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Pathomorphology - slides > Hemodynamic Disorders - 1 > Flashcards

Hemodynamic Disorders - 1 Flashcards

1
Q

What is a hemorrhage?

A

extravasation of blood due to vessels rupture

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2
Q

What is the most common cause of brain stroke?

A

arterial hypertension

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3
Q

What is the most common site of vascular rupture in the brain?
What is the most common site of brain hemorrhage?

A

lenticulostriate arteries – small branches of middle cerebral artery (therefore internal capsule and adjacent basal ganglia are the most frequent site of cerebral hemorrhage).

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4
Q

How can we evaluate the brain hemorrhage?

A

depends upon its size and localization

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5
Q

How does the recent brain hemorrhage look like macroscopically ?

A
  • Cerebral hemisphere is swollen, showing flattened gyri

- On cut surface blood clot can be seen surrounded by compressed edematous tissue

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6
Q

What are the substances that are removed by macrophages Phagocytosis In cases patient survives the brain hemorrhage ?

A

the blood mixed with necrotic brain mass

  • RBCs; their heme is transformed into brown hemosiderin
  • Cerebral lipids; accumulated in the cytoplasm which becomes foamy.
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7
Q

What is the result of The removal of the destroyed masses in old brain hemorrhage ?

A

formation of post-apopletic cavern (lacuna postapopletica) –fluid-filled pseudocyst lined with astroglial cells with hemosiderin-laden macrophages
- pseudocyst (pathologic cavity without epithelial lining)

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8
Q

How does old (inveterated) brain hemorrhage looks under the microscope?

A

the slide reveals the margin of hemorrhagic pseudocyst with hemosiderin-loaded macrophages and free hemosiderin granules derived from ingested erythrocytes

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9
Q

What does the term “congestion” means?

What does passive “venous” congestion means?

A
  • increase in blood volume in dilated vessels.

- impairment of blood out flow from affected area.

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10
Q

What does the term “nutmeg liver” means?

A

Chronic passive liver congestion

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11
Q

What could be the causes of nutmeg liver ?

A
  • right-sided heart failure, the most common cause.

- compression or obstruction of IVC or hepatic veins.

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12
Q

What is the most common cause of morphological changes in nutmeg liver?

A

hypoxia of hepatocytes

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13
Q

What is the gross appearance of nutmeg liver?

A
  • mottled cut surface
  • dark-red centrilobular areas
  • pale, yellowish peripheral zones of lobules
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14
Q

How does the nutmeg liver looks under the microscope?

A
  • central hepatic lobules are highly engorged by blood and
  • centrilobular hepatocytes may become atrophic or necrotic
  • peripheral hepatic lobules shows either normal parenchyma or fatty degeneration
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15
Q

What is the Pulmonary brown induration ?

A

Chronic passive congestion of the lungs

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16
Q

What are the most common causes of Pulmonary brown induration? And what does it lead to?

A
  • as a result of long-standing, gradually developing left-sided heart failure or mitral stenosis
  • may lead to fibrosis due to stimulated collagen formation
17
Q

How does Pulmonary brown induration look macroscopically?

A

brown and firm

18
Q

How does Pulmonary brown induration look under microscope?

A
  • considerable thickening of inter-alveolar septa
  • Numerous erythrocytes can be seen in alveolar spaces
  • heart failure cells; intra-alveolar macrophages containing brown hemosiderin granules
  • hemosiderin Deposits in interstitial pulmonary tissue.
19
Q

What is the characteristics of pulmonary edema?

A

Fluid accumulation in the lungs

20
Q

What is the classification of pulmonary edema?

A
  • hemodynamic edema
  • edema due to microvascular injury (alveolar injury)
  • edema of undetermined origin
21
Q

What are the causes of hemodynamic edema?

A
  1. increased hydrostatic pressure (pulmonary venous pressure)
    - left-sided heart failure
    - mitral stenosis
    - pulmonary vein obstruction
    - over-hydration
  2. decreased oncotic pressure
    - hypoalbuminemia
    - liver and renal diseases
  3. Lymphatic obstruction (rare)
22
Q

What are the causes of alveolar injury edema?

A
  1. Direct
    - infections: pneumoni
    - inhaled gases: high concentration oxygen, smoke
    - liquid aspiration: gastric contents
  2. Indirect
    - drugs and chemicals: bleomycin, heroin
    - blood transfusion
    - burns
23
Q

What might be the causes of undetermined origin edema?

A
  • high altitude

- CNS trauma

24
Q

What is the appearance of pulmonary edema macroscopically?

A

lungs are enlarged, heavy and watery that fluid can be squeezed from the surface cuts

25
Q

How does pulmonary edema look under the microscope?

A
  • some RBCs and hemosiderin-laden macrophages in alveolar lumina
  • empty round spaces within intra-alveolar fluid reflect frothing of edema fluid
26
Q

What are the compositions of atherosclerosis?

A
  1. cells, including SMCs, macrophages, and other leukocytes;
  2. ECM, including collagen, elastic fibers, and proteoglycans
  3. intracellular and extracellular lipids
27
Q

What is the structure of atherosclerosis?

A
  • superficial fibrous cap (composed of SMCs and dense ECM)
  • necrotic core, containing disorganized mass of lipid, dead cells, foam cells, fibrin, variably organized thrombus, and other plasma proteins.
28
Q

What are foam cells ?

A

Foam cells are large, lipid-laden cells that derive predominantly from blood monocytes (tissue macrophages).

29
Q

Where does atherosclerosis develop mainly?

A
  • in elastic arteries (e.g., aorta, carotidarteries)

- in large and medium-sized muscular arteries (e.g., coronary arteries).

30
Q

What are the major consequences of atherosclerosis?

A
  • Myocardial infarction
  • cerebral infarction (stroke)
  • aortic aneurysms
  • peripheral vascular disease
31
Q

What are the non-modifiable risk factors of atherosclerosis ?

A
  • Genetics and family history
  • Aging : clinical manifestations start between 40-60
  • male gender : but increase rapidly in postmenopausal women
32
Q

What are the major modifiable risk factors of atherosclerosis ?

A
  • hypercholesterolemia (increased LDL and decreased HDL)
  • hypertension
  • smoking
  • diabetes mellitus
33
Q

What are the minor risk factors of atherosclerosis?

A
  • inflammation
  • hyperhomocysteinemia
  • metabolic syndrome
  • factors affecting hemostasis
  • obesity
34
Q

What are the key processes in atherosclerosis?

A

intimal thickening and lipid accumulation (fatty streaks)

35
Q

What are the constitutes of An atheroma or atheromatous (atherosclerotic) plaque ?

A
  • accumulation of lipoproteins with cholesterol, phagocytized by myocytes and macrophages (yellow plaque).
  • When it is covered by a firm, white fibrous cap it is (white plaque).

Pathomorphology - slides (2 decks)

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