EXAM 3 PATHO

Interatrial septal defect

• abormal opening in the interatrial septum

• left to right shunt

• increased pulmonary blood flow

Ventricular septal defect

• most common congenital heart defect in clinical practice

• left to right shunt

• right ventricle exceeds the pressure in the left ventricle

  • REVERSES BLOOD FLOW*****

Tetralogy of Fallot

• dextroposition of the aorta

• stenosis of pulmonary artery

• ventricular septal defect involving the uppermost membranous part of the septum

• hypertrophy of the right ventricle, which is adaptive in nature and develops as a result of an increased workload of the right ventricle

Transposition of great vessels

• congenitial heart defect

• aorta arises from right ventricle

• pulmonary artery arises from left ventricle

• mixing of oxygenated and deoxygenated blood

Pathogenesis of atherosclerosis

• endothelial cell injury (metabolic derangements, physical force is accompanied by the deposition of blood platelets and serum lipoproteins)

• growth factors released from platelets stimulate the proliferation of smooth muscle cells in wall of the artery

• internal metabolism (cholesterol and other lipids in their cytoplasm)

• smooth muscle cells transform into foam cells

• attract macrophages (take up cell remnants) (foam cells) (secrete cytokines TNF, TGF-B—>MORE DAMAGE)

• collagen deposition with atheromas leads to hardening of the arteries (sclerosis)

Atherosclerotic aneurysms

• can occur in any part of aorta but are most often located in the abdominal aorta and may occur in several forms

• dilations of the aortic lumen associated with changes in the wall, most often complicating advanced atherosclerosis

• clinically silent

A patient has suffered a myocardial infarction of the posterior wall of the left ventricle. Which artery was occluded?

• posterior descending artery

A patient presents with edema in the lower extremities, ascites, and dyspnea with activity. What do you suspect the patient is suffering from?

• heart failure (CHF- congestive heart failure)

Marker of myocardial infarction

• troponin (best marker)

• occlusion of coronary artery

complications:

• ventricular rupture

• ventricular aneurysm

• endocardial mural thrombus

Alanine aminotransferase

• marker of liver injury/ enzyme found in the liver

• heart conditions (myocardial infarction, troponins)

• high levels—> acute liver injury, viral hepatitis, ischemic live injury

Aspartate aminotransferase

• enzyme found in liver, heart, skeletal muscle, kidney, brain and red blood cells

• biomarker of tissue damage

Troponin I (troponin T)

• cardiac specific proteins that regulate muscle contraction in the heart

• diagonsing myocardial infarction

• elevated troponin: heart failure, acute myocardial infarction, myocarditis

CK

Rheumatic fever

• occurs 2 weeks after an episode of strep throat

• affects joints, the skin, and the brain

• cell mediated immune reaction develops and the suppressor t lymphocytes and macrophages many also damage various tissues

Cause of infectious myocarditis

• heart failure

• cardiogenic shock

• arrthymias

• viral and bacterial infections

Angina pectoris

• chest pain due to myocardial ischemia

• clinical presentation of coronary heart disease

Which of the following organs helps regulate arterial blood pressure?

• kidney

• heart

• blood vessel

Common infection of the respiratory tract

UPPER: Common Cold, Sinusitis, Pharyngitis

LOWER: Bronchitis, Pneumonia, Influenza, Tuberculosis, RSV

Hypostatic pneumonia

• lung inflammation—> prolonged immobility

• symptoms: cough, fever, chills, chest pain, fatigue

• risk factors: COPD (chronic obstructive pulmonary disease)

Lobar pneumonia

• caused by the streptococcus pneumoniae and haemophilus influenzae

• consolidation of the lung tissue

• symptoms: high fever, cough dyspnea

Lobular pneumonia

• affects bronchi and lung tissue

• scattered areas of infection

• RSV, COPD, SP, HI

• symptoms: cough, fever, chest pain

Aspiration pneumonia

• lung infection that occurs when food, liquid or saliva is inhaled into the lungs causing infection and inflammation

• COPD

Interstitial pneumonia

• inflammation of interstitial tissue in the lungs (air sacs alveoli)

• caused by: flu, RSV, mycoplasma pneumoniae

Tuberculosis everything (lab diagnostics, symptoms, classifications….)

• primary infection: Ghons complex (parenchyma with granulomas and lymph node enlargement)

• secondary TB: reactivation or second infection (cavernous TB)

• symptoms: nonrpoductive cough, night sweats, weight loss

• classifications: Pulmonary and Extrapulmonary

• lab diagonostics: chest x ray, skin test, sputum culture

Causes of emphysema

• cigarette smoking

• alpha 1 antitrypsin deficiency

• air pollution

• chronic respiratory infections

• genetic factors

Sarcoidosis

• inflammatory disease that affects the lungs

• formation of granulomas

• organs affected: lungs, lymph nodes, skin, eyes

Coal-workers’ lung

• black lung disease

• increase carbon particles of impurities

• dust accumulates and incites fibrotics

Asbestosis

Associated with:

• pulmonary fibrosis

• pleural fibrosis and pleural plaques

• lung cancer

• malignant mesothelioma

Pathology:

-asbestos bodies

Clincial:

• restrictive lung disease

• risk of cancer

Pneumoconiosis

• inhalation of mineral dusts, fumes, and various organic and inorganic particulate matter

  • duration of exposure

  • size of particle/ larger filtered out

  • concentration and makeup

  • inflammatory response—> fibrosis

Malignant mesothelioma

• rare and aggressive cancer primarily affects the mesothelium

• most common type is pleural mesothelioma

Symptoms of lung cancer

• symptoms depend on the location of the tumor and its size

• persistent cough, hemoptysis, shortness of breath, chest pain, wheezing, fatigue, fever, loss of appetite

Edema in different organs (terminology)

• excess of fluid in the interstitial space and or the body cavities

• localized edema may involve any tissue or organ

Pulmonary edema is a typical complication of

• heart failure

• failure of the left ventricle leads to pulmonary congestion

• left side CHF: shortness of breath/dyspnea

Active hyperemia

• increased blood flow

• causes (exercise, inflammation, heat)

• vasodilation of arterioles

Hemoptysis

• respiratory tract bleeding with expectoration

• coughing up of blood

• causes of hemoptysis: bronchitis, pneumonia, tuberculosis, lung cancer)

Melena

• the production of melena, following internal bleeding or the swallowing of blood

• digested blood

• black stools

HEMORRHAGE

The proteinaceous meshwork that holds a thrombus together is composed of

• fibrin

Clinically significant emboli are most often composed of

• blood clots (thromboemboli)

Most venous emboli that are of clinical significance originate in the veins of the

• deep veins of the legs

• DVT (deep vein thrombosis)

Organs is most affected by venous embolism

• lungs (PE-pulmonary embolism)

• PE occurs when a venous thrombus

Most arterial emboli that cause cerebral infarcts originate from the

• heart

• left atrium or left ventricle

• cartoid arteries

 Shock resulting from massive bleeding is best classified as

• hypovolemic shock

• blood loss, death, exsanguination

What are most congenital malformations in humans caused by? Most malformations have an unknown cause

genetic, environmental, multifactorial factors

Atherosclerosis is the most important complication encountered in persons affected by familial hypercholesterolemia

true

Anasarca

• severe and generalized edema

• fluid accumulation in the subcutaneous tissue and body cavities

• causes: heart and liver failure, nephrotic syndrome

Ascites

• accumulation of edematous fluid in the abdominal cavity (hydroperitoneum)

Hydrothorax

• accumulation of serous fluid in the pleural cavity

• classified as a transudate

• causes: CHF (congestive heart failure, nephrotic syndrome, cirrhosis)

Hematopericardium

• presence of blood within the pericardial sac

• can lead to life threatening cardiac tamponade

Exudate (in diseases such as cirrhosis of the liver) vs transudate

exudate:

• rich in protein and blood cells and is typical of inflammation

• inflammatory edema is related to the increased permeability of the blood vessels

transudate

• less proteins and fewer cells than exudate

• edema is in essence an ultrafiltrate of plasma fluid that may accumulate in tissue because of factors including:

  • increased hydrostatic pressure inside the blood vessels

  • decreased oncotic press of the plasma

  • obstruction on lymphatic vessels impeding interstitial fluid drainage

  • increased tissue hydration because of sodium retention

What type of embolus is most commonly found in clinical practice?

• thromboembolism

• pulmonary embolism (PE)

What condition could develop from the heart failure seen in decompensated shock?

-pulmonary edema

-hydrostatic (increased arterial pressure and increased venous backpressure)