Patho4 Cdsa Circulatory

TISSUE REACTIONS TO INJURY FLUID AND HEMODYNAMIC DISTURBANCES

Prepared by Emmanuel R. de la Fuente, M.D.

Objectives 2. Recognize the essential morphology of important fluid and hemodynamic changes. 3. Identify and describe these morphologic changes. 4. Briefly discuss the etiopathogenesis of these lesions. 5. Correlate these changes with situational events.

Situation No. 1 A 42 year old woman was suffering from periodic abdominal pains. She was diagnosed by ultrasound to have uterine leiomyomas. A hysterectomy was performed. The appendix was also removed.

The appendix prior to its removal is seen at the left photo. Do you see any lesion? Describe the gross and microscopic lesions, if any.

Situation no. 2 A 12 year-old body complained of pain and tenderness in the right iliac region. These were accompanied by leukocytosis, predominantly neutrophils, and fever. An appendectomy was performed.

Appendectomy specimen. Indicate and describe the lesion. Compare with the previous appendix in Situation no. 1

Section of the appendix. Indicate and describe the lesions. Right picture is a higher magnification. How should this circulatory disturbance be classified? Give basis.

1. Correlate the gross and microscpic features. 2. Briefly discuss the etiopathogenesis of this type of circulatory disturbance. 3. Correlate this lesion with the situational events. 4. Study the following glass slides and identify this type of circulatory disturbance: 1) No. GIAP 2) GI – 008 3) GI – 009

Situation no. 3 A 57 year-old hypertensive man suffered a massive myocardial infarction of the left ventricle. This was accompanied by dyspnea caused by acute congestive heart failure. After a week the patient was in chronic congestive heart failure.

Three lung lesions showing the different phases of the expected circulatory disturbance. Indicate the lesions and describe each. How should these lesions be categorized?

A

B

C

1. If all three lesions had occurred in the lungs of the patient, arrange these lesions in chronological order according to their appearance from the time of myocardial infarction to that after a week. Explain. 2. Briefly discuss the pathogenesis of these lesions. 5. Study the following glass slides and identify these lesions: 1) LU – 010 2) LU – 001B

Situation no. 4 The same man in Situation No. 3 after a week went into progressive hypotension. This was accompanied by small amounts of blood coming out of the nasogastric tube. Fibrin split products were increased in the blood. From thereon he went into shock. Before he died he developed wide areas of hemorrhage all over the skin.

Gross of skin lesion. Identify and describe. How will you classify this circulatory disturbance?

Two lesions: A is from the intestine, and B is from the lung. Indicate and describe the lesions, including the lesion indicated by the arrow.

A

B

Two lesions: A is from the lung, and B is from the kidney. Identify and describe the lesions indicated by the arrows..

A

B

1. How should these lesions be categorized? 2. Briefly discuss the etiopathogenesis of the lesions, including the biomolecular aspects. 3. Correlate the lesions with the situational events. 4. Study the following glass slide and identify similar lesions: 1) GI – 038.

Situation no. 5 The same man in situation no. 3 was autopsied. The heart was markedly enlarged with gross evidence of extensive necrosis of the left myocardium. Dissection of the coronary arteries discloses severe atherosclerosis with extensive dystrophic calcification. An obstruction was noted at the left anterior descending branch.

Gross heart with affected coronary artery exposed. Identify and describe the lesions. Low and high magnifications.

Gross appearance of other areas of affected coronary artery cut serially. Identify and describe the lesion.

Microscopic sections from two areas of the affected coronary artery. Identify and describe the lesions.

1. How should the obstructive lesion be categorized? 2. Briefly discuss the etiopathogenesis of the obstructive lesion, including the biomolecular aspects.

Situation no. 6 A 58 year old woman had been bed ridden for the past month because of a chronic illness. A week prior to death, she experienced swelling of the left lower extremity accompanied by pain and tenderness. While going to the bathroom, she suddenly became dyspneic and then collapsed and died.

The event that happened to the woman that caused her sudden death is illustrated in the next slide.

Discuss this event as illustrated in the previous slides along the following areas: 1) Etiopathogenesis 2) Morphologic lesions 3) Correlate this event with the sudden death of the woman.

Opened pulmonary artery with thromboembolus saddling the right and left branches of the artery.

A vertical section through the hilus of the lung showing the thromboembolus.

A section of the pulmonary artery showing the thromboembolus. Identify and describe the features of this lesion and why this is not a post-mortem clot. Higher magnification of area within the square in the next slide.

The features seen indicate that this is a thrombus and not a post-mortem clot. Identify and describe the features. Discuss the pathogenesis.

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