Suppurative Inflammation


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Suppurative Inflammation

  1. 1. Purulent inflammation: Inflammation resulting in large amount of pus, which consists of neutrophils, dead cells, and fluid. Infection by pyogenic bacteria such as staphylococci is characteristic of this kind of inflammation. Large, localised collections of pus enclosed by surrounding tissues are called abscesses. The pus which is the end product of this type of inflammation a whitish-yellow, yellow or yellow-brown exudate produced by vertebrates during inflammatory pyogenic bacterial infections. An accumulation of pus in an enclosed tissue space is known as an abscess, while a visible collection of pus within or beneath the epidermis is known as a pustule or pimple. Pus is produced from the dead and living cells which travel into the intercellular spaces around the affected cells. Examples for this type of inflammation: 1) Suppurative appendicitis 2) Suppurative otitis 3) Post streptococcal glomerulonephritis 4) Pyelonephritis 5) Brain abscess 6) Purulent meningitis 7) Suppurative lymphadenitis
  2. 2. 1) Suppurative appendicitis Appendicitis is a condition characterized by inflammation of the appendix. It is a medical emergency. All cases require removal of the inflamed appendix. Signs and symptoms of acute appendicitis can be classified into two types, typical and atypical. The typical history includes pain starting centrally (periumbilical) before localizing to the right iliac fossa (the lower right side of the abdomen); On the basis of experimental evidence, acute appendicitis seems to be the end result of a primary obstruction of the appendix lumen. Once this obstruction occurs the appendix subsequently becomes filled with mucus and swells, increasing pressures within the lumen and the walls of the appendix, resulting in thrombosis and occlusion of the small vessels, and stasis of lymphatic flow. Rarely, spontaneous recovery can occur at this point. As the former progresses, the appendix becomes ischemic and then necrotic. As bacteria begin to leak out through the dying walls, pus forms within and around the appendix (suppuration). The end result of this cascade is appendiceal rupture (a 'burst appendix') causing peritonitis, which may lead to septicemia and eventually death. Diagnosis is based on patient history (symptoms) and physical examination backed by an elevation of neutrophilic white blood cells. Atypical histories often require imaging with ultrasound and/or CT scanning. A pregnancy test is vital in all women of child bearing age, as ectopic pregnancies and appendicitis present with similar symptoms. The consequences of missing an ectopic pregnancy are serious, and potentially life threatening. Furthermore the general principles of approaching abdominal pain in women (in so much that it is different from the approach in men) Gross picture:
  3. 3. An exemplary case of acute appendicitis in a 10-year-old boy. The organ is enlarged and sausage-like (botuliform). This longitudinal section shows red inflamed mucosa with an irregular luminal surface. Diagnosed and removed early in the course of the disease, this appendix does not show late complications, like transmural necrosis, perforation, and abscess formation. Microscopic picture: A. Brief Descriptions،G
  4. 4. 1. Cause : It is associated with obstruction (fecalith, gallstone, tumor or ball of worms). 2. Abscess formation within the wall and foci of suppurative necrosis in the mucosa. B. Gross Findings،G 1. Congested & swollen. 2. Dilated lumen contain pus, or a fecalith, or both. 3. Serosa coated with fibrin, fibrinopurulent exudate, or pus. C. Micro Findings،G 1. Mucosal ulceration & infiltration by PMNs, eosinophils, plasma cells, &lymphocytes throughout all layers & frequently into serosa. 2. More advanced stage, the inflammatory process involved the full thickness of wall,with partial necrosis or infarction of wall (perforated areas). D. Others: 1. Classified into acute, suppurative, & gangrenous stages. site acute suppurative gangrenous mucosa neutrophils suppurative hemorrhagic necrosis ulceration wall neutrophils suppurative green-black necrosis necrosis serosa congested blood purulent green-black vessels exudates necrosis fibrinous exudates E. Reference،G 1. Robbins Pathologic Basis of Disease, 6th ed. P.839-840. ،@ 2) Pyelonephritis is an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney. If the infection is severe, the term "urosepsis" is used interchangeably (sepsis being a systemic inflammatory response syndrome due to infection). It requires
  5. 5. antibiotics as therapy, and treatment of any underlying causes to prevent recurrence. It is a form of nephritis. It can also be called pyelitis. Acute pyelonephritis is an exudative purulent localized inflammation of the renal pelvis (collecting system) and kidney. The renal parenchyma presents in the interstitium abscesses (suppurative necrosis), consisting in purulent exudate: neutrophils, fibrin, cell debris and central germ colonies (hematoxylinophils). Tubules are damaged by exudate and may contain neutrophil casts. In the early stages, glomeruli and vessels are normal. Gross pathology often reveals pathognomonic radiations of hemorrhage and suppuration through the renal pelvis to the renal cortex. Chronic infections can result in fibrosis and scarring. Causes: Most cases of "community-acquired" pyelonephritis are due to bowel organisms that enter the urinary tract. Common organisms are E. coli (70-80%) and Enterococcus faecalis. Hospital-acquired infections may be due to coliforms and enterococci, as well as other organisms uncommon in the community (e.g. Klebsiella spp., Pseudomonas aeruginosa). Most cases of pyelonephritis start off as lower urinary tract infections, mainly cystitis and prostatitis. Untreated infection may spread and leads to gram negative septicemia with shock. In severe infection: - Renal papillary necrosis caused by inflammatory thrombosis of vasa recta supplying the papillae. Perinephric abscess - Infection spreads to perinepheric fat. - Pyonephrosis (Distension of pelvicalyceal system with pus) maybe present.
  6. 6. Acute pyelonephritis is an exudative purulent localized inflammation of kidney and renal pelvis. The renal parenchyma presents in the interstitium abscesses (suppurative necrosis), consisting in purulent exudate (pus): neutrophils, fibrin, cell debris and central germ colonies (hematoxylinophils). Tubules are damaged by exudate and may contain neutrophil casts. In the early stages, glomeruli and vessels are normal. (Hematoxylin- eosine, ob. x10) Purulent meningitis Infectious disease that involves the inflammation of the meninges, which often extends to the brain and ventricles, causing ventriculitis.
  7. 7. Etiology: Bacteria, fungi, rarely parasites, clinical Headache, stiff neck or back.