Pathological Procedures Flashcards
1
Q
Define neoplasia?
A
A form of abnormal growth that is independent of normal growth regulating factors. It is always pathological
2
Q
Outline clinical symptoms associated with a diagnosis of neoplasia?
A
Feel a mass
See enlargement of an area
Fatigue
Fever/ chils
Night sweats
Loss of appetite
Loss of weight
Pain
Headaches
Nausea
Vomiting
3
Q
Macroscopic and microscopic appearances of uterine fibroid?
A
Macro - well-defined, Pale nodule, +/- bossalated, infarction, Haemorrhage. Can be serosa, subserosal or intramural
Micro - well-defined, spindle cells with cigar shaped nuclei, +/- atypia
4
Q
There are 2 mechanisms for cell death what are they?
A
Apoptosis
Necrosis
5
Q
How do apoptosis and Necrosis differ?
A
Apoptosis - programmed, no inflammatory response, no extra damage to tissues, controlled, pyknosis, karyohexis and karyolysis, active
Necrosis - incidental, responds to stimuli, inflammatory response, damage to surrounding tissues, uncontrolled, swelling and discolouration, passive
6
Q
Define metaplasia?
A
The reversible change of one form of mature epithelium into another mature epithelium in response to an external stimuli
7
Q
Give 2 examples of metaplasia with appropriate clinical settings
A
Cervix - hormone changes, in adolescence cause cervix to enlarge and transformation zone to move into the vagina where the pH is more acidic. Delicate columnar epithelium of the canal changes into squamous epithelium of the vagina.
Oesophagus - continual acid reflux damages the cuboidal epithelium of the Oesophagus to change into mucus secreting stomach or duodenal epithelium for protection
8
Q
Describe the histological features of acute inflammation, including cell types and potential outcomes?
A
Neutrophil infiltrate, oedema in surrounding tissues, fibrin deposits to wall off stimulus.
Abscess formation, progression to chronic inflammation, recovery and removal of inflammatory components and debris
9
Q
Describe the histological features of chronic inflammation, including cell types and potential outcomes?
A
Lymphocytes, histiocytes infiltrate, increase fibrin deposits, collagen laid down, cells that can regenerate do so or scar formation begins
10
Q
Define hamatoma
A
Pool of mostly clotted blood in an organ, tissue, or body cavity
11
Q
Define neoplasm
A
New growth of tissue that is not normal
12
Q
Define carcinoma
A
Tumour that begins in epithelial cells
13
Q
Define sarcoma
A
Tumour that begins in bone or soft tissue
14
Q
Describe with examples the main routes of malignant tumour spread?
A
Adjuvent spread - to adjacent tissues, uterine to colon
Lymphatic - to nearest lymph node then through the lyphatics to be deposited at a new organ MM to lymph nodes
Transcoelimic - across body cavities ovarian to liver
Blood - through he vessel wall to a new organ colon to liver as it is filtered
15
Q
Give 3 examples of tumour markers and their tumours of origin?
A
PSA - hyperplasia or malignancy of the prostate
CA 125 - ovarian cancer
CEA - increased risk of colon cancer
16
Q
What are the advantages and disadvantages of using tumour markers clinically?
A
Aid diagnosis
Non-invasive tests
Direct the patient pathway
Not specific for tumours
17
Q
What is the microscopic appearance of granulomatous inflammation?
A
Multineucleate giant cells
Epitheloid histiocytes
Lymphocytes
Necrosis
18
Q
Name 4 conditions where granuloma to us inflammation can occur?
A
Foreign body reaction
Infective diseases - tuberculosis
Sarcoidosis
Crohn’s disease
19
Q
Describe the 3 pathological processes involved in the development of a thrombus, with examples?
A
Hypercoaguability - something that triggers coagulation of the body at an inappropriate time or increases the level above normal - surgery, trauma, malignancy, pregnancy, infection, IBD, Autoimmune conditions
Circulatory status - natural or acquired areas that allow blood flow to remain static - immobility, venous obstruction, varicose veins, fibrillation, dysfunction, congenital abnornalities
Vascular damage - damage to the vessel wall - cellulitis, atherosclerosis, venopuncture, fractures, long travel, disruption or break in the endothelial wall.
20
Q
What is an embolism?
A
An obstruction of a blood vessel by an embolus
21
Q
What is the pathological effect of an embolism
A
The tissues distal to the embolism are deprived of blood and oxygen. If severe or prolonged this will lead to tissue death
22
Q
Name 6 types of emboli?
A
Thrombus,
Foreign body,
Air,
Metastatic tumour
Atherosclerosis /fat
Infection
23
Q
Describe with examples, autosomal dominant disorder
A
A disorder or disease that is spread via genetic information and only requires one copy of the gene
Polycystic kidney disease
Huntington’s disease
24
Q
Describe with examples, X-linked recessive disorder
A
Disease or disorder that is spread by the X chromosome and requires both X chromosomes to carry the gene in females and only the X chromosome in males. It’s more likely to affect males than females.
Red-green colourblindness
Haemophilia A
25
Define apoptosis
The process of programmed cell death
26
What are the morphological features seen in cells undergoing apoptosis?
Karyohexis
Karyolysis
Pyknosis
Blebbing of cytoplam
27
Give an example of a normal process in which apoptosis occurs
Webbing between fingers and toes during embryonic development
28
What is acute inflammation?
A rapid response to acute tissue injury or infection. It delivers neutrophil and immune cells to the damaged area
29
What are the classic signs of acute inflammation?
Heat
Pain
Redness
Swelling
30
What is the acute inflammatory process?
Damage - vasodilation - increased permeability - oedema - neutrofil activation and migration - phagocytosis - complement cascade activation - immunoglobulins - Fibrinogen leaved - fibrin formed - sealing stimulant and helping with scar formation
31
What is the aim of acute inflammation?
To isolate and contain the site of injury or infection,
Destroy toxins and microbes
Prepare the site for repair
32
What is the Macroscopic appearance of acute inflammation?
Red
Swollen
Exudate
+/- Necrosis
33
What is the microscopic appearance of acute inflammation?
Neutrophil line the vessels
Fiberous tissue has clear spaces (oedema)
Congestion
34
What are the complications that arise from acute inflammation?
Pus formation - abscess formation - increase in liminal pressure - immune response further damaging wall = rupture and associated comolications
35
What types of acute inflammation are there?
Suppurative
Fiberous
Serous
36
What is suppurative inflammation?
Purulent
Exudate rich in neutrophil
Often due to bacterial infections
If closed off = abscess
37
What is fibrinous inflammation?
Exudate rich in plasma proteins
Common to cavity membranes (Pleural, pericardium)
Can lead to adhesions between organs
38
What is serous inflammation?
Fluid in the response has little protein and cells (transudate)
Eg skin in response to burn
39
What is serous inflammation?
Fluid in the response has little protein and cells (transudate)
Eg skin in response to burn
40
What is the outcome of acute inflammation?
Resolution - normal architecture and function eg after Sun burn
Healing - scar formation when tissue cannot regenerate. Structural integrity with impairment of function eg modified bone after a fracture
Abscess formation - progresses to chronic inflammation eg appendicitis, lobular pneumonia
41
What happens when control of inflammatory processes fails?
Autoimmune disorders
42
How long does an acute inflammatory response last before it becomes chronic?
After 3 days
43
What types of tissue repair are there?
Regeneration
Replacement
44
What happens to a tissue if it regenerates?
Original cells type and function returned
45
In prepare what happens to the tissue if it undergoes replacement?
New cell/tissue type usually with some or total loss of function
46
When it comes to repair what types of tissues are there?
Labile
Stable
Permanent
47
What are labile tissues?
Tissues that constantly divide and regenerate during repair processes
Skin, mucosa and haemopoietic tissues
48
What are stable tissues?
Tissues that divide until fully mature then stop. Can regenerate after injury
Connective tissue, liver and pancreas
49
What are permanent tissues, in regards to repair?
Tissues with limited ability to replicate
Usually replaced after injury
Neurons, skeletal and cardiac muscle
50
Repair can be delayed due to what factors?
Stimuli remaining
Foreign body remaining
Poor nutrition
Poor circulation
Pre-exsisting diabetes
Medication (steroids)
51
What is primary intention?
A rapid process with a low rate of infection and only a small amount of scarring
52
What type of wound undergoes primary intention?
The edges of the wound are close together and fit easily together
Surgery
53
What happens during first intension?
Wound fills with blood
Clot forms containing fibrin
Fibrin binds the wound together
Clot dries
Infection prevented
Vasodialtion
Increase permeability
Vessel permeability increases
Oedema in surrounding tissues
Migration and activation of neutrophils
Phagocytosis of damaged tissue
Fibrin contains any infectious agents
Neutrophil die forming pus and exudate
Fibroblasts from surrounding tissue migrate to clot
Fibroblasts produce collagen and extracellular matrix components
I labile tissues capillaries revasculise the area
Fibrin clot breaks down and removed
Delicate connective tissue (granulation tissue) is laid down forming a scar
54
What is granulation tissue?
Delicate connective tissue that forms in wounds during repair
55
What is the function of granulation tissue?
The form a scar when a tissue is unable to regenerate after injury
56
What is the Macroscopic appearance of a scar?
Start off as a shiney red patch but become more white as the capillaries are compressed and the granulation tissue increases
57
What is secondary intention?
Repair process when the edges of a wound are far apart or do not fit easily together
4th degree burns
Skin tears
58
What process occurs in secondary intention?
Blood fills wound
Clots but fibrin is not enough to seal the wound
This slows down the repair process and the wound is still open to infection
Vasodilation
Increase permeability
Vessel permeability increases
Oedema in surrounding tissues
Migration and activation of neutrophils
Phagocytosis of damaged tissue
Fibrin contains any infectious agents
Neutrophil die forming pus and exudate
Fibroblasts from surrounding tissue migrate to clot
Fibroblasts produce collagen and extracellular matrix components
I labile tissues capillaries revasculise the area
Fibrin clot breaks down and removed
Delicate connective tissue (granulation tissue) is laid down forming a scar
59
What process occurs in secondary intention?
Blood fills wound
Clots but fibrin is not enough to seal the wound
This slows down the repair process and the wound is still open to infection
Vasodilation
Increase permeability
Vessel permeability increases
Oedema in surrounding tissues
Migration and activation of neutrophils
Phagocytosis of damaged tissue
Fibrin contains any infectious agents
Neutrophil die forming pus and exudate
Fibroblasts from surrounding tissue migrate to clot
Fibroblasts produce collagen and extracellular matrix components
I labile tissues capillaries revasculise the area
Fibrin clot breaks down and removed
Delicate connective tissue (granulation tissue) is laid down forming a scar
As it is harder to form a scar the wound contracts, pulling the sides together causing debilitating scars (puckering)
60
What are the differences between primary and secondary intension?
Secondary intention has...
Increased inflammatory response
More debris for phagocytes to remove
More risk of infection
More granulation tissue
61
What is angiogenesis?
Formation of new capillaries
62
What happens during granulation tissue formation?
Angiogenesis
Space between capillaries is filled by lymphocytes, macrophages, proliferation Fibroblasts and loose oedematous extracellular matrix
Thin walled vessels leak increasing inflammatory infiktration
Overtime vessels regress and collagen is laid down
Inflammatory cells die or return to circulation
Fibroblasts become activated, increase in size, form collagen
Collagen becomes organised forming and early scar
Fibroblasts regress
Overtime cellularity if the scar decreases
63
Give an example of specialist repair and why?
Bone after a fracture
Scar tissue would not be able to weight bear
64
How do bones undergo repair?
Following injury embryonic development is reactivated
Fracture
Bleeding
Haematoma forms
Acute inflammatory process occurs
Granulation tissue is formed (soft tissue callus)
Callus holds bone together
Stem cells from carribium layer of peristeum are activated
Cells divide forming chrondocytes and osteoblasts
Chondrocytes form cartilage nous matrix
Osteoblasts form osteoid
Granulation tissue gives way
Osteoblasts surround osteoid
Osteoid becomes mineralised to form a boney callus
Initial bone is haphazard (woven)
Over months oxsteoclasts remodel it and Osteoblasts build to form lamellar bone with trabecukated architecture
65
What causes cells to adapt?
An ever changing environmemt
66
Give an example of physiological adaptation to cells?
Thyroid gland in pregnancy
Increase TSH acts on thyroid epithelium
This is within normal range
67
Give examples of environmental (pathological) adaptations?
Toxins
Poisons
Infectious organisms
68
What are the possible outcomes for environmental (pathological) adaptations?
Malfunction
Cell death
69
What happens to cells when a stimuli is removed?
They revert to the normal form or undergo adaptive change
70
Give examples of adaptive change?
Hyperplasia
Atrophy
71
What happens if an adaptive change is sucessful?
The cell survives
72
What happens if an adaptive change is unsucessful?
The cell dies
Usually takes several morphological changes for this to occur
73
What can influence if a cell survives an adaptive change?
Magnitude of stimuli
Type of stimuli
Duration of stimulus
Vunerability of cell (Neurons are more vulnerable to hypoxia than Fibroblasts)
Immunosupression
Immunodeficiency
Poor nutrition
74
How can adaptive changes be seem Macroscopically?
Cloudy
Swelling
Hydropic degeneration
Fatty change
75
Are adaptive changes reversible?
Yes, generally, once stimulus is removed
76
What is autophagy?
Removal of damaged organelles
Synthesis of new proteins
77
What is steatosis and where can it occur?
Fatty change
Subleathal metabolic dearragement
Usually in high energy demanding cells
Liver due to chronic alcohol abuse
Myocardium or skeletal muscle due to lack of use
78
What is Necrosis?
A form of cell injury that results in the premature death by autolysis
79
What causes Necrosis to occur?
Stimuli that remain unchecked
Irreversible cell damage
80
What are the types of Necrosis?
Colliquative
Coagulative
Caseous
Fibrinoid
81
What is colliquative necrosis?
Dead tissue is semi-liquid
Eg ischeamia
82
What is Coagulative necrosis?
Dead tissue is firm
Eg abscess
83
What is Caseous necrosis?
Soft, cream cheese consistency
Eg tuberculosis
84
What is fibrinoid Necrosis?
Occurs in the walls of blood vessels?
85
What is the microscopic appearance of Necrosis?
Pale staining
Cytoplasmic vaculation
No definition to the cytoplasm
Nuclear condensation
86
What happens in a cell if it undergoes reversible cell damage?
Mitochondria fail to produce ATP
Ion pumps in membranes fail
Loss of ion fluid homestasis
Free radicles accumulate
If this fails to correct then the damage becomes irreversible
87
What happens in a cell if it undergoes lethal injury?
Damage to organelles
Lysosomes release autodigestion enzynes
Autolysis
Cell membranes loose specialist structures (microvilli)
Cell function is lost
88
What is apoptosis?
Programmed cell death. A highly organised process to alter the cell and cause cell death. Affects individual cells only
89
Give an example of pathological apoptosis?
Cancer
Failure of apoptosis is a key factor in cancer formation
90
Give an example of embryonic apoptosis
Webbing between toes and fingers
91
Give an example of regressive apoptosis?
Menstrual cycle and endometrium
92
List examples of causes of apoptosis?
Radiation
Certain viruses (HPV)
membrane damage
Mitochondrial damage
DNA damage
Immune mediated attack
93
What is process of apoptosis?
Cells loose specialist structures
Loose attachment to other cells
Cells become rounded
Pyknosis
Karohexis
Karolysis
Blebbing of cytoplasm
Apoptotic bopsies form expressing membrane surface factors encourage phagocytosis
94
What is the aim of apoptosis?
Part of embryonic development
Part of everyday cell turnover
Eliminate damaged and disease cells
95
What triggers apoptosis?
Intrinsic and extrinsic pathways
96
What is the microscopic appearance of apoptosis?
Nuclear enlargment
Pyknosis - chromatic condensation
Karohexis
Karolysis
Naked cytoplasm
Vacuoles in cytoplasm
97
What is the microscopic appearance of apoptosis?
Nuclear enlargment
Pyknosis - chromatic condensation
Karohexis
Karolysis
Naked cytoplasm
Vacuoles in cytoplasm
98
What is an abscess?
A localised collection of pus following excessive tissue damage, often by pyrogenic bacteria
99
What happens during abscess formation?
Bacteria elicit an inflammatory response
Exudate is formed composed of neutrophils
Neutrophils die, releasing lysosomal enzymes
Autolysis
Pus made up of dead and dying neutrophils, fluid from acute inflammatory response and fibrin
Pyrogenic bacteria often survive the response
More pus production
Enlargement of lesion
Acute abscess formation
Acute abscess formation
Acute abscess formation
Eventually the abscess is walled off
Becomes surrounded by granulation and Fiberous tissue
Chronic abscess formation
100
What limits the abscess size?
The repair that forms the margins of the abscess
101
What is chronic inflammation?
A continuation of acute inflammation. A response to prolonged exposure to a stimuli. Can lead to morbidity and mortality.
102
Microscopic appearance of chronic appearance?
Generally lymphocytes, macrophages and plasma cells
103
What types of chronic inflammation are there?
Specific
Non-specific
104
What is non-specific chronic inflammation?
A continuation of acute inflammation
Acute, granulation, repair and chronic inflammation can all co-exsist
105
Give an example on non-specific chronic inflammation?
Peptic ulcer stomach
Local chronic ulceration
Patients become infected by H. Pylori
Ulcer expands to full thickness of mucosa
H. Pylori interferes with control of acid secretion
Imbalance between damaging factors (acid and Peptic enzymes) and protective factors (mucus and alkaline secretion)
More ulceration
Circle begins again
106
How does chronic inflammation demonstrate a dynamic balance?
If repair is favoured fiberous repair occurs then mucosa regenerates ro cover
If damage is favoured the wall thins and the risk of rupture increases
107
What are the types of specific (Primary) chronic inflammation?
Granulomatous
Non-granulomatous
108
What is the key feature of non-granulomatous chronic inflammation?
Activated macriphages
More efficient at phagocytosis
Secrete factors that control inflammatory cells and induce fibrosis
109
What causes damage to normal tissues during an inflammatory response?
Phagocytosis of cells in a non-discrimatory manner
110
What is granulomatous inflammation?
A type of chronic inflammatory response
111
What is the classic appearance of granulomatous chronic inflammatory?
Activated epithelial macrophages and multineucleate giant cells, surrounded by lymphocytes, macrophages, Fibroblasts and varying degrees of fibrosis. Collectively called a granuloma
112
In granulomatous chronic inflammation what are the multineucleate giant cells derived from?
Macrophages
113
Give an example of immune causes of granulomatous chronic inflammation?
Crohn's
Sarcoidosis
114
Give an example of non-immune causes of granulomatous chronic inflammation?
Suture following surgery
Thorn in skin
115
What is a granuloma?
A cluster of macrophages, multineucleate giant cells surrounded by lymphocytes, Fibroblasts and fibrosis.
Different from granulation tissue seen in acute inflammation
116
An example of granulomatous chronic inflammation?
Tuberculosis
117
Give 3 ways a virus can cause diseases, with examples?
Infect cells and cause death.
HIV cell death of T-lymphocytes
Cause excessive proliferation of infected cells. HPV - cervical carcinoma
Integrate themselves into the nucleus producing a latent infection. HSV - coldsores
118
What immune response do most bacteria elicit?
Acute
119
Give an example of a bacterial infection?
C. diff
Produces toxins that destroy the surface of the colon which in turn allows for uncontrolled growth of C. diff
120
Give an example of fungal infection?
Candida
In the Oesophagus
121
Give an example of a protazoan infection?
Trichomonas vaginalis
In the female genital tract
122
What is hyperplasia?
Increased production and maturation of normal cells, in a tissue without an increase in size of the cells
123
What causes hyperplasia?
An external stimuli such as hormones or environment
124
How does metaplasia appear?
Cells are normal to the tissue, may give rise to modules or just overall growth of the tissue.
125
What happens to hyperplasia if the stimuli is removed.
Hyperplasia stops +/- regression
126
How does hyperplasia compare to neoplasia?
Neoplasia is uncontrolled growth, hyperplasia is controlled
127
What are the risks of hyperplasia?
Atypia
Neoplastic change
128
Why do some cases of hyperplasia form nodules?
Non-uniform hyperplasia within the organ/tissue
129
Give 2 examples of hyperplasia?
Endometrial glands in the menstrual cycle
Modular hyperplasia I thyroid, prostate or adrenal glands
130
What is hypertrophy?
Increase in the size of a tissue or organ brought about by enlargement of the cell, but not the number of cells
131
What happens hypertrophic cells once the stimulus is removed?
Hypertrophy stops +/- regression
132
Give 2 examples of hypertrophy?
Skeletal muscle following exercise
Smooth muscle following chronic obstruction by tumours
133
What is hypotrophy?
Tissue or organ shrinks in size due to shrinking cells, not cell mumbers
134
What is a common cause of hypotrophy?
Deficiency during development causing underdeveloped cell types
135
Give an example of hypotrophy?
Muscle hypotrophy
136
What is agenesis?
Complete failure of an organ to develope during embryonic development
137
What is atrophy?
The wasting away of a normally developed organ or tissue due to degeneration of cells. Resultant reduction in function too
138
What are the classic signs of atrophy?
Cells are usually replaced with adipose tissue or fiberous tissue
139
What is the microscopic appearance of atrophy?
Shrinkage of cells
Reduction of organelles
Loss via apoptosis
140
Give 2 examples of atrophy?
Muscle atrophy - lack of exercise
Ischaemic atrophy - lack of blood flow to the kidney
141
What is metaplasia?
The reversible change of one form of mature epithelium into another form of mature epithelium in response to a stimuli
142
What happens in metaplasia is the stimulus is removed?
It should reverse as it is an adaptive change
143
What types of metaplasia are there?
Pathological
Physiological
144
Give an example of pathological metaplasia?
Barrett's oesophagus
Normal stratified squamous to gastric or small bowel cuboidal-columnar epithelium
145
Give a example of physiological metaplasia?
Squamous metaplasia of the cervix
Endocervical columnar epithelium into staitified squamous
146
What is atypia?
Abnormality or Deviation from the normal state
147
What is the process of atypia?
Cells divide rapidly
Don't mature fully before dividing again
Leads to a population of atypical cells
148
What causes atypia?
Response to a persitently damaging stimuli.
149
What happens when the stimulus causing atypia is removed?
The cells reach full maturation
150
What is the microscopic appearance of atypia?
High n/c ratio
Large nuclei
Dark chromatin
+/- prominent nucleoli
Lack of specialist structures
151
What is dysplasia?
Abnormal development of cells within a tissue
152
What is the cause of dysplasia?
Persistent atypia that is not the result of regeneration
153
Where is dysplasia often found?
Metaplastic tissue
154
What is a potential outcome of untreated dysplasia?
It has the potential to become precanceeous
And the further potential for neoplasia
155
What happens in neoplastic tissues once the stimulus is removed?
They continue
156
What is the microscopic appearance of neoplasia?
Cells of various stars of differentiation
Commonly fail to reach full maturation
157
What types of neoplasia are there?
Benign
Malignant
Anaplastic
158
What are the characteristics of benign neoplasia and an example?
Generally slow growing
Remain localised
May be encapsulated
Resemble original tissue
Few mitoses
Normal or slight increase to n/c ratio
Cells are uniform
Breast fibroadenoma
159
What are the characteristics of malignant neoplasm and an example?
Rapid growing
Spread widely
May metasasize
Not encapsulated
May fail to mature fully
Pleomorphic
Can be well or poorly differentiated
Cervical carcinoma
160
What are the characteristics of anaplastic neoplasm?
No evidence of differentiation
Need more morphology to diagnose
161
Which type of malignant neoplasm is more likely to be more invasive or aggressive? Well differentiated or poorly differentiated
Poorly differentiated
162
What is carcinoma in situ?
A carcinoma is a cancer that forms in epithelial tissues.
In situ means that the cancer has remained in the tissue of origin and not spread
163
What will happen to carcinoma in situ if left untreated ?
It will metastasise
164
What is the microscopic appearance of carcinoma in situ?
Cell crowding
Pleomorphism
increased and abnormal mitosis
no invasion through basement membrane
changes to N/C ratio
abnormal nuclei
loss of stratification
165
What is metastases?
The distal spread of a neoplasm away from its primary site
166
What is the clinical presentation of metastases?
Weight loss
loss of appetite
fever
general malaise (body weakness)
+/- loss of function of specific organs or increased functions (eg parathyroid hormone produced by lung carcinoma)
167
What types of modes of spread are there?
Local
lymphatic
vascular
transcolemic
168
What is local spread of cancer and give an example?
The spread of cancer to surrounding tissues by a direct route
breast carcinoma to overlying skin cervical carcinoma to bladder or rectum
169
What is lymphatic spread of cancer and give an example?
Spread of cancer via the lymphatics that drain the site of the primary tumor, it can be a long the lumen or as an emboli
Breast carcinoma to lymph nodes of the axilla
tongue carcinoma to lymph nodes of the neck
170
What is vascular spread of cancer and give an example?
Spread via the veins that drain the sight of the primary tumor, it can invade thin walls of the vessels and then spread as an emboli
Rectal cancer spreads via the portal vein to the liver
171
What is transcolemic spread of cancer and an example?
Spread past colemic (body) cavities emboli from primary tumor break off and float to a new site where they embed
Carcinoma of the ovary to peritoneal surfaces
172
What is atherosclerosis ?
A disease of the arteries in which fatty plaques develop on the inner walls eventually obstruction of blood flow will occur
173
What are the risk factors of atherosclerosis?
Age
Sex (men and menopausal women) genetic
ethnicity (African and Asian) hypertension
hyperlipidemia
smoking
physical inactivity
obesity
diabetes
stress
anxiety
depression
174
What is atheroma?
Porridge or sludge within the arteries, affects the karge and medium arteries
175
What is the process of atherosclerosis?
At vessel branches and other sites of turbulent flow and stress leads to expression of cell adhesion factors by the endothelium which leads to accumulation of and migration of macrophages and lymphocytes.
Epithelial dysfunction leads to increased permiability to lipoproteins, monocytes and lymphocytes leading to an inflammatory response in the intimate.
Smooth muscle migrates from the media and atherosclerosis formation begins as a fatty streak
As the fatty streaking increases a fibrous cap forms between the vessel and the lumen forming a mature plaque
Over time cap remodels and frequently undergoes calcification if the cap ruptures a thrombi is released
176
What would full occlusion of a vessel due to atherosclerosis lead to?
Ischeamia or Infarction
177
What is thrombosis?
A condition from where blood changes from liquid to a solid state within a cardiovascular system, during life, and produces a mass (thrombus)
178
What is the difference between thrombosis and coagulation?
Thrombosis occurs in blood flow it is a dynamic process
Coagulation occurs in static blood.
179
What are the courses of thrombosis?
Virchow 's triad
Damage to endothelium - physical or dysfunction to normal process eg hypertension, turbulent blood flow or bacterial endotoxins
Disordered blood flow - turbulent flow leads to eddy currents with focal stasis of blood flow eg immobility, obesity, varicose veins,
Abnormal homeostatic properties of blood - hypercoagulability eg inherited = IBD or acquired = surgery, trauma, pregnancy, dehydration
180
What is Virchow's triad?
**Damage to endothelium** - physical or dysfunction to normal process eg hypertension, turbulent blood flow or bacterial endotoxins
**Disordered blood flow** - turbulent flow leads to eddy currents with focal stasis of blood flow eg immobility, obesity, varicose veins,
Abnormal homeostatic properties of blood - **hypercoagulability** eg inherited = IBD or acquired = surgery, trauma, pregnancy, dehydration
181
What is the microscopic appearance of a thrombi?
White to pink to red
granular
firm
may have layers of organization on the cut surface
182
What is the microscopic appearance of a thrombi?
Platelets
Insoluble fibrin
Erythrocytes
Leukiocytes
183
What is the thrombosis process?
Endothelial injury platelets adhere to exposed subepithelial collagen
Platelet activation ADP and thromboxane AZ are released triggering further plateless aggregation Platelets degranulate and coagulation cascade is activated
Soluble fibrogen becomes insoluble fibrin
Red cells become trapped
Thrombus increases in size
184
What are the complications of thrombosis?
Occurs in large arteries and veins Affects the peripheral vessels with smaller diameter
They become occluded by the thrombi
185
What is an aneurysm?
Loss of muscle and elastin from vessel wall leads to weakening of the wall allowing local dilation (aneurysm) rupturr is fatal
186
What is an embolism?
The condition in which an emboli becomes lodged in an artery and obstructs the blood flow
187
What are the types of emboli?
Venous thromboemboli
Arterial thromboemboli
Atheromatus debris
Tumor cells b
Bacterial vegetations
Fat or bone marrow
Air
188
What is an example of Venus thromboemboli?
Deep vein thrombosis
189
When does arterial thromboemboli?
Following myocardial infarction
190
When would a fat or bone marrow emboli occur?
Following a fracture
191
Give an example of an air emboli?
Nitrogen
Due to rapid changes in air pressure when deep sea diving
192
How can thrombi resolved?
Fibrinolysis can resolve a thrombi - medications such as warfarin
193
What happens if an emboli is left untreated?
Arteries and veins become blocked ischemia will follow in distal regions or organs and later infarction
194
What is infarction?
The death of part or the whole of an organ that occurs when an artery carrying its blood supply is obstructed by an embolus
195
What is venous infarction?
When an embolus blocks or prevent strainage and blood flow is impaired
196
How can venous infection appear in the kidney, spleen or brain?
A wedge shaped infarction
197
What is the process of infarction?
Infarction excites an inflammatory response
Replacement of an necrotic tissue with granulation tissue which undergoes fibrous repair and scarring
198
What causes arterial infarction?
Complete or partial blockage of an artery by an emboli generally from a pre-existing atheroma
199
What causes venous infarction?
Generally due to mechanical compression of vessels
Torsion of the testes
Hernia strangulation
200
What is the process of venous infarction?
Blockage stops blood from leaving the tissue leading to ischemia due to stasis and eventually infarction
201
What is oedema?
Excessive accumulation of fluid in the body tissues can be local as seen in injury or inflammation or more generally as seen in heart or kidney failure
202
How is homeostasis of fluid in and out of the bloodstream maintained?
Hydrostatic pressure vs plasma colloid and osmotic pressure
Increase capillary pressure means lower colloid osmotic pressure
203
What is capillary pressure?
The pressure of a fluid within the capillary
204
What is of colloid osmotic pressure?
Pressure in the capillary due to the concentration of proteins
205
Give two examples of oedema?
Deep vein thrombosis - impaired venous return leads to increased hydrostatic pressure and oedema around the calf
Liver cirrhosis - decreased albumin leads to decreased colloid osmotic pressure leading to ascites
206
What is coagulation?
The process by which a colloidal liquid changing to a jelly like mass
207
What is the process of coagulation?
It can be initiated by the contact of blood with a foreign surface (intrinsic system) or with a damage to the tissue (extrinsic system)
Both systems use coagulation factors which lead to the production of thrombin
Thrombin converts fibrinogen into fibrin and a clot is formed
208
What is ionizing radiation?
It is used to treat cancer and during imaging
It is a mutantogenic carcinogenic and tetrogenic (abnormalities in fetus)
209
What are the biological effects of ionizing radiation?
Effects depend on the method of delivery
The effect is cumulative - if spread out some repair can occur between doses
The field size - high power in a small area is best for the body
Cell proliferation - rapidly dividing cells are more susceptible
Hypoxia
Vascular damage
210
What is the effect of radiation on a tissue?
Radiation kill cells
Inflammatory response
Fibrosis
211
What is innate immunity?
It is always present
Non-specific
Includes epithelial barriers, circulating plasma proteins, phagocytic leukaocytes and natural killer cells
212
What can problems with immunity lead to?
Congenital immunodeficiencies
Acquired immunodeficiencies
Normal response harms healthy tissue
Allergies caused by excessive or uncontrolled immune response
When self-tolerance fails it leads to autoimmune disease
213
What are autoimmune disorders?
Disorders caused by inflammation and the destruction of tissues by the bodies own immune response
214
Give three examples of autoimmune disorders and where they are found?
Rheumatoid arthritis - joints
Hashimotos disease - thyroid
Crohn's disease - colon
215
What is a tumour marker
Substance produced by a tumour that can be used to aid detection, monitor its size and the effects of treatment
216
Give three examples of tumour markers?
CA125 - ovarian cancer
PAP - prostate cancer
Calcitonin - medullary carcinoma of the thyroid
217
What is an allele?
Different forms of a gene, codes for variation in a genetically inherited trait
218
What is a gene?
Part of the DNA that codes for proteins, carries hereditary information
219
What is a dominant gene?
A gene that shows a specific trait even if it is only passed on from one parent
220
Was what is a recessive gene?
A gene that only shows its trait when passed on from both parents
221
What does homozygous mean?
Two of the same form of a gene
222
What does heterozygous mean?
Two different forms of the same Gene
223
What is a genotype?
Genetic makeup of an individual
224
What is a phenotype?
Outwardly expressing traits of a characteristic
225
What is a phenotype?
Outwardly expressing traits of a characteristic
226
In genetics what is penetrance?
Probability of a genetic trait being expressed
227
What are the different types of genetic disorders?
Chromosomal disorders
Single gene disorders
X-linked disorders
Polygenic disease
228
What is a chromosomal disorder and give an example?
Addition or deletion of an entire/partial chromosome
Down syndrome
229
What is a single Gene disorder and give an example?
A single gene mutant that has a large effect on the patient
Sickle cell anemia
Haemophilia
230
What is a characteristic of x-linked disorders and an example?
Almost all are recessive
Haemophilia A and B
231
What is a degenerate condition?
Diseases of the central nervous system mainly the grey matter
232
Give two examples of disorders that affect the cerebral cortex?
Alzheimer's disease
Vascular dementia
233
Give two examples after disorders that affect the basal ganglia?
Parkinson's Disease
Huntington's disease
234
What is a fistulate?
An abnormal communication between two hollow organs connecting to mucosa lined surfaces or between a hollow organ and the exterior surface
235
How are fistulate caused?
By infection put malignancy can also lead to formation
236
What are the four types of fistulate?
Enterovesical
Enterocolic
Enteroenteric
Enterocutaneous
237
What is an enterovesical fistula?
Between bladder and small bowel
238
What is an enterocolic fistula?
Between small bowel and colon
239
What is an enteroenteric fistula?
Between adjacent loops of the small bowel
Common after surgery
240
What is an enterocutaneous fistula?
Between small or large bowel and skin
