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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
What can haemorrhage be caused by
Trauma or intrinsic disease Amyloid Collagen vascular diseases Rupture of a major vessel causes acute haemorrhage with the risk of hypovolaemia, shock and death
26
What can the consequences of haemorrhaging be
Size of haemorrhage | Rate of bleeding
27
What can chronic low grade haemorrhage cause
iron deficiency anaemia
28
Define shock
a disease state in which tissue perfusion is insufficient to meet metabolic requirements.
29
Describe shock
Characterised by hypotension | Vulnerable organs are the brain, heart, lungs, bowel, kidney
30
Describe hypovolaemic shock
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
31
Describe cardiogenic shock
due to impaired cardiac function (e.g. acute MI, cardiac tamponade) SV is reduced due to malfunctioning heart
32
Describe septic shock
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.
33
Describe anaphylactic shock
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.
34
Describe neurogenic shock
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.
35
Define atherosclerosis
chronic disease caused by the focal accumulation of lipids, fibrous tissue and smooth muscle cells in the tunica intima of an artery.
36
Describe a stable plaque
``` Less infarction Thick fibrous cao Slow growing Low risk of rupture Causes stable angina and chronic limb ischaemia ```
37
Describe an unstable plaque
``` More inflammation Lipid-rich necrotic core Thin fibrous cap High risk of rupture Causes unstable angina, MI, cerebral infarction adnd acute limb ischaemia ```
38
Define inflammation
reactions of living vascularised tissue to sub-lethal cellular injury
39
Which cells may be involved in inflammation
neutrophils, macrophages, lymphocytes, eosinophils, mast cells
40
Describe acute inflammation
``` Transient and early response to injury Histamine release Hours/days May be prominent necrosis Lots of neutrophils Mast cells + eosinophils ```
41
Describe chronic inflammation
Inflammation of a prolonged duration Cytokines Caused by persistent damage e.g. infection Granulation tissue formed Lots of macrophages, lymphocytes and plasma cells
42
Describe granulomatous inflammation
Specialised chronic inflammation Characterised by granuloma formation Granuloma - ball of activated lymphocytes and macrophages giant cells - fused macrophages with horseshoe-shaped nuclei
43
What are the good outcomes of inflammation
Removal of the causative agent Cessation of inflammatory reaction Healing of tissue with preserved integrity and function
44
What are the bad outcomes of inflammation
Local tissue damage and scarring Systemic inflammatory reaction Multi-organ failure
45
What is inflammation resolution and give an example
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
Explain the process of resolution of lobar pneumonia
exudation red hepatisation (red cells move to the alveoli) Red cells break down Gret hépatisation Problem resolves and regenerates functional lung tissue
47
What is inflammation repair
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
Give some complications of inflammation
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
What factors can hinder inflammation repair
``` Poor nutrition Vitamin deficiency Poor blood supply Persistent foreign body Movement ```
50
Define tumour
Mass forming lesion e.g. neoplastic, hamartomatous, inflammatory
51
Define neoplasm
Autonomous growth of tissue which have escaped normal constraints
52
Compare benign to malignant
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
Define cancer
Malignant neoplasm
54
Define hamartoma
Localised benign overgrowths of one or more mature cells types (architectural)
55
Define heterotopias
Normal tissue being found in parts of the body where they are not usually found
56
Define teratoma
Tumours from germ cells
57
Describe the different methods of tumour spread
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
List the 3 ways in which tumours are staged (spread)
Clinicallu Radiologically Pathologically
59
Describe the TNM staging system
T - tumour size and invasion N - nodes, no. of lymph nodes involved M - metastases, presence of distant metastases
60
What is more important in tumour prognosis, stage or grade
stage (grade is differentiation)
61
Give some environmental carcinogens
UV Ionising radiation Asbestos
62
Give some infectious carcinogens
``` H. Pylori - Gastric HIV - Kaposis and cervical HPV - cervical EBV - Burkitts Hep B - HCC ```
63
Give some chemical carcinogens
Hydrocarbons Nitrosamines Amines Azo dyes
64
List the types of cell injury
``` Genetic defects Infectious agents Nutritional imbalances Chemical agents Hypoxia Ageing Physical agents Immunological reactions ```
65
Which factors affect response to injury
Type of injury Duration Severity Cell type
66
Which intracellular mechanisms are vulnerable to injury
Cell membrane integrity ATP generation Protein synthesis Genetic Apparatus
67
Define atrophy and give an example
Decrease in the size of a cell or organ due to cell substance loss e.g. cortisol atrophy in Alzheimer's
68
Define hypertrophy and give an example
increase in the size of cells leading to an increase in organ size e.g. hypertension leading to left ventricle
69
Define hyperplasia and give an example
Increase in number of cells in an organs e.g oestrogen-induced benign prostatic
70
Define metaplasia and give and example
Reversible change where 1 cell type is converted to another type w.g. Barett's oesophagus
71
Define dysplasia and give an example
Precancerous cells which show genetic and cytological features of malignancy (no invasion yet) e.g. cervical intraepithelial neoplasia)
72
Give examples of reversible and irreversible cell injury
Fatty change and cellular swelling | Necrosis and apoptosis
73
Describe apoptosis
Programmed cell death of single cells Active and energy dependent Physiological
74
Describe necrosis and give 4 types
``` Confluent cell death associated with inflammation coagulative - substance liquefactive - tissue breakdwon caseous - granulamatomous fat - fat breakdown ```
75
Define ulcer
local defect or excavation of the surface of an organ or tissue produced by sloughing necrotic inflammatory tissue
76
Define degenerative
change of a tissue to a lower or less functionally active form
77
Define sub-lethal injury
An injury that does not kill the cell/organism
78
What is a coroner
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
Give 4 types of death that must be reported to the coroner
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
What is a hospital autopsy
allows thorough examination of the deceased, the extent of their disease, their treatment and its effects.
81
Give 2 reasons for conducting hospital autopsies
Audit - major discrepancies between stated cause of death and actual cause Monitoring effectiveness of new treatments Teaching Research
82
How does the need for consent differ between a coroners report and hospital autopsy
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
Give the layout of the death certificate
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
Give an example of death certificate layout
1a - haemopericardium 1b - myocardial infarction 1c - ischaemic heart disease 2 - hypertension
85
List four natural causes of sudden unexpected death
``` Cardiac arrhythmia Ischaemic heart disease Coronary artery thrombosis Ruptured aortic aneurism Berry aneurism Asthma Bleeding ulcer ```
86
List 3 unnatural causes of sudden unexpected death
Drugs Alcohol Trauma
87
Define a bruise.
A blunt trauma injury that causes bleeding to the subcutaneous tissue
88
Define an abrasion. Give an example of a mechanism of injury that would lead to an abrasion.
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
Define a laceration. Give an example of a mechanism of injury that would lead to a laceration.
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
Compare a cut and a stab
Cut - length of injury is longer than its depth | Stab - depth of the wound is greater than the width
91
Describe Helicobacter pylori
Gram -ve 20% of adults in developed countries 80% asymptomatic associated with lymphoma
92
List the stages of H. Pylori infection leading to cancer
infection Inflammation Metaplasia and atrophy Adenocarcinoma
93
What are the 3 things atheroma can lead to
Slow occlusion of the artery Weakening of the artery wall Sudden occlusion of artery
94
What can slow occlusion of arteries lead to
Angina Claudication Vascular dementia
95
What can sudden occlusion of the artery lead to
Thrombosis e.g. MI | Embolism e.g. stroke
96
What can weakening of the artery wall lead to
Aneurysms

MCD (13 decks)

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