Hi - Path Museum Flashcards
SoB , raised JVP, ankle oedema. Prev MI. Dx?
heart failure
blood supply and drainage to liver
hepatic artery and vein (central)
portal artery and vein
where does the portal vein come from
gut and spleen
which vein dilates due to fluid overload
central vein
what does a PM liver look like with HF
nutmeg liver
why does the liver change colour in HF
backflow of fluid from heart due to fluid overload, down hepatic vein into liver. causes congestion in liver, leading to extracellular pooling of blood which is white. “nutmeg”
can you see liver BVs in a normal liver
no
vomitting large amounts of blood with chronic hep B. Dx?
oesophageal varices
pathophysiology of oesophageal varices due to hep B
hep B –> fibrosis –> cirrhosis –> backflow pressure on portal vein –> portal HTN –> varices –> rupture –> +++ bleeding due to high pressure
2 biggest causes of varices
viral hep
alcoholic hep
where else do varices occur
oesophageal
rectal
features of liver failure
caput medusae
palmar erythema
ascites
bruising
encephalopathy
dupetrens
gynaecomastia
jaundice
bright red blood in pan after stool passed, change in bowel habit and weight loss over 2 months. DDx?
bowel cancer
IBD
IBS - unlikely due to bleed
gastroenteritis
if suspecting colorectal cancer, what do you do?
2 week wait referral
Colonoscopy, imaging and physical exam
bowel cancer that has not invaded through bowel wall. Dx?
adenoma
bowel cancer that has invaded through bowel wall. Dx?
adenocarcinoma
contrast shared Sx of bowel cancer vs malignant bowel cancer sx only
shared = tenesmus, bleeding, change in bowel habit
malignant = weight loss, fever, night sweats, reduced appetite, bowel obstruction
staging method for bowel cancer
TNM
t = depth of invasion
n = nodes
m = mets
tx options for colorectal ca
colectomy
chemo
radio - only if tumour left after surgery
which colorectcal cancer is primarily treated by radio
rectal ca
left lower abdo pain, fever. Prev PC cramping, constipation. Dx?
diverticulosis –> diverticulitis
cause of diverticulosis
low fibre diet –> constipation –> straining –> stretching of weak points in bowel wall
complications of diverticulosis
diverticulitis
perforation
Tx of diverticulitis
increase fibre in diet
Sx Tx - analgesia, laxatives
ABx
why might someone have a heart attack and not feel it?
Diabetic neuropathy means they feel pain less
what are sx of heart attack in a DM pt?
blurred vision, sweating
define infarction
death of cells due to decreased blood supply
what does infarction look like on a heart specimen
white area
define rheumatic fever
group A beta strep pyogenes infection
what is puerpal fever
rheumatic fever in the 6 weeks post birth
what cardiac issue does rheumatic fever cause
mitral valve vegetations
what ABs are made due to strep sore throat
anti streptolysin O ABs
complications of RhF
autoimmune carditis
arthritis
Sydenham’s chorea
erythema marginatum
mixed mitral valve disease
Ix for RhF
strep bacteria on blood culture
who else gets mitral valve vegatations
RhF pts
IVDU
prosthetic heart valve pts
what bacteria causes vegetations in IVDU
staph aureus
collapse. semi concious when admitted with head deviated to L, L CN palsy, brisk L reflexes, L hypertonia. HTN. where in the CNS is the lesion, and how do you know?
brain / cord as UMN signs. R sided as L Sx
collapse. semi concious when admitted with head deviated to L, L CN palsy, brisk L reflexes, L hypertonia. HTN. Dx?
Haemorrhagic stroke (SAH)
Causes of haemorrhagic stroke
berry aneurysms - secondary to marfans
head injury
PMH AF. Develops dysarthria, L hemiplegia. Dx?
ischaemic stroke - clot due to AF
L homonymous hemianopia, frontal headache, mental deterioration. L hemiparesis. Dx?
space occupying lesion
L homonymous hemianopia, frontal headache, mental deterioration. L hemiparesis. what causes the eye Sx?
R sided tumour thay crosses midline and covers the optic radiation
why do CF pts get lung issues
produce thick mucous due to ion channel dysfunction –> hard to clear therefore infections / plugging
define bronchiectasis
dilated pus filled bronchi visible, especially near apex, with patchy consolidation (bronchopnuemonia)
what causes bronchiectasis
blockage of mucous clearance - tumour, CF etc
what is the issue in emphysema
damage to alveoli wall
what is COPD
emphysema + bronchiectasis + chronic pneumonia due to smoking
commonest causes of lobar pneumonia
strep pneumoniae
staph aureus
haemophilius influenzae
commonest causes of bronchopneumonia
staph pneumonia
klebsiella
what causes pneumonia in kids
pseudomonas
define lobar pneumonia
contiguous air spaces of part or all of a lobe are homogenously filled with exudate that can be visualised on radiographs as a lobar / segmental consolidation
define bronchopneumonia
implies a patchy distribution of inflammation often involving more than one lobe
name the 4 pathological states of pneumonia
congestion
red hepatisation
grey hepatisation
resolution
what is congestion pneumonia
affected lobe is heavy and red with vascular congestion (hyperaemia) and many bacteria in alveoli
what is red hepatisation
lobe has a liver like consistency, alveolar spaces are packed with neutrophils, red cells and fibrins
what is grey hepatisation in pneumonia
the lung is dry, grey and firm as red cells are lysed
fibrino-suppurative exudate persists within the alveoli
what is resolution in peumonia
in uncomplicated cases, the exudate is enzymatically digested to produce debris, which is reabsorbed by macrophages, coughed up, or organised by fibroblasts
what lines airways
cilliated epithelium
goblet cells
what are alveoli lines with
type 1 pneumocytes - flat
type 2 pneumocytes - make surfactant
