Pathology ๐ฉบ Flashcards
what are the types of inflammation of the lips (cheilitis)?
what are the causes of inflammation of the mouth (Stomatitis)?
what are the types of inflamation of the tongue (Glossitis)?
- Acute glossitis
- chronic glossitis
- Chronic atrophic glossitis
- plummer vinson syndrome
what is acute glossitis charachterized by?
characterised by swollen papillae occurs in eruptions of measles and scarlet fever.
what is choronic glossitis charachterized by?
the tongue is raw and red without swollen papillae and is seen in malnutrition.
what is choronic atrophic glossitis charachterized by?
characterised by atrophied papillae and smoth muscle tongue.
what are the symptoms of Plummer Vinson Syndrome?
(anaemia, oesophageal obstruction, Pharyngitis and atrophic glossitis)
what are the types of tongue ulcers?
1- Dental (traumatic) ulcer
2- Dyspeptic ulcer
3- Syphilitic ulcers
4- Tuberculous ulcer
5- Malignant ulcer
6- aphthous ulcers
what are the types of inflammation of the oropharynx?
- Catarrhal pharyngitis
- Acute septic pharyngitis
- plummerโvinson syndrome
-anaemia
-oesophageal obstruction
-Pharyngitis and atrophic glossitis
what are the types of Non-neoplastic diseases of Salivary glands?
(Inflammation = sialadenitis Common in the parotid gland (parotitis))
๏ฟผ๏ฟผ๏ฟผ๏ฟผ๏ฟผ๏ฟผ๏ฟผ๏ฟผ๏ฟผ๏ฟผ๏ฟผ๏ฟผ
1. Acute sialadenitis (Mumps, acute Suppurative, sialadenitis)
- Chronic inflammation (Non specific - specific (T.B, actinomucosis))
- Immue mediated sialadenitis (Mickulicz Disease)
๏ฟผ๏ฟผ๏ฟผ๏ฟผ๏ฟผ๏ฟผ๏ฟผ
what are the complications of mumps?
- Orchitis โInflamation of testisโ
- Pancreatitis
- Mastitis โinflammation of breastโ
- Meningitis
- Encephalitis and Neuritis (8th cranial neve).
what are the causes of esophagitis?
Non-Infective:
- Surface irritation
- Reflux oesophagitis.โvery common in egyptโ
- Alcohol, corrosives, drugs, smoking, cytotoxic drugs, Radiation.
- Vit A,C deficiency.
Infective:
- Herpes Simplex and Candidiasis
Idiopathic
what are the causes of reflux esophagitis?
- Incompetence of the lower oesophageal sphincter.
- Hiatus hernia.
what is the N/E of Reflux oesophagitis?
Hyperemic mucosa with superficial erosions.
what is the M/E of Reflux oesophagitis?
- Present of inflammatory cells (eosinophils neutrophils and lymphocytes) in the epithelial layer.
- Basal hyperplasia.
- Congested lamina propria.
what are the complications of Reflux oesophagitis?
- Barrettโs oesophagus
- peptic ulcerations
- fibrous stricture.
- Hematemesis
what is the cause of Pulsion Diverticulate?
Congenital weakness of inferior constrictor muscle of the pharynx
what is the pathology โor charactersโ of Pulsion Diverticulate?
- Protrusion of mucosa and submucosa though the posterior pharyngeal muscles of the pharynx
- Present in posterior wall of oesophagus at upper oesophagus.
- Directed downwards.
- Distended with food.
- Compress oesophagus
what are the effects of Pulsion diverticulae
Compress oesophagus
- dysphagia
- diverticulitis
what is the cause of Traction Diverticulate?
Traction by fibrosed L.N (T.B)
โdue to fibrous adhesionโ
what is the pathology โor charactersโ of Traction Diverticulate?
- Consists of all layers of oesophagus wall ( true divert) In the anterior wall at the level of tracheal bifurcation
- Directed upwards
- No food enters it
- Symptomless
what are the causes of Oesophageal Obstruction?
Organic and functional
What are the causes of organic obstruction of espohagus?
A. Congenital absence of lumen (atresia) or congenital stricture.
B. Acquired:- due to causes in :
In the Lumen: Contains foreign body, bulging tumor, ring and webs (Plummer- Vinson Syndrome)
In the Wall of oesophagus: strictures (Congenital, postโ inflammatory or malignant)
Outside the oesophagus: (compression from outside) goiter, aortic aneurysm and tumours.
what are the causes of the functional obstruction to the esophagus?
It is due to neuromuscular incoordination as in:
1. Plummer โ Vinson syndrome
2. Acalasia of lower oesophagus
what is Acalasia of lower oesophagus? and what causes it?
- It is a functional disturbance characterized by loss of peristalsis of lower esophageal segment and incomplete relaxation of lower oesophageal sphincter muscle .
- It is due to absence ( or destruction ) of myenteric ganglion cells in lower oesophagus .
what are the pathological changes in the case of Functional Obstruction?
1- Narrow lower end of oesophagus in which ganglion cells are absent.
2- The oesophagus above the narrow part is dilated , elongated with hypertrophy of muscular wall (megaoesophagus). The mucosa may show ulceration and leukoplakia .
what is the definition of gastritis?
inflammation of gastric mucosa
what are the types of gastritis?
1) Acute gastritis
2) Chronic gastritis
For healthy mucosa, what balance should be found?
balance between:
- protective factors: (Bicarbonate, Prostaglandins (Pgs), Mucus Production, & Blood Flow to Mucosa)
- hostile factors: (gastric acid, pepsin, helicobacter pylori infection, and NSAID)
โNSAIDs Inhibit COX which deceases PGs leading to decrease mucosaโ
what are the charachters of acute gastritis?
1) Short Duration
2) Neutrophilic infiltration
3) Mucosal erosions in severe cases.
what is the etiology of acute gastritis?
Infective
- Salmonellosis & staph.
- Food poisoning
Non infective
- Drugs: NSAID and cortisone โstrongerโ (decrease mucosal PGs)
- Alcoholism.
- Smoking (โ acid secretion, & โ mucus and PGs secretion)
- Shock (decrease mucosal blood flow)
- Chemical irritation: alkalies, acids.
- Mechanical trauma: during endoscope
- Idiopathic
what is the pathogenesis of acute gastritis?
By one or more of the following:
1) Increase acid secretion.
2) Decrease blood flow.
3) Decrease the adherent mucous layer.
4) Direct damage to surface epithelium.
5) Decrease PGs secretion from the mucosa.
what is the N/E of acute gastritis?
the mucosa is hyperemic, edematous, shows erosions (in severe cases)
what is the M/E of acute gastritis?
The lamina propria shows edema, hyperemia, neutrophilic infiltration, and erosion of surface epithelium in severe cases
what are the charachteristcs of chronic gastritis?
1) long duration
2) mononuclear infiltration (lymphocytes, plasma cells, and macrophages),
3) usually no mucosal erosions. โbut there is ulcersโ
what are the types of chronic gastritis?
Type A (autoimmune gastritis)
Type B (Antral gastritis)
compare between Types of choronic gastritis
compare between the morphological features of the stages of chronic gastritis
what are the complications of gastritis?
1) Hemorrhage
2) Peptic ulcer
3) Malignancy due to:
- intestinal metaplasia and dysplasia
- H.pylori infection โ gastric carcinoma and lymphoma
what is the definition of peptic ulcer?
defect in the mucosa that develops at any portion of gastrointestinal tract exposed to acid pepsin secretion of gastric glands.
what are the types of peptic ulcer?
1) Acute peptic ulcers (stress ulcers):
- Superficial erosion
- Minimal erosion
2) Chronic peptic ulcer disease:
- Muscular wall erosion with formation of fibrous tissue
- Present continuously for many months or intermittently
what causes acute peptic ulcer?
It occurs within hours of:
- Cases of stress (as shock, burn)
- Cases of severe acute gastritis.
โprophylaxis from ulcers should be done before risky surgries as the pathient has high stress (sympathatic stimulation) which leads to VC and decrease Blood supply leading to acute ulcersโ
what are the sites of acute peptic ulcer?
stomach and first part of duodenum
what are the morphological features of acute peptic ulcer?
- hemorrhagic inflammation and ulcers.
- These ulcers are multiple small (less than 1 cm) and superficial.
- They heal by regeneration.
what are the sites of chronic peptic ulcer?
1) Duodenum: first part (98%), anterior or posterior.
2) Stomach: pyloric antrum on lesser curvature.
3) Lower1/3 of esophagus: as in reflux esophagitis.
4) Other sites:
- Margin of gastrojejunostomy
- Meckelโs diverticulum
what is the etiology of chronic peptic ulcers?
1) Genetic factors. โpeople who are tall,thin with O blood typeโ
2) Hormonal factors:
- Zollinger Ellison Syndrome: gastrin โ stimulate parietal cells โ acid pepsin
3) Environmental factors
4) Alcohol, smoking, coffeeโฆ
5) H. Pylori infection (100% of duodenal ulcers, and 75% of gastric ulcers)
6) Emotional stress.
7) Associated diseases (chronic Bronchitis, emphysema.)
what is the pathogenesis of peptic ulcer?
An imbalance between increased acid pepsin secretion and decreased mucosal defense
what is the pathogenesis of duedenal ulcer?
due to โ acid pepsin + rapid emptying of gastric juice into duodenum
what is the pathogenesis of gastric ulcer?
Due to โ mucosal defense which is due to:
- Chronic gastritis
- Cigarette smoking
- Local ischemia
- Deficiency of mucosal cytoprotective as normal mucous film, buffers e.g bicarbonate, and PGs which help maintenance of blood supply
what is the N/E of peptic ulcer?
Shape: rounded or oval
Size: 2-4 cm
Margin: flattened with blurring of mucosal folds.
Edge: sharp deep penetrating to the muscle coat
Floor: clean and smooth due to peptic digestion of inflammatory exudate.
Base: indurated due to fibrosis.
what is the M/E of peptic ulcer?
- The mucosa surrounding the ulcer shows chronic atrophic gastritis.
- Inner zone: debris, neutrophils, and fibrinoid necrosis
- Intermediate zone: chronic non specific inflammation and granulation tissue.
- Outer zone: fibrosis
what are the complications of peptic ulcer?
1) Hematemesis.
2) Perforation โ Peritonitis โfatalโ
3) Fibrosis:(Hour glass Stomach - Pyloric or Duodenal Stenosis).
4) Duodenal diverticulum.
5) Malignant change: in 1% of gastric ulcers only
what is the definition of inflammatory bowel disease?
chronic Prolonged inflammation of the intestine results in damage to the GI tract leading to impaired absorption of nutrients.
what do inflammatory bowel disease include?
1) Ulcerative Colitis
2) Crohnโs disease(regional ileitis)
what is the definition of Ulcerative Colitis?
Chronic non specific inflammation of large intestine characterized by severe ulceration.
โcomes in the form of recurrent attacksโ
what is the cause of Ulcerative Colitis?
Idiopathic, but it can be:
- genetic predisposition
- Psychosomatic
- virus, amoebiasis, diet
- Allergic
what is the N/E of ulcerative colitis?
Site: โleft side of the bodyโ
- sigmoid colon & rectum.
- No skip lesions
- The lesion occurs only in mucosa and submucosa (No serositis)
Appearence:
The mucosa:
- appears deeply congested associated with:
๏ muco- purulent discharge
๏ superficial irregular ulcers
- the mucosa in between the ulcers is swollen producing pseudopolyposis
what is the M/E of ulcerative colitis?
Mucosa:
- It is congested and infiltrated by inflammatory cells (neutrophils and plasma cells).
- The mucosa at the margins of the ulcers shows mucus depletion, metaplasia (gastric) and hyperplasia.
Crypt abscess:
- They are in the lumen of the crypt
- They fuse to form large abscess which may rupture causing mucosal ulcerations.
Pseudopolyps: consists of hyperplastic mucosa and granulation tissue.
what are the complications of ulcerative colitis?
- Perforations: rare โas they are superficial ulcersโ
- Stricture: rare
- Toxic megacolon
- Malignancy: more common 1/100 (10folds) than crohnโs disease.
- Associated disease: more common
what are the diseases that may be associated with ulcerative colitis?
- Iridocyclitis
- Vasculitis
- Fatty change liver & cirrhosis
- Arthritis
- Erythema nodosum
- Secondary amyloidosis
what is the prognosis of ulcerative colitis?
Chronic course with exacerbation & remission.
what is the definition of Crohnโs disease (regional ileitis)?
Non caseating granuloma of alimentary tract
what is the cause of crohnโs disease?
Idiopathic but it can be:
- Genetic predisposition
- Virus or bacteria
- Autoimmune
what is the N/E of crohnโs disease?
Site: โin the right side of the bodyโ
- terminal ileum and Right colon but any part can be affected.
- Skip lesions: The affected segments are separated by normal tissue
- The lesion occurs in all layers (serositis is present)
Appearence:
- The affected segments show intense edema of the mucosa leading to thickening of the wall and narrowing of the lumen
- Linear deep penetrating ulcers (fissures) are present giving cobble stone appearance.
- The mesentery is thickened and mesenteric LNs are enlarged.
- Fibrosis.
what is the M/E of crohnโs disease?
Inflammatory reaction:
1. extends through whole wall of intestine reaching the serosa and the mesentery.
2. consists of lymphocytes, plasma cells, eosinophils and mast cells.
- Some cases show non caseating granuloma and fibrosis.
- Mucosa shows metaplasia (to mucus secreting pyloric cells), hyperplasia and dysplasia.
what are the complications of crohnโs disease?
- Intestinal obstruction due to stricture
- Perforation:
๏ฒ peritoneal abscess
๏ฒ fistula with nearby organs (intestine, U.B, Peri-anal skin and Rectovaginal) - Secondary malabsorption syndrome.
- Carcinoma: Rare 1/1000
- Toxic megacolon
- Associated diseases: rare
compare between ulcerative colitis according to clinical features
compare between ulcerative colitis according to macroscopic features
compare between ulcerative colitis according to microscopic features
what are the tumors of lips, mouth & tongue?
what are the predisposing factors of cancer tongue?
- Chronic irritation. โlike a broken toothโ
- Oncogenic viruses as HPV
- precancerous lesions as leukoplakia.
what is the site of cancer tongue?
more common on anterior 2/3 than posterior 1/3 at the lateral edge.
what is the N/E of cancer tongue?
mass: fungating, ulcerative or infiltrative.
what is the M/P of cancer tongue?
Squamous cell carcinoma.
what is leukoplakia?
Leukoplakia is defined by the World Health Organization as a white lesion of the oral mucosa that cannot be scraped off and cannot be attributed to another definable lesion.
random adherent white lesion
what is the microscopic picture of Squamous cell carcinoma?
- Ulcerated surface epithelium.
โโโ
- The subepithelial tissue shows :
โข sheets of Malignant squamous epithelial cells separated by desmoplastic stroma.
โข The periphery of the sheets consists of layer of basaloid cell, inner to this are polyhedral cells resemble the prickle cell layer.
โข The central area consists of keratin.
โข The cells show the cytologic criteria of malignancy (describe).
borderโs grading of SCC
- Grade I: 75-100% of tumor consists of cell nests.
- Grade II: 50-75% cell nests.
- Grade III: 25-50% cell nests.
- Grade IV: 0-25% cell nests.
what are the tumors of salivary glands?
what is the incidence, age, site & cell of origin of Pleomorphic adenoma (B. mixed salivary tumor)?
what is the N/E of Pleomorphic adenoma (B. mixed salivary tumor)?
- Rounded, well- demarcated masses with mal-developed capsule allowing tongue-like projections of the tumor into the adjacent salivary tissue.
- The tumor is firm, grayish white with areas of cartilaginous or osseous tissues.
what is the incidence, age, site & cell of origin of (Papillary cystadenoma lymphomatosum - adenolymphoma - Warthin tumor)?
what is the N/E of (Papillary cystadenoma lymphomatosum - adenolymphoma - Warthin tumor)?
- Round to oval, capsulated mass usually located in the superficial part of parotid.
- Cut section shows pale gray surface with cleft- like spaces filled with mucinous or serous secretion.
what is the incidence, age, site & cell of origin of oncocytoma?
what is the M/P of Adenoid cystic
carcinoma?
Sheets of small and dark stained cells showing microcystic spaces containing PAS positive material and the stroma is hyalinized
what is the M/P of Mucoepidermoid carcinoma?
Mixed tumor: Adenocarcinoma with mucus secretion + sheets of squamous cell carcinoma
what are the tumors of the esophagus?
what are the tumors of the stomach?
risk factors for gastric carcinoma
what are the tumors of the small intestine?
what are the tumors of large intestine?
compare between tubular adenoma & villous adenoma according to N/E & M/E
staging of cancer colon (Dukeโs staging)
TNM staging of cancer colon
what is the definition of apoptosis?
single cell death
what is the M/E of apoptosis?
- Cell undergoes acidophilic necrosis
- Cytoplasm is granular & dense
- Nucleus is pyknotic.
- When the nucleus is extruded, Councilman body is produced.
what is the M/E of Interface hepatitis?
Irregular appearance of the limiting plate
what is the M/E of Focal (Spotty) necrosis?
Necrotic foci accumulate macrophages, lymphocytes and may be neutrophils
what are the characters of Bridging (Confluent) necrosis?
- Involves large groups of hepatocytes in more than one lobule resulting in collapse of reticulin framework of the affected lobules and connection between liver structures.
โdue to distruction of cells that they supportโ
what are the characters of acute cholestasis?
- Bile canaliculi above the obstruction are dilated and filled with bile. It may form bile plugs or thrombi.
- Intracytoplasmic bile droplets accumulate in hepatocytes (feathery degeneration) and in von-Kupffor cells
โDue to accumilation of bile within hepatocytesโ
what is chronic hepatitis analyzed according to?
1) the grade ( degree of inflammation) range from very mild to severe
- Considering the presence or absence and the extent of
a. Piecemeal necrosis
b. Lobular necrosis
c. Bridging necrosis
d. Portal inflammation - These items correlate to the activity of the lesion.
- Each of these item is given a score number (0- 4 or 6).
- The sum of score (overall score) is evaluated
2) the stage (extent of fibrosis) divided to a spectrum of 6
what is the microscopic picture of chronic hepatitis B?
- Microscopic appearance of Hepatitis B characterized by Ground glass hepatocytes due to the presence of cytoplasmic hepatitis B surface antigen
what is the microscopic picture of chronic hepatitis C?
- Predominantly sinusoidal lymphocytic infiltrate, often with lymphoid follicles
- Lymphoid aggregates are specific for hepatitis C but only 50% sensitive
- mild and focal macrovesicular steatosis
compare between acute and chronic hepatitis
what are the gross features of cirrhosis?
The liver is shrunken, firm and nodular
- According to the size of the nodules, cirrhosis is classified into:
1. Micronodular cirrhosis: the nodules are less than 3 mm. in diameter.
2. Macronodular cirrhosis: the nodules are more than 3 mm. in diameter (poor prognosis)
3. Mixed micro & macronodular cirrhosis.
what are the microscopic features of cirrhosis?
- Loss of the normal hepatic architecture and replacement by regenerative nodules, which is surrounded by fibrous tissue septa.
- The regenerative nodules: consist of proliferating hepatocytes arranged in thick plates and separated by sinusoidal spaces. The central veins are eccentric or absent, The regenerating hepatocytes may be small, large, uni or binucleated.
- The fibrous tissue septa: the fibrous tissue replace the damaged hepatocytes and develops at certain sites e.g. perivenular, persinusoidal, pericellular and in relation to portal tracts, The fibrous septae contains proliferating bile ductules and chronic inflammatory cells.
(fibrosis everywhere)
what are the gross features of hepatocellular carcinoma?
- May take one of three forms:
1- Single large, well-defined mass with areas of hemorrhage and necrosis.
2- Multiple small nodules scattered all over the liver sparing its periphery.
3- Diffuse infiltration of the entire liver.
- Tumor tissue is yellow-white and may be bile stained (green).
