Pathology part 2

Question 1

What happens after acute inflammation?

Answer 1

Dependent on;
1.Site– different organs, different capacity for repair, different vascular supplies

2. Type of injury – severity, pathogenecity of organism
3. Duration of injury – can be removed, is it sustained

Question 2

What is resolution?

Answer 2

Complete restoration of the tissue to normal after removal of inflammatory components

Question 3

What does resolution depend upon?

Answer 3

Tissue has the ability to repair

Good vascular supply

Easily removable injurious agent

Question 4

What is suppuration?

Answer 4

Pus- contains living, dead and dying cells. Neutrophils, bacteria, inflammatory debris (fibrin)

Question 5

What is an empyema?

Answer 5

When a space is filled with pus and walled off

Question 6

When does organisation occur?

Answer 6

If injury produces lots of necrosis
If injury produces lots of fibrin that isn’t easily cleared
Poor blood supply
Tissue type

Question 7

What is organisation?

Answer 7

Mucosa where damage goes beyond the basement membrane favour healing by organisation and repair, not resolution

Question 8

What does organisation provide?

Answer 8

A scaffold for resolution to occur around

Question 9

What are erosions and abrasions?

Answer 9

Heal rapidly with complete resolution

Basement membrane is in tact

Question 10

What is a common healing response in all tissues?

Answer 10

Granulation tissue formation

Question 11

Describe granulation

Answer 11

Defect is slowly infiltrated by capillaries and then by myofibroblasts

Deposit collagen and smooth muscle cells.

Given constituents it looks very red

Question 12

What can scarring and fibrosis cause?

Answer 12

Loss of function

Contraction

Question 13

Can the liver regenerate?

Answer 13

Yes but can be overwhelmed

Question 14

What is scarring and fibrosis of the liver?

Answer 14

Cirrhosis

Question 15

What is the result of cirrhosis?

Answer 15

Liver failure- can’t remove toxins or make proteins

Vascular disturbance

Question 16

What is seen microscopically in liver cirrhosis?

Answer 16

Thick bands of fibrous tissue

Nodules of regenerative hepatocytes

Question 17

What is chronic inflammation?

Answer 17

Not related to time
No implication of severity
Can occur without preceding acute

Question 18

When is chronic inflammation favoured?

Answer 18

> Suppuration, walled off pus, scarring
Persistence of injury- foreign material, keratin
Infectious agent- virus. persistence of infection (mycobacterium)
Type of injury- autoimmune, transplant rejection

Question 19

What is chronic inflammation characterised by?

Answer 19

Lymphocyte

Macrophage

Question 20

What is a granuloma?

Answer 20

Aggregate of epitheloid histiocytes

Question 21

What causes the formation of granulomas?

Answer 21

Foreign bodies
-endogenous >keratin, bone, crystals

-exogenous> talc, asbestos, suture material, oil

Question 22

What infections cause granuloma infection?

Answer 22

Parasites
Worms
Eggs
Syphilis
Mycobacterium- including TB

Question 23

What is cheesey necrosis?

Answer 23

Tuberculous granulomas- caseous necrosis

Question 24

What is infarction?

Answer 24

Cell death after loss of O2

Question 25

How does hypoxic injury occur?

Answer 25

No O2 > no ATP

Question 26

What happens as a result of no ATP?

Answer 26

Na/K ATPase fails – increased K, swelling | Calcium pump fails – increased intracellular calcium

Question 27

What does increased intracellular calcium stimulate?

Answer 27

1. ATPase (makes things worse) 2. Phospholipase (membrane damage) 3. Proteases (membrane and cytoskeleton damage) 4. Endonuclease (DNA damage and breakdown) 5. Mitochondrial permeability (release pro death factors)

Question 28

What is the window for reversible injury in the myocardium?

Answer 28

20 minutes

Question 29

What happens to cells as a result of hypoxia?

Answer 29

Cells shrink and Become red Nucleus shrinks and becomes dark Marginal contraction bands appear

Question 30

What happens in the 1st 24 hours as a result of hypoxia?

Answer 30

Cell contents leaked Complement cascade initiated Acute inflammation

Question 31

What vascular changes occur as a result of acute inflammation

Answer 31

``` Vasodilation Slowing of flow White cell margination Rolling Pavementing Diapedesis Chemotaxis Phagocytosis ```

Question 32

What is the function of neutrophils?

Answer 32

Phagocytic properties Cytokine production

Question 33

What are the three types of necrosis?

Answer 33

Caseous Liquefactive Coagulative

Question 34

Define coagulative necrosis

Answer 34

cell death with some structure of cells left as “ghost outline” before complete phagocytosis of materials

Question 35

What is the clinical implication of necrosis?

Answer 35

Cardiac rupture risk greatest at 3-7 days

Question 36

What happens after acute inflammation?

Answer 36

Resolution Restitution Suppuration Chronic Inflammation

Question 37

What are neutrophils replaces by after acute period?

Answer 37

Macrophages

Question 38

What does the presence of macrophages show at post mortem?

Answer 38

Yellow appearance

Question 39

When does resolution occur?

Answer 39

only if short duration of injury and if injury is mild and blood supply is good

Question 40

What is restitution?

Answer 40

Gradual process Progressive scarring Macrophages are replaced by fibroblasts

Question 41

What is the role of fibroblasts?

Answer 41

Lay down collagen Occurs progressively after 2 weeks Complete at 6 weels