Cholera

Pathology and pathogenesis
With cholera occurs acute serous or serosanguineous inflammation of the small intestine. Severe dehydration and demineralization cause weight loss, quick stiffness skeletal muscles, bluish coloration of visible mucous membranes and skin. Stiff muscles retain the position in which he found their death. Extremities take bent position with relief muscles, and the fingers can be compressed in a fist ("the position of the fighter"), the skin on fingers wrinkled hand"laundress", Fig. 2), subungual space sharply cyanotic. Eyes and sunken cheeks, a pointed nose, cheekbones are issued.

Fig. 2. "The hand of the laundress" the patient cholera (wrinkling and cyanosis).
Fig. 3. Sharp hyperemia of the small intestine with cholera.

Cadaveric spots purple-purple. In blood vessels, heart cavities and sinuses of the meninges thick, dark red blood. The surface of the serous cavities sticky, covered Slezevicius bloom, resulting in the peritoneum is "soapy". The small intestine is inflated its vessels are filled with blood (Fig. 3); loops reddish color when razdvigaya them stretch sitewide thread. Liquid contents of the small intestine color meat slops. The mucous membrane of the colon swollen dramatically hyperemic, with hemorrhages (printing. table, Fig. 1 and 2).


Fig. 1 and 2. Swollen mucous membrane of thin intestines with varying degrees of hyperemia (death in agenom period of cholera). Fig. 3. Polypous expansion and scar process in the mucosa of the colon as a result of its changes during the cholera typhoid.

Microscopic changes in the deceased in agenom period detected in face, thin and duodenal intestine. The tops of the villi mortify, desquamated epithelial is in a state of coagulation necrosis.
In the content and submucosal layer of the colon huge number of cholera vibrios. In intramural ganglia of the small intestine dystrophic changes. In the gallbladder thick bile, easy planted the causative agent of cholera. The spleen is reduced, flabby. The kidneys are enlarged, red-blooded, and degenerative changes of the epithelial up to necrosis. Pia mater swollen. In the brain there degenerative-necrotic changes ganglion cells, neuronophagia and hemorrhage. Bone marrow bones dark red. At death from lightning forms of cholera ("dry cholera") loops of small bowel spavaca, colon inflated contains typical for cholera liquid mass.
Have died from cholera typhoid in the colon (sometimes in iliac) has diferitele inflammation of mucous membranes, reminding it of bacterial dysentery. In other cases in the colon in the catarrhal inflammation of the mucous membrane and bleeding can occur polypous expansion of the mucous membrane and the scar processes (printing. table, Fig. 3). In the liver, degenerative changes. Frequent cholecystitis. Kidney change the type of acute or subacute jade with symptoms of necrotizing argued.
The pathogenesis of cholera not yet fully installed. On the theory R. Koch Vibrio cholera reaches the stomach and under certain conditions, passing the barrier of gastric juice, hard thrives in an alkaline environment of the small intestine. Simultaneously with reproduction takes place, and the mass destruction of pathogens with the release of endotoxin, which causes changes in the small intestine, intoxication and dehydration of the organism. Sanarelli (G. Sanarelli) believes that the gates of infection is pharyngeal lymphatic ring, where the vibrios fall where they multiply and then penetrate into the blood and entered her current in the wall of the small intestine. Through the mucous membrane they penetrate into the intestinal lumen. Vibrio ALGID Sanarelli regards as heterospecific similar anaphylactic shock, permissive factor of which is the endotoxin of cholerae. The pathogenesis of the cholera typhoid apparently caused by the release of the mucous membrane of the small intestine endotoxins, other toxic substances and accession of secondary infection.
Differential diagnosis of cholera on the corpse is carried out with Salmonella diseases and poisonings arsenic, poisonous mushrooms, seeds of the castor); at death from cholera typhoid - bacterial dysentery, uraemic and diabetic coma, poisoning salts of heavy metals.