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micropathology-Rae Shock
Rae Shock
142
Medical
Graduate
09/07/2011

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Term
what are the 3 types o cell injury?
Definition
1.Reversible (cell recovery)
2. apoptosis
3. necrosis
Term
what enzymes become elevated in blood with heart damage?
Definition
1.AST
2.CK-MB/CK2
3.LDH
Term
what enzymes become elevated in blood with liver damage?
Definition
1.ALT
2.AST
3.Alkaline phosphatase
4.LDH
Term
what enzymes become elevated in blood with pancreatic damage?
Definition
1.amylase
2.lipase
Term
what enzymes become elevated in blood with muscle damage?
Definition
1. CK-MM(CK-3)
2.LDH
3.AST
Term
what are 4 ultrastructural changes in reversible cell injury?
Definition
1.pm alterations...blebbing
2.mito swell & get amorphous
3.diation of ER and ribosomal detachment
4.nuclear alterations
Term
what is the most common change in cell injury?
Definition
cellular swelling
Term
what are the 5 distinct patterns of change in reversible cell injury?
Definition
*1. cellular swelling
*2. hydropic changes/vacuolar degen
*3. fatty changes
4. Hyaline
5. Glycogen
Term
what is an early manifestation of all types of cell injury?
Definition
cellular swelling-reversible but considered to be sublethal
Term
this is usually seen in poisonings like CCl4, polychorinated biphenyls,fever, chicken pox,herpes,hypokalemia
Definition
Hydropic change/vacuolar degeneration. more severe than cellular swelling-cisternae of ER dilate, rupture and form discrete water pockets
Term
any abnormal accumulation of triglycerides within parenchymal cells
Definition
steatosis...most common cause alcoholism. lack of choline & methionine render liver unable to mobilize fat. most freq in liver,CNS, spleen, kidneys, skeletal muscle and occasionally heart
Term
name 4 metabolic disorders of fat metabolism
Definition
1. Lysosomal storage diseases (gauchers,tay,neimann)
2.Steatorrhea
3. Lipofuscin
4. Hand Schuller Christian Disease
Term
excess fat around organs
Definition
marbeling
Term
one of the patterns of reversible cell injury, condition in which there is accumulation of proteins within cells
Definition
hyaline degeneration-"glassy" 1. metabolites from protein digestion get released from lysosomes damaging cellular organelles 2. excess intracellular protein can push against organelles disrupting function and communication
Term
what are 5 types of hyaline degen?
Definition
1.Zenker's (waxy) degen-skel m.
2.Malloy bodies-liver, alcoholism
3.Counciman bodies-acidophilic or apoptopic
4.Crooke's-pit gland & cushing's-+ cortisol
5.Russel bodies-b lymphs, mott cell
Term
what is the most common lysosomal storage disease that stems from steatosis?
Definition
Gaucher's-glucocerebricides build up in RE cells,pinguecula in eyes, "wrinkled tissue paper in cells"
Term
lysosomal disease where gangliosides build up in brain
Definition
tay sachs->mental retardation, death by 2-3yo
Term
lysosomal storage disease with sphingomyelin and cholesterol involvement
Definition
Neimann-Picks-spleen,liver, marrow, lymph nodes, lungs,CNS
Term
abnormal proteinaceous substance that is deposited in many cells and organs of the body in a variety of clinical disorders
Definition
AMYLOIDOSIS. rare disease and cause is unknown-Vit C def,cronic infections,RA,hodgkins, horses hyperimmunized for diptheria antitoxin production
Term
ability of WBCs to move toward an injured area/ response to stimulus of inflammation/and or injury
Definition
chemotaxis
Term
accumulation of intermdiate filaments in liver cells in alcoholic liver disease
Definition
mallory bodies
Term
exogenous material brought into cell via endocytosis or phagocytosis
Definition
heterophagy-ex.neutrophils
Term
cell removes its own damaged organelles
Definition
autophagy
Term
lysosomes with undigested particles which may or may not be extruded eventually
Definition
residual bodies
Term
benign tumors having abundant & enlarged forms (found in kidney, thyroid, parathyroid, & salivary glands)
Definition
oncocytoma
Term
aka for heat shock proteins
Definition
chaperonins-normally produced in cells playing roles in: intracellular housekeeping, protein folding, disaggregation, transport
Term
class of functionally related proteins whose expression is increased when cells are exposed to elevated temperatures or other stress
Definition
heat shock proteins
Term
because heat shock proteins function as chaperones for other proteins, they play an important role in folding. What diseases can ensue from abnormal HSPs?
Definition
-Alzheimer's
-Creutzfeldt-Jacob disease
-Mad Cow-refolding problem of prions
Term
what is the first observable evidence of intracellular damage
Definition
Mito and plasma membrane-within 15min, mito form fine granules and pm thickens-blebs
Term
endocytotic invaginations on membrane
Definition
bleb
Term
what are the 3 intracellular changes in injury and death of the cytoplasm? (becomes homogenous and eosinophilic)
Definition
1. mito and pm change
2.increase water and sodium accumulation
3. disorganization - lysosomes disappear, fat accumulates at fat droplets
Term
what are 3 changes due to breakdown of DNA?
Definition
1. pyknosis-stains dif-blue
2. karyorrhexis-nuclear dust
3. karyolysis
Term
what are the 7 types of necrosis?
Definition
1.coagulative
2.liquefactive
3.caseous
4.fat
5.gangrenous
6.gummatous
7.fibrinoid
Term
which type of necrosis is never found in the brain?
Definition
coagulative
Term
which tissues are most freq involved in coagulative necrosis?
Definition
1.heart (infarcts)
2.kidney
spleen,lungs,adrenal glands
Term
what is the cause of coagulative necrosis?
Definition
ischemic cell death followed by protein degredation, something to do w/increased intracellular calcium->opaque,dry, yellowish mass
Term
characteristic of focal bacterial or fungal infections and CNS
Definition
liquefactive necrosis "colliquative"->WBC abcess,pus from hydrolases released from PMNs liquify bacteria
Term
examples of liquifactive necrosis
Definition
boils,carbuncles,furuncles->brain infarcts
Term
what can cause fat necrosis?
Definition
trauma, abnormal release of pancreas enzymes-lipase->chalky white flecks. saponification. fatty acids combine with Ca,Na,Mg and create soaps
Term
what causes caseous necrosis?
Definition
granulomatous inflammation-interactions of T lymphs,macrophages and cytokines. TB,Pott's disease,Tularemia,L. venereum-disease carried by chlamydia
Term
what is the appearance of caseous necrosis?
Definition
white, cheesy,putty,bubos
Term
necrosis with bacterial activity
Definition
gangrene
Term
this type of necrosis results from interference in blood supply (ischemia)
Definition
dry gangrene-no bacteria involved-skin appears dry,brown or black. ergotism-mycotoxin C. purpurea on grain->acral
Term
bed sores aka decubitus ulcers are a form of___ caused by ___
Definition
gas gangrene, pressure
Term
tertiary syphillis causes which type of necrosis?
Definition
gummatous
Term
what is the first most noticeable sign of somatic death?
Definition
complete cessation of respiration and circulation. skin->pale,yellow. CO poisoning->sometimes lips and cheeks stay life like
Term
what is algor mortis and when does it occur?
Definition
cooling of body. starts gradually then speeds up. 1st 3 hrs after death decrease of 3.5 and then 1.5 per hour
Term
stiffening of body is called
Definition
rigor mortis
Term
what is the cause of body stiffening after death?
Definition
carbs breakdown and ATP in muscle gets depleted; interferes with actin and myosin leading t stiffness as acidic compounds accumulate in muscle. As cellular proteins degen and actin and myosin fibers decompose, it goes away=putrefaction (24-36hrs after death)
Term
postmortem hypostasis
Definition
livor mortis. lividity=skin discoloration=bluish color from pooling of blood in capillaries
Term
what is the 1st distinctive sign of putrefaction?
Definition
green discoloration of abdomen caused by post mortem disinegration of blood
Term
what is the order of disinegration of blood in putrefaction?
Definition
stomach lining,gall bladder,small intestines,brain, kidney tubules
Term
mass formed from blood constituents within a vessel or the heart during life
Definition
thrombosis. physiological protective mechanism but can become pathological
Term
which protein is a good test for inflammation?
Definition
C Reactive Protein. Its physiological role is to bind to phosphocholine expressed on the surface of dead or dying cells (and some types of bacteria) in order to activate the complement system via the C1Q complex.
Term
what is a Virchow's Triad?
Definition
--all lead to thrombosis
1. Endothelial injury
2. blood flow changes
3. Hypercoagulability
Term
what do endothelial cells make normally in order to prevent thrombosis?
Definition
1. nitric oxide
2.prostacyclin
3.antithrombin
Term
thrombosis is started by a release of ___ and ___activators
Definition
vasoconstrictors,platelet. endothelin & von willebrand factor->thromboxin A->stimulates more platelets
Term
deformation of vessel walls, swellings or compressions can cause turbulence called
Definition
eddy currents
Term
what are the 5 major charecteristics of thrombi?
Definition
1.Adhere to endothelium
2.bend in direction of blood flow
3.maj form in veins (towards heart)
4.maj break apart and form embolism
5. lines of Zahn
Term
what are 4 areas of freq occurence of thrombi?
Definition
1.Veins of lower extremities
2. varicose veins
3. post-operative patients (esp pelvis)
4. lungs (peripheral area)
Term
the ability of a solid substance to be reduced to smaller pieces with little effort.
Definition
Friability. The opposite of friable is indurated.
Term
an antemortem thrombus exhibits lines of zahn. what are they?
Definition
lines represent that this formed from flowing blood. Pale area=fibrin and platelets. dark area=RBCs
Term
T or F. a postmortem clot adheres to a vessel wall.
Definition
False. Blood moves to an area, clots and conforms to a vessel wall not adheres
Term
what do postmortem clots look like?
Definition
Gelatinous, rubbery, moist. Part where RBCs settle looks like dark currant jelly and top fluid part looks like yellow chicken fat
Term
what is the diff btn arterial and venous thrombi?
Definition
Art=white from platelets, lines of zahn, brain and coronary aa. common. vein=red from RBCs, not well dev lines of zahn maybe bc blood is not moving as fast?
Term
arterial thrombi arising in heart chambers and/or aorta
Definition
mural thrombi
Term
thrombi occuring as a result of damage from microbial or fungal infections--vegetations
Definition
valvular thrombi-endocarditis (strep) aortic and mitral valves most common
Term
5 steps in fate of thrombi
Definition
1.shrinkage and contraction
2. recanalization
3. lysis
4. resolution
5. organized and incorporated into vessel wall
Term
what is a sign of a thromus where one has pain in calf upon dorsiflexion of foot?
Definition
Homan's sign
Term
what is the most important of embolic diseases? caused by?
Definition
Pulmonary emboli blocking flow of pulmonary artery. Deep femoral veins with phlebthrombosis is most likely source
Term
what is the most important cause of arterial thrombosis?
Definition
Atherosclerosis. Most common of the 3 types of arteriosclerosis
Term
arterial inflammation accounting for some cases of thrombosis
Definition
Arteritis (increased C Reactive protein)
Term
what can protect epithelial cells from thrombosis formation?
Definition
Heparin (body's natural blood thinner) PG12 (type of prostaglandin derived from arachadonic acid released during inflammation)
Term
what can protect the liver from thromobosis formation?
Definition
heparin and Antithrombin
Term
a detacted intravascular solid, liquid or gas carried by blood to a site distant from point of origin
Definition
Embolus. Thrombus is stationary, embolus is a thrombus which travels
Term
what are the 11 types of emboli?
Definition
1.pulmonary
2.solid or systemic
3.saddle
4.paradoxical
5.infected
6.amniotic
7.gas
8.fat
9.tumor
10.bone marrow (flail chest)
11.talc (IV drug users)
Term
what is the most common type of emboli?
Definition
pulmonary. 2nd is fat emboli
Term
95% of this type of emboli originate from deep leg veins above knee and usually from post-op patients,CHF
Definition
pulmonary emboli-considered to be the most common preventable death in a patient
Term
this type of emboli usually arises from heart
Definition
solid or systemic. LA-mitral stenosis; LV-MI; mid cereb a=cerebral infarction; mesenteric=intest infarction; renal aa.=wedge shaped paleness in renal cortex
Term
this is the most serious form of thrombi
Definition
Saddle embolus. lodges at bifurcation of vessel, main pulmonary artery
Term
aka crossed embolus
Definition
paradoxical embolus. congenital septal defect...
Term
embolus from ruptured appendix...septic clot
Definition
infected emboli-from pyogenic org
Term
example of a gas emboli
Definition
Caisson's disease-the bends, Nitrogen slow to resolubilize
Term
least likely site for secondary amyloidosis?
Definition
Lungs. Most likely: spleen, kidneys, liver, adrenal glands
Term
giant, atypical histocytes found in Hodgkin's lymphoma
Definition
Reed Sternberg cells
Term
in acute inflammation, what is the most mobile cell present?
Definition
neutrophil
Term
type of necrosis that produces an infarct in the kidney
Definition
coagulation necrosis
Term
liquefaction necrosis occuring in the CNS is followed by
Definition
Cystic formation
Term
an elevated scar resulting from extensive fibrous tissue formation
Definition
keloid. more freq among brunettes and darker skinned people
Term
which organ is most susceptible to enzymatic necrosis?
Definition
pancreas
Term
what produces coagulation necrosis?
Definition
ischemia
Term
liquefaction necrosis is commonly seen where?
Definition
brain infarcts and abcesses (bacterial associated)
Term
coagulation necrosis is seen?
Definition
Myocardial infarcts and in most tissue except brain
Term
which cells do not regenerate after injury?
Definition
sriated muscle and neurons
Term
type of necrosis found in an infarct
Definition
coagulation
Term
the most constant initial finding as a tissue alteration in an area of inflammation
Definition
vasodilation
Term
fat necrosis occurs most freq in
Definition
liver
Term
parenchymatous repair means healing by
Definition
regeneration
Term
why is a venous thrombus not as serious as an arterial?
Definition
extensive collateral circulation
Term
What is the inflammatory response regardless of the agent?
Definition
1.Blood vessels dilate
2.Fluid in cells goes to site-WBCs
3.Proteolytic degradation of extracellular debris
4.connective tissue repair of fibroblasts
Term
what are the cardinal signs of inflammation?
Definition
RTDCF
1.rubor
2.dolor
3.tumor
4.calor
5.functio lasea
Term
what are the 2 basic forms of inflammation?
Definition
1.ACUTE-neutrophils,fluid & plasma protein exudates
2.CHRONIC-lymphs & macrophages, tissue destruction & repair
Term
At what stage of inflammation do you ice?
Definition
Acute-ice (48-72hrs)
Chronic-heat
Subacute-alternate
Term
what is the role of vessels in hemodynamics of inflammation?
Definition
-initial vasoconstriction
-vasodilation (arteries->veins->cap
Term
what happens to the body from vasodilation?
Definition
hyperemia (redness & warmth)
Term
what happens to blood flow in hemodynamics of inflammation?
Definition
-initial acceleration to area then slow down->statis
-Plasma leaks out from vessels leaving more concentrated blood in vessels->thick sludge
Term
What happens to RBCs in inflammation?
Definition
become sticky and adhere to one another in masses, helping in sluddging or packing of blood mass
Term
what happens to the endothelium in inflammation?
Definition
-lining goes from neg charge to pos charge which allows for attraction of WBCs.
Term
what is diapedisis?
Definition
The movement or passage of blood cells, especially white blood cells, through intact capillary walls into surrounding body tissue. Also called migration. Vascular lining perforates during inflammation (intracellular spaces and gaps
Term
what is the hallmark of acute inflammation?
Definition
Edema-(swelling) intravascular pressure and interstitial luid osmotic pressure increases-> edema due to more water and ions into extravascular tissue
Term
what produces transudate?
Definition
blood flow->intravascular hydrostatic pressure->fluid filtration from capillaries to interstitial tissue=fluid mostly water w/few cells and proteins
Term
what produces exudate?
Definition
Inflam. Increased vascular permeability lets protein rich fluid and cells into interstial tissue
Term
what are the 3 steps involved with WBCs and inflammation?
Definition
RAT-
1. rolling-Selectins
2. adhesion-IFA Proteins & Integrin
3. transmigration
Term
Rolling of WBCs produces _ and _ where they stack up next to each other and form a wall
Definition
margination and pavementing
Term
WBCs role in inflammation is phagocytosis and then release of lysosome enzymes. What are the 3 stages of phagocytosis?
Definition
1. Opsonins
2.Engulfment-triggered by opsonins. Pseudopod formation->phagocytic vacuoles in cell
3.killing and degredation
Term
what does the killing and degredation in WBCs after phagocytosis?
Definition
1. superoxidation
2. Halogenation
3. Lipid peroxidation
Term
what happens in stage 1 of phagocytosis in WBCs?
Definition
Opsonins help in recognition and attachment of WBCs and coat bacteria and bind to receptor sites on cells.
EX: IgG & C3 (complement)
Term
what are the 3 types of granulocytes? name an aka
Definition
1. neutrophils
2.Eosinophils
3.Basophils
aka-myelocytes
Agranulocytes are lymphocytes,monocytes
Term
What WBC is the first to arrive in acute inflammation?
Definition
Neutrophils. Phagocytic. Most readily affected by chemotaxis. Also 1st in bacterial infections (antibacterial)
Term
what is chemotaxis?
Definition
Process by which somatic cells, bacteria, and other single-cell or multicellular organisms direct their movements according to certain chemicals in their environment. This is important for bacteria to find food (for example, glucose) by swimming towards the highest concentration of food molecules, or to flee from poisons (for example, phenol). In multicellular organisms, chemotaxis is critical to early development (e.g. movement of sperm towards the egg during fertilization) and subsequent phases of development (e.g. migration of neurons or lymphocytes) as well as in normal function. In addition, it has been recognized that mechanisms that allow chemotaxis in animals can be subverted during cancer metastasis.
Positive chemotaxis occurs if the movement is towards a higher concentration of the chemical in question. Conversely, negative chemotaxis occurs if the movement is in the opposite direction. Chemotaxis is the process by which white blood cells are drawn to the site of inflammation. White blood cells recognize foreign particles through mannose and scavenger receptors. Opsonins are particles that bind to foreign material and signal leukocytes to remove it.
Term
when are eosinophils the key player?
Definition
chronic allergies. phagocytic to Ag/Ab complexes
Term
what cells are the key players in acute allergies?
Definition
Basophils (in blood)->Mast cells in tissues which contain heparin (prevents clotting in inflammation) and histamine (Type 1 Hypersensitivity)
Term
What is edema caused by?
Definition
fluid exudates; high protein content including fibrinogen moving out of dilated vessels (2nd fluid) 1st fluid-transudate; low protein ultrafiltrate of blood plasma
Term
what are 4 things that act as chemotactic agents?
Definition
1.soluble bacterial products
2.components of complement system (C5)
3.products of arachidonic acid metabolism (leukotrienes)
4.cytokines
Term
what are cytokines?
Definition
small cell-signaling protein molecules secreted by the glial cells of the nervous system and by numerous cells of the immune system. category of signaling molecules used extensively in intercellular communication. Can be classified as proteins, peptides, or glycoproteins; the term "cytokine" encompasses a large and diverse family of regulators produced throughout the body by cells of diverse embryological origin.Term "cytokine" has been used to refer to the immunomodulating agents, such as interleukins and interferons. Biochemists disagree as to which molecules should be termed cytokines and which hormones.
Term
what is fibrin and how is it formed?
Definition
fibrillar protein polymerised to form a "mesh" ->hemostatic plug or clot (in conjunction with platelets) over a wound site. Involved in signal transduction, blood coagulation, platelet activation, and protein polymerization. Formed by the conversion of fibrinogen with help of thrombin
Term
what are 4 direct actions to exogenous agents
Definition
1. agglutination-particulate antigens bind into clumps
2. Precipitation-soluble antigens->precipitate
3. neutralization-ant inactivated by antibody
4. Lysis-antibody attacks cell wall->lysis, usually complement assists
Term
What is a complement?
Definition
Plasma proteins playing a role in inflamation and immunity. System of over 30 distinct beta globulins made by liver and found in blood plasma. When IgG or IgM combine with antigen, complement will assist it and the result will be lysis of the cell
Term
What is the rhogam shot for?
Definition
To prevent rheusus disease or hemolytic disease of the newborn. The medicine is a solution of IgG anti-D (anti-RhD) antibodies that bind to, and lead to the destruction of, fetal Rh D positive red blood cells that have passed from the fetal circulation to the maternal circulation.
Term
what does a complement do?
Definition
1st there is a cascade effect after activation by a specific antigen-antibody complex. Then they attack-punch holes in invader's membrane allowing for increased permeability of WBC chemotaxis-C3 esp involved in this process
Term
what are the 4 types of hypersensitivity reactions
Definition
1-anaphylatic/Immediate
2-Cytotoxic-hemolytic anemia/blood trans
3-Immune mediated/Arthus
4-Delayed/cell mediated
Term
Which type of Hypersensitivity is local: hayfever, urticaria; systemic: peanut butter, penicillin, insect bites?
Definition
I-vasoactive substance affects vascular permeability and smooth muscle
Term
Which hypersensitivity associated with myasthenia gravis, thrombocytopenia, grave's disease?
Definition
II-humoral antibodies injure cells predisposing them to phagocytosis or lysis
Term
Which hypersensitivity associated with rhematic fever, RA, SLE, acute glomerulonephritis, serum sicknes, pheumonitis?
Definition
III-symptoms-painful joints, rash, swollen lymph nodes. Humoral antibodies bind antigens and activate complement
Term
Which hypersensitivity associated with contact dermatitis, fungal diseases, leprosy
Definition
IV-TB-delayed reaction/cell mediated T4 cells 24-72 hrs
Term
After cell membrane phospholipids activate arachidonic acid, what happens?
Definition
1-5-HPETE (chemotaxis)->leukotrines->vasoconstriction, bronchospasm, increased permeability
2-Prostaglandin H2->Prostacyclin and Thromboxane A2
Term
What does prostacyclin do?
Definition
causes vasodilation, inhibits platelet aggregation
Term
What does thromboxane A2 do?
Definition
op of prostacyclin, vasoconstriction,promotes platelet aggregation
Term
T or F Most chemical substances capable of mediating the inflammatory response are Endogenous
Definition
T. Produced by the body. Most mediators affect vascular permeability
Term
A macrophage releases which interleukin to the T4 Helper cell for activation?
Definition
lL-1 and then T4 releases 4,5 to help B cells produce plasma cells
Term
This is the hallmark of repair within 3-5days
Definition
Granulation Tissue. skin under scab when falls off. Pink, soft, new tissue. made of: fibroblasts,endothelial cells, macrophages
Term
This is the hallmark of repair within 3-5days
Definition
Granulation Tissue. skin under scab when falls off. Pink, soft, new tissue. made of: fibroblasts,endothelial cells, macrophages
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