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Pathological anatomy of TUBERCULOSIS

According prof Ya. Bodnar

As.-prof. V.Voloshyn

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TuberculosisTuberculosis

Tuberculosis is the chronic specific Tuberculosis is the chronic specific infectious disease which is caused infectious disease which is caused by tuberculosis mіkobacterias and by tuberculosis mіkobacterias and characterized by the defeat of all characterized by the defeat of all human’s organs, but more human’s organs, but more frequent lungs. This disease has frequent lungs. This disease has undulating motion with the duty of undulating motion with the duty of acute condition and remission.acute condition and remission.

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EtiologyEtiology Mіkobacteria Mіkobacteria of of tuberculosis, which was tuberculosis, which was opened by Koch in 1882 opened by Koch in 1882 year, is the exciter of year, is the exciter of illness.illness.

Distinguish four its varieties: Distinguish four its varieties: human;human;bovine;bovine;birdbird;;cold-blooded.cold-blooded.

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PathogenyPathogeny

Overwhelming ways of infectionOverwhelming ways of infection::

Air-drop (through respiratory way)Air-drop (through respiratory way)

Alimentary (through mouth & Alimentary (through mouth & stomach way)stomach way)

Origin, course (Origin, course (перебіг) перебіг) and and consequence consequence ((resultresult)) of illness of illness depends from organism reactivitydepends from organism reactivity..

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Clinic–morphologic forms of Clinic–morphologic forms of tuberculosistuberculosis

Basic Basic morphological morphological formsforms::

Primary;Primary;

Secondary;Secondary;

HaematogenicHaematogenic

Basic clinical Basic clinical formsforms::

Tubercular Tubercular intoxication in children intoxication in children and teenagers;and teenagers;

Tuberculosis of Tuberculosis of breathing organs;breathing organs;

Tuberculosis of Tuberculosis of other organs and other organs and systemssystems..

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Description of tubercular Description of tubercular processprocess

Localization and Localization and prevalence prevalence ((поширеністьпоширеність):):

In lungs in the lobules;In lungs in the lobules;

In other systems In other systems according to localization;according to localization;

Phases:Phases:

Infiltration, disintegration, Infiltration, disintegration, inseminationinsemination, dissolving, , dissolving, scarring, calciphication.scarring, calciphication.

Selection (excretion) of Selection (excretion) of bacteria:bacteria:

BK+, BK-BK+, BK-

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Primary tuberculosisPrimary tuberculosisA primary tubercular A primary tubercular

complex is a complex is a morphological morphological expression of primary expression of primary tuberculosis and tuberculosis and consists of primary consists of primary tubercular affect, tubercular affect, lymphangitis and lymphangitis and specific lymphadenitis.specific lymphadenitis.

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Variants of course (Variants of course (перебіг) перебіг) of of primary tubercular complexprimary tubercular complex::

1.1. healing; healing;

2.2. progress; progress;

3.3. chronic motionchronic motion..

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Healing of primary tubercular Healing of primary tubercular complexcomplex Healing of primary complex Healing of primary complex

regardless (independently) of its regardless (independently) of its localization begins from dissolving of localization begins from dissolving of perifocal inflammation. The perifocal inflammation. The calciphicated and ossiphicated healed calciphicated and ossiphicated healed origins of primary affects have name origins of primary affects have name the focus of Ghon’sthe focus of Ghon’s. Sclerosis along . Sclerosis along the lymphangitis and sclerosis of the the lymphangitis and sclerosis of the primary destroyed lymphatic nodes primary destroyed lymphatic nodes be going on at the same time. be going on at the same time. Mіkobacterias is savedMіkobacterias is saved in the in the Ghon’sGhon’s focuses many years (tens of years) focuses many years (tens of years) and predetermine unsterile immunityand predetermine unsterile immunity ..

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Forms of progress of primary Forms of progress of primary tuberculosistuberculosis

growth of primary affect;growth of primary affect;

haematogenic spreading haematogenic spreading (generalization);(generalization);

lymphogenic spreading lymphogenic spreading (generalization);(generalization);

intracanalicular spreading intracanalicular spreading (generalization);(generalization);

mixed spreadingmixed spreading..

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Charts of progress forms of Charts of progress forms of primary tuberculosisprimary tuberculosis

Growth of Growth of primary primary affectaffect

Lymphglandular generalization. Tubercular bronchadenitis.

Hematogenic generalization.

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Chronic flowing of primary Chronic flowing of primary tuberculosistuberculosis

It is observed in those cases, when a It is observed in those cases, when a primary affect heals over, but in a primary affect heals over, but in a lymphglandular complex processes of lymphglandular complex processes of cicatrization change with acutening. It cicatrization change with acutening. It cause sensibilisation of organism. In cause sensibilisation of organism. In reply to it there are the paraspecific reply to it there are the paraspecific displays in the inner organsdisplays in the inner organs..

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Morphology of paraspecific Morphology of paraspecific displays of tuberculosisdisplays of tuberculosis

Diffuse or knot proliferation of Diffuse or knot proliferation of lymphocytes and macrophages, lymphocytes and macrophages, hyperplasia of hemopoetic organs, hyperplasia of hemopoetic organs, fibrinoid changes of connecting tissue, fibrinoid changes of connecting tissue, arterioles, dysproteinosis amyloidosis arterioles, dysproteinosis amyloidosis sometimes. The paraspecific reaction sometimes. The paraspecific reaction in joints at the chronic flowing of in joints at the chronic flowing of primary tuberculosis is known as the primary tuberculosis is known as the rheumatism of Ponsierheumatism of Ponsie..

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Causes of deathCauses of death

Death at progress of primary Death at progress of primary tuberculosis mainly comes from tuberculosis mainly comes from tubercular meningitis, peritonitis, or tubercular meningitis, peritonitis, or generality defeat of internal organs. At generality defeat of internal organs. At timely treatment the focuses timely treatment the focuses encapsulate, but they can be the encapsulate, but they can be the source of development of hematogenic source of development of hematogenic tuberculosistuberculosis

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Secondary tuberculosisSecondary tuberculosis

Tuberculosis which arises up after Tuberculosis which arises up after past primary tuberculosis with a some past primary tuberculosis with a some immunity, although can be unstable immunity, although can be unstable immunity. Reason of him is repeated immunity. Reason of him is repeated superinfection, or reactivation of superinfection, or reactivation of process in the place of process in the place of selectionselection in the in the lungs after primary tuberculosis.lungs after primary tuberculosis.

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Features of the secondary Features of the secondary tuberculosistuberculosis

it is localized only in lungs;it is localized only in lungs;

has intracanalicular distribution has intracanalicular distribution from an apex to basis; from an apex to basis;

specific inflammation is absent in specific inflammation is absent in lymphatic nodes;lymphatic nodes;

the changing of clinico-the changing of clinico-morphologic phases is its clinico-morphologic phases is its clinico-morphologic formsmorphologic forms

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Morphogeny of the secondary Morphogeny of the secondary tuberculosistuberculosis

Ghon’s focusGhon’s focus

Simon's focusSimon's focus

Ashoff-Pool's focusAshoff-Pool's focus

Abrikosov's focusAbrikosov's focus

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Clinico-morphologic formsClinico-morphologic forms

Acute focus TBAcute focus TB Fibrotic-focus TB

Infiltratic-pneumonitic of

Assman-Redeker

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Clinico-morphologic formsClinico-morphologic forms

Lobitis. Caseous

pneumonia

Tuberculoma Cirrotic TBAcute cavernous.

Fibrotic cavern.

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Morphology of chronic cavityMorphology of chronic cavity (cavern)(cavern)

The wall of cavity is The wall of cavity is dense. Morphologically dense. Morphologically distinguish three layers distinguish three layers in it's wall: in it's wall:

necrotizing necrotizing (piogenic), is rich by (piogenic), is rich by leucocytes; leucocytes;

tubercular tubercular granulation tissue; granulation tissue;

connective tissueconnective tissue..

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Hematogenic tuberculosisHematogenic tuberculosis

Hematogenic tuberculosis arises up Hematogenic tuberculosis arises up in persons which clinically got better in persons which clinically got better (recovered) from primary tuberculosis, (recovered) from primary tuberculosis, but there is an infection source in fully but there is an infection source in fully healed wound, enhanceable healed wound, enhanceable sensitiveness to the tuberculin is sensitiveness to the tuberculin is saved at a formed immunity to saved at a formed immunity to mycobacteriummycobacterium

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Forms of hematogenic Forms of hematogenic tuberculosistuberculosis

Generalized (Quick as lightning Generalized (Quick as lightning tubercular sepsis of Landuze);tubercular sepsis of Landuze);

Dissimilar, with predominance of Dissimilar, with predominance of lungs defeat;lungs defeat;

Dissimilar, with predominance of Dissimilar, with predominance of extralungs damagesextralungs damages

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Generalized hematogenic Generalized hematogenic tuberculosistuberculosis

Most heavy form. This one Most heavy form. This one arises out from focuses of arises out from focuses of selectionselection, which got in different , which got in different organs in the period of progress organs in the period of progress of primary tuberculosis and did of primary tuberculosis and did not manifestation long time. not manifestation long time. Inflammation shows up by the Inflammation shows up by the origin in the internalss of plural origin in the internalss of plural humps with predominance of humps with predominance of necrosis above exudation & necrosis above exudation & proliferation (quick as lightning proliferation (quick as lightning tubercular sepsis), or by like tubercular sepsis), or by like millet millet humps with predominance humps with predominance of productive reaction (acute of productive reaction (acute general miliary tuberculosis).general miliary tuberculosis).

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Hematogenic tuberculosis with Hematogenic tuberculosis with the primary defeat of lungsthe primary defeat of lungs

This one arises up as This one arises up as a result of lung a result of lung infecting from the infecting from the focuses of focuses of selectionselection, , which localized mainly which localized mainly in genitals or in genitals or lymphatic nodes. lymphatic nodes. Mycobacteriums come Mycobacteriums come in the lungs with the in the lungs with the blood current that is blood current that is why the defeat of why the defeat of lungs are bilateral lungs are bilateral mirror alwaysmirror always. .

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Forms of hematogenic tuberculosis Forms of hematogenic tuberculosis with the primary lungs defeatwith the primary lungs defeat

Distinguish an acute and a chronic Distinguish an acute and a chronic forms. Miliary tuberculosis is the forms. Miliary tuberculosis is the presence of shallow (small) humps, at presence of shallow (small) humps, at presence of large – large niduses. At presence of large – large niduses. At the chronic flowing the scarring of the chronic flowing the scarring of humps, development of emphysema, humps, development of emphysema, cavity and as a result hypertension of cavity and as a result hypertension of pulmonary circle of blood circulation is pulmonary circle of blood circulation is possible with development of possible with development of pulmonary heart.pulmonary heart.

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Hematogenic tuberculosis with Hematogenic tuberculosis with the primary defeat of lungsthe primary defeat of lungs

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Hematogenic tuberculosis with Hematogenic tuberculosis with predominance of extralungs predominance of extralungs

damagesdamagesDevelops from Develops from

focuses of focuses of selectionselection, , by carrying of exciter by carrying of exciter into any organ by a into any organ by a hematogenic way in hematogenic way in the period of the the period of the primary infecting. It primary infecting. It can be acute and can be acute and chronic. Bones, urinary chronic. Bones, urinary system, skin are system, skin are damaged mainly.damaged mainly.

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Hematogenic tuberculosis with Hematogenic tuberculosis with predominance of extralungs predominance of extralungs

damagesdamages

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Complication of tuberculosisComplication of tuberculosis

Complications Complications of of tuberculosis are numerous: so tuberculosis are numerous: so meningitis, pleuritis, pericarditis, meningitis, pleuritis, pericarditis, abscesses, perifocal abscesses, perifocal inflammations can develop at inflammations can develop at primary tuberculosis; at primary tuberculosis; at secondary TB – is bleeding, secondary TB – is bleeding, pneumothorax, empyema of pneumothorax, empyema of pleura, amyloidosis.pleura, amyloidosis.

Death Death mainly comes from the mainly comes from the indicated complications, chronic indicated complications, chronic insufficiency of pulmonary heart, insufficiency of pulmonary heart, uremiauremia..

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Thank you for attention!Thank you for attention!