patology review

7/29/2019 Patology Review

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CellularInjury

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2


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Hypertrophyoftheventricle.

Note:CardiacMuscle,SkeletalMuscle,andNeuronsareterminallydifferenAatedand

CNNOTundergohyperplasiafromstemcells.

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Hyperplasiaofuterus

Notes:

-Increasein#ofcellsresulAngfromphysiologicalorpathologicalsAmuli.

-GrowthfactorderivedproliferaAonofmaturecellsornewcellsfromstemcells

-SAmulateresAngG0cellstoenterG1thenmulAply

-HormonalsAmuli,chronicinjury,orincreasedfuncAonaldemandcanelicitit.-Examples:Estrogensatpuberty(hormonal);HighalAtudesAmulatesbonemarrow;

posthepatectomy

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trophyofthetesAcle.

Notes:

-Reducessizedofofcellsordecreaseincellnumber.

-Physiologicalinuterusandduringdevelopment

-DecreaseproteinsynthesisorincreasedegradaAon(includingubiquiAnrelated

degradaAon)-SelecAvechangesingenetranscripAon

-EliminaAonofNFkBinhibitors(NFkB=atranscripAonacAvator)

-Causes:

-Organatrophycellatrophyorirreversibleloss

-Cellatrophyloseorganellesduetoenhancedautophagy

-Decreaseddemandoroxygensupply(parAalischemia)

-Insufficientnutrients(starvaAon,chronicdisease)

-InterrupAonoftrophicsignals

-Persistentcellinjury(chronicgastriAc,celiacdisease,liversinusoidsinheartfailue)

-ging

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Metaplasiaoftheesophagus

Note:Epitheliumshouldbesquamousinesophaguslikeupperle,butonlowerright

wecanseecolumnarepitheliumwithgobletcellsduetoBarres.

NOTES:

-ConvertfromonedifferenAatedcelltypetoanother.-IfsAmulusnotremovedcanbecomeneoplasAc

-ReversibleifsAmulusremoved

Examples:

-SquamousColumnar(bares)

-ColumnarSquamous(smokers)

-StomachintesAnal(chronicgastriAs)

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Keratomalacia

Note:typeofmetaplasiacausedbyVitaminwhereconjuncAvaoftheeye

becomesthicker.

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Dysplasia

Notes:

-DisorderedgrowthandmaturaAonofcellularcomponentsofaAssueinepithelium

-VariaAoninsizeandshape(pleomorphism)

-Nuclearenlargement,irregularity,hyperchromaAsm

-CellsareNOTenArelyautonomouswhichdifferenAatesfromneoplasia.-MostoeninhyperplasAcsquamousepithelium

-cAnicKeratosisinsundamagedskin;tanbrown,redorskincolored;rough

likesandpaper

-UlceraAvecoliAs

-Squamousmetaplasia

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HydropicSwelling(reversible)

Notes:

-Large,palecytoplasmandanormallylocatednucleus;increaseinwatercontent

-cute,reversibleinjury

-ERisdistendedbyfluidandribosomesdisaggregate.

-Mitochondriaswellandlosevolumecontrol-Plasmamembraneblebs

-NucleolussegragaAonoffibrillarandgranularcomponentsdiminishesleaving

granularcomponent

-ImpairmentofcellularvolumeregulaAon(ioniccontrol)

-RegulaAonofsodium

-SupplyofTPdiminished

-Damagetopumpdirectly

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HydropicSwelling

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HydropicSwelling

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FromConranPracAceQuesAons

nswer:E

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FromConranInteracAveSession:

-ReversibledamageHydropicswellingduetomembranechangeandpossible

leakageofsodium

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CoagulaAonNecrosisofKidney(Le)Nonucleiincellsofglomeruliortubules.

Notes:

-NecroAcAssueremainsfirm

-Cellshapeandorganstructurearepreserved

-Nucleusdisappearsandcytoplasmbecomesmoreeosinophilic

-CharacterisAcofischemicinfarcAonofanyorganexceptbrain-Nucleuscanshowpyknosis,karyorrhexis,karyolysis

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FromConranInteracAveSession

See:protein,noblue=nonuclei=necrosis,diffuse(enAresecAoninvolved)

Organ:Kidney

PathologicProcess:coagulaAonnecrosiscellularoutlinespresentbestbetis

causedbyischemiaRev.orIrreversible:irreversible

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InfarctedKidney

Note:reaofinfarcAonisusuallywedgeshapedandpale,andpointstowardsareaof

infarcAon.

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RedinfarcAonoftesAcle.

Note:RedinfarcAonarisesifbloodre-entersAssueinalooselyorganizedAssue

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GangrenousNecrosisoffoot(circledareashowsliquefacAvenecrosiswhichiswet

gangrenetherestisdry)

Note:

-CoagulaAvenecrosisthatresemblesmummifiedAssue(drygangrene)

-CharacterisAcofischemiaoflowerlimbandGItract-IfsuperimposedinfxnoccurliquefacAvenecrosisensues(wetgangrene)

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FromConranPracAceQuesAons.

nswer:

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LiquefacAonNecrosis

Note:

-TissuebecomesliquefiedduetoenzymaAclysis(mostoenfromneutrophilaka

PMNs)

-reabecomesacavitysurroundedbyfibrousCT

-LocalizedcollecAonofdeadanddyingneutrophilsplusorminusnecroAcdebris=abscess

-SeeninbraininfarcAon,abscess,pancreaAAs

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Caseousnecrosis

Notes

-SonecroAcAssuewithcoagecheese-likeappearance

-ComboofcoagulaAveandliquefacAvenecrosis

-CharacterisAcofgranulomatousinflammaAonduetoTBorfungalinfecAon-lsoseenwithBrucella

-NecroAccellsfailtoretaincelloutlinesbutdoNOTliquify

-Deadcellspersistasamorphous,coarselygranulareosinophilicdebris.

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FromConranPracAceQuesAons

nswer:

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FatnecrosisofperipancreaAcfat.

Notes:

-NecrosisofadiposeAssuewithchalky-whiteappearanceduetodeposiAngofCa2+

-CharacterisAcoftraumatofat(e.g.breast)orpancreaAAsmediatedamageof

peripancreaAcfat

-Dependentuponpresenceoftriglycerides-PancreaAcenzymesfromductorsmallintesAnecanacAvateandaackadipocytes

-FFsbindwithcalciumsaponificaAonsoapsappearamorphous,basophilic

depositsatedges

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FibrinoidNecrosis

Notes:

-necroAcdamagetobloodvesselwall

-seeninimmunerxnsassociatedwithbloodvesselse.g.b-gcomplexes

-leakageofproteinsintovesselwallresultsinbrightpinkstaining

-characterisAcofmalignantHTN,vasculiAs,pre-eclampsia

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Cellundergoingapoptosis(noteeosinophiliccytoplasmandsmallernucleus)

Notes:

-Energydependent,geneAcallyprogrammedcelldeath

-NoinflammaAon

-Cellshrinksandbecomeseosinophilic

-Nucleuscondensesandfragments-MediatedbycaspaseswhichacAvateproteasesandendonucleases

-poptoAcbodiesfallfromcellandareremovedbyMacrophages

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-SinglecellsonotinflammaAon

-Nonecrosis

-Deadcellapoptosis(canbephysiologicalorpathological)

-Processresolveswhenphagocytesphagocytosedebris

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LewyBodies(alpha-synuclein)

Notes:

-bnormalprotein

-ObservedinneuronsofsubstanAanigrainParkinsons

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TauProtein

Notes:

-bnormalprotein

-Neurofibrillarytangles

-CharacterizecorAcalneuronsinlzheimersDisease

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MalloryBodies

Notes:

-bnormalproteins

-Intermediatefilaments

-Hepatocellularinclusionsinalcoholicliverinjury

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lpha-1nAtrypsinDeficiency

Notes:

-MutaAonsincodinginsolubleproteinnoteasilytransportedfromhepatocytes

-Leadstoemphysemaandlivercirrhosis

-UncontrolledproteolysisofCTinlungemphysema

-Eosinophilicdropletsnotesinliverbecausetheproteinismisfoldedandcantbesecreted

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FromConranInteracAveSession:

-Immediatelythinklpha-1-anAtrypsindeficiencybecauseemphysema

-Lookforalpha-1-anAtrypsinparAcles(reddots)

-Proteinsaremisfoldedandcanalsoleadtocirrhosis

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ExamplesofintracellularaccumulaAonsandstorageoffat.

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Notes:

-IntracellularaccumulaAonsofprotein

-Seeninplasmacells

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Notes:

-IntracellularaccumulaAonsofprotein

-ReabsorpAonofproteindropletsinPCTofkidneyduringhyperproteinuria

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Notes:

-IntracellularaccumulaAonofpigment

-Mixtureoflipidsandproteinscontainingceroidpigment

-ccumulatedbyaccreAonofoxidized,cross-linked,indigesAbleproteins

-MainlyseeninterminallydifferenAatedcellse.g.myocardialcells,neurons

-Considerednon-toxicmostly

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BenignNevis;exampleofmelaninaccumulaAon

Notes:

-Insolublebrown-blackpigmentfoundinepidermalcellsofskinandeye

-ResideinmelanosomesandresultfromoxidaAonproductsoftyrosine

-ProtectsfromUVlightbecauseitabsorbstheserays-Canbefoundinneoplasm

-Ifunabletoproducemelaninalbinism

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nthracosis

Notes:

-StorageofcarbonparAclesinalveolarmacrophagesandmacrophagesinlymph

nodes

-Inhaledfromfossilfules

-IndigesAbleandresidesindefinitelyinthesecells

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HemosiderinIntracellularaccumulaAonofiron

Notes:

-HemosiderinisdenaturedferriAn

-LiverandbonearerichinferriAnwhilespleen,marrowandKupffercellsmostly

hemosiderin

-HemosiderosiscanoccurfromincreasedabsorpAonduringanemiatreatmentortransfusions

-Damagetovitalorganscanoccurfromironoverload

-SevereironoverloadcanalsobeinheritedHeridetaryHemochromatosis

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FromConranInteracAveLecture

-Redbloodcellsinthesinusoidsoftheliverandbrownlipofuscingranules.

-TodoublecheckitisnothemosiderinyouwouldstayitwithPrussianBlue.

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DystrophicCalcificaAon

Notes:

-MacroscopicdeposiAonofCa2+saltsininjuredAssue(Requirespersistenceof

necroAcAssue)

-ExtracellulardeposiAonfromcirculaAonorintersAAalfluid

-Canbeinocuous(e.g.TB)orimpairfuncAon(calcificaorAcstenosis)

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-HeartvalveiscalcifiedSinusofvalsalva

-TricuspidvalvelookssAfferthannormalstenoAccouldleadtopulmonary

edema,enlargedheart

-PaAentprobablyalsohassyncope

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MetastaAcCalcificaAon

Notes:

-Derangedcalciummetabolism

-Virtuallyanydisordercausinghypercalcemiacancauseit(renalfailure,Vit.Dintox,

hyperparathyroid)

-DeposiAonofsaltsinalveolarseptae;bloodvessels;andrenaltubules-Stonesw/calciumcarbonatecanbefoundingallbladder,urinarybladder,pancreaAc

duct,renalpelvis

-Mineralsaltsprecip.roundfocuoforganicmaterialrenalorgallstones

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myloid(red)surroundingbloodvessel.NoteitisoutsidethecellsinECM.Notes:-misfoldedproteinthatdepositsinextracellularspace-mulApleproteinscandepositasamyloid(usuallyBeta-pleatedsheet)

-Congoredstainingandapple-greenbifringenceunderpolarizedlight.-Oendepositsaroundbloodvessels.-Examplesincludealcoholichyalineinliver,hyalinemembranesinlung,collagenSystemicDeposiAon.-PrimaryLamyloidderivedfromIglightchainassoc.withplasmacelldyscrasias-SecondaryamyloidfromSacutephasereactantincreasedinchronicinflamm,malignancyandFamilialMediteraneanFever-CommonlyseeninnephroAcsyndrome,restricAvecardiomyopathy,hepatosplenomegaly,tongueenlarging

Localizedmyloidosis:-usuallylocalizedtosingleorgan-NIDDM(TypeIIDiabetes)amylindepositsinamylininisletsofpancreas-lzheimersDiseaseBamyloid;brainformingplaques.DerivedfromBeta-amyloidprecursor(chrom21)-Senilecardiacamyloidosis(25%ofpeople>80yrs)asymptomaAc-FamilialmyloidCardiomyopathyleadstorestricAvecardiomyopathy.

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cuteInflammaAon.Boomleandrightaretwobloodvessels.WithinAssuespace

aremulAlobarnucleatedcells,neutrophils(5circled).Ontoprighttwocircles

showingseparaAonandwhitespacerepresentedema.

Notes:

-CharacterizedbythepresenceofneutrophilsandedemainAssue-risesinresponsetoinfecAonorAssuenecrosis

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ChronicInflammaAon

Notes:

-Hallmarkcellsarelymphocytes(boomle)andplasmacells(circledcellcloserto

middle)

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CrosssecAonofskinblusterwithserousinflammaAonshowingepidermisseparated

fromdermisbyfocalcollecAonofserouseffucAon.

Notes:

Serousexudatehasfewcells;fluidresemblesserum

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Notes:

PurulentExudatenumerousneutrophilsandbacteria

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Notes:

-Polymerizedfibrin

-ssociatedwithcertainbacterialdiseasese.g.strepanduremia;e.g.pericardiAs

(seenhere)

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Notes:

1. EndothelialacAvaAonbymediatorsleadstoexpressionofEandPselecAns;histamine,thrombin,PF

2. RollingrapidandlooseadhesionduetointeracAonsbetweenselecAnsandCHOligand.

3. FirmadhesionChemokines(TNFandIL-1)acAvateleukocytesincreasingavidityofintegrins.

4. TransmigraAonPECM-1inintercellularjuncAonofendothelium.Isonleukocytesurfacesandendothelialcellbordersbetweenconfluentendothelial

cells.TransmigraAonrequiresatransientriseinendothelialcellintracellular

calcium.ThisriseisonlyseenincellsadjacenttotransmigraAnneutrophils.

NeutrophilcaAonicproteins,neutrophilsthemselves,aheparin-bindingprotein

(azurocidin)secretedbyneutrophils,cross-linkingEorPselecAnorVCM-1can

alsotriggerriseincalcium.

5. PassthroughBMviacollagenases6. TransmigraAngneutrophilsarecommiedtoleavevesselandareacAvated.7. Thisoccursinvenulesexceptinlungs(capillaries)8. OnceleukocytesentertheextravascularconnecAveAssue,theyadheretothe

extracellularmatrixby1integrinsandCD44bindingtomatrixproteins.This

allowsthemtoberetainedwheretheyareneeded.

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GivenasexampleofChronicInflammaAon

-24yroldfemalepresentsw/fever,chills,rightflankpainandpyuria.History

significantforboutsofsame.

Notes:

-ChronicinflammaAonlastsweeks,monthsoryearsandhaslilefluidcomponent.-IfacutefirstpersistenceofinflammatorysAmulus,interferencew/healing,

repeatedbouts,orautoimmunedisease

-Ifnoacuteinsidiousonsetofillnesse.g.viraldisease

Morphology

1. mononuclearcellsinfiltrateMO(remainaerNeutrophilsleave),Lympho,plasmacells,mastcells,EO

2. ProliferaAonoffibroblasts3. ProliferaAonofbloodvessels4. DeposiAonofcollagen(fibrosis)5. TissuedestrucAon

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Notes:

cAvatedlymphocytesandmacrophagessAmulateeachother,andbothcelltypes

releaseinflammatory

mediatorsthataffectothercells.IFN-gammainterferongamma;IL-1,interleukin1;

TNF,tumornecrosisfactor

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Notes:

T&BLymphocytes

-usesomeofsameadhesionsmolecules&chemokinesasmonocytes

-mobilizedbyspecificimmunesAmulus(infecAons)

-mobilizedbynon-immune-mediatedinflammaAon(infarcAonorAssue

trauma)

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Notes:

-TerminallydifferenAatedB-cells

-ProduceanAbodies

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Notes:

OldergranulomasdevelopasurroundingrimoffibroblastsandconnecAveAssue

(scarring)whichisusefulincontaininginjuriousagentandmayalsobeacauseof

AssueinjuryanddysfuncAon

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Note:

-Foundininflammatorysites(esp.parasiAcinfecAonsandIgEmediatesimmune

reacAons)

-EmigraAondriverbyadhesionmoleculessimilartoPMNs

-Eotaxin(chemokine)derivedfromleukocytesorepi.Cells

-GranulescontainMajorBasicProtein(MBP)whichistoxictoparasitesbutcanlyseepicells.

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Notes:

-SenAnelcellswidelydistributedinCT

-ParAcipateinbothacuteandchronicinflammaAon

-rmedwithIgEtocertainghistaminesandmetabolitesearlyvascular

changesofacuteinflamm.

-IgE-armedmastcellscanbeinvolvedwithanaphylacAcshockandparasiAcinfecAons-CanelaboratecytokineslikeTNF-alphaparAcipaAnginmorechronicresponses

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Notes:

-Ingranulomaswithcertainorganisms,acomboofhypoxiaandfreeradicalscentralzoneofnecrosis

-TBshouldLWYSbefirstondiff.diagnosislistwhengranulomawithcaseouscenterseen.

-#2onthelistisfungalinfecAons-TotestforTBFBstain

-TotestforFungalInxnGMSstain

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CaseaAngGranuloma

Notes:

-Inthecenteraggregate,crossedoutaredeadcells

-Lotsofpinkdebrisandbluedebrisbutnotcellsandnuclei

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Notes:

-cAvatedMOingranulomashavepinkgranularcytoplasmwithindisAnctcell

boundaries(epitheloidcell)

-Collaroflymphocytessurroundaggregatesofepitheloidmacrophages

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NoncaseaAnggranulomaslackcentralnecrosis.

Notes:

-ReacAontoforeignmaterial(e.g.fluidfromabreastimplants)

-Sarcoidosis

-Berylliumexposure

-Crohnsdisease-CatScratchDisease(usuallyintheneck;stellateshapedgranulomas)

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NoncaseaAnggranuloma

Notes:

-NoAcepinkaggregateofhisAocytes(epitheloidmacrophagesw/abundantpinkcyto)

-NoAceitissurroundedbylymphocytes-Circleinmiddle=mulAnucleatedGiantCellwithabundantcytoplasm-EachofhisAocyteshasnucleuspresentsoyouknowitsnoncaseaAng.

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Notes:

-MulAnucleatedgiantcellsarefoundingranulomaswith20ormoremacrophages

fused

-LargeamountsofcytoplasmandmulAplenuclei

-

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GranulaAonAssuethehallmarkofandiniAalphaseofAssuerepair.

Notes:

-Consistsoffibroblasts(depositTypeIIIcollagen),capillaries(nutrients),

myofibroblasts(contractwound)

-ProliferaAonoffibroblastsandendothelialcellsin24-72hours-New,small,leakybloodvessels,myofibroblastsandmacrophages

-mountdependsonintensityofinflammaAon

-Maximumformedin5-7days

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GranulaAonAssue.

Notes:

-NoAcecircledbloodvessels,twoparallellinesonrightsurroundcollagendeposiAon.

Numerousfibroblastnuclei.

-Willeventuallyproduceascar-TypeIIIcollagenisreplacedbyTypeIcollagen

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VentricleshowingscarAssue.

Notes:

-PermanentAssuelacksregeneraAvepotenAal(Myocardium,SkeletalMuscle,

Neurons)

-ThesecellsthenrepairandreplacedamagedAssuewithfibrousscarAssue.

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EndresultofMIIsLWYSfibrousscarbecausehearthasnoregeneraAvestemcells.

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HypertrophicScar

Notes:

-ExcessproducAonofscarAssuebutLOCLIZEDTOTHEWOUND(unlikekeloid)

-ComposedofTypeICollagen(alsounlikekeloidwhichareTypeIIICollagen)

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Notes:-PredominantlymadeupTypeIIICollagen(unlikeHypertrophicScarwhichisTypeI)-ExcessproducAonwayoutofproporAontothewound.-accumulaAonofexuberantamountsofcollagen-giverisetoprominent,raisedscars(classicsite=ear)

-hereditarypredisposiAontokeloidformaAon-morecommoninblacksorpeopleoffricandescent

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Keloid.PaAenthadearpiercingatsiteofredcirclewhichledtoformaAonofkeloid

WYoutofproporAontothewound.lsoifitwerebiopsieditwouldshowTypeIII

collagen.

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Notes:

-healingwoundsmaygenerateexcessivegranulaAonAssue

-abnormalcellgrowth&ECMproducAoninwoundhealing:-protrudesabovethelevelofsurroundingskin-hindersre-epithelializaAon-CauteryorsurgicalresecAonisnecessaryforrestoraAonofepithelialconAnuity

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B

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B

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D

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B

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101


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B

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E

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C

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nswer:B

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nswer:E

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nswer:

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See:Kidneywithroughsurface

Type:ChronicinflammaAon

Whypied:Scarscontractleadingtoping

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See:NumerousRBCandmarginatedleukocytes

Type:cuteinflammaAon

EAology:nythingcausinginflammaAoncouldcausethis.

Signs:CardinalignsofinflammaAon

Patho:BloodflowincreasesthenslowsandthenstasisLeukocytesmarginatevia

adhesionmoleculesthenleavevesselsMorpho:MarkedcongesAonofbloodvesselandmarginaAonofleukocytesasseen

ehre

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Paern:Purulentexudate

EAology:InfecAous(bacterial)

Signs:Fever,headache,photophobia,nuchalrigidity

Labs:Leukocytosiswithneutrophilia

CSF:Leukocytes,protein,andreducedglucose(bacteriauseupglucose)

Morphology:lotsofPMNS

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See:Erythemaandswelling

Findings:Pain,warmtotouch,lossofrangeofmoAon

Patho:increasedvascularpermability,chemicalmediators,neutrophils,mononuclear

cells,funcAon

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Process:InflammaAonwithcaseousnecrosis

Likelycause:TB

Whatwillhappen:Repair

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See:ulcerontongue

TypeofInflamm:cuteandchronic

EAology:InfecAous?Physical/Chemicals?

Signs:erythema,pain

Morphology:LM,PMNs,MO,Lymphocytes

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SystemicEffects:Fever,somnolence,malaise,anorexia,catabolismofskeletal

muscle,hypotension,changesinWBC,hepaAcsynthesisofacutephaseprotein

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Type:acute

3Outcomes:resoluAon,scarring/fibrosis,progressiontoChronic

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See:Non-caseaAnggranulomas

Type:Chronicgranulomatous

EAology:TB(usuallycaseaAng);Sarcoidosis,Syphilis,FungalInfxn,Silicosis

Morphology:Giantcells,MO,Collaroflymphocytes

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See:Blister

Paern:Serous

EAology:1stdegreeburn,viralinfxn

Typeoffluid:Proteinpoor;nocells

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Diagnosis:foreignbodygranuloma

ProminentcellSeen:Giantcells

Othercells:Lymphocytes

Type:Chronicgranulamatous

EAology:indigesAblesuture

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Mediators:IL-4,IFN-gamma

EAology:TB,Fungalinfxn,Foreignbody

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ChemicalInjurybyCCL4

Notes:

-colorless,volaAle,sweetsmelling,toxic,ubiquitous

-damagesliverandkidneys

-narcoAcandcarcinogenic

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BasophilicsAppling(Punctuatebasophilia)inRBCsduetoleadpoisoning

Notes:

-ChildrenmoresuscepAblethanadults

-MajorsourceofexposureisingesAon

-HighaffinityforSHgroups,compeAAonwithcalcium

-Toxicity:headache,dizzy,memoryproblems,neuropathy(wristdrop),colic,anorexia,HTN

-Crossesplacentaandcanleadtoprematurebirth,oraborAon

-Inmendecreasessexdriveandcancausesterility

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BilateralnecrosisofglobuspallidusduetoCOtoxicity:

Notes:

-Odorlessgas

-bindsAghtlytoHb

-Highexposureheadache,dizzy,losemotorcontrol,coma,deat,cherryredcolor

-Lowexposurechronichypoxia,reducedexercisecapacity,ischemicheartdisease,secondarypolycthemia

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Tractmarksinheroineabuse.

Notes;

-Solddilutedwithanagentsodoseunknown

-SuddendeathrelatedtoODarrythmia,cardiacarrest,severepulmonaryedema

-PulmonaryCausesedema,foreignbodygranulomas,opportunisAcinfecAons,

abscesses-InfecAousComplicaAonsendocardiAs,viralHep,IDS

KidneyDiseaseamyloidosis,focalglomerulosclerosis

**HeroinODwillcausehypothermia,bradycardia,hypotensionandcoma

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FetallcoholSyndrome

Notes:

-higherbloodalcohollevelsinfemales(maleshavehigherstomachmetabolism)

-4,000to12,000infantsperyearinUS

-GrowthretardaAon,facialabnormaliAes,smallhead,reducedintelligence

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lcoholism

Notes:

-faychangeandacutealcoholichepaAAs(reversible)

-micronodularcirrhosis(irreversible)ascites,esophagealvarices,encephalopathy

FayChangecatabolismoffatincreased,excessofNDH,acetaldehydeinteractswithcytoskeletonreducingtransportoflipoproteinsfromliver

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Toxicsystemiceffectsofalcohol

Notes:

CVSdilatedcardiomyopathy,HTN,moderatedrinkershavelessSCVD,thiamine

deficiency

GIacutegastriAs,acute&chronicpancreaAAs

ReprotesAcularatrophy,decreasedferAlity

OncogenesisacetaldehydeactsastumorpromoterbyinducingCyto-P450can

enhanceothercarcinogens.(cancerof:oralcavity,pharynx,liver,esophagus,possibly

breast)

132


133/160

lcoholabuse:LiverHistopathology

Notes:

Steatosis(Faychange)extensive,upperleK.

PortalmononuclearinflammaAon,upperright.

cAvehepaAAs(Mallorybodiesinhepatocytes),lowerleK.Micronodularcirrhosis,lowerright.

133


134/160

WernickesencephalopathyandKorsakoffsyndrome

Notes:

Wernickesthiaminedeficiency,disturbedcogniAon,ataxia,ophtalmoplediaand

nystagmus

Korsakoffmemoryloss,confabulaAon

134


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135


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Contusions

Notes:

Immediate(Red)

1-4hours(blue/purple)

4-7days(green)7-10days(yellow)

14-21days(normal)

136


137/160

137


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138


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139


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IdenAfyingGunshotwounds:

Notes:

Contactabrasionormuzzlestamp

CloserangesootsurroundingwoundwithsAppling(powdergrains)

IntermediatesApplingaroundwoundDistantnosootorsApplingaroundfirstlayerstruck

140


141/160

141


142/160

142


143/160

143


144/160

RadiaAonInjuries

Notes:

Singledoses2-4Gyproducesnecrosis(TherapeuAcdose40-70Gy)

TissuecanberadiosensiAveorradioresistant

Inutero

wks1to9(spontaneousaborAon,congenitalmalformaAon)

aerwk9(mentalretardaAon,retardsdevelofreproducAveorgans;increaserisk

childhoodcancer)

144


145/160

145


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146


147/160

ThermalInjuries:

Notes:

-Lossoffluiddependsonbodysurfaceinjuried

-Hypovolemicshock

-Edema-ThreatofinfecAon(esp.pseudomonasaeuriginosa)

Grade1Burnred,epithelium(repairwithnoscarring)

Grade2burnblister,epidermis,superficialdermis(repairwithnoscarring)

Grade3burndeepdermis,destrucAonofdermalappendages(scarring)

Grade4burncarbonizaAon(scarring)

147


148/160

HypothermiaInjuries

Notes:

-Corebodytemp


149/160

Smoking(thatshitisbadforyou)

Notes:

-IlleffectsofsmokingareparAallyreversible

-ProvenassociaAonbetweensmokingandCOPD

*EmphysemalossofelasAcrecoilallowssmallairwaycollapseatbeginningofexpiraAon

*ChronicBronchiAsedema,fibrosis,recurringinfxninbronchialtree

Centroacinar(Centrolobular)Emphysema:

-Mostcommon

-RespiratorybronciolesareprimarysiteofelasAcAssuedamage

-Usuallyinvolvesapicalsegmentsofupperlobes

149


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PulmonaryFibrosis

Notes:

-MacrophagesaccumulateandengulfparAcles

-Macrophagesreleasefibrogenic,pro-inflamandtoxicfactors

150


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151


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Silicosis

Notes:

-MostcommonoccupaAonaldiseaseinworld

-InhalaAonofsiliconedioxide(foundinquartz)chronicinflammandfibrosis

-Workatfoundries,sandblasAng,mining,drilling,tunneling,stonecung

-Crystalscanbeamorphousorcrystalline(toxicandfibrogenic)-Classifiedbasedonexposure/symptomsacute,chronicorcomplicated

-IncreasedriskofPulm.TB,primarylungcancer,Caplanssyndrome,

-Concentriclayersofcollagenwithbi-refringentsilicaparAcles

EarlymulApleAnynodulesthatgrowlargew/scarAssue

Latemayundergocentralsoening(cavitaAon);mergetoformlargehyalinized

noduleswithscarAssue.

152


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ChestX-ray

Notes:

-mulAplesmallmiliarydensiAesinbothlungfields

-NodulardensiAes=progressivemassivefibrosis

-Silicosismoreprominentinapicesoflungs

153


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Normallung:

:Normallung,grossspecimen,cutsurface:Notehowhomogeneousthe

parenchymais.

B:Normallung,gross,closeup:notehowuniformalveoliare

C:Centriacinaremphysema(mostcommontype)Centralareasshowmarked

emphysematousdamage(E),surroundedbyrelaAvelysparedalveolarspaces.

Notes:

Emphysemahasamorphologic(histologicdiagnosis)defini.on,requiring:

bnormalpermanentenlargementofairspacesInvolvementofairspacedistaltoterminalbronchioleaccompaniedbyDESTRUCTIONoftheirwalls(ifenlargedbutnodestrucAon over-inflaAon)

Thediseaseisrestrictedtotheacinus.

154


155/160

sbestosis

Notes:

-ssociatedwithshipyards,construcAon,demoliAonofbuildings,roofing

-Pleuraleffusions/plaques(plaques=mostcommonlesion)

-Caplanssyndrome-Bronchogeniccarcinomaandmesothelioma

-DiffuseintersAAalfibrosisakaasbestosis

155


156/160

Twosubfamiliesofcrystallinesiicate

SerpenAne lesspathogenic;curly;tendtobeinupperairway(chrysoAle=most

common)

mphibole morepathogenic;straight;delivereddeep,assoc.withmesothelioma(croidolite=mostcommon)

156


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sbestosssociatedDiseases

Notes:

-Benignpleuralplaques:mostcommonlesion

-DiffuseintersAAalfibrosis

-Primarylungcancer(riskgoesupifsmoking;approx20yrsaerexposure)-Malignantmesothelioma(norelaAonshipwithsmoking!25-40yrslater)

-CorpulmonaleandCaplanssyndrome

157


158/160

CoalWorkersPneumoconiosis(CWP)

Notes:

-Inhalingcoaldustforlongperiodsanthracosis

Threeforms:

1. symptomaAcpulmonaryanthracosiscarbonaccumulatesinmacrophagesasdustcells

2.SimpleCWPnodularmassesinlungliledysfuncAon

3.ComplicatedCWPprogressivemassivefibrosis(PMF)

158


159/160

HypersensiAvityPneumoniAs:

Thesymptomsofdyspnea,coughing,andfeverabatewhentheaffectedperson

leavestheenvironmentwheretheoffendingan.genislocated

Notes:

FarmersLungexposuretomoldyhaywithacAnomycesSiloFilersDiseaseinhalaAonofweevilprotein

159


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patology review

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