W19 - Systemic pathology Flashcards
HIV opportunistic infections - what does each cause? PART 1
- Pneumocystic jiroveci =>
- CMV =>
- Candida =>
- Tuberculosis and atypical mycobacteria =>
- Cryptococcus =>
HIV opportunistic infections - what does each cause?
- Pneumocystic jiroveci => pneumonia
- CMV => retinitis, GIT (eosophagitis)
- Candida => oesophageal candidiasis, candidaemia
- Tuberculosis and atypical mycobacteria => pulmonary TB
- Cryptococcus => meningitis
HIV opportunistic infections - what does each cause? PART 2
- toxoplasma gondii =>
- JC papovavirus =>
- Herpes simplex =>
- Cryptospordium, isospora belli, microsporidia =>
HIV opportunistic infections - what does each cause?
- toxoplasma gondii => encephalitis and mass lesions
- JC papovavirus => progressive multifocal leukoencephalopathy
- Herpes simplex => HHV-8 (Kaposi’s sarcoma)
- Cryptospordium, isospora belli, microsporidia => GIT
mycobacteria causes _______ granulomas
sarcoid causes ________ granulomas
mycobacteria causes caseating granulomas
sarcoid causes non-caseating granulomas
What is the likely pathology? Explain findings of gross specimen and histo slide
mycobacterial infection
Gross specimen = cavitations in R upper lobe (most common area for TB infection)
histology slide = granuloma with caseaous necrosis (cheese-like cell death - most commonly associated with TB infection)
Granulomas in sarcoid are _______
Describe the cells in the core and peripehery of a sarcoid granuloma
Granulomas in sarcoid are non-caseating granulomas
Central area contains epitheloid cells, giant cells, and macrophages.
Peripheral area contains lymphocytes
Sarcoid - how to diagnose it?
Sarcoid is a diagnosis of exclusion as it does not have any specific tests. Must rule out all other differential diagnoses
IgG4 related disease - condition per system affected:
- Salivary and lacrimal glands =>
- thyroid gland =>
- Peritoneum =>
- Liver =>
- Pancreas =>
- Mass lesions =>
IgG4 related disease - condition per system affected:
- Salivary and lacrimal glands => Mikulicz syndrome
- thyroid gland => Reidel thyroiditis
- Peritoneum => Retroperitoneal fibrosis
- Liver => Biliary obstruction
- Pancreas => Autoimmune pancreatitis
- Mass lesions => Inflammatory pseudotumour
Describe what IgG4 related disease is
It is a non-infectious inflammatory disease in which inflamation is dominated by IgG4 abs produced by plasma cells
What is the pathophysiology of IgG4 related disease?
Excessive IgG4 ab production and infiltration into tissues => causing fibrosis and obliteration of veins
Alcoholic systemic disease - describe conditions per system affected:
- Liver =>
- GI tract =>
- Nervous system =>
- Cardiovascular system =>
- Pancreas =>
- Foetus =>
- Cancer =>
Alcohol as causing systemic disease - describe conditions per system affected:
- Liver => steatosis, steatohepatitis, cirrhosis, hepatocellular carcinoma
- GI tract => acute gastritis, oesophageal varices
- Nervous system => Peripheral neuropathy, Wernicke-Korsakoff Syndrome
- Cardiovascular system => Dilated cardiomyopathy, Hypertension, atheroma (and may decrease it - remember red wine)
- Pancreas => Acute/chronic pancreatitis
- Foetus => foetal alcohol syndrome
- Cancer => oral cavity, pharynx, oesophagus, liver, breast
Cystic fibrosis as a genetic disease that affects multiple systems - describe effect on each system below:
- Pancreas =>
- Salivary glands =>
- Intestine =>
- Liver =>
- Lung =>
- Male genital tract =>
Cystic fibrosis as a genetic disease that affects multiple systems - describe effect on each system below:
- Pancreas => Duct obstruction, exocrine atrophy
- Salivary glands => Duct obstruction, atrophy
- Intestine => Meconium ileus
- Liver => Biliary obstruction, cirrhosis
- Lung => Bronchial obstruction, superimposed infection with abscess formation (i.e. Staph a., haemophilus influenzae, pseudomonas)
- Male genital tract => Infertility, absence of the vas
Amyloidosis - describe what this condition is
Amyloidosis is the deposition of an abnormal proteinaceous substance in non-branching fibrils in various organs
The proteins in amyloidosis are non-resistant/resistant to enzymatic degradation?
The proteins in amyloidosis are RESISTANT to enzymatic degradation
The proteins in amyloidosis are in what structural format - alpha helix or beta pleated sheets?
Beta pleated sheets
Amyloid - Classification I
Name the classes
Amyloid - Clasification I
AA - derived from serum amyloid A
=> i.e. Crohn’s Disease, Rheumatoid arthritis
AL - derived from light chains
=> i.e. multiple myeloma, B cell lymphoma
Who is at increased risk of developing AA amyloidosis? Name 2 conditions
Crohn’s disease, rheumatoid arthritis
Who is at increased risk of developing AL amyloidosis? Name 2 conditions
Multiple myeloma (MM), B cell lymphoma
H&E slide of kidney - what does it show? What staining would you do next?
thickened vascular walls => protein deposition?
Stain with Congo Red for amyloidosis
Kidney histo slide stained with congo red - what disease is likely present?
Amyloidosis
There are certain proteins that can arise in certain conditions, giving rise to amyloidosis.
Name the protein associated with each of the following:
- Mutational =>
- Peritoneal dialysis =>
- Alzheimer’s =>
- Endocrine tumours =>
- Mutational => transthyretin
- Peritoneal dialysis => beta2-macroglobulin
- Alzheimer’s => Beta2 protein
- Endocrine tumours => insulin, calcitonin
Amyloid staining:
- dye =>
- Under polarised light =>
Amyloid staining:
- dye => Congo red
- Under polarised light => Apple green birefringence
Amyloidosis - clinical features:
- Renal =>
- Cardiovascular =>
- CNS =>
- Rheumatological =>
- Haematological =>
- Elsewhere =>
Amyloidosis - clinical features:
- Renal => proteinuria, nephrotic syndrome, renal failure
- Cardiovascular => restrictive cardiomyopathy, arrhythmias
- CNS => Autonomic neuropathy
- Rheumatological => Carpal tunnel syndrome
- Haematological => Bleeding on injury, macroglossia
- Elsewhere => depositions in blood vessels, endocrine organs, liver, spleen
