Clinical Pathology II Flashcards by Tim Agee

Define Shock:

Hypoperfusion of tissues with blood

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What are the 3 mechanisms of shock (Hypoperfusion of tissues with blood)?

Pump Failure

Loss of Fluid

Septic (G- bacteremia)

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Septic Shock is caused by what?

G- bacteria

Specifically LPS

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What is the most common cause of death in ICU’s?

Septic Shock

*LPS

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Name 6 G- bacteria that can cause Septic Shock:

E. coli

Proteus

Serratia

Pseudomonas

K. pneumoniae

Bacteroides

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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

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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

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What is the demarcation between stage 2 and stage 3 shock?

Progressive and Irreversible

No Urinary Output

*renal vessels constrict

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Would Staph aureus cause Septic Shock?

No. G+

No LPS.

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Where do Pulmonary Thromboemboli originate?

What are they called?

How do they get to the lungs?

Veins

Venous emboli

Venous circulation

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When thromboemboli gets to lungs, where does it lodge?

Pulmonary Arteries

NOT pulmonary veins

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T/F

Venous Emboli lodge in the Pulmonary Veins

False

*Arteries

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How is a Thrombus formed?

Fibrinogen polymerizes to Fibrin

Meshwork thin filaments binds cellular elements

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A Thrombus ______

An Embolus ______

Is Stationary

Moves

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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

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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

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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

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Describe what occurs in the following organs in Shock:

Intestine:

Splanchnic (abdominal cavity):

Intestine: Superficial hemorrhagic necrosis

Abdomen: Vasodilation and pooling

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Acute hyperemia:

Chronic hyperemia:

Active (blushing - arteriole dilation)

Chronic Passive Congestive (Liver and Lungs)

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What causes Acute hyperemia?

What causes Chronic hyperemia?

Arteriole dilation

Venous back pressure

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What is the name of the macrophage that break down RBC inside the lungs?

Heart Failure Cells

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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

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Fat Embolism Syndrome is the result of what?

Trauma

*platelets adhere to fat globules after rupture

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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