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479 Cards in this Set

  • Front
  • Back
What causes skin differences?
Four basic layers and adnexal structures
What are the four basic layers of organization?
Epidermis, Papillary dermis, Reticular dermis, and subcutaneous tissue (hypodermis)
What are the major adnexal structural units?
Pilar (hair), eccrine, and apocrine units
What layer are the adnexal structures found in?
Dermis
What layer does edema and swelling occur in?
Papillary dermis
What is the life span of the epidermis?
21 days
What do keratinocytes accumulate?
Keratin and Melanin
Do keratinocytes get closer together or father apart the further up they go?
Farther apart
What property of skin allows up to keep from absorbing things?
Squamous property
Do melanocytes stay at the basal layer or do they move up?
Melanocytes stay at the basal layer
What do melanocytes make?
Melanosomes
What do melanosomes make?
Dopa
What does dopa secrete?
Melanin
Where is the melanin located?
Keratinocytes
What increases melanosome production?
Sun exposure
What does a melanocyte look like?
Nucleus with a halo arround it
What is a sign of excess keratin?
Dandruff
What are Rete pegs?
Invaginations of the epidermis into the dermis
Where is the vasuclar plexus located?
The papillary dermis
Where are Meissner's corpuscles located?
Papillary dermis
What do Meissner's corpuscles do?
Touch receptors
Where are Meissner's corpuscles most numerous?
Hands and feet
What is the papillary dermis?
A coat for the epidermis; supplies nutrients for rapidly growing keratinocytes
Is the papillary dermis fine and delicate or rigid?
Fine and delicate
What does the reticular dermis do?
Serves as a cushion and stable platform for the epidermis and papillary dermis; skin layer where the adnexal structures are located
Where are adnexal structures housed?
Reticular dermis
What are Pacinian corpuscles?
Pressure receptors
Where are Pacinian corpuscles found?
Deep in the dermis
What is subcutaneous tissue?
loose and dense connective tissue consisting of adipocytes and fibroconnective tissue
What does the subcutaneous tissue connect?
Connects the reticular dermis with fascia of underlying tissue
What is significant about the subcutaneous layer?
Major layer of skin where aging is most effective; there is progressive loss of sub-q tissue as aging progresses
Where are eccrine glands located?
Mid to lower reticular dermis
Where are apocrine glands located?
Deep dermis and often at junction of reticular dermis and sub-q tissue (axilla, scalp, perineum)
Macule?
flat area of color change; <1cm diameter; ex--freckle
Patch?
Larger, flat, non-palpable lesion; >1 cm; ex---cafe-au-lait spot
Papule?
Discrete, solid, raised lesion; <1 cm diameter; ex---nevus
Nodule?
Larger, discrete, rounded, raised solid lesion; ex---rheumatoid nodule
Plaque?
raised, flat-topped lesion; >1 cm diameter; ex---psoriasis
Wheal?
Transient edematous erythematous plaque; ex---hives or urticaria
Vesicle?
Fluid-filled lesion; <0.5 cm diameter; ex---herpes
Bulla?
larger fluid-filled lesion; ex---friction blister
Pustule?
Vesicle like lesion filled with purulent exudate; ex---folliculitis
Erosion?
Partial or complete loss of the epidermis; scratching
Ulcer?
loss of epidermis and part of dermis
Fissure?
Thin, linear erosion or ulceration; ex--cheilitis
Scale?
Hyperkeratosis; ex---dry skin
Crust?
Dried serous and serosanguinous exudate; ex--impetigo
Lichenification?
Accentuation of skin markings with thickening of the skin
Atrophy?
Decrease in amount of epidermis, dermis, or sub-q tissue
Verrucous?
Wart-like surface
What is Lentigo Senilis or Solar Lentigo?
Benign, discrete hyperpigmented macule occuring on chronically exposed skin in adults
Where is Lentigo Senilis usually seen?
On the back of the hands and the forehead
What causes Lentigo Senilis?
Increased melanin pigment in keratinocytes
Is there an increase in the number of melanocytes in Lentigo Senilis?
No
What does the term Lentigo by itself mean?
Proliferation of melanocytes
What is Lentigo Senilis usually referred to?
"Liver spots"
What is vitiligo?
A decrease in number or absence of mealnocytes
What is melasma?
Hypermelanosis characterized by development of blotchy, brown macules in a symmetrical distribution
Where is melasma usually seen on the body?
Cheeks, forehead, and less frequently on upper lip and neck
Who usually gets melasma?
Women--most commonly pregnant women; also ones taking BCP and menopause
What is the "Mask of Pregnancy?"
Melasma
What are feckles?
Increased production of melanin
What exaggerates freckles?
Sun exposure
What is Acanthosis Nigricans?
Hyperpigmentation in the flexural regions (axillae, skin folds of neck, groin, and anogenital regions)
Is Acanthosis Nigricans benign or malignant?
Both
Who is usually diagnosed with benign Acanthosis Nigricans?
Usually children or adolescents
What is the inheritance for benign Acanthosis Nigricans?
Autosomal Dominant
What is benign Acanthosis Nigricans usually associated with?
Obseity and endocrine abnormalities
Who is usually diagnosed with malignant Acanthosis Nigricans?
Middle aged and older individuals
What does Acanthosis Nigricans usually occur in assoication with?
Adenocarcinoma
What are Nevocelluar Nevi?
Benign neoplasms of the melanocytes
Where do nevocellular nevi usually occur?
Face
What are the 3 types of Nevocellular Nevi?
Junctional, Compound, and Intradermal
Where do we find junctional nevi?
At the dermal/epidermal junction
What are junctional nevi normally called?
"Beauty spot" or "mole"
Are junctional nevi macules or papules?
Macules
What is the compound nevus?
Raised and dome shaped--benign
Where is the compound nevus found?
In the dermis
What is special about an intradermal melanocytic nevus?
No longer have cell proliferation at the dermal/epidermal junction
What is specific about a tan/whitish color intradermal nevus?
Not as much blood supply
Do intradermal melanocytic nevus usually go away?
Yes
Are intradermal melanocytic nevus associated with malignancy?
No--80-90% of melanomas arise de novo--not assoicated with a nevus
What kind of nevus has an increase risk for melanoma?
Congenital nevus
What is malignant melanoma?
Malignant neoplasm derived from cells capable of forming melanin
Where does malignant melanoma usually occur?
Skin on any part of the body; can occur in the eye and rarely in mucous membranes of the genitalia, anus, and oral cavity
Who usually gets malignant melanoma?
Adults
Does melanoma originate de novo or with an assoicated lesion?
Usually de novo
What is melanoma in situ?
"Malignant Lentigo"; hasn't descended into the dermis...remains in the epidermis
Do melanomas frequently metastasize?
Yes
What is the most common site for melanoma in females?
Legs
What is the most common site for melanoma in males?
Trunk
What are the characteristics of malignant melanoma?
Asymmetrical, Irregular vague borders, variations in pigment, and maculopapular "chaos"
How is melanoma removed?
Excisional biopsy--DO NOT shave
What do macular areas of melanoma correspond with?
The radial growth phase
What do papular areas of melanoma correspond to?
Nodular aggregates of malignant cells in the vertical phase of growth
What is melanoma survival rate based on?
Dependent on stage--Metastatic to any lymph node is at least stage 3 while mestatic to any distant site is stage 4
What are the Breslow standards for malignant melanoma?
A Breslow level of 0.75-1.5 mm is associated with an 80% 5-year survival rate
What is Fibroepithelial Polyps (FEP)?
Skin tags, acrochrodon, fibroma molle, squamous papilloma
Where do FEP's usually occur?
Occur on neck and groin--usually in older adults
What are Epithelial Inclusion Cysts (EIC)?
Obsturction of a hair follice
Where do EIC's usually occur?
Face and upper trunk
What is Benign Fibrous Histiocytoma?
Benign soft tissue neoplasm seen in adults, frequently on the legs of young-middle aged women
What is another name for Benign Fibrous Histiocytoma?
Dermatofibroma
How does Benign Fibrous Histiocytoma usually present?
Small tan-brown papules; can be tender
What is the malignant superficial variant of benign histiocytoma termed?
Dermatofibrosarcoma Protuberans
Does malignant superficial variant bengin histiocytoma usually metastasize?
No but it is locally aggressive
What is the malignant neoplasm of benign histiocytoma termed?
Malignant Fibrous Histiocytoma
What is Seborrheic Keratosis?
Round, flat, elevated lesions
Where is Seborrheic Keratosis usually seen?
Trunk, proximal extremities, face, and neck
Who usually gets Seborrheic Keratosis?
Middle aged or older individuals
What are the characteristics of benign adnexal tumors?
Symmetrical, small, superficial, and vertical in orientation
What are the characteristics of malignant adnexal tumors?
Assymetrical, large, deep, and wide
What are the 3 types of malignant adnexal tumors?
Sebaceous carcinoma, eccrine carcinoma, and apocrine carcinoma
Where is the sebaceous carcimona the most common?
In the eye
What is Actinic Keratosis?
A precancerous skin condition present on sun exposed areas of the skin-usually appears white and flaky due to excess keratin
Who is most affected by Actinic Keratosis?
Individuals with extensive prlonged sun exposure
What are some conditions that place an individual at increased risk for actinic keratosis?
Fair skin, old scars, organ transplantation, and albinism, and genetic syndromes
Who is usually affected by Actinic Keratosis?
Middle aged and elderly
Where is Actinic Keratosis most likely to appear?
face, forehead, neck and back of hands
What does Actinic Keratosis look like?
Red-brown macules or minimally elevated papules with overlying scales
How is actinic keratosis best thought of?
As incompletely developed or nascent squamous cell carcinoma (SCC 1/2 grade)
What is the progression from Keratosis to Invasive squamous cell carcinoma?
Keratosis-Squamous cell carcinoma in situ-Invasive squamous cell carcinoma
What is squamous cell carcinoma?
A malignat proliferation of epidermal keratinocytes--has the potential for metastasis
Does squamous cell carcinoma frequently cause death?
No--very rarely
What is the second most common cutaneous malignancy?
Squamous cell carcinoma
What does squamous cell carcinoma usually look like?
Small firm skin colored or red nodules with indistinct margins
What does the surface of squamous cell carcinoma look like?
Can be granular and bleed easily or it can be smooth, verrucous, or papillomatous
What is Keratoacanthoma?
A rapidly growing neoplasm on sun exposed areas
What usually happens to Keratoacanthoma?
It usually involutes and goes away
What kind of growth do we see with Keratoacanthoma?
Endo and exo growth--"crater-like"
What is basal cell carcinoma?
A malignant skin neoplasm that has the potential for local invasion and destruction
Does basal cell carcinoma usually mestastasize?
No--very seldom
What is the most common cutaneous neoplasm?
Basal cell carcinoma
Where do most basal cell carcinomas occur?
Head and neck-usually in hair bearing areas
What are the types of basal cell carcinoma?
Nodular, sclerosing or morpheaform, pigmented basal cell carcinoma, and superficial basal cell carcinoma
What is the nodular type BCC?
Dome shaped papule with telangiectasia; surface may be crusted
What is the sclerosing or morpheaform type BCC?
Yellowish-whitish or pearly white plaque with poorly defined margins--difficult to dianose
What type of surgery is done for sclerosing or morpheaform BCC?
Mohs surgery
What is the pigmented basal cell carcinoma?
Dark irregular pigmentation--may be confused with melanoma
What is superficial BCC?
Occurs on NON-EXPOSED location; red, scaly plaque with elevated rolled edges
What is sclerosing BCC commonly referred to as?
"Rodent ulcer"
What is the characteristic cell involved in Langerhans Histiocytosis?
Immature dendritic cell (Langerhan cell) which has the presence of Birbeck granules
What is the name of the multifocal multisystem Langerhans Histiocytosis?
Letterer-Siwe Disease
Who usually gets Letterer-Swie Disease?
Children under 2
What is the name of the mulitfocal unisystem langerhans histiocytosis?
Hand-Schuler-Chrisitan Disease
What is the name of the unifocal and multifocal unisystem langerhans cell histiocytosis?
Eosinophilic granuloma
What are the two basic forms of Eosinophilic granuloma?
Bone lesion (unifocal) and pulmonary lesion (multifocal)
What is Mycosis Fungoides?
A T cell lymphoma specifically in the dermis
What are the types of Mycosis Fungiodes?
Mycosis fungoides and mycosis fungoides d' emblee
What is mycosis fungoides?
A chronic proliferative lymphoma occuring over years
What is mycosis fungoides d' emblee?
A nodular eruptive variant
What are Sczary cells?
A leukimic phase of mycosis fungoides with malignant T cells
What is Sczary syndrome?
A diffuse erythema and scaling of the entire body
What are the three phases of mycosis fungoides?
Chronic dermatitis, patch stage, and plaque stage
What is epidermaltrophism?
An infiltrate of atypical lymphocytes accumulating beneath the epidermal layer creating microabscesses
What is Mastocytosis?
Rare clonal neoplasm with variable clinical presentations
What the Urticaria Pigmentosa?
Multiple oval red-brown scaling papules
Who does Urticaria Pigmentosa mostly affect?
Children
What are the signs and symptoms of Mastocytosis?
Flushing reaction in response to certain food and alcohol, pruritis and nosebleeds
What are the signs and symptoms of Mastocytosis due to?
The release of histamine
Is Mycosis Fungoides more common in men or women?
Twice as common in men
What is Ichthyosis?
Genetic disorders resulting in hyperkeratosis--fish scale apperance
What is the autsomal dominant form of Icthyosis?
Ichthyosis vulgaris
What is the autosomal recessive form of Icthyosis?
Lamellar Ichthyosis
What is characteristic of Icthyosis?
Fish-like scales
What is urticaria associated with?
Allergic reaction
What does eczema look like?
Red, papulovesicular lesions; "boiling over" apperance; may ooze or crust
Who does eczema most commonly affect?
Children
What is Erythema Multiforme?
Hypersensitivity reaction to drugs, infections, malignancy, and collagen vascular diseases
What is the characteristic clinical appearance on erythema multiforme?
"Target" lesions
What is the severe, systemic febrile form of erythema multiforme?
Stevens-Johnson Syndrome
What is Psoriasis?
Pink plaque; well demarcated; many different clinical presentations
How is the epidermal layer affected in psoriasis?
Increased turn over; 8-9 days
What is Lichen Planus?
Inflammatory skin condition of mucous membranes and oral cavity
How does lichen planus present?
Multiple plaques that are symmetrical
Where do you see lichen planus?
Extremities, wrists, elbows, glans penis
What is Discoid Lupus Erythematosus?
Malar erythema across bridge of nose; "Butterfly rash"; coin like plaques
What organ is most affected by lupus?
Kidneys
What is atrophy?
Decreased in cell or organ size
What is hypertrophy?
Increase in cell or organ size
What is hyperplasia?
Increase in number of cells
What is metaplasia?
Replacing one cell type with another
What is an example of physiologic atrophy?
Decrease in size of embryological structures-thyroglossal duct, notochord; decrease in thymus during childhood
What is an example of pathologic atrophy?
Disuse, aging, lack of nutrition
What are some causes of cell injury?
Hypoxia, chemicals, infections, genetic conditions, nutritional causes
What are examples of reversible cell injury?
Hydropic
Fatty
Hyaline Degeneration (Mallory bodies)
Inclusions and deposits
What are some examples of irreversible cell injury?
Necrosis and apoptosis
What is coagulative necrosis?
Decrease in blood flow; membrane remains for a little bit
What is liquefactive necrosis?
Due to an infection; cell membrane is gone
What is caseous necrosis?
Usually due to fungal infections; looks like cheese
What is fibronoid?
Necrosis in small arterioles
What is normal apoptosis?
Due to embryogenesis, hormone dependent, tumor cell death
What is pathological apoptosis?
Following duct obstruction, effect of cyctotoxic T cells, some viral diseases
What are examples of dystrophic calcification?
Necrosis and normal serum calcium
What are examples of metatstatic calcification?
Normal tissue and hypercalcemia
What are the characteristics of acute inflammation?
Short duration, edema, and neutrophils
What are the cardinal signs of acute inflammation?
Rubor, tumor, calor, dolor, and functio leasa
What is chemotaxis?
Movement of cells; cells coming toward other cells
What endogenous factors are involved in chemotaxis?
Complement components, leukotrienes, and chemokines
What are the steps in phagocytosis?
Opsonization, engulfment, and degradation
What are the outcomes of acute inflammation?
Resolution, fibrosis, abscess, and chronic inflammation
What cells are involoved in chronic inflammation?
Mononuclear cells, lymphocytes, plasma cells, and eosinophils
What is characteristic of chronic inflammation?
Granuloma formation
What is dysplasia?
Disorderly but non neoplastic growth
What is neoplasia?
Cancerous growth
What is the difference between ischemia and hypoxia?
Ischemia is the decrease in O2 and nutrients where as hypoxia is the decrease in O2
How do you tell the difference between atrophy and hypoplasia?
If the blood vessels are of normal size but the organ is smaller, that is atrophy; if the blood vessels and organ are both small, that is hypoplasia
What are some ways atrophy is pathologic?
Disuse
Denervation
Decreased blood supply
Nutrition
Loss of endocrine stimulation
Aging
Pressure
Is atrophy an active or passive process?
Active process
What are examples of physiologic hyperplasia/hypertrophy?
Estrogen stimulation of endometrium, hormonal changes in pregnancy, removal of 1/2 liver, excercise
What are examples of pathological hyperplasia/hypertrophy?
Increased workload on the heart
Chronic renal failure
Removal of a kidney
What is squamous metaplasia?
Transformation of different epithelium into stratifed squamous epithelium
What are some causes of squamous metaplasia?
Cigarette smoke, bladder stones, and ducts lodged with caliculi, chronic acid reflux, trauma to muscle or bone
What is a precursor to esophageal cancer?
Barrett's esophagus
What is the mechanism of metaplasia?
Represents a "reprogramming" of stem cells
Is metaplasia a phenotypic change?
No
Is metaplasia a precursor to cancer?
No--but the place where metaplasia has taken place has an increased risk of developing neoplasm
What happens when cells are injured?
Depletion of ATP
Generation of reactive O2 species
Defects in membrane permeability
Increased intracellular calcium
Loss of calcium homeostasis
What are the targets for cell injury?
Aerobic respiration
Cell membranes
Protein synthesis
Nucleus
What are the classes of cell injury?
Reversible and irreversible
What is reversible cell injury?
Changes in ion concentration and influx of water
What is irreversible cell injury?
Cell death.....necrosis and apoptosis
What are examples of reversible cell injury?
Hydropic change
Fatty change
Hyaline degenration
Inclusions and deposits
What changes on the subcellular level of reversibly injured cells?
Endoplasmic reticulum
Mitochondria
Plasma membrane
Nucleus
Is fatty liver a reversible or irreversible process?
Reversible
What are reversible changes in hypoxia most likely due to?
Decrease in cell membrane transport systems
Decrase oxidative phosphorylation
Decreased prtoein synthetic functions
Altered cytoskeletal elements
What are signs seen in hypoxia?
Cell swelling, blebs
What is karyolysis?
Fades away
What is Pyknosis?
Hard and dark nucleus; chromatin is really tight and clumped
What is Karyorrhexis?
Random breakup of nucleus
When are morphological changes usually seen in cells?
6-12 hours after cell death has occurred
What is a repurfusion injury?
When restoring blood flow to the ischemic/hypoxic tissue had bad effects
What can happen in a reperfusion injury?
Production of oxygen free radicals
Complement system becomes activated which further activates inflammation
Cytokines are generated causing vasoconstriction
What are free radicals?
Reactive molecular species that contain a single unpaired electron
How are free radicals formed?
Iron and copper catalyzed Haber-Weiss reaction
What causes free radical formation?
Radiation
Drugs
Oxidation-Reduction Reactions
Iron and Copper contribute electrons
Nitrous Oxide
What is the worst free radical and causes the most damage?
Hydroxyl radical
How do free radicals cause damage to cells?
They combine with other molecules disrupting structure and function
What things do free radicals injure that are important to cells?
Membranes, Proteins, and DNA
What is an example of chemical injury?
Carbon tetrachloride
What problems can carbon tetrachloride cause?
Damage to the ER
Lipid accumulation in hepatocytes
Plasma membrane damage--allows for influx of calcium
What is the main target of carbon tetrachloride?
Liver
How is free radical damage prevented?
Antioxidants (Vit A & E)
Sequestration of molecules that cause free radical formation (iron and copper)
Detoxifying enzymes (SOD, catalase, GPX)
What enzymes would in indicative of a myocardial infarct?
Creatinine Kinase and Troponin
What enzymes would be indicative of liver damage?
AST and ALT
What enzymes would be indicative of pancreatic damage?
Lipase and amylase
What are morphologic changes in cell injury?
Cell swelling
Accumulated products in cytoplasm
Loss of specialized structure
Surface blebs
What nuclear changes are seen in cell injury/necrosis?
Karyolysis, karyorrhexis, pyknosis
What type of necrosis retains a little bit of the cell membrane?
Coagulative necrosis
What is an example of coagulative necrosis?
Myocardial infarct
Gangrene
What type of necrosis destroys the entire cell membrane?
Liquefactive necrosis
What is an example of liquefactive necrosis?
Abscess
Does liquefactive necrosis require bacteria to be present?
Yes--except for brain lesions
What is an example of enzymatic fat necrosis?
Acute pancreatitis
What is an example of caseous necrosis?
Tuberculosis
Where is a pale or white infarct seen?
Heart
Where is a red or hemorrhagic infarct seen?
Lungs
What is gangrene?
Gradual ischemia of distal extremities, especially the foot and leg
Can gangrene be considered a type of liquefactive necrosis?
Yes--usually starts as coagulative necrosis and then progresses, once it becomes infected, to liquefactive
What are the two types of gangrene?
Wet and dry
What is dry gangrene?
Black-brown, mummified appearance
What is wet gangrene?
Bacterial superinfection of necrotic material
What is saponification?
Fatty acids combined with calcium
Where is saponification seen?
Fat necrosis--pancreatitis
What is responsible for caseous necrosis?
Usually due to myocbacterial and fungal infections
What is the typical appearance of caseous necrosis?
"Cheesy"
What is fibrinoid necrosis?
Special type of necrosis occurring in the arterial walls
What usually causes fibrinoid necrosis?
Extreme hypertension or immune complex deposition in artery walls
What does fibrinoid necrosis usually look like?
Bright pink color
Is apoptosis physiological or pathological?
Both
Is necrosis physiological or pathological?
Always pathological
What are three reasons we need apoptosis?
Proper in utero development, involution of hormonally active tissues (menstrual cycle and lactation), destruction of cells that represent threat
What are caspases?
Cysteine proteases--enaymes responsible for alerations characteristic of apoptosis
What are the three types of caspases?
Interleukins
Initiators
Executioners
What are the initiator caspases?
Initiate signal for death but don't actually kill (caspase 2, 8, 9)
What are the executioner caspases?
The ones that cause apoptosis (3, 6, 7)
What are the two initiation pathways of apoptosis?
Extrinsic and Intrinsic
What is the extrinsic pathway of apoptosis?
Death receptor initiated pathway; members of the tumor necrosis factor receptor family
What is the intrinsic pathway of apoptosis?
The mitochondrial pathway; replacement of anti-apototic proteins in mitochondria
What is another way to initiate apoptosis besides the intrinsic and extrinsic pathways?
Receipt of negative signals--free radicals, uv damage, etc.
Does apoptosis involve inflammation?
No
Does necrosis involve inflammation?
Yes
Apoptosis or Necrosis--Hypoxia, toxins, cell swelling, coagulation, disruption, random, diffuse, atp depletion, membrane injury, free radical damage, inflammation
Necrosis
Apoptosis or Necrosis--Physiologic or pathologic, single cells, chromatin condensation, internucleosomal, gene activation, endonuclease, no inflammation
Apoptosis
What is heterophagy?
Uptake by endocytosis--phagocytosis vs. pinocytosis; extracellular
What is autophagy?
Removal of damaged organelles during cell injury, remodeling, or atrophy; intracellular
What are heterophagy and autophagy?
Lysosomal catabollism
What is the cell's response to injury in apoptosis?
Lysosomal catabolism
Hypertrophy of SER
Mitochondrial alterations
Cytoskeletal abnormalities
What does intracellular accumulations signal to the cell?
Damage or adaptation to stress
What things accumulate in the cell during injury?
Lipids
Proteins
Metals
Exogenous and Endogenous Pigment
How does fat accumulation usually begin?
As small droplets of lipid (microvesicular) and then progresses into a single large droplet (macrovesicular)
What are two diseases characterized by microvesicular fat only?
Reyes syndrome and acute fatty liver in pregnancy
What is another lipid besides fat that can accumulate intracellularly?
Cholesterol
What does alpha-1-antitrypsin do?
Inhibits elastase
What is A1AT disease?
Production of abnormally folded A1AT in heptaocytes; protein collects in cytoplasm and results in liver and lung damage
What metals can accumulate in the cell?
Iron and Copper
What are conditions in which iron accumulates?
Aplastic anemia
Sickle cell anemia
Thalassemias
Bone Marrow Transplant
What is hemochromatosis?
AR disorder of iron absorption; increased uptake in GI tract; deposition in various organs resulting in toxicity
What is Wilson's disease?
AR disease of copper toxicity
What types of exogenous pigments accumulate in cells?
Carbon particles or soot
Tattoos
What types of endogenous pigments accumulate in cells?
Iron, billirubin, lipofuscin
What is dystrophic calcification?
Deposition of calcium in necrotic or traumatized tissue with normal calcium levels
What are examples of dystrophic calcification?
Fat, caseous, and coagulation necrosis
Athersclerosis
What is metastatic calcification?
Occurs in normal tissue with high calcium levels
What are examples of metastatic calcification?
Hypersecretion of PTH
Destruction of bone tissue
Vit D poisoning
Milk-alkali syndrome
Is dystrophic calcification localized or systemic?
Localized
Can metastatic calcification affect any tissue/organ or is it localized?
It can affect any organ
What are the most common site for metastatic calcification?
GI, kidneys, and lungs
What is hyaline?
An adjective describing a glassy pink appearnace
Is hyaline intracellular or extracellular?
Can be both
What is hyalin?
A noun; refers to a substance that has a hyaline appearance
Is hyalin intracellular or extracellular?
Intracellular
What is the definition of acute inflammation?
The rapid delivery of defensive devices to the site of injury
What are the components of the acute inflammatory response?
Increased blood flow
Changes in the microvasculature
Loss of plasma proteins and blood cells
What is the Lewis Triple Response?
Transient vasoconstriction
Arteriole dilation
Fluid loss
What vessels are involved in actue inflammation?
Capillaries
Venules
Lymphatics
Are neutrophils long or short lived?
Short lived--they only live a few hours
Are macrophages long or short lived?
Long lived--they live a few days
What are the hallmarks of acute inflammation?
Arteriole dilation
Increased permeability
Fluid into vascular space
What are the likely mechanisms for increased vascular permeability?
Histamine
Bradykinin
Formation of endothelial gaps
When does immediate sustained reaction occur in response to injury?
Burns, lytic bacterial infection--leakage starts with injury and last for several hours to days
What vessels are affected by immediate sustained reaction?
Venules, capillaries, and arterioles
When does the delayed prolonged reaction occur in response to a direct injury?
Mild to moderate thermal injury, X-rays, UV light (sunburn)--2-12 hours after injury lasting for hours to days
What vessels are affected by the delayed prolonged reaction?
Capillaries and venules
What do E-selectins do?
Rolling and adhesion to activated endothelium
What do E-selectins bind with?
Sialylated CHO groups on Lewis type antigens on leukocytes
What are E-selectins induced by?
TNF and IL-1
What do P-selectins do?
Involved in rolling
Where are P-selectins found?
Endothelial cells and platelets
What do P-selectins bind to?
Sialylated CHO group on Lewis-type antigens on leukocytes
What is responsible for redistributing P-selectins to the cell surface?
Histamine, thrombin, platelet activating factor
What are L-selectins found?
Lymphoctes, neutrophils and other leukocytes
What does L-selectins bind with?
CD34 on endothelium
Where are ICAM-1 and VCAM-1 found?
Endothelial cells
What do ICAM and VCAM bind to?
Integrins on leukocytes
What induces ICAMS and VCAMS?
TNF and IL-1
Where are LFA-1 and MAC-1 found?
Many cell types
What do LFA-1 and MAC-1 bind to?
ICAM-1 on endothelial cells
Where is VLA-4 found?
Many cell types
What does VLA-4 bind to?
VACM-1 on endothelial cells
What are the steps in leukocyte delivery to the site of injury?
Margination, rolling, and adhesion
Transmigration across the endothelium
Migration in interstitial tissues
What is chemotaxis?
Unidirectional migration of leukocytes in response to a diffusion gradient of a chemical attractant
What is chemokinesis?
Increased frequency or velocity of locomotion of leukocytes
In what direction do cells move?
Stretch out forward and pull back end up
In a tissue sample that is taken 1 week after cell injury, what cell types will be present?
Macrophages--no neutrophils!
What type of receptors are involved in leukocyte activation?
Toll like receptors, Seven-a-helical, and mannose receptors
What are the steps in phagocytosis?
Opsonization
Engulfment
Killing and degradation
What chemical mediators are preformed in secretory granules?
Histamine, serotonin, and lysosomal enzymes
Where is histamine found?
Mast cells, basophils, platelets
Where is serotonin found?
Platelets
Where are lysosomal enzymes found?
Neutrophils and macrophages
What are the newly synthesized chemical mediators?
Prostaglandins, leukotrienes, platelet activating factors, activated oxygen species, nitric oxide, and cytokines
Where are the newly synthesized chemical mediators usually found?
Mostly leukocytes
What chemical mediators are released from plasma?
Factor XII (Hageman factor) and complement
What does Factor XII stimulate?
Kinin system/Coagulation
What are C3a and C5a? What do they do?
Anaphylatoxins--cause histamine release and increase vascular permeability and vasodilation
What forms the membrane attack complex?
C5-C9
What does the membrane attack complex do?
Causes lysis of bacteria and cells
Which complement pathway involves C1, C2, C4?
Classical pathway
Which complement pathway involves C3?
Alternative pathway
Wha is the Hageman factor?
Factor XII
What activates the Hageman factor?
Collagen, basement membrane, platelets, and HMWK
What does Factor XIIa activate?
Kinin cascade
What does the activation of the kinin cascade cause?
Conversion of Prekallikrein to Kallikrein
What does bradykinin do?
Increase vascular permeability
Smooth muscle contraction
Arteriole dilation
What does Kallikrein activate?
Plaminogen which converts to plasmin
What does plasmin activate?
C3 which converts to C3a
What activates Fibrin?
Plasmin
What does fibrin form that causes increased vascular permeability?
Fibrin split products
What does cyclooxygenase produce?
Prostaglandins
What does lipooxygenase produce?
Leukotrienes
What do prostaglandins produce?
Prostacyclin and Thromboxane
What does prostacyclin do?
Inhibits platelet aggregation and causes vasodilation
What does thromboxane do?
Causes vasoconstriction; produces platelet aggregation
What do leukotrienes do?
Vasoconstriction, bronchospasm, and increased permeability
What is the difference between specific granules and azurophil granules?
Azurophil granules cause a lot more damage and are larger
What does platelet activating factor do?
Produces cardinal signs of inflammation
What are the important cytokines in inflammation?
TNF and IL-1
What are important chemokines?
Platelet 4 and Eotaxin
What does nitric oxide do?
Relaxes smooth muscle and decreases platelet aggregation
What are the three types of Nitric Oxide?
Endothelial, Neuronal, and Inducible NOS
Where does inducible NO play a role?
In monocytes and macrophages by TNF and IL-1
What is the central player in starting the coagulation, fibrinolytic, complement, and kinin cascade?
Hageman Factor
What is a chemotactic agent for neutrophils?
LTB4
What are the major cell players in inflammation?
PMNs, eosinophils, lymphocytes, macrophages, basophils, mast cells and platelets
What is an abcess?
Localized collection of pus
What is cellulitis?
Diffuse edematous spreading inflammation within solid tissues
What is an ulcer?
Defects in the surface of an organ or tissue
What are the hallmark cells of inflammation?
Neutrophils
What do neutrophils function to do?
Phagocytize bacteria and debris
What kind of granules do neutrophils contacin?
Specific and azurophil granules
What are the specific chemotrractants for eosinophils?
Eotaxins 1 and 2
What do eosinophilic granules contain?
Major basic protein
Are basophils circulating or resident?
Circulating
Are mast cells resident or circulating?
Resident
What is contained in the alpha granules in platelets?
Fibrinogen, platelet factor 4, and platelet derived growth factor
What is contained in the delta granules in platelets?
ATP, Histamine, and Serotonin
What is Chediak-Higashi syndrome?
Defects in locomotion and lysosomal degranulation
What is pemphigus?
Autoimmune disease with antibodies directed against the desmosomes of the squamous epithelium
What is the most common form of pemphigus?
Pemphigus vulgaris
What type of hypersenstivity reaction is pemphigus vulgaris?
Type 2
What layers of skin does pemphigus vulgaris affect?
Just the epidermis
Do the blisters form above or below the basal layer?
Above the basal layer--suprabasal bullae
What type of antibodies does pemphigus vulgaris have?
Antibodies against 3-desmoglein--IgG to desmosomes
What might you see on a histo slide signaling pemphigus vulgaris?
Net-like deposit
Are the bullae of pemphigus vulgaris likely to rupture?
Yes
Who is normally affected by bullous pemphigoid?
Older people
Are the bulla in bullous pemphigoid smaller or larger than pemphigus vulgaris?
Smaller fluid filled blisters
Where does bullous pemphigoid typically occur?
At the dermal/epidermal junction
What type of hypersensitivity is bullous pemphigoid?
Type 2
Are the bullae of bullous pemphigoid likely to rupture?
No
What does bullous pemphigoid typically affect?
The hemidesmosomes
Is bullous pemphigoid acantholytic or nonacantholytic?
Nonacantholytic--sub epidermal
What is pemphigus?
Autoimmune disease with antibodies directed against the desmosomes of the squamous epithelium
What is the most common form of pemphigus?
Pemphigus vulgaris
What type of hypersenstivity reaction is pemphigus vulgaris?
Type 2
What layers of skin does pemphigus vulgaris affect?
Just the epidermis
Do the blisters form above or below the basal layer?
Above the basal layer--suprabasal bullae
What type of antibodies does pemphigus vulgaris have?
Antibodies against 3-desmoglein--IgG to desmosomes
What might you see on a histo slide signaling pemphigus vulgaris?
Net-like deposit
Are the bullae of pemphigus vulgaris likely to rupture?
Yes
Who is normally affected by bullous pemphigoid?
Older people
Are the bulla in bullous pemphigoid smaller or larger than pemphigus vulgaris?
Smaller fluid filled blisters
Where does bullous pemphigoid typically occur?
At the dermal/epidermal junction
What type of hypersensitivity is bullous pemphigoid?
Type 2
Are the bullae of bullous pemphigoid likely to rupture?
No
What does bullous pemphigoid typically affect?
The hemidesmosomes
Is bullous pemphigoid acantholytic or nonacantholytic?
Nonacantholytic--sub epidermal
What is pemphigus?
Autoimmune disease with antibodies directed against the desmosomes of the squamous epithelium
What is the most common form of pemphigus?
Pemphigus vulgaris
What type of hypersenstivity reaction is pemphigus vulgaris?
Type 2
What layers of skin does pemphigus vulgaris affect?
Just the epidermis
Do the blisters form above or below the basal layer?
Above the basal layer--suprabasal bullae
What type of antibodies does pemphigus vulgaris have?
Antibodies against 3-desmoglein--IgG to desmosomes
What might you see on a histo slide signaling pemphigus vulgaris?
Net-like deposit
Are the bullae of pemphigus vulgaris likely to rupture?
Yes
Who is normally affected by bullous pemphigoid?
Older people
Are the bulla in bullous pemphigoid smaller or larger than pemphigus vulgaris?
Smaller fluid filled blisters
Where does bullous pemphigoid typically occur?
At the dermal/epidermal junction
What type of hypersensitivity is bullous pemphigoid?
Type 2
Are the bullae of bullous pemphigoid likely to rupture?
No
What does bullous pemphigoid typically affect?
The hemidesmosomes
Is bullous pemphigoid acantholytic or nonacantholytic?
Nonacantholytic--sub epidermal
What is pemphigus?
Autoimmune disease with antibodies directed against the desmosomes of the squamous epithelium
What is the most common form of pemphigus?
Pemphigus vulgaris
What type of hypersenstivity reaction is pemphigus vulgaris?
Type 2
What layers of skin does pemphigus vulgaris affect?
Just the epidermis
Do the blisters form above or below the basal layer?
Above the basal layer--suprabasal bullae
What type of antibodies does pemphigus vulgaris have?
Antibodies against 3-desmoglein--IgG to desmosomes
What might you see on a histo slide signaling pemphigus vulgaris?
Net-like deposit
Are the bullae of pemphigus vulgaris likely to rupture?
Yes
Who is normally affected by bullous pemphigoid?
Older people
Are the bulla in bullous pemphigoid smaller or larger than pemphigus vulgaris?
Smaller fluid filled blisters
Where does bullous pemphigoid typically occur?
At the dermal/epidermal junction
What type of hypersensitivity is bullous pemphigoid?
Type 2
Are the bullae of bullous pemphigoid likely to rupture?
No
What does bullous pemphigoid typically affect?
The hemidesmosomes
Is bullous pemphigoid acantholytic or nonacantholytic?
Nonacantholytic--sub epidermal
What is pemphigus?
Autoimmune disease with antibodies directed against the desmosomes of the squamous epithelium
What is the most common form of pemphigus?
Pemphigus vulgaris
What type of hypersenstivity reaction is pemphigus vulgaris?
Type 2
What layers of skin does pemphigus vulgaris affect?
Just the epidermis
Do the blisters form above or below the basal layer?
Above the basal layer--suprabasal bullae
What type of antibodies does pemphigus vulgaris have?
Antibodies against 3-desmoglein--IgG to desmosomes
What might you see on a histo slide signaling pemphigus vulgaris?
Net-like deposit
Are the bullae of pemphigus vulgaris likely to rupture?
Yes
Who is normally affected by bullous pemphigoid?
Older people
Are the bulla in bullous pemphigoid smaller or larger than pemphigus vulgaris?
Smaller fluid filled blisters
Where does bullous pemphigoid typically occur?
At the dermal/epidermal junction
What type of hypersensitivity is bullous pemphigoid?
Type 2
Are the bullae of bullous pemphigoid likely to rupture?
No
What does bullous pemphigoid typically affect?
The hemidesmosomes
Is bullous pemphigoid acantholytic or nonacantholytic?
Nonacantholytic--sub epidermal
What does dermatitis herpatiformis have a major association with?
Celiac disease
What antibodies in celiac disease can cross react with regions of the dermal papillae?
Anit-gliadin antibodies
Where does dermatitis herpatiformis typically occur?
At the dermal/epidermal junction
What type of hypersensitivity reaction is dermatitis herpatiformis?
3
Where do the blisters of dermatitis herpatiformis typically sit?
In the dermal papillae
Where do you typically see dermatitis herpatiformis on the skin?
In the extensor areas