Path II3

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Path II3
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  1. Lymphoma
    neoplasm of lymphocytes arising as a solid tissue mass in organs other than the bone marrow
  2. Lymphocytic leukemia
    • neoplasm od lymphoid cells that originates from bone marrow
    • can be found in blood (leukemic) or not (aleukemic)
  3. Acute myeloid leukemia (AML)
    • usually leukocytosis
    • undifferentiated blast cells in blood
    • >20% nucleated cells are blasts and >50% total nonerythroid cells are nucleated cell pop
    • blast cell origin cannot be determined by morphology alone
  4. Chronic myeloid leukemia
    • slowly progresses
    • older animals
    • clonal neoplastic proliferations of mature granulocytes, monocytes, erythrocytes, or platelets
    • leucocytosis
    • bone marrow hypercellularity
    • blast crisis- transformation to acute myeloid leukemia
  5. Myelodysplastic syndrome (MDS)
    • pre-leukemic condition
    • <20% blast cells in bone marrow
    • hypercellular bone marrow
    • associated with FeLV
    • possible leukopenia, anemia, thrombocytopenia
    • anemia is nonreg, macrocytic, lack polychromasia, metarubricytes present
    • macrocytosis, abnormal nuclear lobulation
  6. Mast cell neoplasm
    • subset of CFU-GEMM
    • common in dogs, common in skin (consider malignant)
    • cats- skin or visceral (single= bengin, multiple= malignant)
    • mast cell leukemia- formed bad in marrow and released into blood- GI common and release histamine
  7. Histocytic neoplasia
    • cell of mac, dendritic, or langerhan cell lineage
    • common in dogs
    • cutaneous, canine cutaneous, systemic, sarcoma complex
  8. Canine cutaneous histiocytoma
    • unique in young dogs
    • neoplasm of dendritic Ag presenting and Langerhans cells
    • benign
    • solitary
    • excision to cure
    • spontaeously regress
    • cherry red lesion
  9. cutaneous histiocytosis
    • benign
    • multiple lesions
    • wax and wane
    • mostly reactive
  10. Systemic histiocytosis
    • multiple lesions
    • involves regional LN
    • reactive
  11. histiocytic sarcoma complex
    • solitary
    • extends beyond regional LN and involves visceral tissues
    • Bernese mountain dogs
  12. neutrophils in cytology
    • not normally present
    • short life span (12-24hr)
    • non degenerate- none septic mostly
    • degenerate- sepsis
  13. eosinophils in cytology
    • not normally present
    • casuses- hypersensitivity, allergic response, parasites, mast cell tumor, T cell lymphoma, fungal inf, idiopathic
  14. macrophages in cytology
    • aka- histiocytes
    • small numbers normally
    • chronic infection
    • causes- fungal inf, necrosis, foreign body, complex bac, neoplasia
  15. epithelioid macrophage
    • not normally present
    • produce cytokines, Ag presenting
  16. multinucleated giant cell
    • not normally present
    • frustrated phagocytosis
    • granulomatous and pyogranulomatous
  17. mast cell
    • not normally present
    • granules may not stain in Diff- Quik
    • cause- hypersensitivity, mast cell tumor
  18. Lymphocytes
    • not normally present
    • cause- plasma cell tumor
  19. suppurative inflammation
    • 85% neutrophils
    • septic or mycotic?
    • degenerate or nondegenerate neutrophils?
    • usually acute
  20. eosinophilic inflammation
    • 50% eosinophils
    • could be suppurative and eosinophilic inf
    • septic or mycotic?
    • causes- parasite, hypersensitive, mast cell tumor, T cell lymphoma, allergic rxn, idiopathic
  21. mixed inflammation
    • neutrophils, mononuclear cells, eosinophils, mast cells
    • chronicity
  22. pyogranulomatous inflammation
    • neutrophils and macs
    • multinucleated giant cells or epithelioid macs
    • causes- foreign body, fungi
  23. granulomatous inflammation
    • lacks neutrophils
    • multinucleated giant cells
  24. lymphocytic or lymphoplasmacytic inflammation
    inc in small lymphs and plasma cells in non-lymphoid tissue
  25. RBC in cytology
    • contamination- RBCs with platelets
    • hemorrhage- erythrophagocytosis, hemosiderophages, hemosiderin
  26. Basic mechanisms for body cavity effusions
    • dec plasma oncotic press
    • inc hydrostatic press
    • lyph obstruction
    • inc vascular permeability
  27. transudate
    • low total protein and low nucleated cell counts
    • non-inflammatory- hypoalbuminemia, lymph obstruction, inc blood press
  28. Modified transudate
    • mildly inc nucleated cells and protein
    • cause- R sided heart failure, neoplasia, infection (FIP)
  29. exudate
    • high total protein and nucleated cell counts
    • mostly neutrophils
    • cause- inflammation from sepsis, perforated intestine, neoplasia, necrosis
    • suppurative, mixed cell, lymphocytic, eosinophilic?
    • septic or mycotic?
  30. Equine peritoneal fluid
    • normal- transudate
    • nucleated cell count normally higher
    • modified transudate- impaction, gastritis, early GI lesions
    • exudate- ruptured gut, intussusception, colitis
  31. chylous effusion
    • causes- leakage secondary to trauma, heart failure, neoplasia, obstruction, idiopathic
    • milky white fluid
    • lipid will falsely inc TP
    • tryglicerides higher in fluid than serum
    • cholesterol lower in fluid than serum
  32. hemorrhagic effusion
    • lots of RBCs
    • erythrophogocytosis, hemosiderin, hemotoidin
    • no inflammation
    • no platelets
  33. Cerebrospinal fluid (CSF)
    • clot tube
    • microprotein- low
    • pandy- est of Ig- none or trace
    • cell count- few nucleated, no RBC
    • pleocytosis- inc nucleated cells
  34. pleocytosis
    • inc number nucleated cells in CSF
    • microprotein usually also increased
    • neutrophilic (IVD, immune mediated, FPT), eosinophilic, large mononuclear, mixed cell, lymphocytic
  35. synovial fluid
    • highly viscous from hyaluronic acid
    • mucin clot test
    • TP and cell count- must add hyaluronidase to dec viscosity
    • supurative, mononuclear, or mixed cell inf
  36. suppurative inflammation of synovial joint
    • inc nucleated cell counts- primarily neutrophils
    • sepsis- assume if horse
    • immune mediated dz- assume if dog
    • trauma
  37. neoplasia in cytology
    • monomorphic population
    • benign-
  38. benign cells
    • well differentiated
    • slow growth
    • uniform in size
    • blue staining cytoplasm
    • uniform N:C ratio
    • no mitotic figures
    • ddx: hyperplasia
  39. malignant cells
    • mitotic activity
    • high cellularity
    • abnormal cell type for that area
    • monomorphic cells with pleomorphism
    • anisocytosis and macrocytosis
    • basophilic cytoplasm
    • nuclear pleomorphism
    • anisokaryosis
    • variable N:C ratios
    • multinucleation
    • nuclear molding
    • inc mitotic figures
    • abnormal chromatin patterns
    • macronucleoli
    • multiple nucleoli
    • abnormal shaped nucleoli
    • anisonucleoliosis
  40. epithelial tumors
    • small, round cells
    • highly cellular
    • clustering nature
    • benign- oma
    • malignant- carcinoma
    • ex- skin, intestine lining, lung, liver
  41. mesenchymal tumors
    • spindle or round cells
    • low to mod cellularity
    • not in cohesive sheets
    • protein background
    • benign- oma
    • malignant- sarcoma
    • ex- CT, bone, muscle, cartilage
  42. round cell tumor
    • round cells
    • high cellularity
    • cells do not have cohesion
    • cutaneous histiocytoma, lymphoma, cutaneous mast cell tumor, plasma cell tumor, transmissible venereal tumor, histiocytic neoplasia
  43. cutaneous histiocytoma
    • benign
    • young dogs
    • small button like raised mass
    • Langerhan cells
    • many lymphocytes present
    • spontaneous regression
  44. lymphoma
    • malignant
    • normal lymph tissue 90% small lymphocytes
    • with lymphoma >50% immature lymphocytes
  45. cutaneous mast cell tumor
    • benign or malignant (tx like malignant)
    • cells with purple granules
    • eosinophils may be present
    • poor granulation= poor prognosis
    • not as bad in cats
  46. plasma cell tumors
    • benign or malignant
    • cutaneous near footpad
    • if in bone marrow- malignant
    • flame cells
  47. transmissible venereal tumor (TVT)
    • malignant, but excellent prognosis
    • dogs on genitalia or face
    • spread by direct contact
    • small peripheralized and uniformly sized and shaped clear cytoplasmic vacuoles
  48. histiocytic neoplasm
    • malignant or benign
    • spleen, bone marrow, lung, liver
    • originate from macs
  49. malignant melenoma
    • neuroectoderm origin
    • round, mesenchymal, epithelial
    • greenish- black cytoplasm
  50. basic events in normal clot formation
    • vasoconstriction
    • platelet adhesion
    • conformation change of platelets
    • platelet aggregation
    • clotting path activation
    • fibrin meshwork
    • resolution of clot formation thru fibrinolysis
  51. blood vessel endothelium contents
    • anticoagulant- antithrombin, tissue plasminogen activator, tissue factor pathway inhibitor
    • procoagulant- prothrombin, vWF, plasminogen activator inhibitor, endothelin
  52. platelets
    • primary hemostasis
    • live 7-10 days
    • bind to vWF on endothelial collagen in damaged blood vessels
    • conformational change enhances binding, expose phospholipids, release thromboxane/Ca/platelet activating factor
    • form loose plug
  53. Thromboxane (TxA2)
    • released from platelets
    • vasoconstriction
    • platelet aggregation
  54. clotting factor pathway activation
    • secondary hemostasis
    • named with a roman numeral
    • non-activated or resting factor (ex- X, VII)
    • activated factors (ex- Xa, VIIa)
    • most factors made by liver (except IV, III)
  55. factor I(a)
    fibrinogen (fibrin)
  56. factor II(a)
    prothrombin (thrombin)
  57. factor III
    tissue factor
  58. factor IV
    Ca
  59. clotting factors that require vit K
    II, VII, IX, X, protein C&S
  60. exception for factor V and VIII
    • all other factors have enzymatic activity so thy are not consumed in the reaction to activate the clotting path
    • factors V and VIII are consumed so prone to consumption if liver cannot keep up prod
  61. intrinsic pathway
    • XII, XI, IX, VIII
    • HMWK and PK
  62. extrinsic pathway
    • VII
    • Ca
  63. common pathway
    X, II, I
  64. inactivation of clotting pathway
    • tissue factor pathway inhibitor (TFPI)- inactivates VIIa
    • antithrombin- inactivates IIa- amplified by heparan
    • thrombomodulin- activates protein C which combines with S and inactivates V and VIII
  65. fibrinolysis
    • initially plasminogen activator inhibitor is released
    • when healing tissue releases tissue factor plasminogen activator
    • fibrin must be present for plasminogen to convert to plasmin
    • plasmin breaks down clot
    • plasmin is a protease so if free then alpha-2 antiplasmin inactivates it
  66. quanitative platelet disorders
    • thrombocytopenia
    • thrombocytosis
  67. thrombocytopenia
    • hemorrhage when platelets are <25,000
    • normal bone marrow response is megakaryocytic hyperplasia
    • causes- sequestration, consumption (DIC), destruction (IMHA/IMT), hemorrhage, dec production
  68. thrombocytosis
    • reactive- most common, iron deficiency or anemia lead to erythroid hyperplasia and a piggyback megakaryocytic hyperplasia
    • physiologic- splenic contraction, transient
    • neoplastic- essential thrombocythemia (ET)
  69. qualitative platelet disorders
    • hereditary primary platelet defects
    • von Willebrand Disease
    • acquired platelet dysfunction
  70. hereditary primary platelet defects
    • glazmann's thrombasthenia- otterhound, great pyrenees
    • chediak-higashi syndrome- persian cat, hereford cattle
  71. von Willebrand Disease
    • appears as a platelet defect
    • platelet numbers and fxn are normal
    • produced and stored in endothelial cells and bound to VIII
    • type I- fewer numbers of all sizes, doberman
    • type II- loss of high molecular weight multimers, GSP, severe bleeding
    • type III- loss of all multimers, scottish terrrier, shetland sheepdog, severe bleeding
  72. acquired platelet dysfunction
    • aspirin- loss of TxA2
    • DIC
  73. buccal mucosal bleeding time test (BMT)
    • assess formation of platelet plug only
    • 2-4 min
    • do not do if low platelets
    • prolonged= vWD, qualitative platelet defects
  74. deficiency of XI and XII
    • do not cause much bleeding bc alternate path
    • XI- cattle
    • XII- cats
  75. deficiency of VII
    • minor bleeding prob
    • boxer, beagle, malamute
  76. deficiency of V, IX, X, VIII
    • severe bleeding
    • boxer, cocker
  77. vit K deficiency
    • V, VII, IX, X
    • protein C&S
    • cause- rodenticide toxicity, moldy sweet clover
  78. coagulation test
    • Na citrate tube
    • fill to proper level
    • centrifuge ASAP
    • measures time to form clot in tube
    • platelets not present
  79. activated clotting time (ACT)
    • grey top
    • whole blood
    • must be less than 5% of normal (95% dec)- insensitive
    • intrinsic and common path
    • do not perform with severe thrombocytopenia
  80. activated partial thromboplastin time (APTT)
    • intrinsic and common path
    • must be less than 30% of normal (70% dec)
  81. prothrombin time (PT)
    • VII and common path
    • best test for vit K deficiency bc VII affected first
    • nust be less than 30% of normal (70% dec)
  82. D-dimer
    specific breakdown product of cross linked fibrin and so measuring this substance is a better way to evaluate if fibrinolysis of the clot is occuring
  83. FDPs
    increased= DIC, thrombotic dz, liver dz, hemorrhage
  84. hypercoagulability
    • inc platelet activity
    • inc coag factors
    • dec natural inhibitors
  85. antithrombin
    • percent activity compared to a normal standard
    • hepatic insufficiency, protein losing nephropathy, DIC
  86. disseminated intravascular coagulation (DIC)
    • multifactoral- widespread fibrin formation
    • consumption of platelets, coag factors, natural inhibitors, fibrinolytic factors
    • results in thrombosis
    • ischemia and anoxia leads to acidosis
  87. underlying mech for DIC
    • stagnant blood flow
    • endothelial damage
    • release of tissue factors
  88. clinical signs of DIC
    • petechia
    • ecchymoses
    • frank hemorrhage
  89. diagnosis of DIC
    • three of any of the following:
    • thrombocytopenia
    • prolonged PT/APTT
    • inc D-dimer
    • dec fibrinogen
    • dec antithrombin
    • schistocytes
  90. Enzyme summary
    • measurements are based on degree of activity not quantity
    • international units per L
    • do not have fxn in blood
    • dec levels are non-diagnostic
    • inc levels= damaged cells, induction, neoplasia, dec clearance, ingestion
    • degree of enzyme elevation correlates to the degree of cellular damage (does not mean diffuse)
    • 3-5 fold inc is significant
  91. clinical signs associated with hepatic dz
    • lethargy
    • dep
    • icterus
    • bleeding
    • vomiting
  92. lab results associated with liver dz
    • anemia, acanthocytes
    • hypoproteinemia
    • ammonium biurate crystals
    • abnormal coagulation profiles
    • transudate
  93. hepatocellular damage
    • ALT, AST, GLD, SDH
    • near vessels so quick inc in blood
    • leakage from ruptured cells
  94. cholestasis
    • LALP
    • GGT
    • then ALT, AST, GLD, SDH
    • intra or extrahepatic
    • induction of enzyme activity by press
  95. hepatic insufficiency
    • hypoglycemia/albuminemia
    • portosystemic shunt- microhepatica
    • down reg of albumin
    • chronic liver dz
    • inc albumin loss
    • horse albumin has long half life
  96. Alanine transaminase (ALT)
    • liver
    • half life dog-3d, cat-3.5hr
    • inc may result from glucocorticoid or anticonvulsant
    • not run in LA
  97. Aspartate traansaminase (AST)
    • mitochondria- liver and skeletal mm
    • half life dog-12hr, cat-1.5hr, horse-8d
    • not run in SA
  98. Iditol or sorbitol dehydrogenase (ID, SDH)
    • acute injury
    • not run in SA
  99. Alkaline phosphate (ALP)
    • intestine, liver, bone
    • L-ALP half life dog-3d, cat-6hr
    • corticosteroid induced ALP in dogs
    • causes for inc= cholestasis (SA), phenobarb, young growing animal, mammary neoplasm, corticosteroid, hepatic lipidosis, hyperthyroidism
  100. gamma-glutamyl transferase (GGT)
    • liver, bile duct, renal
    • half life 3d
    • causes of inc= corticosteroids, colostrum, cholestasis (SA and horses), biliary neoplasia

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