Path Exam 2
Terms
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- Hyperplasia
-
- direct response to stimulus
- involves parenchymal and stroma
- diffuse
- organized
- typical morphology
- regresses if stimulus is removed - Neoplasia
-
- independent of extracellular stimulus
- involves parenchymal component only
- focal
- disorganized
- cellular atypia
- continues to grow - Mechanism of type I hypersensitivity reactions
-
allergen presentation by dendritic cells to CD4+ T cells --> differentiation to TH2 cells --> secretion of IL-4, IL-5, and IL-13
IL-4: activation of IgE-secreting B lymphocytes
IL-5: activation of eosinophils
IL-13: promotes IgE secretion and mucus secretion
*IgE binds to mast cells (and basophils) on first exposure* ---> mast cell degranulation - Antibody mediated (type II) hypersensitivity
-
- opsonization & phagocytosis: c3b
- opsonization and cell lysis w/o phagocytosis: IgG recognized by Fc receptors
- complement and Fc receptor mediated inflammation: IgM & IgG antibodies bound to ECM proteins, generate C5a
- antibody mediated cellular dysfunction - Cell-mediated (type IV) hypersensitivity
-
Delayed type hypersensitivity
- CD4+ T cells --> TH1 cells --> produce INF-gamma --> macro activated
ie. Tb
T cell-mediated cytotoxicity
- CD8+ T cells kill by perforin-granzyme dependent killing and Fas-FasL depedent killing
**important in killing viral-infected cells - epitope spreading
-
initial autoimmune response may damage self-antigens and expose new epitopes of the antigens that are normally concealed from the immune system..
this can lead to activation of new auto-reactive lympohtocytes and "spreading" of the disease - Amyloid
-
insoluble deposits (proteins) that may cause pressure atrophy or degeneration of surrounding cells, which can lead to organ dysfunction
- commonly found in kidney, spleen, liver
- AL
-
amyloid light chain
- composed of immunoglobin light chains synthesized by plasma cells - AA
-
amyloid associated
- derived from serum amyloid associated (SAA) protein, an acute phase protein synthesized by hepatocytes - AB
-
beta amyloid protein
core of cerebral plaques and in cerebelar blood vessel walls in Alzheimer's disease
- transthyretin (less common amyloid protein) --> binds and transports thyroxine and retinol: deposited in heart of old people -
Edema
- dropsy
- anasarca -
excessive accumulation of fluid in the CT spaces and serous sacs.. ie. the interstitial compartment
- dropsy: lay term for generalized edema
- anasarca: edema of subcutaneous tissue - characteristics of edema
-
- transudate
- clear, straw colored (low prtoein, low coagulation)
- hydropericardium
- hydrothroax
- ascites (hydroperitoneum - characteristics of inflammation
-
exudate (high protein)
turbid, purulent, etc.
pericarditis
pleurisy, pleuritis,
peritonitis - Effusion
-
non-specific term which refers to an accumulation of fluid, which can be transudate, lymph, exudates or blood...
removal of fluid is know as PARACENTESIS (tapping, draining of fluid) - common causes of lymphatic obstruction
-
*causes lymphedema -- "brawny edema" or elephantiasis (in the case of filariasis)
- malignant neoplasms
- chronic granulomatous disease (Tb & bunholderia mallei)
- parasitic disease (filariasis)
- iatrogenic (post surgical or post irradiation)
- compression from the outside - Urticaria
-
cutaneous --> nodular swellings, or "hives"
causes an increase permeability of the vessel wall following the degranulation of mast cells - Causes of generalized edema
-
- cardiac
- hypoproteinemia
- increased retention of sodium
- renal edema (nephritic/nephrotic) - Hyperemia aka congestion!!
-
active: increase inflow of blood pumped actively into the tissue from the Arterial side
- acute - scalding water
- delayed - sunglight
passive: local acute (starving); local chronic ( pitting edema) & left-sided heart failure; generalized chronic (pulmonary stenosis) & right-sided heart failure - Hemorrhage
-
blood that is lost from the intravascular compartment due to:
- rupture or erosion of the vessel wall - rhexis
- diapedisis - due to increased permeability of the vessel or defects of the coagulation mechanism - Shock
-
inadequate blood flow to vital organs or the inability of these organs to use oxygen and other nutrients
- decreased CO
- widespread vasodilation
- loss of fluid
*primary shock is only seen in humans because of our upright posture - Thrombosis
-
formation of a solid mass from the constiutents of the blood within the vascular tree, during life!
(coagulation or clotting can occur outside the vascular system, in vitro, and post-mortem - Tissue factor pathway
- inhibits factor III, VII, and IX
- thrombomodulin
- protein C combines with protein S and they inactivate factor V and VIII
- Plasminogen activator
-
activates plasminogen to plasmin
(stimulated by NE, thrombin, bradykinin, vasporessin, stasis, and shear stress)
- plasmin lysis fibrin (is fibrolytic) - Nitric oxide
- inhibits platelet aggregation and adhesion
- Prostacyclin
-
- vasodilation
- inhibits protein aggregation - Von Willebrand factor + GpIb IX
-
is the carrier protein for VIII (vwf)
- promotes platelet ADHESION - Intrinsic pathway
-
activated *intra*vasculary
Endothelial damage --> Factor XII --> Factor XI --> IX --> X --> common pathway - Extrinsic pathway
-
activated in tissues!
Tissue damage --> Tissue factor III (thromboplastin) --> VII --> X --> common pathway - pathological inhibition of coagulation
-
systemic lupus erythematosus
rheumatoid arthritis
ulcerative colitis - conditions predisposing to thrombus formation
-
*Virchow triad*
- alteration in the vascular lining
- stasis (alteration is flow)
- alteration in the constituents of blood with excessive amounts of procoagulatent constituents or decrease of anticoagulant factors - infaction
-
a localized area of an organ or tissue which has been depreived of its vascular supply
mechanisms of occlusion:
- factor within the lumen (thrombus or embolus)
- factor from the vascular wall (artherosclerosis)
- compression from the outside by contiguous structures
- Red infarct
-
blood filled infarct
* seen in organs with DOUBLE blood supply* after arterial occlusion (LUNg or LIVER) or where venous occlusion was the cause - Anemic infarct
-
Or pale
seen in **arterial occlusion in organs with a single blood supply having orgainzed stromal tissue - Embolus
-
any collection of solid, liquid, or gas traveling in the vascular system
venous embolisum (thromboembolism is most common cause of pulmonary embolism, which is responsible for 20% of ALL hospital deaths)
arterial side of venous embolism
- brain, kiddneys, spleen and lower legs are most common occlusion
- mural thrombus, arterial appendage are most common origin
pulmonary emboli** sudden death! (saddle emoblism) - Aspirin
- blockage of the synthesis of thromboxane A2
- Ticlopidine
-
inhibits plately aggregation by ADP, collagen, arachidonic acid, thrombin and platelet aggregating factor
(superior to aspirin) - Hirudin
-
direct inhibitor of thrombin
- "leech"
*anticoagulant* - Teratoma
- cells represenative of more than one germ layer
- Hamartoma
- aberrant differentiation of mature specialized cells or tissue indigenous to the particular site
- Choristoma
- heterotropic rest of cells in an unrelated organ
- 4 characteristics of malignant tumors
-
- malignant change in the target cell
- growth of the transformed cells
- local invasion
- distant metastases - Anaplasia
-
lack of differentiation
*benign tumors are generally well-differentiated - dysplasia
-
disordered growth
found in epithelia, espcially metaplastic
- loss in uniformity, architectural orientation, and pleomorphism, hyperchromatic/large nuclei, mitotic figures in abnormal locations and more abundant than usual - RAS
- chemically induced tumors
- P53
- viral-associated cancers
- Mechanism and clinical syndrome of *small cell lung cancer*
-
- ACTH: Cushing syndrome
- ADH: SIADH - Mechanism and clinical syndrome of *non-small cell lung cancer*
- - PTHRP: hypercalcemia
- Mechanism and clinical syndrome of *cerebellar hemangioma renal cell carcinoma
- - erythropoietin: erythrocytosis
- Mechanism and clinical syndrome of *lung cancer*
-
- AC receptor ABs: myasthenia
- unknown: hypertrophic osteoarthropathy (clubbing) - TNM staging does not apply to..
-
- acute or chronic leukemia
- multiple myeloma
- lymphoma - HPV E6
- - inhibits P53
- HPV E7
- - inhibits p53, p21, and pRB
- How do HBV and HCV cause HCC?
- Both viruses induce injury to liver cells (inflammation, cell death) and extensive regeneration