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MCD > Cell Pathology > Flashcards

Cell Pathology Flashcards

1
Q

Define oedema

A

An abnormal increase in interstitial fluid

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2
Q

What is the aetiological classification of oedema

A 
Increased hydrostatic pressure
Salt and H2O retention
Reduced plasma oncotic pressure
Inflammation
Lymphatic obstruction
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3
Q

Describe generalised oedema

A

Fluid in serous cavities (pleural, pericardial, peritoneal)
Left heart failure -> causes right heart failure
Inflammation e.g. sepsis
Venous hypertension
Lymphatic obstruction e.g. after radiotherapy and surgery

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4
Q

Describe Localised oedema

A

Pulmonary and cerebral oedema
Congestive heart failure
Hypoproteinaemia (low protein content)
Nutritional oedema - low albumin

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5
Q

Give some consequences of oedema

A

Pitting oedema where widespread of accumulation of fluid in subcutaneous tissues and serous cavities (fluid that resembles serum)

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6
Q

Describe pulmonary oedema

A

Plasma oncotic pressure > hydrostatic in the pulmonary capillaries normally
Left heart failure increases hydrostatic pressure in the pulmonary capillary bed (blood backs up)
Fluid accumulates in the interstitial space then the alveolar spaces

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7
Q

What are the physical symptoms of pulmonary oedema

A

dyspnoea
orthopnoea
Alveolar fluid predisposes to bacterial infection - pneumonia

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8
Q

What can be seen on an X ray in pulmonary oedema

A

Fine white lines, Kerley B

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9
Q

Describe cerebral oedema

A

Localised
Vasogenic, increased permeability of capillaries and venules
Cytotoxic, derangement of Na-K pumps e.g. ischaemic strokes

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10
Q

Define thrombosis

A

Abnormal blood clot formation in the circulatory system

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11
Q

Define stasis and hyper coagulability

A

stasis = stopping of blood flow

hypercoagulability/ thrombophilia = abnormality of blood coagulation

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12
Q

What is Virchow’s triad

A

Causes of thrombosis
Endothelial injury
Stasis in venous circulation or turbulent flow (causes PEs)
Hypercoagulability - genetic or acquired

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13
Q

When will thrombi come to medical attention

A

When they obstruct arteries or veins

Embolisation

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14
Q

What are the fates of thrombi

A

Propagation (bigger)
Embolisation (come off and dislodge)
Dissolution (break down)
Organisation and recanalisation / restoring flow via capillaries growing in the thrombus

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15
Q

Describe venous thrombosis

A

Stasis and hypercoagulability
Most form in deep leg veins (Deep venous thrombosis, DVT)
Pulmonary embolism most important complication

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16
Q

Describe arterial thrombosis

A

Almost always related to vessel wall injury from atherosclerotic plaques
Narrowing/stenosis of the artery by thrombus causes ischaemia of the tissue supplied by the artery
Complete blockage/occlusion of the artery by thrombus causes infarction of the tissue supplied by the artery

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17
Q

Define Emboli

A

An abnormal material within the circulatory system that is carried in the blood to a site distant from its point of origin.

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18
Q

Describe emboli

A

Most emboli are fragments of dislodged thrombus (thromboemboli)
Other rarer types of embolic material include fat, air, amniotic fluid, tumour.
Emboli are important because they can lodge in vessels and block them off.

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19
Q

Give some risk factors of embolism

A 
Immobility
Surgery
Trauma
Contraceptive pill
Thrombophilia
Malignancy 
Obesity
Past DVT
Age
Pregnancy
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20
Q

Define infarct

A

An area of ischemic necrosis caused by occlusion of arterial supply or venous drainage

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21
Q

Compare red and white infarct

A

red - Venous occlusion found in dual circulation organs e.g. lungs
white - Arterial occlusion in dense/solid organs

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22
Q

How are myocardial infarctions caused by occlusion

A

Coronary artery occlusion

Occlusive thrombus in the coronary artery, acute plaque change or rupture

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23
Q

What may an MI be due to

A

Coronary artery vasospasm
Emboli
Vasculitis
Haematological abnormalities (SCD)

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24
Q

Define Haemorrhage

A

Extravasation of blood due to vessel rupture

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25
Q

What can haemorrhage be caused by

A

Trauma or intrinsic disease
Amyloid
Collagen vascular diseases
Rupture of a major vessel causes acute haemorrhage with the risk of hypovolaemia, shock and death

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26
Q

What can the consequences of haemorrhaging be

A

Size of haemorrhage

Rate of bleeding

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27
Q

What can chronic low grade haemorrhage cause

A

iron deficiency anaemia

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28
Q

Define shock

A

a disease state in which tissue perfusion is insufficient to meet metabolic requirements.

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29
Q

Describe shock

A

Characterised by hypotension

Vulnerable organs are the brain, heart, lungs, bowel, kidney

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30
Q

Describe hypovolaemic shock

A

due to loss of intravascular volume (e.g. trauma, haemorrhage)
This leads to reduced cardiac output, and, consequently, reduced mean arterial pressure
The body tries to compensate by increasing heart rate

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31
Q

Describe cardiogenic shock

A

due to impaired cardiac function (e.g. acute MI, cardiac tamponade)
SV is reduced due to malfunctioning heart

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32
Q

Describe septic shock

A

a severe inflammatory response to bacteria in the blood leads to widespread vasodilation and leakage of fluid into the interstitium.
This leads to reduced systemic vascular resistance and, therefore, reduced mean arterial pressure.

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33
Q

Describe anaphylactic shock

A

IgE mediated hypersensitivity reaction results in widespread vasodilation and increased vascular permeability (leading to increased fluid leakage into the tissues).
Leads to reduced systemic vascular resistance and, hence, reduced mean arterial pressure.

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34
Q

Describe neurogenic shock

A

RARE – usually caused by traumatic damage to the sympathetic pathways.
Results in a loss of vasomotor tone  widespread vasodilation  reduced SVR  reduced MAP
Disruption of the sympathetic pathway may also impair the ability of the heart to compensate with tachycardia.

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35
Q

Define atherosclerosis

A

chronic disease caused by the focal accumulation of lipids, fibrous tissue and smooth muscle cells in the tunica intima of an artery.

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36
Q

Describe a stable plaque

A 
Less infarction
Thick fibrous cao
Slow growing
Low risk of rupture
Causes stable angina and chronic limb ischaemia
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37
Q

Describe an unstable plaque

A 
More inflammation
Lipid-rich necrotic core
Thin fibrous cap
High risk of rupture
Causes unstable angina, MI, cerebral infarction adnd acute limb ischaemia
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38
Q

Define inflammation

A

reactions of living vascularised tissue to sub-lethal cellular injury

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39
Q

Which cells may be involved in inflammation

A

neutrophils, macrophages, lymphocytes, eosinophils, mast cells

40
Q

Describe acute inflammation

A 
Transient and early response to injury
Histamine release
Hours/days
May be prominent necrosis
Lots of neutrophils
Mast cells + eosinophils
41
Q

Describe chronic inflammation

A

Inflammation of a prolonged duration
Cytokines
Caused by persistent damage e.g. infection
Granulation tissue formed
Lots of macrophages, lymphocytes and plasma cells

42
Q

Describe granulomatous inflammation

A

Specialised chronic inflammation
Characterised by granuloma formation
Granuloma - ball of activated lymphocytes and macrophages
giant cells - fused macrophages with horseshoe-shaped nuclei

43
Q

What are the good outcomes of inflammation

A

Removal of the causative agent
Cessation of inflammatory reaction
Healing of tissue with preserved integrity and function

44
Q

What are the bad outcomes of inflammation

A

Local tissue damage and scarring
Systemic inflammatory reaction
Multi-organ failure

45
Q

What is inflammation resolution and give an example

A

Regeneration of normal, functional, parenchymal cells
Occurs if cells are capable of regeneration e.g. liver and there is little structural damage
e.g. lobar pneumonia

46
Q

Explain the process of resolution of lobar pneumonia

A

exudation
red hepatisation (red cells move to the alveoli)
Red cells break down
Gret hépatisation
Problem resolves and regenerates functional lung tissue

47
Q

What is inflammation repair

A

Scar tissue formation
Occurs if tissue loss is too great or cells are unable to regenerate
Fibroblasts lay down collagen
Collagen is remodelled for maximise tensile strength
Normal tissue replaced by non-functional scar tissue

48
Q

Give some complications of inflammation

A

keloid - due to excess collagen deposition
contracture - fibrous tissue contracts, can cause reduced join mobility
impaired organ function - due to replacement of functional parenchymal tissue by scar tissue

49
Q

What factors can hinder inflammation repair

A 
Poor nutrition 
Vitamin deficiency
Poor blood supply
Persistent foreign body 
Movement
50
Q

Define tumour

A

Mass forming lesion e.g. neoplastic, hamartomatous, inflammatory

51
Q

Define neoplasm

A

Autonomous growth of tissue which have escaped normal constraints

52
Q

Compare benign to malignant

A

localised vs Invasion of localised cells and spread to distant sites
Well differentiated vs well-differentiated/poorly differentiated
low-growing vs rapid-growing
does not infiltrate BM vs does infiltrate the BM
no metastasis vs metastases

53
Q

Define cancer

A

Malignant neoplasm

54
Q

Define hamartoma

A

Localised benign overgrowths of one or more mature cells types (architectural)

55
Q

Define heterotopias

A

Normal tissue being found in parts of the body where they are not usually found

56
Q

Define teratoma

A

Tumours from germ cells

57
Q

Describe the different methods of tumour spread

A

Direct extension (breast cancer)
Haematogenous (vessels, sarcomas)
Lymphatic (lymph nodes, epithelial cancers)
Transcoelomic (seeding in body cavities, pleural cavities and peritoneal)
Perineural (via nerves)

58
Q

List the 3 ways in which tumours are staged (spread)

A

Clinicallu
Radiologically
Pathologically

59
Q

Describe the TNM staging system

A

T - tumour size and invasion
N - nodes, no. of lymph nodes involved
M - metastases, presence of distant metastases

60
Q

What is more important in tumour prognosis, stage or grade

A

stage (grade is differentiation)

61
Q

Give some environmental carcinogens

A

UV
Ionising radiation
Asbestos

62
Q

Give some infectious carcinogens

A 
H. Pylori - Gastric
HIV - Kaposis  and cervical
HPV - cervical
EBV - Burkitts
Hep B - HCC
63
Q

Give some chemical carcinogens

A

Hydrocarbons
Nitrosamines
Amines
Azo dyes

64
Q

List the types of cell injury

A 
Genetic defects
Infectious agents
Nutritional imbalances
Chemical agents
Hypoxia
Ageing
Physical agents
Immunological reactions
65
Q

Which factors affect response to injury

A

Type of injury
Duration
Severity
Cell type

66
Q

Which intracellular mechanisms are vulnerable to injury

A

Cell membrane integrity
ATP generation
Protein synthesis
Genetic Apparatus

67
Q

Define atrophy and give an example

A

Decrease in the size of a cell or organ due to cell substance loss e.g. cortisol atrophy in Alzheimer’s

68
Q

Define hypertrophy and give an example

A

increase in the size of cells leading to an increase in organ size e.g. hypertension leading to left ventricle

69
Q

Define hyperplasia and give an example

A

Increase in number of cells in an organs e.g oestrogen-induced benign prostatic

70
Q

Define metaplasia and give and example

A

Reversible change where 1 cell type is converted to another type w.g. Barett’s oesophagus

71
Q

Define dysplasia and give an example

A

Precancerous cells which show genetic and cytological features of malignancy (no invasion yet) e.g. cervical intraepithelial neoplasia)

72
Q

Give examples of reversible and irreversible cell injury

A

Fatty change and cellular swelling

Necrosis and apoptosis

73
Q

Describe apoptosis

A

Programmed cell death of single cells
Active and energy dependent
Physiological

74
Q

Describe necrosis and give 4 types

A 
Confluent cell death associated with inflammation
coagulative - substance
liquefactive - tissue breakdwon
caseous - granulamatomous 
fat - fat breakdown
75
Q

Define ulcer

A

local defect or excavation of the surface of an organ or tissue produced by sloughing necrotic inflammatory tissue

76
Q

Define degenerative

A

change of a tissue to a lower or less functionally active form

77
Q

Define sub-lethal injury

A

An injury that does not kill the cell/organism

78
Q

What is a coroner

A

Independent judicial officer of the crown who has a statutory duty to investigate the circumstance of certain categories of death for the protection of the public.

79
Q

Give 4 types of death that must be reported to the coroner

A

Unknown cause of death
Death was violent, unnatural or suspicious
Death may be due to an accident
Death may be due to neglect by self or others
Suicide
Abortion

80
Q

What is a hospital autopsy

A

allows thorough examination of the deceased, the extent of their disease, their treatment and its effects.

81
Q

Give 2 reasons for conducting hospital autopsies

A

Audit - major discrepancies between stated cause of death and actual cause
Monitoring effectiveness of new treatments
Teaching
Research

82
Q

How does the need for consent differ between a coroners report and hospital autopsy

A

hospital - Consent must be obtained from the relatives and any material can be taken
coroners - no consent required, material can only be taken if relevant

83
Q

Give the layout of the death certificate

A

1a - immediate cause of death (e.g. NOT …. But ischaemic heart disease)
1b - predisposing factor
1c - predisposing factor
2 - other factors contributing to but not directly leading to death

84
Q

Give an example of death certificate layout

A

1a - haemopericardium
1b - myocardial infarction
1c - ischaemic heart disease
2 - hypertension

85
Q

List four natural causes of sudden unexpected death

A 
Cardiac arrhythmia 
Ischaemic heart disease
Coronary artery thrombosis
Ruptured aortic aneurism
Berry aneurism 
Asthma
Bleeding ulcer
86
Q

List 3 unnatural causes of sudden unexpected death

A

Drugs
Alcohol
Trauma

87
Q

Define a bruise.

A

A blunt trauma injury that causes bleeding to the subcutaneous tissue

88
Q

Define an abrasion. Give an example of a mechanism of injury that would lead to an abrasion.

A

A graze or scratch (superficial blunt trauma)
Confined to the epidermis
Due to tangential force, friction burn or vertical force e.g. stamp, whip

89
Q

Define a laceration. Give an example of a mechanism of injury that would lead to a laceration.

A

A split in the skin that is the result of blunt force trauma overstretching the skin
Deep and will bleed with a ragged margin
Bruising and crushing
Common where skin is compressed between force and underlying bone
E.g. fall, punch, stick, hammer, bomb, wheel of car

90
Q

Compare a cut and a stab

A

Cut - length of injury is longer than its depth

Stab - depth of the wound is greater than the width

91
Q

Describe Helicobacter pylori

A

Gram -ve
20% of adults in developed countries
80% asymptomatic
associated with lymphoma

92
Q

List the stages of H. Pylori infection leading to cancer

A

infection
Inflammation
Metaplasia and atrophy
Adenocarcinoma

93
Q

What are the 3 things atheroma can lead to

A

Slow occlusion of the artery
Weakening of the artery wall
Sudden occlusion of artery

94
Q

What can slow occlusion of arteries lead to

A

Angina
Claudication
Vascular dementia

95
Q

What can sudden occlusion of the artery lead to

A

Thrombosis e.g. MI

Embolism e.g. stroke

96
Q

What can weakening of the artery wall lead to

A

Aneurysms

MCD (13 decks)

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