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Pathological Processes - Alex's Cards (ESA2) > Session 1 Lecture Notes > Flashcards

Session 1 Lecture Notes Flashcards

1
Q

What is disease?

A

A pathological condition of a body part, organ or system characterised by an identifiable group of signs or symptoms
The cell is always central

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2
Q

What is pathology?

A

Study of disease and cellular dysfunction

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3
Q

What is the importance of a microscopic diagnosis?

A

It gives a definitive diagnosis

Can guide the type and extent of surgery

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4
Q

What is cytopathology?

A

Examining disaggregated cells rather than tissue

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5
Q

What is cytology?

A

Using a needle to suck a sample out

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6
Q

Give some examples of where serous carcinoma can be found

up to 5

A 
Ovary
Fallopian tube
Uterus
Cervix
Peritoneum
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7
Q

What is an adenocarcinoma?

A

Tumour that has formed from glandular structures in epithelium

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8
Q

What does TNM stand for in cancer stages?

A

Tumour (graded 0-3)
Nodes (graded 0-2)
Metastasis (graded 0-X) - depends on number of places it has metastasised

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9
Q

What is Mohs surgery?

A

During Mohs surgery, thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains

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10
Q

Name 2 types of receptors that breast cancers can have and name them

A 
Oestrogen receptors (ER positive breast cancer)
HER2 receptors (HER2 positive breast cancer)
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11
Q

What is tissue autolysis and how can we prevent this?

A

Tissue autolysis = self-digestion which begins when blood supply is cut off
Can block this using fixatives (which inactivate enzymes, denature proteins and harden tissue)

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12
Q

What chemical is used during fixation?

A

Formalin

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13
Q

After formalin is applied to a sample what happens?

A

The sample is cut up into small slices and placed in cassettes

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14
Q

In order to cut tissue very thin for cutting, what hardening agent is applied?

A 
Paraffin wax
Before this is applied:
sample is dehydrated (water removed) using alcohol
alcohol is removed using xylene
xylene is replaced by paraffin wax
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15
Q

What is used to thinly slice tissue?

A

Microtome

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16
Q

What is the tissue stained with and what part of the cells turned what colour?

A

Haemotoxylin and Eosin
Haemotoxylin turns nuclei purple
Eosin turns cytoplasm and connective tissue pink

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17
Q

After the tissue has been hardened, sliced and stained - what is applied to the slide to preserve it?

A

A mounting medium and coverslip

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18
Q

What is immunohistology?

A

Looks for substance in or on cells by labelling them with specific antibodies
The antibody is joined to an enzyme that catalyses a colour producing reaction

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19
Q

What protein is used to identify smooth muscle cells?

A

Actin

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20
Q

What is used to identify carcinomas?

A

Cadherins

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21
Q

What are cytokeratins?

A

Intracellular fibrous proteins present in all epithelium

There are certain cytokines present in different types of epithelium

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22
Q

If a cell is positive for CK7 and negative for CK20 (types of cytokines) what does this mean?

A

The person has lung, breast, endometrium, ovary or thyroid cancer

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23
Q

If a person is negative for CK7 and positive for CK20 what does this mean?

A

They have colon or gastric cancer

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24
Q

If a patient has increase in HER2 proteins what does this mean?

A

Likely to indicate breast cancer

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25
Q

Why is MRNA expression more beneficial to look at?

A

You can see if the genes are being transcribed and may be able to predict behaviour of tumour

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26
Q

When would you use frozen sections?

A

In a surgical emergency when they need an urgent diagnosis before acting

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27
Q

What is macroscopic examination?

A

Looking at a sample with just your eyes

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28
Q

What is the most common cause of cell injury?

A

Hypoxia

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29
Q

What is ischaemia?

A

Decreased blood supply

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30
Q

What is hypoxaemic hypoxia?

A

When the arterial content of oxygen is low eg reduced partial pressure of oxygen at altitude

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31
Q

What is anaemic hypoxia?

A

Decreased ability of haemoglobin to carry oxygen e.g. carbon monoxide poisoning or anaemia

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32
Q

What is ischaemic hypoxia?

A

Interruption to a blood supply e.g. blockage of vessel

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33
Q

When is the only time you will ever see histiocytic hypoxia?

A

In cyanide poisoning - oxidative phosphorylation enzymes are disabled so body cannot utilise oxygen in cells

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34
Q

How long can a person survive hypoxia to neurones?

A

A few minutes

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35
Q

What 4 cell components are most susceptible to injury?

A
  1. cell membrane
  2. Nucleus
  3. Proteins
  4. Mitochondria
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36
Q

What happens in reversible hypoxia injury?

A

Reduction in oxidative phosphorylation in mitochondria = decreased function of NA, K ATPase = sodium, calcium and water influx = cellular swelling
Reduction in ATP = increased glycolysis = reduced glycogen and reduced pH
Detachment of ribosomes from ER = reduced protein synthesis = accumulation of fat in liver

37
Q

What happens in irreversible hypoxia injury?

A

Massive influx of calcium (particularly from ER and mitochondria)
Calcium activates ATPase, phospholipase, protease and endonuclease
Leads to reduced ATP, reduced phospholipidsX disruption of membrane, chromatin (DNA) damage

38
Q

What are free radicals?

A

A molecules with a single unpaired electron in outer orbit

39
Q

What are the 3 free radicals of most significance in cells?

A

hydroxyl
superoxide
hydrogen peroxide

40
Q

Give 5 ways in which free radicals can be produced?

A
  1. metabolic reaction eg oxidative phosphorylation
  2. inflammation - neutrophils use free radicals
  3. radiation
  4. contact with unbound metals in the body - iron and copper
  5. drugs and chemicals eg during liver metabolism by P450 enzymes
41
Q

Give 3 ways in which the body controls free radicals

A
  1. Anti-oxidant system donate electrons to free radicals (vitamins A, C and E)
  2. metal carrier and storage proteins require iron and copper - prevent them producing free radicals
  3. enzymes that neutralise free radicals
42
Q

What are the main target of free radicals?

A

Lipids in cell membranes

Lipid peroxidation

43
Q

What is oxidative imbalance?

A

When the number of free radicals overwhelms the anti-oxidant system

44
Q

What do heat shock proteins do? Give an example of one

A

They aim to mend misfolded proteins

eg ubiquitin

45
Q

In hypoxia what do injured cells look like?

A

Swollen and pink cytoplasm

46
Q

What is karyorrhexis?

A

Where the nucleus of dead cells break apart into small pieces (during hypoxia)

47
Q

What is karyolysis?

A

Where the nucleus of dead cells break disappear (during hypoxia)

48
Q

What do cells look like under microscope during reversible hypoxia injury?

A

Blebs appear as cytoskeleton begins to break apart
Swelling of cell
Dispersion of ribosomes

49
Q

What does the cell look like under a microscope in irreversible cell injury from hypoxia?

A

Nucleus pyknosis, karyolysis or karyorrhexis

Myelin figures appear - fat collects under disrupted cell membrane

50
Q

What is oncosis?

A

Cell death with swelling (the process)

51
Q

What is necrosis?

A

The changes that occur after a cell has been dead some time

52
Q

What are the 2 main types of cell necrosis?

A

Coagulative

Colliquitive (liquefactive)

53
Q

When will you see coagulative necrosis?

A

During ischaemia of solid organs (where there is lots of CT)

54
Q

When will you see liquefactive necrosis?

A

During ischaemia of loose tissues and presence of many neutrophils (little CT)

55
Q

When is the only time you will see caseous necrosis and what is it?

A

When a person has tuberculosis

You see broken down debris of cells with no structure (looked like cottage cheese)

56
Q

What is fat necrosis and what does it looks like?

A

When digestive enzymes eg lipase begin to attack fatty acids
Gives the appearance of wax drops

57
Q

What is gangrene?

A

Necrosis visible to the naked eye

58
Q

What is an infarction?

A

Necrosis caused by a reduction in arterial blood flow

59
Q

What is dry gangrene? Give an example

A

Necrosis modified by exposure to air

eg umbilical cord in babies

60
Q

What is wet gangrene?

A

Necrosis modified by infection

61
Q

What is gas gangrene?

A

Wet gangrene where the infection is from anaerobic bacteria that produce gas

62
Q

What is the most common cause of infarction?

A

Blood clot (thrombus) in a coronary artery

63
Q

What is a thrombosis?

A

Where a clot occurs within an intact blood vessel

64
Q

What is an embolism?

A

Where a clot breaks off and travels in the artery to the brain - blocking the blood supply

65
Q

When does an infarct appear white?

A

In coagulative necrosis (solid organ with CT) - no blood

66
Q

When does an infarct appear red?

A

In liquefactive necrosis (loose organs with less CT) - blood vessels may haemorrhage
The tissue may also have a dual blood supply

67
Q

What is ischaemia reperfusion injury?

What can cause damage in this condition?

A

If blood flow is returned to damaged but not yet necrotic tissue damage can be worse
Damage from:
increased production of free radicals
increased number of neutrophils = increased inflammation and tissue injury
complement proteins = activate complement pathway

68
Q

Name 3 key things that can leak out of a membrane

A
  1. Potassium
  2. Enzymes eg troponin released after myocardial infarction
  3. Myoglobin - after damage to skeletal muscle
69
Q

What is apoptosis?

A

Cell death with shrinkage - cell activates enzymes to degrade its own DNA and proteins

70
Q

Do you see inflammation in apoptosis?

A

No

Cell membrane is maintained

71
Q

When might apoptosis occur physiologically?

A

To maintain a steady state (new cells coming in via mitosis)

Embryogenesis (cells between digits apoptose)

72
Q

When does apoptosis occur pathologically?

A

When cells are damaged

When a graft acts against a host eg WBCs from graft recognise host cells as foreign and attack

73
Q

What does apoptosis look like?

A

Apoptic bodies appear - acellular breaks up into fragments

74
Q

What are the 3 phases of apoptosis?

A
  1. initiation
  2. execution
  3. degradation and phagocytosis
75
Q

What are caspases and what do they do?

A

Enzymes that are activated during apoptosis and cause cleavage of DNA and proteins of cytoskeleton

76
Q

What is the intrinsic pathway of apoptosis? What key protein is activated and what does it release?

A

When the signal is initiated from within the cell
p53 protein is activated which causes outer mitochondrial membrane to become leaky
It causes cytochrome C to be released from mitochondria which causes activation of caspases

77
Q

What is the extrinsic pathway of apoptosis? What does it secrete and what is the result?

A

Initiated by extracellular signals eg. when cells have become a danger
One of the signals is TNFa (secreted by T killer cells which binds to cell membrane death receptor)
Results in activation of caspases

78
Q

When can fluid enter/accumulate in cells?

A

During hypoxia NA, K ATPase no longer functions and sodium calcium and water enter the cell

79
Q

What is steatosis and what does it look like?

A

Accumulation of triglycerides (often seen in liver)
Organ swells and takes on yellow appearance
Fat pushes nucleus to edge of cell

80
Q

Where does cholesterol accumulate?

A

In smooth muscle cells and macrophages in atherosclerotic plaques (cells with bubbled appearance)

81
Q

Name 2 conditions where proteins accumulate in the cell

A

Alcoholic liver disease

a-1 antitrypsin deficiency

82
Q

When do pigments accumulate in cell?

A

Through air pollution or tattooing
Pigments are inhaled and phagocytosed by macrophages remaining in dermis
Some will travel to lymph nodes

83
Q

What is haemosiderin and when does it form?

A

An iron storage molecule derived from haemoglobin

Forms when there is an excess of iron

84
Q

What is hereditary haemochromatosis? What is the treatment?

A

Genetically inherited disorder resulting in increased intestinal absorption of iron
Treatment = repeated bleeding

85
Q

What accumulates in jaundice?

A

Bilirubin (breakdown product of heme)

86
Q

What 2 methods cause hypercalcaemia?

A

Increased secretion of parathyroid hormone (PTH) resulting in bone resorption
Destruction of bone tissue

87
Q

What determines length of cell life?

A

Length of telomeres

88
Q

Why can germ cells and stem cells live indefinitely?

A

They contain an enzyme called telomerase which maintains original length of telomerase

Pathological Processes - Alex's Cards (ESA2) (8 decks)

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