Clinical Pathology II Flashcards
Define Shock:
Hypoperfusion of tissues with blood
What are the 3 mechanisms of shock (Hypoperfusion of tissues with blood)?
Pump Failure
Loss of Fluid
Septic (G- bacteremia)
Septic Shock is caused by what?
G- bacteria
Specifically LPS
What is the most common cause of death in ICU’s?
Septic Shock
*LPS
Name 6 G- bacteria that can cause Septic Shock:
E. coli
Proteus
Serratia
Pseudomonas
K. pneumoniae
Bacteroides
What are the 3 Progressive Phases of Shock?
*Septic, fluid loss, pump failure
Nonprogressive Stage (perfusion maintained through reflex compensation - reversible)
Progressive Stage (Hypoperfusion, Acidosis, Tissue Hypoxia)
Irreversible Stage (survival not possible - body shuts down)
***Disseminated Intravascular Coagulation common
What are 2 ways Metabolic Acidosis in the Progressive stage of shock exacerbates the condition?
*What can this lead to?
low pH dilates arterioles, bools blood in microcirculation, worsens cardiac output
Depresses heart
*ARDS (acute respiratory distress syndrome) and pulmonary edema
What is the demarcation between stage 2 and stage 3 shock?
Progressive and Irreversible
No Urinary Output
*renal vessels constrict
Would Staph aureus cause Septic Shock?
No. G+
No LPS.
Where do Pulmonary Thromboemboli originate?
What are they called?
How do they get to the lungs?
Veins
Venous emboli
Venous circulation
When thromboemboli gets to lungs, where does it lodge?
Pulmonary Arteries
NOT pulmonary veins
T/F
Venous Emboli lodge in the Pulmonary Veins
False
*Arteries
How is a Thrombus formed?
Fibrinogen polymerizes to Fibrin
Meshwork thin filaments binds cellular elements
A Thrombus ______
An Embolus ______
Is Stationary
Moves
What are the 2 layers that make up the “Lines of Zahn” in a Thrombus?
*note, not all thrombi have these - some are “Red”
Red: Cellular elements
White: Fibrin
Pathology of Shock - Describe what occurs in the following:
Adrenal gland:
Brain:
Kidneys:
Spleen:
Adrenal: Bilateral hemorrhage (waterhouse Fredrichsen syndrome)
Brain: Encephalopathy (fever, brain death)
Kidneys: Acute Renal Failure (tubular necrosis)
Spleen: Congestion/hyperplasia
Describe what occurs in the following organs in Shock:
Lungs:
Liver:
Heart:
Stomach:
Lung: ARDS
Liver: Hemorrhagic necrosis
Heart: Focal myocardial necrosis
Stomach: Stress ulcers
Describe what occurs in the following organs in Shock:
Intestine:
Splanchnic (abdominal cavity):
Intestine: Superficial hemorrhagic necrosis
Abdomen: Vasodilation and pooling
Acute hyperemia:
Chronic hyperemia:
Active (blushing - arteriole dilation)
Chronic Passive Congestive (Liver and Lungs)
What causes Acute hyperemia?
What causes Chronic hyperemia?
Arteriole dilation
Venous back pressure
What is the name of the macrophage that break down RBC inside the lungs?
Heart Failure Cells
How do we get a Paradoxical Embolism?
(what must you have to shunt clot from right side to left side of heart?
Open Foramen Ovale in heart
***or other interventricular septal defect
Fat Embolism Syndrome is the result of what?
Trauma
*platelets adhere to fat globules after rupture
Starting with the most important, what are 4 organs involves when dealing with Arterial Emboli?
Brain (most important)
Spleen
Kidney
GI tract
98% of Septic Shock is cause by ____ because of the action of ______.
G-
LPS
What are the 4 fates of Thrombi?
Lysis and resolution
Organization (vascular re-routing)
Recanalization
Embolism
What is Waterhouse-Friderichsen Syndrome?
Adrenal Glands filled with blood due to shock
What Infarcts are seen in solid organs like heart, kidneys, etc?
White Infarcts
What infarct is typical of venous obstruction/congestion?
Where would it be found?
Red Infarcts
Intestines/testes
Which type of Infarct is typical to an organ that has a Dual Blood Supply?
*Liver or lungs
Red Infarcts
What type of Embolism can lead to a Secondary Abscess Formation?
Septic (Infected) Emboli
*abscess tends to heal poorly b/c of inadequate blood supply
What is the most important Emboli?
Pulmonary
Cardiogenic Shock can be caused by what 4 conditions:
MI
PE’s
Congestive heart failure
Myocarditis
Hypovolemic Shock can be caused by what 3 conditions:
Diarrhea
Vomiting
Burns
Septic Shock is caused by:
G- Bacteria
Squames (fetal epithelial squamous cells) and Vernix Caseosa are found in what type of Embolus?
Amniotic Fluid Embolus
Another name for Shock Lungs?
What causes this?
ARDS - Acute Respiratory Distress Syndrome
Pulmonary Edema due to Shock
***Hyaline Membrane
Petechiae:
Purpura
Ecchymosis:
Less than 1 mm
1 mm to 1 cm
1 cm, large blotchy bruises
Bone Marrow Emboli is the result of what?
CPR
What causes blushing?
Acute hyperemia
Name 2 organs that are involved in Fat Embolism Syndrome.
Lungs (ARDS)
Brain (cerebral edema)
Oral Squamous Cell Carcinoma accounts for ____% of all malignant tumors in men and ____% of all malignant tumors in women.
5%
2%
95% of oral cancers are…
Squamous Cell Carcinoma
What is the average age of Oral Cancers?
50-70
*unusual before 40 (more in women)
What is the single most common cancer in men in India?
Oral Cancers
Paan, Belel, Areca
What are the 2 most common Risk Factors in Oral Cancer?
Tobacco
Alcohol
What is the most common location for Oral Cancer?
Tongue
then lip, floor of mouth
Where is Oral Cancer when caused by HPV or EBV?
Back of mouth
What 2 viruses are implicated in Oral cancers preferring the back of the mouth?
EBV
HPV
What are the 2 HPV serotypes that cause both oral and cervical cancer?
What 2 serotypes are associated with genital warts that can be transmitted orally?
16 and 18
6 and 8
What is more common, Leukoplakia or Erythroplakia?
Leukoplakia
T/F
Leukoplakia occurs in equal frequency in both sexes, mostly after 3rd decade.
True
*also, causes same as oral cancer
Where does Leukoplakia most often occur?
Buccal mucosa
Tongue
Floor of mouth
____% of Leukoplakias become malignant.
20%
____% of Erythroplakias become malilgnant.
50%
T/F
Leukoplakia and Erythroplakia have the same risk factors
True
List 8 Risk Factors for Oral Squamous Cell Carcinoma
Tobacco
Alcohol
UV
Irritation/poor hygeine
Immunosuppression
Leukplakia/Erythroplakia
Pahn/Reverse Smoking
Oral Squamous Cell Carcinoma can be related to Tobacco and Alcohol or HPV.
What are 2 major differences?
Location: Anterior traditional/Posterior HPV
HPV very sensitive to Radiation
T/F
Mechanisms that repair are called Fibrosis in the Heart (fibroblasts) and Gliosis in the brain (astrogliocytes)
True
