Path 1 Quiz 3 Flashcards
Exogenous Pigments - what does this mean? What is the most common cause for exogenous pigmentation?
- Comes from outside in
- Carbon/coal
Carbon aka
coal
Who commonly breaths in carbon/coal?
Miners
Define Anthracosis
- Deposition and accumulation of carbon/coal in the lungs
- Benign
- This is not a condition it is used to describe a condition
Define Coal-worker pneumoconiosis
- Lung disease
- accumulation of coal dust in the lungs and the tissue’s reaction to its presence
- lung tissue is modified due to reaction to inhaling of particles - CT is formed to replace normal lung tissue
What is tattooing?
- insulation of the superficial cells of the skin (dermatocytes)
- Ink is not damaging but the problem is if the instrument is infected and not sterilized
- infected can can become inflamed
List the types of Endogenous Pigments
Lipofuscin
Melanin
Homogensitic acid
hemosiderin
AKA for lipofuscin
- Lipochrome
- Wear and tear pigment
- Brown atrophy
Explain Lipofuscin:
- Represents complexes of protein and lipid derived from free radical preoxidation of polyunsaturated lipids of subcellular membranes
- Doesn’t cause any problems
What is the physical representation of lipofuscin?
brown spots/pigmentation
Lipofuscin is commonly seen in…
- elderly patients
- Absence of this is a sign of youth
What is melanin?
Normal Black pigment
What cell produces melanin?
Melanocytes
Function of melanin?
Important protecter of UV radiation
Amount of melanin in individuals bodies varies and can be dependent upon
Where they live
Homogentisic Acid AKA
Alkapton
What color is homogenitistic acid?
Black
Homogentistic acid is a product of what diseases?
alkaptonuria
onchronosis
(deposition of of calcium into IVDs and cartilage)
Hemosiderin
Accumulation in tissues where there is local or systemic excess of IRON and representing large aggregates of ferritin micelles
Presence of ferritin usually means there is a presence of…
iron
Is iron normal in the blood?
How much iron is considered normal?
- Yes it is normal in the blood - but too much locally or systemically will cause hemosiderin
- 2-5 grams
Hemosiderin is commonly deposited systemically in…
liver, spleen, and lymph nodes (focal areas)
Hemosiderin is commonly deposited locally in…
how does this happen?
eyes - ears
(battle sign and raccoon sign)
Trauma - direct contact makes iron react with heme - leads to change in color
Explain hemosiderosis
-It is associated with a deposition of hemosiderin in MANY organs and tissues in the cases of systemic overload of iron!
Explain Hemochromatosis
Excess accumulation of iron - Systemically - can be harmful
Explain Hereditary hemochromatosis?
- AKA?
- Gender, age?
- location
- AKA Genetic or hereditary
- Chromosome problem
- Predominantly distributed among males 7:1
- 40 - 50 years old
- increased absorption of iron in the GI tract - increased iron in the body.
- up to 50G
- accumulation of iron in the liver
Explain Secondary hemochromatosis?
-AKA?
- AKA Acquired Hemochromatosis aka Transfusion reaction
- Systemic iron overload with increased absorption of iron in the body
hemotransfusions / blood transfusions result in _______ when there are elevated iron levels in the blood / hemochromatosis.
Lysis of the RBC
Bantu Siderosis
- Explain it?
- What is it an example of - pathology wise?
Iron interferes with replication of DNA, this can lead to cancer
- ACQUIRED hematochromatosis
- South Africa - Malie
Bantu Siderosis is seen in what type of cases?
Malaria
hemolytic anemia
MOST COMMONLY - this is seen in those of the savanna desert in Africa that make an alcohol in iron barrels - this causes a high ingestion of iron
Secondary iron overload/ Transfusion reaction / Acquired hemochromatosis / Bantu Siderosis Disease
- Problem sites include?
Liver
Pancreas
Cardiac Failure
Pathology that can arise when there is excess iron in the Liver?
Hepatoma = Liver cancer
(increases the chance of liver by 20%)
-Liver fibrosis/cirrhosis (occurs because of excess scar tissue in the liver)
-
Pathology that can arise when there is excess iron in the Pancreas?
Diabetes mellitus
Pathology that can arise when there is excess iron in the heart?
Cardiomyopathy / cardiac failure
- can lead to arrhythmia
Signs and symptoms of secondary iron overload
Hepatomegaly abdominal pain skin pigmentation (hyper pigmentation) diabetes mellitus arrhythmia temporary arthritis Joint pain / arthralgia
What pigmentation is not normal?
Homogenisitc Pigmentation
Wilson’s disease AKA?
Hepatolenticular degeneration
What normally happens when copper enters the blood?
- copper entered body and goes into the liver and in conjunction with alpha - 2 globulin it creates ceruloplasmin. (95% of copper - 2.5 grams a day)
This goes into the blood circulation and goes back into the liver where the complex separates - copper is then excreted from the body with bill via the GI tract
What happens in Wilson’s disease?
How does this affect the body?
Ceruloplasmin is not made and copper is not released from the liver.
Copper in the liver’s lining causes damage to the hepatocytes and leads to liver cirrhosis
What substance would indicate how much copper was in the blood?
Ceruloplasmin
Who is Wilson’s disease predominantly found in?
Rare genetic disease found in males
What are the signs of Wilson’s disease?
- liver chirrosis
- In the eyes between the cornea and conductive (periphery of cornea) there is accumulation of copper causing kayser fletcher rings
- Brain would have damage of the midbrain nucleus - The brain matter would end up with mental underdevelopment - with parkinson like symptoms of the patient (motor dysfunction and loss of intellect)
What areas of the body does Wilson’s disease commonly affect?
Liver, eyes, midbrain
How and when would you make a diagnosis and how would you treat Wilson’s disease?
usually doesn’t occur before the age of 5, but can happen at any age, hopefully and you would treat it with D-Penicillamine
Explain what D-Penicillamine is and what it can treat?
combines (chelating properties) with heavy metals and remove it from the body
-Very dangerous because of its cytolytic effects in inhibiting cell replication
-Can also treat systemic sclerosis along with wilson’s
^Not recommended for use though
What is Dystrophic Calcification?
Deposition of calcium salts into necrotic or atrophic(dead) tissues (NOT BONE)
Ghons focus AKA
-Explain it
Primary Tuberculosis / primary TB complex
- When there is inhalation of Mycobacterium Tuberculosis - the bacteria travel to the upper lobes of the lungs and causes a very specific immune response characterized by accumulation of cells around bacteria in order to restrict their spread.
- Once in the tissue it activates T-helper cells –> granulomatous inflammation occurs —> granuloma (to restrict spread) walls it fall off when the body kill the bacteria - it also kills the tissue —> becomes occupied by calcium salts (forming ghon’s focus)
- It is a sign that the bacteria was successfully killed
What is the presentation of Ghon’s focus on X-ray?
radioopaque
Calcification is normal where and abnormal where?
Normal in bone, abnormal in tissue
Systemic Sclerosis AKA
- Where else is this seen?
- Explain it
Scleroderma Dry Gangrene Over activity of the fibroblast Autoimmune disease Idiopathic -Fibroblasts look for areas of unstabability - when there is over production it starts to replace normal healthy tissue - this leads to problems like contracture of the joints and compression of tissues
Function of fibroblast
Can replace any type of tissue
Signs and symptoms of Scleroderma aka systemic sclerosis
Aggressive contracture of joints Sclerodactyly (claw-like hands) -Face is unable to shows expression -narrow lips -wrinkles manifested -CT starts to shrink and tighten -mm. becomes replaced with CT -Pt. looks aggressive and mean Cardiac Valvular disease: Calcification of the mitral valve - endocarditis (atrophic calcification)
Matestatic Calcification
Calcification salts into the tissue - other than necrotic or atrophic - usually associated with incase calcium concentration in the blood (hyperglycemia)
Causes of matestatic calcification?
1) Increase in the parathyroid hormone secretion
2) Destruction of bone in
- accelerated turnover (page’s disease)
- immobilization
- tumors (multiple myeloma, leukemias, multiple skeletal metastases)
3) Vitamin D disorder (excess)
4) sacrodiosis: chronic idiopathic disease - enlargement of the lymph nodes in multiple areas
5) renal failure in secondary hyperparathyroidism
Define Ischemia
Lack of blood supply to tissue/organ
What organs are vulnerable to Ischemia?
- which one is the most vulnerable?
- which one is the least vulnerable?
Brain * most vulnerable - dies very quickly
Heart muscle (MI)
Lungs , Kidney’s, Spleen (may not lead to death)
Liver * least vulnerable because it has a high regeneration of the tissue
Ionizing Radiation
- What do we call body tissue that suffers the most from radiation?
- what are examples of these vulnerable cells?
“Labile tissue” (high rate of mitosis or ell turnover)
Examples) Hair follicles, sexual cells (spermatozoa and ovum), games, blood cells —> results in the formation of leukemias, EPITHELIAL cells = skin and GI tract, red bone marrow (hematopoietic)
Why would you not want to expose a child to a cat scan?
So much radiation that it could lead to leukemia
What is not vulnerable to ionizing radiation?
Bone
Viral Infections are from ________ parasites.
intracellular parasites
Many viral infections will have a site of reference. This would be called _______. What does this mean?
Tropism : it is the attraction of that tissue to the virus
Polio is an example of a virus infection.
- What is the virus?
- What does it effect?
- What is its area of tropism?
- Polio virus
- Motor function
- neurons of the anterior horn
Rabies is an example of a viral infection.
-What is its area of tropism?
CNS (brain)
*comes from a bite from an infected animal
Acute Inflammation
- Who founded it?
- What are the signs and symptoms in both latin and english?
Celsus over 2000 years ago
- rubor (readness)
- Calor (heat)
- Tumor (swelling)
- Dolar (pain)
- Functio Laesa (loss of function)
Who added functio Laesa?
Galen
List the structures and flow of blood through the arterials that are apart of the micro circular level of acute inflammation:
Arterioles
sphincters
capillaries
post capillary venules
Which arteriole structure regulates the lumen of the arteriole? Where are these located in the arterioles?
sphincter
- Sphincter is only in the distal end of the lumen
Where does the exchange nutrients and wastes occur?
between the arteriole and capillaries
Why is blood in the capillaries important?
Because if there is no blood in the capillaries there there will be no AB
Where does the inflammation process occur?
Only occurs in the capillary and post capillary venue
What are the two layers of the capillaries?
1) Basement membrane (outermost part of the blood vessels)
2) Endothelial line: toward the lumen/center
What are the three components that allow the change between the blood and tissues?
1) Endothelial gaps/open channels between endothelium where nutrients exchange occurs
2) Pinocytic Vessels
3) Blood Hydrostatic Pressure(due to proteins left behind) or Tissue Osmotic pressure (because all the fluid is now on the tissue end)
Blood hydrostatic pressure/tissue osmotic pressure = blood flows _____
OUT
Tissue hydrostatic pressure/blood osmotic pressure = blood flows _____
IN
What must be present in order for inflammation to occur? What tissue do we have that can not have inflammation?
- Blood
- Cartilage
What are the two components of inflammation?
Vascular component
Cellular component
Explain the vascular component to inflammation:
Increased blood flow aka hyperemia
Increased permeability of blood vessels (switch of osmotic pressures - skin distends and hurts)
Stasis:
the blood flow so that its movement in the capillaries and venules stops this is due to fluid portion filtering out of the tissues and protein stays put towards the end of the capillaries
Explain the cellular component of inflammation:
Blood cells flow into the site of inflammation
- Exudate
- Transudate
Both components of inflammation involve vessels or blood cells, therefore avascular tissues cannot be inflamed
TRUE
Explain/define Exudate
(always accumulation at site of inflammation) fluid with proteins in tissue injury with blood cells, alive or dead - eventually more than 1.020
makes space for healing the tissue damage
Explain/define transudate
transudate: (in mm. after working out) normal not inflammatory - NOT a protein rich fluid- perfusion of the fluid portion of the blood accumulating in the tissue in different situations - physiologically and pathological - contains little amount of protein - it is not heavy- LESS THAN 1.012
In what order - how does the lumen respond to hyperemia?
1st you have vasoconstriction
then followed immediately after that you have vasodilation
Passive enlargement of capillary to 20 - 30 % LARGER than normal is due to increased hydrostatic pressure
TRUE
Fluid is pushed out of the capillary into the tissue; blood at the distal end of the capillary is more viscous and the rate of flow decreases = this is _____
Stasis
Increased hydrostatic pressure can be due to_____
Hyperemia
What are the positives of inflammation?
1) dissolution of toxins that are produced at the site of injury
2) swelling - results in pain (due to compression of the nociceptors) allows the person to know that something is wrong
3) Produces of AB against intruders
- Phagocytosis - stimulated by increase in temperature
Serous inflammation?
- List its AKA
AKA: catarrhal
is a response to a mild injury in which only fluid is allowed to escape to the interstitial tissue
- accumulation of fluid
example: second degree burn
Fibrinous inflammation
associated with appearance of the fibrinogen in the exudate fibrinogen is one of the three plasma proteins - 5% of all proteins of the blood - function is to protect us from loosing blood - accounts for hemostasis
List the three plasma proteins of blood:
What is their percentage in the blood?
What is their function?
albumin: 55%, responsible for maintaining oncotic pressure or osmosis
globulin: 40 - 45% AB
Fibrin strands: 5% - production of clots
rheumatoid arthritis has an accumulation of too much _____ in the exudate
Fibrin
Example of Fibrous inflammation is:
Rheumatic Pericarditis:
Fibrinogen is made and this leads to the formation of fibrin strands - this adhere to the pericardium and create friction - you can hear friction rubbing, the fluid must be removed
How is Suppurative (purulent) inflammation characterized?
- Presence of PUS, hazy yellowish color, contains enzymes, dead and living cells
- abscess: localized accumulation of pus that develops at a focus when an agent of injury cannot be quickly neutralized
- Cellulitis: diffuse suppurative inflammation
- Empyema
Lung Abscess
Formation of cavity due to proteolytic enzymes (seen on X-ray from cancer or TB)
Parameningeal abscess
Brain cavities
Empyema
2 cavity types (pleural covers chest and lungs)
pleural empyema: huge amount of pus accumulation in the pleura
subdural empyema - pus in the subdural space
Which of the two empyema is deadly
Subdural
