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CellularInjury
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Hypertrophyoftheventricle.
Note:CardiacMuscle,SkeletalMuscle,andNeuronsareterminallydifferenAatedand
CNNOTundergohyperplasiafromstemcells.
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5
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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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FromConranInteracAveSession
-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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FromConranInteracAveSession
-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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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:
110
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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)
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lcoholabuse:LiverHistopathology
Notes:
Steatosis(Faychange)extensive,upperleK.
PortalmononuclearinflammaAon,upperright.
cAvehepaAAs(Mallorybodiesinhepatocytes),lowerleK.Micronodularcirrhosis,lowerright.
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WernickesencephalopathyandKorsakoffsyndrome
Notes:
Wernickesthiaminedeficiency,disturbedcogniAon,ataxia,ophtalmoplediaand
nystagmus
Korsakoffmemoryloss,confabulaAon
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Contusions
Notes:
Immediate(Red)
1-4hours(blue/purple)
4-7days(green)7-10days(yellow)
14-21days(normal)
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IdenAfyingGunshotwounds:
Notes:
Contactabrasionormuzzlestamp
CloserangesootsurroundingwoundwithsAppling(powdergrains)
IntermediatesApplingaroundwoundDistantnosootorsApplingaroundfirstlayerstruck
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RadiaAonInjuries
Notes:
Singledoses2-4Gyproducesnecrosis(TherapeuAcdose40-70Gy)
TissuecanberadiosensiAveorradioresistant
Inutero
wks1to9(spontaneousaborAon,congenitalmalformaAon)
aerwk9(mentalretardaAon,retardsdevelofreproducAveorgans;increaserisk
childhoodcancer)
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ThermalInjuries:
Notes:
-Lossoffluiddependsonbodysurfaceinjuried
-Hypovolemicshock
-Edema-ThreatofinfecAon(esp.pseudomonasaeuriginosa)
Grade1Burnred,epithelium(repairwithnoscarring)
Grade2burnblister,epidermis,superficialdermis(repairwithnoscarring)
Grade3burndeepdermis,destrucAonofdermalappendages(scarring)
Grade4burncarbonizaAon(scarring)
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HypothermiaInjuries
Notes:
-Corebodytemp
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Smoking(thatshitisbadforyou)
Notes:
-IlleffectsofsmokingareparAallyreversible
-ProvenassociaAonbetweensmokingandCOPD
*EmphysemalossofelasAcrecoilallowssmallairwaycollapseatbeginningofexpiraAon
*ChronicBronchiAsedema,fibrosis,recurringinfxninbronchialtree
Centroacinar(Centrolobular)Emphysema:
-Mostcommon
-RespiratorybronciolesareprimarysiteofelasAcAssuedamage
-Usuallyinvolvesapicalsegmentsofupperlobes
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PulmonaryFibrosis
Notes:
-MacrophagesaccumulateandengulfparAcles
-Macrophagesreleasefibrogenic,pro-inflamandtoxicfactors
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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.
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ChestX-ray
Notes:
-mulAplesmallmiliarydensiAesinbothlungfields
-NodulardensiAes=progressivemassivefibrosis
-Silicosismoreprominentinapicesoflungs
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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.
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sbestosis
Notes:
-ssociatedwithshipyards,construcAon,demoliAonofbuildings,roofing
-Pleuraleffusions/plaques(plaques=mostcommonlesion)
-Caplanssyndrome-Bronchogeniccarcinomaandmesothelioma
-DiffuseintersAAalfibrosisakaasbestosis
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Twosubfamiliesofcrystallinesiicate
SerpenAne lesspathogenic;curly;tendtobeinupperairway(chrysoAle=most
common)
mphibole morepathogenic;straight;delivereddeep,assoc.withmesothelioma(croidolite=mostcommon)
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sbestosssociatedDiseases
Notes:
-Benignpleuralplaques:mostcommonlesion
-DiffuseintersAAalfibrosis
-Primarylungcancer(riskgoesupifsmoking;approx20yrsaerexposure)-Malignantmesothelioma(norelaAonshipwithsmoking!25-40yrslater)
-CorpulmonaleandCaplanssyndrome
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CoalWorkersPneumoconiosis(CWP)
Notes:
-Inhalingcoaldustforlongperiodsanthracosis
Threeforms:
1. symptomaAcpulmonaryanthracosiscarbonaccumulatesinmacrophagesasdustcells
2.SimpleCWPnodularmassesinlungliledysfuncAon
3.ComplicatedCWPprogressivemassivefibrosis(PMF)
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HypersensiAvityPneumoniAs:
Thesymptomsofdyspnea,coughing,andfeverabatewhentheaffectedperson
leavestheenvironmentwheretheoffendingan.genislocated
Notes:
FarmersLungexposuretomoldyhaywithacAnomycesSiloFilersDiseaseinhalaAonofweevilprotein
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