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201 Cards in this Set
- Front
- Back
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 |
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What are the 3 hepatitis viruses?
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Hep A, B, C
|
|
What is Hepatitis A?
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Common virus causing a benign, mild disease of small hepatic necrosis - replaced by hepatic regeneration
|
|
What is hepatitis B?
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A more severe disease with massive necrosis of hepatocytes, leading to hepatic failure
|
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Transmission of Hep B?
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- Blood
- Transfusion - Infusion - Dental surgery |
|
Hepatitis B may proceed to?
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Chronic hepatitis and liver cirrhosis
|
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Definition liver cirrhosis?
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A chronic degenerative disease of liver, where hepatocytes are damaged and replaced by fibrous tissue
|
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Typical for Hep C?
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1. Mild acute phase
2. High chance of change to chronicity |
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Which proffesion has high chance of getting Hep C?
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Medical professionals
|
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Morphology of acute hepatitis?
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- Balloon degeneration
- Apoptosis - Piece-meal necrosis - Lymphocytic infiltrate |
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Requirement for calling hepatitis chronic?
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Must had it for 6 months
|
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What is balloon degeneration?
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A initial reaction of hepatocytes to damage - with ballooning of cytoplasm
|
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What is piece meal necrosis?
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A limited necrosis of a few hepatocytes, in association with lymphocytic infiltrate - around the portal tract
|
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Piece meal necrosis is typical for what liver diseases?
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- Viral hepatitis (esp. chronic)
- Autoimmune hepatitis - Steatohepatitis |
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What is steatohepatitis?
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An inflammation and accumulation of fat of liver at the same time
|
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In who is steatohepatitis found?
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- Alcoholics
- DM - Obesity (assoc. with metabolic syndrome) |
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Classification of toxins of liver?
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1. Predictable / undpredictable
2. Direct / indirect |
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What is a predictable hepatotoxin?
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Toxins toxic for most people
|
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What is a direct hepatotoxin?
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A toxin damaging hepatocytes directly
|
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Consequence in liver of direct hepatotoxin?
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Steatosis and necrosis
|
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Examples of direct hepatotoxin?
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Carbon tetrachloride
|
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What is an indirect hepatotoxin?
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Toxin interfering with metabolic pathways
|
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Consequence of indirect hepatotoxin?
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Causing steatosis, necrosis and cholestasis
|
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Examples of indirect hepatotoxins?
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- IV tetracycline
- Phalloides mushroom - Ethanol |
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What is an unpredictable hepatotoxin?
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A toxin which is toxic only to a small amount of people - usually as a hypersensitivity reaction
|
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Consequences of unpredictable hepatotoxins?
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Massive necrosis
|
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Examples of indirect hepatotoxins?
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- Phenytoin (anticonvulsant)
- Halothane (inhalation general anesthetic) |
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What are the vascular hepatic disorders leading to acute hepatitis?
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- Congestion
- Ischemia |
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Main symptoms of acute hepatitis?
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- Jaundice
- Bilirubinemia - Anorexia - Nausea |
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Main complications of acute hepatitis?
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- Fulminant hepatic failure and encephalopaty
- Hepatorenal syndrome |
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What is fulminant hepatic failure?
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Hepatic failure with encephalopathy within 8 weeks
|
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What is the definition of acute hepatic failure?
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Rapid development of hepatocellular dysfunction, coagulopathy and mental status changes in (encephalopathy) in patient without known liver disease
|
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What is the pathogenesis of hepatic encephalopathy?
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Accumulation of toxins in blood which normally would be removed by the liver
|
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What is hepatorenal syndrome?
|
A rapid worsening of kidney function in hepatic cirrhosis / fulminant liver failure - and fatal unless liver transplant is performed
|
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Theory of hepatorenal syndrome?
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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?
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Inflammation of liver lasting for more than 6 months, which may lead to liver cirrhosis
|
|
Etiology of chronic hepatitis?
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1. Viral
2. Drug-induced 3. Autoimmune |
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Which inherited disorder can lead to chronic hepatitis?
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1. Wilson's disease - copper accumulation
2. Alpha-1-antitrypsin deficiency |
|
Classification of chronic hepatitis according to morphology?
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1. Chronic persistent
2. Chronic lobular 3. Chronic active |
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Characteristics of chronic persistent hepatitis?
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1. Lymphocytic infiltrate in portal tract
2. Low fibrosis and necrosis 3. Portal limiting plate intact |
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What is portal limiting plate?
|
The plate of hepatocytes limiting the portal space (triad: a,v,b,) to the other hepatocytes of the liver
|
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Characteristics of chronic lobular hepatitis?
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1. Lobular features in LM
2. Limiting plate intact |
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Characteristics of chronic active hepatitis?
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- Both portal and preportal inflammation
- Piece meal necrosis - Unclear limiting plate |
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Classifications of autoimmune disorders leading to chronic hepatitis?
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Type I
Type II Type III |
|
Type I liver autoimmune disease?
|
Antibodies against:
- Smooth muscle - Hepatic nuclei |
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Type II liver autoimmune disease?
|
Antibodies against:
- Liver and kidney microscomal antigen |
|
Type III liver atuoimmune disease?
|
Antibodies against:
- Liver soluble antigen |
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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?
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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! |
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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
|
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How to control the fibrosis?
|
Since fibrosis is a result of inflammation - you can lower the inflammation :)
|
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How is regeneration ability of fibrosis and cirrhosis?
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Fibrosis - regenerable
Cirrhosis - Not regenerable - since architecture is lost. |
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What is pseudo-lobule formation?
|
Formation of these pseudo-lobules of hepatic tissue, due to destruction of liver architecture in chronic hepatitis (&cirrhosis)
|
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What are the most common causes of cirrhosis?
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- Alcohol
- Postnecrotic - Metabolic - Cholestasis |
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What metabolic diseases may cause cirrhosis?
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- Wilson's disease
- Alpha-1-antitrypsin deficiency |
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What types of cholestasis may cause cirrhosis?
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- 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) |
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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
|
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Lamblia intestinalis is named after?
|
Lambl
|
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Lamblia intestinalis causes?
|
Giardiasis - by colonizing and reproducing in small intestine
|
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What is the main virulence factor of lamblia intestinalis?
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Flagella
|
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What is giardiasis?
|
Infection by lamblia intestinalis, causing malabsorption syndrome.
Manifested by - DIarrhea - Loss of weight - Steatorrhea - Avitaminosis |
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Classification of the trypanosomas?
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1. African
2. American |
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What is the african trypanosomas?
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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
|
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What is Chaga's disease?
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A generalized disease, eventually leading to chronic myocarditis and cardiomyopathy
|
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Entamoeba histolytica cause?
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Amoebic dysentery
|
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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)
|
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How does entamoeba histolytica spread?
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The protozoa survive in cysts, which goes with the stool, and will infect anyone touching stool without washing hands.
(fecal-oral) |
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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 |
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Visceral leishmaniasis is also called?
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Kala-azar - black fever
|
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In which cells do the leishmania reside?
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Macrophages
|
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How is leishmania transmitted?
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Sandflies
|
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What are the plasmodium species?
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P. falciparum (most common)
P. vivax P. Ovale P. malariae |
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Plasmodium species cause what?
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Malaria
|
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What is malaria?
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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
|
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What type of fever is seen in malaria?
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Intermittent and remittent - since the hemolysis occur in blocks
|
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Main symptoms of malaria?
|
- Intermittent fver
- Anemia (massive hemolysis) - Hepatosplenomegaly - Cachexia - Renal failure - Cerebral malaria |
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What is cerebral malaria?
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Neurological symptoms of nystagmus, seizures and coma
|
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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
|
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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 |
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What happens when toxoplasma comes into our body?
|
First they are tachyzoites - and then transform into tissue bradyzoites
|
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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
|
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Symptoms of acquired toxoplasmosis in adult age?
|
- Lympadenopathy, looking like malignant lymphoma
|
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Histology of acquired toxoplasmosis ?
|
Small epithelioid cells spread over lymphoid tissue
|
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What is ascaris?
|
A nematode (earthworm) which infect small bowel - and may lead to ileus due to obstruction of it.
|
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What is a helminth?
|
Worm-like parasites (pinworms)
|
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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
|
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What disease does ecchinococcus cause?
|
Hydatid cyst - cysts of this parasite forms in liver, spleen lungs (and brain??)
|
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How is ecchinococcus transmitted?
|
Eggs in food contamined with dog's feces
|
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Which parasite causes cysts in muscles - due to undercooked pork?
|
Trichinella spiralis
|
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Which parasite causes teniasis?
|
Taenia saginata (beef)
Taenia solium (pork) |
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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
|
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What type of parasite is schistosomas?
|
Trematode
|
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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 |