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CLINICAL PATHOLOGY III
BMI3707 SYSTEMS PATHOLOGY
QUESTION 1 [20]
Discuss the risk factors for, the pathogenesis of, and the consequences of, coronary
artery atherosclerosis and comment on the possible causes and the subsequent
pathologic findings that could occur with a total serum cholesterol of 268 mg/dl.
In the cardiovascular diseases called Coronary artery atherosclerosis, there is an accumulation
of inflammatory cells, fatty deposits and cholesterols and other substance within the walls of
coronary arteries. This accumulation will cause the arteries to harden and become narrow
reducing the amount of blood flow to the heart. This can cause diseases like angina or
myocardial infarctions.
Risk Factors for Coronary Artery Atherosclerosis:
1. High Blood Cholesterol Levels: Elevated levels of low-density lipoprotein cholesterol
(LDL-C) and total cholesterol are significant risk factors. A total serum cholesterol level
of 268 mg/dl is considered high. LDL cholesterols can deposit in the arterial walls and
initiate atherosclerotic plaque formation.
2. Hypertension: High blood pressure can damage the inner lining of arteries, making
them more susceptible to plaque formation.
3. Smoking: Smoking tobacco products can cause damage to the blood vessel walls, and
oxidative stress leading to inflammation and increased plaque buildup.
4. Diabetes: diabetic patients have a higher risk of atherosclerosis due to elevated blood
sugar levels, which can damage blood vessels over time and lead to metabolic
disturbance.
5. Obesity: Excess body weight, especially abdominal obesity, insulin resistance and
inflammation , is associated with an increased risk of atherosclerosis.
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6. Family History: A family history of coronary artery disease can indicate a genetic
predisposition to the condition.
7. Age and Gender: The risk of atherosclerosis increases with age, and men are
generally at higher risk than premenopausal women.
Pathogenesis of Coronary Artery Atherosclerosis:
1. Endothelial Injury: The process often begins with damage to the inner lining
(endothelium) of coronary arteries, which can be caused by factors such as high blood
pressure, smoking, and inflammation.
2. Lipid Accumulation: LDL-C particles can infiltrate the damaged endothelium and
become oxidized, triggering an inflammatory response. This leads to the formation of
fatty streaks and plaque.
3. Plaque Formation: Over time, the accumulation of cholesterol, inflammatory cells, and
smooth muscle cells in the artery walls forms atherosclerotic plaques.
4. Plaque Rupture: These plaques can rupture or become unstable, leading to the
formation of blood clots (thrombosis), which can block the artery completely.
Consequences of Coronary Artery Atherosclerosis:
1. Angina Pectoris: Partial blockage of coronary arteries can lead to angina, which is
chest pain or discomfort due to reduced blood flow to the heart muscle.
2. Myocardial Infarction (Heart Attack): Complete blockage of a coronary artery can
cause a heart attack, leading to damage or death of heart muscle tissue.
3. Heart Failure: Chronic atherosclerosis can weaken the heart muscle over time, leading
to heart failure, where the heart can't pump blood effectively.
4. Arrhythmias: Atherosclerosis can disrupt the electrical signals in the heart, leading to
irregular heart rhythms (arrhythmias).
Possible Causes and Pathologic Findings with Total Serum Cholesterol of 268 mg/dl: A
total serum cholesterol level of 268 mg/dl is elevated and considered a risk factor for
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atherosclerosis. At this level, there is an increased likelihood of LDL cholesterol being elevated
as well. The potential pathologic findings associated with high cholesterol levels include:
1. Increased LDL-C Levels: High LDL cholesterol levels increase the risk of LDL particles
infiltrating and accumulating in the arterial walls, contributing to plaque formation.
2. Oxidized LDL: Elevated cholesterol levels increase the likelihood of LDL oxidation,
which can trigger inflammation and accelerate plaque development.
3. Atherosclerotic Plaque: With persistently high cholesterol levels, there is an increased
risk of more advanced and larger atherosclerotic plaques in the coronary arteries.
4. Increased Risk of Cardiovascular Events: A total serum cholesterol of 268 mg/dl
raises the risk of angina, heart attacks, and other cardiovascular complications
associated with atherosclerosis.
To mitigate these risks, lifestyle modifications (diet, exercise, smoking cessation) and, in some
cases, medication (statins) may be recommended to lower cholesterol levels and manage
coronary artery atherosclerosis risk factors. Regular monitoring and early intervention are
crucial to reduce the potential consequences of this condition.
QUESTION 2 [20]
Discuss the major aetiologies, laboratory findings, and pathologic consequences in a
patient with disseminated intravascular coagulation (DIC).
Disseminated Intravascular Coagulation (DIC) is a complex and life-threatening condition
characterized by systemic activation of blood clotting mechanisms, which can lead to both
excessive clot formation and widespread bleeding throughout the body. DIC is not a disease
itself but rather a complication of underlying medical conditions. Let's discuss the major
etiologies, laboratory findings, and pathologic consequences associated with DIC.
Major Etiologies of DIC: DIC can be triggered by various underlying conditions and diseases,
including:
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1. Sepsis: Infection is one of the most common causes of DIC, particularly severe
bacterial infections like sepsis. The release of bacterial toxins and the body's
inflammatory response can activate the clotting cascade.
2. Trauma: Major injuries, such as trauma from accidents or surgeries, can lead to DIC
due to tissue damage and the release of tissue factors into the bloodstream.
3. Cancer: Certain types of cancer, particularly leukemia and solid tumors, can trigger
DIC. Cancer cells release procoagulant substances that activate clotting.
4. Obstetric Complications: Conditions such as placental abruption, amniotic fluid
embolism, and preeclampsia can lead to DIC during pregnancy.
5. Liver Disease: Liver dysfunction, as seen in acute liver failure or cirrhosis, can impair
the synthesis of clotting factors and contribute to DIC.
6. Hemolytic Disorders: Conditions like hemolytic anemias and transfusion reactions can
trigger DIC by releasing procoagulant substances.
7. Vascular Disorders: Conditions affecting blood vessels, like vasculitis or thrombotic
microangiopathies, can lead to DIC.
Laboratory Findings in DIC: Laboratory tests play a crucial role in diagnosing DIC. Common
findings include:
1. Prolonged Clotting Times: There is an elevation in prothrombin time (PT) and
activated partial thromboplastin time (aPTT) due to the consumption of clotting factors.
2. Low Platelet Count: Thrombocytopenia (low platelet count) is common as platelets are
consumed in the formation of microclots.
3. Elevated D-dimer: D-dimer is a breakdown product of fibrin clots. Elevated levels
indicate increased fibrinolysis and clot breakdown.
4. Decreased Fibrinogen: Fibrinogen, a clotting factor, is depleted as it's consumed in the
clot formation process.
