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Pathology Final

Terms in this set (111)

myopathy
disease that affects the muscle fiber independent of the neurons. Skeletal muscle undergoes deinnervation atrophy as a response to neuronal pathology.
muscular dystrophy
Group of disorders usually arising in childhood as progressive muscle weakness with atrophy and replacement of muscle by fibro fatty tissue.
Most common type of dystrophy
Duchenne Muscular Dystrophy: X-linked genetic disorder affecting mostly males. Usually child is wheelchair bound, rare survival > 20's (protein mutation)
myositis
inflammatory muscle disease
2 types of myositis
Infectious and Immune. Autoimmune disorders that affect the skeletal muscle can be primary or associated with other autoimmune processes. Such as dematomyositis.
myasthenia gravis
disease of the neuromuscular junction. Autoimmune loss of acetylcholine receptors. Symptoms often start with the eyes drooping. Associated with thymic hyperplasia or thymomas. Tx is acetyl cholinesterase medications.
rhabdomyosarcoma
malignant skeletal muscle tumor that almost always affects children < 20 years of age. Associated with gene trans-location. Very aggressive tumor.
leiomyoma
benign smooth muscle tumor
leiomyosarcoma
malignant smooth muscle tumor in skin and deep tissue of the retroperitoneum and thigh. The deep tumors tend to be large and aggressive.
osteoarthritis
degenerative joint disease and non-inflammatory condition of the cartilage. There is erosion of the cartilage=eburnation; have exposure of the underlying bone. Often in the weight bearing joints (knees, hips). Pain with use, stiffness, asymmetric pain.
osteoporosis
reduced bone mass causing bone porosity and fracture. Associated with advanced age, vitamin deficiency, hormone metabolism and decreased physical activity. Often postmenopausal female due to decreased estrogen.
Secondary osteoporosis
arises from endocrine disorders such as hyperparathyroidism and cancers.
osteomyelitis
inflammtion of bone marrow because of infection. Bacteria can gain access via trauma, blood, and non-healing ulcers.
bone neoplasms
rare but aggressive
osteoma
protuberance of normal bone, usually skull and face.
osteosarcoma
malignant, often in metaphysis of long bones, affects children/elderly
chondroblastic osteosarcoma
malignant that forms cartilage and bone
rheumatoid arthritis
autoimmune chronic systemic condition that affects joints, skin and blood vessels. Destruction of cartilage by inflammation. Joint pain is symmetric and affects non-weight bearing joints as well as weight bearing.
synovitis
inflammation of synovial membrane often in rheumatoid arthritis.
ankylosing spondyloarthritis
inflammation (arthritis)/fusion=ankylo/spine=spondylo. Affects young males, presents with fusion and pain in the sacroiliac joint and lower spine. Can be associated with Crohn's and UC.
Lyme Disease
spirochete - Borrelia burgderfori (deer tick). Transmitted via ticks with flu like symptoms and targetoid rash as at the site of the bite. Untreated patients have relapsing arthritis that moves from joint to joint which can lead to permanent deformity.
nephron
functional unit of the kidney
functions of the kidney
removes metabolic wastes, maintains salt and acid balance by taking out bad things and putting in good things into blood.
endocrine function of the kidney
secretes erythropoietin which starts up production of RBC's and renin which controls aldosterone; urine production
renal failure
failure of the urinary tract to produce adequate amounts of urine
acute renal failure
reversible injury to nephrons due to a definable isolated event such as ischemia or toxic injury; have azotemia
ischemia
lack of blood flow
toxic injury
exposure to chemicals that the body should be exposed to or that are toxic to the kidney
azotemia
increase of serum nitrogen wastes; BUN blood urea nitrogen and creatinine; rise from decreased glomerular filtration
chronic renal failure
irreversible; gradual and an end result to a long standing disease; indicator is uremia.
uremia
clinical term that describes signs and symptoms of azotemia; fluid, acid and electrolyte imbalance that affects almost every organ
clinical signs and symptoms of chronic renal failure
hematuria, proteinuria, hyptertension and hyperlipidemia
hyperlipidemia
increased fats in the blood secondary to proteinuria due to impaired lipoprotein metabolism from proteinuria
UTI
kidneys are highly perfused with blood; important for filtration, therefore susceptible to hematogenous infection (septicemia), also susceptible to ascending infection from the bladder.
Routes of UTI's
1) Ascending is the most common, "going up" infection where bacteria from the outside goes up through the urinary system. 2) Hematogenous "via the blood"
cystitis
bacterial infection of the bladder; inflammation of the urinary bladder. Most often ascending.
pyelitis
inflammation of just the renal pelvis, most often ascending.
pyelonephritis
bacterial infection of the kidney; inflammation of the entire kidney. Either ascending or hematogenous. Most common when people are septic.
Common organisms involved with UTI's
E. coli, klebsiella and enterobacteria
Signs and symptoms of UTI's
hematuria, fever, pyuria, and dysuria
Urolithasis
stone in ureter; classified by chemical structure, most common is calcium. Treatment involves voiding, surgery or lithotripsy
signs and symptoms of Urolithasis
hematuria, renal colic and recurrent infection
renal colic
recurrent pain; intermittent pain from stone in the ureter
glomerulonephritis
involvement of the glomeruli by systemic autoimmune diseases mediated by antibodies (from exposure of these in blood during filtration.) Type III hypersensitivity response.
dysuria
painful urination
pyuria
pus in urine
glomerulosclerosis
hyalinization; thickening or narrowing of capillary loops of the glomeruli due to kidneys not receiving blood supply. Seen in ESRD, diabetic microangiopathy and hypertensive renal disease
most common tumor of urinary bladder
90% are TCC: transitional cell carcinoma
TCC
= urothelial carcinoma
tumors of kidney and renal pelvis
RCC, TCC, Wilm's tumor
tumors of urethra
rare, but SCC
Renal Cell Carcinoma RCC
most common of malignant tumors of adult kidney. 85% of all renal neoplasms! Unknown etiology.
Pathology of RCC
nodules or masses that are well demarcated; tend to met via renal vein. Signs and symptoms include flank plain, hematuria, palpable mass, and weight loss. Tx option is surgery with a prognosis of a 40% 5 year survival rate.
Wilm's Tumor
nephroblastoma; pediatric tumor and most common renal tumor in infants and young children from 2-4 yrs of age typically. Genetic mutation WT-1 on chromosome 11. Usually unilateral. Tx is surgery and/or chemo with a cure rate of 85%
Carcinoma of bladder
90% are TCC which may or may not invade. Prognosis is based on how invasive of underlining muscle. Multifocal meaning several tumors in the bladder with unknown etiology. Risk factors include smoking, and exposure to toxic chemicals. Signs and Symptoms are hematuria, dysuria, lower ab pain and they usually appear early leading to early treatment and improved prognosis. Tx options are surgery, chemo and BCG immunotherapy
jaundice
yellow discoloration of skin and mucosa caused by hyperbilirubinemia
hyperbilirubinemia
elevated blood bilirubin levels
pathogenesis of jaundice
pre-hepatic or hemolytic, hepatic-disease/drugs or post-hepatic or obstructive-gallstones
acute viral hepatitis
Hep A, B, C, D, E viruses: B and C infections predisposed individuals to malignant transformation. There are vaccines for A and B. Carrier are infections.
Hep A Virus
not chronic; poor sanitation; fecal to oral; mild disease; jaundice, diarrhea and ab pain.
Hep D Virus
requires Hep b infection becauses uses hep b protein in its life cycle; fulminent hepatitis from B is more common when hep D is present
Hep E Virus
rare; increased mortality in infected pregnant females.
Alcoholic liver disease
most common cause of liver disease in US
Overreaction pathway of Alcoholic liver disease- ALD
over activity of pathways that breakdown alcohol; 3 patterns to livery injury. Steatosis, alcoholic hepatitis and cirrhosis
Pathway to ALD: Steatosis
accumulation of fat in liver (fatty liver); if stopped, alcohol liver will recover
Pathway to ALD; Alcoholic hepatitis
alcoholic alters surface proteins on hepatocytes leading to inflammation and immunologically mediated destruction of hepatocytes.
Pathway to ALD; Cirrhosis
fibrosis/severe scarring of liver; hepatocyte destruction leads to fibrosis; development of cirrhosis depends on the individual
hepatocellular adenoma (liver)
benign, almost always exclusive to females possibly from oral contraception use. Highly vascular and can bleed leading to exsanguination-bleeding out.
hepatoceullar carcinoma HCC
highly malignant and very aggressive. Most are associated with cirrhosis of liver secondary to Hep B and C viruses. Often synthesize AFP (alpha feto-protien) a blood marker useful for diagnosis. Symptoms are non-specific weight loss, nausea, decreased appetite. Associated with paraneoplastic syndromes that cause increased erythropoietin; insulin like effect (hypoglycemia)
Liver Mets
much more common than a primary liver tumor. Primary sites most often, in order are GI, then lung, then breast. With met's there are often multiple nodules causing a poor prognosis.
Cholelithiasis
gallstones; more common in women than men. If the stones obstruct cholecystic duct leads to cholecystitis
Pathogenesis of Cholelithiasis
Components are those normally found in bile. An imbalance leads to stone formation. Risk factors are obesity, diabetes, pregnancy, and metabolic disorders. Cholesterol is very common: increased cholesterol in bile causing increased cholesterol stone formation. Symptoms range from none to pain, fever, and jaundice if the common bile duct is obstructed. Tx options are lithotripsy, chemical dissolution and surgery (cholecystectomy)
neural tube defects
group of congenital abnormalities of varying severity cause by failure of neural tube to close (from skull to along length of spine). Includes anencephaly (born with no brain) to spina bifida (lower spinal cord defects) Etiology probably decreased maternal folate during pregnancy.
CVD Cerebrovascular disease
Hypoperfusion due to systemic problem or focal (one area in particular) lesion causing ischemia and infarction leading to stroke. TIA
TIA Transient Ischemic Attack
brief neurologic impairment from fleeting loss of blood flow that's quickly restored.
Nervous infections
can be hematogenous, from trauma, or travel along nervs (virus).
Bacteria - staph or strep
Viral- herpes, HIV, polio, etc
Fungi- candida, histoplasma, etc
Prion- mad cow, CJD (Creutzfeldt-Jacob Disease, very contagious)
meningitis
infection of brain covering
abscess
discrete parenchymal infection
encephalitis
diffuse brain tissue infection
Neurodegenerative Diseases
Progressive loss of neurons, etiology is unknown, possibly genetics. Examples are Alzheimer's Disease and Parkinson's.
Alzheimer's Disease
Loss of neurons in the cerebral cortex that leads to dementia. Long progressive disease and confirmation is at autopsy.
Parkinson's
Loss of pigmented dopaminergic neurons of the substantia nigra. Patient has resting tremors, muscular rigidity, slow purposeful movements (bradykinesia) and postural instability.
Myelin Diseases
Either destruction or lack of synthesis of myelin. Multiple Sclerosis for example.
MS Multiple Sclerosis
Etiology is possibly autoimmune or possibly virally initiated in genetically predisposed individuals that cause an abnormal Tcell response, like destruction of myelin. Affects different areas at different times, so patients present with random neurologic impairments. Patients have flare ups and don't completely recover leading to progressive impairment over the years. Occurs in young adults between 15-40 yrs of age. Course of the disease is unpredictable and can have remissions for many years.
Glioblastoma multiforme
most common intracranial tumor. Occurs in adults approx 50 years and older. Prognosis is poor, average 12-14 months following treatment. Tx options are surgery and radiation.
meningioma
2nd most common intracranial tumor. Benign but compresses on brain and can cause seizures. Often occurs in middle aged females. Tx options are surgery and radiation. Prognosis is excellent.
Metastatic tumors
most common type of non-primary tumor, more common than GBM. From lung, breast and skin (melanoma). Prognosis is poor, 12-14 months.
mastitis
usually acute; infection of nipple and/or surrounding breast tissue; can be localized or affect entire breast. Associated with lactation. Etiology is staph or aureus. Tx options are antibiotics if necessary.
gynecomastia
male breast tissue proliferation usually from increased estrogen levels (cirrhosis; estrogen secreting tumors; teenagers @ puberty). Tx options are breast reduction.
fibrocystic changes
Most common disorder of the breast. Fibrosis and cystic change in breast tissue. Cysts are dilated lobules that can rupture and irritate surrounding tissue causing fibrosis. Etiology can be from estrogen sensitivity and maybe caffeine. No increased risk of cancer.
fibroadenoma
Most common tumor affecting young females. Benign tumor often in young females. Firm, painless and well defined. No increased risk of cancer.
Phyllodes tumor
type of fibroadenoma that is also benign but usually larger and can recur and be locally destructive. (tend to be vague in their margins)
Breast Malignancy
Second to lung cancer in females. 1 in 9 will be dx with breast cancer. Genetic risks are BRCA-1 and BRCA-2 genes (mutated suppressor genes). 80% invasive ductal carcinoma, 10% invasive lobular carcinoma and 10% other types.
Pre-invasive Stages
DCIS=Ductal carcinoma in-situ, LCIS=Lobular carcinoma in-situ
Progress to invasive forms and cause desmoplastic response by the body resulting in palpable firm area. Can pucker the skin and/or retract the nipple.
Male breast cancer is often ignored and more advanced at presentation.
If lump is detected:
Biopsy/aspiration to confirm.
Tx options are lumpectomy or mastectomy; Radiation/chemo; Anti-hormone therapy (if tumor has hormone receptors - has better prognosis-tamoxifen)
May or may not dissect lymph node -following sentinel node.
Best prognostic indicator is lack or presence of lymph node mets.
75% breast lymphatics goes to axilla. Mets can also be in lung, liver, brain.
Female Inflammatory Diseases
Vulvitis, vaginitis, salpingitis, endometritis, oophoritis and PID
PID Pelvic Inflammatory Disease
inflammation of entire female reproductive tract
Common female genital infections
genital herpes, chlamydia (most common STD, and treatable), gonorrhea (bacterial), candidiasis (yeast) and syphilis (treatable in first two stages, incurable at third stage)
HPV Human Papilloma Virus
causes precancerous lesions of the cervix and condylomas (warts). High and low risk groups. Dx is through PAP's and biopsies of cervix with HPV typing done. Tx options are cone excision of the cervix if not cancerous or LEEP procedure; hysterectomy if cancerous.
Carcinoma of the cervix
20% of gyn cancers. Risk factors are high # of sexual partners, sexual activity at a young age and + HPV high risk type. Usually SCC: dysplasia progresses to CIS (carcinoma in-situ) progresses to invasive cancer. Tx options are surgery and chemo/radiation. Prognosis depends on presence of mets.
Endometrial carcinoma
Most common gyn cancer 50%. Dx through endometrial biopsy. Often female presents with menorrhagia. Tx options are hysterectomy; chemo/radiation.
Non-malignant tumors
Teratoma, leiomyoma and endometriosis
teratoma
benign ovarian tumor aka dermis cyst
leiomyoma
aka fibroid, can be large and multiple, 1-2% are malignant=leiomyosarcomas
endometriosis
endometrial tissue outside of the uterus; adenomyosis when endometrial tissue in myometrium.
cryptorchidism
congenital malpositioning of testes (not in scrotum). If not surgically corrected can lead to malignancy.
Male inflammations and infections
orchitis, balanitis (inflammation of glans penis), epididymitis and prostatitis
Male STD's
genital herpes, gonorrhea, chlamydia, syphilis, NO HPV lesions but men are carriers.
Neoplasms of testis
1% of all tumors in males. Incidence 25-45 years of age. Self exams. Seminoma has the best prognosis of testicular malignancies. Teratoma are often benign but does have malignant form. Tx options are resection (orchiectomy) and chemo.
BPH Benign Prostatic Hyperplasia
NOT a precursor to cancer. Enlargement of prostate gland causing urinary obstruction. Tx options are testosterone blockers and TURP.
Carcinoma of Prostate
Most common malignancy in males. 2nd in mortality to lung cancer. Usually adenocarcinoma type. Often met to bone and invade locally. Dx through PSA (Prostate Specific Antigen) and biopsy. Tx options are surgery, radiation/chemo.
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