White Blood Cells

White Blood Cells

1. Neutrophils
   Neutrophil:

   - They are Highly phagocytic and have defensive function.
   - They increase in number, reach the inflammed tissue and engulf bacteria which invade the body.
   
   

2. Eosinophils
   Eosinophil :

   - They are related to allergy and hypersensitivity.
   - Their number increases in allergic conditions and in parasitic worm infestations.
   - They absorb histamine released in allergic conditions
   - They prevent the toxic effects of foreign proteins.
   - They are weak phagocytes. 
   
   

3. Basophils
   Basophil:

   - They store heparin, histamine, serotonin and bradykenin.
   - They secrete heparin.
   - They are related to allergy.
   - They are not phagocytic.
   
   

4. Lymphocytes
   Lymphocytes:

   - B-lymphocytes : responsible for humoral immunity.
   - T-lymphocytes : responsible for cell-mediated immunity.
   - Natural killer cells : they act as a defense against viral infections and destroy malignant cells.
   
   

5. Monocytes
   Monocytes:

   - They are highly phagocytic and they digest bacteria and dead neutrophils.
   - Macrophages engulf and kill bacteria.
   - They play an important role in cell-mediated immunity.
   - They secret interleukin-1 which stimulate growth of lymphocytes.
   
   
   

Greater splanchnic nerve

Greater splanchnic nerve

• Preganglionic fibers :

  Arise from Lateral Horn Cells (L.H.Cs) of lower six thoracic segments.

• Relay :

  In coeliac and superior mesentric collateral ganglia.
  - Nerve fibers to adrenal medulla relay in adrenal medulla itself.

• Postganglionic fibers :

  Fibers pass along blood vessels to reach abdominal viscera.

• Functions :

  1. Splanchnic vessels : vasoconstrictor and vasodilator to the blood vessels of stomach, liver, pancreas, kidney, small intestine and proximal colon. (Vasoconstriction is more powerful )
  2. GIT : inhibitory to their walls and motor to their sphincters. Also , inhibitory to gastric and intestinal secretions and motility.
  3. Liver : stimulates glycogenolysis > increased blood glucose level
  4. Spleen : motor to splenic capsule > squeeze of blood rich in RBCs.
  5. Kidney : vasoconstriction > decreased renal blood flow and urine output. Also, stimulate renin secretion.
  6. Pancreas : inhibits insulin hormone and pancreatic juice secretion.
  7. Gall bladder : inhibitory to the wall and motor to the sphincter of oddi.
  8. Adrenal medulla : secretion of adrenaline 80% and nor-adrenalin 20% .

  
  

  

Blood circulations

Blood circulations

There are three types of circulation :

1. Pulmonary circulation :

   - Venous blood passes from the right ventricle through the pulmonary trunk to the lungs to be oxygenated.
   -Oxygenated blood returns from the lungs through 4 pulmonary veins to the left atrium.
   
   
   






2. Systemic circulation :

   - Oxygenated blood passes from the left ventricle through the aorta and its branches to supply the different tissues of the body.
   - Venous blood returns from the tissues of the body along small veins which unites to form superior vena cava, inferior vena cava and coronary sinus which open into the right atrium.
   
   
   
   
   
   
   

3. Portal circulation :

   - The portal vein drains the venous blood from stomach, intestines, spleen and pancreas and passes into the liver.
   - This blood carries the products of digestion to the liver.
   - The portal vein divides repeatedly inside the liver to end in the liver sinusoids.
   - The liver sinusoids lead to hepatic vein which join inferior vena cava.
   - Thereafter, blood in the inferior vena cava enters the right atrium.
   

Connections between arteries and veins

Connections between arteries and veins

The arteries maybe connected to veins by one of the following methods :

1. Capillaries > which connect the arterioles with the venules.
2. Arterio-venous anastomosis > these are direct connections between small arteriols and small venules
3. Sinusoids > these are irregular wide spaces connecting the arteries and veins.

Capillaries

Arterio-venous anastomosis

 Sinusoids

 

 

Types of muscles

Types of muscles

Skeletal muscles	Cardiac muscle	smooth muscles
Attached to skeleton	In myocardium	In internal viscera and blood vessels	Distribution
Voluntary	Involuntary	Involuntary	Contraction
Present	Present	Absent	Striations
Somatic	Autonomic	Autonomic	Nerve supply
Multinuclear	Branched and fused together with single nucleus	Spindle-shaped with one nucleus	Muscle cell
			Image

Synovial joints

Synovial joints

* Structure :

- The joint is enveloped by fibrous capsule.

- The capsule is thickened in some places forming ligaments.

- The capsule is lined with synovial membrane.

- The articular surface of the bone is covered by articular cartilage.

- The joint cavity contains synovial fluid.

- The joint cavity may contain other additional intracapsular structures like 

   inter-articular disc, labrum, meniscus or tendons of muscles.

* Classification :

( According to the number of axes around which movements occur )

1. Uni-axial joints ( one axis ) :
   1. Hinge joints : transverse axis > flexion and extension > elbow joint
   2. Pivot joints : vertical axis > rotation > radio-ulnar joint
2. Bi-axial joints ( two axes ) :
   1. Ellipsoid joints : flexion, extension, adduction and abduction > wrist joint 
   2. Saddle joints : flexion, extension, adduction, abduction and slight rotation > carpo-metacarpal joint of the thumb.
3. Multi-axial joints ( more than two axes ) :All types of movement are allowed > shoulder and hip joints.
4. Other types :
   1. Plane joints : the articular surface are flat > just gliding > intercarpal joints.
   2. Compound joints : more than one type in the same joint > tempro-mandibular joint.

* Illustrations :

Structure of synovial joints :

 

Inter-articular disc

Labrum

Meniscus

Hinge joint

Pivot joint

Ellipsoid joint

Saddle joint

Multi-axial joint

Plane joint

Compound joint

 

Parts of the long bone

Parts of the long bone

A long bone consists of two ends and a shaft.

- Each end is called "Epiphysis" formed of spongy bone and is covered by a layer of hylaine "articular cartilage".

- The epiphysis is separated from the shaft by epiphyseal cartilage.

- The shaft is called "Diaphysis" formed of cylinder of compact bone.

- The region of the shaft close to epiphyseal cartilage is called "Metaphysis".

-The shaft encloses medullary cavity filled with bone marrow.

- The shaft is covered with periosteum.

- The medullary cavity is lined with a membrane called " Enosteum"

 

* Illustrations :

Types of bones

Types of bones

 

• According to morphology ( shape ) :

  1. Long bones > Femur and humerus
  2. Short bones > Carpal and tarsal bones
  3. Flat bones > Scapula and bones of skull vault
  4. Irregular bones > Vertebrae and bones of skull base
  5. Pneumatic bones > Maxilla and frontal bones
  6. Sesamoid bones > Patella and pisiform bones
  7. Sutural bones > Small bones within the sutural lines of the skull

• According to structure :

  1. Compact bones > forms the outer hard layer
  2. Spongy bones > forms the inner delicate trabeculated layer

• According to development :

  1. Membranous bones > Develop in the dense membrane of the mesoderm
  2. Cartilagenous bones > Develop in a preformed cartilagenous models

Important definitions in pathology and common pathological terms

Definitions of some common terms frequently used

in pathology

 

Pneumoconiosis

It is a chronic lung disease due to inhalation of dust.

Goiter

It is non-inflammatory , non-neoplastic enlargement of thyroid

Vegetation

An abnormal growth of a tissue around a valve composed of blood platelets, bacteria and protein involved in clotting. 

Cirrhosis

It is a chronic degeneration disease of the liver in which normal liver cells are damaged and are then replaced by scar tissue.

Teratoma

A true neoplasm made up of different types of tissues , none of these tissues is native to the area in which it occurs.

Hypertrophy

It is increase in the size of an organ due to increase in the size of its cells

Apoptosis

Programmed cell death which affects single cell surrounded by viable neighbor cells

Pathological calcification

Deposition of calcium in soft tissues due to increased uptake of calcium

Sequestrum

It is a necrotic dead piece of bone that is partially or entirely detached from the surrounding healthy bone

Amyloidosis

Deposition of amyloid ( an extacellular homogenous pink material ) in the connective tissue stroma and blood vessels' walls due to prolonged antigen-antibody reaction.

Hamartoma

It is a tumor-like malformation formed of the normal tissues of an organ but in irregular arrangement

Pyemia

It is the presence of septic emboli in the blood producing multiple abscesses in the tissues

Locally malignant tumors

They are malignant tumors characterized by local spread by infiltration but don't give metastases.

Ulcer

It is loss of surface epithelium

Granuloma

It is chronic specific infalmmation

Fistula

It is a tract communicating two surfaces

Sinus

It is a tract communicating a cavity with a surface ( blind end )

Embolism

It is impaction of embolus ( insoluble material ) in a vessel

Toxemia

It is the presence of bacterial toxins in circulating blood

Septicemia

It is the presence of large number of multiplying bacteria with their toxins in the blood

Hyperplasia

It is increase in the size of an organ due to increase in the number of its cells

Metaplasia

It is a change of differentiated tissue into another differentiated tissue of the same type

Regeneration

It is replacement of lost cells by similar new cells

Atelectasis

Incomplete expansion of the lungs or collapse of previously expanded lungs

Salpingitis

Inflammation of fallopian ( uterine ) tubes

Aneurysm

Localized dilatation of an artery

Infarction

It is an area of coagulative ( except brain which is liquafactive) necrosis due to complete ischemia.

Endometriosis

It is the presence of endometrial tissue in abnormal sites

Leukoplakia

White patches of oral mucosa and tongue due to chronic irritation

Complications of some common diseases - Part 4

Complications of some common diseases - Part 4

 

• Mitral incompetence :

  1. Hypertrophy followed by dilatation of left atrium and ventricle
  2. Chronic venous congestion of lungs
  3. Pulmonary hypertension
  4. Hypertrophy followed by dilatation of right atrium and ventricle
  5. Picture of chronic venous congestion

• Aortic stenosis and incompetence :

  1. Hypertrophy followed by dilatation of left ventricle.

• Ischemic heart disease :

  1. Sudden death due to ventricular fibrillation, cardiogenic shock or acute heart failure.
  2. Myocardial infarction

• Buerger's disease :

  1. Pain due to ischemia
  2. Gangrene

• Polyarteritis nodosa :

  1. Thrombosis and infarction
  2. Mycotic aneurysms

• Infectious rhinitis :

  1. Spread of infection > sinusitis, otitis media, pharyngitis, laryngitis and bronchitis.
  2. Chronic rhinitis
  3. Anosmia which maybe permanent

• Pulmonary hypertension :

  1. Right ventricular hypertrophy and failure ( cor pulmonale )
  2. Death due to cor pulmonale ( specially in pregnant women )

• Pulmonary embolism :

  1. Small emboli > undergo fibrinolysis or organisation and canalization.
  2. Large emboli >
  1. Occlusion of pulmonary trunk or the main bronchus leading to sudden death
  2. Occlusion of small pulmonary artery leading to lung infarction only on top of chronic venous congestion of the lung.
  3. Recurrent pulmonary embolism leading to pulmonary hypertension and right-sided heart failure.

• Carcinoid syndrome of ileum :

  1. Flushing of the face due to vasodilatation
  2. Diarrhea and bronchospasm due to smooth muscle stimulation
  3. Right-sided heart failure

• Hemolytic jaundice :

  1. Splenomegaly
  2. Pigment stones of the gall bladder

• Obstructive jaundice :

  1. Itching due to bile acids
  2. Increased cholesterol and alkaline phosphatase enzyme.
  3. Hemorrhage due to vitamin K deficiency

• Carcinoma of the exocrine portion of the pancreas :

  1. Obstructive jaundice ( in carcinoma of head )
  2. Venous thrombosis ( in carcinoma of body and tail )

• Acute pyelonephritis :

  1. Papillary necrosis and renal failure
  2. Chronic pyelonephritis
  3. Recurrence

• Gonorrhea in males :

  1. Acute prosatitis
  2. Acute inflammation of seminal vesicles
  3. Epididymo-orchitis
  4. Arthritis and acute infective endocarditis
  5. Urethral stricture

• Testicular tumors :

  1. Hydrocele
  2. Germ cell tumors secrete HCG and AFP. 

• Endometriosis :

  1. Endometrial or chocolate cysts in the ovary
  2. Adhesions due to rupture of endometrial glands

• Multiple myeloma of bone marrow :

  1. Anemia, leucopenia and thrombocytopenia
  2. Hypercalcemia and metastatic calcification
  3. Pathological fracture
  4. Increased immunoglobulins in blood
  5. Increased light-chains immunoglobulins which appear in urine
  6. Obstruction of renal tubules by pericipitated protiens and metastatic calcification
  7. Secondary amyloidosis
  
  

Complications of some common diseases - Part 3

Complications of some common diseases - Part 3

 

• Acute appendicitis :

  1. Gangrene, perforation and septic peritonitis.
  2. Appendicular mass
  3. Appendicular abscess
  4. Faecal fistula
  5. Portal pyemia
  6. Mucocele of the appendix due to obstruction by fibrosis
  7. Rupture of the mucocele  leads to pseudomyxoma peritonei.

• Ulcerative colitis :

  1. Hemorrhage
  2. Perforation and septic peritonitis
  3. Malignant change

• Piles :

  1. Bleeding
  2. Inflammation
  3. Portal pyemia

• Acute hemorrhagic pancreatitis :

  1. Septic peritonitis
  2. Chronic pancreatitis
  3. Diabetes mellitus

• Acute polycystic disease :

  1. Renal failure
  2. Hypertension
  3. Haematuria due to rupture of the cyst

• Chronic pyelonephritis :

  1. Bilateral chronic renal failure
  2. Hypertension

• Hydronephrosis :

  1. Bilateral chronic renal failure
  2. Secondary infection leading to pyonephrosis.

• Renal calculi :

  1. Renal colic
  2. Haematuria
  3. Infection as cystitis and pyelonephritis.
  4. Obstruction leading to hydroureter and hydronephrosis.
  5. Squamous metaplasia of the renal pelvis and squamous cell carcinoma

• Transitional cell ( villous ) papilloma :

  1. Haematuria
  2. Cystitis
  3. Malignant change into transitional cell carcinoma

• Benign prostatic hyperplasia :

  1. Compression of prostatic urethra leading to obstruction to the flow of the urine.
  2. Hypertrophy of bladder muscle followed by dilatation, trabeculation and diverticulum formation.
  3. Stasis of urine leads to cystitis and phosphate stones
  4. Bilateral hydroureter and hydronephrosis
  5. Ascending infection leads to pyelonephritis in early stage or pyonephritis in late stage.
  6. Death due to chronic renal failure

• Gonorrhea in females :

  1. Bilateral salpingitis
  2. Pelvic peritonitis
  3. Blood spread > septicemia > arthritis and acute infective endocarditis.

• Puerperal sepsis :

  1. Salpingitis
  2. Peritonitis
  3. Pyemia
  4. Septicemia

• Endometrial hyperplasia :

  1. Uterine bleeding
  2. Malignant change

• Leiomyoma :

  1. Infection
  2. Necrosis
  3. Hyaline degeneration
  4. Malignant change into leiomyosarcoma

• Papillary cystadenoma :

  1. Malignant change is common

• Mucinous cystadenoma :

  1. Torsion of the pedicles with necrosis.
  2. Pseudomyxoma peritonei due to rupture of the cyst
  3. Malignant change is less common

• Dermoid cystadenoma :

  1. Torsion of a pedicle
  2. Rupture of a cyst leading to aseptic peritonitis.
  3. Malignant change
  4. Hyperthyroidism

• Nodular goiter :

  1. Pressure effect on the trachea and esophagus
  2. Secondary hyperthyroidism without exophthalmos
  3. Hemorrhage and necrosis
  4. Dystrophic calcification
  5. Malignant change

• Rheumatoid arthritis :

  1. Secondary amyloidosis
  2. Splenomegaly

Complications of some common diseases - Part 2

Complications of some common diseases - Part 2

 

• Acute infective endocarditis :

  1. Systemic pyemia
  2. Ulceration or perforation of the cusps leading to incompetence and heart failure.

• Mitral stenosis :

  1. The auricular thrombus leads to embolism
  2. Haemoptysis due to lung congestion
  3. Subacute infective endocarditis

• Myocardial infarction :

  1. Serofibrinous pericarditis.
  2. Rupture of recent infarct leading to haemopericardium
  3. Rupture of cardiac aneurysm leading to haemopericardium
  4. Congestive heart failure due to healing by fibrosis
  5. Detachment of mural thrombus leading to embolism

• Congenital heart disease :

  1. Heart failure
  2. Infective endocarditis

• Coarctation of the aorta :

  1. Hypertrophy followed by dilatation of left ventricle
  2. Cerebral hemorrhage due to hypertension
  3. Rupture of the aorta
  4. Infective endocarditis

• Aneurysms :

  1. Pressure effects on the surrounding structures
  2. Rupture and hemorrhage
  3. Thrombosis and embolism

• Carcinoma of larynx :

  1. Laryngeal obstruction
  2. Dysphagia due to infiltration of oesophagus
  3. Inhalation pneumonia and lung abscess

• Bronchopneumonia :

  1. Lung abscess ( more common than lobar pneumonia )
  2. Spread of infection > Pericarditis, empyemia and septicemia.
  3. Broncheictasis due to destruction of bronchial walls

• Lung abscess :

  1. Direct spread of infection leading to empyemia or septic pericarditis
  2. Blood spread of infection leading to pyemia
  3. Rupture of the cavity into the pleura leading to pyopneumothorax.
  4. Gangrene of the lung
  5. Pulmonary fibrosis
  6. Secondary amyloidosis

• Silicosis :

  1. Pulmonary hypertension and right-sided heart failure
  2. Predisposes to tuberculosis.

• Asbestosis :

  1. Pulmonary hypertension and right-sided heart failure
  2. Predisposes to bronchogenic carcinoma and pleural mesothelioma

• Hypertrophic ( obstructive ) emphysema :

  1. Barrel-shaped chest
  2. Cyanosis, dyspnea and polycythemia due to hypoxia
  3. Pulmonary hypertension and right-sided heart failure
  4. Pneumothorax due to rupture of superficial bullae.

• Atelectasis :

  1. Infection of collapsed lung leads to bronchiectasis or lung abscess.

• Pulmonary fibrosis :

  1. Pulmonary hypertension and right-sided heart failure.

• Bronchial adenoma :

  1. Haemoptysis
  2. Bronchial obstruction
  3. Carcinoid syndrome

• Bronchiolo-alveolar carcinoma :

  1. Partial bronchial obstruction leading to focal carcinoma
  2. Complete bronchial obstruction leading to atelectasis.
  3. Impaired drainage leading to bronchiectasis or lung abscesses.

• Squamous cell carcinoma of the tongue :

  1. Inhalation lung abscess.

• Pleomorphic adenoma of salivary gland :

  1. Recurrence after removal due to local extension of the tumor through the capsule.
  2. Malignant change

• Gastric Carcinoma :

  1. Hemorrhage leading to haematemesis and melaena.
  2. Pyloric stenosis

• Meckel's diverticulum :

  1. Imflammation giving signs and symptoms of acute appendicitis.
  2. Peptic ulcer due to heterotropic gastric mucosa.
  3. Tumor formation as carcinoid tumor
  4. Intestinal obstruction ( volvulus or intussusception )

• Crohn's disease :

  1. Intestinal obstruction
  2. Perforation and fistula formation

Complications of some common diseases - part 1

Complications of some common diseases - part 1

• Bronchiectasis :

  ( General complications )

  1. Systemic pyemia
  2. Secondary amyloidosis

  ( Local complications )

  1. Lung abscess and gangrene
  2. Suppurative Pericarditis
  3. Empyemia and pyopneumothorax
  4. Pulmonary fibrosis and right-sided heart failure
  5. Bronchogenic carcinoma
  
  

Drugs used in the treatment of some common diseases

Drugs used in the treatment of some common diseases

• Migraine :

  Acute Attack :

  1. Triptans : Sumatriptan and naratriptan 
  2. Dihydroergotamine
  3. Analgesics : Aspirin, naproxen and ibuprofen 

  Prophylaxis :

  1. β-blockers : Propranolol and nadolol 
  2. Tricyclic antidepressants : Amitriptyline
  3. Anticonvulsants : Divalproex 
  4. Calcium channel blockers : Verapamil  
  
  

Contrainidcations of some common drugs

Contraindications of the most important drugs

• Atropine :

  1. Benign prostatic hyperplasia ( Senile prostate )
  2. Closed-angle glaucoma

• Oral contraceptives :

  1. Cerebrovascular disease
  2. Thromboembolism
  3. Estrogen-dependent neoplasm
  4. Liver disease
  5. Pregnancy
  
  

Adverse effects of some common drugs

Adverse effects of the most important drugs

 

• Phenytoin :

  1. Gingival hyperplasia
     Gingival hyperplasia
  2. Confusion
     Confusion
  3. Slurred speech
     Slurred speech
  4. Double vision
     Double vision
  5. Ataxia
     Ataxia
  6. Sedation
     Sedation
  7. Dizziness
     Dizziness
  8. Hirsutism
     Hirsutism
  9. Steven-Johnson syndrome
     Steven-Johnson syndrome