Ulceration stage
In the third week of the disease, the process of rejection of necrotic masses in the intestine begins. During this period, «dirty» ulcers form, which precisely replicate the shape of follicles and Peyer's patches.
- Surface: uneven and dull.
- Edges: overhanging the base.
- Base: covered with necrotic detritus.
The pathological process affects tissues sequentially: first, changes are recorded in the distal ileum, and then they spread to the proximal section.
Stage of clean ulcers and possible complications
In the fourth week of the disease, the rejection of necrotic masses is completed, and mucosal defects transition into the stage of clean ulcers.
- The shape of the ulcers becomes oval or round.
- The edges take on an even, slightly rounded appearance.
- The base becomes smooth.
Complication: In some cases, only a thin serous membrane of the intestine remains as the base of the ulcer. This creates a critical risk of intestinal perforation, which inevitably leads to the development of severe peritonitis.
Healing and repair
In the fifth week, the process of healing of intestinal defects starts. Delicate scars form at the site of former ulcers, and lymphoid tissue gradually regenerates.
- The reparative process proceeds via restitution, i.e., complete structural restoration.
- Clinical feature: at this stage, a striking mismatch is often observed — the patient's well-being is already good, while morphological changes in the intestine still persist.
Reaction of mesenteric lymph nodes
Mesenteric lymph nodes undergo changes that mirror the processes in the intestine:
- Initial stage: the nodes increase in size, are hyperemic; monocytes and reticular cells actively proliferate and displace lymphoid elements.
- Granulomatous stage: specific granulomas form.
- Outcomes: necrosis of granulomas followed by organization and petrification (calcification) of necrotic masses.
Briefly: answers to topical questions
What pathomorphological changes occur in Peyer's patches during the first and second weeks of the disease?
During the first and second weeks of the disease, pathomorphological changes in Peyer's patches go through two successive stages.
- Stage of medullary swelling — against the background of catarrhal enteritis, solitary follicles enlarge, swell, acquire a gray-red color and protrude into the intestinal lumen, their surface becomes uneven.
- Stage of necrosis — in the second week, necrosis of the lymphoid tissue of the follicles occurs.
What is the exact cellular composition of specific granulomas forming in the mesenteric lymph nodes?
In the provided sources, the exact full cellular composition of typhoid granulomas in the mesenteric lymph nodes is not disclosed. The following is indicated:
- Changes similar to intestinal ones occur in the mesenteric lymph nodes.
- At the initial stage, the nodes are enlarged and hyperemic; proliferation of monocytes and reticular cells is observed, which displace lymphoid elements.
- Then, typhoid granulomas are formed.
- Specific macrophages — typhoid cells — form granulomas.
- Subsequently, necrosis of granulomas, their organization, and petrification of necrotic masses are possible.
What systemic (extraintestinal) complications can develop in this disease?
In this disease, a number of severe extraintestinal complications affecting various organ systems can develop.
- Secondary infection — includes the development of meningitis, meningoencephalitis, bronchopneumonia, and intramuscular abscesses.
- Non-ulcerative peritonitis — occurs due to necrosis of mesenteric lymph nodes or rupture of the splenic capsule.
- Typhoid sepsis — proceeds with a pronounced typhoid status in the absence of significant changes in the intestine.
- Rare complications — include purulent perichondritis, osteomyelitis, arthritis, cystitis, prostatitis, and waxy necrosis of the rectus abdominis muscles.
Class and exam questions
What changes occur in the intestine in the 3rd week?
In the 3rd week, the stage of ulceration begins: necrotic masses are rejected, "dirty" ulcers with an uneven surface and overhanging edges are formed.
What is the danger of the 4th week of the disease for the intestine?
By the 4th week, only a thin serous membrane may remain as the base of the ulcer, which creates a high risk of intestinal perforation and the development of peritonitis.
How does ulcer healing proceed in the 5th week?
By the 5th week, delicate scars form, lymphoid tissue regenerates, and repair proceeds via restitution (complete restoration).
What else to study on this topic
- Pathogenesis of necrotic mass rejection in Peyer's patches
- Microscopic picture of solitary follicles stained with hematoxylin and eosin
- Structure and role of specific macrophages (granuloma cells)
- Stages of development and outcomes of mesenteric lymph nodes
- Signs of petrification of necrotic masses in lymph nodes
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