حاجات دكتوره ورده ركزت عليهن

♦️Chronic glomerulonephritis
is one of the most common causes of chronic kidney disease in humans.
♦️ACUTE KIDNEY INJURY (AKI)most common cause of acute renal failure
♦️Diabetic glomerulosclerosis;
It is a major cause of chronic renal disease
📌Azotemia is : elevation of blood urea nitrogen
📌Uermia : is Azotemia + Clinical manifestations
📑 Uermia:-

1. (acidosis)
2. ( anemia and bleeding diathesis )

3. ( secondary hyperparathyrodism )
4. Uremic gastroenteritis
5. Uremic fibrinous pericarditis 6. Peripheral neuropathy

🪢 Nephrotic Syndrome v.imp


✔Heavy proteinuria >3.5 g/day
✔.Hypoproteinemia
✔Severe edema
✔Hyperlipidemia
✔Lipiduria

🪢 Nephritic Syndrome v.imp


✔Grossly visible hematuria (with Casts)
✔Mild to moderate proteinuria
✔Azotemia (with Oliguria)
✔Edema
✔HTN

💡Primary Glomerular Diseases


✔Minimal change glomerular disease
✔Membranous glomerulonephritis
✔Membranoproliferativeglomerulonephritis
✔IgA nephropathy
✔Acute diffuse proliferative glomerulonephritis

🔸️Minimal Change Disease


1,sudden onset
2,Children ( 2 -6 years)

3, after (respiratory infection
immunization.)

4,proteinuria highly selective,
5 Respond rapidly to corticosteroid therapy

🔸️Membranous glomerulonephritis

1,adults.

2 diffuse thickening

3,deposits along the subepithelialside

4,The basement membrane material protrudes between deposits as ‘spikes’ .

🏷these spikes thicken to produce domelike

5, non selective

🔸️Membranoproliferative GN


✔adults.
✔proliferation of mesangial cells & leukocytes.

✔The GBM is thickened
✔The GBM ↪↪"tram track"

▫️Type I MPGN)
🗯circulating immune complexes

🗯Subendothelial granular
deposits of C3 & IgG


▫️Type II MPGN
🗯C3 nephritic factor (C3NeF)
🗯Intra-membranous deposit
C3; deposit as
irregular
granular-linear
worse prognosis
📌Diabetic glomerulosclerosis;.
Nodular GS ( Kimmelsteil-Wilson disease);

🔹️Acute Proliferative
(Poststreptococcal, Post infectious)


✔group A β-hemolytic streptococci
✔ in children 6 to 10
✔hypercellularity
✔subepithelial (humps)
✔inflammatory manifestation
✔ urine appearing smoky brown( cola color 🥤 )

🔹️Rapidly progressive GN (RPGN)

✔crescents
✔ distinct ruptures in the GBM
✔three groups

✔ GOOD PASTURE SYNDROME (anti-GBM disease)↪Cross reaction of the antibody with pulmonary capillary basement membranes results in lung hemorrhage,

✔ endothelial proliferation, and mesangia

📣Crescents
are formed by proliferation of parietal cells 🔸️
may obliterate Bowman's space & compress the glomeruli tuft.

🔹️IgA nephropathy
is the commonest cause of recurrent gross hematuria or microscopic hematuria

& is the most common glomerular disease worldwide
🔹️IgA nephropathy
1. Children
2. 1-2 Days after Upper RTI or GI infection
3. mesengial proliferation
4. Mesengial Deposits
5. IgA granular deposits

🔹️Alport syndrome :
defect in the collagen IV X-chromosome,
males
splitting and lamination
of the lamina densa,
often producing a distinctive basket-weave appearance .🥅

🎗Lupus nephritis
▫️Class I : lupus with no renal lesion 20%
▫️ Class II : mesangail “ proliferative “ nephritis 10%
▫️Class III : focal proliferative nephritis 10%
▫️Class IV : diffuse proliferative nephritis 50%
▫️Class V : membranous nephritis
📌Class III, IV, V
may show:
🔸️Focal necrosis of capillary wall & PNL infiltrate
🔸️Fibrinoiddeposits
🔸️Capillary thrombi
🔸️Wire-loop thickening of capillary wallمهمه !
🔸️Crescent formation
🪢 Renal stone
Calcium oxalate (phosphate) 75%
🪢 Struvite --> (Mg, NH3. Ca, PO4)
🏷 sponge-like appearance
✔Childhood polycystic kidney disease
✔CYSTIC DISEASES OF RENAL MEDULLA
🏷 Swiss-Cheese appearance
CYSTIC DISEASES OF RENAL MEDULLA
📑BladderUrothelial (transitional) tumors :
1) papilloma
2) Papillary urothelial neoplasms of low malignant potential(PUNLMP)
3) Low grade and high grade papillary urothelial cancers
4) Carcinoma in situ.
📌types of transitional cell carcinoma ;
🔹️Flat type (10%) associated with early P53 mutations
#pathology
Renal

🔹️Papillary type (90%) not associated with Early P53 mutation
♦️Renal BENIGN TUMORS
✔Adenoma
✔Angiomyolipoma
✔Oncocytoma
🔹️The most common type of renal cancer in patients who develop dialysis-associated cystic disease Papillary types
#pathology
Renal

LUNG
▫️90% of lung tumors are carcinoma
▫️metastatic lung tumors more common than primary

ORAL  
▫️most common → squamous cell carcinoma  
     
SALIVARY GLAND
▫️most common benign →  pleomorphic adenoma
▫️most commom malignant →  mucoepidermoid carcinoma

EOSOPHAGUS
most commom →  squamous cell carcinoma

GASTRIC
▫️most common → gastric adenocarcinoma

COLON
▫️polyps are mostly found in colon
▫️juvenile polyps are most common in hamartamatous
▫️most common malignant → colorectal adenocarcinoma (derived from neoplastic adenoma)

APPENDIX
▫️most commom →  carcinoid (neuroendocine)

تجميعة most common tumors مهم للmcq
#pathology

📌Metabolic Bone Ds
1- Paget ds
🔸⬆️ Osteoclast activity
🔸Male ⬆️50 yr
🔸activating mutations in RANK impppp
🔸imppp INactivating mutations in OPG↪️ juvenile paget ds
🔸Measles or RNA Vs may play a role
3 phases :imp
📍osteolytic stage↪️⬆️osteoclast activity
نلقى الخليه فيها 100 nuclei
📍mixed st↪️prominant osteoblast / osteoprogenitor cs
📍osteosclerotic st ↪️ hallmark is mosiac pattern (puzzele like) of lamellar bone

2-Osteoporosis
*due to osteopenia (reduce bone mass)
📍primary : most common form
🔸occurs in postmenopausal / elderly persons
📍secondary : ass with defined cause

3-Rickets & Osteomalacia ↪️⬇️ Vi D
4- HYPERparathyrodism

———————————————————————————

📌Osteomyelitis always secondary to infecton
سؤال شورت نوت جاي من قبل كيف توصل البكتيريا للعظم؟؟
1- infection begins in metaphyseal end (congestion / oedema / exudate of neutrophils)
2- infection spread into endosteum causing periosteitis
3- reach subperiosteal space forming subperiosteal abscesses , penetrate the cortex creating draining skin sinus tract(cloaca)
4-erosion and infarction necrosis of cortex (sequestrum)
formation of new bone surrounds sequestra (involucrum)

📍in vertebral pyogenic osteomyelitis infection begins from Disc (discitis)

📌Complications : septicemia/fracture/sq cell carcinoma/amyloidosis/acute bacterial arthritis

A-Bone Forming Tumors:
1-Benign ➡️Osteoid Osteoma:
🔸⬇️2cm / femur or tibia / sever pain relieved by asprin

2- Benign Aggressive ➡️Osteoblastoma:
🔸⬆️2cm / vertebrae (laminae and pedicles) /pain unresponsive to asprin
📍Both are more common in 10-20yr.
📍malignant transformation is rare.

3-Malignant➡️ Osteosarcoma: Malignant mesenchymal tumor
🔸most common primary malignant T
🔸⬇️20yr / man
🔸elderly ass with paget ds
🔸arise in metaphyseal region (50% near the knee)
🔸RB mutatations 70% of sporadic osteosarcoma
🔸TP53 mutated in individuals with Li fraumeni syndrome
🔸painful enlarging mass
🔸20% of Pt➡️ lung metastasis
🔸Codman triangle is characteristic of osteosarcoma on radiographic image
🔸M/S: bizarre tumor giant cell

B-Cartilage Forming Tumors:
📍characterized by formation of hyaline or myxoid cartilage
1-Osteochondroma:
🔸most common Benign bone tumor
🔸Involve metaphysis of long bone
🔸10-30yr age group / male⬆️
🔸85% solitary & sporadic
🔸as a part of multiple hereditary exostosis syndrome (mutation in EXT1 or EXT2 gene)

2-Chondrosarcoma: malignant tumor

C- Miscellaneous Tumors:
1-Giant cell tumors (osteoclastoma):
🔸benign but locally aggressive
🔸epiphyses of long bones(common around knee)
🔸20-40yr
🔸neoplastic cells are primitive osteoblast that express high level ( RANKL)
2-Ewings sarcooma:
🔸malignant characterized by primitive round cells without obvious differentiation second most common in children
🔸⬇️20yr / boy
🔸highly aggressive
🔸painful mass in diaphyses (especially femur)
🔸homer wright rosettes indicate neuroectodermal differentiation
——————————————-
📍secondary tumors :metastatic cancer to bone more common than primary
📍prostatic tumors are blastic.

📌Rh arthritis :
🔸70% Pt blood contain Anti -CCP Ab
🔸joint fusion (ankylosis)
🔸HLA DR4
🔸80% of individuals have autoantibodies to Fc portion of IgG (rh factor)
🔸all small joint except distal interphalangeal

📌Gout:
🔸 transient attack initiated by monosodium urate crystals
🔸Tophi are the pathognomonic Hallmark of gout

📌 osteoarthritis:
🔸over age 50yr (most imp factor)
🔸 chondrocytes die➡️ loose bodies

📍 osteophytes: mushroom shaped bony outgrown
(Small bony projections at joint margin )

📍 Ganglion & synovial cysts:
🔸 around joint of wrist , pea sized
🔸Myxoid degeneration of C.T
#pathology
Bone

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Name the parasitic worms that cause biliary obstruction ?
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