NEET MDS Lessons
General Pathology
Cor pulmonale
a failure of the right side of the heart. It is caused by prolonged high blood pressure in the right ventricle of the heart, which in turn is most often caused by pulmonary hypertension - prolonged high blood pressure in the arteries or veins of the lungs. People with heart disease, or lung diseases such as cystic fibrosis, are at greater risk.
Pathophysiology
There are several mechanisms leading to pulmonary hypertension and cor pulmonale:
Pulmonary vasoconstriction
Anatomic changes in vascularisation
Increased blood viscosity
Primary pulmonary hypertension
Causes
Acute:
• Massive pulmonary embolization
• Exacerbation of chronic cor pulmonale
Chronic:
• COPD
• Loss of lung tissue following trauma or surgery
Adult Respiratory Distress Syndrome
A constellation of pathologic and clinical findings initiated by diffuse injury to alveolar capillaries. This syndrome is associated with a multitude of clinical conditions which primarily damage the lung or secondarily as part of a systemic disorder.
Pathogenesis
There are many types of injuries which lead to the ultimate, common pathway, i.e., damage to the alveolar capillary unit. The initial injury most frequently affects the endothelium, less frequently the alveolar epithelium. Injury produces increased vascular permeability, edema, fibrin-exudation (hyaline membranes). Leukocytes (primarily neutrophils) plays a key role in endothelial damage.
Pathology
Heavy, red lungs showing congestion and edema. The alveoli contain fluid and are lined by hyaline membranes.
Pathophysiology
Severe respiratory insufficiency with dyspnea, cyanosis and hypoxemia refractory to oxygen therapy.
Autopsy
Autopsy is examination of the dead body to identify the cause of death. This can be for forensic or clinical purposes.
Bacterial endocarditis
Endocarditis is an infection of the endocardium of the heart, most often affecting the heart valves.
A. Acute endocarditis
1. Most commonly caused by Staphylococcus aureus.
2. It occurs most frequently in intravenous drug users, where it usually affects the tricuspid valve.
B. Subacute endocarditis
1. Most commonly caused by less virulent organisms, such as intraoral Streptococcus viridans that can be introduced systemically via dental procedures.
2. Pathogenesis: occurs when a thrombus or vegetation forms on a previously damaged or congenitally abnormal valve. These vegetations contain bacteria and inflammatory cells. Complications can arise if the thrombus embolizes, causing septic infarcts.
Other complications include valvular dysfunction or abscess formation.
3. Symptoms can remain hidden for months.
4. Valves affected (listed most to least common):
a. Mitral valve (most frequent).
b. Aortic valve.
c. Tricuspid (except in IV drug users, where the tricuspid valve is most often affected).
Multiple sclerosis
a. A demyelinating disease that primarily affects myelin (i.e. white matter). This affects the conduction of electrical impulses along the axons of nerves. Areas of demyelination are known as plaques.
b. The most common demyelinating disease.
c. Onset of disease usually occurs between ages 20 and 50; slightly more common in women.
d. Disease can affect any neuron in the central nervous system, including the brainstem and spinal cord. The optic nerve (vision) is commonly affected.
Coccidioidomycosis (Valley Fever; San Joaquin Fever)
A disease caused by the fungus Coccidioides immitis, usually occurring in a primary form as an acute benign asymptomatic or self-limited respiratory infection, occasionally disseminating to cause focal lesions in skin, subcutaneous tissues, lymph nodes, bones, liver, kidneys, meninges, brain, or other tissues.
Primary coccidioidomycosis is usually asymptomatic, but nonspecific respiratory symptoms resembling influenza or acute bronchitis sometimes occur or, less often, acute pneumonia or pleural effusion. Symptoms, in decreasing order of frequency, include fever, cough, chest pain, chills, sputum production, sore throat, and hemoptysis.
Progressive disseminated coccidioidomycosis may develop a few weeks, months, or occasionally years after primary infections,, is more common in men than women and is more likely to occur in association with HIV infection, immunosuppressive therapy
Symptoms often are nonspecific, including low-grade fever, anorexia, weight loss, and weakness. Extensive pulmonary involvement may cause progressive cyanosis, dyspnea, and discharge of mucopurulent or bloody sputum. Extrapulmonary lesions are usually focal, involving one or more tissue sites in bones, joints, skin, subcutaneous tissues, viscera, brain, or meninges. Draining sinus tracts sometimes connect deeper lesions to the skin. Localized extrapulmonary lesions often become chronic and recur frequently, sometimes long after completion of seemingly successful antifungal therapy.
PARASITIC DISEASES
AMEBIASIS (Entamebiasis)
Infection of the colon with Entamoeba histolytica, which is commonly asymptomatic but may produce clinical manifestations ranging from mild diarrhea to severe dysentery.
Etiology and Pathogenesis
Amebiasis is a protozoan infection of the lower GI tract. E. histolytica exists in two forms: the trophozoite and the cyst.
Two species of Entamoeba are morphologically indistinguishable: E. histolytica is pathogenic and E. dispar harmlessly colonizes the colon. Amebas adhere to and kill colonic epithelial cells and cause dysentery with blood and mucus in the stool. Amebas also secrete proteases that degrade the extracellular matrix and permit invasion into the bowel wall and beyond. Amebas can spread via the portal circulation and cause necrotic liver abscesses.
Symptoms and Signs
Most infected persons are asymptomatic but chronically pass cysts in stools. Symptoms that occur with tissue invasion include intermittent diarrhea and constipation, flatulence, and cramping abdominal pain. There may be tenderness over the liver and ascending colon, and the stools may contain mucus and blood.
Amebic dysentery, common in the tropics but uncommon in temperate climates, is characterized by episodes of frequent (semi)liquid stools that often contain blood, mucus, and live trophozoites.
Chronic infection commonly mimics inflammatory bowel disease and presents as intermittent nondysenteric diarrhea with abdominal pain, mucus, flatulence, and weight loss.
Metastatic disease originates in the colon and can involve any organ, but a liver abscess, usually single and in the right lobe, is the most common