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HD 2 > Pathology of prematurity > Flashcards

Pathology of prematurity Flashcards

1
Q

What age counts as prematurity

A

<37 weeks

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2
Q

4 common ‘causes’ of prematurity

A

Chorioamniotitis
Preeclampsia
Chronic villitis
MPVFD

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3
Q

What happens in normal pregnancy implantation to spiral arteries

A

Trophoblast invades the wall of the spiral arteries in myometrium
Opens up the spiral arteries so they can’t respond to changes in blood pressure

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4
Q

What happens in preeclampsia in terms of the spiral arteries

A

Failure of invasion

Spiral arteries respond to changes in blood pressure

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5
Q

What is seen in superficial implantation

A

Trophoblast cells seen in the decidua

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6
Q

What is the decidua

A

The uterine lining during pregnancy

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7
Q

What histological changes are seen in pre eclampsia

A

Muscularised arteries
Atherosis (fat) in endothelial wall
Necrosis of the wall

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8
Q

What are the consequences for baby if there is acute chorioamnionitis

A

Baby born prematurely but not necessary IUGR

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9
Q

What is acute chorioamniotic

A

Inflammation of foetal membrane

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10
Q

How do placentas appear in MPVFD

A

Placentas very hard with marbled appearance

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11
Q

What is the histological evidence for MPVFD

A

Chorionic villi are enclosed in fibrin

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12
Q

What can the cause be for chronic villitis

A

Viral invasion

Autoimmune

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13
Q

What is chronic villitis

A

Invasion of villi by lymphocytes

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14
Q

What may babies present with in the short term if born premature

A

RDS
Lung haemorrhage
Pneumonia
Apnoea of prematurity

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15
Q

What is the foetal response to chorioamniotis

A

Pneumonia

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16
Q

What is the long term problem from prematurity

A

Chronic lung disease of infancy

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17
Q

What causes RDS

A

Lack of surfactant due to biochemical immaturity

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18
Q

How do RDS babies present

A

Signs of respiratory distress (tachypnoea, expiratory grunting, recession)

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19
Q

What is the onset of RDS

A

4 hoursa

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20
Q

How do lungs appear in scan of RSD

A

Lungs appear ground glass shadowing

Spot on black- air bronchogram because air is in bronchus but not in the lung tissue

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21
Q

What % of babies less than 28 weeks have RDS

A

60

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22
Q

Describe classic presentation of lung morphology

A

Purple lungs
Liver like consistency
PDA

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23
Q

At what week are first blood vessels seen in lungs

A

17 weeks

24
Q

When can babies breathe

A

25 weeks

25
Q

What is hilum membrane disease

A

Manifestation of acute lung injury
Damaged vascular integrity allows fluid to leak into the air spaces
Partial reabsorption leavs proteinaceous material

26
Q

How does alveolus appear in HMD

A

Covered in pink proteinaceous material- forms a membrane covering the alveolus therefore causing a barrier to oxygenation

27
Q

When do macrophages appear to scavenge the hilum membranes

A

2-3 days

28
Q

What are the acute complications of HMD

A

Air leaks due to increased pressure which can lead to pneumothorax

29
Q

What is pulmonary interstitial emphysema

A

Air in the interstitium

Increased resp distress due to compression on parenchyma

30
Q

What is a chronic complication of HMD

A

Bronchopulmonary dysplasia

31
Q

What are the 3 stages of lung development

A

Canalicular stage
Saccular stage
Alveolar stage

32
Q

What are the features of ‘new’ BPD

A
  • Fewer, larger alveoli and septa
  • Arrest in pulmonary alveolar and vascular development
  • Abnormalities in VEGF
  • Thickened muscular layer of pulmonary arterioles
33
Q

How do you prevent RDS

A

Antenatal steroids
Avoidance of intrauterine hypoxia
Prophylactic surfactant treatment
Keep warm, avoid acidosis

34
Q

When is pulmonary haemorrhage common

A

In babies with hypoxia

35
Q

How does pulmonary haemorrhage look histologically

A

Lumens full of black/ red blood

36
Q

What is necrotising enterocolitis

A

Acute bacterial invasion/ inflammation/ necrosis of bowel with gas formation in bowel wall

37
Q

Risk factors of necrotising entercolitis

A

Prematurity
Hypoxia
Infection
Enteral feeding

38
Q

What is first treatment for necrotising enterocolitis

A

Stop feeds
Antibiotics
Surgery if necessary

39
Q

Clinical presentation of necrotising enterocolitis

A

Abdominal distension, tenderness, discolouration
Blood in stool
Generalised collapse

40
Q

Complications of necrotising enterocolitis

A 
Death
Short gut (after surgery)
Strictures and late obstruction
41
Q

What pathological morphology is characteristic of nectrosing enterocolitis

A 
Perforations of ileocecal region
Deeply congested mucosa
Patchy or diffuse ulceration
Dilation of involved segments
Dusky serosal surface
42
Q

Describe the histological signs of NEC

A

Pneumatosis
Epithelial regrowth and granulation tissue
Fibrosis of muscularisis propria

43
Q

What are the risk factors for periventricular haemorrhage

A 
Prematurity
RDS
Pneumothorax
Hypercapnia
Acidosis
Hypotension
Instability and handling
44
Q

What are the complications of intracerebral bleeding

A

Collapse and death
Loss of brain parenchymal tissue with cyst development
Blockage of CSF circulation leading to hydrocephalus

45
Q

What is intraventricular haemorrhage often secondary to

A

Bleeding in germinal matrix

46
Q

What happens with ventricles that are over distended

A

Blood dissects into parenchyma

47
Q

What are the risk factors for IVH

A 
Prematurity
Conditions that disturb cerebral blood flow
HMD with hypoxia
Hypothermia
Hypercapnia and acidosis
BP instability
48
Q

What is stage 1 of IVH

A

Haemorrhage in the matrix

49
Q

What is stage 2 of IVH

A

IVH without ventricular dilation

50
Q

What is stage 3 of IVH

A

IVH with enlarged ventricles

51
Q

What is stage 4 of IVH

A

IVH with parenchymal haemorrhage

52
Q

What is periventricular leucomalacia

A

Necrosis of the white matter

53
Q

What is damaged by periventricular leucomalacia in term babies

A

The cortex

54
Q

What are the features of hypoxic ischaemic encephalopathy in full term infants

A 
Bilateral damage to cortical grey matter
Shrinkage and gliosis after several weeks
Cellular necrosis and apoptosis
Capillary proliferation
Multifocal ischaemic necrosis
55
Q

What causes placental abruptions

A

Interuption of venous return with backward increase in venous pressure and intracranial and intrathoracic haemorrhages

HD 2 (26 decks)

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