Pathology of Hypertension:
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Hypertension - Introduction Silent Killer – painless – complications dizziness, headache, and visual difficulties, It is the leading risk factor – MI, DM, Stroke 25% of population, <35% unaware. <5% ..! www.indiandentalacademy.com
Introduction Complications bring to diagnosis but late… “Sustained increase in blood pressure” Systolic >140, Diastolic > 90 mm of Hg*
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Control of Blood Pressure:
Blood Volume Na+, Aldosterone
BP Cardiac Factors Rate & Contract..
Vasoconstrictors Angiotensin II Catecholamines
Cardiac Output
Humoral Factors Vasodilators Pg & Kinins
Peripheral Resistance
Neural Factors αAdrenergic – Cons ß Adrenergic - Dil www.indiandentalacademy.com
Local Factors pH, Hypoxia
Etiologic Classification: Primary or Essential Hypertension(95%) Secondary Hypertension (5-10%) Renal – Kidney disorders. Other – endocrine, drugs etc.
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Pathogenesis of complications Of Hypertension Ishchemia – MI, CNS, Kidney, eye Aneurism / Rupture – CNS, Aorta, Myocardial Hypertrophy LVH, Cardiac failure.
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Consequences of Hypertension: Blood Vessels Atherosclerosis, Arteriolosclerosis. Heart Enlarge, Ischemia, Infarction. Kidney Ischemia, Infarction - nephrosclerosis. Eyes: Retinopathy – Ischemia, infarction. Brain: Ischemia, infarction, Haemorrhages. www.indiandentalacademy.com
Thickening of blood vessel:
Narrow Lumen
Onion Skin Thickening Of arterioles. www.indiandentalacademy.com
Hypertrophy of heart:
Left Ventricular Hypertrophy
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Brain Haemorrhage: Cerebral Blood vessels Special features: Thin walled* End arteries* Cong. Aneurisms
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Cerebral Infarction (Stroke) : Haemorrhagic Necrosis
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Cerebral Infarction:
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Kidney damage Benign Nephrosclerosis:
Leathery Granularity due to minute scarring
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Risk Factors for Atherosclerosis:
Hypertension – Hyperplastic A. sclerosis Diabetes – Hyaline A. sclerosis Smoking – Endothelial damage. Hypercholesterol – Endothelial damamge Life style, lack of exercise, stress, obesity. All factors damaging Blood vessels predispose to development of atherosclerosis. www.indiandentalacademy.com
Normal Retina - Fundoscopy
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Hypertensive Retinopathy:
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Conclusions:
Persistent increased blood pressure (140/90) 95% Essential, 5% secondary - Renovascular Benign and Malignant types (>120Diastolic) Vessel damage & Arteriolosclerosis Complicates - Atherosclerosis, Diabetes, IHD Ischemia or Infarction in end organs. Kidney, Brain, Heart & Eyes. Nephrosclerosis, renal damage, IHD, MI, Stroke & Retinopathy. www.indiandentalacademy.com
Pathology of Diabetes
Dr. Venkatesh M. Shashidhar Senior Lecturer in Pathology Fiji School of Medicine www.indiandentalacademy.com
Diabetes Mellitus Disorder of metabolism (Carb, Prot & Fat) Due to Absolute or relative deficiency of insulin. Characterized by hyperglycemia. Clinically : Polyuria, Polydypsia, Polyphagia.
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Classification Primary DM. Type I – IDDM / Juvenile – 10%. Type II – NIDDM /Adult onset – 80%. MODY – 5% maturity onset - young - Genetic
Secondary DM – islet destruction.
Infectious – congenital rubella, CMV. Pancreatitis/tumors/Hemochromatosis. Endocrinopathy, gestational DM, downs. Drugs – Corticosteroids. www.indiandentalacademy.com
Pathogenesis of Type I DM Genetic HLA-DR3/DR4
Environment ? Viral infe..??
Autoimmune Insulitis Ă&#x; cell Destruction Severe Insulin deficiency
Type I DM www.indiandentalacademy.com
Pathogenesis of Type II DM ß cell defect Genetic Abnormal Secretion
Environment Obesity ??? Insulin resistance
Relative Insulin Def.
ß cell exhaustion
Type II DM www.indiandentalacademy.com
IDDM
Complications: Short term Complications: (metabolic) Hypoglycemia Diabetic Ketoacidosis Non Ketotic hyperosmolar diabetic coma Lactic acidosis
Long term Complications:(microangiopathy) Angiopathy, Retinopathy, Nephropathy, Neurophathy www.indiandentalacademy.com
Long term Complications: Angiopathy Atherosclerosis Hyaline arteriolosclerosis Diabetic microangiopathy
Nephropathy Nodular glomerulosclerosis
Retinopathy Non Proliferative & Proliferative
Neuropathy Peripheral axonal neuropathy www.indiandentalacademy.com
Pathogenesis of Microangiopathy: 1. Long standing diabetes 2. Glycosylation of BV proteins. 3. Protein deposits in the BM. 4. Thick and Leaky blood vessels 5. Exudation & Ischemia 6. End Organ damage... www.indiandentalacademy.com
“Diabetic Micro-angiopathy is the primary cause of diabetic …pathies” (hyaline arteriolosclerosis) www.indiandentalacademy.com
Infections in Diabetes:
Blood vessel damage – ischemia Decreased intracellular glucose - defence Glycosylation of inflammatory mediators Glycosylation of immunoglobulins Lastly increased glucose in blood.
*** Not just due to increased glucose….! www.indiandentalacademy.com
Microangiopathy
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Pathogenesis of Complications
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Atheroma Coronary Artery:
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Diabetic Gangrene
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Normal Retina
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Diabetic Retinopathy Cotton wool spots
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Pathogenesis of Nephropathy
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Diabetic Glomerulosclerosis
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Laboratory Diagnosis: Urine glucose - dip-stick –Screening Random or fasting blood glucose (<11) Fasting > 7mmol, Random >11mmol If Fasting level is between 7-11 then OGTT HbA1c - for follow-up, not for diagnosis Fructosamine - for long term maintenance. www.indiandentalacademy.com
Take home points: Type-I – Young, Acute Metabolic complications - Ketoacidosis. Type-II - Chronic Vascular complications Microangiopathy – Kidney,Retina,Brain, BV.
Hypoglycemia is more dangerous.
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Take home points: ď&#x192;&#x2DC; Duration & level of hyperglycemia are directly proportional to Chronic (Vascular) complications. ď&#x192;&#x2DC; Infections are due to microangiopathy and ischemia, immuno suppression and lastly hyperglycemia.
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