Clinical Pathologies 1

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Clinical Pathologies 1
2010-08-13 20:34:52

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  1. Dysplasia
    Changes in size, shape or organization of cells

    Can be precancerous condition
  2. Hyperplasia
    Increased number of cells.

    Not always pathological (high altitude = increase in RBC’s)
  3. Hypertrophy
    Enlarged cells

    Physiological (hormonal) hypertrophy - occurs normally during puberty. Can occur in response to anabolic steroid abuse.

    Increased functional demand - exercise increases muscle fiber size. (Hypertension increases left ventricular myocardial fiber size)
  4. Hypoplasia
    Decreased number of cells
  5. Hypotrophy (atrophy)
    Cells are smaller than normal
  6. Pleomorphism
    Many different sizes and shapes of cells.

    Can also have nuclear pleomorphism.
  7. Anaplasia
    Dedifferentiation of a cell type.

    Existing cells don't actually dedifferentiate, but new, neoplastic cells are less differentiated than normal cells. In case of malignancies, degree of anaplasia determines degree of malignancy, i.e. less differentiated cells are typically indicative of a more malignant neoplasm.
  8. Metaplasia
    Change from one cell type or tissue type to another as a result of physical or chemical stress to a tissue.

    Simple epithelia can become stratified in response to physical stress

    Chronic gastric reflux into lower esophagus causes the stratified squamous epithelium to become a gastric-like epithelium that secretes mucus (Barrett's epithelium). The mucus protects against acid and pepsin.
  9. Classification of Epithelial Tumors
    • Benign
    • 1. Papilloma
    • 2. Adenoma

    • Malignant
    • 1. Carcinoma - many types (i.e. adenocarcinoma)
  10. Factors affecting malignancy are:
    • 1. Anaplasia
    • 2. Mitotic activity (more activity = greater malignancy)
    • 3. Invasion (ability to breach basal laminae)
    • 4. Metastases (spread to distant sites)
  11. Papilloma
    Benign tumor arising from a surface epithelium
  12. Adenoma
    Benign tumor arising from a glandular epithelium
  13. Adenocarcinoma
    Malignant tumor (carcinoma) arising from glandular tissue
  14. The process by which epithelium of the esophagus changes from stratified squamous non-keratinized to simple columnar mucus-secreting cells?
  15. Accumulation of tissue fluid component of connective tissue.
  16. Radiographs
    • Best suited for bone
    • (also picks up densities in tissues)

    film is positioned closest to the object of interest
  17. Computerized Tomography (CT Scan)
    • Best for dense tissues and structures
    • (excellent for bone!)

    Spiral x-ray gives a series of axial plane images

    Images viewed as if you are standing at the patient's feet
  18. Magnetic Resonance Imaging (MRI)
    • Best for soft tissue details (i.e. brain)
    • Provides little information on bones

    Modality of choice for IV disc herniation

    • Protons (H+) alligned by magnetic field
    • (safe - no ionizing radiation)
  19. Ultrasonography
    Best used for studying tissue in real time

    Uses sound waves (1-10 MHZ)
  20. Increase in thoracic curvature
    Excessive kyphosis

    • postural change with aging and poor habit
    • compression fracture of a thoracic vertebral body due to osteoporosis
  21. Increase in lumbar curvature
    Excessive lordosis

    • poor postural habit
    • muscle imbalances (weak abdominals)
    • large abdomen (obesity)
    • pregnancy
  22. Scoliosis
    Lateral curvature of the spine coupled with rotation

    Spinous processes point to concavity of abnormal curve (fryette's principle)

    • Congenital (hemi vertebra)
    • Abnormal muscle tone (polio, c. palsy)
    • Idiopathic (infancy-early adolescence)
  23. Spina Bifida
    Two sides of vertebral arches, usually in lower vertebrae, fail to fuse during development resulting in an "open" vertebral canal

    • Occulta - defect in bone only - asymptomatic
    • Cystica - Defect in bone/meninges - neurolgical involvement
  24. Most common IV disc herniation
    L4/5 IV Disc
  25. What ligament aids in extension?
    Ligamentum Flavum
  26. What structures limit full flexion of vertebral column
    Posterior longitudinal ligament

    Ligamentum flavum

    Interspinous ligament

    Supraspinous ligament

    Facet joint capsules

    Intervertebral discs
  27. What structures limit full extension of vertebral column
    Anterior longitudinal ligament

    Anterior body musculature
  28. Lumbarization vs. Sacralization
    Lumbarization = 6 lumbar & 4 sacral vertebra

    Sacralization = 4 lumbar & 6 sacral vertebra
  29. Lumbar Spondylolisthesis
    Spondylolisthesis is the forward displacement of one vertebrae relative to the one below

    Bilateral fracture of pars interarticularis

    (L5/S1 most common)
  30. Cervical Spondylolisthesis
    Spondylolisthesis is the forward displacement of one vertebrae relative to the one below

    • Bilateral fracture of pedicle
  31. Spondylolysis vs. Spondylolisthesis
    Spondylolysis - Fracture

    Spondylolisthesis - Slippage
  32. Ossification of atlantoccipital membrane
    Restricts blood flow to the brain
  33. Winged scapula
    Lesion of dorsal scapular nerve
  34. Bullous Pemphigoid

    • Antibodies bind to proteins associated w/ hemidesmosomes
    • They detach from basement membrane

    Causes blisters
  35. Kartegener's Syndrome
    Absence of dynein - cilia are immobile

    • Frequent resp. infections
    • Males are infertile
  36. Ehler Danlos
    Genetic disturbance in collagen synthesis

    • 1) defect in procollagen peptidase - forms defective collagen fibrils
    • 2) defect in enzyme lysyl hydroxylase (lysine->hydroxylysine)

    Joint dislocation / hyperelastic skin / pseudotumor over elbow
  37. Marfan's Syndrome
    • Autosomal dominant defect in fibrillin gene (fibrillin 1)
    • Forms abnormal elastic tissue
    • CV abnormalities / dissecting aneurysm of aorta / arachnodactyly
  38. Prader-Willi Syndrome
    • Overproduction of ghrelin
  39. What causes edema?
    • high hydrostatic pressure (congestive heart failure)
    • low colloid osmotic pressure (starvation)
  40. Osteoarthritis
    Erosion of the articular (hyaline) cartilage

    (two layers on the distal end of the femur: fibrocartilge / hyalin cartilage)
  41. Effects of hormones on hyaline cartilage
    Cortisone, hydrocortisone - inhibits cartilage histogenesis, growth and matrix production

    Thyroxine, Testosterone, Somatotrophin - stimulate cartilage histogenesis
  42. Scurvy
    Vitamin C deficiency - enzyme cofactor for collagen synthesis

    Hyaline matrix production stops. Distorts cartilage columns in epiphyseal plates

    Poor bone growth / fracture repair
  43. Osteoporosis
    Bones loss (lose organic matrix and mineral components; ratio = normal)

    There are 3 vitamin K dependant calcium binding proteins produced by osteoblast that are necessary for the mineralization of bone
  44. Estrogen effects on bone
    • Maintains bone density in both sexes
    • inhibits bone resorption

    (testes and adrenals produce estrogen)
  45. What causes rapid loss of bone density?
    After menopause

    During periods of disuse (immobilization)
  46. What marrow is used for biopsy / transplant?
    Red Bone Marrow (sternum and iliac crest)
  47. Osteomalacia
    Impaired mineralization of bone matrix (soft bones)

    Due to vitamin D deficiency which causes deficient calcium & phosphorus absorption in the gut.

    In children/growing bone vitamin D deficiency leads to Rickets
  48. Osteogenesis imperfecta
    “Brittle Bone Disease”

    Genetic disorder of type I collagen characterized by repeated fractures after minor trauma, thin skin, weak tendons, and in certain subtypes blue sclerae
  49. Pituitary Dwarfism
    Deficiency of growth hormone (somatotropin) during the developing years leads to failure of bone growth.
  50. Gigantism
    Excess growth hormone during the developing years (prior to the closure epiphyseal plate) leads to an abnormal increase in the length of bones
  51. Acromegaly
    Excess growth hormone in adulthood leads to thickening of the bones since the growth (epiphyseal) plates have already closed.
  52. Duchenne's Muscular Dystrophy
    Absense of dystrophin (x-linked)

    • Focal fat replacement of muscle fibers
    • Hypertrophic myofibers
    • Increased endomysial fibrosis
    • (causes pseudohypertrophy seen in calves of patients)
  53. Role of dystrophin in muscular dystrophy
    Dystrophin – a cytoskeletal protein located beneath the sarcolema and plays a role in linking to laminin (ECM protein)
  54. Myesthenia Gravis
    • Antibodies made to ACh receptor (autoimmune)
    • prevents ACh from binding to receptors on post-synaptic membranes

    • Progressive weakness: remits with rest / worse with exercise
    • Drooping eyelids / weakness of eye muscles
  55. Amyotrophic Lateral Sclerosis (ALS)
    "Lou Gehrig’s Disease"

    • Denervation atrophy
    • Most common motor neuron disease
  56. Myocardial Infarction (MI)
    Necrosis of cardiac muscle cells due to prolonged ischemia

    Repaired by fibrous connective tissue (function in heart is lost)

    • Assess damage by measuring serum enzymes
    • (serum cardiac specific troponin)
  57. Lymphadenopathy
    Increased size of lymphoid tissue

    Increase number and size of lymphocytes and other cellular pools
  58. Hyperplasia of GALT
    Primary infection

    May cause bowel obstruction in children
  59. Non-specific lymphadenitis
    Follicular hyperplasia

    • Caused by chronic infection and inflammation
    • (RA, toxoplasmosis, early HIV)
  60. Paracortical lymphoid hyperplasia
    Reaction / activation of T-cells

    • Normal structure of B-cell region may disappear
    • Caused by viral infection / drug reaction
  61. Sinus histiocytosis
    Distention and proliferation of sinusoids (non-specific)

    Frequent in cases of malignancy in regional lymph nodes
  62. AC Joint disorders
    AC Dislocation = tear the acromioclavicular ligament.

    AC Separation = dislocation + tear of coracoclavicular ligaments
  63. Fracture at the surgical neck of humerus can injure what structures?
    Axillary N.

    Posterior Circumflex Humeral A.
  64. Rotator cuff tear
    Typically involves supraspinatus m.

    Difficulty abducting / flexing the arm