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This segment of a presentation demonstrates a great example of Giving a description of the pathology slides

This segment of a presentation demonstrates a great example of Giving a description of the pathology slides Discussing the cellular processes that are not directly explained in the case (e.g. how neutrophils kill…) Add humor, necessary to keep your listeners awake!. Case 4: Bringing Sexy Bac.

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This segment of a presentation demonstrates a great example of Giving a description of the pathology slides

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  1. This segment of a presentation demonstrates a great example of • Giving a description of the pathology slides • Discussing the cellular processes that are not directly explained in the case (e.g. how neutrophils kill…) • Add humor, necessary to keep your listeners awake!

  2. Case 4: Bringing Sexy Bac. • A 24-year-old sexually active man experiences dysuria and a tan-to-yellow urethral discharge for 3 days. A Gram’s stain of the urethral discharge is examined in the Emergency Department. He is given antibiotics and sent home.

  3. Gram’s stain of urethral exudate in gonorrhea. The Gram’s stain shows many polymorphonuclear neutrophils several of which contain intracellular gram-negative diplococci. The diplococci show the typical “kidney bean” morphology of Neisseria with the long axes of paired cocci arranged in parallel.

  4. Case 4: How Neutrophils Kill

  5. Case 4: Living in Neutrophils • Attachment to the membranes of or phagocytosis by neutrophils give diplococci a typical intracellular appearance on Gram’s stains (intracellular gram-negative diplococci) • However, as a parasite, gonococci are extracellular bacteria efficiently killed by neutrophils • Sensitivity of a Gram’s stain with a urethral exudate is 90-98% and the specificity 85-98%

  6. Case 5: ARDS • A 43-year-old man with a long history of alcohol abuse has severe epigastric abdominal pain for two days that radiates to his back. He has a temperature of 100.8o F, pulse of 108, respiratory rate of 22, and blood pressure of 90/60 mmHg. His abdomen is rigid and bowel sounds are absent. His peripheral blood white cell count is 17,200 L-1 with 92% neutrophils, and serum values include a glucose of 154 mg/dL, calcium of 6.5 mg/dL, amylase of 860 U/L, and lipase of 960 U/L. His arterial blood PO2 on room air is 74 mm Hg (reference range 95-100). Treatment was initiated with analgesics, intravenous fluid, and nasogastric suction. Within a day he complains of severe shortness of breath and his arterial blood PO2 is 50 mm Hg. Chest X-ray is performed.

  7. Chest X-ray appearance of ARDS. There is diffuse opacification of both lungs and bilateral pleural effusions. The effusions are seen as haziness obscuring the diaphragms and costophrenic angles.

  8. Case 5: ARDS • He is intubated and placed in the intensive care unit, but dies within a few hours. • Histopathological findings observed at autopsy for his pancreas and lungs are shown:

  9. Coagulative necrosis with hemmorrhage Pancreatic acini Pancreatic acini Histopathology of acute pancreatic necrosis. The pancreas shows extensive coagulation necrosis and hemorrhage with only a few residual areas of intact glandular parenchyma. The hemorrhage extends into the peripancreatic fat.

  10. Pulmonary leukostasis in ARDS. An aggregate of neutrophils is present in a small pulmonary blood vessel. The alveoli are atelectatic (collapsed) with early intra-alveolar edema.

  11. fibrin Eosinophilic hyaline membranes line alveolar ducts and alveoli and many alveoli are atelectatic. The membranes are composed of fibrin admixed with necrotic cell debris of sloughed alveolar-lining epithelial cells.

  12. Case 5: Causes of Neutrophilic Inflammatory Response: • microbial agents (bacteria, fungi, viruses) and their products (endotoxin) • tissue necrosis (ischemia, chemical toxins) • physical injury (heat, cold, electricity, trauma) • radiant energy (ultraviolet light, X-ray, radioactive isotopes) • The neutrophilic leukocytosis in this patient reflects extensive hemorrhagic necrosis that has occurred in his pancreas.

  13. Case 5: Neutrophils Injure • During the adult respiratory distress syndrome, neutrophils form intravascular aggregates within small blood vessels of the lung (leukostasis), with damage to endothelium by active oxygen radicals and proteases released by the neutrophils.

  14. Case 5: Shock and ARDS • Leukostasis results in endothelial injury in the lung with increased vascular permeability and exudation of a fibrin-rich fluid. • The alveolar epithelium can also be injured by the oxygen radicals and proteases released by neutrophils. • Eosinophilic hyaline membranes are formed from the fibrinous exudate.

  15. Case 5: Shock and ARDS

  16. Case 6: Lunch Time Any Qs?

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