Biology 334                Pathophysiology                        Fall 2002

Dr. D.'s Overhead Lecture Notes                                Section 5 - REPLACE PAGE NUMBERS WITH PAGES FROM SIXTH EDITION5
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Digestive System Lecture Notes
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Hiatus hernia (pp. 322, 323)
  hernia  =  abnormal protrusion of a body part through an opening
    hiatus hernia  =  abnormal protrusion of the stomach above the diaphragm
    sliding hiatus hernia  =  having the junction of the esophagus and stomach and part of the stomach above the diaphragm (sketch)
        - most common hiatus hernia
    rolling hiatus hernia  =  having part of the stomach above the diaphragm and next to the esophagus (sketch)

Sliding hiatus hernia
     - pathogenesis (sketch)
        cause -> anatomical abnormality -> reflux of stomach HCl and enzymes
    - consequences (sketch)
            1. esophagitis  (-> pain)
              1. Normal esophagus, gross
              2. Normal esophagus, low power microscopic*
              4. Acute esophagitis, microscopic   - sec.
              17. Stomach, scleroderma with fibrosis, Trichrome stain, microscopic* [XRAY]
            2. strictures (-> difficulty swallowing)
            3. peptic ulcers (-> pain, strictures)
              9. Herpes simplex ulcers, gross
              6. Herpes simplex esophagitis, gross
              7. Herpes esophagitis, low power microscopic*

Rolling hiatus hernia
    - pathogenesis (sketch)
        cause -> anatomical abnormality  =  strangulation ->
            1. trapping of contents
            2. pinching of vessels
    - consequences from trapping contents (sketch)
            1. bacteria grow -> (a-c)
                a. infection -> ??
                b. toxins -> ??
                c. gas formation (bloating) -> ??
            2. excess digestion ->
                a. reverse osmosis from body -> loss of water and salts -> fluid/electrolyte imbalance -> ??
        - consequences from pinched vessels (sketch)
            - ischemia -> (1-4)
                1. infection -> ??
                2. necrosis -> ??
                3. gangrene -> ??
                4. perforation (see perforated peptic ulcers) -> ??

Acute superficial gastritis
    definition  =  short term inflammation of the inner lining of the stomach
           22. Stomach, normal, gross
           23. Stomach, pylorus, normal, gross
           24. Stomach, fundus, normal, medium power microscopic*
           26. Acute gastritis, gross
           27. Gastric erosions, gross
           28. Acute gastritis, microscopic*
    causes (e.g.,    ?, ?, ?  )

    pathogenesis
        cause -> cell injury/cell death -> inflammation of mucosa, necrosis, hemorrhaging
    S&S
        pain, anorexia, nausea/vomiting (N/V), endoscopy
    treatments
        - avoid cause, antacids, bland diet
    consequences
        - resolution

Peptic ulcer (pp. 332, 334, 335, 339)
    definition  =  ulcer caused by gastric juice
           29. Acute gastric ulcer, benign, gross
           30. Gastric ulcer, malignant, gross
           31. Acute gastric ulcer, low power microscopic*  - hemorrhaging
           33. Acute gastric ulcer penetrating to artery, low power microscopic*  - hemorrhaging
           32. Acute gastric ulcer, high power microscopic*  - perforation
           34. Helicobacter pylori in stomach, Methylene blue stain, microscopic*  - H. pylori
    causes
        bacteria (H. pylori), NSAIDs, anti-inflammatory steroids,  tobacco juice, bile reflux, ischemia, stress, excess vagus nerve activity
    pathogenesis (sketch)
        cause -> mechanisms 1, 2, or 3 -> entry of HCl -> cell death -> sloughing -> ulcer

         mechanisms of development
                1. weak mucosa -> entry of HCl -> ??
                2. excess HCl -> entry of HCl -> ??
                3. inadequate mucus production -> entry of HCl -> ??

             *** 1, 2, or 3  -> entry of HCl -> cell death -> sloughing -> ulcer

Gastric peptic ulcer
    definition  =  ulcer in the stomach caused by gastric juice

    causes
        - mechanism 1
            - bacteria (H. pylori), NSAIDS, tobacco juice, anti-inflammatory steroids, bile reflux, ischemia -> weak mucosa -> ??
        - mechanisms 2 & 3
            - excess vagus nerve activity -> excess HCl -> ??
            - excess sympathetic nervous activity -> inadequate mucus -> ??
    pathogenesis
            cause -> mechanisms 1 (or 2) -> entry of HCl -> cell death -> sloughing -> ulcer

Duodenal peptic ulcer
    definition  =  ulcer in the duodenum caused by gastric juice

    causes
        - mechanisms 1 (rare)
            - bacteria (H. pylori), ischemia -> weak mucosa -> ??
        - mechanisms 2 & 3 (most common)
            - excess vagus nerve activity -> excess HCl -> ??
            - excess sympathetic nervous activity -> inadequate mucus -> ??
    pathogenesis
            cause -> mechanisms 2 & 3 (or 1) -> entry of HCl -> cell death -> sloughing -> ulcer

Comparing gastric and duodenal peptic ulcers
 
Feature
Gastric
Duodenal
Approx. % of cases
 approx. 20%  approx. 80% 
S&S
 pain  pain
 pain with food  pain w/o food
 weight loss  weight gain
 X-ray  X-ray
 endoscopy (p. 335)  endoscopy
 normal HCl  excess HCl

Stress ulcer
    definition  =  ulcer in the stomach or duodenum caused by stress

    causes
        - mechanisms 1 & 2 & 3
            - excess adrenal steroid -> weak mucosa -> ??
            - excess vagus nerve activity -> excess HCl -> ??
            - excess sympathetic nervous activity -> inadequate mucus -> ??
    pathogenesis
            stress -> mechanisms 1 & 2 & 3 -> entry of HCl -> cell death -> sloughing -> ulcer

Complications from peptic ulcers

    1. hemorrhage
        - slow hemorrhage -> anemia
        - fast hemorrhage -> shock
           31. Acute gastric ulcer, low power microscopic*  - hemorrhaging
           33. Acute gastric ulcer penetrating to artery, low power microscopic*  - hemorrhaging
    2. perforation (sketch)
        - perforation -> contents into body cavity -> (a-c)
           32. Acute gastric ulcer, high power microscopic*  - perforation
            a. infection (widespread in body cavity) -> ??
            b. toxins (widespread in body cavity) -> ??
            c. inflammation (peritonitis) -> (1-5)

                        46. Normal mesentery, gross
                       47. Normal lacteals, gross
                       82. Typhlitis with perforation, gross  - perforation of large intestine
                         58. Peritonitis from bowel perforation, gross  - infection
                         50. Adhesions, peritoneum, small intestine, gross  - adhesion

                1. shock -> ??
                2. fluid/electrolyte imbalance -> ??
                3. paralytic obstruction -> trapped contents ->  ?? (see rolling hiatus hernia)
                4. physical obstruction -> trapped contents ->  ?? (see rolling hiatus hernia)
                5. adhesions -> ??
            c. autodigestion -> ??
   3. physical obstruction
        - swelling, spasms, strictures
        - obstruction -> trapped contents ->  ?? (see rolling hiatus hernia)
    4. intractibility
        - requires radical treatment (e.g., surgery)

Acute ulcer vs. chronic ulcer

Appendicitis (p. 352) (sketch)
    definition  =  inflammation of the appendix
           83. Appendix, normal, gross
        84. Acute appendicitis, gross
        85. Acute appendicitis, gross
        86. Acute appendicitis, gross
        87. Acute appendicitis, low power microscopic*
            Clinically, the patient often presents with  right lower quadrant abdominal pain. Rebound tenderness is noted  on physical examination. An elevated WBC count is usually present.
           88. Acute appendicitis, medium power microscopic*

    causes (sketch)
        1. infected lymph nodes in appendix -> ??
        2. trapped contents (fecaliths) -> ?? (see rolling hiatus hernia)
    pathogenesis
           cause -> cell injury/cell death -> inflamed appendix (appendicitis)

    S&S
        pain, rebound pain, incr. WBCs, fever, N/V, diarhea/constipation, incr. SED rate

    consequences
        1. septicemia (sketch)
        2. many from rupture  (i.e., perforation) (sketch)
            a. infection (widespread in body cavity) -> ??
            b. toxins (widespread in body cavity) -> ??
            c. inflammation (peritonitis) -> (1-5) (sketch)
                        46. Normal mesentery, gross
                       47. Normal lacteals, gross
                       82. Typhlitis with perforation, gross  - perforation of large intestine
                                   58. Peritonitis from bowel perforation, gross  - infection
                                   50. Adhesions, peritoneum, small intestine, gross  - adhesion
                1. shock -> ??
                2. fluid/electrolyte imbalance -> ??
                3. paralytic obstruction -> trapped contents ->  ?? (see rolling hiatus hernia)
                4. physical obstruction -> trapped contents ->  ?? (see rolling hiatus hernia)
                5. adhesions -> ??

Peritonitis (sketch)
    definition  =  inflammation of the lining of the abdominal cavity (i.e., peritoneum)
           46. Normal mesentery, gross
        47. Normal lacteals, gross
        82. Typhlitis with perforation, gross  - perforation of large intestine
           58. Peritonitis from bowel perforation, gross  - infection
           50. Adhesions, peritoneum, small intestine, gross  - adhesion

    causes
        1. physical trauma
        2. chemical trauma
        3. bacteria
    pathogenesis
        cause  ->  cell injury/cell death  ->  inflamed peritoneum =  peritonitis
    consequences (see perforated peptic ulcer, perforated appendix) (1-5)
                1. shock -> ??
                2. fluid/electrolyte imbalance -> ??
                3. paralytic obstruction -> ??
                4. physical obstruction -> ??
                5. adhesions -> ??

Intestinal obstruction
    definition  =  blockage of the intestine preventing forward movement of contents

    causes
        1. paralytic obstruction (any irritation)
        2. physical obstruction (e.g., objects, tumors, position, strictures, spasms) (sketch)
    pathogenesis
        cause -> trapped contents (like hiatus hernia) ->
        1. bacteria grow -> (a-c) (sketch)
            a. infection ->  ??
            b. toxins ->  ??
            c. gas formation (bloating) ->  ??
        2. excess digestion -> (sketch)
            a. reverse osmosis from body -> loss of water and salts -> fluid/electrolyte imbalance ->  ??
    reasons for death
        1. fluid/electrolyte imbalance (from reverse osmosis, N/V)
        2. toxins absorbed (from bacteria)
        3. perforation (from bacteria, toxins, ischemia)
    S&S
        pain, N/V, constipation, abdominal distention, X-ray

Special terms

    appendicitis - inflammation of the appendix

    peritonitis - inflammation of the peritoneum (lining of the abdominal cavity)

    paralytic obstruction - having no peristalsis

    adhesion - abnormal connection of parts be scar tissue

    volvulus - twisted and kinked intestine (p. 353) (sketch)
           53. Cecum, volvulus, gross

    intussusception - telescoping or slipping of one part on the intestine into the adjoining part (p. 353) (sketch)

    strangulated hernia - abnormal protrusion and pinching of a body part through an opening (p. 353) (sketch)

Large intestine (Chap. 26)

Ulcerative colitis (p. 364, Plate 27)
    definition  =  ulceration and inflammation of the lining of the large intestine (sketch)
Go to Tutorial on Inflammatory Bowel Diseases
           77. Normal colonic mucosa, medium power microscopic*
           124. Chronic ulcerative colitis, gross
           125. Chronic ulcerative colitis, gross
           126. Chronic ulcerative colitis, gross
           127. Chronic ulcerative colitis, gross
           128. Chronic ulcerative colitis, low power microscopic*
           130. Chronic ulcerative colitis with crypt abscesses, medium power microscopic*
           132. Chronic ulcerative colitis with dysplasia, medium power microscopic*  - pre-cancerous dysplasia

    causes
        - ? autoimmune response ?
    pathogenesis
        cause -> patchy necrosis & patchy inflammation -> bleeding and exudation
        - chronic flairs and remissions -> scar tissue
    consequences  (1-6) (p. 363)
        1. fluid/electrolyte imbalance -> ??
        2. anemia -> ??
        3. disrupted life (pain, diarrhea) -> ??
        4. abcesses -> ??
        5. obstruction (scarring -> strictures) -> ??
        6. predisposes to colon cancer -> ??
    S&S
        pain, bloody diarrhea, mucus in feces, radiograms, endoscopy

Carcinoma of the colon (colon cancer)
    - most common cancer of the digestive system
        - benign
           90. Colon, adenomatous polyp (tubular adenoma), gross
           92. Colon, adenomatous polyp on long stalk, gross
           91. Colon, adenomatous polyp (tubular adenoma), low power microscopic*
           96. Colon, adenomatous polyp (tubular adenoma) compared to normal mucosa, medium
power microscopic*
           93. Colon, multiple adenomatous polyps, gross
           94. Colon, familial adenomatous polyposis, gross
           95. Colon, familial adenomatous polyposis (Gardner's syndrome), gross
        - malignant
           99. Colon, adenocarcinoma, gross [XRAY]
           100. Colon, descending, adenocarcinoma, gross [MRI]
           101. Colon, adenocarcinoma, gross
           102. Colon, adenocarcinoma arising in villous adenoma, gross

    predisposing factor (risk factors)
        1. specific gene (95% risk)
        2. family history
        3. high fat diet
        4. low fiber diet (less scraping of abnormal cells, slow peristalsis -> accumulation of carcinogens)
        5. ulcerative colitis
    warning signs
        - altered bowel habits, blood in feces

            48. Normal terminal ileum, gross
           49. Normal small intestinal mucosa, medium power microscopic*

Diverticulosis and diverticulitis
    definitions
        diverticulosis  =  having abnormal outpocketings in the large intestine (sketch)
        diverticulitis  =  having inflamed abnormal outpocketings in the large intestine (sketch)
           110. Sigmoid colon, diverticulosis, gross
           111. Colon, diverticulosis, gross
           112. Colon, cut surface, diverticulosis, gross
           113. Colon, cut surface, diverticulosis, gross
           114. Colon,, diverticulosis, low power microscopic*
           115. Colon, diverticulitis, gross
           116. Colon, diverticulitis with perforation, gross
           117. Colon, diverticulitis with perforation, gross

    causes
        1. colon spasms
        2. chronic constipation
    pathogenesis (sketch)

        diverticulosis
            cause -> incr. incr. pressure in bowel -> bulges at weak spots = diverticulosis

        diverticulitis (sketch)
            feces trapped in diverticuli -> inflamed diverticuli = diverticulitis

    S&S
        pain, diarrhea, constipation, bloody feces, X-ray, endoscopy
    consequences
        1. fluid/electrolyte imbalance
        2. anemia
        3. obstruction (strictures)
        4. abcesses
        5. perforation (see perforated appendix)

Hemorrhoids  (pp. 360, 368)
    definition  =  varicose veins in anal area (sketch)
        external vs internal hemorrhoids (sketch)

    causes
        1. forced bowel movements
        2. "bathroom bookworm"
        3. chronic cough
        4. portal hypertension
        5. childbirth
    pathogenesis
        cause -> chronic passive congestion of hemorrhoidal veins -> hemorrhoids
    S&S
        pain, bleeding, palpation, observation
    consequences
        pain, infection, fissures, abcesses

Liver
    functions (pp. 373, 374, 375)
      1. Produce bile  ->  fat digestion, removal of organic waste
      2. Conjugate and excrete bilirubin ->  removal of waste from Hb (p. 391)
            (Unconjugated bilirubin IS NOT water soluble for excretion and IS toxic)
      3. Detoxify chemicals (e.g., NH3 from proteins, alcohol)  -> conversion and removal of toxins (e. g., produces urea from NH3)
      4. Produce balance of organic molecules  ->  nutritional homeostasis
      5. Produce blood proteins  ->  proper COP for capillary exchange
      6. Produce clotting factors  ->  hemostasis
      7. Inactivate hormones  ->  hormone homeostasis
      8. Phagocytize particles  ->  defense and clean-up (e.g., RBCs)
      9. Store blood  ->  homeostasis of blood pressure and flow

Cirrhosis
    definition  =  liver disease with chronic inflammation and scar formation (fibrosis) around lobules
           1. Normal liver in situ, gross
           2. Normal liver, external, gross
           3. Normal liver, cut surface, gross
           4. Normal liver zones, microscopic*
           16. Cirrhosis of liver, microscopic*
           17. Micronodular cirrhosis and fatty change of liver, microscopic*
           18. Mallory's hyaline, liver, microscopic*

    causes
        1. alcohol (most common cause)
            - toxic to cells
           12. Micronodular cirrhosis of liver, gross [MRI]  - from alcoholism
           13. Micronodular cirrhosis and fatty change of liver, gross [CT]  - from alcoholism
           14. Micronodular cirrhosis and fatty change of liver, gross  - from alcoholism
           15. Micronodular cirrhosis and fatty change of liver, gross  - from alcoholism
        2. other toxins (e.g., industrial, medications)
            - toxic to cells
           60. Necrosis with acetaminophen overdose, liver, microscopic*
        3. blocked bile ducts (e.g., gall stones) (sketch)
            - bile injures cells
           19. GIF animation showing complications of biliary tract lithiasis
           29. Cholestasis of liver, microscopic*  - from blocked ducts
           30. Cholestasis of liver, microscopic* - from blocked ducts
        4. hepatitis (viral infraction)
            - virus injures cells
           9. Macronodular cirrhosis of liver, gross - from hepatitis
           10. Macronodular cirrhosis of liver, gross - from hepatitis
           11. Macronodular cirrhosis of liver, gross - from hepatitis
           53. Viral hepatitis C, liver, low power microscopic* - from hepatitis
           54. Viral hepatitis with collapse, liver, Trichrome stain, microscopic* - from hepatitis
        5. malnutrition
            - deficiencies weaken cells
    pathogenesis
           5. Fatty metamorphosis of liver, gross
           6. Fatty metamorphosis of liver, gross
           7. Fatty metamorphosis of liver, microscopic*
           8. Fatty metamorphosis of liver, microscopic*
           16. Cirrhosis of liver, microscopic*
           17. Micronodular cirrhosis and fatty change of liver, microscopic*
           18. Mallory's hyaline, liver, microscopic*
 
 cause -> 
cell injury ->
 decr. liver functions (1-8 above) 
yields
fatty degeneration ->
 decr. liver functions (1-9 above)
(with continued cause) 
yields
chronic inflammation 
yields
scar formation ->
 decr. liver functions (2 & 9 above)
(with continued cause) 
yields
blocked & distorted
vessels & bile ducts (p. 392) ->
 decr. liver functions (2 & 9 above)

    consequences
        1. jaundice(p. 391)
            a. decr. conjugation of bilirubin -> decr. secretion of bilirubin ->
            b. blocked bile ducts -> decr. elimination of bilirubin ->
                    a & b -> incr. incr. incr. bilirubin -> brain cell injury
                  29. Cholestasis of liver, microscopic*  - from blocked ducts
                  30. Cholestasis of liver, microscopic* - from blocked ducts
        2. edema
            a. decr. protein synthesis -> decr. COP ->
            b. decr. inactivation of steroid hormones -> incr. H2O retention -> incr. blood volume ->
                    a & b -> edema -> fluid/electrolyte (F/E) imbalance, pulmonary edema  -> ??
        3. ascites (accumulation of fluid in abdominal cavity) (sketch)
            a. decr. protein synthesis -> decr. COP ->
            b. decr. inactivation of steroid hormones -> incr. H2O retention -> incr. blood volume ->
            c. blocked vessels -> portal hypertension -> (sketch)
                    a & b & c -> transudate into abdominal cavity = ascites -> decr. BP, F/E imbalance -> ??
        4. gastrointestinal varices & hemorrhoids (p. 392)
            a. blocked vessels -> portal hypertension -> varicose veins -> bleeding, hemorrhoids -> ??
         21. Esophageal varices with portal hypertension, gross  - esophageal varices
        5. splenomegaly (sketch)
            a. blocked vessels -> portal hypertension -> splenomegaly -> decr. function (RBCs, BP, lymphatics) -> ??
           22. Splenomegaly with portal hypertension, gross  - splenomegaly
        6. bleeding tendencies
            a. decr. production of clotting factors ->  decr. clotting ->
            b. decr. inactivation of hormones -> weak vessels ->
                    a & b -> incr. bleeding, incr. bruising -> ??
        7. spider nevi
            a. decr. inactivation of hormones -> weak vessels -> vessel dilation -> ??
        8. low hematocrit
            a. decr. balance of nutrients -> decr. RBC production -> anemia -> ??
        9. hepatic coma (p. 396)
            a. decr. detoxification of chemicals (NH3) -> incr. incr. NH3 -> brain cell injury ->
                    brain malfunction (e.g., stupor, tremors, delirium) -> coma -> death

Cholelithiasis
    definition  =  having gall stones
        1. Normal gallbladder, gross
        12. Normal common bile duct, gross
        5. Cholelithiasis, gallbladder, gross [CT]
        6. Cholelithiasis, gallbladder, gross
        7. Cholelithiasis with chronic cholecystitis, gallbladder, gross
        8. Porcelain gallbladder, gross
        13. Biliary tract lithiasis, diagram
        19. GIF animation showing complications of biliary tract lithiasis
        18. Intrahepatic lithiasis, liver, gross
        16. Cholestasis of liver, microscopic*
        15. Obstructive jaundice, medium power, microscopic*

    causes (sketch)
        1.  incr.incr. cholesterol secretion -> incr.incr. concentration
           2. Cholesterolosis, gallbladder, gross
           4. Cholesterolosis and cholelithiasis, gallbladder, gross
           3. Cholesterolosis, gallbladder, microscopic*
        2.  decr.decr. emptying of gall bladder -> incr.incr. concentration
        3. infection in gall bladder -> altered conditions ->
    pathogenesis
        cause -> gall stone formation
    S&S
        indigestion, pain, pain after eating fats,  X-ray
    consequences (sketch)
        1. cirrhosis
        2. infection of gall bladder
        3. perforation of gall bladder
        4. pancreatitis (from blocked pancreatic duct)

Pancreatitis
    definition  =  inflammation of the pancreas
           1. Normal pancreas, gross
           2. Normal pancreas, high power microscopic*
           3. Acute pancreatitis, gross  - acute
           4. Acute pancreatitis, gross  - acute
           6. Acute pancreatitis with fat necrosis, high power microscopic* - acute
           8. Acute pancreatitis, low power microscopic* - acute
           10. Acute pancreatitis with fat necrosis, gross  - acute
           12. Chronic pancreatitis, low power microscopic* - chronic
           13. Chronic pancreatitis, low power microscopic* - chronic

    causes
      1. blocked duct (e.g., gall stones, alcohol) -> retention and activation of enzymes (sketch)
      2. alcoholism -> toxic, block ducts, incr. incr. enzymes ->
      3. trauma
      4. medications
      5. idiopathic

    pathogenesis
        cause -> cell injury/cell death -> inflammation (pancreatitis)
    consequences
        1. diabetes mellitus ( from decr. insulin production)
        2. malabsorption (from decr. enzyme production)
        3. tetany (sketch)
                leaking enzymes -> enzymatic fat necrosis -> binding calcium -> tetany 
              6. Acute pancreatitis with fat necrosis, high power microscopic* - acute
              10. Acute pancreatitis with fat necrosis, gross  - acute
        4. infection (from injured and killed cells, autodigestion)
        5. peritonitis (sketch)
                leaking enzymes -> autodigestion -> peritonitis ->  (1-6)
                    1. shock -> ??
                    2. fluid/electrolyte imbalance -> ??
                    3. paralytic obstruction -> ??
                    4. physical obstruction -> ??
                    5. adhesions -> ??
        6. abdominal organ digestion (sketch)
                 leaking enzymes -> autodigestion -> organ failure

Special terms
    Laennec's cirrhosis  =  cirrhosis from alcoholism
    cholecystitis  =  inflammation of the gall bladder
 

Reproductive System Lecture Notes

Sexually Transmitted Diseases Lecture Notes

Page Index
Sexually transmitted diseases
    Reasons for epidemic proportions
    Bacterial types
        syphilis
        gonorrhea
        Chlamydia
     Viral types
        Herpes - HSV II
        papilloma
        AIDS
Prostatic hypertrophy
Toxemia of pregancy
Endometriosis
Placenta privea
Tumors

Sexually transmitted diseases

Reasons for epidemic proportions
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        1. ease of transmission
        2. mild or absent signs and symptoms
        3. ineffective immune response
        4. resistant strains
        5. difficult diagnostic procedures
        6. relaxed sexual mores
        7. ignorance
        8. denial
        9. unprotected sex

Bacterial types - can be cured with antibiotics
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syphilis (pp, 1007, 1008, Plate 30)
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      - results in four stages if unchecked
          -  chancre in primary stage
          -  rash in secondary stage
          - no S&S in latent stage
          - gummas (scar tissue) in tertiary stage -> (1-3)
               1. atherosclerosis (80%-85% of cases with gummas) ->  ??
               2. in brain -> dementia
               3. in joints -> arthritis
      - infective in primary, secondary, and first part of latent stage
           - newborns
                - passes through placenta (after 4th month) -> abortions, birth defects, stillbirths, syphilis, blindness

gonorrhea
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       - results
           - inflammation -> creamy discharge, pain, scar tissue
           - may result in abscesses (sketch), pelvic inflammatory disease (PID) (sketch), strictures (e.g., sterility, tubal pregnancy) (sketch)
                GIF animation, ovulation, fertilization, implantation, diagram
               GIF animation, ectopic pregnancy, diagram
                Ectopic pregnancy, fallopian tube, ruptured, gross
                Ectopic pregnancy, fallopian tube, ruptured, gross
                Ectopic pregnancy, fallopian tube, low power microscopic *
                Ectopic pregnancy, fallopian tube, medium power microscopic *
       - newborns
             - transmissible during birth -> blindness

Chlamydia - (most common STD)
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       - results
             - inflammation -> discharge, pain, scar tissue
             - may result in PID, cancer, strictures (e.g., sterility,  tubal pregnancy)
       - newborns
             - transmissible during birth -> eye and lung infection in newborns, premature birth

Viral types - cannot be cured with antibiotics
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Herpes - HSV II (p. 1012, Plate 40)
Go to Tutorial on HIV
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       - results
           - inflammation -> rash, pain, burning (may be disabling during flares), embarrassment, psychological health, social interactions, employment
               Herpes simplex esophagitis, gross.
               Herpes simplex esophagitis, low power microscopic. *
               Herpes simplex esophagitis, high power microscopic. *
               Herpes simplex keratitis, cornea sgross, fluorescein stain. *
               Herpes simplex keratitis, cornea high power microscopic. *
               Herpes simplex encephalitis, acute, with hemorrhage, gross.
               Herpes simplex encephalitis, remote, gross.
               Herpes simplex, skin, vesicle, low power microscopic. *

       - newborns
           - transmissible during birth -> inflammation, organ damage, Caesarian sections required

papilloma - (fastest spreading STD) (p. 1012)
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       - results
           - genital warts, promotes cancer (penis, vagina, cervix)
                    Koilocytosis, cervix, low power microscopic *
                    Koilocytosis, cervix, high power microscopic *
       - newborns
           - transmissible during birth -> same results

AIDS(pp. 176, 177, 179, 182, 183, Plates 1-3)
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           - infection into blood vessels -> kills T-helper cells (i.e., CD4 cells) -> weak immune responses
               Human immunodeficiency virus, electron micrograph. *
               Human immunodeficiency virus, electron micrograph. *
               Human immunodeficiency virus, electron micrograph. *
               Human immunodeficiency virus within lymphoid tissues, diagram.
               Schematic diagram of CD4 receptor and chemokine coreceptor.
               Human immunodeficiency virus, life cycle, diagram.
               Human immunodeficiency virus, process of infection, diagram.
               Life cycle of HIV, with the points of pharmacologic agent effectiveness, diagram.
       - results in progressive stages if unchecked
           - mild fever, malaise, swollen glands (2-12 weeks)-> seroconversion -> ARC (fever, weigh loss, swollen glands, night sweats, diarrhea, psychological disturbances {depression, anxiety, withdrawal, delusions}) -> AIDS (infections, cancer, dementia {ARD}) -> death
               - ARC = AIDS-related complex
               - ARD = AIDS-related dementia
       - causes of death
           - cancer, infections, extreme muscle weakness (e.g., -> starvation, aspiration, decubiti)
       - newborns
           - passes through placenta -> AIDS

        Go to Tutorial on AIDS
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           - infections accompanying AIDS

                - Pneumocystis carinii
                    - parasite causing pneumonia
              Pneumocystis carinii, appearance of organisms, diagram.
              Pneumocystis carinii pneumonia, gross.
              Pneumocystis carinii pneumonia with cavitary change, gross.
              Pneumocystis carinii pneumonia, low power microscopic. *
              Pneumocystis carinii pneumonia, medium power microscopic, GMS stain. *
              Pneumocystis carinii pneumonia, high power microscopic, GMS stain. *
              Pneumocystis carinii, kidney disseminated , gross.
              Pneumocystis carinii, spleen, disseminated, CT scan.
              Pneumocystis carinii, exudate with calcification, medium power microscopic. *
              Pneumocystis carinii pneumonia, interstitial fibrosis, medium power microscopic. *

            Cytomegalovirus
                 - virus causing pnuemonia, blindness, and damage to the brain and the digestive system
              Cytomegalovirus, appearance of organisms, diagram.
              Cytomegalovirus, ulcers in cecum, gross.
              Cytomegalovirus pneumonia, microscopic. *
              Cytomegalovirus pneumonia, microscopic. *
              Cytomegalovirus pneumonia, microscopic. *
              Cytomegalovirus pneumonitis, immunoperoxidase stain, medium and high power microscopic. *
              Cytomegalovirus adrenalitis, microscopic. *
              Cytomegalovirus, liver, microscopic. *

            Mycobacteria
                 - tuberculosis in many body parts
              Mycobacterium tuberculosis, lung, gross.
              Mycobacterium tuberculosis, lung, AFB stain, microscopic. *
              Mycobacterium avium complex (MAC), macrophages filled with mycobacteria, spleen, AFB stain, microscopic. *
              Mycobacterium avium complex (MAC), spleen with miliary granulomas, gross.
              Mycobacterium avium complex (MAC), mesenteric lymph nodes, gross.

            Fungal infections
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                 - often Candida in the mouth, esophagus, and respiratory system. Other dangerous fungi affect the meninges and respiratory system
              Candida albicans, lung, gross. *
              Candida albicans, invasive in bronchus, H&E stain, microscopic. *
              Candida albicans, invasive in esophagus, PAS stain, microscopic. *
              Cryptococcus neoformans (without capsules), meninges, GMS stain, microscopic. *
              Histoplasma capsulatum, granulomas in liver, gross.
              Histoplasma capsulatum, liver, H and E stain, microscopic. *
              Histoplasma capsulatum, liver, PAS stain, microscopic. *
              Coccidioides immitis, lung, H&E stain, microscopic. *
              Coccidioides immitis, liver, H&E stain, microscopic. *

            Toxoplasmosis
                 - protozoan parasite, often in the brain
              Toxoplasma gondii, organizing cerebral abscess, gross.
              Toxoplasma gondii, pseudocysts, microglial nodule, microscopic. *
              Toxoplasma gondii, myocardium, microscopic. *
              Toxoplasma gondii, lung, immunoperoxidase stain, microscopic. *

            Herpes simplex virus
                 - Herpes simplex virus in the digstive system and the skin
              Herpes simplex virus, esophagus, microscopic. *
               Herpes simplex virus, esophagus, microscopic. *

            Protozoan parasites
                 - often cause severe diarrhea
               Gastrointestinal protozoa, diagram. *
               Cryptosporidia, electron micrograph. *
              Cryptosporidiosis, small intestine, H and E stain, microscopic. *
               Cryptosporidiosis, stool specimen, AFB stain,microscopic. *

            Miscellaneous infections
                 - respiratory infections, often in children with AIDS
              Lymphoid interstitial pneumonitis (LIP) of lung, low power microscopic. *
               Lymphoid interstitial pneumonitis (LIP) of lung, low power microscopic. *
               Lymphoid interstitial pneumonitis (LIP) of lung, medium power microscopic. *
               Lymphoid interstitial pneumonitis (LIP) of lung, high power microscopic. *
               Progressive multifocal brain leukoencephalopathy (PML), gross.
               Progressive multifocal leukoencephalopathy (PML), Luxol fast blue stain, low power microscopic. *
               Progressive multifocal leukoencephalopathy (PML), high power microscopic. *
               Progressive multifocal leukoencephalopathy (PML) JC viral particles in nucleus, electron micrograph. *

        - cancers with AIDS
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            Kaposi's sarcoma (KS) on the skin and the visceral organs
             Kaposi's sarcoma, skin, gross.
              Kaposi's sarcoma, skin, patch stage, microscopic. *
              Kaposi's sarcoma, skin, nodule, microscopic. *
              Kaposi's sarcoma, skin, extravasation of RBC's, microscopic. *
              Kaposi's sarcoma, skin, hemosiderin and hyaline globules, microscopic. *
              Kaposi's sarcoma, skin, hyaline globules, PAS stain, microscopic. *
              Kaposi's sarcoma, oral cavity, immunoperoxidase with antibody to CD34, microscopic. *
              Kaposi's sarcoma, stomach, gross.
              Kaposi's sarcoma, liver, gross.

            Malignant lymphomas
               Malignant lymphoma, lymph node, gross.
               Malignant lymphoma, small intestine, gross.
               Malignant lymphoma, liver, gross.
               Malignant lymphoma, brain, low power microscopic. *
               Malignant lymphoma, brain, high power microscopic. *

Prostatic hypertrophy (sketch)
    definition  =  non-neoplastic enlargement of the prostate gland
        Prostate, nodular prostatic hyperplasia, gross
        Prostate, nodular prostatic hyperplasia, gross
        Prostate with nodular hyperplasia, and bladder with hypertrophy and calculus
        Bladder, with hypertrophy, gross
        Prostate, normal, high power microscopic *
        Prostate, nodular prostatic hyperplasia, low power microscopic *
        Prostate, nodular prostatic hyperplasia, high power microscopic *
        Prostate, intraepithelial neoplasia (PIN), high power microscopic *
        Prostate, "chips" from transurethral resection of prostate (TURP), gross
         Go to Tutorial on Prostate Pathology

    causes
        - not known
            - possibly from altered ratios of sex steroids (estrogen and testosterone)
            - possibly from increases in testosterone receptors on prostate cells
    pathogenesis (sketch)
        cause -> enlargement of prostate (hyperplasia of cells -> hypertrophy of gland) -> compression of urethra -> urine retention -> abnormal micturition & renal diseases
    consequences
         difficulty starting or stopping urine flow, pain, urinary incontinence, bladder decompensation, (i.e., dilation, hypertrophy), urinary tract infections, hydropnephrosis
    S&S
        difficulty starting or stopping urine flow, pain, urinary incontinence urinary tract infections, palpation during rectal exam
    treatments
        catheterization to relieve pressure, surgical reduction of the prostate gland (e.g., TURP = transurethral prostetectomy)

Toxemia of pregancy
    definition  =  hypertension associated with liver failure, kidney failure, and brain damage

    causes
        - unknown
            - possibly from secretions from the uterus causing abnormally high sensitivity to angiotensin
    pathogenesis
        cause -> (1 & 2 )
            1. high sensitivity to angiotensin -> vasoconstriction -> incr. incr.  BP -> organ/system failure
            2. increased clotting factors from placenta -> systemic intravascular clotting -> organ/system failure
    consequences (1-5)
        1. liver damage (necrosis, liver failure) ->  ??
        2. kidney damage (like glomerulonephritis + hypertensive kidney) -> renal failure ->  ??
        3. brain damage (like ischemic and hemorrhagic strokes) ->  ??
        4. placental damage (hemorrhage = placenta abruptio ->  ??
        5. other organ failure (e.g., heart, lungs) ->  ??
    S&S
        preeclampsia
            - incr. incr. BP, edema, azotemia, proteinuria, rapid weight gain (fluid retention)
        eclampsia
            - same as preeclampsia + convulsions, coma
    treatments
        rest
        dietary management

Endometriosis
    definition  =  metaplasia of endometrium (normal cells in abnormal locations) (sketch)
        GIF animation, endometriosis, diagram
        Endometriosis, low power microscopic
        Endometriosis, medium power microscopic
        Endometriosis, uterine serosa, gross
        Endometriosis, uterine serosa, gross
        Endometriosis, ovary, gross
        Endometrial hyperplasia, gross
        Endometrial polyp, gross

    causes
        unknown
            - possible from displacement of endometrium up oviducts or through circulation
    pathogenesis
        cause -> endometrium cells in abnormal locations -> menstrual cycles of metaplastic endometrium -> hemorrhage -> Hb cell injury/cell -> inflammation -> (sketch)
    consequences
        pain, PID (pelvic inflammatory disease), adhesions, strictures
    S&S
        pain during menstruation, hematuria, blood in feces
    treatments
        hormonal suppression of menstrual cycles, surgery

Placenta privea
    definition  =  growth of placenta near or over the lower uterine opening (sketch)
        GIF animation, ovulation, fertilization, implantation, diagram

    causes
        low implantation of embryo
    pathogenesis
        low implantation -> placenta near uterine opening -> weakening of placenta as uterus stretches -> hemorrhaging ->
    consequences
        shock, death of mother and child
    S&S
        uterine bleeding as pregnancy progresses
    treatments
        rest, pre-pregnancy surgery to secure uterine opening, stopping the bleeding

Tumors
    definition  =  neoplasia in reproductive structures
        Go to Female Genital Tract Pathology
        Go to Male Genital Tract Pathology
        Go to Tutorial on Breast Cancer

    causes
        diverse for different types of neoplasia
    pathogenesis
        diverse for different types of neoplasia
    consequences
        diverse for different types of neoplasia (see effects from neoplasia) (sketch)
           1. block tubes
           2. compress tubes
           3.pressure on structures
           4. infection
           5. inflammation
           6. hemorrhage
           7. compete for nutrients
           8. disrupt tissue and organ structure
           9. excess secretion of substances (e.g., hormones
         10. become malignant
         11. cosmetic
    S&S
        abnormal lump or thickening (palpation)
        altered bladder or bowel habits
        abnormal bleeding
        mammograms
        sonograms
        Pap smear  Go to Tutorial on Cytopathology (Pap Smears) 
                       Normal cervix, gross 
                       Normal cervical squamous epithelium, microscopic *
                       Pap smear, dysplasia, microscopic *
                       Dysplastic and normal cervical squamous epithelium, low power microscopic *
                       Dysplastic and normal cervical squamous epithelium, high power microscopic *
                       Dysplastic vulvar epithelium, low power microscopic *
   treatments
        - "wait and watch", hormonal, radiation, chemotherapy, surgery, immunotherapy

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© Copyright 2002 - Augustine G. DiGiovanna - All rights reserved. All rights reserved. Except as permitted under the United states Copyright Act of 1976, no part of this page may be reproduced or distributed in any form or by any means, or stored in a data base or retrieval system, without the prior written permission of Augustine G. DiGiovanna.
 
 

Do Not Print This Page
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© Copyright 2002 - Augustine G. DiGiovanna - All rights reserved. All rights reserved. Except as permitted under the United states Copyright Act of 1976, no part of this page may be reproduced or distributed in any form or by any means, or stored in a data base or retrieval system, without the prior written permission of Augustine G. DiGiovanna.