final Flashcards
plasma
all parts of blood
serum
fluid remaining if blood is allowed to clot
CBC
complete blood count (total cells)
differential=shows different types of white blood cells
when is blood smear done?
when CBC and diff is abnormal
-pathologist examines blood smear
myeloid progenitors
lymphoid progenitors
give rise to erythrocytes, platelets, granulocytes, and monocytes
give rise to lymphocytes
4 myeloid cell lines
erythroid/megakaryocytic
macrophage/granulocytic
eosinophilic
mast cell/basophilic
how much blood is in the body?
5L (blood and plasma)
hematocrit
ratio of cells to total blood volume
abnormal blood cells
normal=biconcave disk
abnormal=smaller microcyte, target cell, macrocyte, sickle cell, fragments
-useful in diagnosing various disorders
hemoglobin
carries oxygen
- 4 chains, each with heme molecule (which contains iron)
- Fe, B12, B6, and folate needed to make Hb
how long do RBCs live?
120 days
-spleen removes old ones and recycles Hb
bilirubin
breakdown product of heme-goes to liver, then SI in bile, and the reabsorbed
why do bruises change color?
as heme is converted to bilirubin by macrophages, they change to yellow
types of anemias
iron deficient aplastic-no RBCs megaloblastic sickle cell hemolytic
leukopenia
decrease in WBCs
anemia definition
decrease in RBC (and therefore Hb) mass
- in females, Hb less than 115
- in males, less than 130
hemolysis
destruction of RBCs
- inherited
- or acquired-from immune, mechanical, or infections or chemicals
first sign of bone marrow failure
anemia
decreased RBC production mechanisms
- bone marrow failure (aplastic anemia)
- defective DNA synthesis (megaloblastic anemia)
- defective Hb synthesis (iron deficiency anemia)
Sxs of anemia
- pale skin and mucosa
- fatigue, dyspnea on exertion
- brittle nails
- koilonychia (spoon shaped nails)
- headache, decreased vision, drowsiness
- white creases in hands (vs. red normally)
- pale conjuctiva
iron deficiency anemia
- causes of iron deficiency are decreased intake, absorption, loss (eg chronic blood loss), or requirements (eg pregnancy)
- transported bound to transferrin and stored as ferritin
what type of anemia results from iron deficiency?
hypochromic microcytic anemia
low hematocrit and Hb
serum iron and ferritin low
aplastic anemia
loss of myeloid progenitor cells in bone marrow–>pancytopenia
- decreased WBCs in infections
- decreased platelets–>causes bleeding
- decreased hemoglobin causes anemia
causes of aplastic anemia
idiopathic-primary
- may be some autoimmune cause
- secondary-cytotoxic drugs, radiation, viral infection
- radiation and chemo attack dividing cells and there are lots in the bone marrow
pancytopenia
decrease in all myeloid lineages
megaloblastic anemia
characteriized by megaloblasts in bone marrow and their descendants in blood
- 2nd most common cause of anemia
- two major causes are B12 and folate deficiency
B12 deficiency
due to impaired absorption, decreased intake, or increased requirement or lack of intrinsic factor (carrier molecule) as in pernicious anemia
what is the cause of pernicious anemia?
autoimmune destruction of parietal cells in stomach
-see Abs to intrinsic factor
folate and B12
folate reserves are small (months) compared to B12
spinal chord lesion may result if prolonged low B12 (alcoholics, pregnancy)
causes of hemolysis
intracorpuscular defect (problem with RBC) -Hb defect, enzyme defect, or membrane defect extracorpuscular defect-problem with body -autoimmune destruction, infection, mechanical destruction
sickle cell anemia
inherited disorder
- due to defect in beta globin gene
- low oxygen causes RBCs to sickle and small vessel occlusion can happen
sickle disease
homozygotes
sickle cells in blood and sickling crisis
-depend on exchange transfusions
-can be less severe if fetal Hb sticks around
-spleen is affected and dysfunctional b/c of backup by teens
sickle trait
heterozygotes
asymptomatic except in extreme cases (like airplanes w/pressurized cabins)
Sxs of sickle disease
- ulcers
- abnormal bone growth
thalassemias
group of disorders caused by gene defects in Hb gene chains (alpha thalassemia-defective alpha or beta)
what type of anemia do thalassemias cause?
- hypochromic microcytic anemia
- target cells in smear
hereditary spherocytosis
- group of disorders of inherited defect in strutural proteins in red cells
- defective cells unable to maintain shape and are removed by spleen
- variable severities
autoimmune hemolytic anemia
Abs against own RBCs
- ideopathic
- secondary to lymphoproliferative disease or drugs
- challenging b/c lots of transfusions–>Abs to smaller parts of RBCs
shistocytes
RBC fragments
-seen in hemolytic anemia
polycythemia
increase in RBCs
causes of polycythemia
- primary: genetically inclined to make EPO
- secondary: high altitude living, chronic long disease
polycythemia rubra vera
- neoplastic disease of RBC precursors
- increased viscosity of blood
- insensitive to EPO and requires blood removal
leukopenia
decreased WBCs
leukocytosis
- increase in WBCs
- neutrophilic=increase neutrophils
- eosinophilia=increased eosinophils
leukemias
malignant blood cell precursor proliferation in bone marrow
lymphomas
malignant proliferation of cells in lymphoid tissue
acute lymphoid leukemia
most common type in children
-chemo, pretty treatable, 50% cured
most common cause of cancer in kids under 5
leukemia
acute myeloid leukemia
most common form in adults
-treat with bone marrow transplant
chronic myeloid leukemia
- chronic and accelerated phase, then blast crisis
- Philadelphia chromosome
chronic lymphoid leukemia
more common in elderly
low grade and slow progression and therefore not susceptible to treatment as much
Hodgkin’s disease
- characterized by reed steinberg cell
- common in 2 age groups: 25 and 55
- staging is important and chemo is effective
non hodgkin’s lymphoma
- diverse group of diseases
- graded low, medium, or high
follicular lymphoma
most common form
low grade
affects the elderly
diffuse large cell lymphomas
- intermediate or high grade
- poor prognosis
burkitt’s lymphoma
- EBV infection
- highly malignant
- affects children from northern Africa
- lymph nodes less defined
multiple myeloma
malignant disease of plasma cells
- middle aged
- boney lesions, kidney damage
hematostasis
=stopping of bleeding
by interaction of vessels, platelets, and coagulation factors
what makes people more susceptible to clots?
lack of natural anticoagulants
hemophilia A
congenital
factor VIII
hemophilia B
congenital
factor IX
DIC
disseminated intravascular coagulation
-clots form all over and factors are consumed, leading to spontaneous bleeding
4 layers of the GI tract
inner mucosa: epithelium, lamina propria, and muscularis mucosae
submucosa-contains vessels
muscularis propria-responsible for peristalsis
serosa/adventitia/peritonium
what is a concern with cleft lip and palate?
sucking is affected and this is how babies get food
dental caries
cavities
-disease of tooth due to bacterial erosion of structure
streptococcus mutans like sugar in saliva
plaque promotes attachment of bacteria, which secrete degrading enzymes
complications of cavities
pulpitis
atypical abscess
periatipical granuloma
radicular cyst-
which may result in destruction of tooth
periodontitis
inflammation of periodontal recesses-gingiva, periodontal membrane, alveolar bone
what is the most common cause of tooth loss?
periodontitis
-inflammatory cells release enzymes that loosen tooth
stromatitis
inflammation of the mouth
- infectious causes, eg herpes, bacteria, fungi
- or non infectious causes, eg aphthous ulcers (canker sores) or ideopathic causes
leukoplakia
persistant white lesion in the mouth
erythroplakia
persistant red lesion
risk factors for malignant oral neoplasms
tobacco use, alcohol, HPV
other contributing factors: sun exposure (lips)
common locations of oral neoplasms
anterior 2/3 of tongue, lower lip
-possibly metastasize to LN
sialadenitis
inflammation of a salivary gland, usually parotid
- ie both sides of face, each gland is paired
- infectious causes: viral (mumps), bacterial (staph. aureus
- autoimmune causes: lupis, Sjogren syndrome
major salivary glands
parotid, submandibular, sublingual
pleomorphic adenoma
benign salivary neoplasm of epithelial and stromal elements
- needs proper excision, may recur locally
- infectious causes: herpes, fungal (uncommon w/out immune compromise)
- chemical causes: GERD
GERD
reflux of gastric contents to lower esophagus–>inflammation
-due to relaxed sphicnter
barretts esophagus
presence of metaplastic intestinal type epithelium in esophagus-change from squamous to columnar
-means increased risk of developing adenocarcinoma
hiatus hernia
displacement of portion of stomach above diaphragm
- sliding hernia=stomach slides upward (90%)
- paraesophageal hernia=stomach protruding upward beside esophagus (10%)
achalasia
disorder of esophagus resulting in increased resting tone of LES
- food is unable to ent er stomach
- can cause aspiration of food, nutrition problems
esophageal varices
dilation of submucosal veins of distal esophagus
-often due to portal hypertension secondary to hepatic cirrhosis
significant morbidity and mortality when ruptures
acute gastritis causes
stress, drugs (asprin), alcohol
chronic gastritis
- with acute inflammatory flares
- one type: heliobactor pylori infection: survives in acidic environment
- autoimmune: destruction of parietal cells in stomach
what is h pylori infection associated with?
increased risk of gastric adenocarcinoma and lymphoma
what does autoimmune gastritis cause?
- increased adenocarcinoma risk
- megaloblastic anemia due to inability to absorb B12
peptic ulcer disease
-localized chronic ulceration of gastric or duodenal mucosa
risk factors for peptic ulcer disease
H pylori (80%), stress, hormones
complications of peptic ulcer disease
hemorrhage
perforation and peritonitis
scarring (stenosis, obstruction) below submucosa is affected
gastric carcinoma
- adenocarcinoma
- poor prognosis, 5 yr survival 20%
- spreads to LN (virchow node)
risk factors for gastric carcinoma
nitrosamines, japanes, H pylori
lymphoma of stomach
common sit for extra-nodal lymphoma in MALT
-chronic H Pylori
Meckel’s diverticulum
- developmental disorder of small bowel due to persistence of omphalomesenteric (vitelline) duct
- causes all layers of bowel wall to outpouch
- ->malabsorption, celiac, maldigestion
giardia
parasite (bever reservoir) that infects the small bowel
carcinoids (small bowel)
- low grade malignant neoplasm of neuroendocrine cells
- carcinoid syndrome possible (diarrhea, flushing)
- locally invasive
crohn’s disease
- skip lesions-areas of inflammation, then areas of normal
- transmural inflammation-full thickness of bowel wall
- fibrosis and scarring–> intestinal obstruction
- possible fistula of bowel and bladder
- possible fissures, strictures, adhesions
what extra-coloinic manifestations are possible in crohn’s disease
arthritis, skin lesions, eye involvement
ulerative colitis
- only affects colon, no skip lesions
- inflammation limited to mucosa–>no fibrosis/scarring
complications of ulcerative colitis
toxic megacolon-weakened and dilated
- dysplasia
- extra-colonic manifestations (same as crohns)
Hirshprung’s disease
congenital absence of colonic nerve ganglia–>no peristalsis in portion of colon
-dilation of colon proximal to aganglionic segment
diverticular disease
- outpouchings of colonic mucosa
- inflammation of diverticulum
complication of diverticular disease
pericolonic abscess
peritonitis
colonic stenosis
perforation
Pseudomembranous colitis
Acute colitis
Formation of pseudomembrane due to C. difficile bacteria toxin
From long term antibiotic use
Ischemic bowel disease
- parts of bowel susceptible to ischemia (poor blood supply)
- atherosclerosis can contribute
bile
makes fat soluble
-made in liver, stored in gall bladdar
Polyps
-protuberant mass
Hyperplastic polyp
Most common, no malignant potential
Hamartomatous polyp
Occur in children and can become dysplastic
-Peutz-jeghers syndrome-multiple polyps, inherited
Adenomatous polyps
Benign neoplasms
Increased risk of if carcinoma if dysplastic or villous
Colonic carcinoma
- 3rd most common malignant tumour and cause of cancer related death
- peak in 60-80years
- adenocarcinomas histologically, metastasize
Appendicitis
Acute bacterial infection of appendix secondary to lumen obstruction
-abdominal pain, leukocytosis, peritonitis if ruptures
hepatobiliary system functions
- detoxify waste products
- remove old RBCs
- produce bile
- synthesize plasma proteins and lipoproteins
- detoxify drugs
blood flow to hepatobiliary system
portal vein and hepatic artery supply sinusoids
-sinusoids drain to central vein–>hepatic vein–>inferior vena cava
bile
makes fat soluble
-made in liver, stored in gall bladdar
cirrhosis
end stage liver disease
-fibrosis, regenerative nodules
causes of cirrhosis
- alcohol
- hepatitis
- metabolic and hereditary causes
- drugs
- biliary cirrhosis
complications of cirrhosis
portal hypertension
-varices, ascites, splenomegaly
hepatitis E
fecal oral transmission
hemochromatosis
autosomal rescessive disorder of iron metabolism—>iron deposition in various organs
-cause of hepatitis
wilson’s disease
autosomal repressive disease of copper metabolism resulting in copper depositions
-is a cause of hepdaitis
alpha 1 antitrypsin deficiency
autosomal recessive disorder
- decreased alpha 1 antitrypsin
- may cause cirrhosis
- does cause hepatitis
drugs/toxins that can cause hepatitis
acetaminophen
alcohol-causes fatty liver (stenosis), alcoholic hepatitis, and cirrhosis
hepatitis A
fecal-oral transmission
- no chronic state
- vaccine available
- rarely lethal
hepatitis B
parenteral (IV), perinatal, or sexual transmission
- 5-10% become chronic
- massive hepatic necrosis and death uncommon, but increased risk of carcinoma
- vaccine available
hepatitis C
- parenteral (IVDU) or sexual transmission
- 60-70% become chronic
- increased risk of carcinoma
- no vaccine
hepatitis D
parenteral/sexual transmission
-requires co-infection with hep B
hepatitis E
fecal oral transmission
hepatic abscess
abscess in liver parenchyma due to bacteria or parasite
metastatic carcinoma
- most common malignancy of liver
- usual primary sites are GI, lung, breast
gallstones (cholelithiasis)
- cholesterol stones, pigment stones, or mixed stones
- diagnosis by ultrasound
- complications: jaundice, ascending cholangitis, gallstone ileus (obstruction)
ascariasis
liver disease from obstruction of bile duct by a parasite
primary sclerosing cholngitis
- destruction of intra-hepatic and extra-hepatic bile ducts by lymphocytes and macrophages
- most also have inflammatory bowel disease (UC)
- affects younger males
- unknown cause
autoimmune hepatitis
- chronic hepatitis in young females
- Abs to specific antigens
- responds to steroids
primary biliary cirrhosis
- destruction of small intra-hepatic bile ducts–> cirrhosis
- autoimmune disease, affects middle aged females
- antimitochondrial Abs present in most cases
- no cure, unknown cause
pancreatic carcinoma
- adenocarcinoma of duct epithelial cells
- poor prognosis
hepatocellular adenoma
benign neoplasm of hepatocyte origin
-most common in young females on oral contraceptives
hepatocellular carcinoma
- malignant neoplasm of hepatocytes
- risk factors: cirrhosis, HBV, HCV, hemachromatosis, alpha 1 antitrypsin deficiency
- AFP(protein) levels elevated
metastatic carcinoma
- most common malignancy of liver
- usual primary sites are GI, lung, breast
gallstones (cholelithiasis)
- cholesterol stones, pigment stones, or mixed stones
- dagnosis by ultrasound
- complications: jaundice, ascending cholangitis, gallstone ileus
cholecystitis
-inflammation of gallbladdar (acute or chronic)
-usually from gallstones
acalculous cholecystitis (no gallstones)
choledocholithiasis
stone present incommon bile duct
acute pancreatitis
acute inflammation + tissue necrosis due to release of pancreatic enzymes
- 80% from gallstones or alcohol
- complications: abscess, psuedocyst, peritonitis, diabetes
proteinuria
protein in urine
pancreatic carcinoma
- adenocarcinoma of duct epithelial cells
- poor prognosis
hormones that the kidneys produce
renin
EPO
normal production of urine
1.5 L/day (24hour period)
filtration barrier (urinary system)
endothelial cell, BM, and epithelial cell
kidney functions
- urine production
- hormone production
- regulation of acid-base balance of plasma
- excretion of urea and creatine
oliguria
decreased urine production
glomerular diseases
group of diseases, damage to glomerulus
- primary (minimal change glomerulopathy, primary membranous nephropathy, acute post-streptococcal glomerulonephritis)
- secondary (caused by diabetes or immunologic disease)
polyuria
increased urine production
proteinuria
protein in urine
acute nepritic syndrome
oliguria, hematuria, proteinuria, edema, and hypertension
-typically after strep A infection
nephrotic syndrome
-large amounts of protein in urine–>hypoalbuminemia
why are people with nephrotic syndrome prone to infections and thrombi?
b/c of loss of proteins involved in coagulation and immunity in urine
acute renal failure
acute onset of decreased urine production
- over days to weeks
- usually reversible
acute pyelonephritis
bacterial infection of kidney
- via urinary tract (ascending)-gram -
- via bloodstream-gram +
chronic renal failure
insidious decrease in renal function from damage to kidneys
- several stages
1. diminished renal reserve
2. renal insufficiency
3. renal failure
4. end stage: terminally damaged - requires dialysis or transport
glomerular diseases
group of diseases, damage to glomerulus
acute tubular necrosis
sudden sever drop in blood pressure causing death of renal tubular cells and acute failure
minimal change glomerulopathy
- unknown origin, most common cause of nephrotic syndrome in children
- responsive to corticosteroids but may recur
acute glomerulonephritis
- immune mediated inflammation
- follows streptococceal infection in most cases
- usually self limited in children
- worse prognosis in adults: more have prolonged abnormal function
what is the first indication of renal damage in diabetes?
albumin
adult polycystic kidney disease
progressive number of variable sized cysts
- kidneys enlarged
- autosomal dominant inheritance
- autosomal recessive version: fatal (large numbers of small cysts)
cystic renal dysplasia
congenital disorder of development of kidney
- usually unilateral
- affects children
acte pyelonephritis
bacterial infection of kidney
- via urinary tract (ascending)-gram -
- via bloodstream-gram +
types of renal stones
calcium, struvite (chronic UTI), uric acid, or cystine
cystitis
inflammation of bladder
acute tubular necrosis
sudden sever drop in blood pressure causing death of renal tubular cells and acute failure
benign nephrosclerosis
ischemic damage to glomeruli and loss of glomeruli
complications of syphilis
systemic spread if untreated (rash, fever)
small vessel vasculitis, cardiac and CNS complications
seminoma
-germ cell tumor of testes
large cells full of cytoplasm
-scrotal mass, usually diagnosed before metastisis
non seminoma
-germ cell tumour of testes
eg teratocarcinoma, choriocarcinoma
benign prostatic hyperplasia
- benign hyperplasia of epithelim and stroma
- urgency, frequency, dribbling in elderly males
what produces testosterone?
leydig cells in testes
hermaphroditism
discordance b/t genotypic and phenotypic sex
- true: have both male and female gonads
- pseudo-genotypically female and phenotyically male
epidiymoorchytis, urethritis
inflammation of epididymis and testes and/or urethra
-infection, STI, uropathogen, virus
balanitis
inflammation of glans penis
complications of gonorrhea
-protatisis, epididymitis, and arthritis
complications of syphilis
systemic spread if untreated (rash, fever)
small vessel vasculitis, cardiac and CNS complications
endometrial hyperplasia
thickening of endometrial mucosa due to continued estrogen with inadequate progesterone
- an-ovulary cycles
- can be caused by puberty, anxiety, or being an athlete
benign prostatic hyperplasia
- benign hyperplasia of epithelim and stroma
- urgency, frequency, dribbling in elderly males
which parts of female reproductive system have stratified squamous?
vulva, vagina, ectocervix
hermaphroditism
discordance b/t genotypic and phenotypic sex
- true: have both male and female gonads
- pseudo-genotypically female and phenotyically male
ovarian cysts
fluid filled cavities lined by epithelium
-usually from unruptured follicles
polycystic ovary syndrome
multiple cysts in ovaries due to hormonal disturbances
-multiple cysts in both ovaries, menstrual irregularities, possible infertility
PID
extensive infection of upper reproductive tract
- usually secondary to STI
- salpingitis (fallopian tubes), peritonitis, overian abcess
complications of PID
spread
infertility from scarring of fallopean tubes
pelvic mass with pain
leiomyoma
- benign neoplasm of smooth muscle in uterus
- most common uterine neoplasm
- usually asymptomatic
toximia of pregnancy
- unknown pathogenesis
- disease of symptom complex in mother
endometrial adenocarcinoma
- most common female reproductive tract tumor
- endometrial epithelial cells
- elderly females effected
- hysterectomy to treat
ovarian cysts
fluid filled cavities lined by epithelim
-usually from unruptured follicles
polycystic ovary syndrome
multiple cysts in ovaries due to hormonal disturbances
-multiple cysts in both ovaries, menstrual irregularities, possible infertility
ectopic pregnancy
implantation of fertilized ovum outside uterine cavity
-usually fallopian tube-trophoblast cells of placenta then invade and may cause rupture
placenta accreta
abnormally deep penetration of placental villi into uterine wall
threatened abortion
cervical os is closed, spotting
endometriosis
endometrial tissue outside uterus (in ovary or peritoneum usually)
-retrograde flow, pain, infertility, chocolate cyst of ovary
preeclampsia
- hypertension, edema, and proteinuria in third trimester
- may progress to eclampsia
eclampsia
preeclampsia + seizures
-life threatening, must deliver
hydatidiform mole
developmental abnormality of placenta
- trophoblastic proliferation, degeneration of chorionic villi
- enlarged uterus, no fetal movement but some fetal parts
- complete mole: no fetus
choriocarcinoma
rare malignant tumor of placental origin
missed abortion
death of fetus, passed weeks later
threatened abortion
cervical os is closed, spotting
endometriosis
endometrial tissue outside uterus (in ovary or peritoneum usually)
-retrograde flow, pain, infertility, chocolate cyst of ovary
what is the 2nd most common cause of cancer death in females?
breast cancer
most common type of breast cancer
infiltrating ductal carcinoa
pregnant female
terminal buds develop into acini
- prolactin released in response to infant
- milk produced
acute mastitis
inflammation of the breast
- lactating female
- bacterial infection
- possible abscess
fibrocystic change
benign changes in breast tissue due to hormones and age
- reproductive age
- cystic dilation of epithelial ducts
- epithelial hyperplasia
gynecomastia
increased proliferation of male breast due to various factors
fibroadenoma
benign neoplasm of breast of epithelial and stromal elements
-young females
what is the 2nd most common cause of cancer death in females?
breast cancer
most common type of breast cancer
infiltrating ductal carcinoa
achondroplasia
- autosomal dominant defect of bone formation
- normal trunk, short limbs
woven (immature) bone
newly formed bone with haphazard collegen
osteopetrosis
defective osteoclast function
-bones grow but are not remodelled and remain thick and brittle
where are growth plates located?
mid-portion of metaphysis of children
hyaline cartilage locations
articular surfaces of bone
trachea, bronchi
elastic cartilage locations
eustaceon tube, ear, and epiglottis
fibrocartilage
synarthrotic joints (cranial bones) and vertebral disks
osteogenesis imperfecta
- defective collagen I
- osteopenic, weak bone
osteopetrosis
defective osteoclast function
-bones grow but are not remodelled and remain thick and brittle
osteomyelitis
inflammation of bones due to bacterial infection
aseptic necrosis
death of a bone secondary to impact
-infarct from ischemia
osteomalacia and rickets
inadequate mineralization of bone matrix in mature bone
- rickets in children-softening of bone and deformity
- skeletal pain, gradual deformity in adults (reversible if suppliment vitamin D)
myasthenia gravis
autoimmune disease-decreased ACh receptors b/c Abs bind to them
renal osteodystropy
bone changes from chronic renal failure
pagets disease
irregular restructuring of bone w/ thick and deformed bones
osteomyelitis
inflammation of bones due to bacterial infection
aseptic necrosis
death of a bone secondary to impact
-infarct from ischemia
callus
the thing that fills in gap b/t two pieces of broken bone
myasthenia gravis
autoimmune disease-decreased ACh receptors b/c Abs bind to them
congenital myopathies
- muscle wasing and hypotonia
- early onset in life
acquired myopathies
cancer, diabetes
myositis
inflammation of mm
posterior pituitary hormones
ADH and oxytocin
anterior pituitary hormones
GH, TSH, adrenocorticotropin hormone, Gonadotrophin hormones
cushing’s syndrome
excess glucocorticoid hormones (cortisol)
-hypersecretion of ACTH by pituitary
