Somatic death Flashcards by pattie o.

Primary changes during somatic death:

failure of circulatory, respiratory, and central nervous systems

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Secondary changes after somatic death:

(ARLP DPA)
Algor mortis, Rigor mortis, Livor mortis, Postmortem clotting, Dessication, Putrefaction, Autolysis

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Postmortem cooling at a rate of ~7°F/hour

Algor mortis

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Stiffening of muscles postmortem, starts in the neck and head (2-3 hrs), persists for 3-4 days

Rigor mortis

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Purplish discoloration of the body due to blood pooling; does not blanch after 10-12 hours

Livor mortis

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Difference between postmortem lividity and ecchymosis: lividity disappears under pressure, ecchymosis does not

Postmortem lividity vs. Ecchymosis

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Clot formed after death, RBCs settle from plasma, chicken fat present, assumes vessel shape, rubbery consistency

Postmortem clot

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Clot formed before death, not detachable from vessels, no chicken fat, seldom assumes vessel shape, granular and friable

Antemortem clot

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Drying and wrinkling of the anterior chamber of the eye postmortem

Dessication

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Invasion of tissues by intestinal microorganisms postmortem

Putrefaction

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Self-digestion of cells due to lysosomal enzyme release; lysosomes are known as the ‘suicide sac’ of the cell

Autolysis

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Rotting or decomposition of the body by bacterial action

Putrefaction

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Changes seen in putrefaction: Greenish-blue discoloration due to iron sulfide, muscle softening (autodigestion), corneal retraction, loss of rigor mortis, skin peeling, swelling of face

Putrefaction changes

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Liberation of hydrolytic enzymes leading to self-digestion of cells, enhanced by putrefactive bacteria; no inflammatory response postmortem

Autolysis

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Postmortem clot with settling and separation of RBCs from the fluid phase; appearance: Chicken fat (cleared area), Currant jelly (sediment of RBC); assumes blood vessel shape; rubbery consistency

Postmortem clot

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Ante-mortem clot with tangled fibrin, irregular pattern; does not resemble blood vessels; consistency is granular, not rubbery

Ante-mortem clot

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Drying and wrinkling of the cornea and anterior chamber postmortem

Dessication

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1st to describe the 4 signs of inflammation

Cornelius Celsus

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Redness due to increased blood flow to injury

Rubor (Redness)

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Heat due to increased blood flow

Calor (Heat)

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Swelling caused by capillary permeability and fluid extravasation

Tumor (Swelling)

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Pain due to pressure on sensory nerves

Dolor (Pain)

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Loss of function caused by destruction of functional units

Functio laesa (Loss of function)

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Vascular and exudative response involving PMNs transitioning to microphages in tissues

Acute inflammation

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Intermediate stage between acute and chronic inflammation

Subchronic inflammation

Vascular and fibroblastic response involving monocytes transitioning to macrophages in tissues

Chronic inflammation

Continuous abnormal proliferation of cells without control or purpose, e.g., leukemia

Neoplasia/Tumor

Chronic inflammation characterized by granuloma formation; focal aggregation of activated macrophages transformed into epithelial-like cells with pink cytoplasm, surrounded by lymphocytes and plasma cells

Granulomatous inflammation

Examples include syphilis (gummas), TB, leprosy, schistosomiasis, and Bartonella henselae

Conditions with granulomas

Resolution of inflammation with no destruction of normal tissue, neutralization of the offending agent, and clearance of mediators and inflammatory cells

Simple resolution

Replacement of lost or necrotic tissue with new tissue that is structurally and functionally similar to those destroyed

Regeneration

Grading system for tumor differentiation and treatment approach based on the percentage of differentiated and undifferentiated cells

Broder's Classification

75-100% differentiated cells, 0-25% undifferentiated cells; Treatment: Surgery

Grade I

50-75% differentiated cells, 25-50% undifferentiated cells; Treatment: Surgery or Radiation

Grade II

25-50% differentiated cells, 50-75% undifferentiated cells; Treatment: Radiation

Grade III

0-25% differentiated cells, 75-100% undifferentiated cells; Treatment: Radiation

Grade IV

Active tumor cells; functional component of the tumor

Parenchyma

Connective tissue framework of the tumor; supportive component

Stroma

Based on capacity to produce death: Benign (e.g., mole) or Malignant

Types of tumor (1)

Based on histologic characteristics: Medullary (parenchyma > stroma) or Scirrhous (stroma > parenchyma)

Types of tumor (2)

Benign tumors are generally named with the suffix “-oma”

Benign tumor naming

Malignant tumors include mesenchymal/CT (“-sarcoma”), epithelial (“-carcinoma”), leukemia, and lymphoma

Malignant tumor naming

Benign tumor of squamous cells

Squamous cell papilloma

Malignant tumor of squamous cells

Squamous cell carcinoma

Malignant tumor of hepatocytes

Hepatoma/hepatocarcinoma

Malignant tumor of melanocytes

Melanoma/melanocarcinoma

Pregnancy occurring in the Fallopian tube

Ectopic pregnancy

Size, extent of spread to lymph nodes, +/- metastases; evaluated using TNM system

Staging

Staging system that includes tumor size (T), lymph node involvement (N), and metastases (M)

UICC TNM classification

Combines grading (differentiation) and staging (spread)

AJCS Grading + Staging

Primary tumor; classified by size and local extent

T (TNM system)

Carcinoma in situ

Tis

Non-invasive tumor

Cannot be evaluated

No evidence of tumor

Lesion <2 cm

T1 subclassifications: <0.5 cm (T1a), <1 cm (T1b), <2 cm (T1c)

T1 subclasses

Lesion 2-5 cm with muscle invasion

Tumor invading skin/chest wall, T3a = deep muscle, T3b = through organ

Tumor invasion/fixation, T4a = adjacent organ, T4b = fixation (e.g., bladder, colonic wall, edema in breast)

Regional lymph node involvement

N (TNM system)

Not evaluable lymph node involvement

No regional lymph nodes involved

1 mobile regional lymph node involved

Multiple mobile regional lymph nodes involved

Fixed regional lymph node involved

Beyond regional lymph node involvement

Distant metastasis classification

M (TNM system)

No evidence of metastases

Distant metastases are present

Distant metastases not evaluable

Compound tumors; may contain hair, teeth, bones; 'monstrous tumors' (Greek)

Teratomas

Fibroblast-derived benign tumor

Fibroma

Chondroblast-derived benign tumor

Chondroma

Osteoblast-derived benign tumor

Osteoma

Lipoblast-derived benign tumor

Lipoma

Epithelial tumor with glandular pattern

Adenoma

Epithelial tumor with finger-like or warty projections

Papilloma

Epithelial tumor forming a large cystic mass

Cystadenoma

Malignant mesenchymal/connective tissue tumor

Sarcomas

Malignant fibrous tissue tumor

Fibrosarcoma

Malignant cartilage tissue tumor

Chondrosarcoma

Malignant bone tissue tumor

Osteosarcoma

Malignant blood-forming tissue tumors

Leukemias/Lymphomas

Malignant epithelial tumor

Carcinomas

Malignant glandular epithelial tumor

Adenocarcinoma

Malignant squamous epithelial tumor

Squamous cell carcinoma

Most reliable feature of malignancy, allowing cancer cells to enter vessels and cavities for spread

Metastasis

Metastasis through penetration of natural body cavities, often in the peritoneal cavity

Seeding within body cavities

Most common pathway of spread for carcinomas

Lymphatic spread

Most common pathway of spread for sarcomas

Hematogenous spread