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When formed within the heart or the arteries antibiotic resistance in campylobacter jejuni purchase sumycin 500mg with amex, thrombi may have laminations treatment for dogs gas order 500 mg sumycin amex, called the lines of Zahn antibiotic resistant klebsiella buy cheap sumycin line, formed by alternating layers of platelets admixed with fibrin virus 48 order sumycin 500 mg online, separated by layers with more cells. Mural thrombi within the heart are associated with myocardial infarcts and arrhythmias, while thrombi in the aorta are associated with General Pathology Answers 111 atherosclerosis or aneurysmal dilatations. Arterial thrombi are usually occlusive; however, in the larger vessels they are not. Venous thrombi, which are almost invariably occlusive, are found most often in the legs, in superficial varicose veins or deep veins. The postmortem clot is usually rubbery, gelatinous, and lacks fibrin strands and attachments to the vessel wall. Large postmortem clots may have a "chicken fat" appearance overlying a dark "currant jelly" base. These thromboemboli, most of which originate in the deep veins of the lower extremities, may embolize to the lungs. The majority of small pulmonary emboli do no harm, but, if they are large enough, they may occlude the bifurcation of the pulmonary arteries (saddle embolus), causing sudden death. Arterial emboli most commonly originate within the heart on abnormal valves (vegetations) or mural thrombi following myocardial infarctions. If there is a patent foramen ovale, a venous embolus may cross over through the heart to the arterial circulation, producing an arterial (paradoxical) embolus. Types of nonthrombotic emboli include fat emboli, air emboli, and amniotic fluid emboli. Fat emboli, which result from severe trauma and fractures of long bones, can be fatal as they can damage the endothelial cells and pneumocytes within the lungs. Air emboli are seen in decompression sickness, called caisson disease or the bends, while amniotic fluid emboli are related to the rupture of uterine venous sinuses as a complication of childbirth. They can be classified on the basis of their color into either red or white infarcts, or by the presence or absence of bacterial contamination into either septic or bland infarcts. White infarcts, also referred to as pale or anemic infarcts, are usually the 112 Pathology result of arterial occlusion. Red or hemorrhagic infarcts, in contrast, may result from either arterial or venous occlusion. They occur in organs with a dual blood supply, such as the lung, or in organs with extensive collateral circulation, such as the small intestine and brain. These infarcts are hemorrhagic because there is bleeding into the necrotic area from the adjacent arteries and veins that remain patent. Hemorrhagic infarcts also occur in organs in which the venous outflow is obstructed (venous occlusion). In the latter, twisting of the spermatic cord occludes the venous outflow, but the arterial inflow remains patent because these arterial blood vessels have much thicker walls. Testicular torsion is usually the result of physical trauma in an individual with a predisposing abnormality, such as abnormal development of the gubernaculum testis. A deficiency of either of these two enzymes leads to a disorder called orotic aciduria, which is characterized by orotate in the urine, abnormal growth, and megaloblastic anemia. An association is a pattern of nonrandom General Pathology Answers 113 anomalies with an unknown mechanism. A deformation is an alteration of a normally formed body part by mechanical forces. A disruption is a defect that results from interference in a normally developing process. A malformation is a morphologic defect that results from an intrinsically abnormal developmental process. A sequence is a recognized pattern that results from a single preexisting abnormality. Syndrome refers to multiple anomalies having a recognizable pattern and known pathogenesis.

Oriental cholangiohepatitis antibiotic interactions buy sumycin 500 mg otc, seen in eastern Asia antibiotic ear drops for dogs cheap sumycin 250 mg on line, is characterized by infection of bile ducts with Clonorchis sinensis antibiotic resistance lecture generic 500mg sumycin. Benign tumors of the liver include hemangiomas (the most com- Gastrointestinal System Answers 347 mon) antibiotic classes sumycin 500mg low cost, focal nodular hyperplasias, nodular regenerative hyperplasias, and adenomas. Hemangiomas are characterized by numerous small endotheliallined spaces filled with blood. The lack of erythrocytes or blood would raise the possibility of the lesion being a lymphangioma, while pleomorphic or atypical endothelial cells would suggest the possibility of an angiosarcoma. Focal nodular hyperplasia, which has a characteristic gross appearance of a central stellate scar within the tumor, microscopically reveals hepatic nodules surrounded by fibrous bands having numerous proliferating bile ducts. This type of tumor is related to birth-control pills, but has no association with malignancy. In contrast, nodular regenerative hyperplasia involves the entire liver and forms multiple spherical nodules. Histologic sections reveal plump hepatocytes surrounded by rims of atrophic cells. Nodular regenerative hyperplasia is clinically important because it is associated with the subsequent development of portal hypertension. Two types of hepatic adenomas are the liver cell adenoma and the bile duct adenoma. Histologically, cords of hepatocytes are present, but there is no lobular architecture. These tumors are associated with certain viral infections (hepatitis B and hepatitis C viruses), aflatoxin (produced by Aspergillus flavus), and cirrhosis. Microscopic sections of these tumors reveal pleomorphic tumor cells that form trabecular patterns, which are similar to the normal architecture of the liver. Clinically, hepatocellular carcinomas have a tendency to grow into the portal vein or the inferior vena cava and may be associated with several types of paraneoplastic syndromes, such as polycythemia, hypoglycemia, and hypercalcemia. It is important to compare the characteristics of hepatocellular carcinomas with those of another type of primary tumor of the liver, namely cholangiocarcinoma, which is a malignancy of bile ducts. Histologically, the tumor 348 Pathology cells contain cytoplasmic mucin, which is not found in hepatomas. Grossly there may be multiple or single nodules, which microscopically usually resemble the primary tumor. For example, metastatic colon cancer to the liver histologically reveals adenocarcinoma. Metastatic disease to the liver usually does not cause functional abnormalities of the liver itself, and the liver enzymes and bilirubin levels in the blood are usually normal. Angiosarcomas are highly aggressive malignant tumors that arise from the endothelial cells of the sinusoids of the liver. Their development is associated with certain chemicals, such as vinyl chloride, arsenic, and Thorotrast. Microscopically, these tumors consist of ribbons and rosettes of fetal embryonal cells. Cholesterol stones are pale yellow, hard, round, radiographically translucent stones that are most often multiple. Their formation is related to multiple factors including female sex hormones (such as with oral contraceptives), obesity, rapid weight reduction, and hyperlipidemic states. Decreased functioning of this enzyme, such as with a congenital deficiency or inhibition by clofibrate, causes excess secretion of cholesterol and an increased incidence of cholesterol gallstones. The other main type of gallstones are pigment stones, which are brown or black in color and composed of bilirubin calcium salts. They are found more commonly in Asian populations and are related to chronic hemolytic states, diseases of the small intestines, and bacterial infections of the biliary tree. In contrast to 7-hydroxylase and bile acid synthesis, 1-hydroxylase is involved in vitamin D synthesis, while 11-hydroxylase, 17-hydroxylase, and 21hydroxylase are all enzymes found in the adrenal cortex. Jaundice secondary to extrahepatic obstruction is associated with normal hemoglobin levels, normal serum indirect bilirubin levels, and increased levels of direct bilirubin and alkaline phosphatase.

The phenotypic hallmarks are oral leukoplakia and hyperkeratosis of the palms and soles yeast infection 9 months pregnant discount sumycin 250 mg visa. The presentation of squamous cell carcinoma of the esophagus varies; it is often asymptomatic until late in the course antibiotics that treat strep throat buy sumycin 500 mg online. When symptoms do develop they may include progressive dysphagia virus 2014 usa 500 mg sumycin with amex, weight loss and anorexia antimicrobial underpants 250 mg sumycin fast delivery, bleeding, hoarseness, and cough. The progression from Barrett metaplasia to dysplasia and eventually to invasive carcinoma occurs due to the stepwise accumulation of genetic and epigenetic changes. In the United States, adenocarcinoma and squamous cell carcinoma of the esophagus occur with equal frequency. Presentation is the onset of regurgitation and vomiting in week 2 of life; waves of peristalsis are visible on the abdomen and there is a palpable oval abdominal mass. Congenital diaphragmatic hernia occurs when a congenital defect is present in the diaphragm, resulting in herniation of the abdominal organs into the thoracic cavity. The stomach is the most commonly herniated organ due to left-sided congenital 138 Chapter 16 · Gastrointestinal Tract Pathology diaphragmatic hernia. It is caused by profound hyperplasia of surface mucous cells, accompanied by glandular atrophy. It is characterized by enlarged rugal folds in the body and fundus; clinically, patients experience decreased acid production, protein-losing enteropathy, and increased risk of gastric cancer. Acute Inflammation and Stress Ulcers of the gastric mucosa, secondary to a breakdown of the mucosal barrier and acidinduced injury. Patients present with epigastric abdominal pain, or with gastric hemorrhage, hematemesis, and melena. Gastric stress ulcers are multiple, small, round, superficial ulcers of the stomach and duodenum. Chronic Gastritis Chronic gastritis is chronic inflammation of the gastric mucosa, eventually leading to atrophy (chronic atrophic gastritis). Fundic type chronic gastritis is an autoimmune atrophic gastritis that involves the body and the fundus. It is caused by autoantibodies directed against parietal cells and/or intrinsic factor. The result is loss of parietal cells, decreased acid secretion, increased serum gastrin (G-cell hyperplasia), and pernicious anemia (megaloblastic anemia due to lack of intrinsic factor and B12 malabsorption). Microscopically, mucosal atrophy is seen with loss of glands and parietal cells, chronic lymphoplasmacytic inflammation, and intestinal metaplasia. Antral type chronic gastritis (also called Helicobacter pylori gastritis) is the most common form of chronic gastritis in the United States. Other methods of detection include biopsy (histologic identification is the gold standard) and serology. Infection is also associated with duodenal/gastric peptic ulcer, and gastric carcinoma with intestinal type histology. Other microscopic features include foci of acute inflammation, chronic inflammation with lymphoid follicles, and intestinal metaplasia. Chronic Peptic Ulcer (Benign Ulcer) Peptic ulcers are ulcers of the distal stomach and proximal duodenum caused by gastric secretions (hydrochloric acid and pepsin) and impaired mucosal defenses. Complications of peptic ulcer include hemorrhage, iron deficiency anemia, penetration into adjacent organs, perforation (x-ray shows free air under the diaphragm), and pyloric obstruction. Gastric Carcinoma (Malignant Ulcer) Gastric carcinoma is more common in Japan than in the United States, and has a decreasing incidence in the United States. Dietary factors can be risk factors: · Smoked fish and meats 140 Chapter 16 · Gastrointestinal Tract Pathology · Pickled vegetables · Nitrosamines · Benzpyrene · Reduced intake of fruits and vegetables Other risk factors include H. Gastric carcinoma is often (90%) asymptomatic until late in the course, when it can produce weight loss and anorexia. It can also present with epigastric abdominal pain mimicking a peptic ulcer, early satiety, and occult bleeding with iron deficiency anemia.

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The cells at the center of the structure undergo hyalinization or necrosis and may become lysed to leave a cystic structure infection knee joint 250 mg sumycin with mastercard. Some of the cells at the periphery of the corpuscle retain their connections with the surrounding cytoreticulum antibiotics for severe acne cheap sumycin line. The function of the thymic corpuscles is unknown; they have been regarded purely as degenerated structures antibiotics for dogs with heartworms purchase sumycin in united states online, but there is evidence that they may be secretory bodies antibiotics for dogs petsmart purchase sumycin online. Most of the cells of the cortex are lymphocytes that are closely packed with little intervening material between them. Large, medium, and small lymphocytes are present, the latter being the most abundant; they are indistinguishable from small lymphocytes found elsewhere. Large lymphocytes tend to concentrate in the outer cortex beneath the capsule and represent stem cells that have newly emigrated from the bone marrow. Small lymphocytes become increasingly more numerous toward the deeper cortex, where degenerating cells with pyknotic nuclei also are found. Unlike lymph nodes, there are no lymphatic nodules in the cortex of the thymus, nor is there an internal sinus system. Reticular cells in the cortex are highly branched, but their processes are obscured by the mass of lymphocytes. They form a continuous layer at the periphery of the cortex, separating it from the capsule and septa. These epithelial reticular cells contain tonofilaments and membrane-bound structures that appear to be secretion granules. Macrophages are consistently present in small numbers, scattered throughout the cortex. They are difficult to distinguish from reticular cells by light microscopy unless phagocytosed material can be seen in their cytoplasm. In electron micrographs they are distinguished from epithelial reticular cells by the lack of desmosomes. Macrophages that have engulfed degenerating cells can be found scattered throughout the thymus and tend to increase in number toward the junction of the cortex and medulla. Within the cortex, the capillaries run toward the capsule, where they form branching arcades before passing back through the cortex to drain into venules and thence into veins that accompany the arterioles in the corticomedullary region and medulla. The cortical capillaries are enveloped by a collar of connective tissue that forms part of the bloodthymic barrier. This envelope in turn is surrounded by a continuous layer of epithelial reticular cells. The perivascular connective tissue space varies in width and is traversed by reticular fibers that accompany the vessel. Within the perivascular space are granular leukocytes, plasma cells, macrophages, and lymphocytes. The bloodthymic barrier in the cortex thus consists of the capillary endothelium and its basal lamina, the perivascular connective tissue sheath, and the layer of epithelial reticular cells and their associated basal lamina. There is little movement of macromolecules across this barrier, and cortical lymphocytes develop in relative isolation from antigens in a privileged environment. Vessels of the medulla and corticomedullary junction are permeable to circulating macromolecules. Lymphocytes leave the thymus by entering postcapillary venules located in the medulla and near the corticomedullary junction. The cortical areas become infiltrated by fat cells, and the replacement may become extensive. By the time involution commences, T-cells have disseminated into the secondary lymphatic tissue throughout the body. The thymic parenchyma does not disappear completely even in old age, and the thymus maintains some activity in the adult. Other Constituents the thymus frequently shows a number of peculiar structural elements, the significance of which is not known. Among these structures are cystlike spaces lined by cells with brush borders, cilia, or mucusproducing cells or by reticular cells that contain microvillus-lined vacuoles. Most peculiar are the "myoid" cells, which have an imperfect resemblance to striated muscle.