Pathology 1 Flashcards
1. Adaptation, Injury, and Death 2. Clinical apps 3. Repair and Inflammation
Necrosis
Death of cells, tissues, or organs in a living person
Apoptosis
Programmed cell death of single cells
Ischemia
Reversible injury due to inadequate blood supply
Infarction
Irreversible necrosis due to ischemia not relieved in time
Treatment for liquefaction necrosis
Drainage
Treatment for caseous necrosis
Anti-fungal and anti-TB
Treatment for gangrenous necrosis
Amputation
Etiology
Cause
Morphology
Visible manifestation
Adaptation
Physiologic and morphologic changes, modulating function, bringing it to a new altered steady state of homeostasis
T or F: Most vital organs have a large reserve capacity
T
Injury
Reversible pathophysiologic and morphologic response to stress or noxious stimulus
Exceeds capacity of cell, tissue, or organ to adapt but isn’t enough to be lethal
Injurious reactive oxygen species (ROS) include _________ (4).
Superoxide
Hydrogen peroxide
Hydroxyl radical
Peroxynitrite
Why can reperfusion be injurious?
It brings oxygen that can be converted to ROS and calcium that can increase mitochondrial permeability
Features of coagulative necrosis
Preservation of ghost cell outline
Cytoplasm has increased eosinophilia
Nucleus has pyknosis, karyorrhexis, and karyolysis
Acute inflammatory response
Pyknosis
Condensation, shrinkage, and hyperbasophilia of a dead cell nucleus
Karyorrhexis
Fragmentation of a pyknotic dead nucleus
Karyolysis
Fading away of a dead nucleus
Features of liquefactive necrosis
Necrosis with conversion of solid tissue to liquid due to severe acute infection or toxicity
Abscess
Localized area of liquefactive necrosis
Microabscess
Localized area of liquefactive necrosis visible only microscopically
Features of caseous necrosis
Resembles cheese
Granular
Eosinophilic
No ghost cells
Features of gangrene
Form of coagulative necrosis with blackening and shrinkage
Usually distal extremity
Features of fat necrosis
Adipose tissue is digested by pancreatic lipase, creating chalky white saponification
Which enzymes are essential for apoptosis?
Caspases
Features of apoptosis (4)
- Cell shrinkage
- Cytoplasmic hypereosinophilia
- Chromatin condensation and karyorrhexis
- Phagocytosis by macrophages
T or F: There is an inflammatory response in apoptosis.
F
Differences between apoptosis and necrosis in cell number
Apoptosis small clusters or single cells; Necrosis large groups of cells
Differences in apoptosis and necrosis in regard to cell membrane
Apoptosis: cell membrane intact
Necrosis: cell membrane disrupted
What are the categories of disease?
VITAMIN D Vascular Infectious Toxic Autoimmune Metabolic Idiopathic Neoplastic Developmental
What is the most common type of vascular disease?
Atherosclerosis
What comprises infectious disease?
Any disease caused by a virus, bacterium, prion, fungus, protozoan, or parasite
Toxic disease includes ________.
Diseases due to toxins, poisons, or other noxious substances (alcohol, radiation, injury, natural toxins, therapeutic drugs)
What are autoimmune diseases?
Body’s immune system attacks its own cells, tissues, or organs
Metabolic diseases include ________.
Malnutrition, obesity, diabetes, vitamin deficiencies, nutritional disorders, and disorders due to inherited enzyme abnormalities
Neoplasm
A tumor – autonomous growth of cells uncontrolled y the normal controls on cell proliferation
10 aspects for the systematic study of disease
- Definition
- Epidemiology
- Pathogenesis
- Gross Pathology
- Microscopic Pathology
- Symptoms (subjective)
- Signs (objective)
- Diagnosis
- Treatment
- Prognosis
The first step in knowing a disease is _____.
Having a precise definition of it
The first step in knowing the epidemiology of a disease is ______.
Knowing how common it is
Differential Diagnosis
List of all other diseases that can mimic it by producing similar manifestations
Occam’s Razor
A single diagnosis that explains all of a patient’s symptoms, signs, and other manifestations of disease is most likely the correct diagnosis
What are the 5 most medically important electrolytes in order of importance?
K, Na, HCO3, Cl, Ca
Why is potassium important?
Abnormal levels impair the heart’s electrical signaling mechanism for the synchronized contraction essential to pumping blood.
A sufficiently severe disturbance in potassium levels can cause _______.
Potassium pump may fail and the heart may arrest, leading to death
What symptoms can occur due to hypokalemia?
Muscle weakness Fatigue Myalgias Ileus (loss of normal peristalsis) Irritability Tachychardia (rapid heart rate) Possible respiratory muscle weakness
What symptoms can occur due to hyperkalemia?
Renal failure (MOST IMPORTANT) Mental malfunctioning Bradychardia (slow heart rate) Nerve malfunctions Muscle weakness Paralysis Cardiac arrest
T or F: Hypokalemia interferes with contractility of skeletal muscle.
T
Which is more likely to cause fatal cardiac arrhythmia, hypokalemia or hyperkalemia?
Hyperkalemia
(Low/High) levels of sodium cause water to enter cells in excess, resulting in swelling.
Low
Symptoms of hyponatremia
Because of swollen brain cells:
headache, malaise, nausea, confusion, lethargy, obtundation (reduced mental capacity), stupor, coma, seizures, and death
Symptoms of hypernatremia
Confusion, disorientation, lethargy, obtundation, coma
Severe: breathing issues
Muscles of respiration must have _______ to work (vague question… my b).
Stimulus from the brain
How is bicarbonate different from K, Na, and the other electrolytes?
It isn’t an element, and it’s created in the body by renal metabolism
What leads to bicarbonate deficiency, ultimately leading to acidosis?
Renal failure (most common!), diarrhea, alcoholic ketoacidosis, diabeticketoacidosis, shock, respiratory failure, and lactic acid buildup
Bicarbonate deficiency leads to (acidosis/alkalosis), and bicarbonate excess leads to (acidosis/alkalosis).
Deficiency: acidosis
Excess: alkalosis
What leads to bicarbonate excess, ultimately leading to alkalosis?
Hyperventilation and vomiting (vomiting also depletes K)
What is the most important function of bicarbonate?
Maintenance of acid/base balance
What is the traditional method for measuring bicarbonate in the lab?
You can’t measure them directly.
- Treat blood sample with a strong acid
- Strong acid breaks down the bicarb and releases CO2
- CO2 is measured as a surrogate for bicarb
Other than bicarbonate, what is an important source of CO2?
Carbonic acid, accounts for 5%
How is CO2 as a stand-in for bicarbonate improved in the lab?
Expose blood sample to atmosphere with 40 mm Hg of CO2 and add oxygen to fully oxygenate the hemoglobin
T or F: Standard bicarbonate in the lab is not actually bicarbonate being measured.
T
Ischemia
Inadequacy of blood supply
When does total ischemia occur and what is the result?
When the heart stops pumping blood
Causes loss of consciousness
What is the earliest gross pathologic change of ischemia?
Darkening of color
What is enzyme diagnosis?
Diagnosis of injury based upon injured cells releasing some of their contents into the bloodstream
T or F: Blood testing is typically used in diagnosing injury to the kidneys.
F: Not used because renal cells don’t have unique cellular contents
How is renal injury diagnosed?
By monitoring the output of its liquid product and the buildup of waste products in the bloodstream (urea and creatinine)
T or F: Blood testing is typically used in diagnosing injury to the pancreas.
T
How is lung injury diagnosed?
Functional assessment, biopsy
How is myocardial injury diagnosed?
Blood enzyme testing
How is brain injury diagnosed?
Radiological imaging studies (MRI, CT)
How is liver injury diagnosed?
Blood enzyme testing
How is small intestinal injury diagnosed?
Capsule endoscopy – film the lumen of the GI tract
How is colon injury diagnosed?
Colonoscopy
How are stomach problems diagnosed?
Nasogastric Intubation – pass a tube through the nose into the stomach
Gastroscopy (specific diagnosis)
Examine stool
What is one of the most problematic organs in which to diagnose injury, and why?
Jejunum of the small intestine: not accessible by endoscopy, injury must be really advanced to be diagnosed by radiological imaging or surgery
Amylase is secreted by _______.
Pancreas and salivary glands
Lipase function
Digests fats
Injury to the pancreas releases which enzyme(s) into the bloodstream in large amounts?
Amylase and Lipase
How can you diagnose mild, moderate, and severe pancreatitis?
Mild: radiologic imaging
Moderate: causes edema visible on CT
Severe: causes hemorrhage, liquefactive and fat necrosis visible on radiological imaging
T or F: Amylase is only present in the pancreas and salivary glands.
F: Also present in intestine, liver, kidney, muscle, fat, spleen, fallopian tube, heart, lung, and brain
T or F: Amylase is excreted in the urine.
T
What physiological changes can lead to increased amylase levels?
Pancreatitis Renal failure Appendicitis Out of control diabetes Ectopic pregnancy Tumors of the lung or ovary Salivary gland inflammation
Most of the lipase in serum is produced in ________ but some is secreted by ________(4).
Most is in pancreas, but some is secreted by lingual salivary glands (but not parotid), gastric mucosa, intestinal mucosa, and pulmonary mucosa
T or F: Lipase is present in leukocytes and adipose tissue cells.
T
With acute pancreatitis, which serum levels remain elevated longer: lipase or amylase?
Lipase
T or F: The higher the serum amylase or lipase, the higher likelihood that the diagnosis is pancreatitis.
T
What are the two organs for which blood testing is most often used to diagnose injury?
- heart
2. liver