Test 3- Pigments and Tissue Deposits Flashcards
1
Q
Jaundice or Icterus
A
- Jaundice or Icterus = increased bilirubin in tissues
- Gross
– Yellow‐green discoloration of tissue or fluid
– Most prominent in mucous membranes, adventicial surfaces
– Do not use fat to assess, especially in livestock!
2
Q
A
Dog MDx: generalized jaundice
3
Q
- Prehepatic hyperbilirubinemia
A
Bilirubin production exceeds hepatocellular uptake
- conjugated bilirubin
- unconjugated bilirubin
Cause: hemolysis (intravascular or extravascular)- accerated breakdown of RBC
4
Q
- Hepatic hyperbilirubinemia
A
Hepatocellular dysfunction
- Decreased bilirubin conjugated bilirubin uptake
- Decreased conjugation
- Decreased secretion in bile
Causes: hepatic insufficiency, hepatitis, hepatocellular degeneration, etc…- SOMETHING IS WRONG WITH HEPATOCYTES
seen in severe liver disease
5
Q
- Posthepatic hyperbilirubinemia
A
Reflux of conjugated bilirubin into blood
Cause: biliary obstruction (cholestasis) or rupture
6
Q
- JaundiceorIcterus= increased bilirubin in tissues
- Microscopic
A
• Microscopic
– Do not see pigment in jaundiced tissues!
– Exception = cholestatic(some process obstructing bile flow) liver
– Yellow‐brown intracellular (hepatocytes, kupffer cells) or extracellular pigment (bile canalliculi)
7
Q
A
JaundiceorIcterus
8
Q
A
jaudice
9
Q
Hemoglobinuria
A
• Gross
– Red‐brown coloration of kidney and urine
– Pink serum
• Microscopic
– Homogenous re‐orange material in renal tubules
10
Q
A
Sheep kidney with hemoglobinuria
11
Q
You only see hemogloburia with…
A
vascular hemolysis because hemoglobin is free in the blood
12
Q
You are called out to a sheep farm…..
Clinical signs
- 6/500 unexpected death
- Several ewes now weak
- Pale yellow mucous membranes
- Urinated red urine
A
13
Q
What is the term for yellow discoloration of a tissue?
A
Jaundice or Icterus( NOT BILE INHIBITION)
14
Q
Hemoglobin catabolism
A
Heme gets through broken down into billirubin
15
Q
Hemoglobin catabolism with the enzymes
A
16
Q
Bilirubin Processing
A
conjugated bilirubin gets secreted into bile
17
Q
Hyperbilirubinemia
A
Too much billrubin the blood
18
Q
When do you get jaundice?
A
when the billrubinemia is greater than 2mg/dL
HAS TO BE QUITE INCREASED TO GET JAUDICE
19
Q
MDx ?
A
Dog MDx: generalized jaundice
20
Q
Jaundice or Icterus
A
- Jaundice or Icterus = increased bilirubin in tissues
- Gross
– Yellow‐green discoloration of tissue or fluid
– Most prominent in mucous membranes, adventicial surfaces
– Do not use fat to assess, especially in livestock
21
Q
Which mechanism of jaundice is to blame with this sheep?
A
PRE- HEPATIC- because the mucus membrances are pale
22
Q
How do you tell the difference between hemoglobin or myoglobin since they both have the same redish tint?
A
SERUM
hemoglobin has the pink serum
myoglobin has clear serum
23
Q
Extravascular hemolysis
A
macrophages take abnormla RBC out of the blood
NO HEMOGLOBURIA
24
Q
Do you have jaudice with intra or extra vascular hemolysis?
A
BOTH!
25
Etiology of Intravascular hemolysis
Oxidative, immune mediated,
26
What was the Edx for the sheep on the farm?
Etiology = acute copper toxicosis
_Pathogenesis:_ Insufficient **metallothionein** for safe copper storagehigh copper diet (copper‐storing plants)chronic hepatic copper accumulation acute copper release (i.e. from hepatic damage)oxidative RBC damage intravascular hemolytic anemiahemoglobinuria
-----sheep eat plants that have high copper from the soil
27
HEMOGLOBIN INHIBTION- POST MORTEM CHANGE
28
Is pre, hepatic, or post-hepatic the most severe?
slowest onset?
post-hepatic; no billirubin getting out of the body; has the fastest onset
hepatic- onset is the slowest
29
Pre- Hepatic
immune mediated hemolytic anemia
30
Puppy
Hepatic- infectious canine hepatits
31
hepatic- hepatic lipidosis
32
Posthepatic
33
Sick foal....
What would you do with the live animal to determine the cause of jaundice in this case?
Four things you can do clinically:
1. urine- look for intravascular hemolysis
2. blood- serum chem and look at billirubin; you can look at liver enzymes
3. X-ray- of the liver; look for obstruction
4. CBC- look for anemia(no ameia; then not pre-hepatic!)
34
pathogeneiss
Pathogenesis of neonatal isoerythrolysis:
A/Q negative mare bred to A/Q positive stallionfetus develops A/Q blood type fetal cells passed to mares blood during gestationmare sensitizedmare bred again to A/Q stallion2nd foal ingests colostrum packed with antibodies against its blood typeintravascular hemolysis
What other lesions would this foal have?? janudice, and hemogloburia(BAD INJURIES THE KIDNEY)
35
What pigments are responsible for the color of this bruise?
red- hemoglobin
yellow- billirubin
brown- hemosideron
36
Hemosiderin
• I**ron** stored intracellularly as ferritin (bound to apoferritin)
• Gross
– Must have a lot to impart
gross brown color
• Microscopic
– Dark‐yellow‐brown, coarse granular cytoplasmic pigment
– Stains blue‐black with prussian blue / Perls
37
Hemosiderin
38
How do we get accumulation of hemosiderin?
2 types: local or widespread
usually has to do hemoglobin breakdown
39
Dog
## Footnote
Lung
Localized hemosiderosis due to chronic congestion
“Heart failure cells” – hemosiderin‐laden macrophages within alveoli
40
lungs have hemosideron acummulation- VERY HARD TO SEE
41
Mynah bird
Liver
Generalized hemosiderosis due to hemolysis
42
Stain to test for iron to see if the pigment is hemosideron
Prussian blue stain for iron
43
Erythropoietic porphyria
* A developmental anomaly of calves, cats, pigs
* Inherited deficiency of uroporphyrinogen III cosynthetasedefect in heme synthesis porphyrins accumulate in dentin and bone
• Gross
**– Pink‐red discolored bones and teeth - PATHONUEMOTIC LESION**
– Fluoresces with uv light
44
Cow Bone MDx: porphyria
45
Melanin
Gross:
– Black/brown tissue color
Histo:
– Fine brown/black cytoplasmic granules
46
Melanin synthesis
47
Dog, skin MDx: Cutaneous hyperpigmentation (hypermelanosis)
Disease: Flea allergy dermatitis
48
Sheep brain MDx: meningeal melanosis
Pathogenesis: Developmental anomaly
49
Sheep uterus
MDx: endometrial melanosis
Pathogenesis: Developmental anomaly
50
Cow lungs
MDx: pleural melanosis
Pathogenesis: Developmental anomaly
51
had intestines smashed up against it
pseduo-melnosis- PORT MORTEM CHANGE
52
Pig
lungs, liver
53
Lipofuscin
Lipofuscin
• Derived from the **breakdown of lipids**
‐ an un‐degradable remnant of breakdown of organelles
* Composed of lipid complexed with protein
* Commonly in found in **aged cells** and injured cells (“wear and tear” pigment)
* Especially accumulates in post‐ mitotic cells
NEURONS AND MUSCLE CELLS
Gross:
– Usually nothing
– Tissue obtains a brownish color after large amount of accumulation
• Histo:
– Golden‐brown, fine granular
cytoplasmic pigment
54
Lipofusin
55
Elephant heart MDx: Myocardial lipofuscinosis
56
usually can't see grossly- LIPOFUSCIN
57
How can you tell hemosideron from lipofusion?
special stain for iron!
58
What type of pigment is in this lesion from a young cat?
A. Endogenous
B. Exogenous
This could be a melanoma- endogenous
exogenous pigments that produces melanin- Neutorphils, macrophages
PIGMENTED ORGANISM CAN CAUSE THIS!
59
Pony lesser omentum
MDx: omental carotenoid pigmentation
Pathogenesis: vitamin A accumulates in fatty tissues and causes yellow‐orange discoloration
EXOGENOUS PIGMENT
60
Dog lung
MDx: pulmonary anthracosis
Pathogenesis: inhaled carbon deposits in peribronchiolar macrophage aggregates
“Pneumoconiosis” = inhaled dust, anthracosis is a subtype of this
Fig. 1‐56 Anthracosis, lung, aged dog. B, Carbon (black) inhaled into the alveoli has been phagocytosed by macrophages and transported to the peribronchial region. H&E stain.
61
Sheep liver
MDx: chronic cholangitis & biliary parasitic hematin
pigment is from liver flukes- around parasties or lesions that they have caused
62
Macaque lung
MDx: chronic bronchiolitis and parasitic hematin & lung mites
63
A young dog has died unexpectedly..... PM findings.....
Parietal pleura – white chalky plaques
Gastric mucosa – dry, white streaks
Lungs – dry, fail to collapse
Lungs – Basophilic intracellular and extracellular pleomorphic granular material
Stains black with vonKossa stain
These are classic changes of calcification!
64
Calcification
• Gross
– White gritty granules/plaques – Hard
• Histo
– Basophilic amorphous granules
of inconsistent size/shape – Stain black with vonKossa
• Two types:
– Dystrophic
– Metastatic
65
calcification of the heart
66
Dystrophic Calicification
Dystrophic
Local deposition of calcium **in areas of injury**
Especially **necrotic fat** – calcium ions interact with fatty acids, producing
insoluble calcium soaps (“saponification”)
• Also muscle, **granulomas, dead parasites**
67
Metastatic
Metastatic- Type of Calcification
Widespread deposition of calcium **in otherwise normal tissues**
Caused by **hypercalcemia**
Favorite sites
– vascular intima/adventicia
– gastric mucosa
– renal tubular epithelium
– pulmonary interstitium, pleura
– basement membranes
68
What is the best morphological diagnosis for our dog case?
Metastatic Calification
69
Calicum Homeostasis
70
What are the two main causes for hypercalcemia ?
1. Excess PTH
2. Excess Vit. D
71
Dog Pancreas and mesentry
Dystrophic- necrotic fat; pancreas is leaking out fat;
pancreatistic
72
Cow liver
Granuloma- TB
Dystropic
73
Metastatic
Cow heart
Cestrum diurnum toxicitiy
74
Young dog sq mass
Calcinosis circumscripta
Dystropic; usally in large breed dogs at a site of previous injury
75
Calcinosis cutis
**Not really metastatic or dystrophic**
Dogs with hyperadrenocorticism
Pathogenesis not understood
• Widespread mineralization of the dermal collagen and epidermal basement membranes
76
Calcinosis cutis
77
Amyloid
* Fibrils made of stacked **β ‐pleated sheets**
* Can be formed by lots of different protein monomers
* Deposited and accumulates in extracellular space – compresses adjacent tissues causing **atrophy- BAD**
• Gross
– Enlarged, firm organs with
waxy appearance
– Stains blue violet when treated with iodine + sulfuric acid
• Histo
**– Amorphous homogenous eosinophilic extracellular material (“hyaline”)**
**– Stains pink and has green birefringence with polarized light**
78
Macaque liver
MDx: hepatic amyloidosis
79
Amyloid- special stain CONGO RED
80
Types of Amyloid
AMYLOID A- most common
81
A dog that you treated for protein losing nephropathy.....
protein being lost in kidneys/urine
kidneys tan and waxy
kidney have amyloid being deposited into the glomeruli; proteins will be let out from the kidney
MDx: Glomerular amyloidosis
Pathologist comment: consistent with “reactive systemic amyloidosis”
82
**What type of amyloid is deposited in ‘reactive systemic amyloidosis’?**
Amyloid light chain
Endocrine amyloid
Amyloid of alzheimer’s disease
Amyloid A
Amyloid A- formed by chronic inflammation
83
Pathogenesis of ‘reactive systemic amyloidosis’:
Pathogenesis of ‘reactive systemic amyloidosis’:
Chronic inflammationliver produces SAA in response to IL‐4 & IL‐6 spontaneous conversion of SAA to AAformation of amyloid fibrils
**Most common form in animals Hereditary in sharpeis and abyssinians Kidney, liver, spleen, lymph nodes- DIE FROM RENAL FAILURE**
84
Uric Acid
**• Gout = accumulation of uric acid in tissues**
• _Birds and reptiles_
– **No uricase; uric acid is the end product(instead of urea)**
– Get gout from decreased renal function, dehydration
• Mammals
– Urea is the end product
– Get gout from diet, genetic disorders, chemotherapy
85
Gross and Histo of Uric Acid
• Gross
– Chalky white foci on surface of visceral organs and serous membranes (liver, myocardium, spleen, pleura, air sacs, etc...)
• Histo
– Needle‐like clear spaces (crystals dissolve out in processing)
– “Tophi” ‐ granulomatous inflammation surrounding deposit
86
Uric Acid in a macaw
USUALLY IN THE KIDNEYS- THIS CAUSES AN INFLAMMATION RESPONSE
87
Snake lung and kidney MDx: visceral gout
white chalky material on the surface
88
How do we differeniate between gout from ca?
Gout is soft
Ca+ is very hard
89
gout in a macaw
90
Swan heart
MDx: visceral gout
91
What pigment is this?
Vertebral Melanosis in a cow
92
Hilar lymph node of a cow
exogenous- anthrocosis- in the airways, but it can also go to the lymphnodes
