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>> Alright hi everybody and welcome back to part two of Introduction to Pathology. We're
going to go ahead and jump right in and finish up this last session for you. And so next
we're going to move onto inflammation. This is the second type of disease process and
there are two main categories of inflammation. There is chronic and there's acute. Now chronic
inflammation, these are damage caused by injurious agents and may not result in necrosis, it's
a longer duration of inflammation periods. And acute inflammation here are the first
five here are the clinical signs of acute inflammation and you have heat or calor, you
have redness of the skin you have rubor, swelling is tumor, pain is dolor and you also have
a loss of function and in some cases you do have elevated body temperatures and that occasionally
happens when you have conditions associated with the spread of organisms into the blood
stream. So these five acute clinical signs of inflammation are very good to know for
your quiz. So this is a diagram here that is found on page eight of your book. So you
have some type of injury, you have physical injury, chemical, or microbial injury and
that leads the cell death and that leads to cell necrosis. So when you have capillary
dilation you have an increased blood flow and you have the slowing of the flow and that
may cause heat and you have increased capillary permeability and that leads to extravation
of fluids and that is in the process of going from redness and into tenderness and then
you have the attraction of the leukocytes and this is a migration of the white cells
to the site of the necrosis and that will cause the swelling. And you have the systemic
response causing fever or leukocytosis and that's when you have the pain. Then you have
tissue regeneration and this happens when you have this is when the healing process
is going on, you have tissue regeneration, you have scar tissue being formed, you may
have debrevement and that's when you have a need for surgical removal of the contaminated
tissues. And you may get a pyogenic infection and this is the body's response to the infection
by producing a thick yellow fluid called ***. We have inflammatory processes. Again here
we have edema and localized edema results from an inflammatory reaction with the escaper
of the protein rich intravascular fluid into the extravascular tissues. We have a couple
of other terms described under edema and one is the anasarca and that is the term used
to describe pronounced swelling of subcutaneous tissues throughout the entire body. That's
anasarca versus localized edema. And you have elephantitis and that's a term used to describe
local obstruction of the lymphatic drainage, like a woman's arm if she's had an IV placed
on the same side as her mastectomy, sometimes you can cause elephantitis or edema on that
side of the body or the arm. Then we'll move down to ischemia and infarction and ischemia
is the interference of the blood supply to an organ or a part of an organ caused by arterial
narrowing and depriving the organ cells and the tissues of oxygen and nutrients. So an
infarction is a localized area of ischemic necrosis, either by a blockage and it's arterial
supply or even a venous drainage. So necrosis you can have a stroke, which obviously happens
in the brain, myocardial infarctions in the heart and you can even have gangrene and this
is a loss of oxygen and nutrients resulting in tissue necrosis and this is especially
pertinent in a diabetics foot. We have a lot of that having gangrene. This is still the
inflammatory process here. We have a hemorrhage and a hemorrhage is a rupture of a blood vessel
straight forward rupture of a blood vessel excuse me. And because of the rupture of the
blood vessel, then you'll have a hematoma. So if the hemorrhage is outside of the vessel
wall, which it is cause it's a rupture of a blood vessel, it gets trapped within the
body tissues resulting in accumulation of blood called a hematoma. Now you have three
different kinds, you have petechiae and this is a very minimal hemorrhage into the skin,
mucous membrane or serosal surfaces and then you have so it's a tiny, tiny hemorrhage's
into the skin. You have purpura and that's slightly larger hemorrhages and ecchymosis
is a larger greater than one to two centimeters subcutaneous hematoma. So we hope if you bruise
somebody from an IV that you have more of a petechiae, which is the minimal hemorrhage
under the skin versus ecchymosis which is greater than one to two centimeters. Now we
have alternations of cell growth. We have a lot of these terms in your book and there
is a difference between them. You have atrophy and this is the reduction in size, or the
number of cells in an organ or tissue with the corresponding decrease in function. Hypertrophy
is an increase in size of the cells in response to increased function like a pancreatitis.
You have hyperplasia, which is an increased number of cells in an organ or tissue, versus
remember hypertrophy, which is an increased size of the cells; hyperplasia is an increased
number of the cells. And you have dysplasia, which is a loss in deformity of individual
cells and an architectural orientation. And this is usually associated with prolonged
inflammation. So remember minimal hemorrhage into the skin, mucus membranes or serosal
surfaces is called hematomas. Alright and then the different types of hematomas is petechiae,
the purpura, and the ecchymosis. Alright, we're going to go ahead and move onto the
degenerative disease classification and this is a disease cause deterioration of the body
and this may occur following a traumatic injury regardless of age. Ok it's not always the
elderly. It is also a process of aging and the factors affecting the rate of aging is
determined by degenerative diseases. You have atherosclerosis is a degenerative disease,
osteoporosis and osteoarthritis. So here we have a couple of pictures we have this is
a generic x-ray here of osteoarthritis of the ankle and then we have over here on a
younger person we have a osteoarthritis of an AC joint. So we do use a lot of MRI to
evaluate osteoarthritis as well. We have metabolic diseases and this is a disease caused by the
disturbance of a normal physiological function of the body. So these are all of our endocrine
disorders and disturbances of the fluid in electrolyte imbalances. Some endocrine disorders,
thyroid disorders, microadenoma's, macroadenoma's. Fluid imbalance is dehydration and homeostasis
as well. Here's just a quick image of MRI and those of you who haven't seen an MR of
the pituitary gland this is what we call microadenoma and we can see within the cell of turcica
we have the pituitary gland. Let me see if I can get my pen here. So right here is your
cell of turcica, well that's a terrible drawing and you saw this darker spot here which does
not enhance with contrast and that is a microadenoma and you can see now the cell of turcica is
enlarged and you can see the adenoma right here not enhanced and that is a macroadenoma,
an enlargement of the pituitary gland. We're going to go over those a little bit more when
we get to the metabolic diseases and endocrine disorders. Now we have traumatic diseases
and the traumatic diseases well these may result from mechanical forces such as crushing,
twisting, or body part from the effects of ionizing radiation from the body. These are
fractures, wounds, bruises and contusions. And we use a lot of CT for these types of
things especially when it comes to fractures of the spinal cord and the vertebrae. So here
is a burst fracture seen on CT and all of you recognize it's a lumbar vertebrae here
and this should not have cracks here. We also have an axial CT of the upper part of the
abdomen and you can see this CT demonstrates the ruptured spleen resulting from blunt trauma
from a motor vehicle accident and the patient was unrestrained and thrown from the vehicle.
So next we have neoplastic diseases and this is really diseases that result in new alteration
of tissue growth, specifically in an abnormal proliferation of cells. Do have a few terms
that we can go over here. So when a tumor cells flourish causing the patient to become
weak and emancipated this is referred to as cachexia. Some types of neoplastic diseases
are lesions then we have benign neoplasms and those are tumors that closely resemble
the cells of the origin and structure and function, they're non-cancerous. We have malignant
neoplasms and these invade and destroy adjacent structures and spread to distant sites causing
cell death. Now malignant tumors are generally called cancers which came from the Latin word
crab because of the fingerlike projections that extend into the underlying tissues. They
resemble crab like claws I guess. We have metastatic spread and these malignant neoplasms
travel to distant size by one of three pathways and the first one is the hematogenous spread
this is throughout the blood. You have lymphatic spread. This is the most common and major
route of metastatic spread through the lymphatic system. And then you have seeding and that's
when you invade the natural body cavities like a neuroblastoma may spread to the ventricles
and go down the CSF to form a new tumor on the spinal cord. That's called seeding. Some
common terms you should be familiar with are carcinoma versus sarcoma, chondroma, adenoma,
adenocarcinoma, fibroma, lipoma. So what are all of these -omas? [inaudible] they're all
tumors but a carcinoma is a malignancy of epithelial cell origin. Next we have sarcomas,
those are malignant tumors arising from the connective tissue and we use a lot of MRI
and CT for your sarcomas. Now your chondromas are your benign cartilage type tumors. We
have adenomas and these are tumors that grow in a gland like pattern, like a microadenoma
of the pituitary gland like we saw earlier. Adenocarcinoma is our glandular cell malignancy.
Next you have fibromas and those are the benign tumors consisting of fibrous tissue and lipomas,
the soft fatty tissue tumors. Now I took this chart here found on page ten of your book
with common word roots you should be familiar with. Remember adeno- is gland, or angio-
is vascular, chondro- is cartilage, fibro- is fibrous, hemangio- is blood vessels, lipo-like
you said is adipose. Myo-is our muscle and neuro- is nerve and osteo- is our bone. So
we have a x-ray here of a osteosarcoma that has really replaced the distal femoral condyle
and then here is the same image again on MRI and you can see the fats suppressed or protundancy
image here is being the tumor is being replaced again by the osteosarcoma. We have grading
and staging of tumors and really grading is the assessing the tumor aggressiveness the
biological behavior or the degree of malignancy. Ok and our staging is the tumors extensiveness
at the primary site and the presence of metastases throughout the body. And we have altered cellular
biology and again this is out of your book and you should know the difference between
these terms. When you have atrophy again the decrease in cell size, excuse me hypertrophy
generalized increase in cell size again, hyperplasma increased in the number of cells in a tissue
as a result of excessive proliferation. You have metaplasia is an abnormal of a specific
cell into another type of cell. Dysplasia is the abnormal change in mature cells also
called atypical hyperplasia and you have anaplasia absence of the tumor cell differentiation
and it's loss of cellular organization. So those who are pulled directly out of your
book. So what I want you to review for the quiz is pages two through twelve in book.
Ok you have your six disease classifications in the examples that I want you to know. I
want you to know some of these pathological terms that we went over. I want you to know
the difference between your sign versus a symptom and the definitions of the disease
process and the inflammatory process. The differences between your benign and malignant
tumors, your immunity and reactions, your grading and staging and your altered cellular
biology. Alright good luck and we will have your muscular skeletal discussion up shortly.