UNIT 4 : CLASSIFICATION OF DISEASES

Congenital and Hereditary

Birth Defect: Any structural/functional disorder present at birth. -Genetically determined -Environmentally influenced during gestation.

Circulatory Disorders

Circulatory system: -Heart (central pumping station) -arteries, arterioles, capillaries, small venules, veins (series of channels through which blood is pumped, collected, and returned to the heart) Circulatory disturbances: 1. Affect restricted/ localized areas of the body 2. Produce generalized changes

Inflammation -Sum of reactions in the body, incited by an injury. -Not a pathologic condition -Active exaggeration of physiologic processes set in motion by an irritant or injurious agent.

Degenerative or Retrogressive diseases

1. Atrophy Decrease in size of part or organ of the body (previously normal in size) 2. Degenerations -Regressive tissue alterations -Char: -swelling of cells -chemical changes within the cytoplasm (appearance of normally absent substances inside the cell)

Metabolic Disturbances

Gout, Uric Acid infarcts, Pigmentation, Stones

Nutritional Deficiency States

Rickets/ Rachitis, Pellagra, Beriberi, Scurvy, Primary vit.deficiency, Secondary vit.deficiency, malnutrition, protein-calories deficiency, kwashiorkor, iron deficiency, calcium deficiency, potassium deficiency, iodine deficiency.

Neoplasms -Special + abnormal type of excessive tissue growth of a destructive nature. -serves no purpose, has a predisposition toward increasing in size-progressing-persisting at the expense of the body. -Not controlled, limited or regulated by any factors normally restraining growth and multiplication of cells in the body.

CONGENITAL & HEREDITARY DISEASE

Hereditary Diseases

-Disturbances in the inheritance mechanism -Inherited traits/char received from ancestors, transmissible to offspring -May skip generation 1. Normal = body physique, hair color, eye color, mental capabilities, emotional make up 2. Abnormal = coor blindness, mental deficiencies, tendency towards allergic condition, drugs susceptibility, predisposition toward metabolic diseases **Familial disorders = inherited, run in the families,

Congenital Disorders/ anomalies

-First 3 months after conception -Result from a failure/ abnormality in the developmental process -occurs in the embryo -neither present at birth or shortly thereafter -don’t need to have a genetic basis Ex : harelip, cleft palate, spina bifida

Traumatic lesions

-Abnormalities sustained at delivery time. -Birth trauma indicates : obstetric problems (prolonged labor, difficulty of large head passing a small pelvis)

CIRCULATORY DISORDERS

HYPEREMIA Congestion, excess of blood in a body part

HEMORRHAGE Blood escape from vasucular system -(hemorrhage per rhexis) rupture of heart of vascular wall -(hemorrhage per diapedesis) passage of RBC through intact capillary walls w/o visible injury

EDEMA Constant amount of fluid maintained in the tissues by balanced relation between fluid passage from capillaries to the tissue spaces, and its removal from tissue spaces by lymph channel/ its return to capillaries. EDEMA : Balance is upset, excessive amount of fluid accumulates in the tissue outside BV

SHOCK -State of collapse that follows severe tissue injury. -Disturbance of the circulation wherein there’s an acute reductino in blood flow and inadequate supply to body tissue. -Dramatic event clinically, weakness, pallor, rapid feeble pulse, low BP. *Cardiogenic shock = cardiac malfunction

*Peripheral circulatory collapse = pathologic processes of the rest of the circulation.

THROMBOSIS -Formation of a solid mass(thrombus) /blood clot, within heart/BV during life. *Thrombi = composed of all blood constituents in normal proportion or 1/more components to the exclusion of others Ex: platelet and fibrins, or only platelet Attached to 1 spot of wall of a vessel and protrude into the vessel for a short distance…. *Parietal thrombi = leaving a passageway for the blood *Obstructive thrombi = completely occlude the vessel

EMBOLISM Condition of a solid/gaseous object (embolus) floating free in the blood stream. *Emboli = portion of thrombi, clumps of fibrin from diseased heart valves, atheromatous material from vessel wall, agglutinated bacteria, tumor cells, air, fat, animal parasites, foregin bodies (bullet). Emboli = sterile/septic.

ISCHEMIA, INFARCTION

Crucial reduction in the arterial supply of a part of the body. ISCHEMIC FOCUS -reduced in size, pale & cold, functionally less acti ve -persistent = necrosis of tissue INFARCTION = Necrosis of tissue caused by interference in blood supply. -Artery supplying organ/part occluded area becomes necrotic.

GANGRENE An area of ischemic necrosis/infarct becomes the site of growth of saprophytic bacteria.

CIRCULATORY DISORDERS: HYPEREMIA

Active/ arterial

-Increase of arterial blood -site : red & warmer a) Active physiologic = supply nourishment to organs/tissue doing increased work b) Active pathologic = initiates inflammation, forms a feature of inflammation

Passive/venous

-Increase blood produced by interference with the venous return -always pathologic a)Localized passive = because of vein obstruction by: -thrombus/embolus -thickening of a vessel wall -pressure from outside lesion (neoplasm, scar contraction, enlarged/ misplaced organ) Site: bluish red, swollen (asso.edema), cold. b) Generalized passive = because of an obstruction to the passage of blood through a diseased heart. -heart may be in failure -pump efficiency is impaired -blood is dammed back into veins draining in blood from gen. circulation -blood flow effectivity is reduced -anoxemia (less blood is oxygenated) -dyspnea (shortness of breath) -cyanosis (bluish discoloration of lips, nail beds, mucus membranes) -edema of lower extremities often present.

CIRCULATORY DISORDERS: HEMORRHAGE Causes: -Mechanical injury of the heart/ vessels -Disease/altered function of BV walls -Defects in factors related to the blood clotting Types of Hemorrhage

Apoplexy Hemorrhage & its effect within cranial activity

Cardiac tamponade

Amount of blood in pericardial cavity is enough to interfere with action of the heart

Contusions/ bruise

Impact of a blunt injury transmitted throught the skin to the subcutaneous tissue with enough physical force to tear the walls of small BV, causing hemorrhage to the tissue but without a break in the overlying skin. When the bleeding is superficial, the bruise is visible almost at once through the skin.

Ecchymoses Larger than petechiae >10mL

Epistaxis nosebleed

Hematemesis Vomiting of blood

Hematomas Tumorlike collection of blood in the tissue

Hematuria RBC in the urine

Hemopericardium Blood in pericardial cavity

Hemoperitoneum Blood in peritoneal cavity

Hemoptysis Blood in the sputum

Hemothorax Accumulation of blood into pleural cavities

Menorrhagia Excessive uterine bleeding during menstrual period

Metrorrhagia Uterus bleeding between mestrual period

Petechia Very small hemorrhage in the tissue

Purpura 3-10ml, presence of varying hemorrhage size in widespread areas of the skin and mucus membranes

CIRCULATORY DISORDERS: EDEMA Causes -weakened heart action in heart failure -venous obstruction -nephritis -nutritional factors -allergy -inflammation -lymphatic obstruction TYPES OF EDEMA

Ascites Fluid in the periotenal cavity

Anasarca/Dropsy Generalized collection of edema fluid in body cavities

Hydropericardium Fluid in the pericardial cavity

Hydrothorax Fluid in the pleural cavity

Transudates Collection of edema fluid in the tissue/body cavities

CIRCULATORY DISORDERS: SHOCK

Primary Fainting/syncope. -Develops right after injury, tends to be of short duration, usually mild. -presumed to be caused by a neurovascular reaction elicited by pain, emotion, and nerve impulses arising in injured tissues. -after more severe injuries, prolonged primary shock may merege imperceptibly into secondary shock.

Secondary -State of collapse and prostration after injury, requires interval of time to develop. -Surgical, wound or traumatic shock, more severe than primary shock. -trauma, crush injuries, burn, severe and fulminating infections (pneumonia, septicemia, diptheria, gas gangrene, acute peritonitis), heatstroke, freezing injury, radiation injury, blood transfusion reaction, bile peritonitis, myocardial infarction, anesthetic accidents, drowning, asphyxia from CO, perforation of abdominal viscera, pancreatitis, poisonings by chemical agents

Hemorrhagic Occurs after sudden and rapid loss of significant amount of blood. -related to blood loss -associated with many severe traumatic injuries with sizable hemorrhage -secondary shock + coexistance of hemorrhagic shock

Manifestation of patients with secondary shock:

Body Very weak, restless, trash about, exceedingly thirsty

pulse Rapid, feeble

Body temperature Low

Body extremities Cold, clammy

BP Quite low, hard to determine

breathing Swallow

eyes Sunken

Urinary output Oliguria (very small amt), anuria (no urine at all)

CIRCULATORY DISORDERS: THROMBOSIS CAUSES: -BV lining injury by trauma, inflammation or degeneration -slowing of blood flow -eddies in the bloodstream -diseases of the blood itself CIRCULATORY DISORDERS: ISCHEMIA AND INFARCTION CAUSES OF ISCHEMIA: -Embolus/thrombus -external pressure -thickening of vessel wall -nervous influences -action of drugs/cold CIRCULATORY DISORDERS: GANGRENE

DRY No bacteria/infection. -Interference in the artery supply of a part without invasion by saprophytes. -NOT TRUE GANGRENE -an infarct -confined almost entirely to the extremities

-skin color: purplish brown/black -complete mummification -slow spreading

MOIST -TRUE gangrene -rapid spread -saprophytic invasion -affect extremities and internal organs -caused by mechanical obstruction, compression by fibrous bands, twisting of pedicles and thrombosis or embolism of blood vessels -part: cold, swollen, pulseless -skin: moist, black, undertension, blebs on the surface, liquefaction occurs, foul odors

INFLAMMATION PURPOSES:

1. Destroy irritating and injurious agent, remove it, and its related by-products

2. Limit the extension of the causative agent, and its effects through the body

3. Repair or replacement of tissue damaged or destroyed by offending agent

PARTS OF INFLAMMATORY PROCESS

1. Localized vascular and cellular process at injury site

2. Gen. body reactions (fever, leukocytosis, Ab formation)

3. Events designed to repair the injury done and restore part to normal

CAUSES:

Living agents

Infection. Bacteria, viruses, fungi, protozoan parasites, metazoan parasites, isects, higher plants and animals

Nonliving agents

-Physical Mechanical agents of trauma (knives, guns, sharp edged weapons, extremes of cold, electricity, radiant energy) -Chemical Strong acids, alkalis, irritating gases -Immunologic Consequent to Ag-Ab reaction

TYPES ACCORDING TO THE TIME

Acute Few days – few weeks **PMN **fluid & fibrin

Chronic Many months – many years. Causative agent is able to persist partly unchecked by the body for an indefinite periode of time. Or is able to produce injury in the body repeated over a period of time. **Chiefly lymphocytes, plasma cells + pus sometimes. **no fibrin **little fluid **proliferation of conn. Tissue cells

Subacute Intermediate. Few weeks – few months

KINDS OF EXUDATE

Catarrhal Inflammation of mucous membrane + great outpouring of mucus, like in cold

Fibrinous -Presence of large amount of fibrin. -Occurs most frequently on the serous surface of body cavities. -Often lead to permanent fibrous adhesions (fibrin once deposited in serous cavity is poorly reabsorbed by the body)

Hemorrhagic Has many RBC, damage to capillaries and consequent diapedesis

Pseudomembranous Necrosis of epithelium when fibrin is deposited on ept surface, many leukocytes, dead ept cells, bacteria are enmeshed in fibrin threads. Ex: throat of diptheria.

Purulent PMN (pus) Caused by pyogenic organisms (strep, staph, pneumo, menigo, gono)

Serous Liquid portion (serum) + few cells + little fibrin. Simplest form of acute inflammation, often represent earlies type of exudative process + few leukocytes.

If 2 components of exudate are prominent, the inflammatory exudate is so designated (eg: serofibrinous, fibrinopurulent) CARDINAL SIGNS OF INFLAMMATION (RuDoTuCaf)

Rubor/Redness Increase in blood flow + stagnation + engorgement of BV

Dolor/Pain Pressure + action of toxic substances in sensory nerve endings. >>solid & inelastic tissue, >> severe pain *throbing quality of the pain = from increased pressure

transferred from BV with each heartbeat to the nerve endings at the site of inflammation.

Tumor/Swelling Presence of inflammatory exudate + increase amt of blood

Calor/Heat Increase blood in the part, and increase in rate of flow.

Functio laesa/ disturbance of function

Pain + interference with nerve supply + limitation of movement because of inflammatory exudate and destruction of tissue.

SYSTEMIC RECOGNITION IN ACUTE INFLAMMATION -Fever -Increased WBC (leukocytosis) with increased proportion of neutrophils (shift to left) -elevated ESR -Increased lever of CRP in serum DEGENERATIVE /RETROGRESSIVE DISEASES : DEGENERATIONS

Cloudy swelling -Most common, least damaging -occurs in all infectious diseases -follows extensive burns , maybe found with inanition -organs: liver, kidneys, less heart muscle -caused by increased water content in the affected cells (enlarged) -cloudy cytoplasm -organ: large, pale, plump, dipped in water apprearance. -complete recovery -on severe action of causative agent, cloudy swelling may change to fatty metamorphosis/necrosis

Hydrophic degeneration

-similar to cloudy swelling -water content of cells is sogreat -globues are visible microscopically in cytoplasm form

Fatty metamorphosis/ fatty change

-Abnormal accum. / distribution of visible fat in parenchymal cells -liver: heavier, yellowish, soft, rounded margins, greasy cut surface. -follow couldy swelling -may be present in metallic poisoning, anoxic states, chronic passive hyperemia, prolonged fevers, chronic alcoholism, malnutrition, chronic wasting diseases. -other organs: heart, kidneys, (follow severe anemia, severe infections, ingestions of chemical poisons)

Amyloid tissue -unexplained accumof pathologic, waxy starchlike protein subs, formed in the body, deposited in various organs (kidneys, liver, spleen, adrenal glands) -accompaniment of long-continued suppurative conditions (tuberculosis + osteomyelitis)

Pathologic calcification

-deposit within tissue of earthly salts w/o consistent attempt at bone formation. -most found in dead/dying tissue and maybe aftermath of various types of degeneration. Ex: tuberculous areas, arteriosclerosis, tumors, trichinosis

Hyaline degeneration

Conn.tissue take on a glassy appearance

Mucoid degeneration

Cells of certain tumor swell and become converted into jellylike masses

METABOLIC DISTURBANCES

Gout Abnormality in metabolism of UA in the body + accum of large amount of UA in the blood (hyperuricemia) & body tissues. *Tophi (deposition of crystalline urate) in the joints, kidneys, cartilage of external ear & eyelid. Char : acute attacks during there’s intensely painful swelling of joints.

Uric acid infarcts

Increased UA excretion shortly after birth, extensive deposits of UA in renal tubules of newborn infant.

Pigmentation -Endogenous pigmentation Increase amount or irregularity in distribution of normal pigments -Exogenous pigmentation Deposition within tissue of pigments that gain access to the body from without by way of the mouth, lungs, or skin.

Stones/Calculi Solid calcific masses formed within the passages or hollow organs of the body

METABOLIC DISTURBANCES: PIGMENTATION ENDOGENOUS PIGMENTATION

Freckles Localized areas, increased melanin content of the skin

Albinism Congenital absence of melanin from skin & eyes

Pigment moles Tumors made up of melanin containing cells.

or nevi & malignant melanomas

MM : rapidly fatal tumors.

Icterus/ jaundice

Retention within the body of bilirubin, pigment giving color to bile.

EXOGENOUS PIGMENTATION

Carotenemia Yellow discoloration of the skin, folow the consumption of large amounts of carotene

Anthracosis Large amounts of dust (carbon pigments/coal dust) are inhaled over long periods of time. A portion is deposited in the lungs & lymph nodes receiving drainage from the lungs.

Argyria Medications containing silver salts are taken over a long period of time. Conjuctivae and skin assume an ashen gray color (caused by deposit of silver albuminate just beneath the epithelium)

Plumbism Formation of blue line known as lead line along the margins of the gums caused by chronic lead poisoning.

KINDS OF CALCULI

Bladder stones

Vesical calculi

Broncholiths Calculi in the bronchi

Choleliths Gallstones

Fecaliths Stone made up of feces and found in the appendix

Pneumoliths Stones in the substances of the lungs

Prostatic calculi

Deposit of salts on corpora amylacea

Renal Calculi Kidney stones

Rhinoliths Stones formed in the nose

NUTRITIONAL DEFICIENCY STATES

Rickets/ rachitis

-Constitutional disease of infancy. -Diet deficiency in Vit D -overproduction of bone matrix in the skeleton, deficient in bone salts -incomplete and imperfect calcified growth and development of bones Clinical features: bone deformity, long bones, bones of the skull

Pellagra -Seasonal variation -Skin erruption, GI disturbances, nervous and mental changes -diet deficiency in nicotinic acid & vit B complex

Beriberi Polyneuritis -diet deficient in Vit B1 (thiamine hydrochloride) -disturbances in sensation and motion, dropsy, involvement of the heart

Scurvy Lack of Vit C (ascorbic acid)

Primary Vit Deficiency

Inadequate intake of specific vitamin

Secondary vit deficiency

Vitamin intake is adequate, another factor is operative (failure of absorption, failure of utilization, increase need/loss from the body)

Malnutrition Extrinsic : Environment, availability of food in certain geo location, cultural attitudes on certain foods. Intrinsic : interfere with proper absorption and utilization of nutrients. Genetic factors, rare deficiency states, unable to metabolize given nutrients. Iatrogenic: therapeutic drugs, block the metabolism of nutrients in the body.

Protein calorie deficiency

Starvation : deficient calorie intake, relative to caloric expenditure. Consequence : protein deficiency. Marasmus : severe state.

Kwashiorkor Protein def. in infants in certain tropical and semitropical areas. Px: very sick, edematous, skin rash, depigmented hair, fatty liver

Iron deficiency

Consequence: anemia

Ca def

K def

Iodine def

NEOPLASMS NEOPLASTIC TISSUE:

Parenchyma Active element of tumor, made up of tumor cells

Stroma Conn. Tissue framework with lymphatic and vascular channels

Grading factors: -Cells polarity -N:C ration -Number & char of mitosis -Hyperchromaticity

DIAGNOSTIC FEATURES OF TUMOR CELLS

Changes of Intercellular structural pattern -increase in size -irregular shape -Irregular pattern -anisocytosis & anisokaryosis observed in clusters -indistinct cell membrane -excessive grouping and crowding of cells to form clusters

Cytoplasmic changes -Acidophilia/marked orangeophilia -excessive cytoplasmic inclusion bodies -abnormal vacuolation

Nuclear changes -large nucleus (low N:C ratio) -irregular nucleus (size, shape) -more deeply pigmented (hyperchromaticity due to increased DNA) -multinucleated, abnormal cell division (more mitotic activity) -increase in # & size of nucleoli -increased distribution and irregular size of chromatin materials -markedly thickened nuclear membrane -necrotic/degenerative changes (abnormal vacuolation, dissolution of nucleus)

CLASSIFICATION OF NEOPLASMS CLINICAL MANIFESTATION

Benign Innocent, little harm, not life threatening, nonmalignant. -common in younger age, grow slowly, usually by expansion -not fixed to the tissues, easily removed at operation with less changes for recurrences -usually encapsulated and movable. -rare metastasis, no blood or lymphatic invasion -no cachexia (anemia and emaciation) -cells: normal, differentiated, less mitotic figures (<1/1000), not hyperchromatic, less tendency to hemorrhage and necrosis

Malignant Very dangerous, cause death -common in older age, grow rapidly, infiltration or by expansion, more fixed to tissues -not encapsulated, more difficult to remove, high tendency for recurrence -Metastasis is produced through lymphatic and blood invasion, produce ultimate death by cachexia, mechanical pressure or hemorrhage or infection. -malignant cells = indifferentiated, more mitotic figures (20/1000), hyperchromatic, more tendency to hemorrhage and necrosis.

HISTOLOGIC CLASSIFICATION (origin and nature of cells composing the neoplasm) *Tissue of origin = tissue/group of cells in which neoplasm arises

Benign Suffix –oma + stem (name of tissue from which tumor is derived)

Malignant a) carcinoma (tumor of epithelia origin) b) sarcoma (tumor of connective tissue origin)

NEOPLASM FROM EPITHELIUM

Tissue of origin Benign Malignant

Pavement epithelium (squamous, transitional)

Papilloma -Squamous cell (epidermoid) carcinoma -Basal cell carcinoma -Transitional (urothelial) cell CA

Glandular epithelium -Adenoma -Cystadenoma -Adenomatous polyp

-Adenocarcinoma -Cystadenocarcinoma

NEOPLASM ARISING FROM CONNECTIVE

Tissue of origin benign Malignant

Fibrous (adult type) Fibroma Fibrosarcoma

Embryonic tissue Myxoma Myxosarcoma

Fat Lipoma Liposarcoma

Cartilage Chrondoma Chrondrosarcoma

Bone Osteoma Osteochrondroma

Osteosarcoma

Synovial membrane Synovioma Synovial sarcoma

Serous membrane Benign mesothelioma Malignant mesothelioma

NEOPLASM OF MUSCLE

Tissue of origin benign Malignant

Smooth muscle Leiomyoma Leiomyosarcoma

Striated muscle rhabdomyoma Rhabomyosarcoma

NEOPLASM ARISING IN NERVOUS SYSTEM

Tissue of origin benign Malignant

Peripheral nerve sheats Neuroma Neurofibroma Neurilemoma

Neurogenic sarcoma (neurofibrosarcoma)

Sympathetic nervous system

Ganglioneuroma (neurinoma)

Neuroblastoma

Neuroglia Glioma

Meninges Meningioma Retinoblastoma

NEOPLASMS OF ENDOTHELIUM AND STRUCTURES

Tissue of origin benign Malignant

Blood vessels Hemangioma Hemangioendothelioma (hemangiosarcoma) Angiosarcoma

Lymph vessels Lymphangioma Lymphangiosarcoma Lymphangioendothelioma

Bone marrow Multiple myeloma Leukemia

Lymphoid tissue Malignant lymphoma Hodgkin’s disease Lymphosarcoma

PIGMENTED NEOPLASM

Tissue of origin benign Malignant

Melanocytes Nevus Malignant melanoma

NEOPLASM OF TROPHECTODERM

Tissue of origin benign Malignant

Trophoblasts of placenta villi

Hyatidiform mole Chroriocarcinoma (chroioepithelioma)

COMPLEX NEOPLASMS OCCURING IN

Tissue of origin benign Malignant

Ovary Dermoid cyst Teratoma

Testis Teratoma Choriocarcinoma

Kidney Mixed tumor

Salivary glands Mixed tumor