ICS - Pathology Flashcards
Define inflamation
a local physiological response to tissue injury
give a benefit and negative of inflamation
+destroys microorganisms, can stop teh spread of infection
-it can produce disease and leade to distorted tissues
define exudate
a protien rich fluid tha leaks out of vessel walls
what do neutrophils do
phagocytose debris and bacteria, they contain enzymose in lysosomes. they are the first to arrive at the sight of infection
what do fibroblasts do
produce connective tissue
how long do macrophages, lymphocytes and then neuropills live for
Macrophages - montsh to years
neurotphils - 2-3 days
lymphocytes - years
what do macrophages do
phagocytosis, and transport material to teh lymph nodes and cause a secondary immune reaction
what are three specalised macrophages
kuppffer cells in liver
osteoclasts in bone
microglial in breain
what are lymphocytes
produce chemicals whihc crontrol inflamaion and antibodies, they also have memory cells
what is the sequance of inflamation
injury/infection
neutrophills arrive and phagocytose
macrophages arrive and phagocytose
resolution or progression to chronic
what are examples of acute (neutrophil mediated) inflamation
microbial infections - bactera and viruses
hypersensitivity reactions parasites
physical agents - trauma, heat, cold (frostbite)
chemicals - corrosives and acids
bacterail toxis
tissue necrosis - ischemic
what is a granuloma
are collections of macrophges surronded by lymphocytes seen in chronic inflamation
when can granulomas be found
myobacterial infection like TB or leprosy
how does chronic inflamation work
few neutrophils, macrophagesm lymphocytes and then fibroblasts, often scar tissue formed
what is resolution
everything goinf back to normal and te tissue fully regenerating
what is repair
the initiating factor is still present and teh tissue cant regenerate, it is teh repplacement of damaged tissues by fiberous tissues
what is fibrosis
teh thickening and scarring of tissues
name 5 cells that regenerate
hepatocytes, pneumocytes, blood cells, gut epithelium, skin epithelium, osteocytes
what are teh two types of autopsy
hospitlal - medical certification and used for teaching and research
medicolegal - 90% of autopsies, sorted into coronial and fronnsic. conronical means death is not due to unlawful action
what is teh role of the coronial autopsy
who dies, when, where, how did their deat come about
when are 3 times deaths reffered to the coroner
natureal - its uncertain how they dies and they havent seen a doctor within 14 days
iantrogenic - caused by medical miustreatent such as illigal abortions and anastheic deaths
unatural - accidents, industrial deaths, suicide, murder
who refeerres to teh coroner
doctors, registrar of birth and death, poilce, relatives
who perfoerms autopsies?
histophalologists - hospital, coronial, natural deaths and accidents
forensic pathologists - homicide and neglect
what are the three main stages of autopsy
external, evisceration (y shaped inscision t exaine organs and brain) internal examination (heart and vessles, lungs, liver spleen, CNS<, endocrine)
what is _acute_inflamation
the initial and transient tissue reaction to injury
what are the 3 steps of inflamation
vascular - dialation of vessles
exudative component - vascular leakage
neutrophil polymorph - neutrophills are recruited
what are the 4 outcomes of inflamation
resolution - all heals like normal
suppuration - pus formation in a pyogenic membrane and an abcess
organisation - fibrosis, dead tissues removed, granulation tissues is formed in the space, then this fibrosis
preogression - causative agent isnt removed and chronic inflamation starts
what are the 5 main signs of inflamation
redness - rubour
swelling - tumours
heat - calor
pain - dolor
loss of function
what factors increase vascular permeability
histamine, bradykinine, NO, platelet activating factor
what are the stages of neutrophil emigration
margination - they move to the side of teh vessels due to the slowing of flow
adhesion - they begin to stick to the sides, this is called pavementting
emigtation - move out og teh wall of venules and viens
diapedesis - some red blood cells may also leak out which indicates significant injury
what are chemical mediators involved in inflamation
histamine is released fro mast cells and up regulaes teh inflamation
lysosomal compounds
seratonin
chemokine
6 causes of chronic inflamation
- resistance of infecive agens - TB leprosy
- endogenous materals - necrotic tissues
exogenous materials - asbestos, silica
autoimmune conditions - rhumatoid arthiritus
primary granulation diseases - chrons
transplant rejection
which cells are involved in chronic inflamation
lymphocytesm macrophagesm plasma cells
macrospcpic features of chronic inflamation
ulcer, abcess cavity, granulomatous inflamation, fibeosis
microscopic appearance of chronic inflamation
tissue necrossis, lymphocyes, plasma cells and macrophages, continuing destruction
whhat are the cellular components of chronic inflamation
b lymphocytes - turn into plasma cells and produce antibodies
t lymphocytes - cell mediated immunity
macrophages - respond to chemotactic stimuli
what is a granuloma
an aggragate of epithelioid histocytes,
when do granulomas develop
tb, leprosy, chrons, TB, Sarcoidossi
how would you look for a TB stain
ziehl-neeleson stain
what indicates a parasite
granuloma and eosinophil
define laminar flow
cells travelling in the middle and not touching the sides
defien thrombus
solid mass of blood consituents formed within intact vascular systems during life
define embolus
a mass of material in the vascular system which lodges in the vessel and block it - this can be a thrombus whihc has broken off
define ischemia
reduction in blood flow to a tissue
define infarction
a reduction of blood flow leading to cell death
what two factors prevent blood clots
laminar flow, endothelial cells releaseing chemicals
what are the most commen factors of thrmbosis and what do these make up
reduced blood flow, blood vessle injury, increased coaguility
thsi is called virchows traingle
what are 4 causes of embolism
thrombus, air, cholesterol, tumous, fat
what is it called when an organ is ony supplied by one vlood supply
end artery supply
what are platelets
no nucleus, they come from megacaryocytes, they are activated when they ome into contact with collagen
what are teh two granules in plateletS
ALPHA - platelet adhesion
dense - platele aggragation
how does a theombus plaque from athelosclarosis
a plaque causes a chnage in teh vessle wall
this creates turbulance
fibrin and platelets accumulate and start clumping
thsi causes more turbulance and causes positive feedback
what is venous thrombosis
low blood pressure causes the blood to sit
thrombi begins at valves, produces a turbulance
whne blood pressure falls, the flow through the vwins slows
what are clinical theatures of venous, then arteral thrimbus
arterial - loss of pulse distally, area is cold, possible gangrene
venous - tender, area is red and swollen
what are teh 4 fates if a thromvus
resolution
organised - becies a scar causing a slight narrowing of teh vessel
recanalisation - intimal cells proliferate and capilleries grow into teh thrombus and fuse to make larger vessles
embolis - parts break off and lodegg elsewhere
arterial thrombus: causes, pressure, risks, constituents, treatments
atheroma
high oressure
MI and stroke
platelets
Tx - anti platelets such as asprin
venous thrombus: causes, pressure, risks, constituents, treatments
stasis
low pressure
DVT/PE
red blood cells
anticoagulents such as warfrin
what are the three main arterial embolisms and where can they travel
arterial - anywhere down stream
mural (from inside left ventricle) - anywhere
cholesteril crystals - in teh descending aorta can go to lower limbs or renal arterys
which three organs have multiple blood supplys are are less susptable to ischemia
liver brain, lungs
what is a reperfusion injury
damage to tissue dutring re oxeygenation, due to build up of wast materials it can flood bakc in
what is atherleroscarosis
accuulation of fibrolipid plaques in systemic arrteries
what diseases are characterized by atherlosclarosis
MI, aortic anyerisms, gangrene, carotid atheroma, peripheral vascular disease
how do altehrosclarosis form
endotherlial disfunction
hight levels of LDL accumulate
macrophages surround it
formation of fatty streak
realse of cytokines
smooth muscle proliferation around lipid core
risk factors of atherlosclarosis
smoking
hypertension
diabetoes
male
increased age
define apoptosis
programmed cell death, happnes in single cells and prevemts cells with damage from dividing
how does a cell decide to apoptose
DNA damage within the cell, p35 is a protien whihc can detect DNA changes and trigger i
how does a cell apoptose
triggers a series of protiens whihc lead to enzyme release which autodigests teh cell
what enzymes are used in apoptosis
caspases, they work in a cascade
what are two reasons why cells may apoptose in health
deelopment - removal if cells during groth and development
cell turnover - removal of cells during normal turnover for example teh top layer of skin being shawn off o teh cells at teh topi of villu being replaces
apoptosisin disease 2 examples
cancer - cells with damaged DNA
HIV - causes apoptosis of CD4 helper cells
define necrosis
wholesale destruction of large numbers of cells by some external factor
give examples of clincal necrosis
infacrciton due to loss of blood supply,
frostbite
venom and toxis
pancreatisis
what is caseous necrosis
like soft cheese, due to tuberculosis
what factors regulate apoptosis (inducers and inhibitors)
inhibitors:
growth factor
extracellualr matrix
sex steriods
INDUCERS:
glucocortacoids
free radicals
ionising radiation
DNA damage
what is the intrinsic pathway for apoptosis
pro and anti apoptopic of bic -2
bax form bax-bax dimers whihc enchance stimuli
responds to growth factos and biochemical stress
p53 gene incuces cell cycles arrent and intitaes DNA repair or apoptoais
what is teh extrinsic pathway fo apoptosis
ligand binding death receptors are on the cell surface
FAS ligand binding receptors result in teh clustering of receptor molecuels onteh cell surface
caspes are activated triggereing teh process
teh pathway is used by teh immune system to eleiminate lymphocytes
what are eh 4 types of necrosis
coagulative - caused by ischemia
liquefactive - occurs in brain due to lack of soma
caseous - cheese cause by TB
gangrene - necrosis with rotting of eh tissue - smells bad eh
what is hypertrophy
increased cell size witout division
what is hyperplasia
increased cell number by mitosis
what is atrophy
decrease in the size of an organ or cell be reduction in number or size of cell
what is metaplasia
teh change in differentiation from one cell type to another
give an example of metplasia
barretts eosophogus
what is dysplasia
morphological changes seen in cells in eyh progression to becoming cancer
what is carciogenesis
the transformaiton of cells into neoplastci cells though permenant genetic alteraltions
what is a neoplasm
a lesion resulting frm the automomous of relitavly automonous abnormal cell growth
define tumour
any abnormal cell growth
name 5 carciogens
HPV
UV
Smoking
asbestos
b- naphthylamine from dies (bladder cancer)
what is teh role of macrophages in accute inflamation
secrete chemical mediators
cytokines interluikin 1 and tumour necrossi factor alpha
these attract neutophil polymorpjs
thye clear away teh dead cells and tissues
role of teh lymphatic in acute inflamation
terminal lymphatics are blind-ended
they help drain away eh odema of teh inflamitory exudate
antigens are carried in teh lymph syestems to the lymphocytes
how does adhesion to teh microorganisms work
opsonisation by either imunoglobbulin or complemetn components
what is spinla bifida occulta
there is no back process of teh vertebreal body
what s a systolic murmur
when teh foramen ovale doesnt close up and blood leale through
what genes code for parts of teh body
homeobox gnes - they account for teh migration of cells
what is an example of enviromental condenital birth defects
cleft foot - bent feet
what are three risks of down syndroe
early cataracts, early altziemers, heart problems
what is autosomal inheritance
all inheritance of paired chrmoseomes of tehsame size (just excludes sex chromosomes)
what is co dominant alleles
where two are dominatn, such as a b blood grouops
what are three sypmtomsof fetal alcohol syndrome
small eye opsnings, smooth philestrum, thin upper lip
what bones can grow after pubity
hands, feet and jaw
what is mixed hypertrophy and hyperplasia
increase in teh size of teh organ due to increase in number and size of cells
what is teh limit of human cell division called
the hayflick limit
why is there a limit on the number of times cells can divide
the telomere get shorter each time
what is progeria
where ageing is accelerates due to mutations in cell membranes
what are factors that will lead to cell apoptosis
cross linking of protines, loss of calcium ion controll, telomere shorteing, free radicla generation , loss of DNS repait mechanism
what is eh one way show to slow down aging
calorie restriction
what are 6 effects if aging on teh body
skin - wrinliking caused by collagen cross links caused by UV
eyes- protien cross links in the lens caused by UV
osteoporosis - lack of oestrogen in women
dementia - atherlosclarosis and genetics, not being obese
sarcopeia ( loss of muscle ) reduced growth hormone and testosterone
deafness - heor cells dont divide and are damaged by loud noises
are basal cell carcinomas invasive?
it only invades locally and doesnt spread
how do you treat a basal cell carcinoma
cut it out
wha are the nearset lymph nodes to teh breast?
teh axillery
what are the 5 cancers that most commenly spread to bone
breaast, prostate, lung, thyroid kidney
what is adjuvant therapy
treatment given alongside surgical exciscion
what is the name of the main cell in inflamation
neutrohil polymorphs
what is teh name of ye cells tthat produce collagen in scarring
fibroblasts
what is an example of accute inflamation
appendicitus
where is an example of where granulomas will form
chrons disease
what is an example of hyperplasia
benign prostate enlargement
what is an example of a chronic inflamation at the start
infection mononucleousus
what is an example of necrosis
renal infaon
what is an example of necrosis
renal infaon
what is the process of a solid ass formed by blood constituents called
thrombosis
is a drug what is a drug whihc inhbits platelet aggragation
asprin
what is teh pattern of differntiation of metaplasmic cells lining the bronchi of ciggy smokers
cilliated - squamous
what are carcinogens
cancer causing agents
what does oncogenic mean
tumour causing
what % of cancer risk is enviromental
85%
what is an occupation risk and an example
a risk for cancer that comes from your work, such as bladder cancer from analine dye and rubber, this is caused by the beta-naphthylamine
give tw examples of chemical carcinogens
polycyclic aromatic hydrocarbons - lung cancer
aromatic amines - bladder cancer - rubber/dye workers
what are the 5 classes of carciogens
chemical
viral
inoising and non ionising
hormonaes, parasites and mycotoxins
miscalaneous
what percentage of all cancers do viral carcinogens caus
10-15%
give two examples of DNA viruses that are carcinogens
Hep B, epstien barr virus
give two examples of RNA viiruses
Hep c, human t lymphotrophic virus
what is an example of radating carconoma
UVA and UVB radiation
what are two examples of biologica agents
hormons - oestrogen causeing breast and endometrial
Chlonorchis sinensis → cholangiocarcinoma
Shistosoma → bladder cancer
what are two miscalaneous causes of cancer
asbestos and metals such as arsnic
what are host factors
factors of the person whihc can increase or decrease teh risk of developing cancer
what are 5 host factors of cancer
ethnicity, diet, age and gender, transplacental exposure
what is a premalignant condition?
identifiable local abnormality associated with increased risk of malignancy at that sight
what are some examples of pre malignent conditions
colonic polyps, cervial dysplpasia, ulcerative colitis, undescended testes
what is carciogenesis
the transformation of normal cells into neoplasmic cells through permenant genetic alteraltion or mustations
what is teh defornition of a tumour
any abnormal swelling
what are the behavioura lclassificationsn of benign tumours
dont invade basement membrane,
exophyic (grows out)
low mitotic activity
circumcised
necrosis and ulceration rare
whaat are behavioral classification of malignant tumours
invade basement membrane, endophytic (grows inwards), highly mitotic, poorly circumcised, necorsis and ulceration commen
what is teh histogenetic classification of tumours
based on specific cell origin of the tumour
what are three histogenetic classification of tumours
epithelial cell - carcinomas
connective tissues - sarcomas
lymphoid - lymphomas or leukemia
what is the histologiacal grading of tumours
grade based on te hextent to which teh tumour resembles its original
histology
there are three grades -
1 - well differentiated to be like normal tissue
2 - moderatly differentialted
3 - poorly differentiated (this is teh worst one)
define metastasis
teh process where malignant tuours spread to from tuours at other sights
what is a cancer that nerver metastasises
basal cell carcinoma
what is teh process of metastasis
Detachment of tumour cells from their neighbours
Invasion of the surrounding connective tissue to reach conduits of metastasis
Intravasation into the lumen of vessels
Evasion of host defence mechanisms, such as NK cells
Adherence to endothelium at a remote location
Extravasation of the cells from the vessel lumen into the surrounding tissue
Tumour cells proliferate in the new environment
what are he routes of metastasis
Bone metastasises from lung, breast, kidney, thyroid, prostate
Lymphatic metastasis is common (secondary tumours in lymph nodes)
Carcinomas prefer lymphatic spread
what does TNM staging stand for
t - priamry tumour
n - lymphatic node status
m - metastatic status
what do cacers need to invade teh basement bembrane
enzymes such as collegenase, thepsin D
what has to happen to a tumour after its bigger than 1 mm
it ha sto form its own blood supply
how do cancer cells evade host immune defense
aggregation with platelets
shedding of surface antigens
adhesion to other tumour cells
what is angiogenesis
the productino of new blood vessles
what cancers most commently metastasise to lung
sarcomas and any other commen cancers as they travel move int teh venous system and get loged in teh lung whihc is teh next small capiller system thye g though
where is cholerectal cancer most likely to spread to
the liver as it drains though teh hepatic portalvein
what cancers most commenly spread to the liver
colon , stomach, pancreass
what does a neoplasm release in order to initaitae angiogenesis
vascular endothelial growth factors
whta is teh prescens og granulomas and eosinophils indicatibve of
parasitic infection such as worms
what is teh difference between a thrombois and a clot
clot - coagulated outside g teh vascular system
thrombosis - solidification of blood constituents within teh vascual system
what are two reasons thrombuses dont form at all times
laminar flow - cells trave in eh middle and dont touch teh sides
endothelial cells
endothlial cells - arent sticky when healthy
what is a neoplasia
a lesion resulting from teh autonomus or relitavly autonomus abnormal groth of cells whihc persists after teh inititing stimulus has been removed
it means a new growth in greek
what are teh two constituent parts of a neoplasm
neoplasmic cells - deived of nucluated cells and growth patter related to parent cell
stroma - the connective tissue framework whihc provides mechanical support and nutrition
why shold you classify neoplasms
to determine apropriate treatment
to provide prognostic information
what are teh two methods of classification
behavioural - benign/malignant
histogenic - cell of origin
what are teh problems with benign neoplasma
pressure on structure, obstruct flow, release hormones, transform into malignant, patient anxietys
A transitional cell carcinoma of the bladder is a malignant tumour true or false?
true - and carcinoma is malignant
Which tumour has the shortest median survival?
Anaplastic carcinoma of the thyroid
what does the term adenoma mean
benign tumour of teh glandular or secretory epithelium
what is an angioma
vascular neoplasm
ehat is teh diffecne between wet and dry gangrene
dry - teh tissue is mumified around it and it is kind of isolated and falls off
wet - bacterial and it speads (worse)
what are teh nomenclature rules about namng tumours
-oma is benign for example lipoma
-sarcoma is malignant connective tissue for example liposarcoma
-carcenoma is malignnt epithlium tissue, basal cell carcinoma,
what are the exceptions to teh naming of tumours
- not all omas are neoplasms: granuloma is chrominc inflamation, mycetoma is fungus in teh bofy and tuberculoma is a mass of TB
-Not all malignant sumours are carcinomas or sarcomas: melanoma, mesotheioma, lymphoma
-teratoma - neoplasm of germ cells whihc has all three germ layers of the embryo
what are the stages of neutropills entering the tissues in inflamation
margination - migrate to teh edges (margins)
adhesion - selectins bind to teh neutrophills and cause rolling
emigration and diapedesis - they move through teh gaps into tissue
chemotaxis - move to teh sight of inflamation by being called by chemokines
defien granuloma
aggragtes of epitheioid histocytes (macrophages)
form a horseshoe shape
what do granulomas secrete and hat does this mean
ACE - its a blood marker, increased levels inficate granulomatas disease
what are three histologially distuinguishable types of granuloma
central necrosis (caseating, it looks loke cottage cheese) - means its TB
NO nectosis - sarcoidosis, leprosy, vasculitis, chronns
granuloma and eosinophil indicate a parasite
causes, constituents an tratments for venous, and arterial throbi
venous - venous stasis, RBC and fibrin, anticoagulents (warfrin)
arterial - arthrogenesis, platelets and fibrin, antiplatelets (warfrin)
what are teh symptoms of a venous thrombi and an example
tender, swollen red,
deep vein thrombosis
what are teh symptoms of an arterial thrombi and an example
cold, pale, loss of pulse
MI, Strokem peripheral vascular disease
what is teh defornitino for apoptosis
non inflairoy controlled cell death
teh cells shrink, teh organelles are retained and its fragmented for a macrophge to phagosytose
what are the three mehcanisms of apoptosis
- Intrinsic- Bax acts on mitochondial membrane to produce cytrochrome c release
- Extrinsic - Fas Ligend or TNF-ligand beind to receptos and acivates caspase enzymes
- Cytotoxic T cells - CD8 injext perforin which breaks down te hcell membrane
they all lead to caspases being released
define hypertrophy and hyperplasia
hypertrophy - cell gets bigger
hyperplasia - number of cell increases because of mitosis
define atrophy and etaplasia
atrophy - number of cells or size of cells decreases
metaplasia- one cell types changes into another cell type (barretts oesophogus)
define dysplasia
growth of abnormal cell types whihc can be poorly differentiated and be precencerous, the cell hasnt fully differnetiated properly says haroon
define ischemia and infarciotion
ischemia- perfusion is decreased with no cell death
infarction - tissue death due to lack of perfusion
what are teh cells in barretts oesophogus
stratified squamous non keratanising epitheloium of the eosophogus become simple columnar of the stomach
what are teh 5 classes of carcinogen
- Classes of carcinogens - chemical, virus, ionising, hormone, miscalanious (asbestos)
what s teh pathwa of spread throuht the body
- How they spread through the body - detatchement, invasion of other tissue, invasion of bastment membrane, evasion of host defence and extravasiion to distant site
what are teh three main ways that cancers are spread
- Three main wats of spread - heamtogenis, lymphatic, transcolemic (through effusinos)
what are teh 5 mian metastasis to bone
BLTKP
breast, lung, thyroid, kidnry, prostate
how do sarcomas and carcinomas typically travel, and what are the 4 exceptions
Sarcomas - often spread by blood, carcinomas often lymphatically (the exceptions to this are follicular thyroid, chonocarcinoma, Rcc and HCC)
what are teh two Gentetic mutation involved in colorectal cancer
Gentetic mutation involved in colorectal cancer -
-FAP (familial adenomis polypsis) - gene mutation cuaing thousands of precancerous polyps, this is autosomal dominant
-HNPCC (lynch syndrome) - autosomas dominant, there is mutation in the gene involved in renewal and care of teh colerectal cells
what type of prevention in screening and what are teh three ones screened in teh UK
secondary
cervical, breast, cholerectal
