Acute inflammation

Dr. Alaa Hani

 Case 1
• The illustration (a) shows two appendices. The one on the left
is normal, the other is acutely inflamed.
1- What, in basic terminology, are the visible differences?
2- What would you expect to be covering the inflamed
appendices?
3- Why do the inflamed appendices appear plumper than
normal?
4- You are presented with photomicrographs from two
appendices. Examine the normal appendix (b) and try to
identify the following:
• mucosa
• lymphoid tissue
• muscle layers
• fibrous tissue on the outside
 1a 1b

1b

1c 1d
5- Look particularly at the wall of the appendix in
picture (c). What has happened at the point marked
X?
6- What complication could follow this?
7- Now look at picture (d), which is a histological
section through an inflamed appendix (with an inset
high power view). What has happened to the mucosa?
8- Acute appendicitis is a mysterious disease. Its cause
is poorly understood. Can you think of any events that
might trigger acute inflammation in the appendix?
9- List three possible outcomes of acute appendicitis,
assuming that it is not treated. Think about the events
that would lead to each
 Case 2
This is the brain of a young man who died from bacterial
meningitis (b). An illustration of a normal brain is also provided
(a). The folds of the brain are called gyri and the grooves are called
sulci.
1- What can you see in the sulci (S) in (b)?
2- Given the anatomy of the skull, what effect might this have?
3- This is the microscopic appearance of the meninges (c). The
brain substance (B) and blood vessels (BV) are indicated. What has
accumulated adjacent to the brain?
4- What organisms may cause meningitis in the following age
groups?
• Neonates and children:
• Young Adults:
• Older age groups:
5- What are the long-term complications of meningitis?
Mechanisms of Disease Module Session 2 - Acute Inflammation (Sheet 2 )

2a 2b

2c
3
 Case 3
A patient with gallstones has for months
refused operative treatment. He is admitted
with collapse, fever and pain in the right
upper quadrant of the abdomen. An
abdominal ultrasound shows a mass in the
liver with a central cavity, thought to be an
abscess. An example of a liver abscess is
shown in picture 3.
The patient has the following results for laboratory and clinical investigations:

Normal range:
Test: Result 37°C
'Vital signs' approx. 120/80
Temperature 39.5°C approx. 70
Blood pressure 80 / 40
Heart rate 130
'Urea and electrolytes'
Sodium 133mmol/l 134-144
Potassium 6. 5m mol/l 3.3-5.3
Urea 10.6mmol/l 2.5-6.5
Creatinine 31 0µmol/l 60-120
'Liver function tests'
Bilirubin (Total)
35µmol/l 3-17
Alanine transaminase 195 IU/l 2-53
Alkaline phosphatase 590 IU/l 40-130
'Blood count'
Haemoglobi n
13.8g/dl 13.5-18
N eutrop hi ls 35 x109/l 2.0-7.5
'Blood gases'
Arterial oxygen level
5.3kPa 9.8-14.2
Arterial CO2 level 9.5kPa 4.2-6.0
Arterial blood pH 7.1kPa 7.34-7.45
1- What complications have developed from the presence
of the hepatic abscess?
2- Attempt to explain:
A- The abnormal liver function tests.
B- The abnormal temperature and blood count.
C- The abnormal urea and electrolytes.
D- The abnormal blood gases.
3- What is the significance of the low blood pressure and
high heart rate?
4- What treatment would the patient need?
5- Can you think of any other investigations that might not
only confirm your diagnosis but would indicate exactly
which drugs to use in treatment?
6- What is the link between gallstones and hepatic abscess?