ICS Pathology Flashcards
(115 cards)
1
Q
Define Inflammation
A
Local physiological response to tissue injury
2
Q
In what ways can inflammation be beneficial?
A
- Destruction of invading microorganisms
- Walling off an abscess cavity
3
Q
In what ways can inflammation be harmful?
A
- Over-reaction to stimulus
- Autoimmune diseases
- Abscesses can act as space-occupying lesions in the brain
- Fibrosis
4
Q
Define acute inflammation
A
Initial and transient series of tissue reactions to injury
5
Q
Define chronic inflammation
A
Subsequent and/or prolonged tissue reactions following initial response
6
Q
Steps of acute inflammation
A
- Initial reaction
- Vasodilation
- Vascular leakage of protein-rich fluid
- Neutrophil polymorph recruited
- Outcomes
7
Q
Outcomes of Acute Inflammation
A
- Resolution
- Suppuration (formation of pus e.g. abscess)
- Organisation
- Chronic Inflammation
8
Q
Acute Inflammation causes
A
Microbial Infections Hypersensitivity reactions Physical agents Chemical Bacterial toxins Tissue necrosis
9
Q
Appearance of Acute Inflammation
A
Rubor - Redness
Calor - Heat
Tumor - Swelling
Dolor - Pain
10
Q
What cells are required for histological diagnosis of inflammation?
A
Neutrophil polymorphs
11
Q
Describe Neutrophil Polymorphs
A
Contain cytoplasmic granules full of bacteria-killing enzymes. Usually die at scene of inflammation. Attracts macrophages.
12
Q
Describe Macrophages
A
Phagocytic properties, ingesting bacteria and debris. Last weeks to months, can present antigen to lymphocyte
13
Q
Describe lymphocytes
A
Live for years, attract other inflammatory cells, immunological memory etc.
14
Q
Describe endothelial cells in areas of inflammation
A
Become sticky so inflammatory cells stick to them, become porous to allow inflammatory cells into tissues.
15
Q
Describe fibroblasts in inflammation
A
Long-lived, form collagen in areas of chronic inflammation and repair.
16
Q
Example of Acute Inflammation
A
Acute Appendicitis
17
Q
Example of Chronic Inflammation
A
Tuberculosis
18
Q
Treatment for acute inflammation
A
RICE
Aspirin
Ibuprophen (NSAIDs)
Analgesics
19
Q
What is a granuloma?
A
A collection of epithelioid histocytes (macrophages) - a small area of inflammation
20
Q
What is granulation tissue?
A
Important component of healing and comprises small blood vessels in a connective tissue matrix with myofibroblasts
21
Q
What are the two types of autopsy and how common are they?
A
Hospital autopsies - 10%
Medico-legal autopsies - 90% (coronial or forensic)
22
Q
What types of deaths are referred to coroners?
A
- Natural
- Iatrogenic
- Unnatural
23
Q
Causes of Chronic Inflammation
A
Primary chronic inflammation (most common)
Transplant rejection
Progression from acute
Recurrent episodes of acute
24
Q
Is a granuloma a form of acute or chronic inflammation?
A
Chronic (type IV hypersensitivity)
25
What is Rheumatoid Arthritis?
Inflammatory arthritis with granulomatous features with no overt cause
26
Define resolution of an injury
Initiating factor removed and tissue is undamaged or able to regenerate
27
Define repair of an injury
Initiating factor still present, tissue damaged and unable to regenerate. Usually results in fibrous scarring.
28
Lobar Pneumonia
Affects 1 lung lobe. Alveoli filled with polymorphs. Pneumocytes can regenerate so can be resolved.
29
Lung damage in COVID
Interstitial pneumonia, alveolar walls cannot regenerate so fibrosis occurs.
30
Describe healing of abrasions
Abrasion -> scab formed -> epidermis growing out from adnexa protected by scab -> thin confluent epidermis -> final epidermal regrowth
31
Describe healing of skin by 1st intention
Incision causes little damage to surrounding tissues. two sides brought together and healing can proceed quickly.
Incision -> exudation of fibrinogen -> weak fibrin joint -> epidermal regrowth and collagen synthesis -> strong collagen joint
32
Describe healing of skin by 2nd intention
Tissue loss injury, granulation tissue forms -> organisation -> early fibrous scar -> scar contraction
33
What is granulation tissue?
Loops of capillaries supported by myofibroblasts. Actively contracts to reduce wound size.
34
Examples of cells that DO regenerate
- Hepatocytes
- Pneumocytes
- All blood cells
- Gut epithelium
- Skin epithelium
- Osteocytes
35
Examples of cells that DON'T regenerate
- Myocardial cells
| - Neurones
36
What is fibrosis in the brain called?
Gliosis
37
Why are blood clots rare?
Laminar flow
| Endothelial cells aren't sticky when healthy
38
Define thrombosis
Solid mass of blood constituents formed within vascular system
39
Steps of thrombus formation
1. Damage to endothelial cells exposes collagen
2. Platelets begin to stick to exposed collagen – platelet aggregation
3. Red blood cells get trapped within aggregating platelets
4. Clotting factors join the RBCs and platelets, clotting cascade forms fibrin which is deposited and forms a clot
5. Positive feedback loop -> can end up causing a thrombus – blocking the artery
40
What can reduce risk of thrombosis?
Low-dose aspirin
41
Causes of thrombosis
1. Changes in vessel wall
2. Changes in blood flow
3. Changes in blood constituents
42
What is an embolism?
Process of a solid mass in the blood being carried to a place where it gets stuck
43
Types of embolus
- Broken off thrombus (most common)
- Air
- Tumour
- Amniotic fluid
- Fat
44
What happens if an embolus enters the venous system?
Travels to the vena cava and lodges in pulmonary arteries
45
What happens if an embolus enters the arterial system?
Can travel ANYWHERE downstream of entry
46
Define ischaemia
Reduction in blood flow to tissue without other implications
47
Define infarction
Reduction in blood flow causing lack of nutrients to tissue causing tissue death
48
What is an end artery supply
Organ that only receives blood supply from 1 artery (problematic with thrombus)
49
Examples of organs with multiple arterial supplies
Lungs
Liver
Brain
50
What is in a plaque?
- Fibrous tissue
- Lipids (cholesterol)
- Lymphocytes
51
Is atherosclerosis found in low or high pressure systems?
High pressure systems e.g. systemic arteries
52
Risk factors of atherosclerosis
Age, smoking, hypertension, poorly-controlled diabetes, hyperlipidaemia
53
Formation of atheroma
Endothelial damage causes thrombus formation, endothelial cells grow over thrombus and this happens a lot causing build up.
54
What can be used to prevent platelet aggregation?
Low-dose aspirin
55
Complications of atherosclerosis
Cerebral infarction, MI, gangrene, carotid atheroma, aortic aneurysms, peripheral vascular disease
56
What is apoptosis?
Programmed cell death to get cells no longer functioning
57
Process of apoptosis
Nucleus condenses, cell shrinkage, cell breaks into apoptotic bodies
58
Trigger of apoptosis
DNA damage in dividing cells
59
Apoptosis in disease
Cancer (too little)
| HIV (too much)
60
What are the effector molecules of apoptosis?
Caspases
61
What is necrosis?
Traumatic cell death of functioning cells
62
Causes of necrosis
Disease, injury or blood supply
63
Clinical examples of necrosis
- Toxic spider venom
- Frostbite
- Cerebral Infarction
- Avascular necrosis of bone
- Pancreatitis
64
Define Hypertrophy
Increase in tissue size due to increase in size of constituent cells
65
Define Hyperplasia
Increase in tissue size due to increase in number of cells
66
Define Atrophy
Decrease in size of tissue caused by decrease in constituent cell number OR size
67
Define Metaplasia
Change in differentiation of a cell from one fully-differentiated type to a different fully-differentiated type (reversible)
68
Define Dysplasia
Morphological changes seen in cells in the progression to becoming cancerous
69
What occurs to telomeres as we age?
Telomeres get shorter after each cell division – limiting the amount of division that can occur
70
Dermal elastosis in ageing
Accumulation of abnormal elastic in dermis. Result of prolonged exposure to UV light (causing cross-linking)
71
Osteoporosis in ageing
- Loss of coupling in the bone remodelling process – due to increased bone resorption or decreased bone formation due to a lack of oestrogen
- Can cause osteopenia
- Bone matrix mineralised as usual but trabeculae thinned
- Leads to hypercalciuria
72
Cataracts in ageing
- Result of the formation of opaque proteins within the lens resulting in loss of lens elasticity
- UV-B light causes protein cross-linking
73
Senile dementia in ageing
Plaques and neurofibrillary tangles occur in brain
74
Sarcopenia in ageing
Decreased GH, decreased testosterone, increased catabolic cytokines
75
Deafness in ageing
Hair cells cannot divide/regenerate so cannot recover once damaged
76
Pathology of Basal cell carcinoma
Only invades locally, never metastasises - local excision = cure
77
Basic pathology of Leukaemia
Malignant tumour of WBCs so circulates, so needs a systemic treatment e.g. chemotherapy
78
Where can carcinomas spread?
- Lymph nodes draining site of carcinoma
- Bone (breast, prostate, lung, thyroid and kidney)
- Rest of the body
79
Breast cancer care plan
- Core needle biopsy to confirm
- Axillary nodes ultrasound (then biopsy)
- CT scan/radio nucleotide scan of rest of body
- Surgery
80
What is adjuvant therapy?
Extra treatment given after surgical excision to eliminate micro-metastases
81
What can oestrogen-receptor positive breast cancers be combated with?
Anti-oestrogen therapy
82
Define carcinogenesis
The transformation of normal cells to neoplastic cells through permanent genetic alterations or mutations
83
Define oncogenic
tumour causing
84
Define carcinogenic
cancer causing (only malignant neoplasms)
85
Why are carcinogens hard to identify?
Long latent periods, complexity of environment, ethical issues with research
86
Occupational cancer risks
Lung cancer - smoking
Bladder cancer - aniline dye and rubber
Scrotal cancer - chimney sweeps
87
5 classes of carcinogens
```
Chemical
Viral
Ionising and non-ionising radiation
Hormones, parasite and mycotoxins
Misc.
```
88
What percentage of cancer risk is inherited
15% (rest is environmental)
89
How long is the latent period typically between exposure and cancer?
VERY LONG
90
Define neoplasm
o A lesion resulting from the autonomous or relatively autonomous abnormal growth of cells which persists after the initiating stimulus has been removed
91
What makes up neoplasms?
Neoplastic cells and stroma
92
What cells are present in the stroma of a neoplasm?
Fibroblasts
93
Tumour angiogenesis
Blood supply growth to tumour, needed for growth. Malignant neoplasm too fast so has central necrosis.
94
Characteristics of a benign neoplasm
- Localised
- Non-invasive
- Grow slowly (low mitotic activity)
- Close resemblance to normal tissue
- Necrosis and ulceration rare
- Nuclei often normal looking
95
How can benign neoplasms cause morbidity/mortality
Pressure on adjacent structures, hormone production, transformation into malignant, anxiety
96
Characteristics of a malignant neoplasm
- Invasive and can metastasise
- Rapid growth rate
- Variable resemblance to normal tissue
- Poorly defined or irregular border
- E.g. prostate cancer, squamous cell carcinoma
- Hyperchromatic and pleomorphic nuclei
- Increased mitotic activity
- Necrosis and ulceration common
- Encroach upon and destroy surrounding tissues
97
Suffix of all neoplasms
-oma
98
What do you call a benign tumour of non-glandular or secretory epithelium?
Papilloma
99
Name of benign tumour of glandular/secretory epithelium
Adenoma
100
Name of malignant epithelial neoplasm
Carcinoma
101
Name of carcinoma of glandular epithelium
Adenocarcinoma
102
Benign connective tissue neoplasm
```
Lipoma
Chondroma
Osteoma
Angioma
Leiomyoma
Rhabdomyoma
Neuroma
```
103
Malignant connective tissue neoplasms
Sarcoma
104
What is an anaplastic tumour?
Cell-type of origin is unknown
105
Exceptions to neoplasm naming rules (long list)
```
Granuloma
Tuberculoma
Melanoma
Mesothelioma
Lymphoma
Burkitt's lymphoma
Ewing's sarcoma
Grawitz tumour
Kaposia's sarcoma
Teratoma
Blastomas
Mixed Tumours
APUDomas
Carcinosarcoma
```
106
Example of granulomatous inflammation
Chron's disease
107
Chronic inflammatory process never going through acute stage
Infectious mononucleosis
108
Pattern of differentiation of metaplastic cells in bronchi of smokers
Ciliated columnar to squamous
109
What is a carcinoma in situ?
A malignant epithelial neoplasm that has not yet invaded through the original basement membrane
110
Define invasive carcinoma
A carcinoma that has breached the original basement membrane. Needs proteases and cell motility
111
Define metastasis
A malignant tumour spreads from its primary site to produce secondary tumours at distant sites.
112
Steps of the metastatic cascade
1. Detachment
2. Invasion through basement membrane
3. Intravasation
4. Evasion of host immune defence
5. Extravasation
6. Growth at metastatic site
7. Angiogenesis
113
Routes of metastasis
Haematogenous - blood
Lymphatic
Trans-coelomic - pericardial and peritoneal cavities
114
Tumours which commonly metastasise in the lungs
Sarcomas and any common cancers
115
Tumours which commonly metastasise in the liver
Colon, stomach, pancreas and carcinoid tumours of intestine
