Pathology 2 Exam 2: hema/urinary/endrocine Flashcards | Knowt (2024)

• abnormal

• high urea and creatinine in blood

• low GFR

• azotemia that shows CS with extrarenal lesions

• Uremic stomatitis/glossitis

• Hemorrhagic ulcerative gastritis/colitis

• Endocarditis – left atrium

• metabolic acidosis

• Tissue mineralization

• Pulmonary edema

• EARLY indicator of kidney disease

• better than creatinine tests which only test at 75% renal loss

• uremia

• heart failure, shock, dehydration

• poor kidney perfusion

• failure of kidneys to filter or excrete toxic waste

• renal dx

• cant pee

• obstruction or bladder rupture

• External sign of uremia

• Urea in saliva causes oral ulceration

• Uremic ulcers

• Dogs/cats (gastritis)

• horses/cattle (colitis)

• GI Irritation from uremic toxins

• mucosal degeneration, infarction, mineralization

• Left atrium most affected

  • sign of uremia in dogs (only thing to do this)

• ulceration and plaques

• Sign of uremia in dogs

  • Dystrophic type: uremic damage

• Metastatic type:

  • Low GFR, secondary renal

    hyperparathyroidism, high calcium

• affects pleura, pericardium, stomach, kidneys, arteries, lungs

• Vasculitis and fibrin leakage in alveoli

• Predisposition to pneumonia due to compromised lungs

• Lungs fail to collapse upon opening the thoracic cavity

• Failure of kidney development

  • bilateral = abortion

  • Unilateral = incidental

• Compensatory hypertrophy of the remaining kidney

• Rare

• kidney size reduction (50%+)

• Ddx renal dysplasia or fibrosis

• Dogs and pigs

• Normal kidney in abnormal location

• Prone to ureter obstruction

  • hydronephrosis

• Cats, dogs pigs

• Abnormal differentiation of renal tissues;

  • requires histology for diagnosis

• Leads to renal failure, fibrous osteodystrophy (rubber jaw)

• DDx: renal hypoplasia, renal fibrosis, renal disease

• Secondary to chronic kidney disease

  • High P and low Ca

  • PTH pulls Ca from bones

• Bone replaced by fibrous tissue due to calcium depletion

• increase space between teeth, twisty jaw

• common in pigs and calves

• Cystically-dilated tubules

• Caused by faulty tubular epithelial cell growth or renal dx obstruction

• Honeycomb looking and lined by attenuated epithelium

• can cause renal insufficiency if severe

• Swiss Cheese looking kidney and liver cysts

• Autosomal dominant in Persian cats and bull terrier dogs

  • test for PKD1 or PKD2 genes before breeding

• Progressive juvenile nephropathy

• Glomerulopathies with secondary tubular changes

  • tubulopathies affecting reabsorption

• Persistent fetal communication between bladder and umbilicus

• cystitis risk

• Congenital cause of urinary incontinence

  • female dogs

• Ureters terminate abnormally

  • at site other than bladder trigone

  • surgically repairable

• Autolysis: Soft, friable kidneys

  • ruminants and fat animals

• Livor Mortis: Dark due to blood settling

• Pseudomelanosis: Black from hydrogen sulfide and iron reaction

• Hyperemia and Congestion: Bright/dark red kidneys due to hypostatic congestion

• Lipofuscinosis: Dark brown from lipofuscin

  • incidental in cattle

• Hemoglobinuria: Dark red-black kidneys from severe intravascular hemolysis

• Myoglobinuria: Dark red-black kidneys but plasma remains normal colour

• Common

• Petechiae or ecchymoses with Glomerular involvement

• Causes:

  • Bacterial sepsis (salmonellosis, erysipelas in pigs)

  • Viral infections (canine herpesvirus, hog cholera)

  • Coagulopathies (DIC)

• “turkey egg”

• High blood flow and "end artery" vascular pattern

• Wedge shape

  • Acute: Dark red and swollen

  • Chronic: Pale and depressed

• Causes:

  • Thrombosis/thromboembolism

  • Valvular endocarditis

• Bilateral

• acute ischemia due to hypoperfusion

  • shock, DIC, endotoxemia

    See Also

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• High metabolic rate of convoluted tubules

• grossly: Mottled red and yellow

• All cortical structures affected

• Poorly vasculated, low BP, waste accumulation (vulnerable), chronic ischemia

• Long-term NSAIDs

  • Inhibit PGE2 synthesis

• Pale renal papilla, necrotic papilla may detach

• Progressive dilation of renal pelvis with renal parenchyma cortical atrophy

• Fluid-filled balloon with fibrous scaffolding and thin walled cysts

• Urine obstruction

  • Congenital malformations, calculi, chronic inflammation, neoplasia, iatrogenic

• Increased pressure leads to tubular atrophy and occlusion of blood vessels

• Interference with blood flow

• Alteration of permeability: leakage forming Proteinuria

• Progressive renal injury due to protein traffic

• Cause: Bacteremia

• Acute: Suppurative glomerulitis

• Chronic: abscess

• Interference with blood flow

• Alteration of permeability: leakage forming Proteinuria

• Progressive renal injury due to protein traffic

• Primary changes in glomeruli, secondary tubulointerstitial and vascular changes

  Acute: Swollen, pale kidneys

• Chronic: Shrunken kidneys with fine granularity

• Deposition of amyloid protein

• Commonly affects kidneys (glomeruli)

• Primary (Amyloid AL): neoplastic plasma cells

• Secondary (Amyloid AA): most common

• Large, pale, yellow, granular kidneys

• Black staining with Lugol’s iodine

• amorphous pink deposits in glomeruli or medullary interstitium

• Tubular epithelium is highly metabolically active

  • Very susceptible to damage

• Repair is dependent on intact tubular basem*nt membrane

• High mortality without fluid therapy, or dialysis

• Tubular basem*nt membranes damaged

  • limiting repair capacity

• Swollen kidneys

• Patchy coagulative necrosis

• Exfoliation of tubular epithelium

• Hyaline casts in tubular lumina

• Ingestion of toxins

• Basem*nt membranes are preserved

  • good for repair

• Pale, swollen kidneys, parenchyma bulges when capsule cut

• Ingesting antifreeze

• glycolic acid (primary toxic metabolite) → calcium oxalate → crystals

• Crystals seen with polarized light

• Urates, oxalates, ethylene glycol, sulfa drug toxicity, melamine toxicity

  • Presence in urine sediment

• Caused by dehydration

• Tubules and interstitium damage

  • affects both

• Defective reabsorption, concentration, and excretion of glomerular filtrate

• Randomly distributed white foci in cortex/medulla

• Aggregates of lymphocytes and plasma cells

  • blue cell clusters

• may progress to fibrosis and tubular atrophy

• Causes are resolved bacteremia and septicemia

• Leptospirosis

• Acute: Swollen, mottled kidneys

  Chronic: Shrunken, pale, firm kidneys with adhered capsule

• Inflammation of renal pelvis and parenchyma

• Caused by ascending infections

  • Cattle: Corynebacterium renale

  • Pigs: Actinobaculum suis

  • Dogs/Cats: E. coli, Proteus spp., Enterobacter spp., Pseudomonas aeruginosa

• Medulla is most at risk

  • hypoxia and slow blood flow

• Acute: Swollen kidneys, red wedge lesion,

  Chronic: fibrosis, white bands extending from medulla to cortex

• Chronic renal failure is progressive once GFR decreases by 30-50%

• Compensatory capillary hypertension and hyperfiltration, hyperfunction of surviving tubules, fibrous tissue accumulation

• associated with dx causing disseminated granulomatous inflammation

• Hard to ID, needs special stains

• FIP creates peri-venular granulomas: lesions on gross often track along blood vessel

• Parasitic Diseases of the Kidney

• fish-eating mammals

• Largest parasitic nematode

• unilateral (right side) destruction of renal parenchyma

• found in peritoneal cavity

• Magnesium, ammonium, phosphate

• Urease-producing bacteria increase pH, causing increased precipitation

• Form in acidic urine (not a uti)

• Predisposing factors: hypercalcemia and excessive urinary excretion of calcium

• Urethral Obstruction in Males

  • Passed in urine

  • Unilateral hydronephrosis if lodged in the ureter

  • Chronic cystitis from partial urinary obstruction

  • Bladder rupture

  • Acute hemorrhagic urethritis

• Clinical signs: dysuria, stranguria, pollakiruia, hematuria, urinary bladder rupture

• CS: Dysuria, hematuria, pollakiuria, periuria

• Common in males

• STRESS

  Causes: Urolithiasis, urethral plugs, bacterial infections, neoplasia, and idiopathic causes

• Predisposing factors are young cats and stress, neutering (lowers stretch)

• Bacterial: Often ascending infection from the urethra

• Idiopathic: More common in cats, linked to stress

• CS: Dysuria, pollakiuria, hematuria, and stranguria

• Acute: Mucosal hemorrhage/ulceration → fibrinopurulent exudate

• Chronic: Mucous metaplasia of transitional epithelium

• Primary urinary tract tumors rare

  • Primary mesenchymal cell tumors

  • Fibroma, leiomyoma, hemangioma

• Secondary tumors

  • Lymphoma

• cells that secrete hormones directly into the blood

• Hormones modify functions of target cells

• synthesized and stored in granules

• TRH, ADH, ACTH, TSH, PTH

• not stored

• mineralocorticoids, cotisol, steroids, sex steroids

• T3, T4, catecholamine

• issue is is the endocrine organ itself

  • often neoplastic for hyperfunction

• Immune-mediated injury: hypothyroid

• Failure of development: dwarfism

• Genetic hormone synthesis defect: genetic defect

• a lesion in other organ secretes an excess of trophic hormone

• a destructive lesion in one organ such as pituitary, interferes with trophic hormone release

• Most are peptides

• Humoral hypercalcemia of malignancy

  • secretion of PTHrP by cancer

  • T cell lymphoma

  • Apocrine anal sac adenocarcinomas

• insulin resistance

• common in ruminants

• can cause prolonged gestation

• Genetic –failure of development (aplasia) of the adenohypophysis

• Toxic plants - Veratrum californicum in sheep

• Increased degradation

  • Induction of liver enzymes

  • phenobarbital

• Decreased degradation

  • Persistent elevated blood hormone levels

  • hyperestrogenism with cirrhosis

• Posterior lobe of pituitary

  • Hormones: Oxytocin, ADH

• Pituitary section

• Influenced by releasing hormones from the hypothalamus

  • Pars Distalis (Anterior Lobe): ACTH, TSH, FSH, LH, LTH, GH

  • Pars Intermedia (Posterior Lobe): ACTH in dogs

  • Pars Tuberalis: Capillaries

• Pituitary Cyst from failure of Rathke’s pouch differentiation

  • Low GH, TSH, prolactin, and gonadotropins. ACTH

• Autosomal recessive

• Slower growth rate: normal until 2 months old

• retention of puppy coat

• bilateral symmetrical alopecia

• Derived from corticotroph cells in pars distalis or pars intermedia

• Causes cortisol excess

  • canine hyperadrenocorticism (Cushing’s)

• Pot-bellied appearance, hepatomegaly, muscle atrophy, fat redistribution

• PU/PD

  • Bostons, Boxers, Dachshunds

• Common in horses, common in older horses

  • females>males

  • Large and compressive

• Causes Pituitary Pars Intermedia Dysfunction PPID

• Produces POMC-derived peptides

• PU/PD, laminitis, increased appetite, weakness, somnolence, hyperhidrosis, hyperglycemia, glucosuria, hirsutism.

• rare

• Growth hormone-secreting acidophils

• Can cause acromegaly (overgrowth of CT, bone, and viscera) insulin-resistant diabetes mellitus, Jay Leno chin: cats

• Hypophyseal Form

  • Inadequate ADH due to destruction of Neurohypophysis

• Nephrogenic Form

  • Target cell defect

• PU/PD, hypo-osmotic urine,

• Functional ACTH-producing pituitary adenoma

• Functional adrenal cortical adenoma or carcinoma: most common

• Idiopathic hyperplasia: dogs

  • Calcinosis Cutis (calcification)

• Chronic corticosteroid use or excessive cortisol

• Neutrophilia without a left shift, high glucose, high alkaline phosphate, low urine spec gravity

• Delayed wound healing, frequent infections, increased appetite, pendulous abdomen, bilateral alopecia

• Multiple discrete nodules of any of the 3 cortical zones

• Older animals

• bilateral: both glands

• Bilateral, diffuse, uniform

• Response to excessive ACTH from functional pituitary adenoma

  • Hyperadrenocorticism (Cushing’s)

• Single, unilateral, well demarcated and differentiated

• Functional

• Older dogs

• Less common than adenomas

• Large and bilateral often functional

• Highly metastatic & invasive

• Low glucocorticoids and mineralocorticoids

• adrenal glands are mainly medulla

• K+ is retained and Na+ and Cl- are lost

• Idiopathic adrenocortical atrophy, immune-mediated destruction, stopping long-term steroid therapy, pituitary lesions

• Weight loss, gastroenteritis, low stress tolerance, shock

• Common in standard poodles

• Red masses

• Most common adrenal medulla neoplasm

• Composed of Epi or norEpi secreting cells.

• Small: stay localized in adrenal

• Large: metastasize into vena cava and aorta

• Functional: catecholamine overproduction

  • Tachycardia, edema, cardiac hypertrophy.

• Newborns due to birth trauma

• exhaustion/overexertion

• stress response

• toxemia, septicemia

• Surrounding cells

• Thyroid endocrine cell.

• Cuboidal to columnar.

• Single layer around colloid-filled follicles.

• Regulated via Hypothalamic-pituitary-thyroid axis.

• Produce T3 and T4

• Thyroid C cell

• Produce calcitonin

  • Respond to reduce plasma [calcium]

  • Chronic hypercalcemia causes hyperplasia cells

• Not controlled by TSH

• Base of the tongue around developing glands

• Can migrate from caudally to diaphragm

• Dogs: near the ascending aorta

  • thyroid carcinoma is ddx for heart tumor

• From thyroglossal duct remnants.

• Small cysts or sinus tracts along necks midline

• contain watery secretions

• Nonneoplastic Enlargement due to follicular cell hyperplasia

• Diffuse: compensatory, TSH-induced response to hypothyroidism

• multinodular: in old cats, functional, independent, hyperthyroidism)

• High/low Iodine TH defects, goitrogens

• Fetal and neonatal periods: diffuse goiter

• grossly Diffusely enlarged and reddened goiter

• Increased vascularity, large follicles, decreased luminal diameter, follicular cell hypertrophy.

• Fetus – myxedema (edema & glycosaminoglycans) in dermis,

  less hair

• Compounds causing hyperplastic goiter

  • plants and drugs

• High/low iodine increases sensitivity

• involution stage Post-dietary iodine repletion in hyperplastic goiter

• Thyroid gland stays large

• Atrophic follicular cells due to low TSH

• Older dogs

• 90% cases are primary

  • Idiopathic follicular atrophy

  • Lymphocytic thyroiditis.

• Shrunken, pale thyroid gland.

• Parenchyma lost or replaced by fat

• Possible end-stage of autoimmune lymphocytic thyroiditis

• Autoimmune thyroid disease.

  • Infiltration by thyroid-reactive T lymphocytes.

  • Triggered by genetic and environmental factors.

• Old cats> dogs

• functional, leading to hyperthyroidism.

• Discrete tan to brown nodules, tissue compression

• Feel thyroid on PE

• Dogs

• Large and vascular

• Non functional

• from ectopic thyroid tissue with metastasis to lungs

• C-cell Adenoma

  • Equine thyroid tumor

  • incidental at necropsy

• C-cell Carcinoma:

  • Bulls and dogs

    • high-calcium diets

    • Increased vertebral bone density

  • metastasize to regional lymph nodes or lungs.

• paired glands near the thyroids

  • Dogs and Cats: Bilateral external and internal

• made of chief cells (PTH)

• Parathyroid Gland cells

• release PTH in response to low ionized calcium

  • activates osteoclasts to absorb ca

  • block reabsorption of phosphorus

• Low PTH release or poor PTH response

  • low calcemia and high phosphorus

• Risks: Mini schnauzers, thyroidectomy cats

• High PTH secretion

• Parathyroid adenomas, chief cell carcinoma: dogs

• High phosphorus and low calcium

  • low cholecalciferol, calcium deficiency

• More common

• diffuse and bilateral.

• Big head dx in horses

  • bone replaced with CT

• poor calcitriol synthesis

• low GFR, high phosphorus, low calcium in blood

• Causes high PTH leading to fibrous osteodystrophy

  • rubber jaw

• Hypofunction

  • Pancreatic Islet B Aplasia/Hypoplasia: puppies

  • Degeneration or Necrosis

  • Immune-Mediated Inflammation: islet cell destruction.

  • Chronic Pancreatitis: endocrine and exocrine tissue destruction

  • Insulin-Resistance: Cats

• Low immune response, UTI, cataracts, polyuria

• β-Cell (Insulin Secreting) Neoplasms

  • β-Cell Carcinoma common in right lobe of dogs

  • meets liver and lymph nodes

• Common in dogs and ferrets (benign in ferrets)

• Appearance: Solitary, yellow to red, round nodules, small

• Multiple small nodules

• gray to tan

• Old animals

• incidental

• primary adult hematopoietic site

• neonate to adult there is bone marrow contraction found in spaces of axial bone and proximal femur/humerus

• divided into yellow and red

• Dynamically active

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