Pathalogical Diseases Flashcards
What is the link between gallstones and hepatic abscess? What disease can this lead to
Blockage is the main problem (blockage of bile duct by gall stones)
Liver produces bile and its important because it emulsifies fat.
It comes down to the hepatic duct and bile duct, the gall bladder joins to as it concentrates the bile and comes from the common bile duct.
Gall stones blocks these ducts and causes bile not to be secreted.
Another purpose is that it releases toxic material to detoxify the body, but if its blocked the body will not be able to detoxify the body.
This will causes infection and causes pus to form. Pus cant pass through so it will go back to the liver which will cause an abscess
Differnce btw osteoarthritis and RA on xray?
Loss and less
osteoarthritis
L – loss of joint space
O – osteophytes
S – subchondral sclerosis
S – subchondral cysts
RA
L – loss of joint space
E – erosions
S – soft tissue swelling
S – soft bones (osteopenia)
A 38 year old Afro-Caribbean woman presents with tiredness and a cough. A chest x-ray shows enlarged hilar lymph nodes. What diagnosis can u consider (differentials?)
- TB
- LYMPHOMA
- sarcidosis
SHE HAS SARCIDOSIS
explain what happens when Mycobacterium TB enters the lungs
once engulfed by the alveoli macrophages, they produce proteins to inhibit lysozomes from englufing them! this allows them to survuce and they also proliferate!>> PRIMARY INFECTION
A 40 year old woman gives a history of joint pain that began in her fingers but then spread to her wrists and ankles. She says her symptoms are worse in the mornings. Metacarpophalangeal and proximal interphalangeal joints of the hands appear most affected. The joints are warm, swollen and painful.
Rhematoid arthritis!
what is hereditary angio oedema?
autosomal dominaot, inherited deficiency of c1-esterase inhibitor (component of complement system).
- Episodic attacks of swelling that may affect the face, extremities, genitals, gastrointestinal tract and upper airways.
- family history of sudden death Disorder of acute inflammation
chronic granulomatous disease
deficiency in one of components of NADPH oxidase responsible for generating superoxide.. the bacteria r phagocysted, but cannot be killed, since pahgocytes cannot perform the ‘oxygen burst’ this will result in many chronic infections!
Coal- workers pneumonia (CWP)
what it is
presentation
complications
“black lung disease”
is an occupational disease (type of pneumoconiosis) caused by exposure to coal dust free of silica (washed coal).
the spectrum of lung fidings vary from
1) atmpytomic anthracosis
2) simple CWP w/ little or no pulmonary dysfunction
3) complicated CWP w/ fibrosis!
in a nutshell>> prolonged coal dust exposure> alveolar or intersitial macrophages loaded with carbon> Inflammation and FIBROSIS
blackened scars in UPPER LOBE, since its next to the respiratory bronchi (site of initial dust acummalation)
may lead to FIBROSIS> Emphysema & chronic bronchitis
anthracosis: “the asymptomatic, milder type of pneumoconiosis as caused by the accumulation of carbon in the lungs due to repeated exposure to air pollution or inhalation of smoke or coal dust particles”
give complication of gallstones and explain why they occur.
Give four other complications of gallstones and explain why they occur.
-jaudndince -bilary cholic -gall stone ileus- -pancretitis
Pancreatitis
Acute cholecystitis
Cholangitis
Obstruction if bile duct
what is TB? describe how the granuloma looks like?
-caused by mycobacterium, it doesn’t produce any toxins or lytic enzymes, they just survive, and use the body immune’s reaction to kill the human (causes chronic inflammation) -giant cells r formed, they surround bacteria and cause granuloma, they do this to wall off the bacteria to prevent it from spreading! the tissue in the middle dies as a result causing CASEOUS necrosis.
what type of bacteria can cause a bloody stool?
shigella and E coli
what type of giant cell is seen in TB?
Langhans giant cell
classification and manifestation and treatment of sarcoidosis
- young adult women (african-american females)
- non-caseating granulomas, giant cells involves lymph nodes, lung
- high ACE levels
- enlarged lymph nodes
Treat: steroids (if symptomatic)
joint findings in osteoarthritis vs rheumatoid arthritis
osteoarthritis>> osteophytes, joint space narrowing, synovial fluid noninflammatory, heberdens nodes, does not involve MCP joint
rhematoid: soft tissue swelling, sublimation of fingers, ulnar deviation, swan neck, synovial fluid inflamed, ivolves the MCP joint.
TB symptoms
fever, night sweats, cough, weight loss
differentiate btw chron’s disease and ulcerative colitis.
what is a paradoxical embolism
emboli can pass through an inter-atrial or inter-ventricular defect and gain access to the SYSTEMIC circulation
explain the formation of a granuloma in TB and what is a ghons focus and ghons complex?
when does the granuloma form?
3 weeks later after primary infection occured,
the immune system kicks in and immun ecells surround the site of infection making a GRANULOMA. attempting to wall off the bacteria and prevent it from spreading.
the tissue in the middle dies as a result and CASEOUS NECROSIS
this forms a GHONS FOCUS
When Tb goes to near by hilar lymph nodes. there it causes caseation there as well! >> ghon Complex
usually subpleural & seen il lower lobes
what is a Ranke complex in Tb? ghons complex?ghons focus
the tissue that is encapsulated by the granuloma undergoes FIBROSIS and CALCIFICATION>> this calcified ghons complex is called a = RANKE COMPELX
What is the definition of an ulcer?
Ulcer = breach in mucosa to level of submucosa or deeper.
Breach : make a gap in and break through
How does Helicobacter pylori cause gastritis?
Which malignancies are associated with Helicobacter pylori gastritis? (2)
By stimulating production of pro-inflammatory cytokines and by directly injuring epithelial cells and increasing acid secretion.
Gastric adenocarcinoma.
MALT lymphoma.
What r the findings u get in multiple myeloma?
Define multiple myeloma?
Myeloma is a cancer that affects cells in the bone marrow, called plasma cells. As the cancerous plasma cells fill the bone marrow, you are not able to make enough normal blood cells. This can lead to anaemia, bleeding problems and infections.
Difference btw liver cirhosiss and fibrosis
Fibrosis is the first stage of liver scarring. When scar tissue builds up and takes over most of the liver, this is a more serious problem called cirrhosis
a patient with RA, develops subcutaneous lumps on the extensor aspect of her forearms. What are these lumps and how do they appear microscopically?
Rheumatoid nodules
is a local swelling or tissue lump, usually rather firm to touch, like an unripe fruit.
Fibrin necrosis in the middle, surrounded by granuloma formation.
how can u distiguish btw Sarcoidoisis and TB?
**hint= blood tests?
Xiehl-neelsen stain to stain micro bacterium for suspecting TB. (Mycobacteria dont stain cause they don’t have cell wall. )
ACE>> higher in sarcoidosis
A woman had breast augmentation five years ago. She now presents with distortion and firmness of her right breast. what type of giant cell will be see/n
Foreign body giant cell>> nulcei scattered
what is pott’s disease?
TB in vertebrae.
what tissues does miliary TB effect?
what is Bacillus Calmette-Guérin (BCG)
is a vaccine against TB that is prepared
What is a Scrofula?
TB nodes in cervical region.
what is an
* Acid fast test
* Mantoux test test
in TB
* Acid fast- retains stains even on treatment with mixture of acid and alcohol.
* Mantoux test– a screening test for TB. It is a delayed hypersensitivity
how does Miliary TB form?
Ghon focus can be reactivated and spread to the lung.
immune sytem memory T cells releases cytokines to try to control the new outbreak, which forms more areas of caseous necrosis which cavitates>
this allows the bacteria to dissaminate> or spread throughout the lungs> bronchopneumonia
it can also spread via the vascular tissue and effect other tissues in the body!
Ehlers-Danlos syndrome
- inherited disorder
- procollagen doesn’t convert to tropocollagen
- Type 3> Three ED
1) Skin- hyperextensible, thin, fragile & susceptible to injury
2) Joints – hypermobile, predisposition to joint dislocation
**Because the collagen in internal organs is also affected patients can suffer from rupture of the colon and, in some forms, large arteries. Corneal rupture and retinal detachment can also be seen.
what is scurvy? causes? presentation?
vitamen C deficiency > procollagen can’t do hydroxylation in ER > reduced cross- linking and defective helix formation > ppl unable to heal wounds 3adl>tendacy to BLEED
- bleeding gums
- loss of tooth
ppl had black bones when they died> bc there was a lot of bleeding in ur bones!
Osteogenesis imperfecta
“brittle bone disease” It results in bones that break easily.
TYPE 1 COLLAGEN
Patients have too little bone tissue (osteopenia) and hence extreme skeletal fragility.
- Blue sclera>due to decreased collagen in the sclera, making it translucent that permits visualisation of the underlying choroid
- Hearing loss> due to abnormality in bone formation in ears
- Dental imperfections
-multiple fractures
(may be confused with child abuse)
Alport syndrome
-X-linked disease > patients usually male
Type 4 collagen abnormal > BASEMENT MEMBRANE ! (type 4> floor)
Dysfunction of the:
glomerular basement membrane
Cochlea of the ear
lens of the eye
(Also neural deafness and eye disorders _
describe what this is? and exaplin its macroscropic appearence
parenchymal nodules> containing hepatocytes with fibrotic bands in btw
Nodularity> result from hepatocytes regeneration and scarring
Find out what numbers I, 2 and 3 refer to.
With reference to these numbers, in which direction does blood flow in the lobule?
Which area therefore do you think is most susceptible to ischaemic damage?
Oxygenation Zones within a liver acinus
Zone 1> closest to vascular zone
Zone 2> intermediate
Zone 3> furthest
Zone 3 is most susceptible to ischaemic damage as it is the furthest from the oxygenated arterial supply
this is a microscopic slide of a cirhottic liver, describe its microscopic feautres
blue area> sclerosis around central vein
what is cirhossis?
causes?
Cirrhosis is Irreversible scarring of the liver caused by continuous long-term liver damage.
Scar tissue replaces healthy tissue in the liver + prevents the liver working properly.
Causes: ABCDEF
Alcohol
B hepatits
C Hepatits
Drugs
Ethanol
Fe overload (hemochromatosis)
pathogenesis of Cirhossis
***Cirhossis> balwa in the space of dissse***
(normally type 1 & 3 collagen r in> portal tract and around central vein, while collagen 4> is in space of disse)
in Cirhossis>> Collagen 1 & 3 r in space of disse!!
Hepatocytes r injured>kupffer cells activation> releases cytokines that allow stellate cells to change and r constantly active>secrete TGF-B> becomes highly fibrogenic & myofibroblast-like> besides laying down collagen and scar tissue in the space of disse, due to their myofibroblast talent, these cells r contracting and increased vascular resistence! alllll of this will contribute to compressing the sinusoids!
Complications of Cirhossis
Clinical feautures of cirhossis
Arise due to portal hypertension or promblems with liver function itself
Fat embolism
pathophysiology
presentation
after trauma or liposuction.
when a bone is fractures, bone marrow fat cells that r injured break up and realease oil droplets. these oil droplets stick together & r sucked into the ruptured veins.
- (Respiratory & neurological symptoms)*
- breathless, madness*
can reach to the brain!
mostly seen in those with pelvic or long bone fracture!
or sometimes it doesn’t have to be due to long bone, it can be bc of a biochemcial abnormality, theres a depostition of fat in the blood.
Amniotic fluid embolism
Pathophysiology
***Extra: why can it cause DIC?
During delivery, c- section, a tear in the amniotic membrane can occur and amniotic fluid can get into the maternal circulation.
ARDS, hypotension, seizures, loss of conciousness, DIC
(bc amnionic fluid has prothrombotic substances)
Osteosarcoma
- Presentation (location)
- Macroscopic and microscopic appearance
a cancer type of cancer that starts in the bones
a malignant mesenchymal tumor where the cencerous cells produce bone matrix
sarcoma=mesenchymal origin
–>mostly in metaphyisis of long bones, around the KNEE
Macroscopic: codmann’s triangle or sunburst pattern on xray (from elevation of periosteium)
coarse, gritty, gray and white lacelike pattern od neoplastic bone
treat w/ chenotherapy
What is Barrett’s oesophagus?
cause?
complication ?
Metaplasia of oesophageal stratified squamous epithelium to gastric glandular or intestinal type epithelium w/ Goblet cells
Cause: due to chronic acid reflux esophagitis (GERD) , that occurs w/ a hiatus hernia
Complication: asssociated with ^ risk of adenocarcinoma
ur esophageous doesnt like that reflux and decides to change its identity) :P
What r these findings of?
Osteosarcoma
the periosteum here has been lifted, has laid down a proximal traingular shell of bone known as Codmans triangle 🔺
name this condition
anthracosis: aysymptomatic condition dound in many urbna dwellers exposed to sooty air
Benign prostatic hyperplasia (BPH)
macroscopic appearnece
complications
treatment
increase in size of the prostate gland occurs during aging.
occurs in periutheral zone and presses on the urethra and partially obstruct the flow of urine,
Macroscopic: smooth, elastic, firm nodular enlargment
Complications:
- bladder outflow obstruction.
- urinary tract infection (UTI)
- acute urinary retention
- Bladder muscle hypertrophy
- Bladder distension
Symptoms:
- nocturia or dysuria
- difficulty starting & stopping urine
- urge to urinate
Treatment
A1-antagonist> relaxes smooth muscle (terazosin, tamsulosin)
**does not cause cancer!
Psoriasis
Which areas of the body are commonly affected?
presentation
macro and microscopic appearence
pathophysiology?
Thickened Stratum Coreum with a highly proliferative epidermis and thickining (acanthosis)
Commonly seen in> The skin of the elbows, knees, scalp, ears, lumbosacral area, intergluteal cleft and the glans penis.
Macroscopically – papules, pink to salmon-coloured plaques covered by loosely adherent scales which are silver/white in colour.
Microscopically – acanthosis & parakeratosis w/ a low or absent granular layer.
- microabscesses of neutrophils .
- The epidermal rete are elongated and clubbed.
- thinning of the epidermis over the dermal papillae w/ dilated blood vessels within the papillae
- – Pinpoint bleeding points when the psoriatic scale is scarped off.
Pathophysiology:
Psoriasis is a T cell-mediated disease (CD4+ and CD8+) with increased keratinocyte proliferation.
unknown antigen > triggers T cells > produce GF for keratinocytes & induce them to proliferate at approximately 10x the normal rate!!
Psoriasisssss> ssscaly, microabsseeesss
psorasis.
Apart from the skin which other parts of the body can be affected by psoriasis? (2)
- Nails
- Psoriatic arthritis
(They can show yellow-brown discolouration (‘oil-slick nails’), pitting, dimpling, separation of the nail bed (onycholysis), thickening and crumbling.)
what is a hernia?
what is hiatus hernia?
Any time an internal body part pushes into an area where it doesn’t belong,
it’s called a hernia.
is when part of the stomach squeezes up into the chest through an opening (“hiatus”) in the diaphragm.
Peripheral vascular disease
- Role of atherosclerosis
- Presentation/symptoms
affecting blood supply to legs due to atheroscleotic plaque!
- intermittent claudication> pain in calf when walking
- leriche syndrome>Pain that radiates to back of hips and buttocks.
- ischemic rest pain
- Gangrene
Describe the finding of this angiogram
theres a gap in the left iliac artery, meaning there is a blockage! but u can see collateral circulation developed!
Abdominal aortic aneurysm
- Role of atherosclerosis
- Complications
Heterozygous familial hypercholesterolaemia
- What it is
- Consequences
- clinical signs
defects in the LDL receptor > decreased hepatic uptake of LDL and therefore increased circulating LDL
- tend to have MI before age of 20!!!
- “my family did not receive the RECEPIT to the butter”*
What is a berry aneurysm?
Are these usually due to atherosclerosis?
Where do they tend to occur and where does the blood accumulate after they rupture?
A common form of intracranial aneurysm.
No, they are congenital or secondary to blood vessel injury.
circle of Willis and the adjacent arteries.
After rupture the blood accumulates in the subarachnoid space.
what is arotic dissection?
inner layer of tunica media tear! open and blood enter the tear,
this seperates the media into 2 layers!
What is this
Erythema nodosum
is a type of panniculitis. Panniculitis occurs when there is inflammation of the layer of fat lying underneath the skin. The inflammation causes red rounded lumps (nodules) to form just below the skin surface, which are tender. Erythema nodosum most commonly affects both shins.
What are abdominal adhesion?
Bands of fibrous tissue that form between abdominal tissues and organs
Chronic cholecystitis
microscopic and macroscopic appearence
Kaposi’s sarcoma
what is is
what causes it?
Kaposi’s sarcoma is a rare type of vascular tumor cancer caused by a virus.
Xeroderma pigmentosm
genetic changes
presentation
Xeroderma pigmentosum (XP) is a rare, autosomal recessive disorder. There is an impairment of the skin’s ability to repair damage from ultraviolet (UV) light,
🌞🌞🌞🌞🌞🌞🌞🌞🌞🌞🌞🌞🌞🌞
The main presenting features of XP are photosensitivity, skin changes and a high incidence of skin cancer and 👁 damage at a very young age. Skin changes occur first over the areas most exposed to light, initially on the face.
XP is an autosomal recessive genetic condition caused by alterations (mutations) in 9 different genes.
>> Eight of the genes make up the nucleotide excision repair pathway (NER) that identities and repairs UV induced DNA damage. The ninth gene acts to bypass unrepaired damage.
Excessive alchohol intake
Effects on liver?
Lab?
causes fatty liver, mallory’s hyaline accumalated in hepatocytes
What is a traumatic neuroma? What symptoms might it produce?
A disordered proliferation of axons resulting in a tangled mass
Hepatitis B
Presentation?
Lab findings?
Hepatitis can be classified as acute or chronic. Chronic hepatitis is defined as over 6 months history with histology of inflammation and necrosis.
Laboratory diagnosis:
Raised serum ALT, AST and LDH. These are cytosolic hepatocellular enzymes and their presence in the blood indicates poor hepatocyte integrity.
Raised bilirubin (often conjugated) – indicates poor biliary excretory function.
Decreased albumin, raised PT (reliant on factors 2,7,9,10 produced by the liver), raised ammonia – these findings indicate poor hepatocyte function.
Acute Appendicitis
Macroscopic
Microscopic
Causes?
lymphoid follicles r collection of lympohcytes that get to their maxium size in the appendix during adolecense.
if infection occurs> the immun esystem ramps up and the follicles can grow!
Appendicitis
Complciaiotn?
the appendix can keep on swelling and eventually compress on the surrounded blood vessels causing Ischmeia!
increased pressure causes the appendix to burst and rupture and the Pus leaks out c=and goes into the perotineal cavity
Sepsis, abscess, peritonitis
Why does the inflamed appendix (in appendicitis) appear plumper than normal?
why do u get abdominol pain
the appendix is always secreting mucos like the instestines.
when it gets obstructed, the mucos accumalates and compresses on agencent visceral nerves leading to>> abdominol pain
meningitis
shnu ahwa?
complications?
Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, collectively known as the meninges.
- Raised intracranial p>> death
- Septecemia
Macroscopic appearnece of meningtis in brain
Given the anatomy of the skull, what effect might this have?
Sulci cant be seen due to the filling of the lines by Purulent exudate pus, due to acute inflammation.
Compression of the brain because the skull is rigid.
Raised intra cranial pressure
Ascending Cholangitis
~link w/ gall stones
common causative organisms
complicatons
