Pathology Flashcards
What is the role of an autopsy?
Who was deceased?
When did they die?
Where did they die?
Cause of death
How is an autopsy done?
History External examination Evisceration Internal examination Reconstruction
What deaths are referred to a coroner?
Presumed natural - death unknown
Presumed iatrogenic - peri/postoperative deaths
Presumed unnatural - accidents, unlawful killing
What is acute inflammation?
Initial and often transient series of tissue reactions to injury, it’s got a sudden onset, short lived and usually resolves on its own
Causes of acute inflammation
Microbial infections Hypersensitivity reactions Physical agents Chemicals Tissue necrosis
Clinical features of acute inflammation
Redness (rubor) Heat (calor) Swelling (tumor) Pain (dolor) Loss of function
What makes up the cellular exudate for acute inflammation?
Neutrophil polymorphs
Macrophages
Lymphocytes
Features of Neutrophil polymorphs
Short lived, pus cells
First on the scene of acute inflammation
Attract other inflammatory cells
Cytoplasmic granules full of enzymes that kill bacteria
Diagnostic histological feature
Features of lymphocytes
Long lived cells
Produce chemicals that attract other inflammatory cells
Immunological memory
Features of macrophages
Long lived cells
Phagocytic properties
may present antigen to lymphocyte
Features of endothelial cells
Become sticky in areas of inflammation so inflammatory cells adhere to them
Become porous to allow inflammatory cells to pass into tissues
Give an example of acute inflammation
Acute appendicitis
What are the benefits of inflammation?
Destruction of invading microorganisms and wailing off of an abscess cavity preventing infection spread
What are the outcomes of acute inflammation?
Resolution
Suppuration
Organisation (fibrosis)
Progression to chronic inflammation
What are the negatives of inflammation?
Autoimmunity
When it’s an over-reaction to the stimulus
Fibrosis resulting from chronic inflammation
What is chronic inflammation?
Subsequent and often prolonged tissue reactions following the initial response, it has a slow onset, long duration and may never resolve
Causes of chronic inflammation
Primary chronic inflammation
Transplant rejection
Progressing from acute inflammation
Recurrent episodes of acute inflammation
Causes of primary chronic inflammation
Exogenous materials
Endogenous materials
Resistance of infective agent to phagocytosis and intracellular killing – TB
Autoimmune diseases – rheumatoid arthritis
Primary granulomatous diseases – Crohn’s
What is the cellular exudate in chronic inflammation mainly made of?
Lymphocytes
Plasma cells
Macrophages
Fibroblasts
What is a granuloma?
Group of epitheloid histiocytes which can contain lymphocytes and histolytic giant cells
Can cause caseous necrosis
Where are granulomas seen?
Tuberculosis
Leprosy
Sarcoidosis
How can you treat inflammation?
Aspirin, ibuprofen (NSAIDs)
Corticosteroids
What is resolution?
Initiating factor removed, and tissue is undamaged or able to regenerate
What is repair?
Initiating factor is still present, and tissue is damaged and unable to regenerate
Which organ is a good example for resolution?
Liver
What affects resolution of the liver?
Cirrhosis (ongoing damage resulting in abnormal architecture)
What cells can regenerate?
Hepatocytes Pneumocytes All blood cells Gut epithelium Skin epithelium Osteocytes
What cells can’t regenerate?
Myocardial cells
Neurones
What happens after a skin abrasion?
Only top cell layer is removed, leaving the bottom layer/follicles/glands for scab to form and for the epidermis to eventually be regenerated
What are the 2 types of skin wound healing?
Healing by 1st intention (+ve)
Healing by 2nd intention (-ve)
When does 1st intention healing occur?
Incision wound
How does healing by 1st intention work?
Edge to edge healing (heals w/ reasonable scar)
Fibrinogen exudation
Both ends are sealed together, the slight gap is filled with blood, fibrin etc which holds together a little with stitches
Epidermis regrows, fibroblasts produce collagen
Small scar forms
When does 2nd intention healing occur?
When tissue loss has occurred (2 edges can’t be brought together nicely)
How does 2nd intention healing work?
Infection or haemorrhage prevent healing by first intention
Loss of tissue, granulation tissue forms and organisation occurs (phagocytosis of any debris)
Epithelial regeneration and early fibrous scar
Scar contradiction
What is organisation?
Repair of specialised tissue by the formation of a fibrous scar
How does organisation occur?
Granulation tissue is formed and dead tissue is removed by phagocytosis
Granulation tissue contracts and accumulated collagen to form a scar
What produces collagen?
Fibroblasts
Name 3 places where repair occurs and after what
Heart after an MI
Brain after a cerebral infarction
Spinal cord after trauma
What is a thrombosis?
Solid mass of blood constituents formed within intact vascular system during life
What is Virchow’s triad?
Factors that can lead to thrombosis formation:
- Change in vessel wall
- Change in blood flow (laminar –> turbulent)
- Change in constituents of blood
What does Virchow’s triad do?
Predisposes to thrombosis
When does an arterial thrombosis normally occur?
When superimposed on atheroma
How does an arterial thrombus occur?
Vessel wall damage
Laminar flow disruption
Collagen exposed
Platelets stick to collagen and aggregate - positive feedback
Rbc’s can get trapped - thrombus formation and fibrin deposition (fibrinogen –> fibrin by platelet factors)
Fibrin mesh holds it all together
Thrombus can then build up and occlude artery
What is a vein thombus most commonly due to?
Stasis
What are the outcomes of a thrombus?
- Lysis and resolution
- Organisation – into a scar
- Recanalisation – scar and residual thrombus
- Embolism – breaks off
How can you prevent a thrombus?
Exercise
Compression stockings
Aspirin – anti platelet drug, makes endothelial cells less sticky, not a full-blown thrombus occurs
What does an occlusion of a coronary artery result in?
Myocardial infarction
What does occlusion of a cerebral artery result in?
Cerebral infarction (stroke)
What is laminar flow? and why is it important?
Cells travel in the centre of arterial vessels and don’t touch arteries - this is important in reducing risk of blood clots
What is an Embolus?
Mass of material in the vascular system able to become lodged within vessel and block it
What is the most common cause of an embolus?
Piece of thrombus breaking off and getting lodged in a smaller vessel
What is the most common occurrence of an embolus?
Pulmonary embolism from deep leg vein thrombosis
What is Ischaemia?
Reduction in blood flow
What is Infarction?
Death of cells due to reduction in blood supply
What is infarction normally caused by?
Thrombosis of an artery
Explain a reperfusion injury
Occurs after ischaemia
Blood supply severely limited but cells don’t actually die
Blood flow re-established (reactive hyperaemia - cells overwhelmed with O2)
ROS production that cause damage to tissue and inflammatory response
Name organs with 2 blood supplies
Lungs - bronchial arteries and pulmonary arteries
Liver - portal vein and hepatic artery
Some parts of the brain
What areas are most susceptible to infarction?
Watershed territories
What are the functions of histamine?
Vasodilation Emigration of neutrophils (chemotaxis) Increase vascular permeability Pain Itching
Role of plasma factors
Complement system
Kinin system
Coagulation cascade (pro-clotting)
Fibrinolytic system (anti-clotting)
What is the microscopic appearance of chronic inflammation?
Chronic ulcer
Abscess cavity
Granulatomous inflammation
Fibrosis
What is a histiocytic giant cell?
Indeigestible foreign material causes macrophages to fuse together - multinucleate giant cells
Can collect and form granulomas
Causes of an embolus
Air injected Thrombus/atheroma Amniotic fluid Fat Tumour
What happens in a venous system embolism?
Goes to RHS heart
Pulmonary system
Pulmonary embolism
What happens in an arterial system embolism?
Goes to LHS heart
Systemic system
Embolism anywhere
What is end arterial supply?
Single artery supplies organ - more susceptible to infarction
What are watershed territories?
Parts of the brain the have a dual blood supply, but low BP can cause ischaemia
What is an atherosclerosis?
Build up of plague in arteries , narrows arteries
Where are atherosclerosis’ found?
Systemic arterial system - high pressure systems
What are the components of an atheroma?
Fibrous cap
Cholesterol and lipid core
Smooth muscle cells surrounded by foam cells
Macrophages
Risk factors for atherosclerosis
Smoking - free radicals, nicotine, CO
Hypertension - increased shearing forces
Diabetes - superoxide anions and glycosylation products
Hyperlipidaemia - lipids
Increasing age
Male gender
What do the risk factors for atherosclerosis do?
Damage the endothelial cells
Explain the pathogenesis of atherosclerosis
- Endothelial cell damage – see risk factors
- Repeated endothelial damage -> multiple thrombi -> aggregation -> atheroma formation
- Vascularised plaque can haemorrhage – propagates atheroma formation
What are the complications of atherosclerosis?
Cerebral/myocardial infarct
AAA –> weakens aorta and leads to aortic rupture
Peripheral vascular disease - gangrene
How can you treat atheroma?
Aspirin - anti platelet drug
Statins - lower cholesterol
Diet, exercise, control of blood pressure, smoking cessation, weight loss
Define apoptosis
Programmed cell death