Block 1 Flashcards
What is a morphological diagnosis?
Describes the affected structure, process, distribution, severity, time course. Long names
What is the etiological diagnosis?
Diagnosis that names causative agent
What is the disease diagnosis?
States name of disease
What is a lesion localized to a single area
Focal
What is a lesion in multiple areas on the same tissue/organ?
Multifocal
What is a lesion in multiple areas with overlapping regions?
Multifocal to coalescing
What is a lesion fulling spread throughout a tissue/organ?
Diffuse
What is a lesion localized to one portion of an organ/tissue?
Locally extensive
What are the 4 categories of duration?
Acute
Subacute
Chronic
Chronic-active
What is the last part of a word that means inflammation?
“-itis”
What does purulent mean?
Puss
What are the two anti-inflammatory and immunosuppressive cytokines?
IL-10 and TGF-B
What is the subset CD4 T cells that help suppress the immune response via physical contact?
T regs
What do T regs express on their cell surface?
CD4+ and CD25+
What transcription factor do T regs express?
FOXP3
What are the macrophages that suppress inflammation?
M2 macrophages
What cytokines do M2 macrophages release to suppress inflammation?
IL-10 and TGF-B
What does PD-1 do on T cells?
PD-1 is a cell surface suppressor which shuts down T cell activation
What does cancer do to PD-1 on T cells?
PD-1 (programmed cell death) is upregulated which shuts down most all T cell activation therefore stopping the activation of the suppressive cells (stopping the cells that kill the cancerous cells)
What is tolerance in immunilogical terms?
Tolerance is when the immune system fails to mount an immune response toward a specific antigen
What does a failure of self-tolerance lead to?
Auto-immune disease
What are the 2 mechanisms of tolerance in the immune system?
Central tolerance and peripheral tolerance
What is a cryptic antigen?
Self-antigens that are revealed secondary to inflammation
What are the 3 ways that peripheral tolerance addresses auto reactive imune cells?
Peripheral deletion
Anergy
Regulatory T cells
What is peripheral deletion?
T and B cells recognize self antigens in the lymph nodes
What is anergy?
Shut down of self reactive T and B cells due to lack of all 3 signals
What causes anergy?
Removal of either co-stimulation or cytokines (1 or 2 of the 3 signals required for activation)
What induces differentiation into T regs?
Presence of IL-10 or TGF-B
What blood do you use in a biochem panel?
Red top, serum
What “top tube” do you use for CBC? Biochem profile?
Purple top
Red top
What percent of healthy animals will have at least 1 abnormal result?
60%
What is the one type of result that is significant if it falls slightly outside of the reference interval?
Electrolytes
What type of error is most common in laboratory results?
Preanalytical
What is in a routine serum biochem profile?
Electrolytes, minerals, proteins, enzymes, lipids, and glucose
What are the 4 aspects to disease?
Etiology, pathogenesis, morphological change, functional consequences
What are the 2 subsets of etiology?
Intrinsic and extrinsic
What are the 2 subsets in intrinsic etiology?
Primary and secondary
What is a primary intrinsic etiology?
Genomic related
-Family/breed
-Mutation
What is a secondary intrinsic etiology?
Physical Abnormalities
-Age, sex, species
What are the 2 subsets of extrinsic etiology?
animate and inanimate
What is an animate extrinsic etiology?
Pathogens
What is an inanimate extrinsic etiology?
Energy, xenobiotics, surgical
***What is the flow of pathogenesis?
Biochemical change>Functional alterations>Morphological lesions >Clinical signs
What is idiosyncratic?
A patient specific disease
What are lesions?
Visible manifestation of disease
What are the different levels, in order, of visualizing lesions?
Gross pathology > Histopathology > Ultrastructural pathology
What is pathognomic?
A lesion so distinctive and unique that it can only be caused by one etiology
What is the prognosis?
Prediction of future outcomes
Usually worded (excellent, good, fair, guarded, poor)
What are disturbances in electrolytes normally caused by?
Vomiting, diarrhea, and kidney disease
What are the major cations?
Na+ (largest), Ca, Mg, K
What are the major anions?
Cl, PO4, HCO3, A (proteins)
What level is sodium when animal is dehydrates?
Higher
What balances the cation, Na?
Cl and HCO3
What disease is usually indicated from high potassium (hyperkalemia)?
Addison’s
Low aldosterone = high levels of potassium
What hormone removes potassium from the blood?
Aldosterone
What does chloride usually follow?
Sodium (NaCl)
What is bicarbonate an indicator of?
Acid/base status
What is low bicarbonate indicative of?
Metabolic acidosis
A high bicarbonate is metabolic alkalosis
What different things can you check on a biochemical profile for the liver?
Hepatocellular injury
Cholestasis
Synthetic injury
What are the indicators for livers on a chem profile?
ALT, AST, ALP, cholesterol, CK, biliruben
What increases with hepatocellular injury?
ALT and AST
What increases with cholestasis?
ALP and bilirubin
Why is ALT increased during hepatocellular injury?
ALT is found in hepatocytes so when it is increased, that means there is damage to the hepatocytes
Why is an increase in AST nonspecific?
AST is found in liver, muscle, and blood
When is an increase in AST notable for hepatocellular damage?
When it is marketed (more than 3x)
What enzyme is measured most for muscle injury?
CK (creatinine kinase)
What liver biomarkers are used to assess synthetic function?
Cholesterol, albumin, glucose, and BUN
When should measuring cholesterol occue?
After fasting (or may be higher)
What are the steps of bilirubin metabolism?
Bilirubin in blood goes through liver
Liver conjugates bilirubin
Bilirubin enters intestine where it is either excreted in urine or stool
What is biliruben excreted in unrine called?
urobilinogen
What is biliruben excreted in stool called?
Stercobilinogen
Where is conjugated bile secreted?
Into bile
What is cholestasis?
Slowing or stopping of bile through the biliary system
Increased bilirubin can mean what 3 things?
Pre-hepatic icterus
Hepatic icterus
Post-hepatic icterus
What is total protein made up of?
Albumin and globulin
What does increased total protein mean?
Anything that increases immunoglobulins
Neoplasm, inflammation, dehydration
What does decreased total protein mean?
Decreased production via liver
Loss from GI or kidney
What causes hypoalbuminemia?
Decreased production by hepatocytes (liver disease)
Loss from renal or GI loss
Do younger animals have decreased globulins?
YES
How do you determine globulin from albumin and TP?
TP-albumin = globulin
What does decreased globulin indicate?
Liver disease, synthetic function
Will cats have hyperglycemia at vet?
YES, EXCITED
What is another name for persistent hyperglycemia?
Diabetes mellitus
What is DIC?
Disseminated intracellular coagulation (Death is coming)
What are the 4 mechanisms of cellular injuries?
Membrane injury
Nuclear damage
ATP depletion
disturbances in cellular metabolism
What are the 3 cell responses to injury/stress?
Adaptation
Degeneration
Cell death
What is adaptation related to cell injury/stress?
React to stress so that a new homeostatic state is established
What is Degeneration related to cell injury/death?
Reversible cell injury from which a cell can adapt and recover. Either intracellular or extracellular components
What is Death related to cell injury/death?
Irreversible cell injury results in cell death
What are the 2 reversible cell responses?
Adaptation
Degeneration
What are the 2 irreversible cell responses?
Necrosis
Autolysis
What are the 4 types of cell adaptation?
Hyperplasia
Metaplasia
Hypertrophy
Atrophy
What is atrophy?
Reduction of cell size
What is hypertrophy?
Increased cell size
What is hyperplasia?
More cells
What is metaplasia?
Replacement of cell type
What type of adaptation does a portosystemic shunt cause to the liver?
Atrophy of hepatocytes
Due to decreased blood flow
What type of cell adaptation would a chronic smokers mucosal lining undergo?
Metaplasia
What are the 4 types of reversible degeneration that a cell can undergo?
Hyropic (acute cell swelling)
Fatty change
Glycogen accumulation
Myxomatous
What causes degeneration of cells?
Sublethal injury
What is hydropic degeneration?
Swelling due to water accumulation
What happens to ATP when hydropic injury occurs?
ATP is decreased where water moves into cell
What is the cell degeneration, fatty change?
Fatty vacuole accumulation in non-adipose cells
What are causes of fatty change?
Hypoxia, anemia, starvation
Where does fatty change usually occur?
Liver, kidney, and muscle
What gross things can you appreciate on cellular degeneration?
Softer tissue
Light tissue
Larger organs
What is hepatic lipidosis in cats?
Accumulation lipoproteins in liver leading to fat storage
What stains can be used to see adipose cells?
Oil Red O
Suden Black
Where does glycogen accumulation begin?
Centrilobular regions due to lower oxygen content
What is myxomatous?
Accumulation of mucin-like material
What does myxomatous cause?
Conversion of mature proteins to embryonic forms
What types of tissue does myxomatous occur in?
Connective tissue and adipose tissue
When does myxomatous most often occur?
During cachexia (muscle loss) and starvation
What is microcirculation?
Exchange of nutrients and waste between blood and extravascular tissue
What is the space between cells and the microcirculation?
Interstitium
Edema is the accumulation of abnormal quantities of fluid in the interstium
What controls the balance of fluid between the arteriole and the interstitial space?
Physical barriers (arteriole wall)
Differences in pressure
Concentration of substance
What are the driving forces of fluid exchange?
Arteriole blood pressure (ABP)
Colloid osmotic pressure (COP)
Interstitial fluid pressure (IFP)
What is the active driving force of fluid exchange?
Arteriole blood pressure
What is the passive driving force of fluid exchange?
Colloid osmotic pressure
Interstitial fluid pressure
When do we get edema?
When this balance between the fluid exchange is off
What tube is used to run a chem profile?
Red top
What type of blood is used in a red top?
Serum
What does a purple top tube have that a red top doest? (In terms of the blood)
A buffy coat (fibrinogen)
What percent of error is pre-analytical? (Our fault)
65%
What percent of healthy animals will have at least 1 “abnormal” value?
60%
What are the tests most commonly used to determine kidney function tests (GFR)?
BUN, Creatinine, and Phosphorus
What is urea?
A by-product of protein breakdown produced in the liver
What is creatinine?
A by-product of muscle metabolism
What is an increase in BUN and Cr called?
Azotemia
What are the 3 different potential reasons for azotemia?
Pre-renal: dehydration (vomiting/diarrhea)
Renal: Acute or chronic kidney disease
Post-renal: ruptured bladder or urethral blockage
What are the minerals ran on a routine chem panel?
Mineral
Phosphorus
CALCIUM IS REPORTED AS TOTAL (NOT IONIZED) ON CHEM PANEL
What does high phosphorus indicate?
Kidneys are main route of phosphorus excretion so high phosphorus may indicate pre-renal, renal, or post-renal disease
What does low phosphorus indicate?
Possibly kidney disease
What is the most common cause of hypercalcemia in dogs?
Neoplasia
What is a cause of hypocalcemia?
Low albumin (decreased protein-bound fraction)
Describe autolysis
Dead animal
Diffuse
No tissue reaction
Describe necrosis
Alive animal
Focal to multifocal
Induces local tissue reaction
How does autolysis occur?
Progressive tissue anoxia via microbes eating tissue, mostly from gut microflora
What type of animals will autolyse faster?
Large, obese, thick-coated, and herbivores (due to GI microflora)
What general idea causes quicker autolysis?
Anything that increases heat
What is livor mortis
Blue/purple color due to congestion of blood in external tissues
What is dessication?
Poikilotherms (cold blooded) may dry out instead of autolysis
What is putrefecation?
Bubble formation on internal tissues due to bacterial fermentation. Tissue also turns pale
What is imbibition?
Internal: Tissue discoloration
Hemoglobin imbibition: red stain
Pseudomelanosis: blue-black discoloration
Bile imbibition: Green-brown
What is chicken fat?
Clotted serum chunks in autolysis
What is currant jelly?
Clotted erythrocytes in autolysis
Where do blood clots settle in autolysis during microscopy?
Down due to gravity
How are thrombi in post mortem different from thrombi in ante mortem?
Post: unattached to walls, shiny/wet
Ante: thrombi attached to wall, dry/dull, tail extends downstream
What are organisms that grow on dead tissue?
Saprophytes
How do you know saprophytes are invaders?
Gram (+) anaerobic rods
No inflammatory response
Do autolytic borders have sharp or rigid borders?
SHARP
Is necrosis and oncotic necrosis the same?
YES
What are causative agents for cell death (necrosis)
Oxidative stress
ATP decrease
Loss of Ca homeostasis
Mitochondria damage
2 main causes of necrosis?
Failure of mitochondrial function
Breach of cell membranes
What is the pathogenesis of cell death?
Cell injury
Influx of Ca2+
Ca2+ activates degradative enzymes
Further mitochondrial/membrane breakdown
Describe free radicals
Molecule with unpaired electron. Normally controlled by antioxidants but if overwhelmed, the mitochondria will be further depleted
What are common gross morphological changes of necrotic tissue?
Irregular contours
Sharp demarcations
Paler
Colored rim: red or white
What are microscopic changes in necrotic cells?
Loss of internal cell detail
Hypereosinophilia of the cytoplasm
A visual gradient
Nuclear changes
What is karyolysis?
Nuclear fading
What is pyknosis?
Nuclear shrinkage
What is karyorrhexis?
Nuclear fragmentation
What are the functional molecules involved in apoptosis?
Caspases
What is the execution caspase for apoptosis?
Caspase 3
What are the 4 types of necrosis?
Coagulative
Liquifactive
Caseous
Gangerenous
What is coagulative necrosis?
Cell outline remains
common in kidney, liver, muscle
What causes coagulative necrosis?
Heat, decreased blood flow, toxins
What are the subtypes of coagulative necrosis?
Fat necrosis
Zenker’s necrosis
What is fat necrosis?
Coagulative necrosis of adipose tissue
What is Zenker;s necrosis?
Coagulative loss of striated muscle (cardiac and skeletal muscle)
Describe saponification
Release of Ca an dK after adipose breakdown causing formation of soaps on pancreas surface
What is liquefactive necrosis?
Enzyme breakdown of tissues resulting in dissolving or liquefying
What is the term for liquefactive necrosis of the CNS
Malacia
What type of necrosis is an abcess?
Liquefactive necrosis! Bacterial enzymes consuming tissue
What does a thiamin deficiency cause?
Polioencephalomalacia
What is caseous necrosis?
Cheese-like
Granular and friable
What does a caseous necrosis typically form?
A granuloma
What is a granuloma?
Cell debris and inflammatory cells surrounded by connective tissue capsule
What is gangrenous necrosis?
Coagulative necrosis that turns into gangrenous
What are the 3 types of gangrenous necrosis?
Wet
Dry
Gas
What is wet gangrenous necrosis?
Coagulative + liquefactive + saprophytic bacteria
What is dry gangrenous necrosis?
coagulative + infarction
On distal limbs due to vasoconstriction
What is gas gangrenous necrosis?
coagulative + anaerobic bacteria producing a toxin
What happens if a quantity of dead tissue is too large to be removed from the body?
A sequestrum is formed
What is a sequestrum?
A persistent fragment of necrotic bone
What is immune regulation?
The ability for the body to balance clearing a pathogen while not harming self
What is contraction?
Massive reduction in CD8 and plasma cells
What remains after contraction?
Memory cells
What are the 2 immunoregulatory cytokines?
IL-10 and TGF-B
What does a Treg express?
CD4+, CD25+, and FOXP
What do M2 macrophages produce?
IL-10 and TGF-B
What does PD-1 do?
Cell surface receptor on T cells that deactivates T cells (cancer cells use this to deactivate T cells)
What is tolerance?
Lack of an immune response towards something (like self)
FAILURE OF SELF-TOLERANCE IS AN AUTO-IMMUNE DISEASE
What are cryptic antigens?
Antigens only revealed secondary to inflammation
What are the 3 methods of peripheral tolerance?
Peripheral deletion
Anergy
Regulatory T cells
What is peripheral deletion?
Apoptosis in lymph nodes of self reactive cells
What is anergy?
APC dont express all 3 signals required so self reactive T or B cell shuts down
How is pregnancy possible with 1/2 paternal?
Up regulation of Tregs and Tregs with IL-10 and TGF-B in placenta
What bovine disease causes abortions?
BVD
What is cytopathic BVD?
Infection is lytic, causing cell death (cytolytic)
What is non-cytopathic BVD?
Infection results in replication but not kill the cell
What type of BVD occurs in utero?
non-cytolytic BVD
When must exposure to BVDV occur in utero?
80-120 days
Prior to or during negative selection
Calves infected in utero become PI calves (persistently infected)
How is BVD tested for?
Ear notching shows brown/orange cirus
What are symptoms of BVD in non-pregnant cows?
Oral ulcerations
Diarrhea
Pneumonia
What is mucosal disease associated with BVD?
Disease that occurs in PI animals with infection of cytopathic strain of BVD
What is primary autoimmunity?
Genetic susceptibility with no obvious trigger
What is secondary autoimmunity?
A result of some trigger
What are superantigens?
Antigens produced by bacteria that activate massive numbers of T cells through bridging the MHCII
What are cryptic epitopes?
Self tissue released as antigen to T cells
What causes agglutination with IMHA?
Antibodies can bind 2 RBCs which causes agglutination of cells
What does a Coombs test detect?
Presence of erythrocyte-directed auto-antibodies
What is targeted in myasthenia gravis?
Acetylcholine receptors in neuronal junctions
How do you test for myasthenia gravis?
Tensilon test
What are the 2 phases of type 1 hypersensitivity?
Sensitization phase: first encounter
Effector phase: re-encounter
What is the primary cell in type 1 hypersensitivities?
Mast cells (IgE and histamines)
NOT eosinophils
How do infections result from atopic dermatitis?
Scratching from pruritus causes trauma and moisture
Which is the drug that actually treats the “itch”
Lokivetmab (cytopoint)
How does cytopoint work?
Anti IL-31 antibodies
What is hyperemia?
Too much blood flow in (erythema)
What is congestion?
Not enough blood flow out (cyanosis)
What is the nutmeg appearance?
Right sided heart failure in dogs due to hypoxia (cyanosis due to congestion)
What are the heart failure cells?
Hemosiderosis
What is melena?
Digested blood in feces
What is hematochezia?
Undigested blood in feces
What is rhexis?
Hemorrhage via physical disruption of the vascular wall
What is diapedesis?
Hemorrhage via a leakage through intact vascular wall
What is petechia?
Pinpoint hemorrhage
What is ecchymoses?
Blotchy hemorrhage
What is suffusive?
Paintbrush-like hemorrage streaks
What is hyphema?
Bleeding into anterior chamber of eye
What is hemoptysis?
Coughing up blood
What is Hematemesis
Vomiting up blood
What is hemorrhagic diathesis?
Systemic bleeding caused by a deficit of clotting factors
What is coagulopathy?
Hemostasis defect
Where does thrombosis normally occur?
Veins
more serious in arteries tho
What is released during endothelial damage and exposure of subendothelial release?
Platelet-activating factor (PAF)
What are the 3 corners of Virchow’s Triad?
Endothelial damage
Abnormal flow rate
Hypercoagulability
What are the 6 types of thrombi?
Mural
Obterating
Occlusive
Saddle
Septic
Vegetative
What are the different characteristics between a venous thrombi and an arterial thrombi?
Venous: RBC, non-infarction, more common, embolize
Arterial: WBC, infarctious, more deadly, cause alternating layers
What does embolize mean?
Pieces breaking off a thrombi
What are alternating layers in arterial thrombi called?
Lines of Zahn
What are the 4 resolutions to a thrombi?
No scar
Inelastic scar
New channel formed
DIC
What are the possible outcomes of an embolism?
Either ischemia or infarction
What is an infarct?
A local area of ischemia necrosis from a blockage/occlusion
What color is an arterial infarction?
White
blood cant enter
What color is a venous infarction?
Red-black
blood cant leave
What happens in DIC?
Endothelial damage
Multiple thrombus form
consumes all clotting factors
widespread petechia and ecchymoses
What are Russell Bodies?
Hyaline bodies present in cytoplasm
What are Mott Cells?
Plasma cells that contain russell bodies (immunoglobulins)
What is hyaline
Abnormal accumulation of protein
How is hyaline found in cells?
Glomerular damage causes proteinurea, causing protein being taken up by tubular cells (intracellular hyaline droplets)
What are crystalline protein inclusion bodies?
“Brick inclusions”
Normal in hepatocytes and renal cells
What are viral inclusion bodies
Accumulation of viral proteins
What are amyloid fibrils?
Abnormally folded proteins into Beta sheets
What is the precursor for reactive systemic amyloid associated (AA)?
SAA
What is the precursor for primary amyloid amyloid light-chain (AL)?
AL
How does amyloid occur?
Circulating SAA
Misfolding (neoplasia or infection)
Enter cells
Mutated SAA aggregate together
What do you use to stain for amyliod in live tissue?
Fresh tissue - Lugol’s iodine
What stain do you use for amyloid in histo?
Congo red stain
What stain do you use for amyloid in polarized light?
Congo red positive apple green fluorescence
What is the main consequence of amyloidosis?
Organ failure (liver and kidney)
Does gout occur in dogs, cats, cows, etc
NO
What dont other animals get gout?
They have an enzyme called uricase
What is gout?
Deposition of sodium urate crystals on tissues
What causes gout?
Dehydration, kidney failure, high protein diets
What are the 2 types of gout?
Articular
Visceral (pericardium and renal)
What are the 2 types of calcification?
Dystrophic
Metastatic
What is dystrophic calcification?
Calcification of necrotic or diseased tissue
What is metastatic calcification?
Calcification of normal tissue
Hypercalcemia
What are 4 ways that hypercalcemia happens resultin gin metastatic calcification?
Tumor causing increased PTH
Bone destruction from neoplasia
Vitamin D too high from intake
Renal disease causing retention
What is von Kossa stain used for?
Staining calcium black for metastatic calcification
Where do cats often get reactive amyloidosis?
Pancreatic islets of Langerhans
Why should you control the amount of vitamin D an alpaca gets?
Highly sensitive to it and may cause calcification
What causes cyanosis in cat foot pads?
Secondary to a saddle thrombosis
What are the borders like between autolytic and normal tissue?
SHARP borders
What is oncotic necrosis?
swelling of cells leading to eventual burst
What is karyolysis?
Nuclear fading
Unlike autolysis’ clear line, what does necrosis have?
A visual gradient
What is karyorrhexis?
Nuclear fragmentation
What is pyknosis?
Nuclear shrinkage
What are the 4 electrolytes on a panel?
Chloride
Sodium
Potassium
Bicarb
What is sodium balanced by?
Chloride and bicarb
What disease does hyperkalemia indicate?
Addison’s (hypoadreno)
What does transfusion plasma have in it?
albumin, antibodies, clotting factors
What transfusion cannot be used for dogs with von Willebrand?
Stored plasma (4 year shelf life)
What is cryoprececipitate?
Precipitate that forms when frozen fresh plasma (FFP) is thawed slowly
Used for von Willebrand disease
What are the different types of blood component therapies?
Whole blood
Packed RBCs
Fresh Plasma
Frozen fresh plasma
Stored plasma
Cryoprecipitate
Cryosupernate
Why are greyhounds good dogs for blood donor?
High DEA 1.1 negative
Higher PCV than other breeds
Docile
Good veins
What are 5 signs of inflammation?
Heat
Pain
Soreness
Loss of function
Swelling
What are the 4 main stages of leukocyte adhesion cascade?
Margination
Rolling
Activation/adhesion
Transmigration
What is the ligand that leukocytes bind to during endothelial transmigration?
PECAM-1 with CD31
What are the classifications of inflammations?
Serous
Fibrinous
Catarhhal
Hemorrhagic
Purulent
Eosinophilic
What is serous inflammation?
Fluid
What is fibrinous inflammation?
fluid and fibrin protein
What is catarrhal inflammation?
fluid, fibrin, and mucoid
What is hemorrhagic inflammation?
erythrocytes, protein, fluid
What is purulent/supprutative inflammation?
neutrophils and everything else
What is eosinophilic inflammation?
eosinophils
What are the 3 forms of chronic inflammation?
Supporutive
Nonsuppurative
Granulomatous
What are hallmark signs of suppurative chronic inflammation?
Abscess and/or cellulitis
What things normally cause nonsuppurative chronic inflammation?
Viruses
What are the 2 hallmarks of granulomatous chronic inflammation?
Macrophages +/- multinucleated giant cells
What are the 2 types of MNGC and what is their appearance?
Foreign body: In middle of cell scattered
Langhan’s: Semi-circle
Draw out the granuloma architecture. What cells does it contain?
Fibroblasts
Macrophages
Multinucleated giant cell
Epithelioid cell
kymphocyte
What are the 4 outcomes of acute inflammation?
Resolution
Healing by fibrosis
Abscess formation
Chronic inflammation
What is the initiating response to injury?
Direct Endothelial Damage