Cases Flashcards
Prinzmetal angina
Variant unstable angina caused by spasm in coronary artery
Contraction bands
histological finding of a recent MI that was reperfused afterwards- bright eosinophilic bands of condensed contractile proteins
verrucae
formation of vegetations
Aschoff bodies
Widely disseminated focal inflammatory lesions characteristic of rheumatic heart disease
Acute rheumatic fever bacteria cause
Group A beta-hemolytic streptococci
Aschoff cell or Antischkow cell
Plump histiocyte found within Aschoff body in Rheumatic heart disease
Ashoff giant cell
Multinucleated cells found in Rheumatic heart disease
Which valves most commonly associated with acute rheumatic fever
mitral and aortic valves
hemosiderin-laden macrophages
occur from prior alveolar hemorrhage; evidence of CHRONIC severe L heart failure (RBC’s leaked out of vessels into alveoli and taken up by macrophages)
Hemosiderin-laden macrophages in acute or chronic L sided heart failure?
chronic, not acute
Bacterial cause of endocarditis
S. viridans, staphylococci
conditions that predispose to endocarditis
abnormal blood flow (congenital heart shunts, abnormal valves), bacteremia (IV drug abuse, surgery), and abnormal immune response- immunodefiency. So start antibiotic PROPHYLAXIS before procedures likely to produce bacteremia (dental work)
Vegetation
intracardiac thrombus, fibrin, inflammatory cells, often form on heart valves
IV drug abusers likely to have what heart problem?
Tricuspic valve endocarditis
Arterial nephrosclerosis
Granular pattern of scarring in kidney, can result from long standing HTN
Most common causes of secondary HTN
Renal and endocrine system abnormalities. Renal diseases include renal artery stenosis, glomerulonephritis, renin-producing renal tumors, polycystic kidney disease. Endocrine diseases- pheochromocytoma, cushing disease, hyperaldosteronism, hyper and hypothyroidism
Hyaline arteriosclerosis seen in what population
ppl with HTN, diabetes, and elderly
Elevated afterload has what result in LV?
LVH
Aortic dissection is serious complication in which inherited disease?
Marfan syndrome- CT disorder
MOI in marfans
autosomal dominant, mutation in fibrillin gene
Fibrillin
glycoprotein secreted by fibroblasts
Possible causes of sudden death in patient with HTN
Ischemic heart disease (fatal arrhythmias) and aortic dissection
Most aortic dissections are..
.Type A- proximal, involving the ascending aorta- occur within the first 10cm of proximal aorta- problem associated= can rupture into pericardium- hemopericardium-death
Patient presents with severe, tearing chest pain. Uneven pulses, widened mediastinum. Dx?
Aortic dissection
Lysolecithin
hydrolytic product of biliary lecithin produced with bile stasis, is toxic to the gallbladder mucosa, can cause acute calculous cholecystitis
Rokitansky-Aschoff sinuses
May be seen in cholecystitis- outpouchings of the mucosal epithelium through the muscular wall of the gallbladder
Labs in acute pancreatitis
elevated amylase and lipase
Complications of cholelithiasis
acute and chronic cholecytitis, choledocholelithiasis, pancreatitis
Cholesterolosis
geographic yellow mucosal gallbladder surface caused by excess cholesterol
PIgment stones composed of…
calcium bilirubinate
Most common causes of pancreatitis
acute- gallstones (cholelithiasis). Chronic- alcohol
Complications of acute pancreatitis
Psuedocysts, abscess, neoplasm, duodenal obstruction, chronic pancreatitis
Causes of hepatic abscess
Pyogenic abscess (caused by bacteria from ascending cholangitis), amebic abscess (Caused by E. histolytica), and Hydatid cyst (caused by Echinococcus)
Most common cause of esophagitis
Reflux of gastric and duodenal contents
the presence of intraepithelial eosinophils and neutrophils in esophagus inc. diagnosis of..
reflux esophagitis
Barett esophagus
the squamous mucosa is replaced by metaplastic columnar epithelium as a response to prolonged reflux-induced injury in the lower part of the esophagus.
Major complications of reflux esophagitis
(1) ulcer, (2) bleeding, (3) development of stricture, and (4) development of Barrett esophagus.
What do heaped up margins indicate?
heaped up margins around a tumor are a sign of tumor invasion into adjacent tissue
When do adenocarcinomas of barretts esophagus normally present?
in advanced adenocarcinoma stage- this is why its associated with poor prognosis
what layers of esophagus do advanced vs. early adenocarcinoma involve?
early involves only mucosa and submucosa. advanced also involves muscularis propria
3 patterns seen in SCC of esophagus
protruded, flat, and ulcerated
Typical feature of SCC
nests of squamous epithelial cells with lighter-staining keratin in their centers
Predisposing factors to cancer of the lower lip
sunlight and pipe smoking
prognosis for cancers in lip vs. floor of mouth and base of tongue
good, poor
leukoplakia
whitish mucosal patch or plaque caused by epithelial thickening, can be malignant
pleomorphic adenoma
benign tumor of salivary glands
more than half of pleomorphic adenomas occur in…
parotid gland
Most common malignant salivary gland tumor
Mucoepidermoid tumors
Do chronic peptic ulcers undergo malignant transformation?
No
How to differentiate benign vs. malignatn ulcer
endoscopy and multiple biopsies
H. pylori associated with…
peptic ulcers and gastric cancer
Maltoma
mucosa-associated lymphoid tissue, low grade gastric lymphoma
complications of chronic peptic ulcers
bleeding (so will have to transfuse blood in these patients), perforation, penetration into adjacent viscus, obstruction, intractable pain
fibrosis associated with acute or chronic peptic ulcer
chronic
Are acute gastric ulcers associated with H. pylori
No- associated in chronic. (peptic ulcer disease)
Causes of bowel infarction
mechanical obstruction to blood flow by arterial thrombosis, volvulus, stricture or by reduced perfusion (cardiac failure, shock)
What layers of intestine would transmural infarction involve?
all
Carcinoid syndrome
associated with flushing of skin, diarrhea, cough, wheezing, systemic fibrosis, and hepatomegaly. result from secretion of serotonin by the tumor cells
Carcinoid tumor
type of neuroendocrine tumor
endocrine syndromes associated with carcinoid tumors
ZES, insulinoma, and cushing syndrome
Markers present in IBD patients
HLA-B27 and ankylosing spondylitis (but etiology is unknown)
ankylosing spondylitis
Chronic inflammatory disease of the axial skeleton
Pseudopolyp
Bulging mass of inflamed residual mucosa
Polyp
any nodule or mass that projects above the level of surrounding mucosa- can by hyperplastic or neoplastic
Histological feature in Crohn’s not seen in UC
granulomas and transmural inflammation that results in fibrosis and thickening of the bowel wall
complications of UC
carcinoma, toxic megacolon, severe diarrhea, electrolyte disturbances, perforation, peritonitis, massive hemorrhage
toxic megacolon
severe colonic dilation
creeping fat
when the mesenteric fat wraps around the bowel surface, seen in crohn’s
Risk of colon carcinoma more in crohn’s or UC
UC
Rhabdomyolysis
skeletal muscle damage
