Histopathology Flashcards
What is the evolution of an MI, in terms of histological findings, between hours-weeks/months after
under 6 hours- histologically normal (CK-MB also normal)
6-24hrs- loss of nuclei, homogenous cytoplasm, necrotic cell death
1-4 days- infiltration of polymorphs then macrophages to clear debris
5-10 days- removal of debris
1-2weeks- granulation tissue, new blood vessels myofibroblasts, collagen synthesis
weeks-months- strengthening, decellularising scar tissue
common causes of heart failure
Ischaemic heart disease
Myocarditis
hypertension
cardiomyopathy
valve disease
arrhythmias
signs of heart failure
LHF
pulmonary oedema
dyspnoea, orthopnoea
wheeze
fatigue
RHF
congestion of systemic and portal venous system
Oedema
ascites
facial engorgement
nutmeg liver
Investigations for HF
BNP/ NT-proBNP
CXR
ECG
Echo
causes of dilated cardiomyopathy
alcohol
thyroid disease
haemachromatosis
idiopathic
viral myocarditis
casues of hypertrophic cardiomyopathy
hypertension
valve disease
???
causes of restrictive cardiomyopathy
sarcoidosis
amyloidosis
radiation induced
describe hypertrophic cardiomyopathy
thick walled heart, heavy and hypercontractile
myocardium cells in dissarray which is arrhythmogenic
autosomal dominant
mutation in the beta-myosin genee most common
cause of sudden cardiac death in young people
HOCM- (obstructive)- septal hypertrophy resulting in outflow obstruction
multisystems affected in acute rheumatic fever
heart: pericarditis, myocarditis, endocarditis (pancarditis)
joints: arthritis, synovitis
skin: erythema marginatum, subcutaneous nodules
CNS:encephalopathy, sydenhams chorea
clinical features of rheumatic fever
develops 2-4 weeks after strep throat
diagnosis: GAS infection +2major or 1major+2minor
JONES’ MAJOR (CASES)
Carditis
Arthritis
Sydenhams chorea
Erythema marginatum
Subcutaneous nodules
MINOR CRITERIA
Fever
raised CRP/ESR
PR prolongation
arthralgia
previous rheumatic fever
malaise
tachycardia
Histological findings in rheumatic fever
Beady fibrous vegetations (verrucae- small warty veg found along closure of valve leaflet)
Aschoff bodies (small giant cell granulomas)
Antischkov myocytes (regenerating myocytes)
Causes of cardiac vegetations
Rheumatic heart disease (verrucae)
Infective endocarditis (large vegetations of colonising bacteria)
thrombotic endocarditis (eg. DIC- small vegetation attached to lines of closure)
Libman-sacks endocarditis (small warty vegetations that are sterile and rich in platelets)- SLE
non bacterial thromboemboli
Causative organisms of IE and RFs
staph aureus –> IVDU (tricuspid), cannulae, central lines, cellulitis
Strep viridans –> poor dental hygeine/ dental surgery
Strep pyogenes
staph epidermidis –> prosthetic valves
steptococcus bovis –> colon cancer
HAECK
Dukes criteria of IE
Major
- positive blood culture of typical IE organism or 2 positive cultures 12hrs apart
- positive finding on echo
Minor
- evidence of immune phenomena(osler, roth)
- evidence of thromboembolic phenomina (janeways, septic abscess, splinter, splenomegaly)
- fever
- risk factor (IVID, prosthetic valve, valve abnormalities)
- positive culture not meeting major criteria
Treatment of acute IE
Flucloxacillin (MSSA)
gentamycin+ rifampicin + vancomycin (MRSA)
Treatment for subacute IE
benzylpenicillin+ gentamycin or vancomycin for 4 weeks
what classification is used to assess severity of GORD
Los Angeles Classification
obese people have GORD and people in LA are obese
what is the progression of disease from GORD-> cancer
GORD –> metaplasia (barretts) –> dysplasia –> adenocarcinoma
where is adenocarcenoma of the oesophagus found
distal 1/3
associated with barretts
where is SCC of oesophagus found
middle 1/3 (50%)
upper 1/3 (20%)
lowe 1/3 (30%)
common lung infectious organism in people with CF
Pseudomonas aeruginosa
what is cystic fibrosis?
Autosomal recessive condition casued by a mutation in the CFTR gene which is responsible for Cl transport
Results in abnormally thick secretions
what is the FEV1/FVC ratio in restrictive disease
FEV1 relatively large but FVC reduced
FEV1/FVC >70%
Clinical findings in interstitial lung disease
fine end inspiratory crackles
chronic SOB
pulmonary HPTN and cor pulmonale
ground glass/ honeycomb appearance on CTCAP