📖 General Pathology
Paget Disease
General PathologyPaget Disease (Osteitis Deformans)
This unique bone disease is characterized by repetitive episodes of exaggerated, regional osteoclastic activity (osteolytic stage), followed by exuberant bone formation (mixed osteoclastic-osteoblastic stage), and finally by exhaustion of cellular activity (osteosclerotic stage). The net effect of this process is a gain in bone mass; however, the newly formed bone is disordered and lacks strength. Paget disease usually does not occur until mid-adulthood but becomes progressively more common thereafter. The pathognomonic histologic feature is a mosaic pattern of lamellar bone (likened to a jigsaw puzzle) due to prominent cement lines that haphazardly fuse units of lamellar bone. (Fig. 12-5) The axial skeleton and proximal femur are involved in the majority of cases. In patients with extensive disease, hypervascularity of the marrow spaces can result in high-output congestive heart failure. Cranial nerves impingement also occurs and can lead to head ache and auditory disturbances. Rarely Paget disease is complicated by bone sarcoma (usually osteogenic).
Iron deficiency anaemia
General PathologyIron deficiency anaemia.
Absorption of iron is affected by :
- Iron stores.
- Rate of erythropoiesis
- Acid pH aids absorption.
- Phosphates and phytates in diet impair absorption.
Causes of deficiency:
- Increased demand:
o Growth (in children)
o Menstruation, Pregnancy, lactation.
- Inadequate intake and absorption.
o Dietary deficiency.
o Achlorhydria or gastrectomy.
o Malabsorption states.
- Chronic blood loss
o Peptic ulcer, bleeding piles
o Menorrhagia.
o Hook worm infestation
Features:
- Anaemia.
- Koilonychia.
- Atrophic glossitis and angular stomatitis.
- Dysphagia-Plummer Vinson syndrome.
Blood findings:
- Microcytjc_hypochromic cells, ring cells and pessary cells.
- Anisocytosis and poikilocytosis.
- Low MCV. MCH and MCHC.
- Serum iron is low but iron binding capacity is increased
Bone marrow
Erythroid hyperplasia with imcronormoblasts. Iron stains reveal depleted stores
Differential diagnosis .-
- Sideroblastic anaemia which is also microcytic hypochromic but there is excess iron in the erythroid cells .Some are pyridoxine responsive.
- (ii) Thalassaemia
ANAEMIA
General PathologyANAEMIA
Definition. Reduction of the hemoglobin level below the normal for the age and sex of the patient
Classification
1. Blood loss anaemia:
- Acute.
- Chronic (results in iron deficiency).
2. Deficiency anaemia:
- Iron deficiency.
- Megaloblastic anaemia-BI2 and Folic acid deficiency.
- Protein deficiency.
- Scurvy-Vitamin C deficiency.
3. Marrow dysfunction:
- Aplastic anaemia.
- Marrow infiltration.
- Liver failure.
- Renal failure.
- Collagen diseases.
4 Increased destruction (Heamolysis)
- Due to corpuscular defects.
- Due to extra corpuscular defects
Alcoholic cirrhosis
General PathologyAlcoholic (nutritional, Laennec’s) cirrhosis
Pathology
Liver is at first enlarged (fatty change), then return to normal size and lastly, it becomes slightly reduced in size (1.2 kg or more).
- Cirrhosis is micronodular then macronodular then mixed.
M/E
Hepatocytes:- show fatty change that decreases progressively. Few hepatocytes show increased intracytoplasmic haemochromatosis.
b. Fibrous septa:- Regular margins between it and regenerating nodules.
-Moderate lymphocytic infiltrate.
– Slight bile ductular proliferation.
Prognosis:- It Progresses slowly over few years.