PATHO1P

PRACTICALS REVIEWER
GROSS

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LUNGS
 ANTHRACOSIS
● Most innocuous coal-induced pulmonary lesion in coal
miners
● Carbon pigment is engulfed by alveolar or interstitial
macrophages, accumulate in the connective tissue along the
lymphatics, or in organized lymphoid tissue along bronchi
● Heavily involved regions include:
○ Upper Lobes
○ Upper Zones of the Lower Lobes
● Site of initial dust accumulation:
○ Respiratory bronchioles
● Benign; can also be found in normal lungs
● Sequelae
○ Progressive Massive Fibrosis
■ Increasing pulmonary dysfunction
■ Pulmonary hypertension
■ Cor pulmonale
● Does not increase susceptibility to
○ Tuberculosis
○ Lung Ca
PULMONARY INFARCT
● Usually due to pulmonary emboli
○ Occurs in patients with predisposing condition that
produces and increase tendency to clot
● Classically hemorrhagic
● Appears as raised, red-blue area in early stages
● Red cells begin to lyse within 48 hours, lesion becomes
red-brown as hemosiderin is produced
● Gray white peripheral zone
○ Due to fibrinous replacement
○ Begins at the margins
 BRONCHIECTASIS
● Destruction of smooth muscle and elastic tissue by chronic necrotizing
infections leading to permanent dilation of bronchi and bronchioles
● Dilated bronchi appear cystic, filled with mucopurulent secretions
● Major conditions associated:
○ Obstruction
○ Infection
● Seen in the following diseases:
○ Cystic Fibrosis
○ Primary Ciliary Dyskinesia
○ Kartagener Syndrome
○ Allergic Bronchopulmonary Aspergillosis
● Affected areas of the lung:
○ Lower lobes bilaterally
○ Vertical air passages
○ Distal bronchi and bronchioles (most severe)
● Clinical manifestations:
○ Severe persistent cough
○ Foul smelling, sometimes bloody, sputum
○ dyspnea/orthopnea
○ Hemoptysis
 PULMONARY
ADENOCARCINOMA
● Most common form of lung cancer
○ Particularly in women and non smokers
● Risk factor: cigarette smoke
● Age of Incidence
○ Occurs usually 40-70 y/o
○ Peaks at 50-60 y/o
● Oncogenic gain-of-function mutations in genes encoding
receptor tyrosine kinases
○ EGFR, ALK, ROS, MET, RET
● More peripherally located
● Subtypes:
○ Microinvasive Adenocarcinoma
■ Better prognosis
○ Mucinous Adenocarcinoma
■ Likely to form satellite tumors
■ May be solitary, multiple, or involve entire lobe
■ Less likely to be cured by surgery
● Prognosis:
○ Slightly better; Remains localized longer, possibly
resected
LIVER & GALLBLADDER
 FATTY CHANGE
● Risk factors
○ Alcohol Intake
■ 80gm (six beers)
○ Gender
■ Women are more susceptible
■ Men are the majority of patients
○ African American
● Pathogenesis
○ Shunting of normal substrates away from catabolism and
toward lipid biosynthesis
○ Impaired assembly and secretion of lipoproteins
○ Increased peripheral catabolism of fat
● Fatty liver in individuals with chronic alcoholism is a large (4 - 6
kg) soft organ that is yellow and greasy
● Completely reversible if there is abstention from further intake of
alcohol
 CHRONIC HEPATIC
CONGESTION
● Nutmeg Liver
○ Centrilobular accumulation of RBC
○ Results from the congestion around central veins, usually
from right sided heart failure
○ Red-brown, slightly depressed
○ With possible centrilobular necrosis (zone 3)
● Chronic Congestion
○ Chronic hypoxia results in ischemic tissue injury and
scaring
○ Capillary congestion may cause focal hemorrhage
○ Tissues are brown, contracted, fibrotic
● Right Sided Heart Failure
 CHRONIC
CHOLECYSTITIS
● Caused by impaired bile formation and bile flow that gives rise to
accumulation of bile pigment in the hepatic parenchyma
● Causes
○ Extrahepatic/Intrahepatic bile channel obstruction
○ Defects in hepatocyte bile secretion
● Clinical manifestations
○ jaundice
○ Pruritus
○ Skin xanthomas
○ Intestinal malabsorption
 LIVER CIRRHOSIS
● Not a specific diagnosis, lacks clear prognostic implications
● Occurs diffusely; depressed areas of dense scar separating
bulging regenerative nodules over the liver surface
● Not all cirrhosis leads to chronic liver failure and not all
end-stage chronic liver disease is cirrhotic
● Child-Pugh Classification of Cirrhosis
○ Class A
■ Well compensated
○ Class B
■ Partially Decompensated
○ Class C
■ Decompensated
 GALLBLADDER
STONES
● Cholesterol Stones
○ Crystalline cholesterol monohydrate
○ Arise exclusively in the gallbladder
○ Pale yellow, round to ovoid with fine granular hard external
surface which on transection reveals a glistening radiating
crystalline palisade
○ Radiopaque if composed largely of cholesterol

● Pigment Stones
○ Bilirubin & Calcium salts
○ Black Stones
■ Found in sterile gallbladder bile
■ Radiopaque
○ Brown Stones
■ Found in infected large bile ducts
■ Radiolucent
GIT
 GASTRIC ULCER
GASTRIC PEPTIC ULCER
● Chronic mucosal ulceration affecting the duodenum and
stomach due to imbalances in mucosal damage and
defenses
● Most common form occurs in the gastric antrum or
duodenum associated with H.pylori Infection
● Epidemiology
○ Associated with
■ H.Pylori
■ NSAIDs
■ Cigarette Smoking
● Morphology
○ Most ulcers are solitary
○ There is a sharply punched out defect with
overhanging mucosal borders, and smooth clear
ulcer bases
● Clinical Manifestations
○ Epigastric gnawing, burning, or aching pain worse
at night and 1-3 hrs after meals
 INTESTINAL INFARCT
● Women, > 70 y/o
● Ischemic necrosis of the intestine due to compromised blood flow
○ Commonly mesenteric vessels
● Red Infarct
○ Dual blood circulation
○ Usually with coagulative necrosis
● Segmental occlusions results in well demarcated sections of visible
ischemia
● Mucosal Infarction
○ Ne deeper than the muscularis mucosae
○ Due to acute or chronic hypoperfusion
● Mural Infarction
○ Involves mucosa and submucosa
○ Due to acute or chronic hypoperfusion
● Transmural Infarction
○ Involves all 3 mucosal layers
○ Often caused by acute vascular obstruction
● Watershed Zones
○ Splenic Flexure
■ Termination Site of:
● Superior Mesenteric Artery
● Inferior Mesenteric Artery
○ Sigmoid Colon & Rectum
■ Termination Site of:
● Inferior Mesenteric Artery
● Pudendal Artery
● Iliac Arterial Circulation
 TB ENTERITIS
● Caused by swallowing of sputum in patients with TB
INTESTINAL LYMPHOMA
WITH INTUSSUSCEPTION
● Segment of the intestine telescopes into immediately distal segment
● Most common cause of intestinal obstruction in children < 2yo
● Pathogenesis
○ usually idiopathic
○ assoc with viral infection and rotavirus vaccines
○ in older children and adults, it is generally caused by
intraluminal mass or tumor
● Intussusceptum
○ entering or inner tube
● Intussuscipiens
○ sheath or outer tube
● Diagnosis
○ contrast enemas (used both diagnostically and
therapeutically)
● Treatment
○ Surgical intervention
 COLONIC CANCER
COLONIC ADENOCARCINOMA
● Epidemiology
○ Most common malignancy of the GI tract
○ Responsible for 10% of cancer deaths
○ Incidence highest in North America
● Associated Dietary Factors:
○ Low intake of unabsorbable vegetable fiver
○ High intake of refined carbohydrates and fat
● APC gene
● Proximal / Right Sided Colonic Ca
○ Polypoid, exophytic masses that extend along one wall
○ Rarely cause obstruction
○ Manifests as fatigue and weakness due to iron deficiency anemia
● Distal / Left Sided Colonic Ca
○ Napkin-ring constrictions
○ Luminal narrowing
○ Manifests as occult bleeding, changes in bowel habits, cramping,
left lower bowel discomfort
● Two most important prognostic factors
○ Depth of Invasion
○ Presence of Lymph Node Metastasis
● Liver
○ Most common site of metastasis
■ Except in Carcinomas of the Anal Region, which
circumvent the portal drainage