Module 8-Environmental Pathology Flashcards Preview

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Flashcards in Module 8-Environmental Pathology Deck (24):
1

Nasal Septal Perforation is due to cocaine abuse, what is the pathogenesis for how this happens?

Vasoconstriction of the blood vessels ---- leads to coagulative necrosis ---- over time perforation
---CNS: inhibited reuptake of dopamine
---PNS: inhibited reuptake of catecholamines (epi and noepi) ---these bind alpha one receptors

2

What effect does cocaine have on the brain?

Coagulative necrosis and stroke (ischemic or hemorrhagic)
--hemorrhagic is due to malignant HTN which ruptures the cerebral arteries and you get projectile vomiting and headaches due to the increased ICP

3

What effect does cocaine have on the eye?

Retinal hemorrhages and detachments and blindness all from malignant HTN
---pupil dilation (mydriasis)

4

What effect does cocaine have on the aorta?

Dissection (From the HTN) you get an initmal tear
---vasoconstriction leads to HTN and this ruptures the intima

5

What effect does cocaine have on the heart?

Die from arrhythmias due to ischemia to the conduction system (Sudden cardiac death, dont normally see an infarction because its too soon)
--can get an MI
--can also get dilated cardiomyopathy

6

What effect does cocaine have on the kidney?

Sudden onset maligant HTN (fibronoid necrosis also called necrotizing arteriolitis)

7

What is the most common cause of death from cocaine?

Arrhythmias

8

If you inhale cocaine with TALC, what complication do you see?

Pulmonary fibrosis

9

Review: What are the fat stains?

Oil red O
Sudan Black
Osmic Acid

10

What morphological changes do you see in a person with alcoholic hepatitis ?

Macrovasicular steatosis
Mallory- Denk Bodies: sign to liver injury (also found in cirrhosis)(made up of intermediated keratin filaments --- sign of liver injury)
Inflammation: neutrophil infiltration
Pericellular fibrosis

11

Alcohol is a type of _____ injury?

Cell

12

What is the pathogenesis for hepatic hepatitis due to alcohol?

Alcohol oxidation by alcohol dehydrogenase causes a decrease in NAD and an increase in NADH. NAD in required for fatty oxidation in the liver. Its deficiency is a main cause of fat accumulation in the liver of alcoholics. The increase in NADH/NAD ratio in alcoholics causes lactic acidosis
Metabolism of ethanol in the liver by CYP2E1 produces reactive oxygen species and causes lipid peroxidation of cell membranes.

13

What are the ALT and AST levels in alcohol hepatitis?

AST/ALT > 2

14

Carbon Monoxide Poisoning is common in whom?

Automobile exhaust in enclosed environment
--incomplete combustion of furnace and water heaters
---fires, automobiles and stove in closed spaces

15

How does acute carbon monoxide poisoning present?

Cherry red discolorization of the skin due to carboxyhemoglobin
--CO binds to Hb tighter than O2 (200X greater affinity)

16

How does chronic carbon monoxide poisoning present?

A family that cant afford a fireplace and using gas heaters then this is chronic
--headache
---flu like symptoms
(patients will eventually get the cherry red skin)

17

What is the most common cause of death of carbon monoxide poisoning?

Guy trapped in a fire
---asphyxiation due to carbon monoxide poisoning

18

What is the treatment for carbon monoxide poisoning?

--High flow O2
---hyperbaric chamber

19

What blood work will you check for carbon monoxide poisoning?

Measure CO levels
--O2 levels will be normal

20

What are some complications of carbon monoxide poisoning?

Brain: globus pallidus necrosis (only seen if the patient survives long enough)
Heart: MI due to hypoxia and coagulative necrosis

21

Reye syndrome is a rare fatal childhood hepatoencephalopathy associated with what?

with children viral infections treated with Aspirin
--never given aspirin to children with viral infections
--seen with chickenpox or viral flu treated with aspirin

22

What is the pathogenesis for Reyes Syndrome?

Aspirin metabolites --- decrease Beta-oxidation by reversible inhibition of mitochondrial enzymes
Mitochondrial dysfunction in the liver --- disrupts UREA cycle --- increase ammonia buildup
(therefore for lab testing check blood ammonia levels and liver function test)

23

Reye syndrome starts in the liver and ends in the brain, explain this

Brain: ammonia is toxic to the brain -- cytotoxic cerebral edema
Liver: microvesicular fatty change

24

What does Buddchiari mean?

Hepatic vein stenosis or thrombosis