SPECIAL
PATHOLOGY
VIII. DISEASES OF THE BLOOD
A. Reactive Changes
1. Leukocytosis
– a temporary increase in the number of circulating white blood cells.
– part of the protective mechanism in inflammation
2. Leukopenia
– a temporary decrease in the number of circulating leukocytes.
-seen in typhoid fever, measles, mumps, flu, and T.B.
Leukocytosis
Leukopenia
3. Acapnia
– a marked decrease in carbon dioxide content
– seen in instances of asthma, pulmonary emoblism and anxiety
4. Acidosis
– the condition in which there is an excessive proportion of acid in the blood
– often seen in diabetes, renal disease, and sever dehydration
5. Alkalosis
– the condition in which there is an excessive proportion of alkali in the blood
– can be seen in many metabolic disorders
B. Anemia
– a deficiency of circulating erythrocytes and/or hemoglobin
– a sign of disease
B. Anemia
– a deficiency of circulating erythrocytes and/or hemoglobin
– a sign of disease
1. Primary Anemia
– anemia due to a decrease in production of erythrocytes
– occurs in two ways
a. Nutritional deficiencies
1. Iron
– most common deficiency
– iron is essential for R.B.C. development
2. Pernicious Anemia
– occurs when Vitamin B12 cannot be absorbed from food
– erythrocytes (R.B.C.) require two factors to mature: an intrinsic factor found in normal gastric juice and an extrinsic factor – vitamin B12. The intrinsic factor is the carrier for B12 and it is not secreted in pernicious anemia. Therefore, B12 is not being absorbed from the small intestine
– because of this, R.B.C. cannot develop properly
Pernicious Anemia – commonly occurs in the white race after 40 years of age
– rarely before 35
– it is associated with the absence of hydrochloric acid
– treated with intramuscular injections of vitamin B12
b. Aplastic Anemia
– anemia due to marrow suppression
– the result of drug and chemical damage, radiation, infection, and metabolic disorders
Normal Bone Marrow
Bone Marrow in Aplastic Anemia
2. Secondary Anemia
– anemia due to increased destruction or loss of erythrocytes
– due to disease or trauma such as:
a. Hemolytic Anemia
– the rupturing of R.B.C.
– seen in malaria, sickle cell anemia, erythroblastosis fetalis
2. Secondary Anemia
– anemia due to increased destruction or loss of erythrocytes
– due to disease or trauma such as:
a. Hemolytic Anemia
– the rupturing of R.B.C.
– seen in malaria, sickle cell anemia, erythroblastosis fetalis
b. Hemorrhage
– acute from trauma
– chronic from lesions of the gastro- intestinal tract
C. Hematopoietic Disorders(Hemopoietic)
– the disruption of any substance that assists in or stimulates the production of blood cells
1. Leukemia
– a malignancy of the hemopoetic tissues (blood-forming organs)- bone marrow, lymph nodes, and W.B.C.
– commonly called “cancer of the blood”
– an uncontrolled overproduction of white blood cells that are malformed
Normal Bone Marrow
Bone Marrow in Leukemia
Normal blood smear on left and one with leukemia shown on right
– Common signs and symptoms include:
– swollen spleen and lymph nodes
– a tendency to hemorrhage
– fever
– weight loss
– fatigue
– joint pain
2. Polycythemia Vera (Erythrocytosis)
– an uncontrolled production of red blood cells
– referred to as a chronic, life-shortening myelo-proliferative disorder involving all bone marrow elements
– leads to an increase in R.B.C. mass and hemoglobin concentration that increases blood viscosity, causes high blood pressure, and leads to extra work on the heart
– secondary to many disorders
D. Bleeding Disorders
1. Hemophilia
– an hereditary abnormality resulting in a defect in the clotting mechanism
– characterized by a tendency toward excessive and sometimes spontaneous bleeding
– affects males but transmitted by females
2. Thrombocytopenia
– an abnormal decrease in the number of platelets
– platelets are responsible for initiating the blood clotting process
– a deep purplish pigmentation known as
– this leads to a tendency toward widespread, spontaneous bleeding into the skin or mucus membranes resulting in…
Purpura
IX. DISEASES OF THE HEART AND BLOOD VESSELS
Predisposing Conditions
1. 2.
3.
4.
5.
a)
b)
c)
d)
Social Factors
Predisposing Conditions
1. 2.
3.
4.
5.
a)
b)
c)
d)
Heredity
Social Factors
Predisposing Conditions
1. 2.
3.
4.
5.
a)
b)
c)
d)
Heredity
Obesity
Social Factors
Predisposing Conditions
1. 2.
3.
4.
5.
a)
b)
c)
d)
Heredity
Obesity
Diabetes
Social Factors
Predisposing Conditions
1. 2.
3.
4.
5.
a)
b)
c)
d)
Heredity
Obesity
Diabetes
Elevated cholesterol levels
Social Factors
Predisposing Conditions
1. 2.
3.
4.
5.
a)
b)
c)
d)
Heredity
Obesity
Diabetes
Elevated cholesterol levels
Social Factors
Smoking
Predisposing Conditions
1. 2.
3.
4.
5.
a)
b)
c)
d)
Heredity
Obesity
Diabetes
Elevated cholesterol levels
Social Factors
Smoking
Substance abuse
OH MY GOODNESS,
ANOTHER TEST???
Predisposing Conditions
1. 2.
3.
4.
5.
a)
b)
c)
d)
Heredity
Obesity
Diabetes
Elevated cholesterol levels
Social Factors
Smoking
Substance abuse
Stress
OR
Predisposing Conditions
1. 2.
3.
4.
5.
a)
b)
c)
d)
Heredity
Obesity
Diabetes
Elevated cholesterol levels
Social Factors
Smoking
Substance abuse
Stress
Diet
B. Heart Disease
– the most common cause of disability and death in the United States
1. Dilatation
– enlargement of the heart due to stretching of the heart walls
– usually occurs as a result of the over-filling of a heart chamber
2. Hypertrophy
– enlargement of the heart due to an increase in size of the muscle fibers
– the result of an increased amount of work put upon the heart
obstructions of the peripheral vessels
– this increased work may be caused by:
1)
2)
3)
disease conditions involving the heart valves
inflammatory and degenerative changes in the heart muscle
BOTH DILATATION AND HYPERTROPHY CAUSE ENLARGEMENT OF THE HEART
– which is an important sign of heart disease
3. Endocarditis
– includes inflammation of the heart valves
– valvular endocarditis
– vegetations
– inflammation of the inner layer of the heart (endocardium)
– without qualification, this always means…
– usually caused by bacteria that are deposited on a valve
– this collection creates thrombi known as…
4. Valvular Defects
– Imperfect valve closure that permits leakage or regurgitation of blood
– the narrowing or constriction of a valve
b. Valvular Stenosis
a. Valvular Insufficiency or Incompetence
4. Valvular Defects
– valve closure that permits leakage or regurgitation of blood
– the narrowing or constriction of a valve
– a valve or one of the cusps of the valve turns inside out
c. Prolapse
b. Valvular Stenosis
a. Valvular Insufficiency or Incompetence
5. Pericarditis
– inflammation of the outer sac of the heart – the pericardium
– can be caused by:
T.B., pyogenic organisms, neoplasms, trauma, myocardial infarction
– inflammation of the muscle layer of the heart- the myocardium
6. Myocarditis
– occurs commonly after rheumatic fever and diphtheria or may be idiopathic
7. Rheumatic Heart Disease
– Group A Beta Hemolytic Streptococci
– a febrile inflammatory disease that is a sequelae of rheumatic fever
a. Cause
– called Aschoff's Nodules or Aschoff’s Bodies
– small nodules formed within the connective tissue of the heart
b. Lesion
– these nodules lead to the formation of scar tissue in the tissues of the heart
– commonly seen in the mitral valve
– causing stenosis
– all of this leads to serious, chronic heart disease
8. Coronary Artery Disease
Atherosclerosis
Thrombosis or Embolism
– pathologic changes in the walls of the coronary arteries and the consequences or results
Caused by:
a.
b.
At high magnification, the dark red thrombus is apparent in the lumen of the coronary. The yellow tan plaques of atheroma narrow this coronary significantly, and the thrombus occludes it completely.
c.
Spasms
– usually caused by syphilitic involvement of the mouths of the coronaries
– this causes uncontrolled contractions of the heart muscle
– the contractions occlude the lumens of the coronary arteries
– Consequences:
1)
2)
Coronary Occlusion
Myocardial infarction(heart attack)
Scar Tissue
Cardiac Failure
Myocardial infarction
Congestive Heart Failure
– the condition resulting from the inability of the heart to pump sufficient blood to meet the body's needs
2 types:
a. Acute –
b. Chronic –
– as a result of high blood pressure, arteriosclerosis, prior myocardial infarctions, etc.
10. Hypertensive Heart Disease
– condition caused by constant pumping against resistance
– caused by hypertension
– which is also known as high blood pressure
– slowly "wears out" the heart
11. Cardiomyopathy
– disease of the myocardium due to a primary disease of the heart muscle
– accompanies congestive heart failure, infectious diseases, hypertrophy of the heart chambers, and chronic alcoholism
12. Carditis
– a general term to encompass inflammation of any of the layers or valves of the heart
13. Congenital Heart Disease
– septal defects
– patent ductus arteriosus
– a defect in the closing of the opening between the pulmonary artery and the aorta
– causes mixing of pulmonary and systemic blood
– more importantly, this defect predisposes to infection and thrombosis
C. Disease of the blood vessels
– like any other tissue, blood vessels are subject to various disease processes
– they react to injury and repair, infection, inflammation and tumors like any other tissue
1. Arteritis
– inflammation of an artery
2. Arteriosclerosis
– the thickening, hardening, and loss of elasticity of the walls of arteries
– hardening of the mitral valve of the heart
– results in altered function of tissues and organs because of decreased blood flow
Mitral Sclerosis
3. Atherosclerosis
– a form of arteriosclerosis characterized by the deposition of fatty deposits called plaques
– specifically occurs in the large elastic arteries such as the aorta, coronary arteries, and cerebral arteries
These three aortas demonstrate mild, moderate, and severe atherosclerosis from bottom to top. At the bottom, the mild atherosclerosis shows only scattered lipid plaques. The aorta in the middle shows many more larger plaques. The severe atherosclerosis in the aorta at the top shows extensive ulceration in the plaques.
4. Aneurysm
3 types:
– a localized weakening and dilation of an artery
– an equally dilated circum-ference creating a tubular swelling of the vessel
a. Fusiform Aneurysm
– the yielding of a weak area on one side of the vessel not involving the entire circumference
b. Sacculated Aneurysm
– appears as a bulging, sac-like dilation
c. Dissecting Aneurysm
– a separation of the tissues in the wall of an artery
– allows blood to enter and further separate the tissues
– any one of these types of aneurysms may increase in size and rupture causing a severe hemorrhage
5. Phlebitis
– inflammation of the veins
6. Varicose Veins
– dilated, tortuous superficial veins
pregnancy
obesity
occupations requiring prolonged standing or sitting
– varix or varices
– can occur in almost any part of the body, but are most commonly observed in the lower extremity, the esophagus, and the perianal veins
– some causes may be:
– other names are
–
–
–
DISEASES OF THE
NERVOUS SYSTEM
THE BRAIN
Any infectious disease of the nervous system is called
a neurotropic disease
A. Trauma
1. Concussion
– an injury of a soft structure, such as the brain, resulting from a blow or violent shaking with no physical damage apparent
– an immediate and temporary disturbance of brain function
– it may result in only a temporary grogginess or there may be a wide spread loss of cerebral control with a sudden drawing of the knees and severe vomiting
A. Trauma
2. Contusion
– a bruise to the brain causing swelling and pain
– the skin is not broken at the site of the injury
– may lead to hydrocephalus
A. Trauma
3. Laceration
– tearing of brain tissue
– may occur with or without fracture of the skull
A. Trauma
3. Laceration
4. Intracranial Hemorrhage
– tearing of brain tissue
– may occur with or without fracture of the skull
– hemorrhage in the cranium
– categorized according to the location in relation to the meninges
– Layers: – Bone, Dura Mater, Arachnoid Mater, Pia Mater, Brain
4. Intracranial Hemorrhage
Types:
a.
b.
c.
Extradural or Epidural
– between the bone and dura mater
Subdural
– between the dura mater and arachnoid mater
Subarachnoid
– between the arachnoid mater and pia mater
4. Intracranial Hemorrhage
– Consequences depend on the location
– Subdural is the most common
– will cause sudden death in severe cases
B. Meningitis
– inflammation of the membranes around the spinal cord and brain
B. Meningitis
– inflammation of the membranes around the spinal cord and brain
– caused by numerous bacteria and viruses
– the form caused by the meningococcus (Neisseria meningitidis) is called
epidemic meningitis
– this is the most serious form
B. Meningitis
– transmitted via the respiratory tract by droplet spray or direct contact with discharges
– it then reaches the meninges via the blood or lymph stream
C. Encephalitis
– inflammation of the brain
– can be bacterial or viral
– the most common form is viral encephalitis
– transmitted to humans via an infected mosquito
– it may also only be a complication of other infectious disease like malaria, influenza, measles
D. General Paresis
– a diffuse meningoencephalitis seen in the tertiary stage of syphilis
– inflammation and degeneration of brain tissue that will lead to death
E. Cerebrovascular Accident/
Stroke/Apoplexy
– damage to the brain as a result of circulatory interruption
– usually due to thrombosis, embolism, or hemorrhage
– these are usually secondary to atherosclerotic disease
– if hemorrhage occurs where blood escapes into the tissue of the brain it may be due to hypertension or possibly a congenital aneurysm
F. Encephalomalacia
– softening of the brain due to death of tissue from lack of blood supply
G. Transient Ischemic Attack (TIA)
– a temporary interference with blood supply to part of the brain
– no permanent damage occurs
– characterized by:
–
–
–
dizziness
fuzzy vision in one eye
numbness or loss of sensation on one side of the body
– may last a few minutes or several hours
H. Hydrocephalus
-"Water on the brain”
– the increased accumulation of cerebro-spinal fluid within the ventricles of the brain
– caused by a blockage of the normal outflow of the fluid
– brain is pushed against the skull in adults
– dramatic enlargement of the cranium in infants
– severe cases lead to stillbirths or very short lifespans
I. Myelitis
– inflammation of the spinal cord
– occurs due to infection or injury to the spinal cord
J. Poliomyelitis
– inflammation of the gray matter of the spinal cord
– often affects brain tissue also
Poliomyelitis
– acquired through a viral infection from respiratory system or contaminated food then reaches the spinal cord through the bloodstream
– affects the motor neurons of the central nervous system resulting in serious damage and paralysis of the muscles controlled by these nerves
Anytime the brain and spinal cord are both involved —– the term
is used
encephalomyelitis
K. Neuritis
– inflammation of the nerves
– may be a direct infection or a complication of other infections like tuberculosis, tetanus, or measles
– may also be from damage by trauma or toxins
L. Epilepsy
– a chronic disorder of the nervous system with recurring convulsions and losses of consciousness
– the result of some form of interference with normal electrical activity in the brain
– most cases are idiopathic
– some are associated with brain injury, trauma at birth, or tumors
– characterized by convulsions of which there are two types:
1) Grand Mal or Tonic Clonic seizures
– Violent convulsions
– includes the making of peculiar sounds, biting the tongue, excess salivation
2) Petite Mal or Absence seizures
– loss of consciousness for short periods of time with dizziness
– this form is more common in children
– often appears to be day-dreaming
M. Rabies
– an acute, viral, infectious disease of warm-blooded animals
– commonly known as hydrophobia
– transmitted to humans through the saliva of an infected animal via a bite
– characterized by involvement of the central nervous system
– results in paralysis and death
N. Multiple Sclerosis
– a chronic degenerative disease of the nervous system characterized by remissions and relapses
– the myelin sheaths of the nerves are destroyed
– impairs motor and sensory nerve impulses
– the areas of damaged or “demyelinated” nerves are replaced with sclerotic plaques
– scattered diffusely throughout the gray and white matter of the brain stem and spinal cord
– affects young adults between 20 and 40 years of age
O. Parkinson's Disease
– a chronic, degenerative nervous disease
– characterized by a slow spreading tremor, muscle weakness and rigidity with a peculiar gait
– sometimes referred to as “shaking palsy” or paralysis agitans
– walking occurs in short, rapid steps
– loss of balance and falling often occurs
P. Alzheimer's Disease
– a chronic, organic mental disorder which leads to presenile dementia
– characterized by loss of memory, mood changes, and other mental disturbances
– tends to occur after the age of 60
– destruction of neurons in the cortex of the brain occurs and plaques are deposited upon the nerve fibers
– this is believed to be due to neuro-fibril degeneration
Q. Creutzfeld – Jakob Disease
– a central nervous system disease that causes a slow degeneration
– leads to dementia
– caused by a small protein particle called a
– can be transmitted by a parenteral injury with an object contaminated with the infectious agent
prion
R. Cerebral Palsy
– a non-progressive paralysis resulting from some type of brain damage before or shortly after birth
– may also include some mental retardation
EXAM TIME
!!!!!
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