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67 Cards in this Set
- Front
- Back
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Etiology
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the cause
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Pathogenesis
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Sequence of events from the cause to the manisfestations (different etiologies may produce disease through similar pathogeneic mechanisms)
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Lesion
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Generic term for a localized change representing an abnormality or injury. To be avoided when a more specific or descriptive term can be used.
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Pathognomonic features
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Those sign/symptoms diagnostic of the diease
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Syndrome
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Defined or observed collection of signs and symptoms; a set of signs and symptoms that occur together.
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Idiopathic
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Cause unknown
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Iatrogenic
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Caused by treatment, usually referring to an undesirable result of treatment.
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Nosocomial
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Relating to the hospital, a "nosocomial infection" = hospital acquired infection
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Prodrome
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Early symptoms of a disease usually before diagnostic features are manifest; indicating onset of a disease
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Remission
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Lessening the severity of a disease
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Adaptations to Cellular Injury
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Hyperplasia, hypertrophy, atrophy, metaplasia, intracellular storage (accumulations)
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Atresia
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Developmental Lesion - Loss of the lumen - congenital absence of a lumen in a 'hollow' organ
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Hypoplasia
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Developmental Lesion - Arrested or diminished development with failure to atain normal size (pulmonary hypoplasia assoc with congenital diaphr hernia)
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Agenesis, Aplasia
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Absence of a structure or tissue due to failure to develop (agenesis) or no development beyond rudimentary anlage (aplasia)
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Ectopia, heterotopia, choristoma, "rests"
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normal tissue in an abnormal location (ectopic adrenal tissue in the psermatic cord)
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Dysplasia (in the context of developmental anomalies)
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cells are generally normal but the organization is abnormal
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Hamartoma
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Tumor-like overgrowth of mature normal tissues that are native to that site, usually in a disorganized fashion. It is a distinct MASS.
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Metaplasia
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Replacement of one differentiated cell type by another. "from one normal-looking cell type to another normal-looking cell type (in response to injurious stimuli the stem cells differentiate)..."
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Neoplasia
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Clonal proliferation of cells, usually as the result of mutations. May be benign or malignant.
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carcinoma
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Epithelial in origin, most common type of cancer (by class). Tend to metastasize first by way of lymphatics, later metasteses go by way of bloodstream.
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sarcoma
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cancers arising from stuctural and mesenchymal tissues ("not-epithelium"). Tend to metastasize by way of bloodstream (to the lungs especially) nut not to the lymph nodes.
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Dysplasia (neoplastic)
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Premalignant disordered cell growth. Neoplastic and normal cells coexist and invasion of surround structures has not occurred.
Dysplasia is NOT cancer - no invasion or mestastasis. |
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In-situ
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A cancer that is still confined to a natural border. it has completely replaced the epithelium at this site. Usually applied to carcinomas due to occurance of natural boundaries seen in epithelium.
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Atrophy
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Reduction in size - often associated with reduction of cell number. Occurs after organ or tissue has achieved normal development. Organelle digestion via autophagocytosis or ubiquination-proteasome pathway. Indiv cells lost by apoptosis.
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Involution
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Reduction in size after a period of normal growth or hyperplasia, generally a physiologic process.
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Hypertrophy
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Increased size of cells or organized but NOT increased NUMBER of cells. Due to increased workload, neural, hormonal stimulation, increased synthesis of structural components, resistance to apoptotic signals.
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Hyperplasia
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Increased NUMBER of cells. Occuring in tissue with mitotic capabilities, increase workload, increased neural or hormonal stimulation. A controlled process that stops when the stimulus ceases.
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What is a tumor?
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May be benign or malignant and is a clonal autonomous growth of cells...'clonal proliferation'
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Polyp
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neoplastic or non-neoplastic which protrudes beyond the surface of a hollow organ. Broad based = sessile, narrow based = pedunculated, finger-like projections = papillary
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Malignant
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ability to invade beyond normal boundaries or metastasize (spread) to distant sites.
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Hematogenous
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Spreading of a tumor through vessels, requiring invasion of blood or lymphatic vessels.
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What is the morphologic distinction between "dysplasia" and "cancer"?
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Often it is only based on the extent of the lesion.
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Intra-epithelial neoplasia
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When dysplasia and carcinoma-in-situ are lumped together as terms. Ex: cervical intraepithelial neoplasia.
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High-grade neoplasm
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"Poorly differentiated" or "anaplastic" - which means it has little or no similarity to the original tissue.
Grade often used as a predictor of behavior of tumor. |
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Low-grade neoplasm
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"Well-differentiated" - looks the same or nearly the same as tissue of origin.
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Stage of a neoplasm
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Description of the extent of spread of a neoplasm and is often used as a predictor of outcome.
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Low Stage neoplasm
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(Stage 1) indicates limited extent and potentially a good prognosis.
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High Stage neoplasm
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(Stave 4) indicates spread beyond the site of origin to other organs. Poor prognosis.
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Sequential steps in development of neoplasia (4)
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1. Metaplasia
2. Dysplasia 3. Carcinoma-in-situ 4. Carcinoma |
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Metaplasia
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NON-NEOPLASTIC change in tissue at site of irritation. Genes guiding different differentiation are activated but not necessarily mutational changes.
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Dysplasia
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NEOPLASTIC mutations which result in abnormal features in some but not all original or metaplastic cells. Mix. Abnormal cells probably have some of the mutational changes.
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Carcinoma-in-situ
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NEOPLASTIC mutations which result in replacement of all the normal epithelial cells with abnormal cells without invasion of the basement membrane.
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Carcinoma
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Invasion through the basement membrane (or other confining boundary) and/or metastases.
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Malignant "-omas"
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lymphoma, melanoma, seminoma, astrocytoma, glioma, myeloma
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What is the prefix used for tumors arising from glandular epithelium?
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"adeno-"....Adenocarcinoma = malignant, adenoma = benign
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What is an example of adaptive hyperplasia?
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lymphoid hyperplasia in inflammation
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Metaplasia
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Change from one normal-looking cell type to another normal looking cell type.
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Breast and pregnancy are hormonally induced to grow...what is this an example of?
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Physiologic hyperplasia
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What kind of hyperplasia will occur after removal of part of the liver?
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Compensatory
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Gingival hyperplasia due to drug reaction (phenytoin, cyclosporin A) is an example of what kind of hyperplasia?
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pathologic, abnormal stimulation from exogenous sources.
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How are metaplasias normally named?
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They are normally named by the new cell type. "Squamous metaplasia" - new kinds of cell are more adept at surviving the irritation/stress.
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What is the transition in Intestinal (glandular) metaplasia?
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Bladder = cystitis glandularis (urotheliam to mucous columnar cells)
Chronic gastritis = gastric-type mucous columnar cells replaced by intestinal-type goblet cells. Esophagus = squamous cells are replaced by intestinal type goblet cells = BARRETT'S ESOPHAGUS |
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What are some of the processes that are more vulnerable to injury?
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Cell membrane integrity, aerobic respiration, protein synthesis, maitenance of genetic integrity.
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What kinds of changes occur in most cases of cell injury? (6)
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1. Increase cytosolic water (ER cisternae)
2. ATP depletion 3. Mitochondrial damage (phospholipid and Ca++ deposits) 4. Loss of Ca++ homeostasis, inc. Ca++ intracellularly 5. Production of ROS 6. Defects in membrane permeability (pumps/channels, and membrane blebs) |
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What is the most immediate cause of cell injury?
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Hypoxia
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What are the mechanisms for hypoxia? (3)
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1. Decrease blood supply (ischemia)
2. Diminished O2 carrying capacity (CO) 3. Poisoning of oxidative enzymes (cyanide) |
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What is the sequence of reversible events in Hypoxic injury?
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1. Decreased O2 tension, decreased ATP production
2. Decreased ATP --> Dec Na/K pump, --> influx of Na, Cl, H20. Efflux of K+, and manifests as acute cellular swelling and organelle swelling. Also increase anaerobic glycolysis ( inc. lactate, dec pH-->worse injury) 3. Detachment of ribosomes...fatty degeneration |
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What is the sequence of events when a hypoxic injury has become irreversible?
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1. Extensive damage to the plasma and organelle membrane
- Dec. ATP, release of ROS, loss of phospholipids, detergent lipid breakdown products, influx of calcium...lysis of lysosomes. 2. Marked swelling of mitochondria "high amplitude swelling" with "amorphous densities" and calcium deposits in mito matrix. **First ultrastructural sign of irreversible injury** |
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In irreversible hypoxia, what is the significant of the influx of calcium?
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It inhibits cell enzymes and denatures proteins.
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What is the first ultrastructural sign of irreversible injury?
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High amplitude swelling with amorphous densities and calcium deposits in the mitochondrial matrix.
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ROS, a major final common pathway in cell injury, is initiated by what?
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Abs of ionizing radiation, endogenous oxidative reactions of normal metabolism (neutrophils, xanthine oxidase), and metobaolism of exogenous chemicals.
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What are ways that ROS are inactivated?
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1. Spontaneous decay (they are unstable)
2. Antioxidants (E, C, retinoids, transferrin, etc) 3. Enzymes 4. NO* Nitric oxide scavenges NO. |
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Re-Perfusion Injury
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occurs following ischemia of intermediate duration, overproduction of ROS due to the influx of O2 at reperfusion...also uric acid is formed from abundant purines (product of ATP catabolism). Influx of neutrophils, they produce ROS.
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What is it called when cell death occurs in the context of an organism?
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Autolysis. Release of intracellular enzymes break down adjacent structures.
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Necrosis
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Localized areas of cell death in surround living tissue.
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Pyknosis
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Shrunken nuclei and condense chromatin - indicative of necrosis
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Karyolysis
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The nucleus dissovles evenly and diffusely. Indicative of necrosis.
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