W8 - Engagement + feedback Flashcards
What does this liver specimen show? What are the red spots?
What does it indicate?
nutmeg liver
dilated, congested central veins (dark spots) and paler, unaffected surrounding liver tissue.
chronic passive congestion of the liver secondary to right heart failure
What do you see?
very thickened pleura, especially can be seen on bottom of lung as well as top right - seems as though it is invading the chest wall
70-year old man presented with breathlessness, raised JVP, and ankle oedema. Died a week later. His heart showed previous MI, but his liver biopsy showed features of HF - what did it show?
Nutmeg appearance
77 year old heavy smoker with progressive breathlessness and weight loss. He has cor pulmonale and presents in respiratory failure. He dies shortly after admission.
What CT changes do you see?
Describe the specimen
What examination finding would you have found in this patient before death?
- CT changes: Bilateral fibrotic changes = cystic bronchial spaces are called “honeycomb” appearance The * on CT are large bullae
- There are lots of carbon depositions on the lung, mostly from smoking, bullae ( >1.0 cm) and blebs (<1.0 cm)
- From the CT, the lungs are very hyper-expanded and the diaphragm is very flat => barrel-chested
72-year-old wife of a long-time shipyard worker complained of chest pain, breathlessness, and accompanied by weight loss. She died shortly afterwards and a post-mortem was carried out. What would you expect to see on the specimen of her lung?
A thickened pleura => mesothelioma
What is the most common cause of mestholioma in the UK? What is the latency period? Which pleura could be affected?
What lung complication is mesothelioma associated with?
Asbestos exposure
about 20 years
visceral or parietal pleura
associated with pleural effusions
Describe the specimen
- Dilated air spaces, especially in the periphery
- bronchioles rimmed by yellowish muco-purulent material
In a 9 year old, the diagnosis is CF
Describe the pathophysiology behind bullous emphysema
How woud patient present?
Thin alveolar septa and dilated air spaces => irreversible enlargement of airspaces distal to terminal bronchioles => impaired gas exchange
patient would be:
- dyspnoeic, chest pain, wheezing
- may experience pneumothorax is bullae rupture
- pulmonary hypertension => cor pulmonale
Describe how lung fibrosis would cause barrel chest phenomenon
Fibrotic changes => increased compliance of lungs to accumulation of air pockets => increased intrathoracic pressure => chest wall naturally expands outwards + reduced circo-sternal distance
*essentially, lung NOT as ELASTIC as before!
What is the pathology seen?
What would appear on his ECG?
necrotic changes int he septum and anterior wall of left ventricle => acute MI
his ECG would show ST elevation in anterior (V1-V4) and septal (V1-V2) leads
What do you see in the pathological specimen of the heart?
Fibrotic changes in the anterior wall of the LV => healed MI
What is the pathology seen?
2 common causes
uniform hypertrophy of left ventricular muscle => left ventricular hypertrophy (LVH)
lumen is narrowed
Hypertension (COMMONEST), athletic hypertrophy
What is the most likely diagnosis?
Previous silent infarct due to DEEP Q waves in V1-V4, a bit V5
Which coronary artery is most likely to be blocked?
Gross ST elevation in V1 - V4 => anterior therefore LAD infarct
Mutations in what gene are responsible for CF?
mutations in CFTR gene => problem with chloride secretion => improper water movement through osmosis => very thick mucus!
