Patho review stuff!!! COPY Flashcards
1
Q
Types of gastric polyps
A
- hyperplastic (80%) 2. fundal gland polypes (10%) 3. adenomatous polypes (5%)
2
Q
which tutors elict desmoplastic reactions?
A
- gastric adenocarcinoma 2. breast 3. breast 4. ledt sided Large intestine
3
Q
difference of interstitial and diffused gastric adenocarcinoma?
A
interstitial: precancerous lesion is intesterstial metaplasia of gastric mucosa, better differentiated, associated with chronic gastritis and H. pylori. diffused: de novo mutation of gastric mucosal cells, associated with rear e-cadherin mutation, poorly differentiated.
4
Q
main metastatic sides of Gastric carcinomas
A
via lymph bc carcinoma… 1. virchows ln 2. liver 3. peritoneum 4. ovaries (kruckenberg tumor)
5
Q
how do we classify GIST? and what’s wrong in GIST? where is is Gist most common?
A
not by being or malignant by mitotic number and size of tumor High and big = aggressive low and small= chill mutation of cKIT (CD117) leading to ligand less activation and therefore unstopped proliferation and growth. most common in stomach, then small intestine, then colon and rectum
6
Q
why does HCC can cause ischemic bowl disease?
A
Bc in HCC low levels of Protein s and c are presents leading to a hypercoagulative state causing vinous thrombosis and therefore leading to Ischemic bowl disease.
7
Q
classification of Ischemic bowl disease
A
- transmural: entire thickness 2. mural: mucosal & submucosal 3. mucosal: mucosal…
8
Q
classification of malabsorption
A
- intraluminal (pancreatic enzymes are broken) 2. mucosal (damaged cell surface transporters(lactose intolerance), intestinal surface reduction(Celiac and Crohns), mucosal infection (whipples)) 3. nutrient delivery
9
Q
extra intestinal complication of Crohns disease
A
- uveitis 2. sacroilitis 3. polyarthritis 4. erythema nodosum 5. blue duct inflammation 6. obstructive uropathy
10
Q
morphology of crohns disease
A
- sharp demarcation of diseased bowl segments 2. non-caveating granulomas 3. fistula formation (connection between bowl parts)
11
Q
Etiology of hepatocellualr carcinoma?
A
- HBV, HCV 2.chronic alkoholism 3. Alfatoxin 4. hemochrombtosis
12
Q
Hepatic malignant tumors
A
- HCC 2. Cholangiocelular carcinoma 3. hepatoblastoma
13
Q
most common hepatic tumor?
A
metatasatis from portal organs… can get tumors for virtually any organ tho
14
Q
benign tumros of the liver?
A
- cavernous hemangioma 2. hepatocellular adenoma
15
Q
ethology of hepatucellular adenoma
A
associated with oral contraceptives and steroids
16
Q
most common hepatic benign tutors?
A
cavernous Hemangioma
17
Q
what is a cavernous hemanigoma?
A
large dilated vessels, infiltrative, no capsule,
18
Q
what is von hippel Lindau disease?
A
genetic multi systemic disease of the epidymes, benign tumors called cavernous hemagnionomas…
19
Q
what is a cholangiocellular carcinoma?
A
adenocarcinoma arraising from cholangiocytes in intrahepatic ducts. pre disposition for ppl with PSC
20
Q
changes in a cirrhotic liver
A
- death of hepatocytes loss of microvilli– problems taking up and secreting proteins 2. extracellular matrix deposition in space of disse form stalate cells 3. vascular reorganisation loss of fenestration hypo perfusion leads to atrophy
21
Q
what does stalate cells normally do? and fnx in cirrhosis?
A
normally: storage of Vitamin A cirrhosis: production of Collagen in disse space
22
Q
what activates stalate cells of liver in cirrhosis?
A
endothelial cells, Kupffer cells, hepatocytes cytokines: IL1, TNF
23
Q
Etiology of Cholangitis?
A
alsmot always Bacterial infection via oddi also obstruction
24
Q
forms of cholangitis?
A
- ascending 2. Suppurative cholangitis – most severe from, purulent bile fills bile ducts, attacks ducts, and causes liver abscess
25
what's the most severe from of Cholangitis?
Suppurative: causes pus bile to attack lining and liver abscess formation
26
most common tumor of the biliary tract?
Carcinoma of the gallbladder
27
ethology of gallbladder carcinoma?
1. gallstones 2. bacterial 3. parasitic
28
what histological form do gallbladder carcinomas have?
Adenocarcinoma.
29
what are hepatic bile duct tumors in hilum of the liver called?
KLATSKIN tumor is a cholangiocarinoma of the hepatic bile ducts
30
pathogenisis of cholecystitis?
obstruction-- lecithin-- isolecthin-- toxic disruption of mucosa-- bile aggressive eon mucosa too-- PGI= inflammation yay
31
types of pankreatitis and its subclassifications
1. acute 1.1. intestinal 1.2. hemorragic 2. chronic 2.1. fibrotizing 2.2 obstructive 2.3 autoimmune
32
ethology of acute pancreatitis
1. cholelithiasis 2. alcohol 3. idiopathic 4. trauma from surgery 5. ruptured posterior duodenal ulcer 6. infections 7. hypercalemia: enzyme activaor
33
pathogenesis of acute interstitial pancreatitis
enzymatic destruction of fat cells-- FA released -- combine with Ca-- insoluble salts
34
pathogenesis of acute hemorraghic pancreatitis
affects ascinar and ductal cells and langerhans affects blood vessels-- hemorrhage
35
Pthaogeneis of Acute pancreatitis
increased pressure will lead to damage of acing cells which will release enzymes duodenal pancreatic refulx bilo pancreatic refulx epithelial dame due to bile salts hyper activation of enzymes
36
what causes acinar injury in acute pancreatitis?
Alcohol virus trauma hypercalcemia
37
what causes ductal obstruction in acute pancreatitis? and pathogenesis?
stones CF tumors oddin edema pathogenesis: obstruction-- high intraluminal pressure- -- accumulation of enzyme rich fluid-- lipase is active-- fat necrosis-- injury and pro inflammatory enzymes
38
which enzymes are active in acute pancreatitis?
Amylase: Lipase: Free FA bind with Ca= fat necrosis Proteases: digest vessels, parenchyme etc.
39
consequences of acute pancreatitis
1. recovery 2. fat necrosis 3. pseudocysts (liquified fat necrosis) Becomes pancreatic Abscess 4.Abcess 5. Pancreatic Apoplexia
40
systemic consequences of acute pancreatitis?
1. paralytic ileus 2. shock 3. peritonitis 4. DIC 5. ARDS 6. DM 7. hypocalcemia
41
forms of chronic pancreatitis?
general idea: acing cells don't fucntion so fibrosis 1. chronic autoimmune 2. chronic obstructive 3. chronic fibrotizing
42
explain chronic autoimmune pancreatitis
high IgG4 infiltration of T cells in PERIDUCTAL AREA massive periductal myofibroblastic proliferation ASSOCIATED WITH SJÖRGENS SYNDROME
43
explain chronic obstructive pancreatitis.
periductal fibrosis
44
explain chronic fibrotizing pancreatitis
most frequent chronic alcoholism fibrosis due to no enzyme production
45
what is duct ectasia of the breast?
dilated ducts, filled with green viscid matter nipple discharge significant degree of fibrosis mimics carcinoma
46
what are fibrocystic changes?
cyct formation and fibrosis
due to cyclic change of breast in menstrual cycle
subdivieded into non proilferative and prolfiverative
47
classification of fibrocystic chances in Brest.
1. **non proliferative**-- fibrosis without hyperplasia
2. **proliferative**-- hyperplasia, scleorisng adenosis
48
explain non-proliferative fibrocystic changes in the breast
+ diseases considered non proliferative fibrocystic
most common type
increased fibrous storm no hyperplasia **dilation** of ducts--\> cysts form Bilateral
diseases:
1. **Duct ectasia**
**2. Cycst**
**3. Apocrine change**
**4. mild hyperplasia**
**5. Adenosis**
**6. Fibroadeoma with out complex features**
49
explain proliferative fibrocystic changes in breast
epithelial hyperplasia (2 layers in duct instead of one) Ductal papillomatosis- papillary processes in lumen atypical lobular hyperplasia- resebeles carcinoma in situ sclerosing adenosis- enlarge meant of lobules with many acini and hardening
50
what is atypical lobular hyperplasia in fibrocystic changes?
proliferative carcinoma in situ (doesn't fill all acini) very high risk for carnimoa development calcification may appear
51
what is sclerosing adenosis in fibrocystic changes?
proliferative enlargement of lobules with acini proliferation of fibroblasts along the ducts causing the compression of lumina of the ducts
52
benign tumours of the breasts
Fibrocystic changes
Fibroadenoma adenoma
Phyllodes
intraductal papilloma
53
malignant tumors of the breast
1. non invasive (insitu) carcinoma
1. 1 DCIS ductal carcinoma in situ
1. 2 LCIS Lobular cis
2. invasive carcinoma
2. 1 invasive ductal carcinoma NST
2. 2 invasive lobular carcinoma
2. 3 Special types
2. 4 Rear and salivary gland type
2. 5 neuroendocrine tumors
2. 6 inflammatory carcinoma
54
Explain fibroadenoma
most common benign tumor do to high levels of oestrogen raises from CT enlarges during mesntrual cycle and pregnancy due to Estrogen
55
explain Phyllodes tumor
mixed epithelium and stromal tumor
hypercellular stroma
classification: being, borderliner, mallignant
Arises from periductal storma leaflike appearance increased stomal cellularity and high mitotic activity
56
explain intraductal papilloma
solitary lesion in larger ducts serous + bloody nipple discharge papillary growth into lumen of duct double layers epithelium single elation stays benign, multiple can get malignant
57
inflammatory disorders of the breast
1. Acute mastitis
2. Mammary duct ectasia
3. Fat necrosis
4. Lymphocytic mastopathy
5. granulomatous mastitis
58
ethology of Acute mastitis
usually doing 1st moth of lactation bacterial infection due to nipple cracy and fissures self resolved by breast feeding or antibiotics
59
What is peridcutal mastitis?
duct plugging; duct dilation; rupture; intese chronic+granulamotaous inflammation due to squamous metaplasia of the nipple shedding keratin in ducts
60
what is zuska disease?
Periductal mastitis due to squamouscell metaplasia of nipple
61
what is Lymphocitic mastopathy?
Autoimmune?! collagenized storma around atrophic ducts with shitloads of Lymphocytes associated with DM1 and AI thyroid diseases
62
which fiibrocystic leasions have minimal to no rsik to become breast carinoma?
1. fibrosis
2. cycst
3. apporcine metaplasia
63
which fibrocystic leasion have slight risk in becomming breast carinomas?
1. ductal hyperplasia (no atypia)
2. scleoring adenosis
64
which fibrocystic changes have high risk in becomming breast carinomas
atypical hyperplasia of ducts and lobles
65
most common type of invasive breast cancer?
invasive ductal carinoma
NST
66
most common breast tumor?
fibroadenoma
67
special features of invasive ductal carinomas NST of the breast:
1. tubular carinoma
2. mucinous carinoma
3. medullary carinoma
4. inflammatory carinoma
68
classification of Phyllodes tumors?
benign
borderline
malligantn
69
which genes are mutated in breast carinomas?
1. BRCA 1/2
2. p53
3. ataxia teleangiectasia (ATM) gene
4. Cowdens disease (10q mutation)
5. Her 2
6. Ras
7. MYC
70
what do we use the notingham grading system for?
invasive breast carinoma
3 components
1. how many tubukles are there
2. polymorphism
3. mitotic acitvity
71
whats the recent classificaton of breast carinoma WHO?
**_Insitu_**
1. ductal/DCIS
2. Lobular/LCIS
**_Invasive_**
1. **_n_**ospecial type NST
2. Invasive lobular ca
3. special types
4. rear/salivary gland type ca
5. Neuroendocrine neoplasms
72
what is the Van Nuys grading?
for DCIS
a bit simpler then the perfect grading system
based on necrosis and grade of the cells
73
what are the different 'looks' of the NST Carinomas of the breast?
with medullary features
with NE differntiation
glycogen rich
Lipid rich
etc
74
what is the classificaiton based on gentic prifile of breast carinoma
Based on Estrogen receptor positive or negative
gerneally: over stimulation of E causes low grade Ca
E+: Luminal A/B : low grade
E-: her2, Normal breast like, basal like: high grade
75
classification of Rhinitis?
1. allergic
2. infectious
3. chronic
76
what type of reaction is alleric rhinits?
type 1 hypersensitivity
allergen activates b cell which produces IgE which then causes degranulation of mast cells
77
important formes of Laryngitis
1. tuberculoid
2. diphteric
78
risk factors for vainous thrombosis
1. prolonged bed rest
2. post surgery
3. severe trauma
4. **Contraceprive**
5. **pregnancy**
6. **CHF**
7. **overweight**
8. **SMOkER**
79
What is Atelectatic lung?
80
forms of atelectasis
1. Resorption
2. Compression
3. Contraction
81
what is resorption atelectasis
follows compleat airway obstruction
leads to decreased O2 that makes it to the alveoli
may be due to exessive mucus production etc.
Mediastinum goes towards lung
82
what is Compression Atelectasis?
when pleural space is expanded
pressure on lung
mediasitum goes away from collapsed lung ('mass effect')
83
what is contraction Atelectasis?
due to local fibrotic change
holds the lung to gether
84
what is ARDS?
end reult of acute alveolar injury
imbalance of pro and anti inflammatory mediators
85
what casues ARDS?
imbalace of Pro and anti inflamamtory state
increase IL1, IL8 and TNF
86
Pathogenesis of ARDS
1. damage to vesel wall or alveolar epithel
2. acitve pulmo macrophages (IL1, IL8, TNF)
3. Neutrophiles due to chemotactic cytokines
4. neutrophioes damage walles even more (ROS, Lysozym, AA)
5. leads to loss of surfactant and increased vascular permability
Results in: lungs not able to expand
87
what are restricive lung diseases chracterized by?
the loss of compliance
for example due to fibrosis
88
type of pneumoconiosis
1. coal workers
2. silicosis
3. berylliosis
4. asbestosis
89
types of chronic bronchitis
1. simple chronic bronchitis
2. chronic asthmatic bronchits
3. chronic obstructive broncitis
90
what is chrnic brnochitis
mucosal gland metaplasia
mucus hypersecretion
91
what causes obstrction of airways in chronic bronchtis
92
what is the index called to histologically classify chronic bronchitis?
Reid index
93
what is bronchiectasis?
permanent dialatrion of bronchi due to destrctuion of msucle and elastic tissue, results in chronic necrosis
its a secodnary disease
94
what casues bronchiectasis?
95
parthogenesis ob bronchiectasis?
obstruction or infection is the etiology
due to obstrcution we will get an infection and inflammation opccours eventually leading to tissue damage
96
types of emphysema
97
what is the differecne between Centriacinar and pan acinar emphysema
98
pathogenesis of emphysema
imbalacne of oxidants and antioxidants
tabbaco-- macrophages-- NFkB transcription-- neutrophils release proteases-- destruction of CT oof alveolar walls
99
effect of Cystic Fibrosis on lung
1. viscous mucus
2. hyperplasia and hypertrophy
3. obstrctuion
100
What is chronic bronchitis?
COPD
Hypertrophy of the mucus glads (reid index)
Excress of mucus prodctuion ( productive cough)
Cyanosis due to CO2 trapping in blood
Smiking associated
101
what is COPD?
air has issues leaving the lungs due to a condtion:
1. Chronic bronhitis
2. Ashma
3. Emphysema
4. Bronchioectasis
increases TLC due to air trapping
decreased FEV1/FVC ratio
102
what leads to destrcution of alveolar walls in emphysema?
either exessive inflammation or antitrypsin deficnecy
A1AT inhibts proteases which is secreated by neurotphils. so if lack of A1AT neutropphils will destroy the walls
smoking causes excessive inflammation
103
what is asthma?
Reversible airway bronchoconstriction
hypersensitivity type 1
104
Pathogeneseis of Asthma.
1. allergen activates Th2 cells
2. release of IL4(class switch to IgE) IL5(eosinophils come) IL10(inhibits Th1 cells)
3. rexeposure leads ti IgE activation of mast cells
4. Histamine release
5. brconhospasm
105
what is in the mucus of an asthma patient?
Spiral shaped mucus plugs (= **Curschmann spirales**)
Eosinophil derived crystals (**= Charcot-lyden crystals**)
106
what causes bronchiectasis?
Cystic fibrosis
Kartagner syndrom (due to dynein arm, no cillilary movement)
tumor
necrotiszing infection
107
what is Kartagerner syndrom?
mutation of dynein arm
no cilia movement
results in bronchiectasis, infertility, sinusitis etc
108
etiology of sialoadenitis?
1. traumatic
2. viral
3. bacterial
4. Autoimmune
109
traumatic pathogegesis of sialoadenitis
blockadeg or rupture of salivary duct.
saliva attacks neighbour tissue
Mucocele
110
Viral etiology of sialoadenisits
1. Mumps
2. CMV
111
what are the autoimmune causes for Sialoadinatis?
1. sjorgen sydnrom
2. sarcoidosis
112
What is a warthin tumor?
Salivary gland tissue trapped in regional LN
only in parotid
mucus cysts
Papillary cystadenoma lymphomatosum
113
what is a pleimophic adenoma?
most commmon benign tumor of salivary glands
114
classic gross phases of Lobar pneumonia?
1. Congestion
2. Red hepatization with exudate
3. gray hepatization
4. resolution
115
histological soectrum of Pneumonia?
1. fibrinopurulent alveolar exudate (acute bacterial)
2. Mononuclear interstial infultate( atypical/Viral)
3. Granulomatous (chronic benumonia)
116
Patterns of pneumonia
117
describe Bronchopneumonia
patchy distribution
more the one lobe
inital infection of bronchi extednig to alvolus
caused by: Staph, Haemophilus, pseudomona, moraxrlla, legionella
118
describe Lobar pneumonia:
consolidation of entire lobe
bacterial: strep pneumonia, klepsiella
Congestion-- red hepatization-- grey hepatization-- resolution
119
tumors of the nose
1. squamous cell ca
2. adenoca
3. malignant melanoma
4. inverting papiloma
5. esthesioneuroblastoma (olfactory)
120
histological variants of nasopharyngeal carinoma
1. keratinizing squamous cell ca
2. non keratinizing squamous cell ca
3. undifferentiated ca
121
pathogeneisis of nasopharyngeal carinoma?
EBV associated
replicates in nasopharynx mucoa, then ifects tonsils
epithelium changes of tonsisl= carinmoam
122
anatomical sites of laryngeal carinoma
1. supraglottic
2. glottic
3. infraglottic
**spuraglottic**: rich in lymphatics-- early spread to cervial LN
**Glottic**: more common, directly on vocal chords, keratinizing, better prognosis not rich in Lympahtics
**Infraglottic**: least common, worst prognosis, no early symptoms, goot Lympahtic spread
123
what are aschoff bodeis?
found in heard in reumatic fever
T lymphocyte accumulations
124
