Topic 8♥️

Question: What is inflammation (воспаление)?

Answer: A typical vascular-mesenchymal reaction (типовая сосудисто-мезенхимальная реакция) developing in response to tissue damage (повреждение тканей), aimed at removing the damaging agent and restoring tissue integrity (удаление разрушающего агента и восстановление целостности тканей) — i.e., it has a protective-adaptive character (защитно-приспособительный характер).

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Question: What are the three consecutive phases of inflammation (три последовательные фазы)?

Answer: 1) Alteration (альтерация); 2) Exudation (экссудация); 3) Proliferation of hematogenous and histiogenic cells (пролиферация гематогенных и гистиогенных клеток).

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Question: What two forms of inflammation are distinguished based on the predominance of the exudative or proliferative phase?

Answer: Exudative (экссудативное) and proliferative/productive (пролиферативное/продуктивное) inflammation.

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Question: What underlies the effects of inflammation?

Answer: The action of biologically active substances (биологически активные вещества).

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CLINICAL-ANATOMICAL FORMS OF EXUDATIVE INFLAMMATION (КЛИНИКО-АНАТОМИЧЕСКИЕ ФОРМЫ ЭКССУДАТИВНОГО ВОСПАЛЕНИЯ)

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SEROUS INFLAMMATION (СЕРОЗНОЕ ВОСПАЛЕНИЕ)

Question: What is serous inflammation (серозное воспаление)?

Answer: Inflammation characterized by a light, cloudy exudate (светлый, мутноватый экссудат) in which fluid predominates and there are few formed elements — leukocytes (мало форменных элементов — лейкоцитов).

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Question: How does serous exudate differ from transudate (отёчная жидкость)?

Answer: By higher specific gravity (более высокий удельный вес) and protein content (> 2%) (содержание белка > 2 %).

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Question: Where does serous inflammation most often occur?

Answer: In serous cavities (серозные полости), mucous and cerebral membranes (слизистые и мозговые оболочки), less often in the skin (кожа).

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Question: What is the outcome of serous inflammation?

Answer: Favorable (благоприятный).

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FIBRINOUS INFLAMMATION (ФИБРИНОЗНОЕ ВОСПАЛЕНИЕ)

Question: What is fibrinous inflammation (фибринозное воспаление)?

Answer: Inflammation developing in areas of damage to mucous and serous membranes (слизистые и серозные оболочки), where high-molecular-weight protein — fibrinogen (крупномолекулярный белок — фибриноген) penetrates from blood plasma and turns into fibrin (фибрин) in zones of tissue necrosis.

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Question: How does alteration always manifest in fibrinous inflammation?

Answer: As necrosis (некроз).

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Question: What two types of fibrinous inflammation are distinguished on mucous membranes?

Answer: Croupous (крупозное) — with superficial thin films (поверхностные тонкие плёнки); diphtheritic (дифтеритическое) — with thick films (толстые плёнки) involving deeply necrotized tissues (глубоко некротизированные ткани).

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Question: What determines the thickness of films in fibrinous inflammation?

Answer: The depth of necrosis (глубина некроза) and the type of epithelium (вид эпителия).

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Question: In zones of which epithelium does croupous inflammation occur, and what is its characteristic?

Answer: In zones of columnar epithelium (цилиндрический эпителий); a thin film forms on the surface of the mucous or serous membrane, loosely connected (непрочно связана) to underlying tissues.

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Question: In zones of which epithelium does diphtheritic inflammation occur, and what is its characteristic?

Answer: In zones of stratified squamous epithelium (многослойный плоский эпителий); a thick film forms, firmly connected (плотно связана) to tissues, and inflammation involves deeply necrotized tissues.

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Question: What are the outcomes of croupous inflammation on mucous membranes?

Answer: After detachment of the films, the defects are superficial (поверхностные).

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Question: What are the outcomes of diphtheritic inflammation?

Answer: The film detaches with difficulty (отделяется с трудом), ulcerative defects (язвенные дефекты) form; scars and strictures (рубцы и стриктуры — connective tissue bands narrowing the organ lumen) are characteristic.

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Question: What is fibrinous pericarditis called and why?

Answer: "Hairy heart" («волосатое сердце»).

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Question: What are the causes of fibrinous pericarditis (причины фибринозного перикардита)?

Answer: 1) Uremia (уремия — intoxication with nitrogenous wastes that, released by serous membranes, cause aseptic inflammation); 2) Rheumatism (ревматизм); 3) Spread of fibrinous inflammation from adjacent tissues (переход с прилежащих тканей), e.g., pleura in pneumonia.

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PURULENT INFLAMMATION (ГНОЙНОЕ ВОСПАЛЕНИЕ)

Question: What is purulent inflammation (гнойное воспаление)?

Answer: Inflammation in which large numbers of band neutrophils (ПЯЛ — палочкоядерные лейкоциты) leave the vascular bed; ПЯЛ disintegrate and damage tissue — it begins to melt (расплавляться).

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Question: What is pus (гной)?

Answer: Disintegrated ПЯЛ, necrotic detritus, and bacteria (распавшиеся ПЯЛ, некротический детрит и бактерии).

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Question: What does purulent exudate look like?

Answer: Cloudy, green or yellow (мутный, зелёный или жёлтый) depending on the causative agent.

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Question: What clinical-anatomical forms of purulent inflammation are distinguished?

Answer: 1) Abscess (абсцесс); 2) Furuncle (фурункул); 3) Carbuncle (карбункул); 4) Phlegmon (флегмона); 5) Empyema (эмпиема); 6) Fistula (свищ); 7) Natetchnik (натёчник).

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Question: What is an abscess (абсцесс)?

Answer: Limited inflammation (ограниченное воспаление) with formation of a cavity filled with pus (полость, в которой образуется гной).

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Question: What is a furuncle (фурункул)?

Answer: An abscess of the skin in the area of a hair follicle and its associated sebaceous gland (абсцесс кожи в области волосяного фолликула и связанной с ним сальной железы).

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Question: What is a carbuncle (карбункул)?

Answer: Several merged furuncles (несколько слившихся фурункулов).

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Question: What is a phlegmon (флегмона)?

Answer: Unlimited, spreading purulent inflammation (неограниченное, распространяющееся гнойное воспаление) of adipose tissue or fascial sheaths (жировая клетчатка или фасциальные влагалища).

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Question: What is an empyema (эмпиема)?

Answer: Accumulation of pus in an anatomical cavity (скопление гноя в анатомической полости) — pleura, appendix, gallbladder.

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Question: What is a fistula (свищ)?

Answer: A canal lined with granulation tissue (канал, выстланный грануляционной тканью) connecting a focus of purulent inflammation with the external environment (внешняя среда).

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Question: What is a natetchnik (натёчник)?

Answer: Passive flow of purulent exudate along interfascial spaces (пассивное стекание гнойного экссудата по межфасциальным щелям).

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PUTREFACTIVE (ICHOROUS) INFLAMMATION (ГНИЛОСТНОЕ/ИХОРОЗНОЕ ВОСПАЛЕНИЕ)

Question: What is putrefactive (ichorous) inflammation?

Answer: Inflammation arising when putrefactive bacteria (гнилостные бактерии) enter purulent detritus.

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HEMORRHAGIC INFLAMMATION (ГЕМОРРАГИЧЕСКОЕ ВОСПАЛЕНИЕ)

Question: What is hemorrhagic inflammation (геморрагическое воспаление)?

Answer: Inflammation in which erythrocytes (эритроциты), which lack active transport systems, leave the vascular bed due to increased vascular permeability (повышение проницаемости сосудов).

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Question: How does hemorrhagic exudate resemble blood and how does it differ from it?

Answer: It resembles blood, differing from hemorrhage by the addition of leukocytes (присоединение лейкоцитов).

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Question: In what diseases does hemorrhagic inflammation occur?

Answer: In influenza (грипп), plague (чума), anthrax (сибирская язва).

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CATARRHAL INFLAMMATION (КАТАРАЛЬНОЕ ВОСПАЛЕНИЕ)

Question: What is catarrhal inflammation (катаральное воспаление)?

Answer: Inflammation occurring only on mucous membranes (только на слизистых оболочках), in which mucus (слизь) is mixed with serous or purulent exudate.

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Question: What types of catarrhal inflammation are distinguished?

Answer: Serous-catarrhal (серозно-катаральное) and purulent-catarrhal (гнойно-катаральное).

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MIXED FORMS (СМЕШАННЫЕ ФОРМЫ)

Question: What mixed forms of inflammation are distinguished?

Answer: Serous-purulent (серозно-гнойное), serous-fibrinous (серозно-фибринозное), purulent-hemorrhagic (гнойно-геморрагическое), fibrinous-hemorrhagic (фибринозно-геморрагическое).

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Question: Which mixed form of inflammation does NOT occur and why?

Answer: Fibrinous-catarrhal inflammation does not occur, because in fibrinous inflammation necrosis of the mucosa (некроз слизистой) occurs.

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OUTCOMES OF ACUTE INFLAMMATION (ИСХОДЫ ОСТРОГО ВОСПАЛЕНИЯ)

Question: What does resolution (рассасывание) mean as an outcome of acute inflammation?

Answer: Complete restoration of normal tissue structure (полное восстановление нормальной структуры ткани); observed when tissue changes are small and cellular changes are reversible (обратимые).

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Question: When does healing by scar (заживление рубцом) occur as an outcome of acute inflammation?

Answer: With severe tissue destruction (сильное разрушение ткани), if complete regeneration does not occur; healing proceeds via fibrosis (фиброз).

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Question: When does the acute process progress to suppuration (нагноение)?

Answer: When pyogenic bacteria (гноеродные бактерии) cause acute inflammation leading to pronounced tissue necrosis (выраженный некроз тканей).

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Question: What happens when acute inflammation transitions to chronic (хроническое воспаление)?

Answer: The processes of alteration, exudation, and proliferation occur simultaneously (одновременно).

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PRODUCTIVE (CHRONIC) INFLAMMATION (ПРОДУКТИВНОЕ/ХРОНИЧЕСКОЕ ВОСПАЛЕНИЕ)

Question: When is chronic inflammation spoken of?

. Продуктивным (хроническим) воспалением является длительно тельно протекающая ответная реакция организма на патогеннв раздражители биологической, неорганической или мунной природы, персистирующие в тканях за счет их

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Question: What factors contribute to the development of chronic inflammation?

Answer: 1) Presence of a specific type of causative agent (определённый вид возбудителя — tubercle bacillus, pale treponema, fungi, parasites); 2) prolonged action of potentially toxic exogenous or endogenous factors (длительное действие потенциально токсичных факторов — silica particles → silicosis, lipoprotein deposition in vessel intima → atherosclerosis); 3) rheumatic diseases (ревматические болезни — rheumatoid arthritis, systemic lupus erythematosus).

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Question: What is observed in chronic inflammation?

Answer: 1) Infiltration by mononuclear cells (инфильтрация мононуклеарными клетками); 2) tissue destruction due to activity of cellular elements (разрушение тканей); 3) signs of regeneration via connective tissue growth and angiogenesis (ангиогенез).

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Question: Which cells are the main elements in chronic inflammation?

Answer: Macrophages (макрофаги), lymphocytes (лимфоциты), plasma cells (плазматические клетки), fibroblasts (фибробласты), and eosinophils (эозинофилы).

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Question: What is productive (chronic) inflammation?

Answer: A long-lasting response (длительно протекающая ответная реакция) to pathogenic stimuli of biological, inorganic, or immune nature (биологической, неорганической или иммунной природы), persisting in tissues due to their slow destruction by cells migrating from blood or multiplying in the inflammation zone.

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Question: Into what forms are all forms of productive inflammation divided?

Answer: Interstitial (интерстициальное), granulomatous (гранулематозное), inflammation around animal parasites and foreign bodies (вокруг животных паразитов и инородных тел), inflammation with polyp and pointed condyloma formation (с образованием полипов и остроконечных кондилом).

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INTERSTITIAL INFLAMMATION (ИНТЕРСТИЦИАЛЬНОЕ ВОСПАЛЕНИЕ)

Question: What is interstitial inflammation (интерстициальное воспаление)?

Answer: Formation of a cellular infiltrate in the organ stroma (клеточный инфильтрат в строме органа — myocardium, liver, kidneys, lungs); externally the organ changes little; the infiltrate consists of young cambial cells (молодые камбиальные клетки).

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Question: What does progression of interstitial inflammation lead to?

Answer: Sclerosis (склероз).

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GRANULOMATOUS INFLAMMATION (ГРАНУЛЕМАТОЗНОЕ ВОСПАЛЕНИЕ)

Question: What is granulomatous inflammation (гранулематозное воспаление)?

Answer: Inflammation characterized by formation of granulomas (nodules) (гранулёмы — узелки); a granuloma is a limited focus of productive inflammation (ограниченный очаг продуктивного воспаления).

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Question: What is the basis of granulomatous inflammation?

Answer: Endocytobiosis (эндоцитобиоз) — insufficiency of phagocytosis (недостаточность фагоцитоза).

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Question: What non-infectious forms of granulomatous inflammation are distinguished?

Answer: Dust (пылевидные — silicosis, asbestosis), drug (медикаментозные), foreign body (инородных тел), rheumatoid granulomas (ревматоидные гранулемы).

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Question: What infectious forms of granulomatous inflammation are distinguished?

Answer: Typhus (сыпной тиф), typhoid fever (брюшной тиф), rabies (бешенство), tuberculosis (туберкулёз), syphilis (сифилис), leprosy (лепра), scleroma (склерома), glanders (сап).

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Question: What are the sizes of granulomas and what is located in the center and periphery?

Answer: As a rule, 1–2 mm; in the center — cellular or tissue detritus with the causative agent (клеточный или тканевой детрит с возбудителем); at the periphery — macrophages, epithelioid cells, and giant cells formed by fusion of epithelioid cells or macrophages (symplast — симпласт, containing up to 100 nuclei or more).

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Question: What is a symplast in a granuloma?

Answer: A special form of cells with high metabolic activity (особая форма клеток с высокой метаболической активностью), formed by fusion of epithelioid cells or macrophages and containing up to 100 nuclei or more.

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Question: What is the outcome of granulomas?

Answer: Sclerosis (склероз).

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PRODUCTIVE INFLAMMATION AROUND ANIMAL PARASITES, FUNGI, AND FOREIGN BODIES (ВОСПАЛЕНИЕ ВОКРУГ ЖИВОТНЫХ ПАРАЗИТОВ, ГРИБОВ И ИНОРОДНЫХ ТЕЛ)

Question: What is characteristic of productive inflammation around animal parasites, fungi, and foreign bodies?

Answer: Foreign body giant cells (гигантские клетки инородных тел), epithelioid cells (эпителиоидные клетки), and development of a connective tissue capsule (соединительнотканная капсула).

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Question: What does unilocular echinococcosis (однокамерный эхинококкоз) look like?

Answer: A parasitic cyst (паразитарная киста) containing amber-colored fluid (жидкость янтарного цвета); internally lined by a germinal layer and chitinous membrane (зародышевый слой и хитиновая оболочка), externally has a connective tissue capsule (капсула из соединительной ткани).

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Question: What does multilocular echinococcosis (альвеолококкоз) look like?

Answer: No clear cyst outlines (чётких очертаний кист нет); fields of sclerosis alternate with necrosis (поля склероза чередуются с некрозом), where the chitinous membrane can also be found, appearing in histological preparations as homogeneous eosinophilic rings or bands (гомогенные эозинофильные кольца или ленты).

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Question: How does productive inflammation arise in schistosomiasis (шистосомоз), and what do the eggs look like?

Answer: In response to eggs laid by the female trematode (яйца, откладываемые самкой трематод) along the venous systems of the liver, intestines, or urinary system; eggs are elongated (продолговатую форму) with spines (шипики). Granulomas around them consist mainly of epithelioid cells, lymphocytes, individual multinuclear giant cells, and as a rule include eosinophils (эозинофилы).

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Question: What do fungi look like in tissues during productive inflammation?

Answer: They form drusen (друзы) — colonies with a dark-staining center and radial eosinophilic rays (тёмно-окрашиваемый центр и радиальные эозинофильные лучи); microscopically around the drusen are small abscesses surrounded by granulations with xanthoma cells (ксантомные клетки), giving the granulomas a yellow color (жёлтый цвет).

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PRODUCTIVE INFLAMMATION WITH POLYP AND POINTED CONDYLOMA FORMATION (С ОБРАЗОВАНИЕМ ПОЛИПОВ И ОСТРОКОНЕЧНЫХ КОНДИЛОМ)

Question: Where are polyps and pointed condylomas observed?

Answer: On mucous membranes (слизистые оболочки) and in the adjacent squamous epithelium (граничащий плоский эпителий).

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Question: What is characteristic of polyp formation?

Answer: Proliferation of glandular epithelium (разрастание железистого эпителия) together with cells of the underlying connective tissue (подлежащая соединительная ткань).

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Question: How are pointed condylomas (остроконечные кондиломы) formed?

Answer: When squamous epithelium is located near prismatic epithelium (призматический эпителий), mucous discharge irritates the squamous epithelium (отделяемое слизистых раздражает плоский эпителий) and leads to proliferation of epithelium and stroma, forming papillary structures — pointed condylomas (recently shown that papillomavirus infection — папилломавирусная инфекция — participates in their formation).

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Question: In what prolonged inflammation are such polypoid proliferations observed?

Answer: In prolonged inflammation of the mucous membrane of the nose, stomach, rectum, uterus, vagina (нос, желудок, прямая кишка, матка, влагалище).

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NON-SPECIFIC AND SPECIFIC PRODUCTIVE GRANULOMATOUS INFLAMMATION (НЕСПЕЦИФИЧЕСКОЕ И СПЕЦИФИЧЕСКОЕ)

Question: What is called specific inflammation (специфическое воспаление)?

Answer: Inflammation in which the morphological features of the inflammatory reaction allow a diagnosis without bacteriological examination (морфологические особенности дают возможность поставить диагноз без бактериологического исследования).

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Question: In what diseases does specific inflammation occur?

Answer: In tuberculosis (туберкулёз), syphilis (сифилис), leprosy (лепра), scleroma (склерома), glanders (сап).

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TUBERCULOUS GRANULOMA (ТУБЕРКУЛЁЗНАЯ ГРАНУЛЕМА)

Question: What are the signs of a tuberculous granuloma?

Answer: 1) Caseous necrosis (казеозный некроз) in the center; 2) a rim of epithelioid cells (вал из эпителиоидных клеток) around the necrosis zone; 3) presence of Langhans giant cells (гигантские клетки Лангханса); 4) lymphocytes (лимфоциты) at the periphery; 5) growth of connective tissue (рост соединительной ткани) around the granuloma.

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Question: What is the tuberculous granuloma called and how does it look in miliary tuberculosis?

Answer: Tuberculous tubercle (туберкулёзный бугорок); in miliary tuberculosis — small millet-seed grains 1.5–2 mm (мелкие просовидные зёрна диаметром 1,5–2 мм).

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SYPHILITIC GRANULOMA — GUMMA (СИФИЛИТИЧЕСКАЯ ГРАНУЛЕМА — ГУММА)

Question: In which syphilis does the syphilitic granuloma (gumma) occur?

Answer: In tertiary syphilis (третичный сифилис).

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Question: What are the main morphological characteristics of the syphilitic gumma?

Answer: 1) Gummatous (cheesy) necrosis (клееобразный некроз) in the center; 2) necrosis surrounded by a connective tissue rim (соединительнотканный вал) with many plasma cells (плазматические клетки), lymphoid-cell infiltration (лимфоидно-клеточная инфильтрация), and rare giant cells (редкие гигантские клетки); 3) vasculitis (васкулиты) in the connective tissue capsule of the gumma.

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Question: What two types of gummas are distinguished?

Answer: Large solitary (крупная солитарная), sometimes reaching the size of a chicken egg (куриное яйцо), and small miliary (мелкая милиарная), the size of a millet seed (просяное зерно). Solitary gummas are typical of acquired syphilis (приобретённый сифилис), miliary — of congenital (врождённый).

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Question: What is the outcome of productive inflammation in syphilis?

Answer: Sclerosis (склероз) and colliquative necrosis (колликвационный некроз), the latter turning the gumma into a cheesy focus (клееобразный очаг) — which gave rise to the name gumma.

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LEPROMATOUS GRANULOMA — LEPROMA (ЛЕПРОМАТОЗНАЯ ГРАНУЛЕМА — ЛЕПРОМА)

Question: What is leprosy (лепра)?

Answer: A chronic infectious disease (хроническое инфекционное заболевание) affecting the skin, upper respiratory tract, peripheral nerves (кожа, верхние дыхательные пути, периферические нервы); characterized by foci of productive inflammation in the form of nodules — lepromas (узелки — лепромы).

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Question: What is a leproma (лепрома)?

Answer: Granulomatous tissue (гранулематозная ткань) containing large numbers of macrophages (макрофаги), among which are large cells with fatty vacuoles in the form of balls (большие клетки с жировыми вакуолями в виде шаров), containing cigar-packed leprosy mycobacteria (микобактерии лепры в виде сигар — acid-fast Hansen's bacilli — палочки Хансена) — these cells are called Virchow's lepra cells (лепрозные клетки Вирхова).

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Question: What three clinical-anatomical forms of leprosy are distinguished?

Answer: 1) Lepromatous (лепроматозная); 2) tuberculoid (туберкулоидная); 3) indeterminate (недифференцированная).

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Question: What is the characteristic of the lepromatous form of leprosy?

Answer: Predominant facial involvement in the form of "lion face" («львиная морда»); macrophages contain multiplying bacilli in the form of "cigars" (размножающиеся бациллы в виде «сигар» — imperfect phagocytosis); cellular infiltrates do not reach the epidermis, leaving a "light band" («светлая полоска») beneath it.

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Question: What is the characteristic of the tuberculoid form of leprosy?

Answer: Partial phagocytosis (частичный фагоцитоз) with formation of epithelioid cells and tuberculoid-type tubercles (бугорки типа туберкулоидных) with lymphocytes and giant cells.

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Question: What is the characteristic of the indeterminate form of leprosy?

Answer: Accumulation of lymphocytes around nerve trunks (скопление лимфоцитов вокруг нервных стволов); pronounced trophoneurotic disturbances (трофонейротические нарушения).

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SCLEROMATOUS GRANULOMA (СКЛЕРОМНАЯ ГРАНУЛЕМА)

Question: What does the scleromatous granuloma contain?

Answer: Plasma and epithelioid cells, leukocytes, among which are many hyaline balls (гиалиновые шары); characteristic is the appearance of large macrophages with light cytoplasm called Mikulicz cells (клетки Микулича), in whose cytoplasm the causative agent is found — the Volkovich–Frisch bacillus (палочка Волковича–Фриша).

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Question: What is noted clinically in scleromatous granuloma?

Answer: Sclerosis and hyalinosis (склероз и гиалиноз) of the granulation tissue.

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