Pathology Quest

• Epidermis
• Dermis
• Hair Follilcles
• Nails
• Sabaceous Glands
• Sweat Glands

Largest

15-20%

• Protection against injury
• Secretion of oils that lubricate the skin
• Maintenance of homeostasis via fluid blance and body temp.
• Excretion of excess water, urea and salt via sweat
• Maintenance of body shape
• Cosmesis (preserves bodily beauty) and identity
• Vitamin D synthesis

• Outer most superficial layer of the skin
• Five Layers in the lips, palms and soles of the feet with four layers elsewhere
• Stratum Basale
• Stratum Spinosum
• Stratum Granulosum
• Stratum Lucidum (specialized 5th Layer)
• Stratum Corneum

• Contains blood vessels, lymphatics, nerves, collagen and elastic fibers
• Deeper and thicker than the epidermis
• Contains sebaceous and sweat glands

• Interface between the epidermis and the dermis that is characterized by structural ridges and valleys
• Increases surface area between epidermis and dermis (improved adherence)
• Ridges are absent in highly damaged skin (burn patients, chronic skin conditions)

A wearing away of the upper layer of skin usually as a result of friction

• Blood vessels are broken as a result of a direct blow
• ex) punched in the arm=bruise

• Skin discoloration caused by the escape of blood into the tisues from a small rupture in a blood vessel
• (Takes longer to form a bruise than would a contusion)

Traumatic loss of epdermis; generally mild

Wound is deeper than the superficial skin layer


Penetration of the skin in which the wound is deeper than the superficial layer

A lesion on the surface of the skin or mucous membrane produced by sloughing of inflammatory or necrotic tissue

• Acute inflammation with infection of the skin and subcutaneous tissue that spreads through tissue spaces
• patients with co-morbidities: increased risk for infection
• patients with failure of the lymphatics that lead to chronic lymphedema
• Treated w/ antibiotic usually but intavenous infusions
• Often occurs as a result of a primary injury
• May be iatrogenic (introduced to patient by physician activity, manner, therapy)
• Often has the appearance of red streaks

• Skin normally caries bacteria
• invasiveness of the particular organism and the host resistance

• Mixture of aerobic and anaeobic bacteria
• Severe inflammation and tissue necrosis (usually due to virulent strain of gram-positive, group A, beta-hemolytic streptococcus)(Bacteria secrete toxins that break down fascia and conn. tissue, causing massive tissue destruction)
• Often a history of minor trauma or infection in skin and subcutaneous tissue of an extremity
• Delay in treatment = greater tissue loss, potential amputation, and higher probability of mortality

• Reactivation of the varicella virus that causes chicken pox
• usually occurs during physiological sress particularily aging
• Following resolution of the chicken pox, the virus remains dormant in the dorsal root ganglion
• The skin eruptions usually occur along a specific dermatome commonly in the thorax
• Post herpatic neuralgia is a comon sequal of shingles and may lead to significant discomfort
• Vaccine is now recommended for all adults age 55 and older to prevent reactivation of thevirus

• Very common and benign condition
• Characterized by rapid proliferation of the skin cells resulting in raised plaques
• Often runs in families
• In about 10% of patients it is accompainied by arthritis--- PSORIATIC ARTHRITIS
• Mild cases are treated with topical medications
• Moderate cases respond well to reatment with ultraviolet light
• Severe cases are treated with Biologic Medications (also used to treat arthritis)

• A diffuse conn. tissue disorder that causes fibrosis of the skin, joints, blood vessels and internal organs
• Has several subtypes characterized by the extent of the disease
• Limited Sclerosis is the most common type

• CREST syndrome
• Limited to distal extremities and face
• Progresses slowly and patients have a 70% survival rate at 10 years
• May ultimately progress to visceral involvement

• Widespread skin involvement including proximal extremities, face and trunk
• Progresses quickly to visceral involvement
• Higher mortality rate

• Raynaud's Phenomenon: Paroxysmal vasoconstriction of the blood vessels of the hands and feet (Common in conn. tissue disorders such as scleroderma but may be a benign stand alone condition)
• Skin thickening is the chracteristic symptom of Scleroderma
• Often leads to contractures that result in significant functional limitation

The branch of science tht studies the form and structure of blood and blood forming tissues

• Plasma
• Formed Elements

• Transport nutrients (O₂ & glucose)
• Remove waste (CO₂ & lactic acid)
• Transport cells and stubstances b/t organs

BONE MARROW

ERYTHROPOIETIN

• The direct control of erythrocyte production
• Erythropoietin is secreted from the KIDNEYS

• Assists in the management of circulation by removing fluid not otherwise managed by the circulatory system
• Integrated w/ the function of the hematologic system & the immune system

Buildup of excessive fluid w/in the intersitial tissues or w/in the body cavities

Not enough oxygen = localized necrosis

A localized area of necrosis caused by a reduction in O₂ perfusion that is below the level necessary for cell viability

presence of a solid mass of clotted blood w/in a vessel or chamber of the heart

Mass of solid liquid or gas that moves w/in a blood vessel to lodge at a site distant from its place of origin

A chronic swelling of an area due to buildup of interstitial fluid especially in the extremities secondary to the obstruction or absence of lymphatic vessels or nodes

Dramatic reduction in arterial blood supply and oxygenation to an organ or tissue

• Enlargement of the lymph nodes
• Common in viral conditions
• Malignant conditions
• May include enlargement of the spleen

• Edema
• Infarction
• Thrombus & Embolism
• Lymphedema
• Hypotension & Shock
• Bleeding & Bruising that is not consistnet with size and magnitude of injury
• Lymphadenopathy

• CBC
• Differential Count for WBCs
• Morphology
• Hematocrit
• Hemoglobin
• Chemical Analysis
• Bleeding Time
• Prothrombin Time & Partial Thromboplastin Time

• Includes total RBCs, WBCs, & Platelets
• Leukocytosis = Increased WBCs (associated with inflammation/infection)
• Leukopenia = Decreased WBCs (associated w/ some viral infections; radiation & chemotherapy)
• Increased Eosinophils: Common in allergic responses

Increased Eosinophils

• Increased WBCs
• Associated w/ inflamation/infection

• Decreased WBCs
• Associated w/ some viral infections; radiation & chemotherapy

• Observed with blood smears
• Shows size, shape, uniformity, & maturity of cells
• Different types of anemia can be distinguished

Percent by volume of cellular elements in blood

Amount of hemoglobin per unit volume of blood

• Determine serum levels of components
• Iron, vitamin B₁₂, folic acid, cholesterol, urea, glucose, ect.

Measures platelet function

• Measures function of various factors in coagulation process
• INR is a standardized version--how quickly blood clots

• Abnormality in the ability of the blood to transport oxygen
• May be a symptom of many other disorders
• Causes a reduction in oxygen transport
• Basic problem is a hemoglobin deficit
• Oxygen defitic leads to...
• >less energy production in all cells: cell metabolism & reproduction diminished
• >Compensation mechanisms: Tachycardia and peripheral vasoconstriction
• >General signs of anemia: Fatigue, pallor (pale face), dyspnea, tachycardia

• Insufficient iron impairs hemoglobin synthesis
• Microcytic, hypochromic RBCs
• Result of low hemoglobin concentration in cells

• Pallor of skin and mucous membranes
• Fatigue, lethargy, cold intolerance
• Irratabiity
• Degenerative changes
• Menstral Irregularities
• Delayed Healing
• Tachycardia, heart palpitations, dyspnea, snycope

• Dietary intake of iron below min. requirement
• Chronic blood loss: Bleeding, ulcer, hemorrhoids, cancer, etc.
• Impaired duodenal absorption of iron: In many disorders-malabsorption syndromes
• Sever liver disease: may affect iron absorption as well as storage

IMPAIRMENT or FAILURE OF BONE MARROW

VITAMIN B₁₂ DEFICIENCY

• Genetic condition
• Sicle-shaped cells are too large to pass through microcirculation

• Severe pain due to ischemia of tissues and infarction
• Pallor, weakness, tachycardia, dyspnea
• Hyperbillirubinemia = JAUNDICE
• Splenomegaly
• Vascular occlusions and infarctions
• Delay of growth and development
• Congestive Heart Failure

• Classic hemophilia
• Deficit or abnormality of factor VIII
• Most common inherited clotting disorder (x-linked recessive trait, manifested in men, carried by women)

• Opportuistic infections including pneumonia
• Sepsis
• Congestive Heart Failure
• Hemorrhage
• Liver Failure
• Renal Failure
• CNS Depression and Coma

• Normal tissue contains cells of uniform size, shape and nuclear struture
• Cells undergo changes as they develop to form the different tissues of the body
• In malignant cells differentiation is altered and the malignant cell may not look anything like its parent tissue.

• Adult cells change to indicate a disorganization of shape or size
• Dyspasia is often viewed as pre-cancerous condition although in many cases, it may reverse itself

• An increase in the number of cels in tissue
• May be a normal occurrence or it may be neoplastic which is suggestive of tumor formation

• Abnormal growths of tissue that serve no useful purpose
• May compete with healthy tissue for vital blood supply and nutrients
• May be benign or malignant

Arise locally

Result from (metastasis) or spread from another area

• Tissue of origin
• Being BENIGN or MALIGNANT

• External body surfaces and the lining of the internal spaces and cavities
• CARCINOMA

• Elastic, fibrous and collagenous tissues
• SARCOMA

• Brain, spinal cord and related structures
• Named for the specific type of cell involved
• GLEAL CELLS = GLEAPHOMA

• Anywhere in the body where lymph tissue is present
• LYMPHOMA-- very common

• Blood and bone marrow
• LEUKEMIA and MYELOMA

-oma

adenoma

-carcinoma

adenocarcinoma

sarcomas, malignant

• Hodgkin Disease
• Wilms tumore
• Leukemia

• Usually differentiated cells that reproduce at a higher rate than normal
• Encapsulated
• Tissue damage is a result of compression of adjacent structures, this can be life-threatening in the brain.

• undifferentiated, non-funtional cells
• Rapid reproduction--abnormal mitotic figures
• Infiltrate/spread into surrounding tissue
• Spread to distant sites

Glands

HORMONES

Chemical Mediators

• Specific receptor sites for hormones
• After acting on the target tissue the hormones are metabolized or inactivated by the cells of the liver and excreted by the kidneys

• Acting on the developing fetus to differentiate the reproductive system and the nervous system
• Stimulate growth and development through childhood and adolesence
• Coordinate the male and female reproductive system
• Maintains optimal internal environment through the lifespan
• Initiates corrective responses to physiological emergency

• Growth Hormone
• TSH

Thyroxine

• Aldosterone
• Cortisol
• Epinephrine

• Estrogen
• Testosterone

• Insulin
• Glucagon

• Deficient hormone levels...
• --Antagonistic hormone production is increased
• --Malnutrition
• --Tumor produces too little hormone
• --Atrophy, surgical removal of gland
• --Congenital deficit

• Excess hormone Levels...
• --Tumor produces high levels (happens when tumor takes on gladular function)
• --Excretion by liver or kidney is impaired
• --Congenital condition produces excess hormone

• Benign tumors
• Deficit in target cells
• Signs and symptoms of endocrine pathology vary depending on the gland affected and wheather it is hypo or hyper function
• Blood tests are commonly used to measure levels of circulating hormone
• The effectiveness of hormones can also be measured through blood test
• Various types of scans and diagnositc ultrasound may be used to examine structural changes in glands that lead to dysfunctions

• VERY common
• Have genetic link
• More common in women

• Enlargement of the thyroid gland caused by various conditions of the thyroid--may indicate malignancy or malfunction
• Easily palpable in teh anterior neck
• May compress other structures if it is very large (trachea, esophagus, blood vessels)

• Graves Disease
• More common in women
• Manifested by hypermetabolism and goiter
• Most often treated with RAI (radioactive iodine) which destroys the hyper secreting tissue
• patients usually require life long maintenance with medication

• A deficiency in thyroid hormone that results in slowed body metabolism
• Early symptoms are diffuse and poorly recognized
• (2 types): Hashimot's Thyroiditis & Myxedema

• Inflammatory autoimmune disorder that leads to diminished thyroid function
• Most common form of hypothyroidism
• Easily managed by a pill

• A severe form of thyroid dysfunction that may lead to coma
• Type of hypothyroidism

Blood tests

For presence of TUMORS

RARE, HIGH

THYROXINE -very cheap

LEUKEMIA

• Excessive level of glucocorticoids
• ex) taking a lot of steroid-based medications--cortisone (like people with athsma)

• Round face w/ ruddy color
• Truncal obesity with fat pad between scapulae
• Thin limbs
• Thin hair
• Fragile skin

• Deficiency of adrenocorticoid secretions
• Also called Primary Adrenal Insufficiency

• Decreased blood glucose levels
• Inadequate strees response
• Fatigue
• Weight loss; frequent infections
• Low serum sodium concentration
• --Decreased blood volume
• --Hypotension
• --High potassium levels (may cause cardiac arythmias)

• A chronic systemic disorder characterized by hyperglycemia and insulin deficit.
• Results in abnormal carbohydrate, protein, and fat metabolism

• American Diabetes Association: more than 14.6 million Americans diagnosed w/ millions more not diagnosed
• More than 40 million American may have pre-diabetes or early stages of meatabolic disorder

• Responsible for appropriate carbohydrate metabolism
• Secreted by the pancreas
• Islets of Langerhans

• Type 1 (Juvenile Diabetes/Insulin Dependent Diabetes Mellitus-IDDM) 10% of diabetes
• Type 2 (Adult Onset/Non-Insulin Dependent Diabetes Mellitus) 90% of diabetes

• Results from the auto immune destruction of islet cells of the pancreas
• usually effects children and young adults
• Sudden onset
• Genetic component
• Patients have very low levels of circulating insulin
• Require life long exogenous inslin
• Patients do not secrete adequate insulin to sustain necessary physiological functions
• Insulin is required to facilitate the movement of glucose from the blood stream into the cells
• Patients with type 1 diabetes will have high levels of circulating glucose (blood sugar) because the glucose cannot move into the cells to be metabolized

• Non-Insulin Dependent
• Oral hypoglycemic medications may be used
• Caused by decreased production of insulin/increased resistance by body cells to insulin
• Onset is slow and insidous and usually in 50+ ages
• Associated with obesity
• Increased incidence in teens and young adults

• Insulin deficit results in decreased trasportation and use of glucose in many cells (polyphagia & fatigue)
• Blood Glucose levels rise --hyperglycemia
• Excess glucose in urine glucosuria (dehydration results from hypersmolar filtrate--polyuria--polydipsia)
• Diagnosed with a blood test (fasting blood glucose test-- 70-110mg)
• Glycosylated hemoglobin test (HbA1c)--clinical and subclinical diabetes--monitor glucose levels over several months

• Maintenance of blood glucose levels in normal range (reduced complications)
• Diet & Exercise (reduces blood glucose as skeletal muscle uses glucose)
• Oral medication (increases insulin secretion & reduces blood glucose levels)
• Insulin replacement