Flashcards in Module 3 -Path continued Deck (29):
What is the etiology of a nitrogen embolism/ the bends/Caisson's Disease
Deep sea diving without Caisson's chamber or deeper than 10meters
What is the pathogenesis of a nitrogen embolism?
O2, N2 dissolve in high amounts in blood and tissues due to high pressure --> sudden resurfacing releases N2, O2 --> O2 reabsorbed, N2 bubbles out --ruptures tissues and forms emboli in vessels --> platelets adhere to N2 ,form secondary thrombi and aggravate ischemia
In regards to nitrogen emboli, what are the effects if found in the brain, muscles/joints, or lungs
Brain = death
Muscles/Joints = bends
Lungs = edema and hemorrhage (chokes)
What is Caisson's Disease?
Persistent (Chronic) gas emboli in bones --> necrosis in femur, tibia, and humerus
What is the treatment for Caisson's Disease?
Pressure chamber (slow decompression)
What is an air embolism?
150mL of air in venous circulation through neck wounds, thoracentesis, cut jugular vein, hemodialysis, child birth, abortion
What is the pathogenesis for air embolism?
Air bubbles coalesce and obstruct flow of blood in right ventricle, lungs and brain
Frothy mixture in right ventricles --> ineffective ejection --> may occlude large vessels
Where does a white infarct occur?
Solid organs with single blood supply (no dual or collateral circulation)
What is the pathogenesis for a white infarct?
Arterial occlusion --> decreased O2 supply --> white infarct (wedge shaped) --> ischemic coagulative necrosis
In the heart what is the common etiology for a white infarct?
Occlusion of LAD due to atherosclerosidic plaque with superimposed thrombus and this causes an MI and a pale infarct
In the kidney what is the common etiology for a white infarct? And how would you get a white or pale infarct in the kidney?
Unilateral - asymptomatic
Bilateral --> decreased urine output
Hypovolemic show because this leads to acute ischemia
In the spleen what is the common etiology for a white infarct?
Sickle cell disease
Where do Red (hemorrhagic) infarcts occur?
Loose tissues with collateral/dual blood supply (lungs, small bowl, testicles)
Reperfusion injury via TPA ( free radical damage)
Venous obstruction via testicular torsion (testicular veins are torsed)
If a red infarct occurs in the lungs what is this usually do to?
Usually due to Major pulmonary embolus (from DVT) + compromised bronchial artery --> hemorrhage/congestion -- >red infarct --> coagulative necrosis
In the GI system if there is a red infarct the area is referred to as a watershed area, where is the exact location in the GI tract?
Splenic Flexure (where SMA ends, IMA begins) most vulnerable to hypoxia
In the small intestine a red infarct is caused by what?
Volvulus, obstruction, or intersusception (proximal bowel goes into the distal bowel)
A cerebral infarct is usually do to what?
Atherosclerosis with superimposed thrombus in vertebro-basilar artery
(thrombo-emboli in the internal carotid/MCA are less common)
In regards to a cerebral infarct explain the progression of necrosis that will be seen
12-24 hours: Coagulative necrosis/hemorrhage due to reperfusion
24-48 hours: microglia engulf necrotic material --> Gitter cells
Then you have liquefactive necrosis and gliosis of surrounding area
What are key findings of a Myocardial infarction?
Coronary atherosclerosis with superimposed thrombosis
Left anterior descending is the commonest involved
Initially blotchy , later pale scar tissue
Cardiac enzymes raise in serum
Presents with severe chest pain
In a white infarct where is the site of occlusion on gross specimen?
What is the most accurate test for an MI?
Troponin I (does not lower until 7-10 days post MI)
however if a patient is admitted to the floor post MI and you think they are experiencing another MI, what test would you order???? CK-MB because trop will most likely still be high (CK-MB has a much shorter window)
In the lab slides the picture on the left shows what kind of morphological changes of an MI ?
Acute MI: 1-3 days because no nucleus in myocardial fibers: coagulative necrosis and this is irreversible and lots of neutrophils
In the lab slides the picture to the right shows what kind of morphological changes of an MI?
Granulation tissues and collagen so this shows up between 10-14 days post MI. Type III collagen and angiogenesis
What is the most common cause of death when a person experiences an MI?
Arrhythmia's due to damage to the purkinje fibers
In the GI system the patient experiences a red infarct, what is the last place that will get blood?
Mucosa (last place to get oxygenated blood)
A red infarct is a surgical emergency why?
because the walls are soo weak they are ready to perforate
perforation -->peritonitis --> gram negative septic shock from e.coli --> DIC
What are findings on exam of a GI red infarct?
absent/reduced bowl sounds
What diagostic tools would you do an a patient with a GI red infarct?