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201 Cards in this Set

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Acute hepatitis has 6 origins - which?
1. Viral
2. Toxic / drug induced
3. Autoimmune
What is really, hepatitis?
A diffuse interstitial inflammation of liver with destruction of hepatocytes

= Infectious hepatitis
What are the 3 hepatitis viruses?
Hep A, B, C
What is Hepatitis A?
Common virus causing a benign, mild disease of small hepatic necrosis - replaced by hepatic regeneration
What is hepatitis B?
A more severe disease with massive necrosis of hepatocytes, leading to hepatic failure
Transmission of Hep B?
- Blood
- Transfusion
- Infusion
- Dental surgery
Hepatitis B may proceed to?
Chronic hepatitis and liver cirrhosis
Definition liver cirrhosis?
A chronic degenerative disease of liver, where hepatocytes are damaged and replaced by fibrous tissue
Typical for Hep C?
1. Mild acute phase
2. High chance of change to chronicity
Which proffesion has high chance of getting Hep C?
Medical professionals
Morphology of acute hepatitis?
- Balloon degeneration
- Apoptosis
- Piece-meal necrosis
- Lymphocytic infiltrate
Requirement for calling hepatitis chronic?
Must had it for 6 months
What is balloon degeneration?
A initial reaction of hepatocytes to damage - with ballooning of cytoplasm
What is piece meal necrosis?
A limited necrosis of a few hepatocytes, in association with lymphocytic infiltrate - around the portal tract
Piece meal necrosis is typical for what liver diseases?
- Viral hepatitis (esp. chronic)
- Autoimmune hepatitis
- Steatohepatitis
What is steatohepatitis?
An inflammation and accumulation of fat of liver at the same time
In who is steatohepatitis found?
- Alcoholics
- DM
- Obesity (assoc. with metabolic syndrome)
Classification of toxins of liver?
1. Predictable / undpredictable
2. Direct / indirect
What is a predictable hepatotoxin?
Toxins toxic for most people
What is a direct hepatotoxin?
A toxin damaging hepatocytes directly
Consequence in liver of direct hepatotoxin?
Steatosis and necrosis
Examples of direct hepatotoxin?
Carbon tetrachloride
What is an indirect hepatotoxin?
Toxin interfering with metabolic pathways
Consequence of indirect hepatotoxin?
Causing steatosis, necrosis and cholestasis
Examples of indirect hepatotoxins?
- IV tetracycline
- Phalloides mushroom
- Ethanol
What is an unpredictable hepatotoxin?
A toxin which is toxic only to a small amount of people - usually as a hypersensitivity reaction
Consequences of unpredictable hepatotoxins?
Massive necrosis
Examples of indirect hepatotoxins?
- Phenytoin (anticonvulsant)
- Halothane (inhalation general anesthetic)
What are the vascular hepatic disorders leading to acute hepatitis?
- Congestion
- Ischemia
Main symptoms of acute hepatitis?
- Jaundice
- Bilirubinemia
- Anorexia
- Nausea
Main complications of acute hepatitis?
- Fulminant hepatic failure and encephalopaty
- Hepatorenal syndrome
What is fulminant hepatic failure?
Hepatic failure with encephalopathy within 8 weeks
What is the definition of acute hepatic failure?
Rapid development of hepatocellular dysfunction, coagulopathy and mental status changes in (encephalopathy) in patient without known liver disease
What is the pathogenesis of hepatic encephalopathy?
Accumulation of toxins in blood which normally would be removed by the liver
What is hepatorenal syndrome?
A rapid worsening of kidney function in hepatic cirrhosis / fulminant liver failure - and fatal unless liver transplant is performed
Theory of hepatorenal syndrome?
A failing liver with portal hypertension, secrete substances leading to visceral vasodilation.

This will lead to vasoconstriction of renal arteries, in an attempt to counterbalance it - and subsequently renal failure.
Definition chronic hepatitis?
Inflammation of liver lasting for more than 6 months, which may lead to liver cirrhosis
Etiology of chronic hepatitis?
1. Viral
2. Drug-induced
3. Autoimmune
Which inherited disorder can lead to chronic hepatitis?
1. Wilson's disease - copper accumulation
2. Alpha-1-antitrypsin deficiency
Classification of chronic hepatitis according to morphology?
1. Chronic persistent
2. Chronic lobular
3. Chronic active
Characteristics of chronic persistent hepatitis?
1. Lymphocytic infiltrate in portal tract
2. Low fibrosis and necrosis
3. Portal limiting plate intact
What is portal limiting plate?
The plate of hepatocytes limiting the portal space (triad: a,v,b,) to the other hepatocytes of the liver
Characteristics of chronic lobular hepatitis?
1. Lobular features in LM
2. Limiting plate intact
Characteristics of chronic active hepatitis?
- Both portal and preportal inflammation
- Piece meal necrosis
- Unclear limiting plate
Classifications of autoimmune disorders leading to chronic hepatitis?
Type I
Type II
Type III
Type I liver autoimmune disease?
Antibodies against:
- Smooth muscle
- Hepatic nuclei
Type II liver autoimmune disease?
Antibodies against:
- Liver and kidney microscomal antigen
Type III liver atuoimmune disease?
Antibodies against:
- Liver soluble antigen
What is liver fibrosis and how do we classify it?
A excess deposition of fibrous tissue in interstitial space of liver - with increasing ratio between fibers and hepatocytes - but still keeping the liver architecture and framework intact.

Classify it from F0-F4

F0 = no fibrosis
F4 = cirrhosis
Stages of chronic hepatitis?
1. Regeneration
2. Reparation
3. Fibrosis
4. Cirrhosis
What is liver cirrhosis and what does it arise from?
It always arise from fibrosis, but some things are different:
- Fibrous tissue hypertrophy
- Pseudo-lobule formation

So the basic framework and architecture of liver is destroyed!
How often does liver cirrhosis occur from chronic hepatitis?
Very rare - and if it happens it is due to lack of treatment for fibrosis the first years
How to control the fibrosis?
Since fibrosis is a result of inflammation - you can lower the inflammation :)
How is regeneration ability of fibrosis and cirrhosis?
Fibrosis - regenerable
Cirrhosis - Not regenerable - since architecture is lost.
What is pseudo-lobule formation?
Formation of these pseudo-lobules of hepatic tissue, due to destruction of liver architecture in chronic hepatitis (&cirrhosis)
What are the most common causes of cirrhosis?
- Alcohol
- Postnecrotic
- Metabolic
- Cholestasis
What metabolic diseases may cause cirrhosis?
- Wilson's disease
- Alpha-1-antitrypsin deficiency
What types of cholestasis may cause cirrhosis?
- Biliary tract atresia
- Chronic cholestatic cirrhosis
- Biliary cirrhosis
What are the complications of cirrhosis?
1. Portal hypertension
2. Ascites
3. Porto-caval anastomoses
4. Hepatic failure
5. Splenomegaly
6. Infections + bleeding disorders (failing liver)
What are the porto-caval anastomoses in liver failure?
1. Esophageal varices
2. Hemorrhoids
3. Capud medusae
What is caput medusae?
A spider-like nevi, made of telangiectasias (dilated veins)

Since when you push it and release, they are filled from the center, so they look like a spider growing its legs really fast
Definition parasite?
An organism that lives of another organism - without contributing anything for the survival of the host
How to classify parasites?
1. Protozoa
2. Helminths (worms)
3. Arhtropods (belt-animal)
What are the main protozoas important for medicine? (9)

"Once there was a LAMB who TRIPPED over the ENT of the world. He fell and fell until he met the devil, who wanted to give him LEISure for his time-consuming activity. The devil said: "Give me your blood PLASMA and your LUNG (pneum), and you will ENTER back to your world. The lamb agreed, but knew he would TRICK the devil, since his plasma was TOXIC. The devil got very sick, and he ASKed the lamb: "How did you know that?" The lamb said: "I am the lamb of God, who takes away the sin of the world - my blood will always be toxic to you".
1. Lamblia
2. Trypanosomas
3. Entamoeba
4. Leishmania
5. Plasmodium
6. Pneumocystis
7. Toxoplasma
8. Trichomonas
9. Ascaris
Lamblia intestinalis is of the genus?
Giardia
Lamblia intestinalis is named after?
Lambl
Lamblia intestinalis causes?
Giardiasis - by colonizing and reproducing in small intestine
What is the main virulence factor of lamblia intestinalis?
Flagella
What is giardiasis?
Infection by lamblia intestinalis, causing malabsorption syndrome.

Manifested by
- DIarrhea
- Loss of weight
- Steatorrhea
- Avitaminosis
Classification of the trypanosomas?
1. African
2. American
What is the african trypanosomas?
T. gamense
T. rhodisiense
African type of trypanosomas cause?
African trypanosomiasis
What is african trypanosomiasis?
Sleeping sickness and encephalitis

Initially only fevers, some headaches and itching. Later detoriation confusion, coordination troubles and insomnia.
What is the american type of trypanosomas?
T. cruzi
What disease does T.cruzi cause?
Chaga's disease
What is Chaga's disease?
A generalized disease, eventually leading to chronic myocarditis and cardiomyopathy
Entamoeba histolytica cause?
Amoebic dysentery
What is amoebic dysentery?
A tropical disease, where you have extreme diarrhea with also blood in the stools, and all it's consequences (weight loss, anemia..dehydration)
How does entamoeba histolytica spread?
The protozoa survive in cysts, which goes with the stool, and will infect anyone touching stool without washing hands.

(fecal-oral)
What are the leishmania types?
Leishmania donovani
Leishmania tropica
Leishmania cause?
Leishmaniasis
What is leishmaniasis?

3 types.
1. Cutaneous - non-healing ulcers of skin

2. Mycocutaneous - non-healing ulcers of mucous membranes and skin

3. Visceral - ulcers of skin and later fever, anemia, hepatosplenomegaly
Visceral leishmaniasis is also called?
Kala-azar - black fever
In which cells do the leishmania reside?
Macrophages
How is leishmania transmitted?
Sandflies
What are the plasmodium species?
P. falciparum (most common)
P. vivax
P. Ovale
P. malariae
Plasmodium species cause what?
Malaria
What is malaria?
Infection of RBC's with the parasite plasmodium. They enter RBC and after 72 hours there is rupture with hemolysis and symptoms arise about after 9 days after infection with fever
What type of fever is seen in malaria?
Intermittent and remittent - since the hemolysis occur in blocks
Main symptoms of malaria?
- Intermittent fver
- Anemia (massive hemolysis)
- Hepatosplenomegaly
- Cachexia
- Renal failure
- Cerebral malaria
What is cerebral malaria?
Neurological symptoms of nystagmus, seizures and coma
What is now the new name of pneumocystis carinii?
Pneumocystis jirovecii (czech parasitologist)
What is pneumocystic jirovecii?
A fungus - earlier believed to be protozoa! So that's why it changed name I think
Pneumocystis jirovecii cause?
Pneumocystis pneumonia - Interstitial pneumonia
In who does pneumocystis cause pneumocystic pneumonia?
- Infants
- Immunocompromized people
How does pneumocystic pneumonia look?
Alveoli filled with granular PAS-positive organisms (vesicles with inclusions of the fungi)
What does trichomonas vaginalis cause?
Trichomoniasis:
- Vaginitis in women
- Urethritis / prostatitis in men
Transmission of trichomonas vaginalis?
Sexual intercourse
Who is the main carrier of toxoplasma gondii - and why does sheeps in norway die in houndreds of this protozoa?
It is carried by cats - and sheeps die because when they come down to the farm - they may somehow eat the cat's faeces - and they're infected and die
Classification of toxoplasma?
1. Congenital
2. Acquired
When toxoplasma parasites are seen in blood smear - what are they called?
Tachyzoites, bradyzoites
Transmission of toxoplasma?
1. Oocysts from cat feces
2. Tissue cysts from animal muscle infected by oocyst
What happens when toxoplasma comes into our body?
First they are tachyzoites - and then transform into tissue bradyzoites
It mother if infected by toxoplasma - fetus can be infected via blood stream. What is this called and what consequences for baby?
Congenital toxoplasmosis - affects the fetus brain around the ventricles - lead to obstruction of aqueduct of Sylvius, and hydrocephalus
Symptoms of acquired toxoplasmosis in adult age?
- Lympadenopathy, looking like malignant lymphoma
Histology of acquired toxoplasmosis ?
Small epithelioid cells spread over lymphoid tissue
What is ascaris?
A nematode (earthworm) which infect small bowel - and may lead to ileus due to obstruction of it.
What is a helminth?
Worm-like parasites (pinworms)
Name the most common helminths?
- Oxyuris vermicularis
- Ecchinococcus
- Trichinella
- Taenia
- Schistosomas
We have a slide of oxyuris vermicularis. What is it?
A worm which lies eggs in the anus at night - the child itches it and somehow eats it - and the cycle repeates.

Common in kindergarden
What disease may oxyuris vermicular simulate?
Chronic appendicitis
What is ecchinococcus?
A tapeworm - a parasitic flatworm
What disease does ecchinococcus cause?
Hydatid cyst - cysts of this parasite forms in liver, spleen lungs (and brain??)
How is ecchinococcus transmitted?
Eggs in food contamined with dog's feces
Which parasite causes cysts in muscles - due to undercooked pork?
Trichinella spiralis
Which parasite causes teniasis?
Taenia saginata (beef)
Taenia solium (pork)
What type of parasite is taenia?
Cestodes
What is taeniasis?
Infection of taenia cestode - which can grow up to 1 meter (!) and cause weight loss since it steals your food
What type of parasite is schistosomas?
Trematode
What are the 3 types of schistosomas?
1. S. hematobium
2. S. mansoni
3. S. Japonicum
S. hematobium is located where and cause?
Egypt and middle east

Cause:
- Inflammation of bladder
- Stenosis
- Hydronephrosis
S. mansoni is found where and cause?
Black africa

Cause:
- Liver fibrosis
- Liver cirrhosis
--> Cor pulmonale
What are the physical examination sign of s.mansoni?
Extremely dilated superficial gastric veins!!
S. japonicum is found where and cause?
East asia, lead to liver infection (hepatosplenomegaly) and cor pulmonale with heart failure and encephalitis
This guy slept with a girl who had not washed her clothes for 6 years. A while after, he got these itching (pruritis) with red spots on palms and inguinal area.

What have he got?
What is it caused by?
He got scabies - caused by the arthropode (segmented parasite) - burrowing itself to the stratum corneum of skin
What are the most common sexually transmitted DISEASES? (not agents)
1. Gonorrhea
2. Syphilis
3. Lymphogranuloma venerum
4. Chancroid
5. Granuloma inguinale
6. HPV infections
7. Trichomoniasis
8. AIDS, Hepatitis B,C
Etiological agent of gonorrhea?
Neisseira gonorrheae
Transmission of gonorrheae?
Direct contact of mucosas - essential for infection
Main male symptom of gonorrheae?
Mucopurulent urethritis
--> Spreading to:

- Prostate
- Epidydimis
We can distinguish a gonorrheae infection into 2 parts:
- Anterior
- Posterior

What does it mean?
Anterior
- Only mucopurulent urethritis (pars spongiosa) - with pus flowing out

Posterior
- Spreading to membranous and prostatic part of urethra and alter epidydimis
If gonorrheae is untreated - it may lead to?
Scarring of tubules - leading to infertility
Clinical presentation of gonorrheae in males?
2-7 days after microbe contact:

1. Dysuria with increased frequency
2. Mucopurulent exudate
Main female symptoms of gonorrheae infection?
Only colpitis with discharge - urethra is spared
In untreated gonorrheae female - what happens?
Bacteria spred to cervix--> uterus --> Fallopian tube.

Here it cause purulent inflammation of tube and ovary - a so-called 'tuboovarian abscess'
Complication of a tuboovarian abscess?
Scarring of fallopian tube, increasing risk of:
- Infertility
- Ectopic pregnancy
Clinical presentation of female gonorrheae?
- Dysuria
- Vaginal discharge
- Pelvic pain
In females the N. Gonorrheae can disseminate. To where?
To joints causing arthritis - especially in the knee!
If mother is pregnant and has gonorrheae - what disease can the child get by infection of the eyes?
Child gets "opthalmia neonatorum" - leading to blindness
What is the etiological agent of syphilis?
Treponema pallidum - a spirochete
How did syphilis get to Europa?
Imported from America in the 16th century
Source and transmission of syphilis?
During sexual intercourse, one person has mucosal / cutaneous lesions (primary/secondary) from which the treponema enters small injuries on penis or vagina.

This is called acquired syphilis
Classification of syphilis?
1. Congenital / acquired
2. Primary / secondary / tertiary
How is congenital syphilis transmitted?
Transplacentally - from infected mother - at about the 3rd month of pregnancy
The manifestation of congenital syphilis depends on?
1. Amount of bacteria
2. The time of infection (the later the better)
3 outcomes of congenital syphilis?
1. Stillborn
2. Infantile syphilis
3. Late (tardive) congenital syphilis
What is stillborn congenital syphilis?
If mother have got massively infected in the start of the pregnancy.
How is baby affected in stillborn syphilis?
Flint liver (green/black)
- Hepatomegaly - due to high fibrous prod. and inflamm

Pneumonia alba
- Pneumonitis and congenital lung fibrosis
What are the signs of infantile syphilis?
1. Chronic rhinitis of mucosa
2. Rash or mucocutaneous lesions similar to acquired
What is the late signs of congenital syphilis - if it remains untreated?
Hutchinson's triad
What is the Hutchinson's triad?
1. Notched incisors
2. Keratitis --> Blind
3. CN VIII disordered --> Deaf
First manifestation of primary syphilis occur 2-3 weeks after sexual contact. What is the manifestation, in male and female?
Male - Hard painless chancre / ulcer on penis

Females - ulcer may be hidden in vagina or cervix
Another name for the hard painless ulcer?
Ulcus durum
Histology of the ulcus durum?
1. Treponema pallidum
2. Inflammation
3. Proliferative endarteritis
What inflammatory cells do we find in ulcus durum of syphilis?
- Plasma cells (most important) - parasite
- Lymphocytes
What is proliferative endarteritis?
A reactive change - by narrowing of lumen of arteries by fibrous tissue
Clinical signs of primary syphilis?
- Painless enlargement of inguinal lymph nodes
- Ulcer disappears after 4-6 weeks
How many % of patients proceed to secondary syphilis?

And how long time after ulcer resolution?
30-40%

2 months after ulcer dissapear - so about 3-4 months after primary infection
Main signs of secondary syphilis?
- Generalized lymphadenopathy
- Mucocutaneous lesions
- Skin lesions
Histology of secondary syphilis lymph nodes?
1. Lymph node hyperplasia
2. Plasma cells
3. Proliferative endarteritis
What skin lesions occur in secondary syphilis?
- Dermatitis
- Condylomata lata
- Chancre
Dermatitis in secondary syphilis occur where?
Palms and soles
What is condylomata lata? What are typical locations?
Wart like lesions in skin moist area, singular or many, typically in:
- Axilla
- Anogenital region
- Oral cavity, pharynx
Latent phase between secondary and tertiary syphilis may last how long?
5-15 years
How many untreated patients will go into tertiary syphilis?
35%
What 3 main manifestations are there of tertiary syphilis?
1. Cardiovascular syphilis
2. Neurosyphilis
3. Benign syphilitic lesions
What is the main manifestation of syphilic aortitis?
Syphilic aortitis
What is syphilic aortitis?
Endarteritis of the vasa vasorum of wall of proximal aorta - leading to ischemia of wall
How does a syphilic aortitis look grossly?
Bark-like appearance, like a tree
What are the main complications of syphilic aortitis?
1. Aneurysms - since elastic fibers are destroyed in scarred areas

2. Aortic insufficiency - due to a dilated aorta (leaves are separated in diastole)

3. Coronary ostium stenosis --> Cardiac ischemia
Neurosyphilis - common or rare?
Very rare
What are the 3 main manifestations of neurosyphilis?
1. Meningeal syphilis
2. Tabes dorsalis
3. General paresis of the insane
What is meningeal syphilis?
Thickening of small vessels and plasma cell inflammation
What is tabes dorsalis?
A slow degeneration of especially the dorsal columns of spinal cord - leading to sensory and motor disorders (gait)
What is general paresis of the insane?
1. Atrophy of brain cortex
2. Neuronal loss
What is the benign lesions of tertiary syphilis?

Where are they found?
Gumma - a soft elastic mess found in:

- Bones (nose)
- Skin
- Oral mucosa
- Liver
What do we call a liver affected by gumma in tertiary syphilis?
Hepar lobatum - many foci of gumma
Histological morphology of gummas?
- Caseous necrosis with plasma cells
- Fibroproduction
What is lymphogranuloma venerum?
A manifestation chlamydia trachomatis infection:
- Ulcerative lesions
- Urethritis
- Regional lymphadenopathy in 30 days
How does lymphogranuloma venerum look in LM?
Granulomatous inflammation with abscesses
What is chancroid - what is etiological agent and how does it present?
It is ulcers on the genitalia, caused by Haemophilus ducreyi bacteria

Presenting as a erythematous papule with irregular ulcer
In untreated chanchroid patients - what happens?
2 weeks - enlargement of regional lymph nodes
---> Erosion of skin and draining ulcer
What is granuloma inguinale?
STD with papules and ulcers in moist areas - and later huge amount of granulation tissue is formed
Granuloma inguinale late complication?
Scarring of lymphatic vessels and lymph nodes - leading to elephantiasis of external genitalia!
What is the causative agent of granuloma inguinale?
Lecture = Calymmatobacterium donovani
Wiki = Klebsiella granulomatis
What confirms the diagnosis in granuloma inguinale?
Findings of Donovan bodies in the tissue
How does Donovan bodies look?
Deep purple when stained with Wright's stain
What STD is caused by herpes virus?
Genital herpes simplex type II
Manifestations of Genital herpes?
Very painful vesicles on lower genitalia - sometimes recurrent
How can neonate by infected by herpes?

What is the disease of child called?
During delivery - called neonatal herpes infection
What are the manifestations of neonatal herpes infection?
By the 2nd week of life baby has:
- Encephalitis
- Pneumonia
- Liver necrosis

==> Leading to death :(
HPV serotypes causing condyloma acuminatum?
6,11
HPV serotypes causing high risk dysplastic changes?
16, 18, 31, 33, 35
Inclusion bodies in HPV infected cells?
Koilocytes
What are koilocytes?
Keratinocytes with halo circle around shrunken nucleus
How to 100% diagnose HPV particles inside nuclei of koilocytes?
FISH method
Who was awarded the nobel prize for discovery of the HPV etiology?
Harald zur Hausen
What is the only anti-cancer vaccine we have?
HPV vaccination :)
What is the bad thing with the HPV vaccines?
1. Only offered to girls - so must be vaccinated before sexual age (guys are full of STDs..)

2. Only against the most common serotypes 16, 18
What is trichomoniasis?
STD caused by trichomonas vaginalis (protozoa)
Male manifestations of trichomoniasis?
Usually asymptomatic - or uretitis
Female manifestations of trichomoniasis?
- Colpitis
- Unpleasant itching
- Vaginal discharge