Practical 4 Cardivascular and Hepatobiliary System
Transcript of Practical 4 Cardivascular and Hepatobiliary System
8/18/2019 Practical 4 Cardivascular and Hepatobiliary System
http://slidepdf.com/reader/full/practical-4-cardivascular-and-hepatobiliary-system 1/9
UTAR UDDD 2124
ESSENTIAL PATHOLOGY
Year 2 Sem 1
Practical 4
GASTROINTESTINAL TRACT CARDIOVASCULAR SYSTEM
Atherosclerosis
General gross description
- lesions in childhood appear as fatty streaks
- adults plaques are discrete, yellow white random elevations, more prominent around ostia
of large branches, abdominal aorta and coronary, internal carotid and cerebral arteries
- plaque may have sclerotic firm surfaces, or ulcerate with soft exposed material
-
plaques may become confluent with thrombosis- severity increases with age, into very old age
General Microscopic Description
- an intimal lesion, made up of a deposition of fats, cholesterol`l esters, necrotic debris and
foam cells with a variable chronic fibrotic inflammatory response forming a superficial
fibrous cap containing smooth muscle and foam cells and lymphocytes
- complications are ulcers with ulcers with thrombi, bleeding into plaque, embolization of
thrombi and/or atheroma, calcifications and atrophy of media with formation of aneurysm
Ruptured
plaque
Lumen
thickening of
intima layer
8/18/2019 Practical 4 Cardivascular and Hepatobiliary System
http://slidepdf.com/reader/full/practical-4-cardivascular-and-hepatobiliary-system 2/9
Advanced plaque
- note the discrete intimal nodulae thickening the arterial wall, obstruction of lumen and
ruptures of atheromatous plaque
- the increased cellularity is made up of both fibroblasts and smooth muscle cells
-
the proliferation of these cells is a major component of the genesis of the atherosclerotic plaque
field shows atheromatous plaque in intima layer
The more deeply pinker staining right upper portion of the field is the sclerotic fibrous
cap. the lighter stain elsewhere is due to deposition of neutral fats which are washed out
by the tissue processing for slide preparation
note the slit like clear spaces which were occupied by washed out cholesterol esters
crystals before processing
the fine blue stipples throughout are calcific spherules
the high magnification the atheroma shows numerous foam cells and an occationalcholesterol cleft. a few dark blue inflammatory cells are scatter within the atheroma.
Foam cells filled with lipid appear as large, pale staining cells very vacuolated cytoplasm.
These cells may derive form myointimal cells or macrophage. As the lesion progress
some of the foam cells break down and liberate free lipid into the intima where it is
represented by non staining angular clefts.
Question
1. Draw and describe the histopathological changes of the given slide
2.
Explain the pathogenesis of atheroma formation
3. Discuss the sequelae of atherosclerosis
8/18/2019 Practical 4 Cardivascular and Hepatobiliary System
http://slidepdf.com/reader/full/practical-4-cardivascular-and-hepatobiliary-system 3/9
Myocardial Infarct
General Gross Description
- lesions not visible before 18 – 24 hours after onset
- size variable up to entire transverse sectional area
- may involve partial (subendocardial) or full (transmural) thickness of left ventricular wall
- Earliest change is a poorly defines pale area some with hemorrhagic changes. Area
defines better with time turning yellow with a pink margin of organizing tissue and
finally a discrete scar.
General Microscopic Description
- Earliest changes at 4 to 12 hours, shows feature of acute inflammation processes; nuclear
necrosis, muscle coagulative necrosis at 24-72 hours, loss of fiber nuclei and heavy
neutrophilic infiltrate
- Macrophage phagocytic activity and early organization at 3 to 7 days; healed scar by 7
weeks.
early acute MI
- note the copious exudates of neutrophils (PMN) between the muscle fibers
- note the absence of nuclei in the myocardial fibers indicating necrosis, eg infarction
- PMN’s have a life span of 24 hours and then undergo karyorrhexis which is not seen here
suggesting that this lesion is less than 2 days old.
8/18/2019 Practical 4 Cardivascular and Hepatobiliary System
http://slidepdf.com/reader/full/practical-4-cardivascular-and-hepatobiliary-system 4/9
Healing acute MI
- capillaries, elongate fibroblast nuclei, collagen fibrils and macrophages all typical
components of granulation tissue can be seen
- macrophages can be seen containing a dark pigment which is probably hemosiderin
because of the color and variation in particle size
- the rest, wave fibers are collagen and represent the scar tissue that will ultimately replace
the dead myocardium
8/18/2019 Practical 4 Cardivascular and Hepatobiliary System
http://slidepdf.com/reader/full/practical-4-cardivascular-and-hepatobiliary-system 5/9
Healed old myocardial infarct
- this is a myocardial infarct perhaps hypertrophic fibers
- the extra cellular matrix appears sparsely cellular and densely collagenized indicating that
this is an old lesions from a few months to years old
Questions
1. Draw and describe the histopathological changes of the given slide
2. Identify the stage of infarction.
Cirrhosis of liver
Cirrhosis is the end result of continued damage to liver cells from a great many causes. It is
characterized by wholesale disruption of the liver architecture and the formation of nodules of
regenerating liver cells separated by fibrous band. There are two main effects of this altered liver
architecture and cellular damage namely disturbance of blood flow through the liver from portal
vein to hepatic vein. The classification of cirrhosis is based on the disease which causes theunderlying liver damage. The most important causes are chronic alchol abuse, chronic hepatitis
and biliary cirrhosis. In small percentage of cases no underlying disease can be found: this is
known as cryptogenic cirrhosis.
8/18/2019 Practical 4 Cardivascular and Hepatobiliary System
http://slidepdf.com/reader/full/practical-4-cardivascular-and-hepatobiliary-system 6/9
General Gross Description
Macronodular Cirrhosis: Larger nodules
separated by wider scars and irregularly
distributed throughout the liver usually due
to an infectious agent such as viral hepatitis
which does not diffuse uniformly throughout
the liver.
Microndular Cirrhosis: Small rather
uniform• 2m nodules seperated by thin
fibroussepta usually due to a chemicalagent
as alcohol which diffuseuniformly throught
the liver.
General Microscopic Description
Alcoholic cirrhosis
- broad fibrous bands connecting portal areas and intervening nodules of liver cells
-
marked fatty changes
8/18/2019 Practical 4 Cardivascular and Hepatobiliary System
http://slidepdf.com/reader/full/practical-4-cardivascular-and-hepatobiliary-system 7/9
Cryptogenic cirrhosis
- bands of fibrous tissue disrupting the lobular architecture
- no inflammation, fatty changes or specific features
Cirrhosis due to progressive chronic hepatitis
- the portal tracts contain large number of chronic inflammatory cells and in some area
these inflammatory cells spill over the limiting plate into nodules of hepatocytes
-
fibrous bands containing inflammatory cells found
1. Identify the type of liver cirrhosis and describe the features.
8/18/2019 Practical 4 Cardivascular and Hepatobiliary System
http://slidepdf.com/reader/full/practical-4-cardivascular-and-hepatobiliary-system 8/9
Metastatic carcinoma of liver
Though most any type of cancer may metastasize to the liver, some are more likely to do so than
others. Breast, lung, colorectal, stomach, pancreas, and small intestine tumors are among those
that are most closely associated with the liver. The prognosis of an individual with metastases in
the liver is to some extent related to the site of the primary cancer.
General Gross Description
- Separate lesions (not clustered)
- Necrotic tissue
General Microscopic Description
Liver-Metastatic pulmonary small cell carcinoma.
nests of small primitive appearing epithelial cells with hyperchromatic nuclei and high nuclear
to cytoplasmic ratio
8/18/2019 Practical 4 Cardivascular and Hepatobiliary System
http://slidepdf.com/reader/full/practical-4-cardivascular-and-hepatobiliary-system 9/9
Liver-Metastatic adenocarcinoma of stomach
Glandular type carcinoma can be found with hyperchromatic nuclei and high nuclear to
cytoplasmic ratio
1. Identify the type of metastatic carcinoma in liver and describe the features.