Pathology Chapter on Suppurative Inflammation

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Questions and Answers

Which of the following is a characteristic feature that differentiates suppurative from non-suppurative inflammation?

Lyses of fibrin deposits.

Presence of coagulase enzyme.

Involvement of streptococci bacteria.

Formation of pus. (correct)

What is the primary function of hyaluronidase and streptokinase in diffuse suppurative inflammation?

To facilitate the formation of abscesses.

To dissolve fibrin and aid bacterial spread. (correct)

To produce intense necrosis within the tissue.

To stimulate fibrin coagulation for localization.

In the pathogenesis of an abscess, what is the central core primarily composed of in the early stages?

A dense network of fibrin.

Liquified pus and exudate.

A zone of acute inflammation with neutrophils.

Necrotic tissue. (correct)

The pyogenic membrane of an abscess is characterized by which of the following?

It is the peripheral zone of inflamed tissue. Signup and view all the answers

What role does the coagulase enzyme produced by Staphylococcus aureus play in an abscess?

It triggers the formation of a fibrin network to localize the inflammation. Signup and view all the answers

What is the mechanism by which pus is primarily formed in a suppurative inflammation?

By the liquefaction of necrotic tissue by proteolytic enzymes from neutrophils. Signup and view all the answers

Which of the following bacterial species is most commonly associated with causing diffuse suppurative inflammation?

Streptococcus haemolyticus. Signup and view all the answers

Approximately how long does it typically take for the abscess cavity to form after the onset of inflammation?

Approximately 48 hours. Signup and view all the answers

Which enzyme produced by Streptococcus hemolyticus contributes to the spread of bacteria by dissolving hyaluronic acid?

Hyaluronidase Signup and view all the answers

In contrast to serous inflammation, serofibrinous inflammation is characterized by an exudate that is particularly rich in which of the following?

Fibrin Signup and view all the answers

A patient presents with acute diffuse suppurative inflammation. Which combination of findings most strongly suggests the causative agent is Streptococcus hemolyticus?

Thin, bloody pus with many sloughs Signup and view all the answers

An individual has a skin blister after a burn. Which type of acute inflammation is most likely characterized by the fluid within the blister?

Serous inflammation Signup and view all the answers

Which of the following is a common site for diffuse suppurative inflammation caused by Streptococcus hemolyticus?

The loose connective tissue of the orbit Signup and view all the answers

A patient presents with inflammation of the mucous membranes with excess mucus secretion. Which type of inflammation is most likely the culprit?

Catarrhal inflammation Signup and view all the answers

Which of the following best describes the composition of the pseudomembrane formed in pseudomembranous inflammation?

Fibrin, desquamated epithelium, and inflammatory cells Signup and view all the answers

Which type of inflammatory response is characterized by a fluid exudate rich in eosinophils?

Allergic Signup and view all the answers

What is a characteristic visual indicator of a subcutaneous abscess?

Localized, tender swelling covered by red edematous skin with an opaque yellow center Signup and view all the answers

An abscess in which of the following locations is LEAST likely to open into a hollow organ?

Skin Signup and view all the answers

A large abscess that is not surgically evacuated is most likely to lead to:

Pointing and spontaneous rupture Signup and view all the answers

What is the primary difference between a sinus and a fistula?

A sinus is a tract that does not have a second opening, while a fistula has at least two openings. Signup and view all the answers

What is indicated by the term 'pyemia'?

Multiple small abscesses caused by septic emboli. Signup and view all the answers

Which of the following best describes a furuncle?

A small abscess associated with a hair follicle or gland. Signup and view all the answers

Which of these is a key distinction between a furuncle and a carbuncle?

A furuncle is smaller and related to a single follicle whereas a carbuncle involves multiple, communicating suppurative areas. Signup and view all the answers

In which condition is one most likely to find multiple communicating suppurative foci in the skin and subcutaneous fat?

A carbuncle on the back of the neck Signup and view all the answers

Study Notes

Acute Inflammation Types

Acute inflammation is categorized by the presence or absence of pus
Acute suppurative inflammation includes localized types (abscesses, boils, furuncles) and diffuse types (cellulitis)
Acute non-suppurative inflammation includes various types based on exudate characteristics

Suppurative Inflammation (Purulent)

This type involves pus formation
Associated with septic or pyogenic bacteria
Localized:
Abscess: A localized collection of pus
Furuncle (boil): A localized infection of a hair follicle or sebaceous gland
Carbuncle: A cluster of interconnected furuncles
Diffuse:
Cellulitis: A widespread bacterial infection of connective tissue

Mechanism of Pus Formation

Strong pyogenic bacteria (like Staphylococcus aureus and Streptococcus haemolyticus) cause necrosis
Large numbers of neutrophils are attracted, but die due to bacterial virulence
Presence of proteolytic enzymes produced by neutrophils and necrotic tissue liquefy the necrotic tissue and fibrin
The liquefied material mixed with pus cells and fluid exudate forms pus

Abscess

Definition: Localized suppurative inflammation forming a pus-filled cavity
Site: Commonly subcutaneous, but can be in internal organs
Pathogenesis: The abscess initially has a necrotic center surrounded by inflammatory cells. Later it develops a 3 zone structure consisting of:
Central necrotic core
Mid zone containing pus (formed in ~48 hours)
Peripheral zone of inflamed tissue which is called pyogenic membrane.
Course:
Abscess enlarges by further necrosis and liquefaction of surrounding tissue.
Staphylococci produce coagulase to help localize the inflammation.
Subcutaneous abscess appears as a localized tender swelling covered by red, edematous skin with a yellow center
The covering epidermis may undergo necrosis.
An ulcer is formed as pus is evacuated.
An internal abscess can open into a hollow organ.
Complications of Acute Abscess
Ulcers
Sinuses
Fistulas
Hemorrhage
Complications of Healing: Keloid (excessive scarring)
If not evacuated (Chronic Abscesses): can develop fibrosis and may contain cholesterol crystals or dystrophic calcification (e.g., chronic breast abscess)
Spread of infection: direct spread, lymphatic spread, blood spread (toxemia, septicemia, pyemia)

Types of Acute Non-suppurative Inflammation

Serous inflammation: Thin, watery fluid exudate (e.g., blisters after burns)
Serofibrinous inflammation: Fluid exudate rich in fibrin; occurs in serous membranes like the pleura, peritoneum, and pericardium
Allergic/Hypersensitivity inflammation: Eosinophil-rich fluid exudate; occurs in hypersensitivity reactions (e.g., urticaria, asthma, allergic rhinitis, and contact dermatitis)
Catarrhal inflammation: Mild inflammation of mucous membranes with excess mucous secretion; (e.g., rhinitis)
Pseudomembranous inflammation: Acute inflammation characterized by pseudomembrane formation consisting of fibrin, desquamated epithelial cells, and inflammatory cells (e.g., diphtheria, bacillary dysentery)
Hemorrhagic inflammation: Inflammation characterized by bleeding (e.g., meningococcal infection)
Necrotizing inflammation: Acute inflammation with extensive tissue necrosis (e.g., oral mucosa in malnourished children)

Furuncle (Boil)

Definition: Small abscess related to hair follicles, sebaceous glands, or sweat glands.
Cause: Staphylococci
Site: Primarily hairy areas (face, axilla); multiple boils are termed furunculosis

Carbuncle

Definition: Multiple communicating suppurative foci in skin and subcutaneous tissue (fat)
Cause: Staphylococci
Site: Thick skin areas (back of neck, scalp, buttocks)
Often associated with diabetes

Cellulitis

Definition: Acute diffuse suppurative inflammation of connective tissue
Cause: Streptococcus hemolyticus that produce hyaluronidase enzyme and fibrinolysin (streptokinase) enzyme.
Sites: Loose connective tissue areas; orbit, scrotum, appendix
Pus characters: Thin and bloody, many sloughs

Complications:

Lymphatic dissemination of infection
Blood spread with conditions like septicemia and pyemia

Summary & Wrap-up

Acute inflammation is classified into two categories based on the presence and absence of pus
Acute, non-suppurative, and exudate-based further classification further subcategories.

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Description

Test your knowledge on the characteristics and mechanisms of suppurative inflammation with this quiz. It covers important concepts such as the roles of enzymes, abscess formation, and the bacterial species involved. Perfect for students studying pathology or related fields.