CASE 1:
A 41 year old woman had a long history of epilepsy for which she took phenobarbital on a regular basis. One day she stumbled over a curbstone and twisted her knee. Her knee became very painful and swollen and she therefore began to take acetaminophen (tylenol) in doses slightly in excess of those recommended on the package. Over the next week she developed nausea, tenderness high in the right upper quadrant and slight jaundice. Abnormally high levels of aminotransferase (transaminase) enzymes were detected in the blood. It was recommended that she discontinue acetaminophen intake. In addition she was given n-acetyl cysteine.
1. Why might her liver have been exceptionally vulnerable to acetaminophen toxicity?
2. Why did the aminotransferase enzymes appear in her blood?
3. What was the rationale for giving her n-acetyl cysteine?
CASE 2
A 62 year old male with calcific stenosis of a congenital bicuspid aortic valve had open heart surgery during which the valve was replaced with and artificial valve. A few weeks later he died because blood clots were forming on the valve, coming loose and traveling to other parts of the body in which they were blocking blood flow. The photo shows how one kidney looked at the autopsy. You are looking at a cross section of half a kidney. Renal cortex is at the top; medulla and the boundary of the calyceal system is at the bottom.
1. What kind of necrosis is occurring in the roughly triangular pale area? You can assume that the pale material is rather solid.
2. Why does the necrotic area have the shape that it has?
CASE 3
The following photograph shows a frontal section of a portion of cerebral cortex from a patient who died of a stroke and subsequent complications. Notice how grey matter definition is lost on the left side of the sulcus just to the right of top center in the photo. Notice how both grey and whithe matter are affected. Think about the oval cavity to the left of top center in the photo.What kind(s) of necrosis are present in the photograph?
CASE 4
The following photograph shows two large areas and a few smaller areas of coagulative necrosis in the spleen. Because of the chalky or cheesy character of the large one on the right, students like to call this caseous necrosis, but this would be wrong. Caseous necrosis is a term that is pretty much restricted to lesions of tuberculosis (which we will talk about later) or other granulomatous diseases (also to be discussed later). This coagulative necrosis is due to arterial occlusion; the shape of the lesions suggests the distribution of an artery.
What would be the microscopic appearance of these areas of coagulative necrosis?
CASE 5
This photograph shows some brown pigmented macrophages in the alveoli of a man who died while attempting to recover from pneumonia. While he had the pneumonia he was coughing up a mixture of mucus, fluid, white blood cells and red blood cells.
What is the brown pigment?
CASE 6
The following photograph came from the autopsy of a woman who had lived for many years down-wind from a coal burning electricity generating plant. You are looking at the pleural surface.
1. What is the material giving the surface the black markings?
2. In what microscopic structures is the black pigment contained?
CASE 7
A 45 year old woman was having episodes of colicky abdominal pain and eventually developed signs of liver disease incuding jaundice. A liver biopsy was done and it had the following appearance.
Although it is not easy to make out in this photograph the number of bile ducts is increased and many of them contain yellow brown pigment. It was subsequently determined that she had bile duct obstruction due to a tumor in the head of the pancreas.
1. What is the pigment?
2. What is jaundice and why does she have it?