NEET MDS Lessons
General Pathology
Parkinson’s disease
a. Characterized by the degeneration of neurons in the basal ganglia, specifically the substantia nigra and striatum.
b. Histologic findings in affected neurons include Lewy bodies.
c. Clinically, the disease affects involuntary and voluntary movements. Tremors are common. Symptoms include pin-rolling tremors, slowness of movements, muscular rigidity, and shuffling gait.
1. Human papillomavirus types 6 and 11 → condyloma acuminta (venereal warts).
2. Molluscum contagiosum is characterized by a bowl shaped lesion filled with keratin, the latter containing the viral inclusions (molluscum bodies) in the squamous cells.
INFARCTION
An infarct is an area of ischemic necrosis caused by occlusion of either the arterial supply or the venous drainage in a particular tissue
Nearly 99% of all infarcts result from thrombotic or embolic events
other mechanisms include: local vasospasm, expansion of an atheroma, extrinsic compression of a vessel (e.g., by tumor); vessel twisting (e.g., in testicular torsion or bowel volvulus; and traumatic vessel rupture
MORPHOLOGY OF INFARCTS
infarcts may be either red (hemorrhagic) or white (anemic) and may be either septic or aseptic
All infarcts tend to be wedge-shaped, with the occluded vessel at the apex and the periphery of the organ forming the base
The margins of both types of infarcts tend to become better defined with time
The dominant histological characteristic of infarction is ischemic coagulative necrosis
most infarcts are ultimately replaced by scar. The brain is an exception, it results in liquefactive necrosis
RED INFARCTS:
occur in
(1) venous occlusions (such as in ovarian torsion)
(2) loose tissues (like lung) that allow blood to collect in the infarcted zone
(3) tissues with dual circulations (lung and small intestine)
(4) previously congested tissues because of sluggish venous outflow
(5) when flow is re-established to a site of previous arterial occlusion and necrosis
WHITE INFARCTS
occur with:
1) arterial occlusions
2) solid organs (such as heart, spleen, and kidney).
Septic infarctions - occur when bacterial vegetations from a heart valve embolize or when microbes seed an area of necrotic tissue. - the infarct is converted into an abscess, with a correspondingly greater inflammatory response
FACTORS THAT INFLUENCE DEVELOPMENT OF AN INFARCT
- nature of the vascular supply
- rate of development of the occlusion (collateral circulation )
- vulnerability to hypoxia - Neurons undergo irreversible damage
- 3 to 4 minutes of ischemia. - Myocardial cells die after only 20 to 30 minutes of ischemia
- the oxygen content of blood
Str. agalactiae
β-hemolytic, with its capsule being the major virulence factor. Capsule inhibits phagocytosis and complement activation. The CAMP factor (a hemolysin) is another virulence factor.
Group B strep are normally found in GI tracts and vaginas.
Major disease is neonatal sepsis/meningitis after passage through infected birth canal. May lead to meningitis, and CNS damage is high. Mothers colonized with Group B strep should be treated pre-delivery.
DYSPLASIA
It is disturbed growth or cells in regard to their size, shape arrangement. In its mild degrees it represents a reversible reaction to chronic inflammation whereas the most severe degrees warrant a labelling of intraepithelial neoplasia. Hence it includes a wide spectrum of changes ranging from a reversible disorientation to 'carcinoma-in-situ'.
Histologically it is characterized by:
o Basal cell hyperplasia.
o Variation in size and shape of cells.
o Disorderly maturation.
o Increased mitotic activity.
o Disorientation of arrangement of cells (loss of polarity)
Dysplasia is commonly seen in:
o Squamous epithelium of cervix.
o Bronchial epithelium in habitual smokers.
o Gastric and colonic mucosa in long standing inflammation
o Oral and vulval leucoplakia
Primary vs. secondary disorders - Most nutritional disorders in developed countries are not due to simple dietary deficiencies but are rather a secondary manifestation of an underlying primary condition or disorder.
• Chronic alcoholism
• Pregnancy and lactation
• Renal dialysis
• Eating disorders
• Prolonged use of diuretics
• Malabsorption syndromes
• Neoplasms
• Food fads
• Vegans
• AIDS
INFLAMMATION
Response of living tissue to injury, involving neural, vascular and cellular response.
ACUTE INFLAMMATION
It involves the formation of a protein .rich and cellullar exudate and the cardinal signs are calor, dolor, tumour, rubor and function loss
The basic components of the response are
Haemodynamic changes.
Permeability changes
Leucocyte events.
1. Haemodynamic Changes :
- Transient vasoconstriction followed by dilatation.
- Increased blood flow in arterioles.
- More open capillary bed.
- Venous engorgement and congestion.
- Packing of microvasculature by RBC (due to fluid out-pouring)
- Vascular stasis.
- Change in axial flow (resulting in margination of leucocytes)
.2. Permeability Changes:
Causes.
- Increased intravascular hydrostatic pressure.
- Breakdown of tissue proteins into small molecules resulting in
- increased tissue osmotic pressure.
- Increased permeability due to chemical mediators, causing an
- immediate transient response. .
- Sustained response due to direct damage to microcirculation.
3. White Cell Events:
.Margination - due to vascular stasis and change in axial flow.
Pavementing - due to endothelial cells swollen and more sticky.
Leucocytes more adhesive.
Binding by a plasma component
Emigration - of leucocytes by amoeboid movement between endhothe1ial cells and beyond the basement membrane. The passive movement of RBCs through the gaps created during emigration is called diapedesis
Chemotaxis - This is a directional movement, especially of polymorphs and monocytes towards a concentration gradient resulting in aggregation of these cells at the site of inflammation. .Chemotactic agents may be:
- Complement components. (C3and C5 fragments and C567)
- Bacterial products.
- Immune complexes, especially for monocyte.
- Lymphocytic factor, especially for monocyte.
Phagocytosis - This includes recognition, engulfment and intracellular degradation. It is aided by .Opsonins., Specific antibodies., Surface provided by fibrin meshwork.
Functions of the fluid and cellular exudate
1. Dilution of toxic agent.
2. Delivers serum factors like antibodies and complement components to site of inflammation.
3. Fibrin formed aids In :
- Limiting inflammation
- Surface phagocytosis
- Framework for repair.
4. Cells of the exudate:
Phagocytose and destroy the foreign agent.
Release lytic enzymes when destroyed, resulting in extracellular killing of organisms- and digestion of debris to enable healing to occur