Lab Review

Kidney
Cytomegalic Inclusion Disease (CID) (59)
- Cuased by herpes V virus; find Granular Hyaline + Waxy casts in urine
-
Diabetic Glomerulosclerosis (61)
- Nodular glomerulosclerosis (KW disease) is most freq renal complication in DM
- Organ changes is DM- hypertension, atherosclerosis, glomerulosclerosis, cataracts
+ glaucoma (eyes), mononeuropathy (CNS)
- Other kidney lesions if DM- intra-renal atherosclerosis, necrotizing papillitis,
glomerulosclerosis (diffuse + nodular)
Metastatic Calcification (62)
- Kidney (renal tubules b/c pH graient), Lung, Stomach commonly effected

Heart
General
- Edema- too much interstitial fluid
o Caused by hydrostatic P (heart failure), oncotic P, Lymphatic
Obstruction, Na + H2O retention
- Hydrothorax- excess fluid in pleural cavity
- Hydroperitoneum- ascites
- Hydropericardium- excess fluid in pericardial cavity
- Transudate- fluid forced from a vessel
- Hyperemia- blood flow to an organ (active process)
- Congestion- blood flow to an organ (passive process)—results in blood volume
- LFT heart failure- CPC (lungs), Hypoperfusion (kidney), Hypoxia (brain),
changes in heart failure cells
- RT heart failure- CPC (liver, spleen, kidney), Hypoxia (brain), Nutmeg liver
- Arteriosclerosis- Atherosclerosis, Monckeberg’s Medical Calcific Sclerosis,
Arteriolosclerosis (2 lesions—hyaline + hyperplastic)
Atherosclerosis (aorta) (55)
- Masses of cholesterol laden cells, sm. m. hyperplasia, inflammatory cells
- Lg aa.- tunica intima, media (thick), adventia (defined)
- Lg vv.- layers not well defined, less media, valves present
- Syphilitic Atherosclerosis- in thoracic aorta w/ tree barking
- Risk Factors- LDL, Smoking, Hypertension, DM
- Complications- ischemic atrophy, thrombosis, embolism, aneurysm,
- Most effected area (plaques)- abdom aorta, coronary, propliteal, internal carotid
o Complicated due to Calcification, Ulceration, Thrombosis, Hemorrhage
Medial Calcification (artery) (57)
- Monckeberg’s Sclerosis- dystrophic calcification of media, cause unknown + does
not produce narrowing of lumen
Myocardial Scar (78)
- Infarcts heal to form scar in 7-8 wk—(rupture of heart may occur at 7-10 d)
- Complications- arrythmia, rupture, thrombosis, emboli, aneurysm, mural
Recent Myocardial Infarct (79)
- Angina Pectoris- pain in the chest radiating from precordium to left shoulder +
down arm (due to ischemia of heart m.)
- Dx acute myocardial infarction: (1) sxs- pain in left shoulder, sweating, nausea
vomiting, (2) ECG Changes- new Q wave + T wave changes, (3) Serum
Enzymes- cardiac troponins, creatine kinase, LDH
- Rupture of myocardium can cause death w/in 1-2 wks
- Biochemical Markers- Troponins (cTnI, cTnT) replace Creatine Kinase (CK-MB)

Spleen
Chronic Passive Congestion (73)
- Found in those w/ Liver cirrhosis, Rt heart failure, Portal hypertension
- Formaldehyde Pigment- artifact of fixation—diffuse + extracellular
o Hemosiderin is intracellular—pos Prussian blue stain = Fe present
Infarction (Anemic) (81)
- White, Arterial Occlusion, Solid Tissue
- Infarct Healing- slight splenomegaly, fibrotic lesionsdepressed scars

Lung
Edema + Sickling Phenomenon of RBC (71)
- Manifests in LEFT ventricular heart failure
- Brown Induration of Lung- hemosiderin m-pahges, fibrosis, thick alveolar walls
- Sickling Trait- heterozygous + gives slight tendency to sickle (anemia is homo)
Chronic Passive Congestion (72)
- Most commonly seen w/ Mitral/Aortic valve defect
- Can lead to edema, hemosiderin formed in heart failure cells (alveolar m-phage)
- Cor Pulmonale- leads to RT hear failure- result of extreme fibrosis of alveolar
septa
Thromboembolism (77)
- Embolus- detached intravascular solid, liq, gas mass carried via blood stream
o FAAST- Fat, Air, Amniotic Fluid, Saddle, Thrombembolus, Paradoxical
 Thromboembolism- usually from deep leg vv.—also affects heart,
spleen, kidney, brain
 Fat Emboli- effects brain + kidney
- Embolism- obstruction of a vessel by an embolus
- Thrombus- clotted mass that occurs in cardiovascular system of live person
Infarction (hemorrhagic) (82)
- Red, Venous Occlusion, Loose Tissue, Double Blood Supply (i.e. lung, liver,
ulnar aa.)
- Sxs: instant death, chest pain, shock, temp, serum LDH
- Infarction- ischemic necrosis (hemorrhage), congested pleura, coagulat necrosis
- Bronchopneumonia- alveoli filled w/ exudates, inflammatory cells, atelectais
Fat Embolism (83)—Osmic Acid Stain
- Other stains- Sudan 4, Oil red-o
- Sx: sudden respiratory insufficiency, irritability, restlessness, delerium, coma
Liver
Hemochromatosis (64/65)
- Etiology- defective HFE gene in primary hemochromatosis, alcoholics + cirrhosis
of liver in secondary hemochromatosis
- Sxs- skin bronzing, liver cirrhosis, artharalgias (joint pain), endocrine hypofnction
- Hepatocellular carcinoma is seen in 20% of pxs w/ primary hemochromatosis
Jaundice (66)
- Secondary Effects- itching, alkaline phosphatase, malabsorption of fat,
hyperlipidemia, cholesterol, yellowing of skin
- Bilirubin- synthesis in RES, liver, spleen, bone marrow
o Conjugated Bilirubin- Direct VDB rxn, Soluble, Loose, In Urine
 Alcohol induced, Dubin-Johnson + Rotor Syndrome
 Extrahepatic: Obstructive (gallstones, pancreas carcinoma),
Congenital atresia
o Unconjug Bilirubin- Indirect VDB rxn, Insoluble, Toxic, Tight, Hemolytic
 Gilbert’s Syndrome (mild) + Crigler-Najjar (severe)
 Kernicterus- neurologic damage due to unconjugated bilirubin
accumulation in brain
- Hepatocellular Jaundice- caused by poison, alcohol, virus, drugs
- Obstrcructure Jaundice- Carcinoma tumor, Parasites, CF, Gallstones, Stenosis
Chronic Passive Congestion (CPC) (74)
- Causes enlarged liver
- Cardiac Cirrhosis- extensive fibrotic rxn w/in liver as a result of congestive heart
failure
- End result- central lobule becomes red/blue surrounded by yellow/brown zone of
uncongested liver substance—nutmeg liver

Skin
Calcinosis Cutis (63)
- Metastatic Calcification- Ca deposited in undamaged tissue, Ca levels in blood
o Hyperparathyroidism, Vit D Intoxication, Multiple Myeloma, Sarcoidosis
- Dystrophic Calcification- Ca deposited in necrotic or degenerated (damaged)
tissues, blood Ca levels are Nx
o Atherosclerotic Plaques, Damaged heart valves, Sinuses of valsalva
Tattoo (68)
- Most common cause of tattooing in oral mucosa is Amalgam tattoo
- Exogenous Pigment- Heavy Metals, Minocycline Drugs, Amalgam + Body Tattoo
- Endogenous Pigment- Melanin, Bilirubin, Lipofuscin, Hemosiderin

Prostate
Thrombosis (75)
- Morphology- Venous, Arterial, Mural, Lines of Zahn, Occlusive, Propagating
- Antemorem- friable, firmly attached, lines of Zahn
- Postmortem- rubbery, not attached, chicken fat, current jelly
- Thrombogenesis- Injury to endothelium, Blood Flow change, Hypercoagulability
- Fates- Propagation, Embolization, Dissolution, Organization (+ recanalization)
- Common Sites of Venous Thrombosis- vv. of lower extremities (dp calf, femoral)