Download Interstitial inflammation HEART

Interstitial Inflammation I.
Heart, blood vessels, breast,
salivary glands, pancreas, liver.
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discussion
Interstitial inflammation
HEART
• ENDOCARDIUM
• MYOCARDIUM
• (PERICARDIUM)
Interstitial inflammation
HEART
• RHEUMATIC FEVER
• INFECTIOUS
ENDOCARDITIS
Interstitial inflammation
HEART
RHEUMATIC
FEVER
(febris
rheumatica)
acute,
non-infected,
immune-conditioned
inflammation with a tendency to relapse
beta-hemolytic streptococcus (pharyngitis or
tonsilitis)
onset of symptoms within weeks after infection
autoimmune diseases (cross-reactions against
streptococci Ag and Ag of heart tissue)
Interstitial inflammation
HEART
• RHEUMATIC FEVER Clinics:
acute febrile disease with disabilities of large
joints (polyarthritis migrans)
Erythema marginatum (skin)
rheumatic knots under the skin
chorea minor (meningoencephalitis)
heart disease (the most serious -LATE
EFFECTS)
Interstitial inflammation
HEART
• RHEUMATIC FEVER morphology:
acute heart disease - PANKARDITIS
-pericarditis (serous or serofibrinózní)
-myocarditis
microscopic nodules in the interstitium and along the
veins – ASCHOFF nodules, dilation (myocarditis)
bearing in the center of fibrinoid necrosis COLLAGEN,
some inflammation (neutrophilic granulocytes,
histiocytes later – ASCHOFF cells. ANIČKOV cells)
later change of ASCHOFF nodules onto small scars
-endocarditis (mitral and aortic valve) - edema and
fibrinous growths (endocarditis verucosa)
chronic heart disease - valvular
fibrohyalin valve thickening, adhesions among
commissures, leaflet retraction, calcifications,
pathological vascularization
insufficience, stenosis, combined defect
Interstitial inflammation
HEART
akutní
reumatismus
Interstitial inflammation
HEART
porevmatická
srdeční vada
Interstitial inflammation
HEART
• Infectious endocarditis
-presence of thrombi with infectious agents on
the endocardium, usually valvular
-bacteria, fungi
required penetration inf. agents into the blood
wedge.
• Acute and subacute FORM
predilection: affecting the damaged valve
(congen. malformation, postrheumatic disability,
previous heart surgery), recently increasing
disability of undamaged valve (virulent agents,
immunocompromised, IV drug users-right sided
valves, permanent catheters)
- 90% left-side involvement
result - growths, calcification, perforations,
defects of chordae tendineae
Dg .- CULTIVATION!
Záněty intersticiální
SRDCE -ENDOKARD
bakteriální endokarditis
Interstitial inflammation
HEART - MYOCARDIUM
• myocarditis - infrequent, younger
individuals, cardiomyocyte necrosis,
often heal without sequelae
noninfectious
- idiopathic (giant cell, Fiedler)
- infectious
viral (adenoviruses, enteroviruses)
bacterial (Lyme)
fungal
parasitic (Toxoplasmosis, Chagas
disease)
Interstitial inflammation
BLOOD VESSELS
• ANGIITIS (aortitis, arteriitis, arteriolitis, vasculitis,
phlebitis)
1) allergic vasculitis (heterogeneous - SLE, RA, drug reactions,
infections, Henoch-Schönlein purpura - immune complexes,
Goodpasture's syndrome. - direct action of antibodies,
Wegener's granulomatosis - no deposition of immune
complexes PAUCIIMUNNE, ANCA antibodies)
Micro: fibrinoid necrosis of vessel walls, dusting,
leukocytoclastic change
2) polyarteritis nodosa - aneurysm, rosary, various histological
changes in aging, Kawasaki disease - in children, often the
coronary arteries
3) granulomatous inflammation - temporal arteritis (giant
cells, thrombosis), Takayasu (pulseless) disease
4) OTHER
Bűrger disease - DK veins, fibrosis neurovascular bundle,
ischemia, smokers
luetic aortitis - scarring of the media
Interstitial inflammation
SALIVARY GLANDS
• sialoadenitis
- s. acuta - bacteria, pus. inflammation
- s. chronica - fibrosis (Küttner tumor), stone formation
- epidemic parotitis (paramyxovirus) lymfoplasmocytic
infiltration, eosinophils
- cytomegalovirus p.
- s. autoimmune (Sjögren's syndrome.) - prim (sicca
syndrome), secondary (RA, SLE ...) – apoptosis, epithelial
hyperplasia, debris, fibrosis, inflammatory infiltration
lymfoplazmocytic
Interstitial inflammation
PANCREAS
• exocrine – pancreatitis
acute
- a. non-infectious interstitial (scarlet fever, measles, sepsis,
CMV) – serous inflammation
- a. interstitial suppurative (abscesses, phlegmone)
- acute hemorrhagic pancreatitis (lithiasis, alcoholism),
autodigesce, shock, fat necrosis (Balser). SEC. INFECTION,
ev. survival and organization, pseudocyst formation
chronic - subclinical, lithiasis, alcoholism, tissue fibrosis,
calcification
• endocrine - insulitis
break
Interstitial inflammation
LIVER
1) liver abscesses
2) hepatitis (inflammation of
the parenchyma)
3) granulomatous inflammation
4) inflammation of the
intrahepatic bile ducts
Interstitial inflammation
LIVER
1. liver abscesses
acute X chronic
- cholangiogenic (ascending)
- metastatic (portal and
central pyemie)
DO NOT confuse with cysts
Interstitial inflammation
LIVER
2. hepatitis (inflammation of
the parenchyma)
diffuse interstitial nonpurulent inflammation of liver
damaging mainly hepatocytes
(X cholangoitis)
Interstitial inflammation
LIVER
2. hepatitis (inflammation of the
parenchyma)
Acute (less than 6 months
duration, without microscopically
fibrosis)
- hepatotropic viruses (A, B, D, E)
- autoimmune hepatitis
- other (Wilson disease, drugs,
HSV)
Interstitial inflammation
LIVER
2) hepatitis (inflammation of the parenchyma)
CHRONIC (6 or more months duration, the
risk of transition to fibrosis and cirrhosis)
HISTOLOGICAL DETERMINATION OF
INFLAMMATION ACTIVITY (biopsy)
- hepatotropic viruses (B and C)
- autoimmune hepatitis (autoantibodies SMA /
ASMA, ANA, alpha actin ...)
- other (PBC, PSC, m. Wilson, drugs, deficiency
of α-1 AT, cryptogenic)
Interstitial inflammation
LIVER
2) hepatitis (inflammation of the
parenchyma)
– HSV, zoster, EBV, CMV
– leptospirosis (Weil disease)
Interstitial inflammation
LIVER
3) granulomatous inflammation
- part of other damage
- TB
- sarcoidosis
Interstitial inflammation
LIVER
4) inflammation of the intrahepatic bile
ducts
PBC - chronic idiopathic inflammation of
the small bile ducts, chronic. cholestasis
with progression to cirrhosis. Granulomas
bound to bile ducts, duktopenia, serologic
tests (animitochondrial antibodies) middle
aged women
PSC - chronic. progress. inflammation of
the bile ducts, scarring, association with
ulcerative colitis
Interstitial inflammation
MAMMA
• peripartu mastitis (s.
aureus)
• granulomatous lobular
mastitis (unknown
aetiology)
• other (sarcoidosis,
fungi, parasitic, silica….)
discussion
Thank you for your
attention!