Pathology Quest

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xdiabx
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106540
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Pathology Quest
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2011-10-11 17:55:55
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Oncology disorders blood lymphatic systems Integumentary Disorders
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Path Quest Wednesday, October 5, 2011
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  1. Skin & Related Structures
    • Epidermis
    • Dermis
    • Hair Follilcles
    • Nails
    • Sabaceous Glands
    • Sweat Glands
  2. The skin is the ________ organ system in the Body.
    Largest
  3. The skin is what percentage of body weight?
    15-20%
  4. Key Functions of the skin (8)
    • Protection against injury
    • Secretion of oils that lubricate the skin
    • Maintenance of homeostasis via fluid blance and body temp.
    • Excretion of excess water, urea and salt via sweat
    • Maintenance of body shape
    • Cosmesis (preserves bodily beauty) and identity
    • Vitamin D synthesis
  5. Epidermis: definition
    (how many layers and what are they called)
    *Which layer is the specialize layer?*
    • Outer most superficial layer of the skin
    • Five Layers in the lips, palms and soles of the feet with four layers elsewhere
    • Stratum Basale
    • Stratum Spinosum
    • Stratum Granulosum
    • Stratum Lucidum (specialized 5th Layer)
    • Stratum Corneum
  6. Dermis
    -What does it contain
    -How does it differ from the epidermis
    -Which glands does it contain
    • Contains blood vessels, lymphatics, nerves, collagen and elastic fibers
    • Deeper and thicker than the epidermis
    • Contains sebaceous and sweat glands
  7. RETE PEG REGION
    -What is it
    -What is its purpose
    -Why would it be absent
    • Interface between the epidermis and the dermis that is characterized by structural ridges and valleys
    • Increases surface area between epidermis and dermis (improved adherence)
    • Ridges are absent in highly damaged skin (burn patients, chronic skin conditions)
  8. Abrasion
    A wearing away of the upper layer of skin usually as a result of friction
  9. Contusion
    • Blood vessels are broken as a result of a direct blow
    • ex) punched in the arm=bruise
  10. Ecchymosis
    • Skin discoloration caused by the escape of blood into the tisues from a small rupture in a blood vessel
    • (Takes longer to form a bruise than would a contusion)
  11. Excoriation
    Traumatic loss of epdermis; generally mild
  12. Laceration
    Wound is deeper than the superficial skin layer


    Penetration of the skin in which the wound is deeper than the superficial layer
  13. Ulcer
    A lesion on the surface of the skin or mucous membrane produced by sloughing of inflammatory or necrotic tissue
  14. Cellulitis (bacterial infection)
    • Acute inflammation with infection of the skin and subcutaneous tissue that spreads through tissue spaces
    • patients with co-morbidities: increased risk for infection
    • patients with failure of the lymphatics that lead to chronic lymphedema
    • Treated w/ antibiotic usually but intavenous infusions
    • Often occurs as a result of a primary injury
    • May be iatrogenic (introduced to patient by physician activity, manner, therapy)
    • Often has the appearance of red streaks
  15. Bacterial Infections
    -what affects the ability of the bacteria to cause a clinical disease
    • Skin normally caries bacteria
    • invasiveness of the particular organism and the host resistance
  16. ACUTE NECROTIZING FASCITIS (bacterial infection)
    -what kind of bacteria
    -symptoms due to what

    -delay in treatment can lead to what
    -assosiated with a history of what
    • Mixture of aerobic and anaeobic bacteria
    • Severe inflammation and tissue necrosis (usually due to virulent strain of gram-positive, group A, beta-hemolytic streptococcus)(Bacteria secrete toxins that break down fascia and conn. tissue, causing massive tissue destruction)
    • Often a history of minor trauma or infection in skin and subcutaneous tissue of an extremity
    • Delay in treatment = greater tissue loss, potential amputation, and higher probability of mortality
  17. HERPES ZOSTER (shingles)-- VIRAL
    -deals with which virus
    -occurs when
    -where does the virus remain
    -which condition may follow leading to
    discomfort

    -after which age is the vaccine recommended for
    • Reactivation of the varicella virus that causes chicken pox
    • usually occurs during physiological sress particularily aging
    • Following resolution of the chicken pox, the virus remains dormant in the dorsal root ganglion
    • The skin eruptions usually occur along a specific dermatome commonly in the thorax
    • Post herpatic neuralgia is a comon sequal of shingles and may lead to significant discomfort
    • Vaccine is now recommended for all adults age 55 and older to prevent reactivation of thevirus
  18. PSORIASIS (autoimmune dissorder of the skin)
    -Common/uncommon
    -how is it characterized
    -may be accompanied with______ what is the percentage
    • Very common and benign condition
    • Characterized by rapid proliferation of the skin cells resulting in raised plaques
    • Often runs in families
    • In about 10% of patients it is accompainied by arthritis--- PSORIATIC ARTHRITIS
    • Mild cases are treated with topical medications
    • Moderate cases respond well to reatment with ultraviolet light
    • Severe cases are treated with Biologic Medications (also used to treat arthritis)
  19. Scleroderma = Systemic Sclerosis
    -affects which parts of the body
    -how are subtypes characterized
    -what is the most common type
    • A diffuse conn. tissue disorder that causes fibrosis of the skin, joints, blood vessels and internal organs
    • Has several subtypes characterized by the extent of the disease
    • Limited Sclerosis is the most common type
  20. Limited Sclerosis
    -which syndrome
    -where on the body would this be located
    -progress quickly or slowly?
    • CREST syndrome
    • Limited to distal extremities and face
    • Progresses slowly and patients have a 70% survival rate at 10 years
    • May ultimately progress to visceral involvement
  21. Diffuse Sclerosis
    -affects the body where?
    -progress quickly or slowly?
    • Widespread skin involvement including proximal extremities, face and trunk
    • Progresses quickly to visceral involvement
    • Higher mortality rate
  22. SCLERODERMA--Raynaud's Phenomenon
    -what is Raynaud's Phenomenon
    -where does it occur in the body
    -what is the characteristic symptom of Scleroderma... this can lead to what
    • Raynaud's Phenomenon: Paroxysmal vasoconstriction of the blood vessels of the hands and feet (Common in conn. tissue disorders such as scleroderma but may be a benign stand alone condition)
    • Skin thickening is the chracteristic symptom of Scleroderma
    • Often leads to contractures that result in significant functional limitation
  23. Hematology
    The branch of science tht studies the form and structure of blood and blood forming tissues
  24. 2 components of blood
    • Plasma
    • Formed Elements
  25. Functions of Blood (3)
    • Transport nutrients (O2 & glucose)
    • Remove waste (CO2 & lactic acid)
    • Transport cells and stubstances b/t organs
  26. Where does the formation and development of blood cells take place?
    BONE MARROW
  27. Which hormone acts of the bone marrow to stimulate the maturation and proliferation of erythrocytes by hematopoiesis?
    ERYTHROPOIETIN
  28. Erythropoiesis
    -which hormone regulates this process?
    -from where is it secreted?
    • The direct control of erythrocyte production
    • Erythropoietin is secreted from the KIDNEYS
  29. Lymphatic System
    • Assists in the management of circulation by removing fluid not otherwise managed by the circulatory system
    • Integrated w/ the function of the hematologic system & the immune system
  30. Edema
    (Hematological System Dysfunction)
    Buildup of excessive fluid w/in the intersitial tissues or w/in the body cavities
  31. Infarction
    (Hematological System Dysfunction)
    Not enough oxygen = localized necrosis

    A localized area of necrosis caused by a reduction in O2 perfusion that is below the level necessary for cell viability
  32. Thrombus
    presence of a solid mass of clotted blood w/in a vessel or chamber of the heart
  33. Embolism
    Mass of solid liquid or gas that moves w/in a blood vessel to lodge at a site distant from its place of origin
  34. Lymphedema
    A chronic swelling of an area due to buildup of interstitial fluid especially in the extremities secondary to the obstruction or absence of lymphatic vessels or nodes
  35. Hypotension & Shock
    Dramatic reduction in arterial blood supply and oxygenation to an organ or tissue
  36. Lymphadenophathy
    • Enlargement of the lymph nodes
    • Common in viral conditions
    • Malignant conditions
    • May include enlargement of the spleen
  37. Hematological System Dysfunctions (8 Bullets)
    • Edema
    • Infarction
    • Thrombus & Embolism
    • Lymphedema
    • Hypotension & Shock
    • Bleeding & Bruising that is not consistnet with size and magnitude of injury
    • Lymphadenopathy
  38. DIAGNOSTIC TESTS (8)
    • CBC
    • Differential Count for WBCs
    • Morphology
    • Hematocrit
    • Hemoglobin
    • Chemical Analysis
    • Bleeding Time
    • Prothrombin Time & Partial Thromboplastin Time
  39. Complete Blood Count (CBC)
    -what does it include
    -what are 3 indications from a CBC
    • Includes total RBCs, WBCs, & Platelets
    • Leukocytosis = Increased WBCs (associated with inflammation/infection)
    • Leukopenia = Decreased WBCs (associated w/ some viral infections; radiation & chemotherapy)
    • Increased Eosinophils: Common in allergic responses
  40. ______________ is common in allergic responses
    Increased Eosinophils
  41. Leukocytosis
    • Increased WBCs
    • Associated w/ inflamation/infection
  42. Leukopenia
    • Decreased WBCs
    • Associated w/ some viral infections; radiation & chemotherapy
  43. Morphology
    • Observed with blood smears
    • Shows size, shape, uniformity, & maturity of cells
    • Different types of anemia can be distinguished
  44. Hematocrit
    Percent by volume of cellular elements in blood
  45. Hemoglobin
    Amount of hemoglobin per unit volume of blood
  46. Chemical Analysis
    • Determine serum levels of components
    • Iron, vitamin B12, folic acid, cholesterol, urea, glucose, ect.
  47. Bleeding Time
    Measures platelet function
  48. Prothrombin Time & Partial Thromboplastin Time
    • Measures function of various factors in coagulation process
    • INR is a standardized version--how quickly blood clots
  49. Anemia
    • Abnormality in the ability of the blood to transport oxygen
    • May be a symptom of many other disorders
    • Causes a reduction in oxygen transport
    • Basic problem is a hemoglobin deficit
    • Oxygen defitic leads to...
    • >less energy production in all cells: cell metabolism & reproduction diminished
    • >Compensation mechanisms: Tachycardia and peripheral vasoconstriction
    • >General signs of anemia: Fatigue, pallor (pale face), dyspnea, tachycardia
  50. IRON DEFICIENCY ANEMIA
    • Insufficient iron impairs hemoglobin synthesis
    • Microcytic, hypochromic RBCs
    • Result of low hemoglobin concentration in cells
  51. IRON DEFICIENCY ANEMIA
    --signs & symptoms--
    • Pallor of skin and mucous membranes
    • Fatigue, lethargy, cold intolerance
    • Irratabiity
    • Degenerative changes
    • Menstral Irregularities
    • Delayed Healing
    • Tachycardia, heart palpitations, dyspnea, snycope
  52. IRON DEFICIENCY ANEMIA
    --Etiology--
    • Dietary intake of iron below min. requirement
    • Chronic blood loss: Bleeding, ulcer, hemorrhoids, cancer, etc.
    • Impaired duodenal absorption of iron: In many disorders-malabsorption syndromes
    • Sever liver disease: may affect iron absorption as well as storage
  53. APLASTIC ANEMIA
    IMPAIRMENT or FAILURE OF BONE MARROW
  54. PERNICIOUS ANEMIA
    VITAMIN B12 DEFICIENCY
  55. SICKLE CELL ANEMIA
    • Genetic condition
    • Sicle-shaped cells are too large to pass through microcirculation
  56. SIGNS & SYMPTOMS OF SICKLE CELL ANEMMIA CRISIS
    • Severe pain due to ischemia of tissues and infarction
    • Pallor, weakness, tachycardia, dyspnea
    • Hyperbillirubinemia = JAUNDICE
    • Splenomegaly
    • Vascular occlusions and infarctions
    • Delay of growth and development
    • Congestive Heart Failure
  57. HEMOPHILIA A
    • Classic hemophilia
    • Deficit or abnormality of factor VIII
    • Most common inherited clotting disorder (x-linked recessive trait, manifested in men, carried by women)
  58. COMPLICATIONS OF LEUKEMIA
    • Opportuistic infections including pneumonia
    • Sepsis
    • Congestive Heart Failure
    • Hemorrhage
    • Liver Failure
    • Renal Failure
    • CNS Depression and Coma
  59. Differentiation
    • Normal tissue contains cells of uniform size, shape and nuclear struture
    • Cells undergo changes as they develop to form the different tissues of the body
    • In malignant cells differentiation is altered and the malignant cell may not look anything like its parent tissue.
  60. Dysplasia
    • Adult cells change to indicate a disorganization of shape or size
    • Dyspasia is often viewed as pre-cancerous condition although in many cases, it may reverse itself
  61. Hyperplasia
    • An increase in the number of cels in tissue
    • May be a normal occurrence or it may be neoplastic which is suggestive of tumor formation
  62. Tumors
    • Abnormal growths of tissue that serve no useful purpose
    • May compete with healthy tissue for vital blood supply and nutrients
    • May be benign or malignant
  63. Primary Tumors
    Arise locally
  64. Secondary Tumors
    Result from (metastasis) or spread from another area
  65. Tumors are classified according to...
    • Tissue of origin
    • Being BENIGN or MALIGNANT
  66. Epithelial Tumor
    • External body surfaces and the lining of the internal spaces and cavities
    • CARCINOMA
  67. Connective Tissue Tumor
    • Elastic, fibrous and collagenous tissues
    • SARCOMA
  68. Nervous Tissue Tumor
    • Brain, spinal cord and related structures
    • Named for the specific type of cell involved
    • GLEAL CELLS = GLEAPHOMA
  69. Lymphoid Tissue Tumor
    • Anywhere in the body where lymph tissue is present
    • LYMPHOMA-- very common
  70. Hematopoietic Tumor
    • Blood and bone marrow
    • LEUKEMIA and MYELOMA
  71. Benign tumors use the suffix...
    -oma

    adenoma
  72. Malignant Tumors (cancers) use the suffix...
    -carcinoma

    adenocarcinoma
  73. Tumors of Connective Tissue are termed ___________ and are often ___________.
    sarcomas, malignant
  74. Unique Names of Malignant tumors
    • Hodgkin Disease
    • Wilms tumore
    • Leukemia
  75. Benign Tumor
    -characteristics
    -risks associated
    • Usually differentiated cells that reproduce at a higher rate than normal
    • Encapsulated
    • Tissue damage is a result of compression of adjacent structures, this can be life-threatening in the brain.
  76. Malignant Tumor
    • undifferentiated, non-funtional cells
    • Rapid reproduction--abnormal mitotic figures
    • Infiltrate/spread into surrounding tissue
    • Spread to distant sites
  77. The endocrine system is composed of __________ located throughout the body.
    Glands
  78. Glands synthesize and release _____________ which are transported by the blood stream to the cells and organs that require hormones for proper function.
    HORMONES
  79. What are hormones?
    Chemical Mediators
  80. Target cells
    ~what do they have that makes them unique
    ~How are they inactivated and where are they secreted from?
    • Specific receptor sites for hormones
    • After acting on the target tissue the hormones are metabolized or inactivated by the cells of the liver and excreted by the kidneys
  81. 5 Functions of the endocrine system
    • Acting on the developing fetus to differentiate the reproductive system and the nervous system
    • Stimulate growth and development through childhood and adolesence
    • Coordinate the male and female reproductive system
    • Maintains optimal internal environment through the lifespan
    • Initiates corrective responses to physiological emergency
  82. Hormones produced by the pituitary gland(2)
    • Growth Hormone
    • TSH
  83. Hormone produced by the thyroid gland (1)
    Thyroxine
  84. Hormones produced by the adrenal gland (3)
    • Aldosterone
    • Cortisol
    • Epinephrine
  85. Hormones produced by the gonads (2)
    • Estrogen
    • Testosterone
  86. Hormones produced by the pancreas (2)
    • Insulin
    • Glucagon
  87. Endocrine Disorders: Hypofunction
    ~what is it
    ~ what are the 5 outcomes of it
    • Deficient hormone levels...
    • --Antagonistic hormone production is increased
    • --Malnutrition
    • --Tumor produces too little hormone
    • --Atrophy, surgical removal of gland
    • --Congenital deficit
  88. Endocrine Disorders: Hyperfunction
    • Excess hormone Levels...
    • --Tumor produces high levels (happens when tumor takes on gladular function)
    • --Excretion by liver or kidney is impaired
    • --Congenital condition produces excess hormone
  89. Causes of Endocrine Dissorders
    • Benign tumors
    • Deficit in target cells
    • Signs and symptoms of endocrine pathology vary depending on the gland affected and wheather it is hypo or hyper function
    • Blood tests are commonly used to measure levels of circulating hormone
    • The effectiveness of hormones can also be measured through blood test
    • Various types of scans and diagnositc ultrasound may be used to examine structural changes in glands that lead to dysfunctions
  90. Thyroid Disorders
    • VERY common
    • Have genetic link
    • More common in women
  91. Goiter
    -what is it
    -what could it indicate
    -what are adverse affects
    • Enlargement of the thyroid gland caused by various conditions of the thyroid--may indicate malignancy or malfunction
    • Easily palpable in teh anterior neck
    • May compress other structures if it is very large (trachea, esophagus, blood vessels)
  92. Hyperthyroidism
    • Graves Disease
    • More common in women
    • Manifested by hypermetabolism and goiter
    • Most often treated with RAI (radioactive iodine) which destroys the hyper secreting tissue
    • patients usually require life long maintenance with medication
  93. Hypothyroidism
    • A deficiency in thyroid hormone that results in slowed body metabolism
    • Early symptoms are diffuse and poorly recognized
    • (2 types): Hashimot's Thyroiditis & Myxedema
  94. Hashimoto's Thyroiditis
    -what is it & what could it lead to
    -what form of condition is it
    • Inflammatory autoimmune disorder that leads to diminished thyroid function
    • Most common form of hypothyroidism
    • Easily managed by a pill
  95. Myxedema
    • A severe form of thyroid dysfunction that may lead to coma
    • Type of hypothyroidism
  96. How are thyroid dissorders diagnosed?
    Blood tests
  97. Why are enlargements of teh thyroid scanned further?
    For presence of TUMORS
  98. Thyroid cancer is relatively common/rare but usually responsibe to treatment with a very high/low success rate.
    RARE, HIGH
  99. Hypothyroidism is easily treated with _________.
    THYROXINE -very cheap
  100. Hyperthyroidism is often a secondary cancer to people who had _____________ as a child.
    LEUKEMIA
  101. What causes Cushing Syndrome
    • Excessive level of glucocorticoids
    • ex) taking a lot of steroid-based medications--cortisone (like people with athsma)
  102. Appearance changes associated with Cushing Syndrome
    • Round face w/ ruddy color
    • Truncal obesity with fat pad between scapulae
    • Thin limbs
    • Thin hair
    • Fragile skin
  103. Addison's Disease
    • Deficiency of adrenocorticoid secretions
    • Also called Primary Adrenal Insufficiency
  104. Manifestations of Addison's Disease (5 main, 3 sub)
    • Decreased blood glucose levels
    • Inadequate strees response
    • Fatigue
    • Weight loss; frequent infections
    • Low serum sodium concentration
    • --Decreased blood volume
    • --Hypotension
    • --High potassium levels (may cause cardiac arythmias)
  105. Diebetes Mellitus
    • A chronic systemic disorder characterized by hyperglycemia and insulin deficit.
    • Results in abnormal carbohydrate, protein, and fat metabolism
  106. Incidence of Diabetes Mellitus
    • American Diabetes Association: more than 14.6 million Americans diagnosed w/ millions more not diagnosed
    • More than 40 million American may have pre-diabetes or early stages of meatabolic disorder
  107. Insulin
    -what is it responsible for?
    -where is it secreted from?
    • Responsible for appropriate carbohydrate metabolism
    • Secreted by the pancreas
    • Islets of Langerhans
  108. Two Types of DM
    • Type 1 (Juvenile Diabetes/Insulin Dependent Diabetes Mellitus-IDDM) 10% of diabetes
    • Type 2 (Adult Onset/Non-Insulin Dependent Diabetes Mellitus) 90% of diabetes
  109. Type 1 Diabetes
    -what does it result from
    -who does it affect
    -patients have low levels of _______ which means they require ________ ______ __________ _______
    • Results from the auto immune destruction of islet cells of the pancreas
    • usually effects children and young adults
    • Sudden onset
    • Genetic component
    • Patients have very low levels of circulating insulin
    • Require life long exogenous inslin
    • Patients do not secrete adequate insulin to sustain necessary physiological functions
    • Insulin is required to facilitate the movement of glucose from the blood stream into the cells
    • Patients with type 1 diabetes will have high levels of circulating glucose (blood sugar) because the glucose cannot move into the cells to be metabolized
  110. Type 2 Diabetes
    -which kind of medications are used
    -what may the 2 causes be?
    -associated with what
    • Non-Insulin Dependent
    • Oral hypoglycemic medications may be used
    • Caused by decreased production of insulin/increased resistance by body cells to insulin
    • Onset is slow and insidous and usually in 50+ ages
    • Associated with obesity
    • Increased incidence in teens and young adults
  111. General Manifestations of Diabetes
    • Insulin deficit results in decreased trasportation and use of glucose in many cells (polyphagia & fatigue)
    • Blood Glucose levels rise --hyperglycemia
    • Excess glucose in urine glucosuria (dehydration results from hypersmolar filtrate--polyuria--polydipsia)
    • Diagnosed with a blood test (fasting blood glucose test-- 70-110mg)
    • Glycosylated hemoglobin test (HbA1c)--clinical and subclinical diabetes--monitor glucose levels over several months
  112. Treatment of Diabetes
    • Maintenance of blood glucose levels in normal range (reduced complications)
    • Diet & Exercise (reduces blood glucose as skeletal muscle uses glucose)
    • Oral medication (increases insulin secretion & reduces blood glucose levels)
    • Insulin replacement

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