Transcript Pleuritis

2009
Pancreas
42. Inflammations and tumors of the pancreas
43. Pathology of diabetes mellitus in dogs
Serous membranes
65. Abnormal content of the abdominal cavity;
Derzsy’s disease
66. Peritonitis; Feline infectious peritonitis;
tumors of the peritoneum
67. Pleuritis
Anatomy of the pancreas
• Endocrine – Langerhans islets
– α - glucagon
– β – insulin (60-70%)
– δ - somatostatin
• Exocrine – acinar cells
– Production of digestive enzymes
Pathologic changes
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post mortem changes
developmental anomalies
traumas
circulatory disorders
regressive changes
inflammations
tumors
Pathological changes
• Fast autolysis – imbibition
• Developmental anomalies
– Pancreas divisum – two parts
– Pancreas anulare – ring around the
duodenum
– Pancreas accessorium
– Cystic degeneration – cat
– Hypoplasia of the exocrine part – dog, cattle
Circulatory disturbances
• Edema
• Hemorrhages
– Toxicosis – dikumarol, uremia !
– Trauma
– Infectious diseases
swine fever, salmonellosis, Rubarth-d.,
leptospirosis, rabies
– (inflammation)
Regressive changes
• Atrophy
– Age, cachexia, tissue proliferation
– Digestion problems
– Congenital
• Liponecrosis pancreatica
– Free catabolic enzymes
• Lipomatosis pancreatica
– obesitas
Exam questions
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Inflammations and tumors of the
pancreas
Pathology of diabetes mellitus in dogs
Abnormal content of the abdominal
cavity; Derzsy’s disease
Peritonitis; Feline infectious peritonitis;
tumors of the peritoneum
Pathologic changes
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post mortem changes
developmental anomalies
traumas
circulatory disorders
regressive changes
inflammations
tumors
42. Inflammations
• Acute pancreatitis
– hemorrhagic – dog, pig
– serous
• Purulent
• Chronic pancreatitis
– interstitial
– Pancreas-cirrhosis
Etiology
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Secondary to ischemia
Free catabolitic enzymes
Viral (swine fever, Rubarth, rabies)
Toxicosis
Drugs
Post obstructive changes
– calculi, cystic fibrosis
• Obesitas
• Latent DM
• Traumatic
Acute hemorrhagic pancretitis
Chronic
pancreatitis
Pathologic changes
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post mortem changes
developmental anomalies
traumas
circulatory disorders
regressive changes
inflammations
tumors
42. Tumors of the exocrine
pancreas
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Benign Tumors
– Serous or Mucinous Cystadenoma
– Intraductal papillary adenoma
– Mature Teratoma
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Borderline Tumors
– Mucinous cystadenoma with atypia
– Intraductal papillary mucinous adenoma with atypia
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Malignant Tumors
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Ductal dysplasia severe (insitu Ca)
Ductal Adeno Ca , 85% of cancers in pancreas. Mucinous non-cystic Ca
Signet ring Ca
Adenosquamous Ca
Undifferentiated Ca
Mixed ductal-endocrine Ca
Osteoclast-like giant cell tumor
Serous cystadeno Ca
Pancreatoblastoma
Metastatic Ca
Tumors of the
neuro-endocrine pancreas
• Insulinoma (benign or malignant)
• Gastrinoma
– 50% of gastrinomas in pancreas, mainly in head of
pancreas
– Zollinger-Ellison syndrome - hypersecretion of
gastric acid and recurrent peptic ulceration in the
GI tract
– 60% Carcinoma
• Lipomas
– 80% malignant
• Glucagonoma
• PPoma (pancreatic peptide)
Tumors
• Hyperplasia (nodular)
• Adenoma
• Carcinomas
– simplex
– adenocarcinoma
– scirrhus
• Insulinoma
– Islet cell carcinoma
– β-cells of the Langerhans islands
• Sarcomas
• Metastasis
Cystadenoma
Metastasis to the liver
Duct carcinoma
Insulinoma
Insulinoma
43. Diabetes mellitus
• Chronic disorder of carbohydrate metabolism
due to relative or absolute insulin deficiency
• Common in dogs (small breeds) and cats
• Decreased insulin production and secretion
– Destruction of islet cells
– Severe (chronic) pancreatitis
– Selective degeneration
• Insuline resistance or secondary DM
– Hyperadrenocorticism
• Obesity, stress, administration of corticosteroids
Causes
• Multifactorial disease
– Autoimmun disorders
– Hereditary
– Nutritional disorders
– Congenital hypoplasia
• Lack of β-cells
Forms
• 1. primary
– IDDM (insulin-dep.-diabetes-mellitus)
– NIDDM (non – ins.-dep.-diab.-mellitus)
• 2. secondary
– Other hormonal dysfunctions
• 3. gestation type
– Hypersecretion of the sexual hormons
Pathology of diabetes mellitus
• Pancreas
– firm, multinodular
– areas of hemorrhagies and necrosis
– Hyalinosis, amyloidosis and sclerosis of the islets
• Liver
– hepatomegaly (due to lipid accumulation)
• Eye
– Cataracts (lenticular opacities due to edema)
• Secondary and/or chronic infections
– Cystitis, prostatitis, bronchopneumonia, dermatitis
Langerhans islet
• Smaller
• Decreased number of islets
• First β-cell degeneration
– Granular appearence of the cytoplasm
– Hydropic changes
• Degeneration of the other cell types
Complications
• Acute
– Hyperglycaemic or hyperosmotic coma
– Ketosis, death
• Chronic
– Long hyperglycaemia
– Pathological changes in the organs
– Micro- and macroangiopathies
Serous membranes
65. Abnormal content of the abdominal cavity;
Derzsy’s disease
66. Peritonitis; Feline infectious peritonitis;
tumors of the peritoneum
67. Pleuritis
65. Abnormal content
of the abdominal cavity
• Transsudate (stagnation)
• Exudate (inflammation)
• Foreign bodies
– through the abdominal wall
– from the gastro-intestinal tract
• autointoxication
• Consequence: peritonitis
ASCITES
Due to rupture of the organs
• Contant of the stomach, intestines
• Urine
– Sterile – uraemia
– Infected - peritonitis
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Blood (haemoperitoneum)
Bile
Fetus or egg
Parasites
Complications
• Death
– Autointoxication
– Bleeding
• Peritonitis
• Healing
– Resorption
– Organisation
Ascites (hydrops peritonei)
• Cause:
– Increased serum secretion
• High blood pression (livercirrhosis or thrombosis)
– Decreased resorption
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Mesothelioma
Problems in the lymphcirculation
Blokage of the ductus thoracicus
Cardial dysfunction
Decreased blood supplementation in the kidney
Hypoproteinemia (cachexia)
Ascites
• increase in the
amount of lymph
normally found in
the peritoneal
spaces.
• Usually, in the
ventral hepatoperitoneal spaces, in
the pericardial sac,
and in the intestinal
peritoneal space.
Transsudate
• First: clear, transparent
– Intact peritoneum
• Later: opalec
– Desquamation
– Villus-like growings
• Types:
– Hydrops haemorrhagicus (blood)
– Hydrops chylaris (lymph)
– Hydrops adiposus (fat)
65. Goose parvovirus infection
Derzsy’s disease
• Acute disease in young goslings
– 1-4 weeks old (between 10-30 days)
• highly contagious condition of geese and
young Muscovy ducks
– Parvo virus
• horizontal and vertical
– direct contact (p.o), egg, iatrogenic (vaccination)
• secondary infections (fungi, Salmonella)
Pathogenesis
• Infection (proliferation in the intestines)
• Viremia
• Proliferation in the liver
– Serous hepatitis
• Proliferation in the „young” cells
– Lieberkühn glands, kidney, heart muscle
• Major effect
– lesions in the blood vessels - leakage
– Edema in the subcutis, ascites, hemorrhages
- Gosling 7 day of age, listless and
reluctant to move
- Retarded growth and incomplete
feathering of the neck and back –
„striptease”
- Swollen liver and
hydropericardium
Macroscopic findings
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Lack of feathers (neck and back)
Exsiccosis
Enteritis
Serous hepatitis
Rounded heart
Normal spleen
Respiratory changes
Gross pathology
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Liver: enlarged and congested.
Heart: dilated, flaccid, pale and rounded at apex (coronaries!)
Spleen and pancreas: sometimes swollen and congested.
Viscera: may have petechiae.
• Subacute:
– Abdomen: ascites (large amount of jelly-like serum)
– Liver: swollen , copper-coloured, friable and petechiated, serofibrinous perihepatitis, gall bladder large and bile-filled.
– Heart: variably dilated, sero-fibrinous pericarditis.
– Also variably: focal pancreatic necrosis, pulmonary oedema,
catarrhal enteritis, nephrosis, occasionally haemorrhages in thigh
muscles and pectoral muscles.
• In muscovy ducks:
– nephritis, non-suppurative polioencephalomyelitis and myopathy.
Gross pathology 2.
• Transsudation
– pericardium, abdomen, subcutaneous c.t.
• Dystrophy of the myocardium
– Focal Ly-histiocytic myocarditis
• Nephrosis
• Hemorrhages
– Under the serosal membranes
• Catarrhal enteritis
Histopathology
• Liver
– serous hepatitis and focal hepatic necrosis
– hepatocyte degeneration with vacuolation
– intranuclear inclusion bodies in hepatocytes.
• Heart
– focal myocardial necrosis
– degeneration of myocardial cells with loss of
striation
– Focal lympho-histiocytic myocarditis
– fatty infiltration and scattered Cowdry type A
intranuclear inclusions
66. Peritonitis
• General or diffuse
– Depends also on species
• Primary (rare) or secondary
– No inflammation in other organs
– Spreading from neighboring organs
• Expansion, lymphogen, hematogen metastasis
• Microbiology
– Steril or septic
Causes
• Acute, subacute, chronic
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Virus
Bacteria
Chemicals (uric acid)
Parasites
Long mechanical irritation
• Consequence: metastasis, autointoxication
Types
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Serous
Serous-fibrinous
Fibrinous
Purulent / abscess
– Actinomyces pyogenes (bo, sus)
• Putrid
Consequences
• Acute, Circumscribed
– Not a life-threatening situation
• Acute, diffuse
– Autointoxication
• Chronic, diffuse
– Cachexia
• Chronic, circumscribed
– Adhesion
– Purulent: acute, diffuse
Diseases
• Pig
– Salmonellosis, streptococcosis, Glässer, tuberculosis
• Dog
– Rubarth, nocardiosis
• Chicken
– Uricosis, coli-granulomatosis, tuberculosis
– Chronic pasteurellosis, anatipestifer disease in ducks
• Cattle
– Arcanobacterium pyogenes, actinobacillus, tuberculosis
• Cat - FIP
66. Feline infectious peritonitis
• Coronavirus - cats (felidae)
– fatal disease of domestic cats
• Pyogranulomatous inflammation,
vasculitis and necrosis
– Noneffusive form
• Leptomeningitis, chorioependymitis, focal encephalomyelitis,
opthalmitis (visceral involvement)
– Effusive form
• Serositis, surface oriented pyogranulomas in visceral organs
Feline Infectious Peritonitis
• classical example of type-III
hypersensitivity
– The virus elicits both cell mediated and
humoral immune responses.
– While a strong cell-mediated immune
response tends to protect against disease,
a strong humoral immune response will
enhance the disease process.
• The distended abdominal wall on either side of the longitudinal
incision. The distended loops of intestine are surrounded by red
fluid. The inflamed omentum is deep red and traverses the middle
of the abdominal cavity.
• The peritoneal fluid has accumulated due leakage from the injured
blood vessels.
Forms
Dry
Perivascular microabscess formation
pyogranuloma
Inflammatory-necrotic foci
Ophthalmitis, iridocyclitis
Glomerulonephritis, nephropathia
Liverdystrophy
Wet
Exudation: Ascites
Hydrothorax, hydroperitoneum
FIP pathogenesis
• 1. phase
– Oral infection
– Virus replication in the intestinal epithelium
– Infection without symptoms
• 2. phase (always lethal)
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Dispersion through infected macrophages
Strong cellular response  resistance
Incomplete cellular response  dry form
Humoral response  effusive form
Periventricular
vasculitis, accumulation
of gelatinous material in
the ventricles, cat, FIP
IP
Tumors
• Mesothelioma
– From the mesothel cells
– nodules
– ascites
• Lipoma
– pedunculation
Parasites
• Threadworm, Setaria equina
– 5-12 cm long, frequent in horses
• Migration of Strongylus vulgaris larvae
• Tetrahyridial larvae
– Tapeworms in genus Mesocestoideus
– Dog – chronic serous peritonitis, ascites
• Fasciolosis, cysticercosis,
echinococcosis
67. Pleuritis
• In general – bacterial infections
– Direct spereading (lungs-trachea)
– Abscessation
– Hemato-, lymphogenous
– traumas
Pleuritis
• Pneumonia – crupous
– Fibrinous pleuritis
• Changes due to systemic diseases
Pleuritis
• Acute –chronic
• Primer – secunder
• Types
– Serous
– Sero-fibrinous
– Purulent
– Ichorous (reticuloperitonitis)
Pleuritis
• Consequences
– Accumulation of inflamatory exudate
– Lung atelectasy
– Circulatory disturbance (local – general)
– Autointoxication (ichorous)
Pleuritis
• Healing processes
– restitutio ad integrum - absorption (serous)
– restitutio cum defectu – disturbed absorption
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Chronic pleuritis
Angiofibroblast – connective tissue
Disturbances in the respiration …
and lymph circulation
» Hydrothorax
» Chylothorax
Pleuritis
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Actinomyces pyogenes
Glässer’s disease
Nocardiosis (Nocardia asteroides)
Tuberculosis
Malleus (Glanders)
Actinomyces pyogenes
• Purulent pleuritis
– Content: green-yellow pus
– and: small-larger abscesses
Glässer’s disease
• Haemophilus parasuis
• Serous-fibrinous pleuritis
• Other organs
– Peritoneum
– Pericardium
– Joints
– meninx
Nocardiosis (Nocardia asteroides)
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Gram+, Ziehl Neelsen+
Percutan infection
Primer granuloma
Metastasis
– Sero-fibrinous pleuritis
• With granulomas
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Brain
Kidney
Spleen
Liver
Lungs (bronchopneumonia + granulomas)
Tuberculosis
• Early generalisation
– Hematogenous
– Lymphogenous (peritoneum, lymphnode)
– Lung fistula
pleuritis tuberculosa nodosa
(pleuritis tuberculosa caseosa,
pleuritis tuberculosa proliferativa,
Ca – intensive exudation!!! – lung atelectasia)
Malleus (Glanders )
• Secondary hematogen metastasis
– Small granulomas