all pathology

What are the six steps of blood vessel inflammation response?

Initial vasodilation

Increased capillary permeability

Protein leakage and fibrin formation

Local heat increase

Fluid accumulation

Pain due to nerve compression

What happens during initial vasodilation?

Arteriolar dilate and increase blood flow

More white blood cells are delivered to the area

What happens during increased capillary permeability?

Endothelial cells pull apart allowing proteins to move into tissues

What happens during protein leakage in tissues?

Proteins enter tissues

Fibrinogen is converted into fibrin and forms a sticky mesh to contain bacteria

What happens during local heat increase?

Warm blood raises tissue temperature, slowing bacterial growth and phagocyte activity

What happens during nerve compression after inflammation?

Swelling of tissue oedema compresses nerve endings creating pain and limiting healing

What is an abdominal aortic aneurysm?

Permanent ballooning of a blood vessel caused by arterial wall weakness

How does damage to the tunica intima cause an aortic anyuerysm?

Triggers an inflammatory and immune regimes causing fibrosis and further weakening

What is a dissecting aortic aneurysm?

Originates with a tear in the aortic intima

High arterial blood pressure causes it to haemorrhage

What is a pulmonary embolism?

An abnormal mass travelling through the blood gets trapped in a pulmonary artery of branch, causing a blockage in blood flow

What are possible sources of pulmonary embolisms?

Air, fat, amniotic fluid, tumour mass, thrombus

What occurs after a pulmonary artery is blocked?

Ischarmia and infarction of supplied lung tissue

Triggers an inflammatory response causing further vasoconstriction

What are the six steps of early atherosclerosis formation?

Low density lipoproteins entering the arterial wall

Become oxidised

Activate the endothelium

Endothelium allows leukocytes entry

Macrophages take up oxidised ldl and become foam cells

Foam cells accumulate to thicken arterial wall

What are the five steps of advanced atherosclerosis?

Growing plaque causes hypoxia

New blood vessels form inside the plaque to supply enough oxygen

New blood vessels are prone to bleeding

Haemorrhage stimulates more leukocytes to the area

Inflammation releases substances to promote plaque expansion

What is coronary artery disease?

Narrowing or blockage of coronary arteries by atheroma or blood clots

What is the main effect of coronary artery disease?

Reduced blood flow and oxygen supply causing myocardium to become ischaemic

What is heart failure?

Inability of heart to meet the body’s demand for oxygen

What occurs in early heart disease?

Compensatory mechanism aid heart function

Heart function deteriorates due to strain

Heart chambers hypertrophy

Myocardium thickens, reducing heart space and interferes with contraction

What happens when the ventricles are too weak to pump blood effectively?

Blood pressure builds in ventricle and atrium and then pulmonary veins or vena cava

What is cholestasis?

Obstruction of bile flow between liver and duodenum or bile production abnormality

What is the most common cause of bile obstruction?

Gallstones

What are the effects of reduced bile delivery?

Impaired digestion and absorption

Reduced vitamin absorption

What is the cause of gallstone formation?

Concentration of dissolved substances exceed digestive capacity of bile

What are gallstones made up of?

Crystallised cholesterol and bilirubin

What is cholecystitis?

Jaundice

Why are women more susceptible to gallstones?

Oestrogen increases cholesterol excretion in the bile

What is diverticular disease?

Mucosa lined pouch pushing out through the muscular layer of the colon wall

What are three causes of diverticular disease?

Structural and moralities in colon wall

Disordered intestinal motility

Deficiencies of dietary fibre

What is the structure of diverticula?

Form parallel rows between the taenia coil at areas of structural weakness

What are the three benefits of fibre?

Lowers intracolonic pressure

Contributes to frequency bowel movements

Increases stool volume

What is diverticulosis?

Asymptomatic diverticula

What is diverticulitis?

Symptomatic diverticula

What is the main symptom of diverticulitis and what is the cause?

Chronic inflammation and perforation due to faecal matter lodging in diverticulum

What is the main consequence of chronic inflammation?

Erosion of blood vessels causing significant bleeding

Why do tissues go through adaptive growth paterns?

Coping strategies for unusual and excessive stress

What is hyperplasia?

Increase in tissue mass e.g. callouses

What is hypertrophy?

Increase in tissue mass due to enlargement of existing cells due to increased workload

What is metaplasia?

Reversible replacement of mature cell type with another more withstanding cell

What is dysplasia?

Irreversible abnormal tissue changer where cells vary in size, shape and organisation

What is stroma?

Mesh work of proteins, structures and non neoplasticism cells where neoplasticism cells grow

What is hepatocellular failure?

Regeneration of hepatocytes does not keep pace with damage and is replaced by fibrous tissue

What is chronic hepatitis?

Any form of hepatitis for more than six months

What occurs during chronic hepatitis?

Progressive inflammation leading to necrosis

Lobules and lobule framework collapse

Blood supply is impaired

Hepatocytes become hypoxic and more fibrosis occurs

What is cirrhosis of the liver?

Long term liver injury caused by inflammation, necrosis and fibrosis

What is hepatocellular carcinoma?

Liver cancer caused by chronic liver disease where constant hepatocyte regeneration leads to dna mutations

What are the segments of the caudate lobe of the liver?

Segment 1 at the back of the liver

What are the segments of the quadrate lobe of the liver?

Segment 4

What are the segments of the left lobe of the liver?

Segments 2, 3, 4a, 4b

What are the segments of the right lobe of the liver?

5, 6, 7, 8

What is chron’s disease?

Chronic segmental granulomatous inflammatory bowel disease

What are the three most common sites of crohns disease?

Terminal ileum, proximal colon, perianal region

What is the cause of Crohn’s disease?

Immune system reaction to the gut bacteria, causing bowel to be swollen and thickened

What is the appearance of the bowel effected by crohns disease?

Cobblestone appearance

What are skip lesions of Crohn’s disease?

Normal sections between patchy inflamed areas

What is urolithiasis/urinary and renal calculi?

Excess mineral forms stone out of crystalline particles

What are two contributing factors to the formation of urinary and renal calculi?

Low urine volume and urinary pH (changes solubility of stone forming chemicals)

What are the four chemicals in urine which inhibit crystallisation of minerals?

Citrate

Glycosaminoglycans

Pyrophosphate

Nephrocalcin

What are the four main types of urinary stones?

Calcium/phosphate

Uric acid

Sycstine

Struvite

What causes calcium phosphate stone formation?

Acidification of urine reduces calcium solubility

Calcium excretion rises if nephrons are naturally unable to resorb

Excessive calcium Resorbption

What causes uric acid stone formation?

High levels of purine (breakdown)

Purine found in alcohol and meat

Not soluble in acidic fluids

What causes cystine stone formation?

Cystinuria (disorder causing excessive loss of cystine)

Insoluble in acidic urine

What causes struvite stone formation?

Insoluble in alkaline urine

Associated with repeated urinary tract infections

Aka. Staghorn calculi

What are the two main types of bladder tumours?

Transitional cell carcinomas

Solid tumours

What are transitional cell carcinomas?

Arise from transitional epithelium

Benign

Stalk of fine branching fronds

Aka. Papillomas

What are solid bladder tumours?

Malignant

Invade bladder walls

May ulcerate and cause haemorrhage and necrosis

Why do 90% of bladder tumours start in transitional cell lining?

Lining is exposed to carcinogens excreted in urine

What is the appearance of transitional cell carcinomas?

Finger like projections

May penetrate basement membrane and grow into muscle of bladder walls

What are the characteristics of squamous epithelial cells?

Associated with chronic inflammation

What are two tumour suppressor genes which commonly suffer mutations and what do they do?

GSTM1 is responsible for enzyme glutathione S transferase

NAT2 is responsible for enzyme acetyltransferase

What are the characteristics of renal tumours?

Rare

Commonly renal adenomas

What are the origins of renal cancers?

Majority originating from nephron epithelial lining

Minority from collecting duct etc.

What is the commonest kidney malignancy and what is the origin?

Renal cell carcinoma

Arises from the epithelial lining of the proximal convoluted tubule

Which gene mutation contributes the most to renal cell carcinoma?

VHL on chromosome 3

What is polycystic ovarian syndrome?

Hormonal disorder causing enlarged ovaries

Multiple small cysts

Irregular ovulation

What is endometriosis?

Condition where endometrial tissue grows outside the uterus causing pain and inflammation

What is endometrial carcinoma?

Malignant tumour arise from lining of the uterus

What is an ectopic pregnancy?

Implantation of a fertilised egg outside of the uterus

What is cryptorchidism?

Failure of one or both testes to descend into scrotum before birth

What is dysmenorrhea?

Painful menstruation caused by uterine contractions or underlying pathology

What is amenorrhoea?

Abscence of menstrual periods

What is epididymitis?

Inflammation of epididymis

What is orchitis?

Acute inflammation of testes due to infection or viral illness

What is mastitis?

Inflammation of breast tissue due to infection

What are the three possible locations for endometriosis?

Ovaries

Uterine tubes

Other pelvic

What are the symptoms of endometriosis?

Menstrual type bleeding

Pain

Formation of chocolate cysts in ovaries

Inflammation, fibrosis and adhesions

Where does functional endometrial tissue appear on organs?

The surface or on ligaments in ectopic patches

How does displaced endometrial tissue respond to oestrogen?

Proliferates when oestrogen is high

Degenerates when oestrogen falls

What happens when displaced tissue bleeds?

Causes local inflammation and release of inflammatory cytokines

What is the most common type of benign breast tumour?

Fibroadenomas

What is the most important risk factor for breast cancer?

Oestrogen exposure

What are three examples of increased oestrogen exposure due to increased amounts of menstrual cycles experienced?

Early menarche

Late menopause

No pregnancy

What is the most common placement of breast tumours?

Upper outer quadrant of the breast, near the axillary region

What are three symptoms of breast cancer?

Nipples retraction

Nipples necrosis

Ulceration of overlying skin

Why is it dangerous for breast tumours to be found in the axillary region?

Metastasise via the lymphatic system relating to axillary lymph nodes and internal mammary nodes

What is leiomyoma?

Multiple benign myometrial tumours

What are the four symptoms of large tumours?

Pelvic discomfort

Urinary frequency

Irregular or painful periods

Reduced fertility

What is the stucture of leiomyoma tumours?

Proliferating smooth muscles with significant connective tissue

Firm and well defined

What is the nature of leiomyoma?

Benign but may display indications of malignancy

What is the most common nature of testicular cancer?

Malignancy

What is the biggest risk factor for testicular tumour?

Undescended testes