Pathological Processes Flashcards
What is Excessive Alcohol Intake?
- Regularly drinking more than 14 units a week
What happens due to Excessive Alcohol Intake?
- Fatty change
- Acute alcohol hepatitis
- Cirrhosis
- Heart disease, stoke, brain damage
- Cancers of the mouth, throat and breast
What is Hepatitis B?
- An infection of the liver caused by a virus that’s spread through blood and body fluids
What causes Hepatitis B?
- Caused by an infection which spreads by vertical transmission and bodily fluids
What are the symptoms of Hepatitis B?
- Tiredness, aches and pains, high temperature, general sense of feeling unwell, loss of appetite, sickness and Diarrhoea, abdominal pain, dark urine and jaundice
- Usually lasts about 1-3 months but if lasts more than 6 months then is chronic
What is the treatment of Hepatitis B?
- Acute- plenty of rest, painkillers (over the counter) and any medication needed for symptoms
- Chronic- Peginterferon alfa-2a or antivirals Prevention with vaccine
What is Acute Pancreatitis?
- Sudden inflammation of the pancreas
What are the causes of Acute pancreatitis?
- Gallstones alcohol consumption
- Accidental damage, medications, infections
What are the symptoms of Acute pancreatitis?
- Severe dull pain around the top of your stomach that suddenly develops
- Nausea, Diarrhoea, indigestion, high temperature, jaundice and tenderness of abdomen
What is the treatment for Acute pancreatitis?
- Fluids
- Oxygen
- Painkillers
- Endoscopic retrograde cholangiopancreatectomy
What is Hereditary Hemochromatosis?
- Disorder that causes the body to absorb too much iron from the diet
What causes Hereditary Hemochromatosis?
- Humans cannot increase there secretion of iron so have to store it and will eventually damage tissues
What are the symptoms of Hereditary Hemochromatosis?
- Early symptoms- fatigue, joint pain, abdominal pain, loss of sex drive
- Later symptoms- arthritis, liver disease, diabetes, heart abnormalities and skin discoloration
- Complications- cirrhosis, diabetes, hepatocellular carcinoma, congestive heart failure
What is the treatment for Hereditary Hemochromatosis?
- Phlebotomy
What is Alpha-1-antitrypsin deficiency?
- Lack of Alpha 1 antitrypsin produced so less in blood and lungs so excessive abnormal A1AT protein in liver 1-5% of patients with COPD have the disorder
- More vulnerable to smoke and other toxic materials
What are the symptoms of Alpha-1-antitrypsin deficiency?
- Shortness of breath, cough, wheeze, chest infections
- COPD and chronic bronchitis
What is Coal workers pneumoconiosis?
- Black lung disease caused by long exposure to coal dust and accumulation of coal dust in the lungs
What are the symptoms of Coal workers pneumoconiosis?
- No symptoms or a cough, chest tightness, mucus, shortness of breath
What are the complications ofCoal workers pneumoconiosis?
- Chronic bronchitis, COPD, right sided heart failure, respiratory failure
What is the treatment for Coal workers pneumoconiosis?
- Symptomatic
What is Lobar pneumonia?
- Inflammation of entire pulmonary lobe congestion, red hepatization, grey hepatization, resolution
What causes Lobar Pneumonia?
- Streptococcus Pneumoniae
What are the complications of Lobar Pneumonia?
- Bacteria in the blood stream, difficulty breathing, fluid around the lungs and lung abscess
What is Acute appendicitis?
- Painful swelling of the appendix
What causes Acute appendicitis?
- Obstruction of the appendix
What are the symptoms of Acute appendicitis?
- Main in the middle of the abdomen and travels to the lower right hand side
- Nausea, loss of appetite, Diarrhoea, high temperature
What are the complications of acute appendicitis?
- Ruptured appendix which causes bacteria to travel throughout the blood, fistulas and abscesses
What is the treatment for appendicitis?
- Removal of the appendix
What is Bacterial meningitis?
- Infection of the meninges
What are the causes of Meningitis?
- In Neonates- Group B streptococci
- Children- Streptococci pneumoniae
- Young adults- Neisseria meningitis
- Older- Streptococci pneumonie
What are the symptoms of Meningitis?
- Nausea
- Vomiting
- Head ache
- Non-blanching rash
- Photophobia
- Confusion
- Seizures
- Coma
- Sepsis
- Abscess
- Thrombosis
- Stiff neck
What is the treatment for Meningitis?
- Antibiotics, fluid and oxygen
- Vaccine as prevention
What are Gallstones?
- Small stones usually made of cholesterol that forms in the gallbladder
- Most cases they don’t cause symptoms or need treatment If they get trapped in an opening e.g. gallbladder duct then can cause biliary colic
What causes Gallstones?
- Imbalance of chemicals that make up bile
- Cholesterol level in bile is too high
What are the symptoms of Gallstones?
- No symptoms
- Biliary Colic- constant severe abdominal pain in the centre that reads under the right hand side of the ribs and then to the shoulder blade
What are the complications of Gallstones?
- Obstruction of the common bile duct, inflammation or infection of the gallbladder or common bile duct, spread elsewhere and jaundice
What is the treatment for Gallstones?
- Monitoring Surgery to remove Gallbladder
- Medications
- Endoscopic retrograde cholangiopancreatectomy
- Change in diet
What is Ascending Cholangitis?
- Infection of the common bile duct usually partially obstructed by gall stones
What causes Ascending Cholangitis?
- Escherichia Coli, Enterbacter, Enterococcus
What are the symptoms of Ascending Cholangitis?
- Abdominal pain in right upper quadrant, fever, rigors, malaise and jaundice
What are the complications of acute Cholangitis?
- Pancreatitis, hepatic abscess
What is the treatment for Ascending Cholangitis?
- Fluids
- Antibiotics
- Endoscopy Cholecystectomy
What is Hereditary angio-oedema?
- Swelling in various parts of the body-hands, feet, face and airways
What are the causes of Hereditary angio-oedema?
- Genetic change in SERPING 1 gene or F12 gene
What is the inheritance pattern of Hereditary angio-oedema?
- Autosomal dominant
What are the symptoms of Hereditary angio-oedema?
- Swelling in body
- Vomiting
- Painful colic like intestinal spasms
What is the treatment for Hereditary angio-oedema?
- Antihistamines
- Epinephrine in life threatening reactions
What is Chronic Granulomatous Disease?
- Body susceptibility to infections caused by bacteria and fungi due to not being able to produce Hydrogen peroxide to fight off specific kinds of infection
What causes Chronic Granulomatous Disease?
- Inherited mutation in the X chromosome
What are the symptoms of Chronic Granulomatous Disease?
- Short stature, recurrent infections like pneumonia
What is the treatment for Chronic Granulomatous Disease?
- Antibiotics, Immunomodulation, Hemopotetic stem cell transplantation
What is Rheumatoid arthritis?
- Long term condition that causes symmetrical swelling and stiffness in the joints
What are the causes of Rheumatoid arthritis?
- Autoimmune condition so body attacks the cells that line the joints, risk factors include genetics, hormones and smoking
What are the symptoms of Rheumatoid arthritis?
- Joint pain
- Swelling
- Stiffness
- Inflammation in other parts of the body
What is the treatment for Rheumatoid arthritis?
- DMARDs and biological treatments which have side effects
What is Chronic Cholecystitis?
- when the gallbladder is damaged due to block of the cystic duct so becomes thick walled, scared and small
What causes Chronic Cholecystitis?
- Gallstones
- Infection
- CBD blockage
- Decreased blood supply to the gallbladder due to diabetes
- Tumours
What are the symptoms of Chronic Cholecystitis?
- Biliary Colic, Fever, Chills, Nausea, Vomiting and Jaundice
What is the treatment for Chronic Cholecystitis?
- Causes will determine the treatment e.g. antibiotics or surgery Pain relief
What is Bacterial Chronic Gastritis?
- Hpylori infection of the gastric mucosa
What are the symptoms symptoms of Bacterial Chronic Gastritis?
- Asymptomatic or pain, nausea and vomiting
What are the complications of Bacterial Chronic Gastritis?
- Peptic ulcers, adenocarcinoma, MALT lymphoma
What is Autoimmune Chronic Gastritis?
- Autoantibodies to gastric parietal cells can lead to pernicious anaemia
What are the symptoms of Autoimmune Chronic Gastritis?
- Symptoms of anaemia, glossitis, anorexia and neurological symptoms
What is chemical reactive causes of Chronic Gastritis?
- Chronic alcohol abuse, NSAIDs and reflux of bile
What is Cirrhosis?
- Liver fibrosis producing hard shrunken nodular liver
- Causes pressure and occlusion of the hepatic sinusoid so portal hypertension , shunting and oesphageal varices, blood directed away from the liver
- Pressure on the bile canaliculi therefore reduced ability to excrete toxins, bilirubin etc
- Replacement of hepatocytes by fibrous tissue which leads to reduced albumin and clotting factor produced
What are the symptoms of Cirrhosis?
- Fatigue Bleeding and bruising easily
- Swollen abdomen and legs
- Weight loss
- Jaundice
- Haematemesis and melaena
- Confusion, drowsiness and slurred speech
What are the blood test findings in Cirrhosis?
- May all be normal but may show low albumin and or prolonged INR, may show a raised bilirubin, slight rise in ALT if inflammation, ALK phos normal, Gamma GT raised if due to alcohol
What is the treatment of Cirrhosis?
- Life style changes to stop it getting worse
- Treat symptoms Liver transplant
What is Primary TB?
- Occurs when the primary complex does not heal but progresses and causes TB
- So gets tuberculosis and has signs of the infection straight after the exposure to Mycobacterium Tuberculosis
- May be asymptomatic with flu like symptoms
What is Post Primary TB
- Reactivation of latent TB which occurs most often in the lungs
What is Extra Pulmonary TB?
- Reactivation of latent TB in other sites than the lungs e.g. lymph nodes, bones, joints, CVS, GI or UT
What is Miliary TB?
- Rupture of the caseous pulmonary focus into blood vessels which leads to widespread dissemination of bacilli throughout the body like seeds
What is the shape of Mycobacterium tuberculosis?
- Rod shaped Waxy cell wall- mycolic acid so acid fast
- Needs oxygen as aerobe Hardy so resists weak disinfectants and survive on surfaces
How is TB spread?
- Respiratory droplets
What is the pathophysiology of TB?
- Usually turbulent so bacteria can be cleared TB can avoid these mucus traps
- Macrophages phagocytose bacteria, this then fuses with a lysosome and they are broken down with enzymes
- However TB produces a protein which inhibits the fusion
- Can then proliferate and create an infection
What happens in Primary TB?
- Asymptomatic 3 weeks after infection cell mediated immunity kicks in and a granuloma forms to wall of the bacteria
- Causes caseous necrosis (cheese like) this is a Ghon Focus
- Can travel to lymph nodes and cause caseous there too- Ghon complex in lower lobes Fibrosis and calcification then occurs TB can be killed off by the immune system or dormant and then cause post primary tuberculosis
What happens in Post Primary TB?
- Ghon complex reactivated due to age or immunodeficiency
- Spreads to upper lobes due to oxygenation being greatest in these areas
- Memory T cell release cytokines to try and control outbreak making more areas of caseous necrosis then form cavities
- This will then form cavities which means TB can spread throughout lungs causing bronchopneumonia
- May also spread through vascular system- miliary TB
What happens in Miliary TB?
- Kidneys- sterile pyuria and WBCs in urine
- Meninges of brain causing meningitis
- Lumbar vertebrae causing Pott disease
- Adrenal glands causing Addison’s disease Liver causing hepatitis
- Cervical lymph nodes causing lymphadenitis in neck (scrofula )
What are the symptoms of TB?
- Fever, night sweats, weight loss, coughing up blood, tired, caseating granulomas
- Examination- fever, weight loss, maybe crackles in affected area, signs of caviation and fibrosis
- Pleural effusion may occur if serious
How would you diagnose TB?
- Purified protein derivative intradermal skin test
- Interferon gamma release assay
- Chest X-ray
- Sputum and bronchoalveolar lavage for staining, culture and PCR
What is the treatment for TB?
- RIPE Rifampicin Isoniazid Pyramidamide Ethambutol
- for 2 months and RI for 4 more months
- Close monitoring of compliance
What is the BCG vaccination?
- Live attenuated M.Bovis strain given to babies to prevent severe TB
What is Sarcoidosis?
- Chronic disease small patches of swollen tissue called granulomas develop in organs of the body, mainly the skin and lungs
What causes Sarcoidosis?
- Immune system has gone into overdrive and the body starts to attack is organs
- This results in inflammation and granulomas to develop in organs
What are the symptoms of Sarcoidosis?
- No symptoms
- Lung- shortness of breath and dry cough
- Skin- rashes- tender red bumps or patches
- Tender or swollen glands in neck, tired, painful joints, sore eyes, blocked nose, headaches
What is the treatment for Sarcoidosis?
- Goes away by itself in a few months-year
- Over the counter medication Steroid tablets
What is Scruvy?
- Rare condition that can develop if you don’t have enough vitamin C in your diet Vitamin C deficiency
What are the symptoms of Scurvy?
- Weaker collagen so poor healing and bone formation
- Muscle and joint pain, tiredness, red dots on skin, bleeding and swelling of the gums
What is the treatment for Scurvy?
- Vitamin C supplement
What is Alport syndrome?
- A condition where type IV collagen, which is found in basement membrane, is misfolded
What are the causes of Alport syndrome?
- Mutation in genes COL4A3,4,5
- Within the lamina densa there is Collagen IV Glomerulus have basement membrane which is part of a selective filter In Alport syndrome the missing or misfolded collagen IV over time causes thin and overly porous basement membrane so red blood cells and proteins can get through Sclerosis occurs Renal insufficiency and Reno vascular hypertension
- Also problems in ear and eye
What are the symptoms of Alport syndrome?
- Hematuria and Glomerulonephritis in kidney
What is the treatment for Alport syndrome?
- Focused on symptoms ACE inhibitors and blockers
- Kidney failure may lead to dialysis or new kidney
What is a keloid scar?
- Scars that grow lumpy and larger than the wound they’re healing
What causes Keloid scars?
- Dont stop growing, more collagen
What are the symptoms of Keloid scars?
- Shiny, hairless, raised above the skin, hard and rubbery, red or purple and then brown or pale
- Usually painless but may have pain, be itchy, tender, burning pain or have limited movement of joint
What is the treatment for Keloid Scars?
- Steroid injections or creams
- Freezing, laser treatment or surgery
What is Haemophilia A?
- Factor VIII deficiency
- Most common hereditary disease associated with serious bleeding
What is the inheritance pattern for Haemophilia A?
- X linked recessive
- Can be random mutation
What are the symptoms of Haemophilia A?
- Easily bruised Massive Haemorrhage in areas of minor trauma e.g. joints normal bleeding time and platelet and PT but prolonged APTT and low VIII
What is the treatment for Haemophilia A?
- infusion of recombinant factor VIII
What is Haemophilia B?
- factor IX deficiency
What is Von Willebrand disease?
- Deficiency or abnormality in von willebrand factor
What are the symptoms of Von Willebrand disease?
- Can be asymptomatic or have a severe bleeding disorder- assists in platelet plug formation as attracts platelets and destabilized factor VIII protecting it from premature destruction Bleeding time and APTT raised
What is Thrombocytopenia?
- A low platelet count- normally between 150-400x109/L but less than 100 is thrombocytopenia, spontaneous bleeding if less that 20 Prolonged bleeding time but normal PT and APTT Lack step 2 of Haemostasis
What are the causes of Thrombocytopenia?
- Decreased production of platelets
- Bone marrow infiltration by malignancy, drugs, infections, B12 and folate deficiency
- Decreased platelet survival
- Sequestation- enlarged Spleen
- Dilutional Massive blood transfusion
What are the symptoms of Thrombocytopenia?
- No symptoms
- Blood in urine, headaches, heavy menstrual periods, purple or red bruises, tiny red or purple spots on skin
What is the treatment for Thrombocytopenia?
- Steroids
- Blood or platelet transfusion
- Surgery to remove spleen
What is disseminated intravascular coagulation?
- Secondary complication in a variety of conditions
- DIC gets into the blood and is an activator for clotting and microthrombi form
- Fibrinolysis activated Hemorrhage may occur
What causes DIC?
- Always a complication of another condition e.g. sepsis- especially gram negative, severe trauma, burns, malignancy, snake bite or complication of child birth
What are the symptoms of DIC?
- Condition causes neurological impairment, gangrene, renal failure, respiratory distress and gastrointestinal ulceration due to microvascular thrombosis and hemorrhagic causes intercerebral bleeding, petechiae
- Also causes anemia as red blood cells are damaged by microthrombi, increase D dimers
How do you treat DIC?
- Must treat the cause and then transfuse platelets, fresh frozen platelets, cryoprecipitate (factors) and red blood cells, sometimes anticoagulants are given
What is Thrombophilia?
- Blood has an increased tendency to form clots Inherited or acquired defects of hemostasis resulting in predisposition to thrombosis
What causes Thrombophilia?
- Imbalance of clotting factors Factor V Leiden Antithrombin deficiency Protein C and S deficiency
- Antiphosphlipid syndrome
What are the symptoms of Thrombophilia?
- If causes a blood clot may be at risk of having a DVT Pain and swelling in leg, ache, warm skin in clot area, red skin
- Also at risk of PE Chest or upper back pain, shortness of breath, coughing, lightheaded, fainting
What is the treatment for Thrombophilia?
- Wont need treatment unless develop a blood clot
- Warfarin or heparin
What is a DVT?
- Blood clot that develops within a deep vein in the body Legs- popliteal, femoral or posterior tibial
What causes a DVT?
- Inactivity, blood vessel damage, medial and genetic conditions, pregnancy, Contraceptive pill and HRT
- Overweight, smoke, dehydrated, over 60
What are the symptoms of a DVT?
- Pain and swelling and tenderness in one of your legs
- Heavy ache, warm skin and red skin in affected area
- May cause pulmonary embolism
What is the treatment for a DVT?
- Warfarin or Heparin
What are the different types of embolism?
- Thromboembolism
- Air Fat
- Amniotic fluid
- Foreign object e.g. bullet
What happens in a pulmonary thromboembolism?
- This is a blocked blood vessel in the lungs
- Caused by DVT breaking off and travelling to the lungs
- Pain in chest or upper back, difficulty breathing, coughing up blood Heparin or warfarin
What happens in an air embolism?
- Bubble that gets trapped in a blood vessel and blocks it
- May occur if too long under water and come to the surface too quickly while holding their breath as they come up, nitrogen bubbles form
- May cause joint of muscle pain, low blood pressure, irregular heart beat, breathlessness, chest pain, paralysis, fits, loss of consciousness Leads to stroke, heart attack or pulmonary embolism
- Hyperbaric chamber
What happens in a fat embolism?
- Fat gets trapped in blood vessel and blocks it
- Caused by physical trauma or burns
- Symptoms of pulmonary heart disease, tachypnea, elevated temperature, anuria, drowsiness and mild neurological symptoms, Pectineal rash, confusion Treatment by maintain intravascular volume
- Albumin can be used
What happens in an amniotic fluid embolism?
- Rare childbirth emergency in which amniotic fluid enters the bloodstream of the mother
- Reaction causes cardiorespiratory collapse and massive bleeding, low blood pressure
- Supportive treatment
What is Coronary Heart disease?
- Major cause of death in the UK and world wide
- Also known as ischemic heart disease
What causes Coronary Heart disease?
- Hearts blood supply is blocked or interrupted by a build up of fatty substances in the coronary arteries
- Atherosclerosis- smoking, high cholesterol, high blood pressure and diabetes
What are the symptoms of Coronary Heart disease?
- Angina
- Heart attacks
- Heart failure
What is the treatment for Coronary Heart disease?
- Lifestyle changes
- Medication- antiplatelet, statins, beta blockers, nitrates, ACE inhibitors, Angiotensin II receptor antagonists, calcium channel blockers and diuretics
- Angioplasty
- Surgery- CABG or heart transplant
What is Benign Prostatic Hyperplasia?
- Enlarge prostate
What causes Benign Prostatic Hyperplasia?
- Unknown but could be linked to hormonal changes as a man gets older
What are the symptoms of BPH?
- Difficulty urinating, frequent need to urinate, difficulty fully emptying bladder
How is diagnosis of BPH done?
- Urinary frequency volume chart
- IPSS questionnaire
- Feel the prostate
What is the treatment for BPH?
- Lifestyle changes
- Medication- alpha blockers (relax prostate gland and at the base of the bladder), anticholinergic
- Catheter Surgery
What is a Uterine Leiomyoma?
- Benign tumours that arise from the overgrowth of smooth muscle and connective tissue in the uterus
- Fibroids
What is an osteosarcoma?
- Type of cancer that produces immature bone, most common bone cancer at the end of long bones
What is Chronic lymphocytic leukaemia?
- Type of cancer that starts in cells that become white blood cells in the bone marrow, begin in bone marrow and then go into the blood
What is a well differentiates neuroendocrine tumour?
- Carcinoid tumour
- Rare cancer of neuroendocrine system tumour that usually grows slowly in the bowel or appendix
What is Burketts lymphoma?
- Form of non-bodkins lymphoma
- Cancer begins in B cells and is a very fast growing tumour
What is Familial adenomatous polyposis?
- Inherited disorder of cancer of the large intestine and rectum, may develop benign growths in teenage years
What is Hereditary non-polyposis colorectal cancer
- Autosomal dominant high risk of colon and other cancers
What is Retinoblastoma?
- Rapidly progressive develops from immature cells in the retina only found in really young children
What is Malignant mesothelioma?
- Malignant cells in the pleura or peritoneum
What is a Squamous cell carcinoma of the skin?
- Uncontrolled growth of abnormal cells in squamous cells
- Red patches, open sores, elevated, central depressions, warts and crusts
What is a basal cell carcinoma?
- Skin cancer, painless raised area of skin may be shiny with small blood vessels
What is Kaposi Sarcoma?
- Patches of abnormal tissue grown under the skin in the lining of the mouth, nose throat and lymph nodes, usually purple or red
What is Hodgkins Lymphoma?
- Cancer that comes from lymphocytes some due to epstein barr virus
What are head and neck cancers usually?
- SCC
What is the staging system for most cancers?
- TNM staging
- Tumour Node Metastasis
What are tumours of the vulva usually?
- SCC
What are 30% of vulva tumours related to?
- HPV infection
What are 70% of vulva tumours related to?
- longstanding inflammatory and hyper plastic conditions e.g. lichen sclerosis
What is the precursor to vulval carcinomas?
- Vulvar intraepithelial neoplasia
- Atypical squamous cells within the epidermis with no invasion
What is the precursor to cervical carcinomas?
- Cervical intraepithelial neoplasia
- CIN-I- most regress spontaneously but some progress
- CIN-II-some progress, may become carnimoa
- CINIII takes 7 years then 2-10 years to become carcinoma
What are cervical carcinomas usually?
- SCC
What is the treatment for micro invasive cervical carcinoma?
- Cervical cone excision
What is HPV vaccination?
- Given to girls 12-13 year old
- Protected for 10 years against cervical, vulvar and vaginal cancers, genital warts, oral and anal cancers In males would protect against penile cancers
Why is screening done for CIN?
- Visual examination and sampling, slow progression, Pap tests detect low stage cancer, early diagnosis and curative, tests for HPV
What are the types of Endometrial adenocarcinoma?
- Endometroid- oestrogen and obesity
- Serous carcinoma- aggressive and worse prognosis
What mutation is Ovarian tumours associated with?
- BRACA
What Serum is used in diagnosis and monitoring progression of Ovarian tumours?
- Serum CA-125
How can ovarian tumours be classified?
- Mullerian epithelium- Ovarian epithelial tumours, serous, mutinous
- Germ cell- teratomas, mono dermal ovarian teratomas
- Sex cord stromal
- Metastasis
What is Krukenberg tumour?
- Metastatic gastrointestinal tumour within the ovary
What are the types of testicular tumour?
- Germ cell tumours- seminomas and non-seminomatous
- Sex cord stromal- servoli and leydig Lymphomas
What are the types of urological malignancies?
- Renal Cell Carcinoma
- Bladder Transitional Cell Carcinoma
- Upper Urinary Tract
- Transitional Cell Carcinoma Prostate Cancer
What are the different types of lung cancer?
- Non small cell- SCC, adenocarcinoma, Large cell carcinoma
- Small cell carcinoma
What are the different types of GI cancers?
- Oesophageal cancers- SSC, lower 1/3 adenocarcinoma
- Gastric cancer
- Gastric lymphoma- MALT
- Liver cancer
- Pancreatic cancer- adenocarcinoma
- Large bowel cancer- adenocarcinoma
- Small bowel cancer- storm, lymphoma, adenocarcinoma, sarcoma, carcinoid
- Usually adenocarcinoma