Cell Pathology Flashcards

(121 cards)

1
Q

Intro

A

Our bodies react to physiological stress or pathological stimuli

Cells constantly adjust their structure and function to accommodate extracellular stresses

Maintain normal homeostasis

Adaptive changes lead to a new steady state to preserve viability and function

Cell death can occur as a normal or abnormal process

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2
Q

Causes of cell injury

A

Infectious agents range from viruses, bacteria and fungi to tapeworms
Immune reactions can cause cell and tissue injury e.g. autoimmune reactions or allergic reactions
Genetic defects may cause injury through deficiency of functional proteins, accumulation of DNA damage or misfolded proteins. Sickle cell anaemia a.a. substitution in hemoglobin S

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3
Q

Adaptive responses

A

Reversible changes in:

Number
Size
Phenotype
Metabolic Activity
Function

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4
Q

2 Adaptation examples

A

Physiological Adaptations
e.g. hormone-induced enlargement of breast during pregnancy

Pathological Adaptations

Pathological adaptations are cellular responses to adverse stimuli or diseases that, while attempts to survive, result in changes that impair normal function or lead to disease.

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5
Q

What are the principal adaptive responses?

A

Principal adaptive responses are:
Hypertrophy
Hyperplasia
Atrophy
Metaplasia

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6
Q

Hypertrophy

A
  • Increased size of cells
  • Increased size of organ

Cells enlarged due to increased amount of structural proteins and organelles
Occurs largely in cells that do not divide
Can be physiological or pathological
Can occur simultaneously with hyperplasia
Requires mechanical signals –stretch and trophic triggers eg alpha adrenergic stimulation
Which turn on genes that increase protein synthesis

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7
Q

Hyperplasia

A
  • Increased number of cells
  • Increased organ size

Takes place in cells capable of replication
Can occur together with hypertrophy
Can be physiological eg hormonal; compensatory hyperplasia
or pathological – excessive hormone or growth factor secretion
Gingival hyperplasia from phenytoin.

Examples e.g. receding gum, enlarging prostate

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8
Q

Atrophy

A
  • Reduced size of Cells
  • Reduced size of Organ

Diminished function but not dead, caused by decreased work load through: Loss of innervation; Diminished blood supply; Inadequate nutrition; Loss of endocrine stimulation; Ageing; Reduced protein synthesis (due to reduced metabolic activity), increased protein degradation

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9
Q

Metaplasia

A
  • Reversible change in phenotype
  • Replaced by a cell type which can better withstand the adverse environment

Cells are replaced with a different cell type.

This is thought to arise from genetic reprogramming of stem cells

. An example is epithelial metaplasia in smokers where specialised ciliated columnar epithelial cells are replaced with hardy squamous epithelial cells. This adaptation helps survival but protective mechanisms are lost eg cilia clearance
It is often caused by chronic irritation and persistence can lead to the a transformation to malignant cells.

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10
Q

Cellular changes in injury

A

Reversible

  • Cell swelling
  • Swelling of organelles
  • Lipid deposition
  • Detachment of ribosomes
  • Loss of microvilli
  • Clumping of chromatin
  • Surface blebs

Irreversible

  • lysosomal enzyme release
  • Protein digestions
  • Severe cell swelling
  • Membrane damage
  • Mitochondrial vacuolation
  • Nuclear changes
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11
Q

Adaptive Responses FLOWCHAT

A

MEMORISE

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12
Q

Cellular changes in injury

What can the microscopes see

A

Light microscope
- fatty change
- vacuoles
- cloudy swelling
- Membrane blebbing
- Necrosis
- Nuclear changes

Electron microscope
- ER swelling
- loss of ribosomes
- loss of specialised membrane structures
- myelin bodies
- condensation of mitochondria
- vacuolisation of mitochondria

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13
Q

Summary

A

Our bodies react to any form of injury or assault

All adaptive responses are reversible

If stimulus is not removed, cells die or undergo neoplastic change

Cellular pathological investigations allow us to see the changes

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14
Q

What is apoptosis

A

Apoptosis is the process of programmed cell death. It is used during early development to eliminate unwanted cells; for example, those between the fingers of a developing hand. In adults, apoptosis is used to rid the body of cells that have been damaged beyond repair.

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15
Q

What is necrosis

A

Necrosis is the death of the cells in your body tissues. Necrosis can occur due to injuries, infections or diseases

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16
Q

Cell death

A

Main targets for cell injury are cell membranes, mitochondria, cytoskeleton and DNA

Loss of ability to divide

Loss of normal synthetic functions

Biochemical changes, followed by structural changes

Cell death via necrosis or apoptosis

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17
Q

How can cell death occur

A

1) Small blebs form; the structure of the nucleus changes
2) The blebs fuse and become larger; no organelles are located in the blebs
3) The cell membrane ruptures and releases the cell’s content; the organelles are not functional

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18
Q

Nuclear Changes in Cell Death

A
  • Pyknosis
  • Karyolysis
  • Karyorrhexis
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19
Q

What is Pyknosis

A

Nuclear shrinkage

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20
Q

What is Karyolysis

A

Nuclear fading

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21
Q

What is Karyorrhexis

A

Nuclear fragmentation

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22
Q

What is necrosis + cause

A

Necrosis is caused by factors external to the cell or tissue e.g. infections, toxins or trauma

It results in unregulated digestion of the cell components

Loss of cell membrane integrity and uncontrolled release of products of cell death brought about by autolysis

Inflammatory response in the surrounding tissue

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23
Q

Tissue Response to Necrosis

A

Haemorrhage

Resolution

  • Site, type and extent of injury
  • If cannot resolve, body attempts to repair

Repair

  • Removal of dead tissue
  • Action of neutrophils and macrophages
  • Granulation tissue
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24
Q

Necrosis can be divided into 5 distinct types based on the morphological changes that occur:

A

Necrosis can be divided into 5 distinct types based on the morphological changes that occur:

  • Coagulative necrosis
  • Liquefaction (colliquative necrosis)
  • Caseating necrosis
  • Fat necrosis
  • Gangrenous necrosis
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25
What is Coagulative Necrosis
Coagulative Necrosis Most common Affects solid organs Artery occlusion - ischaemia is most common cause Firm and pale
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Microscopic view of coagulative necrosis
- Cellular outline and tissue architecture maintained - Lack of lysosomes/ injury destroys lysosomal enzymes
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What is Colliquative or Liquefactive Necrosis
- Semi-liquid - Degradation of cellular and extracellular components by hydrolytic enzymes - Cystic cavities containing fluid and cell debris - Main causes include cerebral infarction or bacterial infection
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What happens in Liquefactive Necrosis in the Brain
- Loss of neurones and neuroglia cells - Many macrophages clearing cell debris
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What is Caseating Necrosis
Soft and white – resembling cream cheese - Unstructured protein mass - Associated by tuberculosis
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What is Fat Necrosis
- Hard yellow material seen in dead adipose tissue - Pancreatitis - release of proteolytic & lypolytic enzymes - Breast trauma - release of fatty acids - inflammatory response
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What is Calcification of Necrotic Tissue
Dystrophic calcification - Large amounts of calcium enter the cell - Combine with phosphate to form crystals - Extracellular calcification can also occur
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What is Gangrene
Not a distinctive type of necrosis Describes black dead tissue Most common in lower limb of patients with severe atherosclerosis Irreversible ischaemic damage
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Types of Gangrene
1) Dry gangrene - Coagulative pattern of necrosis 2) Wet gangrene - Gram-negative bacteria converts it to liquefactive necrosis 3) Gas gangrene - Follows infection with gram-positive organism Clostridium welchii (found in the soil) - Releases toxins which produce gas
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What is Dry Gangrene
- Coagulative necrosis from ischaemic injury - Commonly caused by poor circulation or obstruction - Slow, gradual process - Usually seen in smokers, diabetics, atherosclerosis
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What is Wet Gangrene
- Largely affects moist tissues and organs - Characterized by liquefactive necrosis - Untreated wound infections.
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2) Wet Gangrene
- Swelling and inflammation - Blockage of blood supply oedematous, decayed, reddish to dark brown - Promotes further bacterial growth necrosis and gangrene
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Gas Gangrene
Clostridia are the main etiologic agent Invade wounds and injuries with diminished blood supply Release gas-producing toxins. Affected skin may appear greyish to purplish red Bubbly skin which makes a crackling sound whenever pressed
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Apoptosis
- Programmed cell death - Normal process - Energy-dependent - Orderly packaging in membrane bound vesicles - Vesicles phagocytosed – no inflammatory response
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Apoptosis why is it important
Important for: - Controlling cell number - Tissue remodelling - Removing damaged cells
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Necrosis + Apoptosis
Necrosis Group of cells affected Caused by injurious agent Changes due to energy deprivation Cells swell Ruptured lysosome & cell leakage Inflammatory response Apoptosis Single/few cells affected Programmed cell death Energy-driven Cells shrink Organelles & nuclear fragments packaged in vesicles No inflammatory response
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Summary
Cells and tissues react in different ways to injury and assault, attempting to limit damage, thus avoid cell death Cell death occurs as necrosis or apoptosis Different tissues undergo necrosis in different ways Apoptosis is largely a physiological process
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INFLAMMATION FLOWCHART
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Inflammation causes
Causes: Mechanical injury Bacteria, viruses, parasites Ischaemia Chemical injury Temperature Radiation Immune mechanism Foreign body
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Symptoms of inflammation
1) Redness 2) Swelling 3) Heat 4) Pain 5) Loss of function
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Inflammatory Process
Microvasculature changes - Vasodilation - Redness & heat ⬆️ Permeability - Swelling Inflammatory exudate - Fluid Cells - Chemical mediators
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What is the immediate transient response
Immediate-transient response: Peaking at 5-10 minutes Lasts 15-30 minutes Produced by chemical mediators Nettle stings or insect bits
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What is immediate persistent response
Immediate-persistent response Direct endothelial damage Peaking at around 1h Lasts until thrombus plugs vessel Severe direct injury e.g. burns
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What is the Delayed-persistent response and its causes
Delayed-persistent response Subtle endothelial damage Leakage starts 18-24hr later Last 36h or more Causes include: Sunburn Radiotherapy Bacterial toxins
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Cellular Events to inflammation
Margination and Adhesion -Changes in Blood flow -White cells fall to edge of vessels -Adhesion molecules allow attachments between endothelial cell and leukocyte Emigration - Pseudopodia form - Push between endothelial cells - Proteases released - Digest basement membrane
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Chemotaxis What is it
Leukocyte migrates between endothelial cells Basement membrane seals behind them Cells move towards chemical signal Towards inflammatory mediator
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Phagocytosis
1) Bind Foreign Material (opsonin) 2) Engulf foreign material (Phagosome) 3) Kill foreign material (Phagolysosome) 4) Damage to surrounding tissue
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What is opsonin
Opsonins are molecules, like antibodies or complement proteins, that act as "tags" to mark foreign substances or cells, making them more easily recognized and ingested by phagocytes
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What are granulocytes
Granulocytes are a type of white blood cell characterized by the presence of granules in their cytoplasm. The primary examples of granulocytes are neutrophils, eosinophils, and basophils
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Leukocyte order in blood
Neutrophils > lymphocytes>monocytes>eosinophils >basophils
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What are Neutrophils
Neutrophils - Mediates majority of acute inflammatory effects - Granule contents increase vascular permeability - Migrate to damaged area by chemotaxis - Phagocytic
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What is Eosinophils (Granulocyte)
Eosinophils - Allergic/parasitic conditions - Granules include major basic protein
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What is Basophils (Granulocyte)
Basophils - Give rise to mast cells - Granules include histamine
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What are Macrophage
Macrophage - Derived from monocytes - Migrate to damaged area (later than neutrophils) - Low numbers which increase with time - Survive much longer than neutrophils
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What are lymphocytes + Examples
Lymphocytes T Cells: - Antigen recognition and presentation - Cell killing B cells - Give rise to plasma cells - Synthesize immunoglobulin's
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Cell-derived mediators:
- Vasoactive amines (histamine and serotonin) - Arachidonic acid derivatives (prostaglandin and leukotrienes) - Cytokines (interleukins, interferons, chemokines and GFs) - Platelet activating factor - Nitric oxide - Lysosomal content
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Plasma-derived mediators:
- Kinin system (bradykinin) - Coagulation and fibrinolytic system (plasmin/fibrin degradation products) - Complement system (C3a and C5a)
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Systemic effects of inflammation
Systemic effects: ALL ARE ACUTE PHASE REACTIONS - Leukocyte production - Fever - Tachycardia - ↓ Blood pressure - loss of appetite - vomiting - skeletal weakness - aching
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What is Acute Inflammation
Acute Inflammation - Short duration - Minutes to days - Sequential process - Neutrophil and macrophage driven - Protective and reparative mechanism - Sometimes inflammatory response more harmful than initial tissue damage/infection
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What is Chronic Inflammation
- Persistent (months or years) - Defined by type of cell present (Lymphocyte, macrophage and plasma cell) - Necrotic cell debris - Tissue granulation - Fibrosis - Balance between repair and continues tissue damage
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What are the main effector cells in chronic inflammation
Macrophage are the main effector cells in chronic inflammation: - Antigen presentation (to lymphocytes) - Scavenging - Phagocytosis - Giant cell formation - Harbouring of organisms - Secretion - Reactive oxygen metabolites - Proteases - Arachidonic acid metabolites - Cytokines - Growth factors
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What is Granulomatous Inflammation
Special type of chronic inflammation, characterized by the presence of a granulomata Can occur through foreign material or immune response – microbe digested and antigens presented to TH cells – release INFy, which activated the macrophage to transform into epithelioid cell - Collection of macrophages frequently surrounded by lymphocytes - Macrophage fuse forming multi-nucleated giant cell or epitheliod cell - Micro-organisms which excite an immune response eg mycobacteria - Non-living foreign material
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Chronic inflammation Types
Nonspecific Occurs following infection Lymphocyte and plasma cells Chronic suppurative Continued neutrophil production and recruitment Surrounded by fibrous tissue & poorly vascularized Eosinophil-rich Granulomatous Agents difficult to destroy using lysosomal enzymes Autoimmune
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What is Tuberculosis
- World wide issue Each accounted for between 1.1 million and 1.2 million deaths in 2014 – world most deadly infectious disease together with HIV There are two strains of TB which can affect humans. Bovine TB can pass to humans through milk – enters the GI tract causing abdominal TB. Infection with Mycobaterium Hominis is the common form and it causes pulmonary TB with symptoms including cough, blood stained sputum, night sweats, weight loss. The incidence of TB was relatively low at the beginning of the twentieth century, however it has increased over recent decades
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Tuberculosis primary
Primary Never affected before Produce lesions Neutrophil inflammatory response - macrophage influx Macrophage ingest bacilli - present antigen to lymphocytes Proliferation of specific T lymphocytes - attract macrophage - Granuloma Caseating necrosis
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Tuberculosis secondary
Secondary Patients previously sensitized Largely due to reactivation of latent mycobacteria More common in immune compromised e.g. steroid treatment, HIV/AIDS
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Tuberculosis Miliary
Miliary Extensive caseous necrosis Tissue destruction Bacilli may enter bloodstream Granulomas appear in other organs
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What is Crohn’s Disease
Chronic inflammation Affects all layers of the bowel wall Unknown aetiology Non-caseating granulomas
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Four stages in wound healing
Four stages in process 1) Haemostasis 2) Inflammation (removal) 3) Cell proliferation (regeneration) 4) Remodelling (replacement)
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What is primary intention wound healing
Primary Intention -Cleanest type of wound -Aseptic -Minimal tissue trauma - Two sides need to be held together (sutures)
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What is Secondary intention wound healing
Secondary Intention 1. Fibrin clot 2. Cell infiltration Temporary matrix Wound contraction Epithelial migration Clot dissolution 3. Surface intact New basement membrane Definitive matrix 4. Scar formation
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Factors which affect wound healing can be local or systemic: What is systemic factors
Systemic: Nutrition (vitamin C and zinc) Therapy (steroids, chemotherapy and radiotherapy) Disease (metabolic, connective tissue disorders, diabetes)
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Factors which affect wound healing can be local or systemic: What is Local factors
Local: Foreign bodies and/or Infection Blood supply Mechanical (direction of wound and movement) Size of wound Capacity of cell for regeneration
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Role of Cellular Pathology
Involves investigation of the aetiology and pathogenesis that result in the signs and symptoms of the patient Cell pathology looks at cells in tissue or fluid Cell arrangement, development and function is investigated to determine if a patient has a disease, inflammation, or cancer Multi-disciplinary teams are involved to decide an appropriate treatment plan or review how a treatment is progressing. Can be used to diagnose patients or determine cause of death
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When are autopsies undertaken?
At request of a coroner or hospital doctor Coroner- if death is sudden, suspicious, unexplained, violent, occurs soon after a hospital stay or occurs from accident or injury Doctor – To gain a better understanding of the illness To further research
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What Happens in an Autopsy?
First, the height, weight, age, and gender of the body should be noted and recorded.  Distinguishing characteristics like birthmarks, scars, or tattoos should be noted as well. An external examination is performed.  - Performed ASAP (usually within 3 days following death) - Performed in examining room licensed and inspected by HTA - Prior to an autopsy information about the subject and the events leading to his or her demise is gathered, consulting medical records, doctors and family members and examining the location and circumstances of death.
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What happens in an autopsy 2
- A blood sample for toxicology and biochemical analysis
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Autopsy internal examination
Internal examination: A large "Y" shaped incision is made from each shoulder across the chest to the brisket, then down to the belly button, The skin is then spread open to check to see if any ribs are broken. The ribcage is split open, and the internal organs examined Each organ is examined individually Organs are weighed and tissue samples taken and fixed for further examination
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What is Histology/Histopathology
- The microscopic examination of healthy or diseased tissue
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What is Cytology/Cytopathology
-The microscopic examination of healthy or diseased cells -Usually split into gynaecological and non- gynaecological cytology Body fluids naturally contain cells Cells can also be scraped from the surface of tissues. These cells can be collected and transferred onto glass slides where they are dyed and examined under the microscope for abnormalities
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Specimen Collection-Biopsy
Cells can be taken from tissue removed: During surgical procedures in theatres At outpatient clinics At GP clinics During post-mortem examination Or can be collected from fluid Blood Urine CSF Sputum
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What is Endoscopic biopsy
Endoscope is used to remove tissue, such as from the stomach during a gastroscopy
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What is Punch Biopsy
The lines of least skin tension are determined.  Skin is stretched 90 degrees perpendicular to the lines of least skin tension The punch biopsy is performed. Following relaxation the wound can be closed with sutures parallel to the lines of least skin tension.
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When is a punch biopsy used
A punch biopsy – is for diagnosing skin conditions using a special instrument to punch a small hole in the skin to obtain a skin sample
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Punch biopsy 2
The instrument is pressed down and rotated clockwise and anti-clockwise, cutting down into the subcutaneous fat. The punch biopsy instrument is removed.  The biopsy specimen is gently lifted with a needle to avoid crush artifact. Scissors are used to cut the specimen free at a level below the dermis.
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What is Needle Biopsy
Fine-needle aspirate - Superficial lumps or masses - Usually palpable - A thin hollow needle is used - Cells aspirated a needle biopsy – a special hollow needle, guided by ultrasound, is used to obtain tissue from an organ or from tissue beneath the skin
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What is a core needle biopsy
A Core needle biopsy - A larger hollow needle is used - Solid sample of tissue is removed - Assisted by ultrasound, PET or CT
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What happens in the needle biopsy
A needle is used to draw sample fluid and tissue from a lump to be studied
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What is Surgical Biopsy 2 types
- An excisional biopsy  - Perioperative biopsy 
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What is an excisional biopsy
An excisional biopsy – where surgery is used to remove a larger section of tissue
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What is a Perioperative biopsy 
Perioperative biopsy – if consent has been given, a perioperative biopsy can be carried out during surgery; the sample will be tested straight away so that the surgeon can be given the diagnosis and provide appropriate treatment
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Why is fixing crucial immediately
It is crucial that tissue is fixed immediately to prevent degradation/ loss of integrity
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What is Fixing and whys it necessary
1) Fixation is an attempt to preserve tissue as close to its natural state as possible - Fixatives kill tissue/disable biomolecules (eg proteolytic enzymes) preventing autolysis and putrefaction 2) Protects sample from extrinsic damage - Fixatives are toxic to most common organisms preventing infection 3) Preserve morphology - Fixatives increase the strength and stability of the tissue
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Properties of Fixatives
- Penetrate tissue quickly and evenly - Kill cells quickly and evenly - Prevent autolysis - Prevent putrifaction - Not add extraneous material - Not swell or shrink tissue - Be compatible with later processing - Prevent tissue from drying out - Safe - Cheap - Convenient No fixative has all of these properties, compromises must be made.
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What are common fixatives
- Formaldehyde - Glutaraldehyde - Alcohol
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What is formaldehyde
Formaldehyde Most commonly used fixative 40% solution in H20 called formalin Commonly used diluted 1:10 in PBS buffer called 10% neutral buffered formalin (10% NBF) Same as 4% Formaldehyde Best for good architecture
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What is Glutaraldehyde
Glutaraldehyde Reacts more quickly than formaldehyde Difficult to remove from tissue Inactivates all enzymes preventing enzyme histochemistry Binds and masks many antigens Gives excellent morphology (widely used in EM)
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Alcohol
Alcohol Non-additive fixative Preserves chemical reactivity Tissue shrinks and becomes brittle More common for fixing smears or fresh sections
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FIXATIVES ADV AND DISADV
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What is Sectioning
Fixed tissue is still quite soft and needs extra support to allow thin sections to be cut (usually 3-6µM) Hard embedding medium such as paraffin wax is therefore used to support the cells and keep the tissue firm Processing is the method by which tissues are converted into a block for microtomy
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How does Processing work
1) Dehydration (Ethanol or Methanol) 2) Clearing (Toluene or Xylene) 3) Impregnation (Molten wax) 4) Removal of clearing agent 5) Blocking out tissue 6) Microtomy
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What is the rule on Paraffin wax impregnation in processing phase
Paraffin wax impregnation Specimen cannot simply be immersed in wax, it must be impregnated Water must be replaced with wax
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What do all microtomes have
Various different types of microtome but all have: Mechanisms for holding block firmly in place A knife holder Mechanism to move blade across block A feed mechanism to advance the block so that subsequent sections can be cut
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Frozen Tissue pros and cons and use
- Tissue is frozen quickly to reduce damage by ice crystals Pros: - Freezing H20 is quicker than replacing it - Doesn't involve treating with chemicals - Better survival of many antigens Cons: - Poor morphology - Poor resolution at higher magnification - Special storage - Difficulties cutting
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What is used to freeze tissue
Chlorofluorocarbons (commercial spray) Liquid CO2 Liquid N2
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Sectioning how is it done + prepared
Using a cryostat Deep freeze cabinet with microtome inside and controls outside Sections are cut from frozen tissue Sections are then picked up onto warm (room temp) slides Adhesion good due to sudden change in temperature
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Why is staining necessary and most common methods?
- Staining is required to provide contrast between different cell types and cell components - Haematoxylin and eosin (H&E) is the most common staining method
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What is Haemotoxylin
Haemotoxylin (blue) is a basic dye and therefore stains acidic components eg DNA & RNA
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What is eosin
- Eosin (Pink) is an acidic dye and therefore binds and stains basic components eg. Proteins in the cytoplasm, cytoplasmic filaments and extracellular fibres
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What is Periodic acid-Schiff (PAS)
- PAS is a staining method used to detect polysaccharides such as glycogen, glycoproteins and glycolipids Often used to stain kidney biopsies, liver biopsies, certain glycogen storage diseases in striated muscles and suspected fungal infections.
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What is Masson's trichrome
Masson's Trichrome (skin). Rat airway & skin sections This stain is intended for use in histological observation of collagenous connective tissue fibres in tissue specimens. It is used to assist in differentiating collagen and smooth muscle in tumours and assists in the detection of diseases or changes in connective/muscle tissue
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What is Alcian blue
- A mucin stain that stains certain types of mucin blue. Cartilage is also stained blue. It can be used with H&E, and with van Gieson stains.
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What is Van Gieson
- Stains collagen red, nuclei blue, and erythrocytes and cytoplasm yellow. It can be combined with an elastic stain that stains elastin blue/black. It is often used for blood vessels and skin.
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What is Luxol Fast Blue
Attracted to bases found in lipoproteins of the myelin sheath. Commonly used to detect demyelination in the CNS but cannot discern myelination in the PNS.
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What is Silver Impregnation
Variety of silver stains available to stain neurons Bielschowsky silver stain highlights tangles and plaques in Alzheimer’s disease
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What is Sudan Black
Stains triglycerides, lipids and lipoproteins Stains myeloblasts but not lymphoblasts
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What is Immunohistochemistry
Antibodies used to detect specific molecules (antigens)