Pathology I Review 7

8/9/2019 Pathology I Review 7

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Pathology I Review 7

Igor Areinamo


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Case 1Arterial blood gas on 4 L of inspired oxygen showed a pH of 7.41, carbondioxide 36 mm Hg, and oxygen 81 mm Hg, with 97% saturation calculated.A chest radiograph showed bilateral perihilar fullness but a lack of infiltrate. Based on the patient's persistent oxygen requirement and hercontinued tachycardia and tachypnea, a D-dimer assay and ventilation-

perfusion scan were obtained. Four hours postoperatively the patient hadoxygen saturations of 78% on room air and 91% on 4 L of inspired oxygen.

The D-dimer assay results were between 1,500 and 2,000 mg/L, apositive result. The ventilation-perfusion scan was read as intermediateprobability with matched segmental and subsegmental defects bilaterally,predominately at the lung bases and worse on the left. The patient was

given heparin. Approximately 1 hour before her initial bolus of heparinwas given, however, the patient's oxygen saturations suddenly began toimprove, from 89% to 95% on 4 L of oxygen. Her pulse returned to 100beats per minute, and her systolic blood pressure stabilized in the range of 125 to 135 mm Hg.


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Case 1The D-dimer assay results were between 1,500 and 2,000 mg/L, apositive result. The ventilation-perfusion scan was read asintermediate probability with matched segmental andsubsegmental defects bilaterally, predominately at the lung basesand worse on the left. The patient was given heparin.Approximately 1 hour before her initial bolus of heparin was given,however, the patient's oxygen saturations suddenly began toimprove, from 89% to 95% on 4 L of oxygen. Her pulse returned to100 beats per minute, and her systolic blood pressure stabilized inthe range of 125 to 135 mm Hg.During the next 24 hours, she was weaned from oxygen, her low-

grade temperature resolved, and her blood pressure remainedstable. Several new petechiae were noted on the patient's anteriorchest wall.


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Case 1

Fat embolism syndrome: include petechiae(chest!, Infraclavicular, axillary, retinalpetechial hemorrhages ), hypoxemia, pyrexia,tachycardia, and relative thrombocytopenia.


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Case 2A 17-year-old, nulliparous, white, female adolescent without significant medicalhistory arrived at a rural hospital in premature labor, where she delivered aliveborn female infant at 27 weeks' estimated gestational age. Marked uterinebleeding and gross hematuria were observed postpartum. Serial examinationsrevealed a firm uterus, without evidence of atony. The patient became anxiousand 30 minutes later was found to have severe dyspnea, hemoptysis, and

hypoxemia. The patient had transfusion of 2 units of packed red blood cells andwas placed on a 100% oxygen nonrebreather mask and transferred to the I CU.On arrival, she was found to be afebrile with a respiratory rate of 32/min, pulserate of 126/min, and blood pressure of 90/62 mm Hg. Chest examination wasremarkable for tachycardia, tachypnea, moderately labored breathing, andbilateral basilar scattered rales. Extremities were without clubbing, cyanosis, oredema. The uterus was firm to palpation. Complete blood count yielded thefollowing values: white blood cell count 12,300/mm 3 , hemoglobin 11.4 g/dL,hematocrit 33.9%, and platelet count 105,000/mm 3. The peripheral smearrevealed 1+ schistocytes. Arterial blood gas values on 100% oxygen were PaO 2 192mm Hg, Pa CO2 29 mm Hg, and pH 7.43.


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Case 2

5 hours after admission to the I CU the patientdeveloped seizures and loss of consciousness.Despite all efforts, the patient waspronounced dead and hour after. On autopsythe following was found: (L UNG)


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Case 2


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Case 3

Diagnose the following:


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Case 3


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Case 3


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Case 3


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Case 4

The 5-year-old boy was referred to hospital for investigationof a persistent anaemia. He was stunted with both heightand weight below the fifth percentile and had mild pittingedema in both legs. His hair was pale and easily pluckable

and a soft liver edge was palpable. Plasma albuminconcentration was 16 g/I and the plasma amino acidpattern, which revealed markedly reduced levels of essential but normal to high non-essential amino acids.A dietary history revealed that for about 2 years the child'sdiet had contained very little protein but adequate energyand had been supplemented with multivitamin pills. Therewas no evidence of other pathology, neglect or abuse andthe child responded rapidly to refeeding with a balanceddiet.


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Case 4

Any thoughts?Describe what caused the pitting edema.

Flag Sign????What can you say about Caloric Intake?Would you expect any mental delay? Why?


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REVIEWMarasmus starvation, total caloric deficiency (carbs, prot + fat )

Weight loss - loss of subcutaneous fat + muscle Failure to thrive + impaired growth Aware - not encephalopathic

Kwashiorkor - protein deficiency w/ only carbohydrates May have normal weight Fatty + enlarged liver liver Edema decreased intravascular osmotic pressure (hypoalbuminemia ) Encephalopathic cognative disturbance

Glutamate => glutamine b/c of liver insufficiency Hair discoloration flag sign

Diseases Cancer cachexia Crohn s Dz Short Bowel Syndrome resegmented, congenital reduced Jejunum/ilium Bariatric Surgery


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REVIEWMalabsorption adequate diet but inability of SI to absorb nutrientsPancreatic Enzyme Insufficiency

Chronic Pancreatitis (alcoholic ) - fat malabs, diabetes destroy Islet of Langerhans, S/S abdominal pain Pancreatic Cancer - lose significant wt in 1 mos, abdomminal pain radiating to back (clench abdomen ) CF (kids) defect in CFTRCl channel reabs of H20 + Na => secretions dry, viscous + obstruct ducts

Pancreatic insufficiency malabsorptionObstructive Lung Dz - brochiole mucus dry

Salty sweat - excess Cl secretion in sweatBlockage of Bile Salts - bile salts required for emulsifying fat

Obstruction of intrahepatic, bile ducts, hepatitis, obstructive jaundice 1o Biliary Cirrhosis autoimmune CD4 cells attack bile ducts (Middle age, F ) => fat malabsorption, fat sol vit

defic risk for osteoporosis/fractures 1o schlerosing panangitis (M 30 yo ) fibrosis of duct, assoc w/ chronic ulcerative colitis

SI muscosa Celiac Dz - antibodies (endomysial Ab ) agst gliadin wheat, glutem ,barley, In - villi fuse + flatten (lose SA )

Test - Xylose abs 5 chain sugar - absorbs thru mucosaDeficiency in Fat Soluble Vitamin A,D,K,E

Vit A => Blindness Vit D req for Ca abs - mineralization of bone + cartilage

thickened cartilage => ricketsa rosary on costochondral angle of ribsOsteomalacia2ndary Hyperparathyroidism stim osteoclasts to destroy bone

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Pathology I Review 7