Uremia: etiology, pathogenesis, macro- and microscopic changes in the kidneys. Complications, causes of death, clinical significance.
Chronic renal failure (CRF)-uremia is a syndrome caused by a gradual decrease in the level of glomerular filtration (5-50%) with the development of long-term azotemia and a variety of symptoms and syndromes associated with it. (the morphology is based on sclerosis)
Etiology:
1. Extrarenal. It develops in diseases of non-renal origin: GB, diabetes mellitus, IE, Systemic diseases.
2. The real one. It develops in kidney diseases (chronic glomerulonephritis, pyelonephritis, amyloidosis of the kidneys, polycystic kidney disease, congenital kidney abnormalities)
3. Postrenal. It develops in diseases of the urinary tract (tumors, strictures, congenital malformations).
Pathogenesis:
Macro- and microscopic changes:
At the autopsy of a corpse that died of uremia, the smell of urine is felt. The reaction with xanthhydrol reveals urea in all organs, especially in the stomach, lungs, and spleen. Volatile ammonia compounds give ammonium chloride vapors in the form of a cloud with strong hydrochloric acid. This reaction is used to diagnose uremia during autopsy. The skin is earthy-gray in color as a result of the accumulation of urochrome. Sometimes, especially on the face, it is powdered with a whitish powder (chlorides, crystals of urea and uric acid), which is associated with hypersecretion of sweat glands. Rashes and hemorrhages are often observed on the skin — an expression of hemorrhagic diathesis. Uremic laryngitis, tracheitis, and pneumonia are often noted to be fibrinous-necrotic or fibrinous-hemorrhagic in nature. Uremic pulmonary edema is especially characteristic. Pharyngitis, gastritis, enterocolitis of a catarrhal, fibrinous or fibrinous-hemorrhagic nature are often found. There is fatty degeneration in the liver. Very often, serous, serous-fibrinous or fibrinous pericarditis, uremic myocarditis are detected, less often — warty endocarditis. Uremic pleurisy and peritonitis are possible. The brain in uremia is pale and edematous, sometimes foci of softening and hemorrhage are detected. The spleen is enlarged, resembles a septic spleen. Uremia develops not only in chronic, but also in acute renal failure. It is also observed in eclampsia (eclamptic uremia) and chlorohydropenia (chlorohydropenic uremia).
Complications:
Pneumonia, pulmonary edema, encephalopathy, gastritis, steatosis, uremic pericarditis, uremic pleurisy, peritonitis.
Causes of death:
Among the causes of death of patients with uremia, the most common are cardiovascular disorders (including pericarditis with cardiac tamponade), hyperkalemia, associated infectious diseases (pneumonia and others), sepsis, hemorrhagic complications, and uremic coma.
Inflammatory diseases of the female and male genital organs: causes, types, pathological anatomy, complications, outcomes, clinical significance.
Types of inflammatory diseases of the genital organs:
For men:
Prostatitis (Inflammation of the prostate gland)
Funiculitis (Inflammation of the spermatic cord)
Balanitis (Pathology, which is an inflammation of the skin of the glans penis)
Orchitis (Inflammation of the testicle)
Vesiculitis (Inflammation of the seminal vesicle)
Cavernitis (Inflammation of the cavernous bodies of the penis)
Colliculitis (Inflammation of the seminal tubercle)
Epididymitis (Inflammation of the epididymis)
For women:
Inflammatory diseases of the lower part of the female genital organs: vulvitis, bartholinitis, colpitis, endocervicitis.
Inflammatory diseases of the upper part (inflammatory diseases of the pelvic organs): endometritis, endomyometritis, salpingitis, parametritis.
Reasons:
Most often, the cause is conditionally pathogenic microorganisms, which multiply intensively with reduced immunity. These include mainly Staphylococcus, streptococcus, fungi of the genus Candida, and some viral particles. Of the pathogenic ones, gonococci, chlamydia, trichomonas, and others have their negative effects.
Pathological anatomy of some diseases:
Acute endometritis. The mucous membrane is covered with a purulent or putrid coating of gray-red color. When inflammation passes to the vessels of the myometrium, purulent metritis and thrombophlebitis develop.
In chronic endometritis, there is a picture of chronic catarrh of the uterine mucosa with mucopurulent or purulent, sometimes very abundant discharge. The mucous membrane is full-blooded, infiltrated by a variety of cells, among which lymphoid, plasma cells, and neutrophils predominate. The epithelium of the glands is in a state of increased desquamation and proliferation. With a prolonged course of endometritis, glandular atrophy develops, fibrosis of the stroma of the mucous membrane, infiltration by its lymphoid cells — atrophic endometritis. When the fibrous tissue squeezes the excretory ducts of the glands, their contents thicken, cysts form — cystic endometritis develops. If the mucous membrane undergoes hyperplasia as a result of chronic inflammation, they talk about hypertrophic endometritis. Differential diagnosis of it with glandular hyperplasia of the uterine mucosa is difficult.
Complications of endometritis: parametritis, peritonitis, pelvic abscesses, sepsis, thrombophlebitis of the pelvic veins. Outcomes: resolution of the disease with timely treatment, chronization of the process, the appearance of complications.
Clinical significance:
pain in the lower abdomen;
pain during gynecological examination, sex;
abnormal uterine bleeding (after sexual intercourse, spotting in the middle of the cycle, metrorrhagia, amenorrhea);
increased body temperature (typical for acute endometritis);
chronic endometritis may be asymptomatic.
Acute prostatitis. Morphological forms are catarrhal, follicular and parenchymal prostatitis, which are considered as stages of an acute process. In the catarrhal form, purulent catarrh of the ducts of the prostatic glands, vascular fullness and swelling of the interstitial gland occur. This form usually turns into follicular prostatitis, in which foci of inflammatory infiltration of the glands join the changes in the ducts. In the parenchymal form, leukocyte infiltration becomes diffuse, abscesses and foci of granulation appear.
In chronic prostatitis, the development of which is associated with gonococci, trichomonas, chlamydia, mycoplasma, mycobacteria, fungi, lymphohistiocytic infiltration of the stroma of the gland, the proliferation of granulation and scar tissue prevail, in some cases granulomas appear. Atrophy of the gland is combined with proliferation and metaplasia of the epithelium of the ducts, which leads to the formation of cribritic and papillary structures.
A complication of prostatitis, especially chronic, is recurrent urinary tract infection, prostate abscess, infertility, impaired urination, prostate adenoma.
Outcomes: resolution of the disease with timely treatment, chronization of the process, the appearance of complications.
Clinical significance:
pain in the lower abdomen, in the lumbar region, in the groin, in the perineum and genitals;
frequent urination (caused by irritation of nerve endings);
difficulty urinating, incomplete emptying of the bladder (caused by swelling of the prostate gland);
disorders of sexual function.
Acute orchitis is a common complication of a number of acute infections (typhus, scarlet fever, malaria, gonorrhea), especially mumps (20-30%). Purulent inflammation usually develops, with mumps — diffuse interstitial inflammation with a predominance in the infiltrate of lymphocytes.
Chronic orchitis can be both the outcome of acute orchitis and a manifestation of chronic infection (tuberculosis, syphilis, actinomycosis) or testicular injury. Autoimmune mechanisms (autoimmune orchitis) are involved in its development. It is characterized by chronic diffuse or granulomatous inflammation; when spermatozoa are introduced into the testicular stroma, peculiar sperm granulomas are formed.
Complications of orchitis: epididymitis, bilateral orchitis, infertility, testicular atrophy.
Outcomes: resolution of the disease with timely treatment, chronization of the process, the appearance of complications.
Clinical significance:
Clinical symptoms are variable and depend on the severity of the pathological process and the nature of the pathogen. Common manifestations may include weakness, fever with chills, headache, and muscle aches.
The affected testicle is enlarged, sharply painful, and the skin above it is hyperemic. Swelling due to inflammation can be so pronounced that it is not possible to probe any structures in the scrotum on the affected side. In the supine position, the painful sensations are less pronounced.
Precancerous processes and cancer of the uterine body: terminology, pathological anatomy (macro- and microscopic signs). Forms of growth, features of cancer metastasis, complications, outcomes, clinical significance.
Precancerous processes:
Glandular endometrial hyperplasia
Atypical glandular hyperplasia
Polyposis
Uterine body cancer occurs more often in women over the age of 50. Hormonal imbalance (estrogen content) plays an important role in its development. It causes hyperplasia of the epithelium of the uterine mucosa, leading to malignant transformation. The appearance of cancer is preceded by precancerous changes — hyperplasia and endometrial polyps.
Cancer of the uterine body is more often exophytic growths in the form of cauliflower or a polyp on a wide base (exophytic growth). The tumor can occupy the entire uterine cavity, undergo decay and ulceration. Endophytic growth is rarely observed.
The histological structure of uterine body cancer is highly, moderately, or low—grade adenocarcinoma. Undifferentiated cancer is rare.
Metastases of uterine body cancer are observed primarily in the lymph nodes of the pelvis, hematogenous metastases are rare.
Complications: anemia, bleeding, compression of neighboring organs, complications associated with metastases.
Outcomes:
they depend on the stage of the disease. In the early stages, complete recovery is possible (after surgical treatment in combination with chemotherapy or radiation therapy), with time the probability of death increases.
Clinical significance:
With preserved menstrual function, uterine body cancer can manifest itself with prolonged copious menstruation, acyclic irregular bleeding, and therefore women may be mistakenly treated for ovarian dysfunction and infertility for a long time. In postmenopausal patients, blood secretions of a meager or abundant nature occur.
In addition to bleeding with cancer of the uterine body, leukorrhea is often observed - abundant watery liquid whites; in advanced cases, the discharge may have the color of meat slops or purulent in nature, an ichorous (putrid) odor. A late symptom of cancer of the uterine body is pain in the lower abdomen, lower back and sacrum of a permanent or cramping nature. Pain syndrome is noted when the serous lining of the uterus is involved in the oncoprocess, compression of the nerve plexuses by parametral infiltration.