №8 ABSCESSES OF THE BRAIN IN SEPTICOPIEMIA
The preparation presents sections of the brain. In each section, there are multiple foci of irregular round shape, clearly delimited from the brain tissue by a thick wall. Filled with contents of white-yellowish or white-greenish color, the consistency of thick sour cream. This is a purulent exudate.
Focal accumulations of pus, delimited from the brain tissue by a wall, are abscesses.
The wall of an acute abscess consists of two layers: 1) the inner layer - the pyogenic membrane and 2) the outer layer - nonspecific granulation tissue.
Three layers are distinguished in the wall of a chronic abscess: 1) inner - pyogenic membrane, 2) middle - nonspecific granulation tissue and 3) outer - coarse fibrous connective tissue.
Abscesses of the brain develop with generalization of purulent inflammation in the lungs, intestines and other organs, that is, with sepsis, septicopyemia.
MACRO PREPARATION №9 STENOSIS OF THE MITRAL HOLE (RHEUMATIC HEART DEFECT)
The preparation shows a transverse section of the heart, made above the level of the atrio-ventricular openings, so that the leaflets of the bicuspid, mitral and tricuspid valves are clearly visible.
The leaflets of the mitral valve are deformed. They are sharply thickened, with a bumpy surface, opaque, rigid due to the growth of connective tissue in them. There is a gap between the closed valve leaflets, that is, mitral valve insufficiency has developed.
In addition, there is a narrowing of the left atrio-ventricular opening.
Thus, in the area of the mitral valve there is a combined heart disease - insufficiency and stenosis of the mitral valve.
Such acquired heart defects are most often formed during rheumatic valve endocarditis.
The described changes in the mitral valve correspond to the stage of fibroplastic endocarditis.
It can be assumed that the patient died of progressive chronic cardio - vascular insufficiency caused by decompensated rheumatic heart disease.
MACRO PREPARATION №10 CHORIONEPITHELIoma OF THE UTERINE
The preparation has a longitudinal section of the uterus with appendages.
The size of the uterus is increased (normally, the height of the poppy is 6-8 cm, the width is 3-4 cm and the thickness is 2-3 cm). In the uterine cavity, the growth of tumor tissue is visualized, which grows into the myometrium, that is, invasive tumor growth takes place.
The consistency of the tumor is soft, porous, since the tumor does not contain connective tissue at all.
The color of the tumor tissue in the preparation is gray with dark brown patches. In a fresh preparation, it is dark red, variegated, since the tumor has cavities, gaps filled with blood.
Based on the nature of growth, the tumor is malignant. It develops from the epithelium of the chorionic villi (placenta). This is chorionepithelioma.
It is an organ-specific tumor. It is built from two types of cells - large mononuclear cells with a light cytoplasm, or Langhans cells, derivatives of cytotrophoblast, and large ugly multinuclear cells, derivatives of synticiotrophoblast. The tumor is hormonally active. Tumor cells secrete the hormone gonadotropin found in the woman's urine; due to the hormone, the uterus is enlarged in size.
The tumor developed in connection with pregnancy. This is a differentiated tumor.
It metastasizes predominantly hematogenously to the liver, lungs, and vagina.
In this preparation, in the area of the vaginal portion of the cervix and in the wall of the vagina, rounded foci are visible in appearance similar to the primary tumor. These are tumor metastases.
MACRO PREPARATION №11 CHRONIC GASTRIC ULCER WITH PENETRATION INTO THE PANCREAS
The preparation shows a fragment of the stomach wall from the mucosal side and the pancreas located behind the stomach.
In the wall of the stomach there is an ulcerative defect with raised dense, callused, callous edges and a sloping bottom. One edge of the defect, facing the esophagus, proximal - undermined, with an overhanging mucous membrane. The other edge, opposite, distal, is gently sloping or terraced. The difference between the edges is due to the presence of a peristaltic wave.
A defect in the wall of the stomach is a chronic ulcer, since there was an overgrowth of connective tissue in its edges, which caused a change in the edges of the defect.
In the bottom of the ulcer, it is not the tissue of the stomach wall that is determined, but the lobed, white tissue of the pancreas.
Thus, there is an ulcerative-destructive complication of chronic gastric ulcer - penetration into the pancreas.
It can be assumed that the patient died from diffuse pritonitis.
MACRO PREPARATION №12 NUTLE LIVER
The preparation shows a frontal section of the liver.
The size of the liver is enlarged.
The color of the liver tissue on the cut is variegated: areas of gray-black color (these are areas with gore) are interspersed with areas of gray-brown color (the color of hepatocytes).
Areas of gray - black color, and in a fresh preparation - red, due to plethora and expansion of the central veins and the central 2/3 sinusoids of the liver lobules flowing into them.
In view of the similarity of the appearance of the surface of the cut of the liver to the surface of the cross section of nutmeg, the drug got its name.
It occurs with the development of chronic venous plethora in the body, which occurs in conditions of chronic cardiovascular insufficiency, which is a complication of chronic diseases of the heart, such as mitral valve disease, myocarditis with an outcome in cardiosclerosis, chronic coronary heart disease.
MACRO PREPARATION №13 PROSTATE ADENOMA WITH URETEROHYDRONEPHROSIS
The preparation presents an organocomplex consisting of a longitudinal section of the kidney with the ureter, longitudinal sections of the bladder and prostate gland.
Changes in the structure of the prostate gland led to compensatory - adaptive changes in the structure of the overlying organs.
The prostate gland is enlarged in size, due to the growth in one of its lobes of the tumor node, rounded in shape, with clear boundaries of growth, delimited from the prostate tissue by a connective tissue capsule. This is a benign tumor - prostate adenoma.
Due to the presence of an adenoma, the prostatic part of the urethra narrowed sharply, which led to a violation of the outflow of urine.
Working hypertrophy developed in the bladder wall. Along with wall hypertrophy, the bladder cavity expanded, that is, eccentric decompensated bladder hypertrophy developed.
The ureter, pelvis and calices of the kidney expanded due to a violation of the outflow of urine - hydroureteronephrosis.
In the parenchyma of the kidney, a kind of local pathological atrophy developed - pressure atrophy.
MACRO PREPARATION №14 CENTRAL LUNG CANCER
The preparation shows the trachea with cartilaginous half-rings located on its front surface, the main bronchi, a part of the left lung adjacent to the left main bronchus.
The lumen of the left main bronchus is sharply narrowed due to the fact that around the bronchus in the lung tissue there is a pathological proliferation of gray-beige tissue, of a dense consistency, in the form of a node with fuzzy growth boundaries. This is a malignant tumor growing from the epithelium of the main bronchus - lung cancer. Outside the main node of the tumor there are multiple foci of irregular round shape - cancer metastases to the lungs.
Since cancer grows from the main bronchus, it is central in localization.
Since tumor growth is represented by a node, the macroscopic form of cancer is nodular.
Most often, central lung cancer in its histological form is squamous, the development of which is preceded by metaplasia of the glandular epithelium of the bronchi into a stratified squamous non-keratinizing epithelium during chronic bronchitis.
In relation to the surrounding tissues, cancer grows infiltratively.
In relation to the lumen of the main bronchus - into its wall, that is, endophytic, compressing the lumen of the bronchus.
Due to a violation of the patency of the bronchus due to compression of its tumor in the lung tissue adjacent to the bronchus, complications such as atelectasis, abscess, pneumonia, bronchiectasis can develop.
Lung cancer is an epithelial organ-specific tumor.
Metastasizes predominantly by the lymphogenous route. The first lymphogenous metastases are found in regional lymph nodes - peribronchial, paratracheal, bifurcation.
MACRO PREPARATION №15 POLYPOSIS-ULCER ENDOCARDITIS OF THE AORTIC VALVE
We see the preparation of the heart in a longitudinal section from the side of the left ventricle, since its myocardium has a thickness of more than 1 cm. The cavity of the left ventricle is expanded. There is eccentric decompensated working hypertrophy of the myocardium of the left ventricle of the heart and tonogenic dilation.
The crescents of the aortic valve are changed, they are thickened, tuberous, rigid, opaque. On two of the three crescents, an ulcerative defect is clearly visible, on the surface of which thrombotic deposits in the form of polyps have formed. Such changes in the crescents of the aortic valve are called polyposis-ulcerative endocarditis, which is one of the clinical and morphological forms of sepsis.
Microscopically, in the thickness of these thrombotic overlays, colonies of microbes and deposits of lime salts can be detected.
Thrombobacterial embolism and the formation of aortic heart disease can become complications of this process.
Since polyposis-ulcerative endocarditis has developed on the already altered crescents of the aortic valve, this is secondary endocarditis.
MACRO PREPARATION №16 STOMACH CANCER (SAUCTOR-SHAPED)
The preparation shows a fragment of the stomach from the mucosal side. The stomach is cut along the greater curvature.
In the region of the lesser curvature of the body of the stomach, there is a pathological growth of the tumor tissue into the lumen of the stomach with loose raised edges and a flat bottom. The boundaries of tumor growth are indistinct in places. At the bottom of the tumor growth there are foci of white necrosis.
Fuzzy boundaries of tumor growth and the presence of secondary changes in it in the form of foci of necrosis indicate the malignancy of the tumor.
A malignant tumor growing from the epithelium of the stomach is gastric cancer.
According to localization, this is a cancer of the body of the stomach.
By the nature of growth, it is an ecophyte-expansive cancer.
Macroscopically, it is a saucer-shaped cancer.
Microscopically, it will most often be represented by a differentiated form of cancer - adenocarcinoma.
Since gastric cancer, according to the international classification of tumors, belongs to the group of epithelial organ-specific tumors, the predominant route of its metastasis will be lymphogenous. The first lymphogenous metastases may appear in regional lymph nodes - four collectors of lymph nodes located along the lesser and greater curvatures of the stomach.
Since the stomach is an unpaired organ of the abdominal cavity, the first hematogenous metastases are found in the liver.
MACRO PREPARATION №17 ABSCEDING PNEUMONIA IN SEPTICOPIEMIA
We see a cross section of the right lung, since it contains three lobes.
In each lobe, against the background of an airy tissue of a light beige color, there are multiple foci of round and irregular shape, the size of a match head, in places merging with each other, of a dense consistency, airless or low-air, with a smooth cut surface, white-gray. These are foci of inflammation in the lung tissue - foci of pneumonia.
A white wall forms around some foci, and the contents of the foci become the consistency of thick sour cream. A complication of pneumonia develops - abscess formation.
Abscessing pneumonia can develop with septicopyemia, one of the clinical and morphological forms of sepsis.
MACRO PREPARATION №18 croupous pneumonia (with abscess formation)
The preparation shows a longitudinal section of the right lung, as three lobes are visible.
The lower lobe is entirely gray, airless. Its cut surface is fine-grained.
The consistency of the lobe of the lung corresponds to the hepatic density.
The interlobar pleura is thickened with gray-beige membranous overlays.
This is croupous pneumonia, the stage of hepatization, a variant of gray hepatization.
In the lower segments of the lobe, cavities are defined, delimited from the lung tissue by a wall. These are abscess cavities.
There is one of the pulmonary complications of pneumonia - abscess formation. The reason for it is the addition of a secondary purulent infection due to a decrease in immunity and increased fibrinolytic activity of neutrophilic leukocytes.
MACRO PREPARATION №19 SMALL-NODULATE LIVER CIRRHOSIS
The preparation shows a section of the liver.
The liver is reduced in size, as its corners are pointed, and the capsule is wrinkled.
On the outer surface of the liver, multiple nodes of regenerates, up to 1 cm in size, are determined, making the surface of the liver uneven.
On the surface of the cut, the boundaries of the false lobules are clearly visible (whereas the boundaries of the hepatic lobules are not visualized normally) due to the growth of fibrous tissue in the region of the portal tracts.
This is cirrhosis of the liver.
In macroscopic appearance, it is small-nodular. Microscopically, it is monolobular, since the size of the false lobules corresponds to the size of the nodes - regenerates.
According to pathogenesis, this is portal cirrhosis of the liver, in which portal hypertension develops primarily, and secondarily - hepatic cell failure.
Such cirrhosis can develop as a result of fatty hepatosis, chronic form of viral hepatitis B and chronic course of alcoholic hepatitis.
MACRO PREPARATION №20 UTERINE BODY CANCER
A longitudinal section of the uterus is shown.
The uterus is enlarged. It can be seen that in the uterine cavity there is a pathological proliferation of tissue with a non-smooth, papillary surface, in places with ulcerations, with fuzzy growth boundaries. This is a tumor growth.
The tumor develops from the endometrium, it can be seen that it grows into the wall of the uterus. This is a malignant tumor of the epithelium - cancer of the body of the uterus.
Histologically, it is represented by a differentiated form of cancer - adenocarcinoma.
The nature of the growth of the tumor in relation to the lumen of the uterus is exophytic, in relation to the surrounding tissues - infiltrating.
May develop as a result of atypical glandular hyperplasia of the endometrium.
It is an epithelial organ-specific tumor. It metastasizes predominantly by the lymphogenous route. The first lymphogenous metastases are found in regional lymph nodes.
MACRO PREPARATION №21 PURULENT - FIBRINOUS ENDOMYOMETRITIS
A longitudinal section of the uterus with appendages is seen.
The uterus is sharply increased in size, its cavity is sharply expanded, the wall is thickened.
The endometrium is dirty-gray, dull, covered with membranous overlays of beige color, in places hanging down into the uterine cavity. In the endometrium there is an inflammatory process - purulent - fibrinous endometritis.
In addition, the inflammation has spread to the muscular membrane of the uterus, as the myometrium is dull, dirty gray.
Thus, in the presented preparation there is purulent-fibrinous endomyometritis, which could arise as a result of a criminal abortion and cause uterine sepsis.
MACRO PREPARATION №22 MULTIPLE UTERINE FIBROMIOMAS
A transverse section of the uterus is shown.
In the wall of the uterus, tumor tissue grows in the form of nodes, of different sizes, round and oval, with clear growth boundaries, surrounded by a thick-walled capsule, which is a reflection of the expansive growth of the tumor.
Nodes located inside the wall of the uterus - intramural, lying under the endometrium - submucosal, lying under the serous membrane - subserous.
The nodes are built from two types of fibrous structures - some beige fibers are smooth muscle fibers, others are gray-white - connective tissue fibers. Fibrous structures have different thicknesses and go in different directions, which are manifestations of tissue atypism.
Since the nodes of the tumor contain a large number of connective tissue fibers, their consistency is dense.
Due to the fact that the tumor grows expansively and has only signs of tissue atypism, it is benign. A benign tumor of smooth muscle with an admixture of fibrous tissue is called a fibromyoma.
Based on the international classification of tumors, it belongs to mesenchymal tumors.
MACRO PREPARATION №23 BUBBLE SKID
The drug is represented by a cluster of thin-walled vesicles linked to each other and filled with a clear liquid. This is a cystic drift, a benign organ-specific tumor that develops during and after pregnancy from the epithelium of the chorionic villi.
Hydropic dystrophy of epithelial cells is the basis for the development of cystic drift.
The cystic drift is benign until it begins to grow into the wall of the uterus, into the veins. After that, it becomes malignant, or destructive. Against the background of a malignant hydatidiform mole, a malignant organ-specific tumor of chorionepithelioma may develop.
MACRO PREPARATION №24 THROMBOEMBOLISM OF THE PULMONARY ARTERY
The drug is represented by an organocomplex: the heart and fragments of both lungs.
The heart is cut from the side of the right ventricle, since the thickness of its myocardium is approximately 0.2 cm. The pulmonary trunk emerges from the right ventricle, which is divided into two pulmonary arteries, respectively, to the right and left lungs.
In the lumen of the pulmonary trunk and its bifurcation there are massive heavy, dense, crumbling masses with a corrugated surface that are not attached to the walls of the vessels. These are thromboemboli. The source of such massive thromboembolism could most likely be the veins of the lower extremities.
The thromboembolus located in the lumen of the pulmonary artery trunk and its bifurcation irritates the receptors of the reflexogenic zone located in the intima of the above vessels and causes the development of a pulmo - coronary reflex, which consists in an instant spasm of the small bronchi and bronchioles and coronary arteries of the heart, with the development of acute cardio - vascular insufficiency and the onset of instant death.
MACRO PREPARATION №25 ATHEROSCLEROSIS OF THE AORTIC WITH ATHEROMATOSIS AND PARTILEAL THROMBOSIS
The abdominal aorta is shown in a longitudinal section and the area of aortic bifurcation into the common iliac arteries.
The intima of the aorta is changed. It defines multiple round-longitudinal spots of white-yellow color, which are lipid deposits and proliferation of fibrous tissue. These are atherosclerotic plaques. They bulge into the aortic lumen, making it narrower. Below the opening of the inferior mesenteric artery, the plaques are ulcerated, atheromatous (necrotic) masses have formed on their surface and hemorrhages have occurred.
The appearance of atherosclerotic plaques in the intima of the aorta indicates the presence of atherosclerosis, a clinical and morphological form of aortic atherosclerosis.
The described changes in plaques correspond to the macroscopic stage of complicated lesions.
Damage to the intima of the aorta was one of the local prerequisites for thrombosis. In the lumen of the abdominal aorta and in the lumen of the iliac arteries, parietal and even obstructive thrombi formed, which disrupted the passage of blood through the aorta to the lower extremities.
MACRO PREPARATION №26 SMALL INTESTINAL DEFECT IN TYPHOSIS
The preparation shows the small intestine in a longitudinal section from the mucosal side.
On the mucous membrane, longitudinal oval-shaped formations are visible, protruding above the surface of the mucous membrane and having on their surface a kind of furrows and convolutions, as in the brain. These formations are pathognomonic for typhoid fever. They arose as a result of acute productive inflammation in the area of lymphatic follicles located in the submucosal layer of the intestine. Due to the proliferation of macrophage and histiocytic elements, the follicles increased in volume and size and began to rise above the mucosal surface.
Due to the presence of furrows and convolutions on the surface of the follicles, the first stage of typhoid fever is called cerebral swelling.
MACRO PREPARATION №27 FIBROUS-CAVERNOUS PULMONARY TUBERCULOSIS
The preparation is represented by a longitudinal section of the right lung, since it has 3 lobes. In each of the lobes there are cavities, large caverns with thick, non-collapsing walls. Since the walls of the cavities do not collapse, these are old, chronic cavities inherent in fibrous-cavernous pulmonary tuberculosis, one of the phases of forms of secondary pulmonary tuberculosis.
The wall of the old cavity consists of 3 layers: 1) internal - caseous necrosis; 2) medium - specific granulation tissue; 3) external - fibrous tissue.
The patient develops cor pulmonale, chronic pulmonary heart failure, tuberculosis intoxication and cachexia, from which he dies.
MACRO PREPARATION №28 LYMPHOGRANULOMATOSIS OF PARAORTAL LYMPHONODES
The specimen shows the aorta in longitudinal section.
Atherosclerotic plaques are determined in the intima of the aorta.
On both sides of the abdominal aorta, above the bifurcation, lymph nodes are sharply enlarged and, because of this, soldered to each other, forming "packages" of lymph nodes.
The consistency of the lymph nodes is densely elastic, the surface is smooth, the color on the section is gray-pink.
Lymph nodes lying on the sides of the aorta are called para-aortic.
Enlargement of the para-aortic lymph nodes and their merging into packets occurs with lymphogranulomatosis, malignant Hodgkin's lymphoma.
MACRO PREPARATION №29 ARTERIOLOSCLEROTIC NEPHROSCLEROSIS
Two intact kidneys are visible in the preparation.
Their size and weight are sharply reduced (both kidneys in humans weigh 300-350 g). The surface of the kidneys is wrinkled, fine-grained. The consistency of the kidneys is very dense.
This type has a primary - wrinkled kidney due to the benign course of primary arterial hypertension. The wrinkling is based on hyalinosis and sclerosis of the capillaries of the renal glomeruli - arteriolosclerotic nephrosclerosis.
The same appearance has a secondary - wrinkled kidney, which develops as a result of chronic glomerulonephritis.
Clinically, against the background of primary and secondary shrunken kidneys, chronic renal failure develops, accompanied by the development of azotamic uremia, which can be treated with chronic hemodialysis or kidney transplantation.
MACRO PREPARATION №30 MILIARY PULMONARY TUBERCULOSIS
A longitudinal section of an enlarged lung is shown.
It is clearly seen that the entire surface of the lung tissue is diffusely dotted with small, the size of a millet grain, dense tubercles, light yellow in color.
This type of lung has miliary tuberculosis, which develops with hematogenous generalized and hematogenous tuberculosis with a predominant lesion of the lungs.
Each tubercle has the following structure: in the center there is a focus of caseous necrosis, the severity of which depends on the state of the patient's immunity; it is surrounded by a cell wall of epithelioid cells, lymphocytes, plasmocytes and single multinuclear Pirogov-Langhans cells.
According to the classification of granulomas, tuberculous granulomas are infectious, specific. Specific cells of tuberculous granuloma are epithelioid cells of hematogenous, monocytic origin, which are the most in the granuloma.
MACRO PREPARATION №31 NODAL GOITER
The preparation shows the thyroid gland in section.
Its dimensions are sharply increased (normally weighs 25 g).
The outer surface is bumpy.
On the surface of the cut, the lobular structure of the gland is distinguished, and in the lobules there are follicles of different sizes filled with a brown colloid.
A persistent increase in the size of the thyroid gland, not associated with inflammation, swelling, or circulatory disorders in it, is called a goiter.
In appearance, it is a nodular goiter.
According to the internal structure - colloid goiter.
Most often occurs with endemic goiter, the occurrence of which is associated with a lack of exogenous iodine.
Despite the compensatory increase in the size of the gland, its function is reduced.
MACRO PREPARATION №32 TUBE PREGNANCY
The fallopian tube is seen in cross section.
The tube is sharply expanded. Its wall is thinned in places, thickened in places. In places of thickening of the wall of the tube, the tissues have a dark brown color due to hemorrhage. In the center of the tube is a human embryo, in which the head, torso, hands and fingers are clearly distinguishable. The embryo is surrounded by fetal membranes.
This is an ectopic, tubal pregnancy, complicated by incomplete tubal abortion.
The fetal egg separated from the walls of the fallopian tube, as evidenced by hemorrhage, but remained in the tube.
MACRO PREPARATION №33 RENAL - CELL CANCER
It is represented by a section of the kidney, in the upper pole of which the tumor tissue grows in the form of a node with clear growth boundaries, forming a pseudocapsule around itself, which indicates the expansive growth of the tumor.
The tumor node is light yellow in color, since the tumor cells contain a large amount of lipids; motley, since the tumor is characterized by the development of necrosis and hemorrhage; soft consistency, since the tumor contains little fibrous tissue.
Despite the nature of growth, the tumor is malignant, differentiated, epithelial organ-specific, developing from the epithelium of the tubules of the kidney.
Occurs in adults.
MACRO PREPARATION №34 DRY GANGRENE OF THE FOOT
The foot of the right lower limb is visible in the preparation.
In the region of the dorsal surface of the metatarsus, at the base of the fingers, the skin is absent, and the soft tissues are dry, mummified, gray-black in color.
This is dry gangrene of the foot, one of the clinical and morphological forms of necrosis.
Gangrene is the necrosis of tissues in contact with the external environment.
Soft tissues with gangrene are stained gray-black with pseudomelanin pigment, or iron sulfide.
Foot gangrene can develop as a result of atherosclerotic damage to the vessels of the lower extremities, which occurs primarily or as a result of diabetes mellitus due to the development of macroangiopathy.
MACRO PREPARATION №35 EMBRYONAL RENAL CANCER
Represented by a kidney in longitudinal section.
In the upper pole of the kidney there is an overgrowth of tumor tissue, large in size, with clear growth boundaries, forming a pseudocapsule around itself. In the center of the tumor node there is a large cavity due to necrosis of the tumor tissue.
The lower pole of the kidney is small, which indicates that the kidney belongs to a small child.
Despite the nature of the growth of the tumor - expansive and given the presence of secondary changes in the tumor - it is a malignant, undifferentiated tumor that develops from metanephrogenic tissue and affects children from two to six years old.
Expansive growth over time is replaced by invasive.
The tumor is epithelial organ-specific.
It metastasizes predominantly by hematogenous route to the opposite kidney, lungs, bones, and brain.
MACRO PREPARATION №36 MAMMARY CANCER
The drug is presented by the mammary gland.
In one of the quadrants of the mammary gland, a pathological proliferation of tumor tissue occurred, emanating from the epithelium of the ducts of the mammary gland, and sprouting onto the surface of the skin, which indicates invasive tumor growth.
This is a malignant, epithelial organ-specific tumor - breast cancer.
The human body is a reasonable and fairly balanced mechanism.
Among all infectious diseases known to science, infectious mononucleosis has a special place ...
The disease, which official medicine calls "angina pectoris", has been known to the world for quite a long time.
Mumps (scientific name - mumps) is an infectious disease ...
Hepatic colic is a typical manifestation of cholelithiasis.
Cerebral edema is the result of excessive stress on the body.
There are no people in the world who have never had ARVI (acute respiratory viral diseases) ...
A healthy human body is able to absorb so many salts obtained from water and food ...
Bursitis of the knee joint is a widespread disease among athletes...
Renal amyloidosis micropreparation
Micropreparations for classes
Topic: Parenchymal dystrophies.
Micropreparation No. 17
Granular dystrophy of the epithelium of the convoluted tubules of the kidneys (surrounding with hematoxylin-eosin).
1. Protein inclusions in the cytoplasm of the epithelium of the convoluted tubules of the kidneys.
Micropreparation No. 25 Micropreparation No. 26
Fatty liver disease Fatty liver disease
(surrounding with hematoxylin-eosin). (environment of SudanIII).
1. Inclusion of cytoplasmic fat in hepatocytes.
Topic: Stromal-vascular dystrophies.
Micropreparation No. 19
Amyloidosis of the kidneys (red. Congo red).
1. Deposition of amyloid in the renal glomerulus.
2. Deposition of amyloid in the stroma of the kidney.
3. Deposition of amyloid in the vessel wall.
4. Deposition of amyloid under the basement membrane of the tubules.
Micropreparation No. 27
Fatty heart (environment with hematoxylin-eosin).
1. Deposition of fat under the epicardium.
2. Deposition of fat between cardiomyocytes.
3. Atrophy of cardiomyocytes.
Topic: Mixed dystrophies.
Micropreparation No. 111
Brown induration of the lungs (surrounding with hematoxylin-eosin).
1. 2. 3. 1. 2. 3.
1. Clusters of siderophages.
2. Sclerosis of the interalveolar septa.
3. Vascular plethora and perivascular hemorrhages.
Micropreparation No. 100
Liver with obstructive jaundice (biliary cirrhosis of the liver) (surrounded by hematoxylin-eosin).
1. Bile thrombi in the bile ducts.
2. Accumulation of bilirubin granules in hepatocytes.
Subject: Fullness. Bleeding.
Micropreparation No. 1
Nutmeg liver (surrounding with hematoxylin-eosin).
1. 2. 3. 4. 1. 2. 3. 4.
1. Plethora of central veins and hemorrhages in the central sections of the lobules.
2. Fatty degeneration of hepatocytes of the peripheral sections of the lobules.
3. Sclerosis of the periportal zone.
4. Dystrophic changes and focal necrosis of hepatocytes in the central sections of the lobules.
Micropreparation No. 11
Hemorrhage in the brain (hemorrhagic infiltration) (surrounded by hematoxylin-eosin).
1. Infiltration of erythrocytes into the brain tissue.
2. Preserved structural elements of the brain in the area of hemorrhage.
Micropreparation No. 153
Pulmonary edema (surrounding with hematoxylin-eosin).
1. Accumulation of edematous fluid in the lumen of the alveoli.
Subject: Thrombosis. Embolism. Heart attack.
Micropreparation No. 6
Hemorrhagic infarction of the lung (surrounded by hematoxylin-eosin).
1. Infiltration of erythrocytes into lung tissue with necrosis.
Micropreparation No. 7
Ischemic infarction of the kidney (environment with hematoxylin-eosin).
1. Zone of necrosis.
2. Hemorrhagic corolla (paretic dilated vessels and hemorrhages).
3. Zone of unchanged renal tissue.
Micropreparation No. 5
Mixed thrombus in the vessel (surrounding with hematoxylin-eosin).
1. Zone of damaged vascular endothelium.
2. Elements of a mixed thrombus in the lumen of the vessel.
Subject: Necrosis.
Micropreparation No. 9
Necrosis of the epithelium of the convoluted tubules of the kidneys (surrounding with hematoxylin-eosin).
1. Necrotized epithelial cells of the convoluted tubules.
Subject: Inflammation. exudative inflammation.
Micropreparation No. 76
Fibrinous pericarditis (environment with hematoxylin-eosin).
1. Myocardium.
2. Cellular infiltration of the epicardium.
3. The imposition of fibrin on the epicardium.
Micropreparation No. 173
Purulent leptomeningitis (environment with hematoxylin-eosin).
1. Infiltration with neutrophilic leukocytes of the pia mater.
2. Plethora of vessels of the pia mater.
3. Edema of the substance of the brain.
Micropreparation No. 114
Diphtheritic colitis (surrounding with hematoxylin-eosin).
1. Epithelium of the intestine.
2. Cellular infiltration and focal necrosis of the intestinal mucosa.
3. Imposition of fibrin.
Topic: Productive and specific inflammation.
Micropreparation No. 131
Tuberculous granulomas in the lung (surrounded by hematoxylin-eosin).
1. Cell shaft of lymphocytes and epithelioid cells.
2. A focus of caseous necrosis.
3. Giant multinucleated Pirogov-Langhans cells.
Topic: Compensatory-adaptive reactions.
Micropreparation No. 40
Glandular cystic hyperplasia of the endometrium (surrounding with hematoxylin-eosin).
1. Proliferation of endometrial stromal cells.
2. Proliferation and cystic changes in the glands.
3. "Tangles" of spiral arteries.
Micropreparation No. 43
Granulation tissue (surrounding with hematoxylin-eosin).
1. Newly formed vessels.
2. Cellular infiltration.
3. Connective tissue fibers.
Topic: Immunopathological processes.
Micropreparation No. 23
Autoimmune thyroiditis (Hashimoto's goiter) (surrounded by hematoxylin-eosin).
1. Lymphocytic infiltration with the formation of lymphoid follicles.
2. Atrophy of thyroid follicles.
Subject: Tumors. Tumors from the epithelium.
Micropreparation No. 62
Squamous cell keratinizing skin cancer (environment with hematoxylin-eosin).
1. Accumulation of atypical tumor cells with the formation of cancer "pearls".
Micropreparation No. 64
Adenocarcinoma of the rectum (surrounding with hematoxylin-eosin).
1. Unaltered glands of the mucous membrane.
2. Complexes of tumor glandular structures.
Micropreparation No. 58
Skin papilloma (surrounding with hematoxylin-eosin).
1. 2. 3. 1. 2. 3.
1. Acanthotic bands.
2. Vascular pedicle.
3. Violation of the stratification of stratified squamous epithelium.
Micropreparation No. 61
Papillary cystadenoma of the ovary (environment with hematoxylin-eosin).
1. Papillary outgrowths of the epithelium.
2. Stromal vascular pedicles.
Topic: Mesenchymal tumors.
Micropreparation No. 41
Skin fibroma (surrounding with hematoxylin-eosin).
1. Chaotic arrangement of connective tissue fibers.
Micropreparation No. 51
Cavernous hemangioma (surrounding with hematoxylin-eosin).
1. Cavities with endothelial lining filled with blood.
Micropreparation No. 49
Chondroma (surrounding with hematoxylin-eosin).
1. Chaotic arrangement of chondrocytes.
Micropreparation No. 51
Fibromyoma of the uterus (okr. pikrofuksin according to Van Gieson).
1. Connective tissue fibers.
2. Smooth muscle fibers.
Micropreparation No. 79
Pleomorphic liposarcoma (surrounding with hematoxylin-eosin).
1. Adipose tissue cells with cellular atypia.
Micropreparation No. 55
Polymorphic cell sarcoma (environment with hematoxylin-eosin).
1. Cells with cellular atypia.
Topic: Cancers of individual localizations.
Micropreparation No. 66
Fibroadenoma of the mammary gland (surrounding with hematoxylin-eosin).
1. Proliferation of the glandular component of the tumor.
2. Proliferation of the stromal component of the tumor.
Micropreparation No. 104
Cancer metastasis to the lymph node (environment with hematoxylin-eosin).
1. Complexes of glandular tumor structures.
2. Lymph node tissue.
Topic: Tumors of the blood system.
Micropreparation No. 118
Lymph node with lymphogranulomatosis (environment with hematoxylin-eosin).
1. Reed-Berezovsky-Sternberg cells.
2. Large Hodgkin cells.
Micropreparation No. 120
Leukemic infiltrates in the kidney in acute undifferentiated leukemia
(surrounding with hematoxylin-eosin).
1. Infiltration of the kidney with undifferentiated leukemic cells.
Subject: Atherosclerosis. ischemic heart disease. GB.
Micropreparation No. 201
Atherosclerosis of the artery (surrounding with hematoxylin-eosin).
1. Vessel lumen.
2. Petrificats.
3. Atheromatous masses.
Micropreparation No. 143
Acute myocardial infarction (environment with hematoxylin-eosin).
1. Necrotized myocardium.
2. Demarcation zone.
3. Unaltered myocardium.
Micropreparation No. 97
Post-infarction macrofocal cardiosclerosis (surrounding with hematoxylin-eosin).
1. Connective tissue.
2. Hypertrophied cardiomyocytes.
Micropreparation No. 140
Arteriolosclerotic nephrosclerosis (primary wrinkled kidney) (surrounded by hematoxylin-eosin).
1. Hyalinosis of arterioles.
2. Sclerosis and hyalinosis of the glomeruli.
3. Sclerosis and lymphocytic infiltration of the stroma.
Subject: Rheumatic diseases.
Micropreparation No. 133
Acute verrucous endocarditis (environment with hematoxylin-eosin).
1. Thrombotic overlays.
Micropreparation No. 134
Recurrent warty endocarditis (environment with hematoxylin-eosin).
1. Thrombotic overlays.
2. Lymph-macrophage valve infiltration.
3. Mucoid swelling and fibrinoid valve changes.
4. Sclerosis and neovascularization of the valve.
5. Petrificats.
Topic: Acute inflammatory diseases of the lungs.
Micropreparation No. 75
Croupous pneumonia (surrounding with hematoxylin-eosin).
1. Exudate consisting of neutrophils and alveolar macrophages.
2. Fibrin threads.
Micropreparation No. 72
Focal pneumonia (surrounding with hematoxylin-eosin).
1. Leukocyte infiltrate in the lumen of the bronchus.
2. Serous-leukocytic infiltrate in the alveoli.
Topic: Chronic nonspecific lung diseases.
Micropreparation No. 92
Chronic bronchitis with bronchiectasis (environment with hematoxylin-eosin).
1. Squamous metaplasia of the bronchial epithelium.
2. Cystic transformation of the bronchus with purulent contents.
3. Sclerosis of lung tissue.
Topic: Diseases of the gastrointestinal tract.
Micropreparation No. 144
Chronic gastric ulcer with exacerbation (environment with hematoxylin-eosin).
1. Fibrinous-purulent exudate.
2. Granulation tissue and sclerosis at the bottom of the ulcer.
3. Preserved mucosa.
Micropreparation No. 146
Acute phlegmonous appendicitis (environment with hematoxylin-eosin).
1. Neutrophilic infiltration of all layers.
2. Paretic expansion and plethora of blood vessels.
Subject: Diseases of the liver.
Micropreparation No. 171
Toxic dystrophy of the liver (environment with hematoxylin-eosin).
1. Necrosis of the central sections of the lobules.
2. Fatty degeneration of the peripheral sections of the lobules.
Micropreparation No. 77
Portal cirrhosis of the liver (environment with hematoxylin-eosin).
1. Fatty degeneration of hepatocytes.
2. Narrow septal layers.
Micropreparation No. 189
Postnecrotic cirrhosis of the liver (environment with hematoxylin-eosin).
1. Protein degeneration of hepatocytes.
2. Wide septal layers.
Subject: Kidney disease.
Micropreparation No. 184
Subacute extracapillary glomerulonephritis (environment with hematoxylin-eosin).
1. Proliferation of the extracapillary epithelium with the formation of "crescents".
2. Dystrophic and atrophic changes in the epithelium of the tubules
Micropreparation No. 185
Chronic glomerulonephritis with an outcome in wrinkling (environment with hematoxylin-eosin).
1. Hyalinosis and sclerosis of the glomeruli.
studfiles.net
Kryuchkov - description of micropreparations according to Patan
Department of Pathological Anatomy, State Educational Institution of Higher Professional Education "PGMA of the Ministry of Health of Russia"
A.N. Kryuchkov, A.V. Retz
MATERIALS FOR PRACTICAL CLASSES
ON PATHOLOGICAL ANATOMY FOR STUDENTS OF MEDICAL AND MEDICAL AND PREVENTIVE FACULTIES
A.N. Kryuchkov, A.V. Rec. Materials for practical classes in pathological anatomy for students of medical and preventive faculties. - Perm, 2003. - 32 p.
The publication contains descriptions of drugs, the study of which is mandatory at the Department of Pathological Anatomy of the Perm State Medical Academy and is intended for third-year students of the medical and preventive medicine faculties. The "Introduction" gives the general principles of the descriptive method, which is widely used in practical medicine.
In practical classes in pathological anatomy, students get acquainted with the basics of the descriptive method (description method).
The method of describing macroobjects is used by almost all doctors of clinical specialties, which determines the need to study this method by medical students. Most often, the method of describing macroobjects is used when a doctor detects changes in surface tissues (skin and visible mucous membranes) during an examination of a patient. During surgical interventions, the visible changes in internal organs, primarily those that are removed, are reflected in the operation protocol by the surgeon.
In pathological anatomy, the study and description of macroobjects is the first step in the morphological analysis of autopsy and surgical material, which is then supplemented by microscopic examination.
The concept of morphological methods. Especially-
morphological methods of research in biology
and medicine is the use of empirical information obtained directly from the study of the object. In contrast, it is possible to study the properties of an object without directly perceiving it, but based on the nature of secondary changes in the environment caused by the very existence of the object (such research methods are widely used in pathological physiology).
in clinical medicine). The basis of the morphological method is the direct perception of the object being studied, primarily its visual characteristics (the result of observation).
Morphological methods, like any other scientific methods, are implemented in three stages:
1.empirical stage - obtaining primary information about the object from the senses. In pathological morphology, in addition to visual, tactile information is of great importance.
2.theoretical stage - the stage of understanding the obtained empirical data and their systematization. This requires a broad erudition of the researcher, since the effectiveness of the perception of empirical information directly depends on the completeness of theoretical knowledge, which you
expressed in the formula "We see what we know."
3. stage of practical implementation - the use of research results in practice. The results of a morphological study in medicine are the basis of the diagnosis, which determines the important practical significance of the method.
The main morphological methods include:
1.macromorphological method - a method of studying biological structures without a significant increase in the object. A study using a magnifying glass with a small increase refers to the macromorphological method. The macromorphological method should not be called a macroscopic study, since the information obtained is not only visual.
study).
descriptive method. Among the morphological methods at the empirical stage, of particular importance is
scripting method (description method) - a method of fixing perceived information using verbal symbols (means of language as a sign system). A correct description of pathological changes is a kind of informational copy of the object of study. That is why it is necessary to strive to ensure that it is as accurate as possible.
Macromorphological parameters. Description
tological changes in organs are carried out using the following main parameters:
1. localization of the pathological process in the organ
(with the defeat of not the entire organ, but its part);
2. the size of the organ, its part or pathologically
changed area (dimensional parameter, volumetric characteristic);
3.color characteristics of the fabric from the surface and in the section;
4. consistency of pathologically altered tissue;
5.configuration (outline, shape) of a pathologically altered organ or part thereof;
6. the degree of homogeneity of the pathologically altered tissue in color and consistency.
If the parameter is not changed, it is usually not reflected in the description of the object.
Micromorphological method. Tissue sections for conventional light-optical examination are prepared using special instruments (microtomes) and stained by various methods. The optimal thickness of such sections is 5-7 microns. A histological preparation is a colored tissue section enclosed between a glass slide and a cover slip in transparent media (balm, polystyrene, etc.). There are survey and special (differential) staining methods. Certain tissue structures, for example, certain substances, are detected by special methods (histochemical and immunohistochemical studies).
The most commonly used tissue sections are stained with hematoxylin and eosin. Hematoxylin - a natural dye, an extract of the bark of a tropical log tree - stains blue cell nuclei ("nuclear dye"), deposits of calcium salts, colonies of gram-positive microorganisms and fibrous tissue in a state of mucoid edema. Hematoxylin is the main (alkaline) dye, therefore the property of the tissue to perceive it is called basophilia (from lat.basis - base). Eosin is a synthetic pink dye, a dye of the color of the dawn (named after the daytime Greek goddess of the morning dawn, Eos). Eosin belongs to acidic dyes, therefore the property of tissue structures to perceive it is called acidophilia, or oxyphilia.
2. micromorphological (microscopic) method Eosin stains the cytoplasm of most cells
- a method of morphological research, which is - ("cytoplasmic dye") and intercellular material uses devices (microscopes), significantly increasing.
image of an object. Many variants of the microscopic method have been proposed, but the most widely used is light microscopy (light-optical
Other methods of staining tissue sections, including histochemical ones, will be given in the description of the corresponding micropreparations.
DEATH OF THE ORGANISM. NECROSIS
Gross preparations
No. 1. Dry gangrene of the foot. On the skin of the foot, black areas are visible; their size and shape are different in different preparations. Altered tissues are compacted (due to dehydration of detritus). The boundary of the lesions is clear. In non-fixed material, intact skin surrounding the area of dry necrosis is bright red. The presence of a halo of hyperemia around the blackened tissues creates the impression of "burning" and subsequent "charring" of the skin, which determined the old Russian name of anton fire, which denoted dry gangrene of the distal extremities. The term γάγγραινα (“gággraina”, transformed in Russian into the word gangrene) was introduced into the European medical tradition by Hippocrates and formed from the verb γραίνω - to gnaw, i.e. "Gangrene" literally translated from ancient Greek means "something that gnaws [the body]", "something that devours [flesh]".
No. 2. Wet gangrene of the intestine. The tissues of the intestinal wall are dirty gray, almost black, moist, easily torn. The relief of the mucous membrane (folds present in the norm) is smoothed. The peritoneum covering the altered segment of the intestine is dull in fresh unfixed preparations (normally, the serous membranes are moist and shiny).
No. 3. White infarction of the spleen. In the tissue of the spleen, an area of irregular or conical shape, whitish-gray, with clear boundaries is visible. In some preparations, several infarctions are found in the spleen. The apex of the cone-shaped areas of necrosis faces the gates of the spleen, and they touch at the base
capsule (in such cases, the infarction zone is visible from the surface of the organ).
No. 4. Caseous necrosis of lymph nodes in tuberculosis (caseous tuberculous lymphadenitis). Lymph nodes are enlarged, dense, soldered together and form a conglomerate. Their tissue on the cut is homogeneous, whitish-gray.
No. 5. Center of white (gray) softening in the brain. In the brain, a section shows a rounded whitish-gray area formed by loose moist detritus. The size of the focus of encephalomalacia and its localization
in the brain are different in different preparations.
Micropreparations
No. 2. Caseous necrosis of the spleen tissue in tuberculosis
culose. Stained with hematoxylin and eosin. In the spleen,
mainly in place of white pulp structures, compact accumulations of hypereosinophilic amorphous masses (caseous detritus) are visible. Around the foci of necrosis, remnants of the lymphoid tissue of the organ are visible. In addition to detritus, changes characteristic of tuberculosis develop in the tissue (their detailed characteristics will be given at the corresponding practical lesson). In a number of preparations, detritus is saturated with fragments of collapsing cell nuclei (karyorrhexis), giving the necrotic masses a basophilic hue.
No. 4. Center of white softening in the brain.
Stained with hematoxylin and eosin. The site of necrosis in the brain tissue is formed by loose eosinophilic amorphous masses, in which numerous round-shaped macrophages are visible with abundant, often granular, cytoplasm ("granular balls").
No. 5. Demarcation inflammation in the kidney. Stained with hematoxylin and eosin. In the preserved tissue of the kidney,
the circle of the focus of necrosis, small vessels are dilated and plethoric (inflammatory hyperemia), neutrophilic granulocytes and macrophages (inflammatory cell infiltration) are visible in the perivascular tissue, partially penetrating into detritus (scavenger cells).
PARENCHYMATOUS DYSTROPHY
Gross preparations
No. 37. Dull (cloudy) swelling of the kidney. The kidney is somewhat enlarged, its tissue is flabby, slightly edematous. The cut surface of the organ does not shine (dull), a small amount of turbid liquid flows from it. Such changes in the kidney are reversible and are found only in native (fresh) material. Microscopic examination revealed granular degeneration of the epithelium of the renal tubules.
No. 47. Fatty parenchymal degeneration of the myocardium ("tiger heart"). This condition develops with de-
compensation of cardiac activity (in the "worn out heart") as a result of severe heart damage of various origins. At the same time, the heart is enlarged due to the expansion (dilatation) of the cavities, its walls are thinned (compared to the compensated state); myocardium is flabby, yellowish-gray. Numerous small, sometimes merging yellowish spots and stripes are visible from the side of the endocardium. Sometimes yellowish stripes are arranged parallel to each other, forming a characteristic “tiger skin” pattern (in such cases, the heart with fatty parenchymal degeneration of the myocardium is called “tiger heart”).
No. 49. Fatty parenchymal degeneration of the liver (hepatic steatosis, fatty hepatosis, goose liver).
The liver is enlarged, its tissue is flabby, from yellowish-brown to grayish-yellow color (normal liver tissue is dark brown). With pronounced steatosis, the liver becomes very light and is called "goose" (a similar appearance of the liver in waterfowl is not a sign of a pathological process).
Micropreparations
No. 18. Hydropic degeneration of the epithelium of the kidneys
canals. Stained with hematoxylin and eosin.
The epitheliocytes of some renal tubules are enlarged, their cytoplasm is light (optically empty). Normally, the cytoplasm of tubular nephroepithelial cells is eosinophilic (stained pink with eosin). The tinctorial properties of the cytoplasm of cells in a state of hydropic dystrophy are due to edema (hydration); at the same time, water entering the cell liquefies the cytosol, making it unable to fix the dye.
No. 31. Fatty parenchymal degeneration of the liver
neither. Stained with hematoxylin and Sudan III (or only Sudan III). In the cytoplasm of hepatocytes of all parts of the hepatic lobule, numerous rounded inclusions of various sizes are visible, stained orange with Sudan III.
MESENCHYMAL (STROMA-VASCULAR) DYSTROPHYS
Gross preparations
No. 41. Hyalinosis of the spleen capsule ("glazed spleen"). The spleen capsule is focally or totally thickened,
compacted, whitish-gray. Most often, such changes are formed in the outcome of fibrinous perisplenitis.
No. 42. Sago amyloidosis of the spleen ("sago spleen"). The spleen is slightly enlarged, slightly compacted, on the cut in its tissue numerous small translucent rounded foci are visible, resembling grains of boiled sago (sago is starch pressed in the form of grains, which, when boiled, takes the form of translucent balls). "Sago spleen" is the initial morphologically verified stage of spleen amyloidosis; amyloid in this case is deposited mainly in the structures of the white pulp, so the lesions have a rounded shape.
No. 43. Sebaceous amyloidosis of the spleen ("sebaceous spleen"). The organ is enlarged, dense, on the section, the tissue is
The grains are homogeneous, pale red, shiny (“greasy sheen of the cut surface”). "Sebaceous spleen" refers to late changes in the organ in amyloidosis with a pronounced lesion of both white and red pulp. Some authors use the term "ham spleen" to refer to such changes in the organ.
No. 44. Amyloidosis of the kidney (large white amyloid kidney). The kidney is enlarged, dense, the cortex is expanded, light gray with a yellowish tint; the cut surface is shiny (“greasy sheen of the cut surface”). The yellowish hue of the renal tissue is due to fatty parenchymal degeneration. This type of kidney is characteristic of the stage of advanced clinical manifestations of nephropathic amyloidosis (nephrotic stage of renal amyloidosis). With advanced amyloidosis, atrophy of the parenchyma develops and the kidneys decrease in size.
No. 46. obesity of the heart. The heart is enlarged due to a significant growth of subepicardial adipose tissue (normally, adipose tissue under the epicardium is located only along the course of the neurovascular bundles). Heart obesity may be accompanied by myocardial lipomatosis (growth of white adipose tissue in the myocardium).
Micropreparations
No. 21. Amyloidosis of the spleen.
nom and congo red. In the tissue of the spleen, focal accumulations of compact cell-free masses stained with Congo red are visible. Predominantly amyloid is located in the structures of the white pulp, displacing and replacing the cells of the lymphoid tissue.
No. 23. amyloidosis of the kidney. Stained with hematoxylin and Congo red. In various structures of the kidney (in the glomeruli, walls of tubules and vessels), red-stained (congophilic) compact cell-free masses (amyloid) are found. Amyloid is predominantly located in the renal glomeruli. - tubules of the nephron.
No. 26. Hyalinosis of the renal glomeruli and vessel walls
dov. Coloring according to van Gieson. Some glomeruli are reduced, replaced by coarse fibrous connective tissue, partially or completely hyalinized, stained red with acid magenta. Hyaline is a homogeneous hyperoxyphilic (i.e. intensely stained with acid dyes such as acid fuchsin and eosin) masses. The walls of individual vessels are also hyalinized. - normal glomerulus, - nephron tubules.
MIXED DYSTROPHYS
Gross preparations
No. 53. A calcified tuberculous focus in the lung (Gon's focus). A whitish focus is located in the lung tissue.
wadded-gray, rounded, up to 1 cm in diameter, stony density, with fairly clear boundaries.
No. 54. Kidney stone (nephrolithiasis). The pelvis, large and small calyces of the kidney are occupied by a large coral-like calculus.
No. 56. Stones in the gallbladder (cholelithiasis). Numerous stones are visible in the gallbladder. The color, size and shape of the stones are different in different preparations.
No. 60. Hemosiderosis of the spleen. The tissue of the spleen on the incision is brown due to the deposition of a large amount of hemosiderin in its tissue (“rusty appearance” of the incision surface). Hemosiderosis of the spleen is a manifestation of generalized (systemic) hemosiderosis, in which hemosiderin accumulates and stains brown tissue in the bone marrow, liver, spleen and lymph nodes.
No. 61. Hemomelanosis of the spleen (malarial pigmentation of the spleen). The spleen is somewhat enlarged, thickened
on, its fabric on the cut is gray-black (slate-gray) color. Hemomelanin refers to hematins - hemoglobinogenic pigments containing ferric iron. Hematins, unlike pigments containing ferrous iron (ferritin and hemosiderin), stain the fabric black.
Micropreparations
No. 40. Deposition of calcium salts in the kidney (nephro-
calcification). Staining with hematoxylin and eosin.
in the light of some renal tubules, calcium salts are located, stained hyperbasophilically (hematoxylin
dark blue). Nephroepitheliocytes of these areas are in a state of severe hydropic dystrophy or are destroyed.
No. 42. Hemosiderosis of the liver. Perls reaction (staining with yellow blood salt). Numerous hemosiderin granules are visible in the cytoplasm of hepatocytes, stained
blue color ("Prussian blue").
The Perls reaction reveals only ferritin and its polymerization product, hemosiderin, i.e. hemoglobinogenic pigments containing divalent iron. To detect all iron-containing hemoglobinogenic pigments (including hematins) in the tissue, the Tirman reaction is used (treatment of tissue sections with reducing agents followed by staining with red blood salt).
No. 45. Liver with obstructive jaundice. Staining with hematoxylin. Interlobular bile ducts and bile capillaries are dilated, filled with brown-green masses (bile); the walls of some ducts are thinned. In the cytoplasm of hepatocytes there are dark green grains of bile (intracellular cholestasis). The tissue of individual portal tracts and lobules is stained with bile ("biliary necrosis").
CIRCULATION DISORDERS (1 session)
Gross preparations
No. 7. Muscat liver. The liver is a little increased, condensed; on a section, the tissue of the organ has a mottled appearance (numerous evenly spaced small red foci are visible on a yellowish-seroma background), resembling a nutmeg kernel with a characteristic alternation of lighter and darker areas. Red foci correspond to the central sections of the lobules, the vessels of which are sharply full-blooded; the yellowish-gray background is due to fatty degeneration of hepatocytes in the peripheral sections of the lobules.
No. 8. "Nutmeg" fibrosis of the liver (congestive compaction of the liver). The liver is slightly enlarged, dense,
its surface is smooth. The tissue on the cut is variegated: on a red background, multiple whitish-gray small foci are visible (“muscat vice versa”). Light gray foci correspond to the central sections of the lobules, where fibrous tissue grows; the sinusoidal capillaries of the peripheral sections of the lobules and the vessels of the portal tracts are full-blooded, which gives a red color to other sections of the liver tissue.
No. 9. Brown induration of the lungs. The lungs are slightly enlarged, compacted, the cut surface is brown (due to the high content of hemosiderin in the tissue).
No. 13. Fresh cerebral hemorrhage. In the brain tissue there is a cavity filled with coagulated blood (hematoma). In some preparations, the blood is in the lateral ventricles (haemocephaly).
No. 27 (169). Hydrocephalus (dropsy of the brain). The ventricles of the brain are stretched by an increased amount of cerebrospinal fluid. The volume of brain tissue is reduced due to prolonged compression of it by CSF (atrophic changes).
Micropreparations
No. 51. Muscat liver. Hematoxylin staining
iosin. The lobular structure of the liver is preserved. The central venule and adjacent sections of the sinusoidal capillaries are dilated, sharply plethoric (plethora of the central sections of the lobule). Centrilobular hepatocytes are reduced in size, their number is reduced (atrophy of parenchymal cells of the central sections of the lobules). The cytoplasm of hepatocytes of the peripheral sections of the lobules contains fatty inclusions (rounded voids with clear contours).
No. 53. Brown induration of the lungs. Staining hematoxy-
lin and eosin. The interalveolar septum is thickened due to the plethora of capillaries and fibrosis. In the lung tissue, especially in the lumen of the alveoli, numerous sideroblasts (alveolar macrophages with hemosiderin granules in the cytoplasm) are visible.
No. 54. Fresh hemorrhage in the brain. Ok-
stained with hematoxylin and eosin. In brain tissue
ha outside the vessels are numerous erythrocytes. In some parts of the brain, small cavities without clear boundaries are formed, filled with blood (microhematomas); in others, the brain tissue is more or less evenly saturated with blood (hemorrhagic infiltration).
CIRCULATION DISORDERS (2nd lesson)
Gross preparations
No. 11. White kidney infarction. In the cortical substance of the kidney, a whitish-gray area with clear boundaries is visible, adjacent to the fibrous capsule of the organ. There may be several foci of necrosis (heart attacks).
No. 14. Hemorrhagic pulmonary infarction. In the lung, under the pleura, there is a dark red area, of a dense consistency, with fairly clear boundaries. The tissue in the lesion is airless. There may be several infarcts in the preparation. Hemorrhagic infarction is the result of thromboembolism of the branches of the pulmonary artery.
No. 16. White thrombus in the aorta. A light-gray thrombus with an uneven (rough) surface is attached to the inner surface of the abdominal aorta. Sometimes the surface of the thrombus is wavy ("corrugated"). In some preparations, the thrombus completely blocks the lumen of the vessel (obturating thrombus), in others - partially (parietal, or parietal, thrombus). Unlike a thrombus, a post-mortem blood clot is not attached to the vessel wall, it is soft-elastic (jelly-like), its surface is even, moist, and shiny.
No. 20. Massive pulmonary embolism. In the pulmonary trunk and both pulmonary arteries, there are thromboemboli folded into a ball, completely blocking the lumen of the vessels. With massive pulmonary embolism, as a rule, a fatal outcome develops.
No. 21. Purulent metastases in the kidney with sepsis (septicopyemia). Under the kidney capsule there are small cavities filled with purulent exudate (abscesses).
No. 22. Cysticercosis of the brain. The brain tissue contains numerous vesicles with a diameter of 2-3
No. 23. Metastasis of stomach cancer to the liver. In the liver, rounded whitish-gray nodes of various sizes are visible, with fairly clear boundaries.
Micropreparations
No. 57. Hemorrhagic infarction of the lung. Stained with hematoxylin and eosin. The site of infarction is formed by amorphous eosinophilic masses (detritus) with numerous erythrocytes. In intact tissue adjacent to the area of necrosis, microvessels are dilated and plethoric; inflammatory cell infiltration from macrophages and neutrophilic granulocytes is formed in the interalveolar septa and fibrous stroma, and the alveolar cavities are filled with cell-rich exudate
(signs of demarcation inflammation).
No. 61. Thrombus organization. Coloring according to van Gieson.
The lumen of the vessel is filled with a thrombus stained yellow with picric acid. Fibrous tissue (thrombus organization) grows into the thrombus from the vessel wall, the collagen fibers of which are stained red with acid fuchsin. Small vessels form in the thrombus, some of which do not contain blood cells (thrombus endothelization); in other vessels of the thrombus, signs of restoration of blood flow are revealed - the presence of blood cells in the lumen (vascularization)
thrombus).
No. 63. Microbial emboli (bacterial meta-
stasis) in the kidney. Staining with hematoxylin and eosin. B
In the lumen of small vessels of the kidney, including the capillaries of the glomeruli, there are colonies of gram-positive bacteria (staphylococci), stained dark blue with hematoxylin.
EXUDATIVE INFLAMMATION
Gross preparations
No. 66. Vesicular exanthema in smallpox. Numerous vesicles (vesicles) filled with a clear or cloudy liquid (serous exudate) are located on the skin. Elements of a rash (a rash on the skin is called an exanthema) up to 0.5 cm in size with a characteristic central depression of the lid of the bubble.
No. 68. brain abscess. In the brain tissue, a cavity with a diameter of 1.0-2.5 cm is visible (the diameter of the cavity is different in different preparations), containing purulent exudate.
No. 70. Purulent leptomeningitis with meningococcal infection. The soft meninges, especially the convexital surface of the brain, are whitish-gray, thickened due to edema, pronounced plethora of blood vessels and the presence of purulent exudate in their tissue.
No. 73. Fibrinous pericarditis ("hairy heart"). The epicardium is covered with a layer of soft yellowish-gray mass (fibrinous exudate) that forms hair-like outgrowths.
No. 78. diphtheritic endometritis. The mucous membrane of the uterus is covered with thin, gray, spontaneously exfoliating films of fibrinous exudate.
Micropreparations
No. 76. Fibrinous pericarditis. Van Gee stain
zone. The epicardium is covered with amorphous picrinophilic (yellow-stained by picric acid) masses of fibrinous exudate. In the submesothelial tissue, the microvessels are dilated and plethoric (inflammatory hyperemia), surrounded by numerous cells of the inflammatory infiltrate (primarily macrophages and neutrophilic granulocytes). - subepicardial adipose tissue; - myocardium.
No. 80. Phlegmon of soft tissues. Staining hematoxy-
lin and eosin. Numerous neutrophilic granulocytes are located around the fibers of the striated muscle tissue and fat cells. Decaying neutrophilic granulocytes that form purulent exudate are called purulent bodies in classical pathology. - skeletal muscle tissue, - cells of white adipose tissue.
No. 131. Fibrinous laryngitis. Staining hematoxy-
lin and eosin. The mucous membrane of the larynx is in a state of necrosis. Detritus and fibrinous exudate form a film (fibrinous-necrotic film) covering the underlying intact tissues, the small vessels of which are dilated and full-blooded (inflammatory hyperemia), and cells of the inflammatory infiltrate are visible in the perivascular tissue. The inflammatory cellular infiltrate consists mainly of histiocytes (macrophages) and neutrophilic granulocytes.
studfiles.net
description
DESCRIPTIONS AND SYMBOLS
OF EDUCATIONAL MICROSPREPTS
AT THE RATE OF GENERAL AND SPECIAL
PATHOLOGICAL ANATOMY
TOPIC: Parenchymal dystrophies
micropreparation
Turbid swelling of the epithelium of the tubules of the kidney.
Already at low magnification, it is noticeable that the boundaries of the epithelial cells of the convoluted tubules are unclear, their cytoplasm is dull, and nuclei are not visible in all cells. In the tubules of the intercalary part, the epithelial cells, on the contrary, do not represent changes, the nuclei and outlines of the cells are clearly visible, the cytoplasm of the cells is transparent. The glomeruli are also not changed.
At high magnification, it is easy to establish that cells with dull cytoplasm are enlarged in size, the cytoplasm is fine-grained. The lumens of the tubules are narrowed or have a characteristic stellate appearance, due to the fact that the apical ends of the dystrophic cells are, as it were, broken off. In the lumen of some tubules, a fine-grained or homogeneous protein mass (the so-called cylinders) is visible.
Notation
1) unchanged glomeruli;
2) enlarged epithelial cells of convoluted tubules with dull, fine-grained cytoplasm;
3) pale colored nuclei of these cells;
4) narrowed lumen of convoluted tubules;
5) stellate lumen of convoluted tubules;
6) tubules of the intercalated section (collecting ducts) with unchanged cells;
7) protein masses in the lumen of the tubules.
Micropreparation X
Cloudy swelling of the liver
Even at low magnification, it can be seen that in the center and along the periphery of the lobules, the trabecular structure of the beams is disturbed, the cells are arranged randomly (the so-called discomplexation of the hepatic beams).
At high magnification, it is clearly seen that the cells are enlarged in size. In this case, the granularity of the cytoplasm is completely optional, it may or may not be present. On the periphery in most cells, the nuclei are preserved, in the center only their shadows (karyolysis) are visible - the outcome is necrosis.
Notation
1) normal liver cells along the periphery of the lobules;
2) discomplexation of hepatic beams;
3) enlarged liver cells with granular and homogeneous cytoplasm;
4) pale colored nuclei.
micropreparation
Mucosal degeneration of the epithelium
Staining: a) mucicarmine; b) CHIC reaction; c) according to Hale
Watered the nose with symptoms of inflammation, which is expressed in the impregnation of the stroma with inflammatory exudate rich in segmented leukocytes. The epithelium covering the polyp is partially in a state of mucous degeneration:
swollen, the entire cytoplasm is filled with mucus. Pay attention to the colorful reactions to mucus: mucicarmine - in pink, according to Hale - in turquoise, positive CHIC - reaction - in raspberry. Draw separately epithelial cells stained with different methods. In those areas where there is no mucous degeneration, mucus is preserved only in the apical sections and on the surface of the epithelium.
Notation
1) mucous degeneration of the epithelium (with various staining methods);
2) normal epithelium.
micropreparation
Fatty degeneration of the myocardium (tiger heart)
Staining - hematoxylin-eosin
In contrast to the "simple" obesity of the heart, with dystrophic obesity of the myocardium, the muscle fibers themselves become fat, and not the small layers of connective tissue between them. Fat deposits in the form of small droplets that do not merge with each other are found mainly near blood vessels, and not individual muscle fibers become fat, but groups of them. The resulting peculiar spotting explains the name - tiger heart. In some cases, there may be a breakdown of the muscle fiber, its transformation into a fine-grained mass, dystrophic changes in the nuclei, if any, are much less pronounced than changes in the muscle fibers.
Notation
1) blood vessels
2) small drops of fat in muscle fibers located near blood vessels
3) muscle fibers without fat droplets
micropreparation
Fatty degeneration of the liver
Staining - hematoxylin-sudan
Not only different preparations, but also different parts of the same
drugs can differ significantly from each other in the degree of obesity. IN
in severe cases, the entire lobule becomes fat. Hepatic nuclei. cells
are pushed aside by drops of fat to the periphery and there is a significant similarity with
normal adipose tissue. In other cases, not the entire lobule becomes fat, but part of it, peripheral or central. Drops of fat can be both small and large. Based on the size of the fat droplets and their location in the center or along the periphery of the lobule, it is impossible to distinguish physiological obesity from dystrophic. The only convincing criterion is dystrophic changes in the nuclei of the liver cells, but these changes are observed in advanced cases.
Notation
1) hepatic beams;
2) large (small) drops of fat in the liver cells along the periphery (in the center) of the lobules;
C) whole, fatty liver lobule.
TOPIC: Stromal-vascular dystrophies
Micropreparation Z
Hyalinosis of the spleen capsule
Coloring - pyerofuxin
The capsule of the spleen in some areas is sharply thickened. At low magnification, it can be seen that in the thickest places the collagen fibers swelled, merged with each other, there were few connective tissue cells, they were squeezed by homogeneous red-colored masses. In a normal capsule, collagen fibers are thin, each fiber is clearly contoured, and a significant number of cells can be seen between them. This is an example of hyaline degeneration of connective tissue.
Notation
1) hyalinized area of the capsule (the fibers are thickened, swollen, merged with each other)
2) normal capsule with well-defined fibrous structures
H) spleen tissue:
a) lymphatic follicle
b) trabecula
c) red pulp
micropreparation
Hyalinosis of arterioles of the kidney in hypertension
At low magnification, small vessels are visible in the cortical substance of the kidney. In cross section, they look like uniform rings of pink or slightly bluish color (the chemical structure of hyaline is not the same). Their aperture is narrow. Accordingly, such vessels are depleted of the glomeruli with their subsequent scarring, as well as atrophy of the tubules with the growth of connective tissue. Scar tissues have the appearance of homogeneous, pale-colored rounded formations with single nuclei. There are tubules with an expanded lumen containing homogeneous masses of protein, the so-called. hyaline casts (hyalinosis of dead masses).
Notation
1) hyalinized arteriole
2) sclerosed (scar) glomerulus
3) atrophying tubules and proliferation of connective tissue
4) dilated tubules with hyaline cylinders
micropreparation
Kidney amyloidosis
Coloring - Congo-mouth + hematoxylin
Amyloid masses, clearly visible in the preparation due to elective brick-red staining, are found in the greatest amount in the glomeruli. Some glomeruli are so rich in amyloid that only single endothelial cells have been preserved. In smaller amounts, amyloid deposits are found along the small vessels of the cortical and medulla, as well as in the tubule proper.
Notation
1) deposits of amyloid under the endothelium of the capillaries of the glomerulus
2) deposits of amyloid under the endothelium of the capillaries of the cortical and medulla
3) deposits of amyloid in the lining of the tubules
Micropreparation X
Sago spleen
Coloring - Congo-mouth + hematoxylin
Amyloid is selectively deposited in follicles. They are easily detected as round brick-red formations. Only a few lymphocytes remained in the follicle. The rest underwent atrophy and death from compression by amyloid masses. There is no amyloid in the red pulp. The venous sinuses between the enlarged follicles containing amyloid masses are compressed.
Notation
1) enlarged, containing amyloid follicles
2) single lymphoid cells preserved in follicles
3) compressed venous sinuses between follicles
Micropreparation 3
Heart in general obesity
Staining - hematoxylin-eosin
The epicardium is sharply thickened, it is a strip of adipose tissue with passing ones. Between groups of fat cells by blood vessels. The boundary between the epicardium and myocardium is not clearly expressed due to the fact that adipose tissue seems to penetrate deep into the myocardium in the form of strands of fat cells. In those places where the obesity of the connective tissue layers between the muscle fibers is most pronounced, the latter are thinned (pressure atrophy). In the deeper parts of the myocardium, where there is no adipose tissue, muscle fibers without significant changes have a normal thickness.
Notation
1) thickened epicardial fat layer
2) fat cells between worn out muscle fibers
H) muscle fibers of normal thickness
micropreparation
Intermediate obesity of the intima of the vessel (artery)
Coloring - sudan
At low magnification, focal thickening of the intima is visible. At the site of thickening, the intima is stained diffusely with Sudan - this is obesity of the interstitial substance. As lipids accumulate in the interstitial substance, macrophages appear that capture fat droplets (resorptive obesity), such cells are called xanthomic. Xanthoma cells in the preparation look like orange spots of various shapes containing a nucleus.
Notation
1) intimal thickening
2) obesity of the intermediate substance
H) xanthoma cells
TOPIC: Blood and lymph circulation disorders -1
(hyperemia, ischemia, bleeding, hemorrhage).
micropreparation
Brown induration of the lungs
Small vessels of the lung are dilated and filled with blood. The interalveolar septa are thickened due to the growth of connective tissue in them. In the alveoli and septa, large cells, macrophages containing the pigment hemosiderin (brown) are visible - the so-called cells of heart disease. Such changes in the lungs are observed most often with heart defects, less often with chronic heart failure of another origin.
Notation
1) thickened interalveolar septum
2) dilated capillaries
H) heart disease cells
micropreparation
Congestive plethora of the liver
The central veins are sharply dilated. In the centers of the lobules, the capillaries are dilated and filled with blood. The hepatic beams located between them, on the contrary, are narrowed (atrophy from pressure), in some places they are not defined at all. On the periphery of the lobules, stagnation is much less pronounced, the hepatic beams and capillaries have a normal appearance.
Notation
1) dilated central veins
2) dilated capillaries in the center, lobules
H) compressed hepatic beams in the center of the lobules
4) unchanged hepatic beams and capillaries along the periphery of the lobules
micropreparation
old cerebral hemorrhage
Under low magnification, an old hemorrhage center surrounded by a demarcation line is visible. There are many macrophages containing hemosiderin (a granular yellow-brown pigment) in the demarcation zone. The pigment is produced in macrophages. When macrophages are destroyed, the pigment lies freely in the tissue. Given the accumulation of hemosiderophages in the tissue around the outflow of blood, hemorrhage should be considered old.
Notation
1) a large focus of hemorrhage
2) demarcation line
a) macrophages with hemosiderin
b) free grains of hemosiderin
H) brain tissue
TOPIC: Blood and lymph circulation disorders-2
(thrombosis, embolism, infarction).
micropreparation
Obturating thrombus with organization
When examining the preparation with the naked eye, it is easy to determine the stenosis of the artery and the red-pink mass of a blood clot that completely clogs the lumen. Using a low magnification, they study the composition of the thrombus, noted the presence of various thicknesses of fibrin filaments and numerous erythrocytes, as well as hemosiderophages. In places of contact of the thrombus with the wall of the artery, thin-walled vessels and accompanying cells of granulation tissue growing into the thrombus are visible.
Notation
1) artery wall
2) capillaries and their accompanying cells, mainly macrophages and fibroblasts growing into a thrombus (thrombus organization)
H) fibrin threads and thrombus erythrocytes
micropreparation
Fat embolism of the lung
Staining: sudan + hematoxylin
Drops of fat are visible in the vessels of the interalveolar septa. Such changes can be with fractures of tubular bones, with crushing of adipose tissue, with convulsions.
Notation
1) interalveolar septum
2) drops of fat in the vessels of the interalveolar septum (stained yellow with Sudan)
micropreparation
Hemorrhagic pulmonary infarction
In the preparation, three areas that are not sharply delimited from each other can be distinguished: necrosis, reactive inflammation, congestive plethora. The area of necrosis is completely saturated with blood. Nuclear detritus is located along the interalveolar septa. Of the vessels, only the outlines of the walls have been preserved. On the pleura, respectively, the site of the infarction - the imposition of fibrin. The zone of reactive inflammation is a strip of lung tissue with sharply dilated vessels, small hemorrhages, leukocytes and erythrocytes in the lumen of the alveoli. Surrounding the site of necrosis lung tissue with symptoms of venous congestion: the capillaries of the interalveolar septa are dilated, filled with blood. In the lumen of the alveoli, there are many alveolar macrophages with grains of coal and hemosiderin in the cytoplasm, as well as erythrocytes (diapedesis).
Notation
1) site of infarction
a) erythrocytes impregnating the entire area of necrosis
b) nuclear detritus along the interalveolar septa
c) necrotic vessels that retained only general outlines
2) zone of reactive inflammation
a) dilated capillaries filled with blood b) small hemorrhages and leukocytes
H) lung tissue surrounding necrosis with symptoms of venous congestion
a) dilated, blood-rich interalveolar septa
b) cells of heart defects
c) erythrocytes in the lumen of the alveoli
micropreparation
Ischemic myocardial infarction with the onset of organization
In the myocardium, for a large extent, there are no nuclei in the muscle fibers, but the contours of the fibers are preserved - this is a heart attack. Young connective tissue grows along its periphery, rich in vessels, macrophages, fibroblasts - this is an organization.
Notation
1) necrotic muscle fibers
2) connective tissue growing into the area of necrosis
3) normal muscle fibers
TOPIC: Necrosis.
micropreparation
Ischemic infarction of the kidney
The kidney has an extensive approximately triangular area of necrosis. The glomeruli and tubules of this area are devoid of nuclei and are structureless formations that have retained only general contours. Kernels of connective tissue layers in a state of pycnosis and rexis. Fragments of nuclei are mixed into a total mass of detritus. Along the periphery of the necrotic area, sharply dilated, full-blooded vessels and small hemorrhages are noticeable. Behind the hemorrhagic belt is a tissue with a well-defined cellular structure of the glomeruli and tubules.
Notation
1) site of necrosis
a) necrotic glomeruli (nuclei are not stained)
b) necrotic tubules
c) nuclear detritus
2) hemorrhagic belt, formed by small hemorrhages and dilated vessels filled with blood
3) normal kidney tissue
a) glomerulus with stained nuclei b) tubule with stained nuclei
micropreparation
Necrosis of the epithelium of the convoluted tubules of the kidney (necrotic nephrosis)
The epithelium of the convoluted tubules is sharply swollen, filling the lumen of the tubules. Nuclei in most cells are absent, the borders are poorly expressed. Necrotized cells are saturated with lime salts in places. The cellular structure of the glomeruli and straight tubules, in contrast to the convoluted tubules, is well expressed.
Notation
1) necrotic epithelium of the convoluted tubules (the nuclei are not stained)
2) normal glomerulus
H) normal straight tubules
micropreparation
The focus of caseous necrosis in the lung with encapsulation
There are areas in the lung tissue in which the alveoli are filled with exudate and the border of the alveoli is poorly distinguishable, however, the nuclei in the partitions and cells of the exudate are stained, therefore, the tissue is not yet necrotic. Against this background, foci of necrosis are visible, in which the nuclei are not stained, the structure of the tissue is not distinguishable. Fibrous connective tissue grows around such foci (encapsulation). Near the capsule in necrosis of a clump of disintegrating nuclei (karyorrhexis).
Notation
1) area of necrosis with karyorrhexis
2) connective tissue capsules
H) normal lung tissue
TOPIC: Inflammation -1. exudative inflammation.
Micropreparation Z
Necrotic angina
Staining - hematoxylin-eosin
In the depths of the crypts of the tonsil, the epithelium is necrotic, it is distinguished by the absence of nuclei. On the surface of the foci of necrosis, protein exudate with fibrin threads and accumulations of microbes in the form of microcolonies (dyed blue with hematoxylin). Proliferation is weakly expressed.
Notation
1) tonsil tissue
a) follicles
b) crypts
2) necrosis of the epithelium in the wall of the crypts
micropreparation
Croupous tracheitis
Staining - hematoxylin-eosin
The epithelial lining of the trachea is almost universally absent. On the surface of the mucous membrane there are fibrin deposits in the form of thin, intertwining threads, among which are leukocytes, mostly decaying. There is pronounced edema in the submucosa, it is sharply thickened, infiltrated with many lymphoid cells and leukocytes with a predominance of the latter, contains dilated vessels filled with formed elements.
Notation
1) mucous membrane of the trachea
2) superficially located fibrinous overlays in the form of thin interlacing threads
H) decaying leukocytes among fibrin threads
4) thickened, edematous submucosa, and in it a) dilated vessels
b) infiltrate, consisting mainly of leukocytes
Micropreparation of intestinal phlegmon
Staining - hematoxylin-eosin
The intestinal wall is sharply thickened. All its layers (mucosal, submucosal, muscular) are diffusely infiltrated with exudate consisting of leukocytes (purulent exudate). Purulent exudate is especially clearly visible in the intermuscular layers and in the submucosa.
Notation
1) layers of the intestinal wall
2) purulent infiltrate of all layers of the wall
C) inflammatory vascular hyperemia
micropreparation
Metastatic abscess in the myocardium
Staining - hematoxylin-eosin
In the muscle tissue of the heart, limited foci of purulent inflammation are visible, according to which the muscle tissue is melted - these are abscesses. In the center of some of them, microbial emboli are visible; they are stained with hematoxylin in an intense blue color. Such abscesses are called metastatic, because. they arise due to the transfer of microbes from some other focus.
Notation
1) myocardium
2) abscess
H) microbial embolism
micropreparation
Diphtheritic pharyngitis
Staining - hematoxylin-eosin
A thick fibrinous film replaces the stratified squamous epithelium over a large extent and penetrates deep into the epithelium (diphtheria inflammation). The film is permeated with leukocytes, accumulations of microbes can be seen on the surface of the film. The throat tissue is edematous, infiltrated with leukocytes, lymphoid cells, histiocytes, blood vessels are dilated.
Notation
1) fibrinous film penetrating into the thickness of the epithelium
2) edematous tissue of the pharynx with dilated vessels
H) cell infiltration
TOPIC: Inflammation -2. Productive and specific inflammation,
micropreparation
Granulation tissue
The basis of ordinary granulation tissue is a set of thin-walled blood vessels, around which various types of cells are located. The most common are macrophages and fibroblasts. Macrophages are large cells, mostly irregular in shape. The nuclei of macrophages can differ significantly from each other in shape, size and content of chromatin; a large amount of cytoplasm is common to these cells. Fibroblasts are elongated, spindle-shaped. Their elongated nuclei are poor in chromatin, often containing two or three large nucleoli. In addition to macrophages and fibroblasts, leukocytes with segmented nuclei are found in one or another amount, then lymphocytes, plasma cells with a characteristic nucleus structure in the form of wheel spokes, giant cells of foreign bodies, and others can be found. Depending on the degree of maturity of the granulation tissue, single or, on the contrary, numerous collagen fibers lie between the cells.
Notation
1) thin-walled blood vessels
2) macrophages
H) fibroblasts
4) leukocytes
5) lymphocytes
Micropreparation 3
Fibrinous pericarditis in the organization stage
Fibrinous overlays on the epicardium are presented in the form of different thicknesses of filaments and clumps. Between the fibrin threads there are gaps into which granulation tissue grows from the side of the epicardium. Granulation tissue consists of vessels and accompanying cells, mainly macrophages and fibroblasts. In places where macrophages come into contact with fibrin, small cavities are found in the latter (lacunar resorption of fibrin by macrophages). Sometimes it is possible to see phagocytosed fibrin particles, fragments of nuclei in the cytoplasm of macrophages. In those places where fibroblasts predominate in the granulation tissue, the destruction of fibrin is less pronounced. Among the fibroblasts there are thin collagen fibers. -
Notation
1) imposition of fibrin in the form of threads and lumps
2) granulation tissue growing into fibrin deposits:
a) blood vessels
b) macrophages
c) fibroblasts
3) lacunar resorption of fibrin by macrophages
4) epicardial fat cells
micropreparation
Cirrhosis of the liver
Stained with picrofuchsin according to Van Gieson
When stained with picrofuchsin, strands of connective tissue are clearly identified in the form of rings covering groups of hepatic lobules. Dystrophic changes in the liver parenchyma are expressed primarily in fatty degeneration of the liver cells. The exudative factor is represented by the lymphoid
infiltration, productive - the formation of the aforementioned
connective tissue strands and the so-called false passages in the form of small epithelial tubules. Areas of progressive inflammation are characterized by significant lymphoid infiltrate and relatively numerous false bile ducts. In those places where the inflammatory process has ended or subsides, the connective tissue layers are represented by coarser bundles of fibers.
Notation
1) fibrous connective tissue in the form of rings covering groups of hepatic lobules
2) lymphoid infiltrate in fibrous connective tissue
3) fatty degeneration of liver cells
Micropreparation X
Metaplasia of stratified ciliated bronchial epithelium into stratified squamous
Longitudinal section of the bronchus. Its lumen is expanded with sawtooth outgrowths due to chronic inflammation of the wall (bronchiectasia, the epithelial lining is heterogeneous; in some places it retains the appearance of a multi-row ciliated, and in some places stratified squamous epithelium). The transformation of stratified epithelium into stratified squamous is called metaplasia.
Notation
1) bronchus wall
a) stratified ciliated epithelium b) stratified squamous epithelium
micropreparation
Epithelioid tubercles in the lung
Already with the naked eye in the preparation, you can see tubercles in shape and size resembling a pinhead. Microscopic examination reveals that the bulk of the tubercle is made up of epithelioid cells, large and light. Among the epithelioid cells there are giant Langans cells with a characteristic arrangement of nuclei in the form of a palisade. The accumulation of epithelioid cells is surrounded by a halo of lymphocytes. The tubercles merge with each other in places. By moving the preparation, it is possible to detect different stages of tubercles development. Often there are tubercles with caseous necrosis in the center. Epithelioid cells, having turned into fibroblasts, are located around the necrosis, forming a capsule, or grow into necrosis, organizing it.
Notation
1) epithelioid tubercle
2) epithelioid tubercle with caseous necrosis in the center
Micropreparation X
Caseous pneumonia
At low magnification, it can be seen that almost all lung tissue is airless. In some areas, the lung tissue is necrotic, has the appearance of a pink fine-grained mass with fragments of chromatin with poorly distinguishable contours of the alveoli. Along the periphery of these necrotic foci, the structure of the interalveolar septa is still preserved, the lumen of the alveoli is filled with protein exudate with an admixture of alveolar macrophages and single leukocytes.
Notation
1) caseous pneumonia (cells of exudate and interalveolar septa are necrotic)
2) exudate consisting of albuminous fluid, alveolar macrophages and leukocytes
In the preparation stained with fuchsilin for elastic fibers, it can be seen that the elastic framework of the partitions in the areas of caseous necrosis is mostly preserved.
micropreparation
Syphilitic aortitis
The main changes are found in the middle shell. Hummous infiltrate, consisting of lymphoid cells with an admixture of plasma cells, is located along the vessels. In places of accumulation of cells, elastic fibers are destroyed. Lymphoid infiltrates are also found, albeit to a lesser extent, in the adventitia and intima. In the inner shell there are characteristic retractions in the places of formation of scar tissue
Look at the preparation stained with hematoxylin-eosin, and then compare it with the Weigert-stained preparation for elastic fibers:
Notation
1) gummy infiltrate from lymphoid cells along the vessels in the middle shell
2) intimal retractions in places where scar tissue develops
H) destroyed elastic structures in the middle shell
Micropreparation I4
Actinomycosis
Granuloma with actinomycosis consists of lymphoid, epithelioid and xanthoma cells. In the locations of the drusen, the granuloma undergoes a purulent transformation. Along with this, there is the development of connective tissue, which, depending on the stage of the process, has a different maturity, but more often scar tissue predominates. The farther from the drusen, the less purulent fusion is expressed, the inflammatory infiltrate is gradually lost in the surrounding tissue of the organ.
Notation
1) druse of radiant fungus
2) accumulations of leukocytes surrounding the drusen
H) xanthoma cells
4) epithelioid cells
5) lymphocytes
TOPIC: Compensatory-adaptive processes.
micropreparation
Emphysema
The lumens of the alveoli and alveolar ducts are dilated. The interalveolar septa are significantly thinned, poor in capillaries. In some places, the interalveolar septa are not only atrophied, but also torn. Due to the rupture of the interalveolar septa, common cavities are formed from a number of adjacent alveoli.
studfiles.net
Description of drugs in Lesson No. 09
Description of drugs in Pathological Anatomy in Lesson No. 9
(This is an indicative description, not a cathedral one, some preparations may be missing, as a description of past years)
LESSON №9 PATHOLOGY OF THE IMMUNE SYSTEM
ELECTRONOGRAM MUCOID Swelling
Tissue edema, accumulation of acidic aminoglycans in the stroma. Collagen fibers are preserved.
ELECTRONOGRAM FIBRINOID NECROSIS
Collagen fibers are destroyed, their transverse striation is not determined. Between the preserved collagen fibers, the spaces are expanded (this is preceded by plasmoria).
ELECTRONOGRAM CELLULAR CYTOLYSIS IN CHRONIC ACTIVE HEPATITIS B (DEMONSTRATION)
MICROPRODUCTION №149 BIOPTAT OF BRONCH IN BRONCHIAL ASTHMA (HEM.-EOZ.)
In the lumen of the bronchus, a layered secret is determined, consisting of eosinophs and flattened epithelium (cylindrical epithelium). The basement membrane of the mucous membrane is thickened. The lamina propria is infiltrated by mast cells, lymphocytes, macrophages, and plasma cells. Marked hypersecretion of the mucous glands (enlarged, secreted). Vessels are plethoric, dilated, noted perivascular edema. Sclerosis of the submucosa. Marked hypertrophy of muscle fibers. Additional staining - tuloidine blue: mast cells okr in lilac color.
MICRO PREPARATION №81 EXTRACAP. PRODUCTIVE GLOMERULONEPHRITIS (HEM.-EOZ.)
Antibodies damage the glomeruli. The main percentage is extracapillary (Shumlyansky's capsule - outer leaf => in the form of crescents). The glomeruli are enlarged, marked proliferation. Fibrinoid necrosis of individual loops was noted. Deposition in the glomerulus of fibrin. In the epithelium of the proximal tubules - hyaline-drop dystrophy, edema.
MICROSLOPE № 222
The glomeruli are enlarged, the capillary membrane bases are bare, thickened, look like "wire loops". Fiber necrosis of individual loops, karyorrhexis is characteristic; the presence of hematoxylin bodies (hyalinosis at the site of fibrinoid necrosis). In the epithelium of the proximal tubules - hydropic dystrophy. Thrombi are visible in the capillaries.
MICRO PREPARATION №228(B) CHRONIC VIRAL ACTIVE HEPATITIS B (HEM.-EOS.)
Sclerosis, abundant infiltrate by leukocytes, macrophages. Hepatocytes in the state of necrosis and apoptosis. Noted hydropic dystrophy of hepatocytes.
MICROPRODUCTION №150 THYMUS GLAND WITH MYASTENIA
There is an increase in the number of lymphocytes and hyperplasia of Hassal's bodies (increased in volume).
MICRO PREPARATION №153 HASHIMOTO'S GOITER (HEM.-EOZ.)
The parenchyma of the gland secretes an infiltrate composed of macrophages and lymphocytes. In some places forms follicles with reproduction centers. Preserved thyroid follicles are lined with cells with eosinophageal granular cytoplasm
MICROSLOPE No. 20 SAGA SPLEEN (HEM.-EOZ.)
Amyloid is excellent in the intima of arteries and in follicles. Amyloid appears as shapeless eosinophils, hyaline-like masses.
MICRO PREPARATION №20 (B) staining CONGO-ROT
Amyloid brick red. Glow mark in the form of a green apple
MICRO PREPARATION №19 SEBLY SPLEEN
Amyloid overlay was noted in the red and white pulp. Displacement of cellular elements occurs
GREAT PIECE KIDNEY
Increased in volume
Flabby
The surface is smooth, variegated
On the cut motley, yellow with red specks
MACRO PREPARATION GOITER HASHIMOTO
The thyroid gland is asymmetrical
dense
The surface is finely-coarsely bumpy
Brownish in section, consisting of many nodes of various diameters (bur-ser), separated by layers of whitish tissue
Encounters fine-grained areas with pale gray patches
Rubber consistency
MACRO PREPARATION SAGA SPLEEN
Increased in size
On the cut, it is brownish-cyanotic with whitish-gray diff patches, in the form of Sago grains.
MACRO PREPARATION SEBLY SPLEEN
Increased in size (much larger than the sago)
dense
The surface is smooth
On the cut, brownish with a greasy sheen
Nutmeg liver is a consequence of chronic congestive venous plethora of internal organs. This condition affects not only the digestive system, but also the heart, lungs, kidneys and brain.
Classification
Morphologically, there are three stages of changes that occur in the liver as the disease progresses:
- Nutmeg liver: against the background of fatty degeneration of cells (yellow), dilated vessels are visible (dark red).
- Congestive fibrosis: Tissue is denser due to ingrowth of connective tissue. Blood impregnates the parenchyma of the organ, and foci of sclerosis also appear.
- Cardiac cirrhosis: the surface of the organ becomes bumpy.
Etiology
Violation of the outflow of blood from the portal vein system leads to the formation of such a phenomenon as nutmeg liver. The causes of stagnation are dysfunction of the ventricles of the heart and a decrease in venous return. These are manifestations of heart failure, and often they accompany coronary heart disease. Increased pressure in the venous system, as well as the accumulation and stagnation of blood in the vessels, prevent effective blood flow in the organs.
Epidemiology
The disease is not related to gender or age. But statistically, men of senile and advanced age most often suffer from it. Most often, only at an autopsy can it be determined that the patient had nutmeg liver. Pathoanatomy can provide answers to questions that interest the attending physician. To do this, the organs are not only visually assessed, but also sent for
Risk factors for the development of liver pathology are physical inactivity, malnutrition, bad habits, a history of heart disease, and advanced age.
Clinic
In most cases, the symptoms of heart failure dominate the clinical picture of the disease, so the patient may not suspect that he has problems with the liver. Nutmeg liver, like any other cirrhosis, is manifested by pain in the right hypochondrium, yellowness of the skin and mucous membranes, swelling in the legs at the end of the day, ascites (accumulation of fluid in the abdominal cavity). But these are all indirect signs. A 100% diagnosis can only be made after an autopsy, because none of the modern imaging methods can show whether the organ resembles nutmeg. The liver on palpation will be dense, its edge is rounded and protrudes from under the costal arch.
Diagnostics
In order to make a diagnosis of "chronic passive venous plethora", it is necessary:
1. Confirm the presence of heart failure (instrumental or physical examination):
- chest x-ray (indicates a change in the heart, in the lungs, or the presence of an effusion);
- Doppler study of the heart and inferior vena cava (to identify the causes of heart disease);
- CT or MRI;
2. Conduct laboratory tests such as a biochemical blood test and:
- bilirubin in the blood rises;
- transaminases moderately increase (ALT, AST);
- an increase in the content of alkaline phosphatase;
- decreased albumin and prolonged clotting time.
3. To resort to instrumental diagnostics in order to morphologically establish the fact of liver degeneration. Such studies include:
- laparocentesis (aspiration of free fluid from the abdominal cavity) to determine the causes of ascites;
- puncture biopsy (to confirm the diagnosis of "nutmeg liver", a micropreparation can be made during the patient's lifetime).
Complications
Nutmeg liver and the cardiac cirrhosis that causes it do not affect the outcome of heart failure. Cases in which acute liver failure caused death are isolated and cannot be considered indicative. Blood clotting disorders are also quite rare, although not unprecedented. Some experts suspect that there is a link between cirrhosis of the liver and the occurrence of its malignant neoplasms, but this theory has not yet been proven.
Treatment
Drug therapy should be aimed at eliminating the underlying disease, that is, heart failure. And cirrhosis itself has no specific therapy. In addition, the patient is advised to follow a salt-restricted diet and change his daily routine in order to get good sleep, be in the fresh air and get enough physical activity. These simple manipulations will help reduce blood pressure in the main vessels, including
Symptomatic therapy consists in taking diuretics (to reduce the number of as well as beta-blockers and ACE inhibitors (to normalize the work of the heart).
Surgical treatment is usually not performed. This is associated with a great risk for the patient and does not justify itself. Sometimes the doctor may decide to bypass the intrahepatic portal vein, but this can lead to serious heart failure of the right ventricular type and pulmonary edema due to a sharply increased venous return.
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Rice. 5.1. Gross preparations. Chronic venous plethora of the liver (nutmeg liver). The liver is enlarged in volume, dense consistency, the capsule is tense, smooth, the anterior edge of the liver is rounded. On the section, the liver tissue appears mottled due to the alternation of small foci of red, maroon and yellow, resembling the pattern of nutmeg on the section. Liver veins are dilated, plethoric. Insert - nutmeg
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Rice. 5.2. Micropreparations. Chronic venous plethora of the liver (nutmeg liver): a - pronounced plethora of the central sections of the lobules (up to the appearance of "blood lakes" in the center of the lobules with necrosis of hepatocytes around the central veins), normal blood supply in the outer third. Blood stasis does not extend to the periphery of the lobules, since at the border of the outer and middle third of the lobules, blood from the branches of the hepatic artery flows into the sinusoids. Arterial blood pressure interferes with the retrograde spread of venous blood. Fatty degeneration of hepatocytes of the outer third of the hepatic lobules; b - fatty degeneration of hepatocytes of the outer third of the hepatic lobules, vacuoles with lipids are stained with Sudan III in orange-yellow color, stained with Sudan III; a - ×120, b - ×400
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Rice. 5.3. electronogram. Nutmeg (congestive, cardiac) fibrosis of the liver; 1 - newly formed collagen fibers, the appearance of a basement membrane in the perisinusoidal space (Disse space) near lipofibroblasts (sinusoid capillaryization) with signs of synthetic activity. From
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Rice. 5.4. macropreparation. Pulmonary edema. Lungs with reduced airiness, full-blooded, a large amount of light, sometimes pinkish, foamy liquid flows from the cut surface due to the admixture of blood. The same foamy liquid fills the lumen of the bronchi
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Rice. 5.5. Gross preparations. Cerebral edema with dislocation syndrome: a - the brain is enlarged, the convolutions are flattened, the furrows are smoothed, the meninges are cyanotic, with full-blooded vessels; b - on the tonsils of the cerebellum and the brain stem, an impression from the wedging into the foramen magnum, petechial hemorrhages along the line of the wedging - dislocation syndrome
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Rice. 5.6. macropreparation. Brown induration of the lungs. The lungs are enlarged in size, of a dense consistency, on a cut in the lung tissue - multiple small inclusions of brown hemosiderin, gray layers of connective tissue in the form of a diffuse mesh, proliferation of connective tissue around the bronchi and blood vessels (chronic venous plethora, local hemosiderosis and sclerosis of the lungs). Black foci are also visible - anthracosis
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Rice. 5.7. Micropreparations. Brown induration of the lungs; a - when stained with hematoxylin and eosin, freely lying granules of the brown pigment hemosiderin are visible, the same granules in cells (sideroblasts and siderophages) in the alveoli, interalveolar septa, peribronchial tissue, lymphatic vessels (also in the lymph nodes of the lungs). Plethora of interalveolar capillaries, thickening of interalveolar septa and peribronchial tissue due to sclerosis; drug N.O. Kryukov; b - when stained according to Perls (Perls reaction), hemosiderin pigment granules are stained in a bluish-green color (Prussian blue); ×100
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Rice. 5.8. macropreparation. Cyanotic induration of the kidneys. The kidneys are enlarged in size, dense consistency (induration), with a smooth surface, on the section of the cortex and medulla are wide, evenly full-blooded, cyanotic (cyanotic)
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Rice. 5.9. macropreparation. Cyanotic induration of the spleen. The spleen is enlarged, of a dense consistency (induration), with a smooth surface, the capsule is tense (slightly pronounced hyalinosis of the spleen capsule is also visible - the “glazed” spleen). On section, the spleen tissue is bluish (cyanotic) with narrow grayish-white layers
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Rice. 5.10. Acute and chronic (congestive dermatitis) venous plethora of the lower extremities; a - the lower limb is enlarged in volume, edematous, cyanotic (cyanotic), with petechial hemorrhages - acute venous plethora in acute thrombophlebitis of the veins of the lower extremities; b - the lower limb is enlarged in volume, edematous, cyanotic (cyanotic), the skin is thickened with severe hyperkeratosis - trophic disorders - congestive dermatitis in chronic venous plethora due to chronic heart failure (b - photo by E.V. Fedotov)
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Rice. 5.11. macropreparation. Hemorrhage in the brain (intracerebral non-traumatic hematoma). In the region of the subcortical nuclei, the parietal and temporal lobes of the left hemisphere, in place of the destroyed brain tissue, there are cavities filled with blood clots; due to the destruction of the walls of the left lateral stomach - a breakthrough of blood into its anterior and posterior horns. Throughout the rest of the brain architectonics is preserved, its tissue is edematous, the grooves are smoothed, the convolutions are flattened, the ventricles are dilated, and there is an admixture of blood in the cerebrospinal fluid. Intracerebral hematoma can be non-traumatic (with cerebrovascular disease) or traumatic (with traumatic brain injury)
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Rice. 5.12. Micropreparation. Hemorrhage in the brain (intracerebral non-traumatic hematoma). In the focus of hemorrhage, the brain tissue is destroyed, structureless, replaced by blood elements, primarily erythrocytes, partially lysed. Around the foci of hemorrhages - perivascular and pericellular edema, dystrophic changes in neurons, accumulation of sideroblasts and siderophages, proliferation of glial cells; ×120
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Rice. 5.13. macropreparation. Acute erosions and ulcers of the stomach. In the gastric mucosa, there are multiple small, superficial (erosions) and deeper, capturing the submucosal and muscular layers of the stomach wall (acute ulcers), rounded defects with soft, even edges and a brownish-black or gray-black bottom (due to hydrochloric hematin, which is formed from erythrocyte hemoglobin under the action of hydrochloric acid and gastric juice enzymes). At the bottom of some acute erosions and ulcers - blood clots (occurring gastric bleeding)
