Pathology 2 Flashcards
Where does LDL build up in atherosclerosis?
Tunica intima
Which arteries are most prone to atherosclerosis?
- Abdominal aorta
- Coronary arteries
- Popliteal arteries
- Thoracic aorta
- Internal carotids
90% of ischemic heart disease is due to _________
Atherosclerosis
What is “critical stenosis”?
> 75% reduction in the diameter of the artery
Leads to compensatory vasodilation
When can an MI be seen histologically and macroscopically?
Histologically from 4 hours
Macroscopically from 12 hours
What are the potential complications of MI?
Arrhythmias Cardiac arrest Ventricular aneurysm Pedicarditis Papillary muscle dysfunction Myocardial rupture Heart failure
What is diastolic heart failure?
Reduced filling due to increased resistance
What are the causes of diastolic heart failure?
LV hypertrophy
Aortic stenosis
Hypertension
What are the causes of systolic heart failure?
IHD
MI
Cardiomyopathy
How does systemic hypertension affect the left ventricle?
LV hypertrophy
Without dilation
Impaired filling
What is the most common type of valvular heart disease?
Mitral regurgitation
due to a floppy mitral valve
What is functional regurgitation?
When a valve becomes incompetent due the dilation of a ventricle
What is the main causative organism of rheumatic fever?
Strep pyogenes
What are the signs and symptoms of rheumatic fever?
- Fever
- Painful joints
- Involuntary muscle movements
- Non itchy rash- erythema marginatum
Which factors predispose to infective endocarditis?
Artificial valve Bicuspid aortic valve Floppy mitral valve Stenosis Immunosuppression Diabetes Alcohol IVDU Dental work
Which 3 organisms most commonly cause ACUTE endocarditis?
Highly virulent organisms-
- S. aureus
- Pneumococcus
- S.pyogenes
Which 2 organisms most commonly cause SUBACUTE endocarditis?
Low virulence organisms- 1. Strep viridans
2. Enterococci
What type of endocarditis is more common in replacement valves?
Subacute
What is the most common type of cardiomyopathy?
Dilated cardiomyopathy
What can cause dilated cardiomyopathy?
Alcohol
Genetics
Chronic anaemia
What is the pathophysiology of heart muscle in hypertrophic cardiomyopathy?
NO dilation of chambers
Hypertrophic fibres
Cardiac wall thickened
Decreased chamber size
What is the pathophysiology of heart muscle in restrictive cardiomyopathy?
Both atria dilated
Normal sized ventricles, but decreased ventricular compliance
What is the main cause of myocarditis?
Viruses
What can cause pericarditis?
- Infection
- Immune mediated eg. SLE, Rheumatic fever
- Trauma
- Radiation
What are the causes of right to left cardiac shunts?
- Tetralogy of Fallot
- Transposition of great arteries
- Perisitent truncus arteriosus
- Tricuspid atresia (right ventricle underdeveloped)
What are the causes of left to right shunts?
ASD
VSD
Can lead to pulmonary hypertension
Which sinus is susceptible to sinusitis due to dental infection?
Maxillary sinus
What us GPA/ Wegener’s?
Vasculitis of small and medium vessels
Affects upper respiratory tract, kidneys, lungs
What are the signs/ symptoms of Wegner’s Granulomatosus?
Nose bleeds/ sores Ulcers Subglottic stenosis -> hoarseness Chronic ear infections Haemoptysis Haematuria
Which antibodies will be present in Wegner’s Granulomatosus?
ANCA
What age patients does Wegner’s Granulomatosus usually affect?
30-50years
How can Wegner’s Granulomatosus be treated?
Steroids
Cyclophosphamide
Methotrexate
Surgery
What are the potential complications of Wegner’s Granulomatosus?
Nasal septum perforation
Airway stenosis
Respiratory or renal failure
What is an inverted papilloma?
Nasal tumour in mucous membrane
Grows into underlying bone
Usually benign
May be caused by smoking, pollution, allergens
What is Samter’s triad?
- Asthma
- Nasal polyps
- Aspirin hypersensitivity
How can a nasal papilloma be treated?
Endoscopy
What is the main cancer of the larynx/ nose/ sinuses?
Squamous cell carcinoma
Who is affected by juvenile nasal angiofibroma?
Males
Aged <20 years
What are the symptoms of Juvenile Nasal Angiofibroma?
Nasal obstruction
Bleeding
hearing loss
headache
What is nasopharnygeal carcinoma?
Rare undifferentiated cancer
Affects the nasopharynx
Can cause otitis media (glue ear)
Which factors increase the risk of nasopharyngeal carcinoma?
EBV
Nitrosamines in diet
HLA
_____________ is caused by Corynebacterium diphtheria and can cause a “pseudomembrane” seen histologically
Diphtheria
What epithelial cell type is found in the oesophagus and anus?
Squamous
What epithelial cell type is found in the stomach, duodenum and colon?
Columnar
What is the main cause of oesophagitis?
GORD
Gastritis is often associated with which type of infection?
H.pylori
What can be detected in breath if H.pylori infection is present?
Urease
What is the triple therapy for H.pylori infection?
- PPI
- Clarithromycin
- Amoxicillin/ Metronidazole
What is the histological appearance of coeliac disease?
Crypt hyperplasia
Villous atrophy
Intra epithelial lymphocytosis
Lamina propria rich in plasma cells
What is the HLA association in coeliac?
HLA DQ2/ HLA DQ8
What are the potential complications of coeliac disease?
Anaemia
Oesteoporosis
Dermatitis herpetiformis
Increased risk of malignancy
In which part of the bowel is diverticular disease most common?
Sigmoid colon
What are the complications of diverticular disease?
Bowel perforation Haemorrhage Fistula Obstruction Superinfection with CMV/ C.Diff
What conditions is ulcerative collitis associated with?
Primary sclerosing cholangitis
Ankylosing spondolytis
What are the histological features of UC?
Mucin depletion Pseudopolyps Punctuate ulcers Inflammation Basal plasmocytosis Crypt abscess Haemorrhagic mucosa
How can UC be managed medically?
- 5-ASA Eg. Mesalazine
- Oral prednisolone
- IV hydrocortisone and fluids
- Anti TNF eg. Infliximab
What is the histological appearance of Crohn’s?
Granulomas
Fat wrapping
Transmural lymphoid aggregates
What is microscopic collitis?
Condition typically in middle aged women
Longstanding diarrhoea
Normal colonoscopy
What are the 2 types of oesophageal carcinoma?
- Squamous cell carcinoma
2. Adenocarcinoma- develops from Barrett’s mucosa
What are the risk factors for squamous cell carcinoma of the oesophagus?
Smoking Alcohol Low protein diet HPV infection Family history in Iran
What are the risk factors for oesophageal adenocarcinoma?
GORD Smoking Alcohol Obesity NSAIDs
What type of cancer has “signet ring” appearance histologically?
Gastric adenocarcinoma
What is achalasia?
Lower oesophageal sphincter fails to relax
Due to degeneration of myenteric plexus
Leads to dysphagia, regurgitation and weight loss
What are the causes of dysphagia?
- Mechanical blockage: Malignancy, stricture, mediastinal mass, retrosternal goitre, pharyngeal pouch
- Motility disorder- Achalasia, oesophageal spasm, Bulbar palsy
- Oesophagitis
