Pathomorphogenesis of dysentery

April 20, 2018 13:00 | Symptoms And Treatment
symptoms and for dysentery
bacteriocarrier Pathogenesis pathomorphogenesis
Acute dysentery
chronic dysentery
Heart disease dysentery
Prevention of dysentery
Treatment of patients with intestinal infections

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The study morbid anatomy picture with dysentery in the past years there has beensignificant gap. The data obtained were based on the study of sectional materials, mainly heavy forms. There were no data on pathohistological changes in the intestine in various clinical variants of dysentery, especially with light, erased forms. This gap is filled only in recent years with the introduction into practice of the method of intravital morphological study of the mucous membrane of the small and large intestine with the help of aspiration biopsy. Repeated control biopsies make it possible to study changes in dynamics.

Histological examination of biopsy material showed that there are changes in the acute phase of the disease, mainly in the mucosa of the colon. With a mild form of dysentery in children in the mucosa of the large intestine, catarrhal inflammation is noted in the form of dystrophic epithelial lesions, secretory, vascular disorders and reactive disorders in solitary follicles of the gut. The stroma is edematic, full of blood, with foci of hemorrhage. With a moderate form of the disease, more severe dystrophic lesions of colon epithelium with cell lysis are characteristic. In the intercritical epithelium, micronecrosis sites and erosive lesions of the epithelium, extensive foci of hemorrhages are observed. At the same time, it was established that clinico-rectomano-scopic recovery comes much earlier than histological.

FA Solovieva, VN Levin, when studying the histological features of the mucous membrane of the colon during dysentery using biopsy, note that changes are observed mainly in the superficial layers of the mucous membrane of the colon. The severity of these changes, the authors distinguish three degrees - light, medium and pronounced. With a mild degree of lesion, there is only focal infiltration by lymphoid and plasma cells of the superficial layers of the mucous membrane with slight dystrophic changes in the surface epithelium in the form of swelling, less often pycnosis of the nuclei. With more pronounced changes( medium degree), infiltration of the stroma extends into deeper layers of the mucosa, sometimes with predominant localization around the crypts. Slime formation is almost not observed. At the third degree the cellular infiltration of the stroma reaches the basal parts of the mucous membrane, and the dystrophic changes develop in the form of foci both in the superficial epithelium and in the cells of the deep crypts. Infiltration of epithelium with segmented leukocytes, as a rule, leads to necrosis of it. In cases of prolonged course of dysentery proliferation of goblet cells is noted, occasionally focal sclerosis of submucosal layer is encountered, as well as an increase in the number of crypts. The period of convalescence is characterized by hypertrophy of goblet cells throughout the crypt with increased secretion of mucus.

GI Osipova, VV Kuzmenko, comparing the obtained data on the study of gastric function in children with dysentery, with the results of an intravital morphological study of the mucosa of the large intestine in the dynamics of the disease, established a parallelism. When erosive lesion of the intestine in children with prolonged course of dysentery, deeper and persistent disturbances of gastric secretion( decrease in the amount of gastric juice, decrease in acid formation, pepsin secretion) were revealed.

Morphological changes in the gastric mucosa in acute dysentery were established with gastro biopsy ES Normansky et al. In 22 out of 29 patients there was pronounced plethora of capillaries of the gastric mucosa, multiple hemorrhages, especially around the glands.

Using the method of aspiration biopsy, structural disorders of the mucous membrane of the small intestine were also detected. It is full-blooded, edematous, infiltrated with mononuclear cells. Lymphatic vessels are dilated, there are foci of hemorrhage. Deformation and shortening of villi, lengthening and disorganization of crypts are noted. In the study of histological changes in the mucosa of the colon in chronic dysentery, TA Levitov established a flattening of the cylindrical epithelium, a decrease in the number of crypts, the formation of cysts that are overcrowded with a secret, and cellular infiltration.

Along with the great achievements of recent years on the lifetime study of morphological changes in the intestinal mucosa with different clinical forms of dysentery, it should be noted the great importance of the works of previous years, based on the study of sectional material. Pathomorphologists also found the defeat of the stomach, small and large intestine in dysentery in both adults and children. N. A. Maksimovich with dysentery in children showed a distinct defeat of the stomach( in 33%) in the form of degenerative changes in epithelial cells with a sharp violation of the permeability of the walls of the vessels and perivascular hemorrhages. In children of early age, even in the upper sections of the small intestine, phenomena of mucosal epithelium with small areas of superficial necrosis, edema and plethora of the mucous and submucosa layers with small perivascular infiltrates were detected. In the lower sections of the small intestine, the changes were more pronounced, up to necrotic processes.

The most pronounced and characteristic for dysentery lesions were noted in the large intestine, mainly in the distal part. Four periods were distinguished: 1) catarrhal inflammation, catarrhal-hemorrhagic and catarrhal-necrotic;2) fibrinous inflammation;3) the period of ulceration;4) period of mucosal regeneration. Even then, MA Maksimovich noted that along with typical lesions of the large intestine in the form of necrotic and ulcerative colitis, light catarrhal enterocolitis is increasingly encountered, up to the time when macroscopic changes are not established.

When studying the state of the intestines of children treated with antibiotics that died from dysentery, there was almost complete absence of severe fibrinous and ulcerative colitis. Most often, only minor catarrhal or follicular-ulcerative colitis was observed. With chronic dysentery, changes were established only in the histological examination of the intestine. There were superficial necrosis of the mucosa, perivascular infiltrates in the submucosal layer. The centers of the follicles expressed the phenomena of cell decay. Dystrophic changes, phenomena of sclerosis of the mucous and submucosal layers were observed in the epithelium of villi and libericun crypts. In some cases, deep epithelized cavities in the submucosa layer were found, filled with pus and associated with narrow passages with an intestinal lumen. Such changes, according to NA Maksimovich, are observed only with dysentery. Changes in other organs were not specific for dysentery, but were associated with general intoxication of the body. Thus, changes in the myocardium were characterized by fullness and parenchymal dystrophy, in the lungs - with emphysema, fullness and hemorrhage, in the liver - pronounced parenchymal dystrophy of liver cells, edema and mild liver tissue, degenerative obesity of the liver, hepatitis up to the initial cirrhosis of the liver. There were also signs of parenchymal degeneration of the glandular epithelium of the pancreas, the phenomenon of toxic edema and interstitial pancreatitis, the kidneys showed parenchymal dystrophy of the epithelium of convoluted tubules and Henle loops with necrosis in severe cases, plethora of glomeruli and kidney tissue, in the spleen - fullness and enlarged follicles. Pathohistological changes were also established in the brain. In the acute stage of the disease, children showed marked circulatory disorders, cerebral edema, dystrophic changes in ganglion cells, discirculatory encephalopathy, as well as deep dystrophic and inflammatory processes not only in the central but also in the peripheral parts of the autonomic nervous system, in a number of casesencephalitis.

It is interesting to point out the morphologists' lack of parallelism between the nature of the lesion in the large intestine and the severity of the general condition in the lifetime, the character of the stool in dysentery in children.

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