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Disease

The Common Vein copyright 2007

Introduction

 

We learned in an earlier part of the module that there is a universal equation that defines the interactions between objects.

            Things interact with other things in a given environment at a moment in time resulting in a change.  This change may be either good or bad – positive or negative.

When the change is bad – disorder results and the biological equivalent of disorder is disease.

 There are about 12 basic disorders of disease.

1  Inflammation

2  Infection

3  Neoplasm amd other growth abnormalities

4  Mechanical disorders

5  Trauma

6  Metabolic disorders

7  Circulatory

8  Immune disorders

9  Iatrogenic

10 Inheritd

11 Idiopathic

12 Functional

13 Healling that has as a consequence a degree of disorder

Inflammation

Inflammation is th body’s response to an injurious or noxious agent.  This noxious agent by virtue of its perceived malintent generates a protective response by the body.  This response initially  consists of two a vascular response and a cellular response.  The vascular response results in an increase in blood flow to the region resulting in both an increase in fluid and an increase in leukocytes to the interstitial space at the site of injury.

The increase fluid in the region dilutes the noxious agent and the infiltration of leukocystes serves as a direct atttempt at destroying the invasive agent.

The damage caused by both the invasive agent and to variable extent the inflammatory response requires repair which is also instituted by the inflammatory response.  Initially this consists of fibrin deposition with subsequent evolution of a longer lasting fibrotic change.

 

 

Celsus 200 years ago – rubor calor dolor tumor laesio function (Virchow (1821 -1902

Hyperemia calor

 

Radiation Hepatitis – Hyperemia
The straight line and the hyperemia are characteristis features radiation induced change

22975 Courtesy Ashley Davidoff MD

 

Infection

 

Splenic Granulomas
21327a  21324 spleen + multiple splenic nodules dx non specific splenic granulomas + grosspathology inflammation infection

Tuberculosis – Chronic Granulomatous Disease
89 year old female with a history of bovine TB 20752 spleen + liver splenic nodules + fx calcification + calcified hepatic granulomas TB + imaging radiology CTscan C- infection granulomatous disease

Aspergillus – A Fungal Ball
20760 lung + fx mass + fx air + soft tissue aspergillus + imaging radiology CTscan aspergilloma fungus fungal infection pulmonary systemic fungemia with involvement of liver and spleen code air crescent sign

Before and After Antibiotic Therapy
41819c02 Courtesy Ashley Davidoff MD medical students code chest CXR imaging lung plain film pneumonia radiology resolution

Malignancy

Growth of a Malignancy
32354c01.800 tube colon trachea bronchus small bowel bile duct epithelium neoplasm benign malignant malignancy epithelial cell multiply multiplication growth mucosa submucosa muscularis serosa adventitia vein lymph node circumferential metastasixe metastasis metastases narrowing stenosis obstruction complication cancer uncontrolled growth Davidoff drawing Davidoff art Davidoff tube Davidoff MD

Malignancy Occupying Space – The Faces of Malignancy

Spiculated Masses

Stellate
69595b05.800 Davidoff art  star stellate corona radiata spiculated aggressive cancer carcinoma

70142.800 tree roots stellate shape Davidoff photography New Hampshire

46361b01 lung fx spiculated nodule dx carcinoma CTscan Courtesy Ashley Davidoff MD

Spiculated Lung Nodule
46361 lung fx spiculated nodule dx carcinoma CTscan Courtesy Ashley Davidoff MD

Click screen to closeSpiculated Mass in the Right  Breast
This is an MRI of the right breast of a 78 year old patient with a remote history of invasive lobular carcinoma.  The finding on the MRI is characterized by an enhancing spiculated mass.  Recurrent carcinoma was present at pathology. Courtesy Priscilla Slanetz MD MPH 42977

Infiltrative Malignancy

Infiltrative Adenocarcinoma of the Lung
46588 46581 lung fx consolidation dx adenocarcinoma of the lung malignancy cancer Davidoff MD

Malignancy – Vascular Invasion

Vascular Invasion
46579 liver hepatic vein fx tumor thrombus lung fx consolidation dx infiltrative adenocarcinoma of the lung with metastases to the liver and adrenal and invasion of the hepatic veins malignancy cancer Davidoff MD 46581 46588 46587

Malignancy – Vascular Encasement

Vascular Encasement
46645c03.800  46645c04.800heart artery pulmonary trunk encasement right ventricle RV infundibulum dx carcinoma of the lung CTscan Davidoff MD

 Malignancy – Space Occupying

Squatters in the Left Lobe
46587.800 liver bone vertebra fx mass space occupying disease dx liver metastases metastasis dx primary lung carcinoma malignancy cancer CTscan Davidoff MD

Congenital Growth Disorders

Pelvic Kidney
46610c01 kidney pelvic kdney renal position ureterolthiasis ureterovesical junction stone UVJ stone ureteric stone fx hydronephrosis fx etravasation dx acute obstruction of the right ureter from a 2mm calcified ureteric stone in a patient with a pelvic kidney CTscan Davidoff MD

Sinle Kidney Bicornuate Uterus
46527c01 uterus kidney renal bicornuate uterus single kidney congenital abnormality congenital growth disorder USscan MRI Davidoff MD

Mechanical Disorders – Obstruction

Acute Ureteric Obstruction
46610c01 kidney pelvic kdney renal position ureterolthiasis ureterovesical junction stone UVJ stone ureteric stone fx hydronephrosis fx etravasation dx acute obstruction of the right ureter from a 2mm calcified ureteric stone in a patient with a pelvic kidney CTscan Davidoff MD

Mechanical Disorder Fracture

Fractured Mandible
45669 bone maxillofacial mandible face cheek orbit frontal sinus teeth maxilla nasal bone concha zygomatic bone dx fracture of the mandible fracture of the left condyle TMJ skull CT scan Courtesy Ashley Davidoff MD 5star

Mechanical Disorders – Degeneration

Wrath of Time
46707c01 bone wrist carpals thumb degenerative changes osteoarthritis osteopenia age time normal vs abnormal X-ray plain film Davidoff MD

Mechanical Disease – Loss of Elasticity

Normal Alveoli of the Lung and Emphysema

 
This diagram illustrates the branching pattern of the tracheobronchial tree that extends from the bronchi to the terminal bronchioles transitioning into the alveoli via the alveolar sacs. Courtesy Ashley Davidoff MD 32645b04b04

This diagram shows alveoli and respiratory bronchioles that are too large due to loss of elasticity, so that air cannot be moved efficiently through them This is a diagram of emphysema causing hyperinflated lungs lung volumes 32645b01.800

Davidoff art

Large lungs
A patient with hyperinflated lung volumes, COPD, and emphysema with surgical removal of a lung carcinoma from the LUL.  Note how flattened the hemidiaphragms are and note the large retrosternal air space and the shapoe of the chest – like a barrel – called pectus carinatum – or pigeon chest.  The lungs are literally so large that they are pushing the chest wall forward.

Courtesy Ashley Davidoff MD 30672c

Segmental emphysema 
This is a chest CT of a 29 year old man man who has segmental emphysema in the right lower lobe and midle lobe characterised by lucencies at 3 and 12 oclock where there has been air trapping in the alveoli.  The left lung is normal  This condition is called Swyer James syndrome Courtesy Ashley Davidoff MD. (30314 )

Emphysema
This is an image of an emphysematous lung. Note the larger air spaces where the septae between the alveoli, alveolar sac, salveolar ducts and respiratory bronchioles have been broken down. 19932e

Circulatory Disorders

Cardiogenic Shock Drowned Lung
46813c01.800 chest lung pulmonary edema alveolar edema batwing distribution drowned lung dax cardiogenic shock normal CXR plain film of the chest Davidoff MD

CHF – AVR
46432c01 heart cardiac chest fx pulmonary congestion interstitial edema enlarged pulmonary arteries pulmonary arteriole to bronchiole ratio increased cardiomegaly fx enlarged Kerley B line thickened interlobular septa dx congestive heart failure CHF cardiac failure CTscan CXR plain film Davidoff MD 46425 46427 46428 46431 46432 46432c01

Skin CHF
46786c02 skin heart cardiac breast fx left atrial enlargement LAE fx third spacing fx effusions fx skin edema cardiac failure CHF CTscan Davidoff MD

Acute and Chronic Infarction
49685C01 brain DWI occipital lobe fx vague hypodensity right occipital lobe with encephalomalacia and ex vacuo changes in the left occipital and posterior parietal region dx acute infarction right occipital lobe chronic infarction left occipItoparietal lobe a IR white matter disease vague increase in right b T2 gliosis left parietal c DWI bright acute right occipital d CT vague hypodensity right occipital old infarct left dx acute infarction right occipital lobe chronic infarction left parietal lobe MRI diffusion weighted imaging CTscan Courtesy Ashley Davidoff MD

Acute GI bleed
46590 small bowel fx radioisotope leak into small bowel dx GI bleed hemorrhage Radioactibe labelled sulfur colloid Nuclear Medicine NMscan Davidoff MD

Acute Subdural Hematoma
46633c01.800 brain cerebral meninges subdural hematoma blood SDH hemorrhage bleed acute blood fx acute hematoma s/p trauma CTscan Davidoff MD

Hemorrhage – Ectopic Pregnancy
46750c01.800 hx young female presentingwith vaginal bleeding for 2 weeks, hematocrit of 25, left lower quadrant pain, and LLQ mass HCG 7000 fx uterus endometrial stripe ovary fx mass echogenic cystic complex free fluid loculated fluid hemorrhage blood fx no intrauterine pregnancy dx ectopic pregnancy death Davidoff MD

Hemorrhage
46750c02.800 hx young female presentingwith vaginal bleeding for 2 weeks, hematocrit of 25, left lower quadrant pain, and LLQ mass HCG 7000 fx uterus endometrial stripe ovary fx mass echogenic cystic complex free fluid loculated fluid hemorrhage blood fx no intrauterine pregnancy dx ectopic pregnancy death USscan Davidoff MD

Wedge Shaped Infarction
46772c01.800 spleen splenic fx wedge shaped defects dx emboli dx systemic embolization dx splenic infarcts CTscan Davidoff MD

Functional Disorders

Achalasia
46561c01.800 esophagus stomach gastroesophageal junction fx enlarged esophagus megaesophagus fx dilated fx narrowing at the GE junction fx stenosis dx achalasia CTscan Davidoff MD

Normal and Abnormal
46561c02.800 esophagus size normal dilated enlarged dx achalasia obstruction proximal dilation CTscan Davidoff MD

Aspiration
46508c01.800 esophagus dysphagia fx large osteophyte causing difficulty with passing a scope fx aspiration barium swallow x-ray contrast Davidoff MD

Healing

Healing over 4 weeks
46797 bone hand metacarpal fx fracture dx boxer’s fracture position alignment post pinning healinhg over 4 weeks osteoid X-ray plain film Davidoff MD Davidoff MD

Death

Life and Death based on size shape and Position
46592c01 uterus OB pregnancy fetal demise spontaneous abortion shape size position heart rate USscan Davidoff MD death

Ectopic Pregnancy
46767c01.800 hx young female presentingwith vaginal bleeding for 2 weeks, hematocrit of 25, left lower quadrant pain, and LLQ mass HCG 7000 fx uterus endometrial stripe ovary fx mass echogenic cystic complex free fluid loculated fluid hemorrhage blood fx no intrauterine pregnancy dx ectopic pregnancy death USscan Davidoff MD