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Path_2 - Patho 2 1 The use of broad-spectrum antibiotics...

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Patho 2 1. The use of broad-spectrum antibiotics can produce a bleeding diathesis characterized by hematomas, hematuria, melena, and bleeding from the gums by decreasing the normal gut flora and inducing a deficiency of which of the following vitamins? A. Vitamin A B. Vitamin B 1 C. Vitamin B 6 D. Vitamin C E. Vitamin K The answer is: E Vitamin K compounds include phylloquinone (K 1 ), which is the major form of vitamin K in plants, and menaquinone (K 2 ), which is produced by bacteria. Up to 50% of the vitamin K needed by the body is provided by the normal bacteria of the GI tract. Vitamin K is required for the posttranslational conversion of glutamyl residues in some proteins into -carboxylates. It participates in the hepatic carboxylation of four procoagulants (factors II, VII, IX, and X) and plasma proteins C and S. For these four proclotting factors, this -carboxylation provides the calcium-binding sites necessary for the calcium- dependent interaction with a phospholipid surface. A deficiency of vitamin K, which can result from fat malabsorption, broad-spectrum antibiotics, or diffuse liver disease, produces a bleeding diathesis characterized by hematomas, ecchymoses, hematuria, melena, and bleeding from the gums. Laboratory tests reveal an increased bleeding with prolonged PT and PTT and normal bleeding time. 2. A 48-year-old male who has a long history of excessive drinking presents with signs of alcoholic hepatitis. Microscopic examination of a biopsy of this patient’s liver reveals irregular eosinophilic hyaline inclusions within the cytoplasm of the hepatocytes. These eosinophilic inclusions are composed of which of the following? The answer is: C Hyalin is a nonspecific term that is used to describe any material, inside or outside the cell, that stains a red homogenous color with the routine hematoxylin and eosin (H&E) stain. There are many different substances that have the appearance of hyalin. Alcoholic hyaline inclusions (Mallory bodies) are irregular eosinophilic hyaline inclusions that are found within the cytoplasm of hepatocytes. Mallory bodies are composed of prekeratin intermediate filaments. They are a nonspecific finding and can be found in patients with
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several diseases other than alcoholic hepatitis, such as Wilson’s disease, and in patients who have undergone bypass operations for morbid obesity. Immunoglobulins may form intracytoplasmic or extracellular oval hyaline bodies called Russell bodies. Excess plasma proteins may form hyaline droplets in proximal renal tubular epithelial cells or hyaline membranes in the alveoli of the lungs (hyaline membrane disease). The hyalin found in the walls of arterioles of kidneys in patients with benign nephrosclerosis is composed of basement membranes and precipitated plasma proteins. Lipofuscin is an intracytoplasmic aging pigment that has a yellow-brown, finely granular appearance with H&E stains. Its appearance does not resemble that of hyaline material.
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