* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download LABORATORY
Electrocardiography wikipedia , lookup
Heart failure wikipedia , lookup
History of invasive and interventional cardiology wikipedia , lookup
Hypertrophic cardiomyopathy wikipedia , lookup
Aortic stenosis wikipedia , lookup
Quantium Medical Cardiac Output wikipedia , lookup
Management of acute coronary syndrome wikipedia , lookup
Artificial heart valve wikipedia , lookup
Arrhythmogenic right ventricular dysplasia wikipedia , lookup
Cardiac surgery wikipedia , lookup
Myocardial infarction wikipedia , lookup
Lutembacher's syndrome wikipedia , lookup
Coronary artery disease wikipedia , lookup
Mitral insufficiency wikipedia , lookup
Atrial septal defect wikipedia , lookup
Dextro-Transposition of the great arteries wikipedia , lookup
LABORATORY Week 2 Blood Pathologies Heart Anatomy Objectives: 1. Observe prepared slides of pathologic blood samples (pernicious anemia, iron deficiency anemia, sickle cell anemia, chronic lymphocytic leukemia and eosinophilia). Describe the appearance of each smear and indicate how it deviates from normal. 2. Human Heart Anatomy Identify the following structures using charts, diagrams and models available in the lab: apex base aorta myocardium endocardium bicuspid (mitral) valve coronary sinus chordae tendineae marginal artery pectinate muscle epicardium visceral pericardium middle cardiac vein inferior vena cava atrioventricular sulcus left common carotid artery 2.1 right atrium left atrium right ventricle left ventricle pulmonary trunk pulmonary veins tricuspid valve papillary muscles circumflex artery fossa ovalis left subclavian artery great cardiac vein superior vena cava right and left auricles interatrial septum left subclavian artery interventricular septum ligamentum arteriosum pulmonary semilunar valve inferior vena cava left common carotid artery aortic semilunar valve trabeculae carneae pulmonary arteries left coronary artery right coronary artery anterior interventricular artery brachiocephalic artery posterior interventricular artery posterior interventricular sulcus anterior interventricular sulcus 3. Sheep Heart Dissection Complete a dissection of a sheep heart specimen and identify the following structures: apex right ventricle right atrium aorta tricuspid valve bicuspid (mitral) valve coronary sinus brachiocephalic artery myocardium fossa ovalis atrioventricular sulcus 4. base parietal pericardium visceral pericardium inferior vena cava pulmonary veins pectinate muscle chordae tendineae aortic semilunar valve interventricular septum pulmonary semilunar valve ligamentum arteriosum right and left auricles left ventricle left atrium pulmonary trunk pulmonary arteries superior vena cava moderator band endocardium anterior interventricular sulcus posterior interventricular sulcus fibrous pericardium Microscopic Anatomy of Cardiac Muscle Observe prepared slides of cardiac muscle and identify the nucleus, striations, sarcolemma and intercalated discs. Introduction: Hematology involves the scientific study of the anatomy, physiology and pathology of blood and blood forming tissues. Hematological tests can help diagnose anemias, hemophilia, blood-clotting disorders, and leukemias. In this lab, you will observe blood smears that represent common blood disorders. The heart is located in the thorax, in a region between the lungs known as the mediastinum. The function of the heart is to collect blood from veins and eject that blood into arteries. In this lab session, you will examine the gross anatomy of the heart and the pericardium and review the microscopic anatomy of cardiac muscle. 2.2 Activity 1 Blood Pathologies Materials: Per student: compound microscope Per pair of students: colored pencils lens cleaner lens paper immersion oil box of prepared slides: pernicious anemia, iron deficiency anemia, sickle cell anemia, chronic lymphocytic leukemia, eosinophilia Procedure: 1. Observe each of the prepared slides using the 40X and/or the 100X objective. 2. Prepare sketches of each slide in the spaces provided in the Lab Worksheet. Tips: 2.3 1. When viewing the slides of pernicious anemia, iron deficiency anemia and sickle cell anemia, compare the color, shape and size of the RBCs to that of normal RBCs. 2. When viewing the slides of chronic lymphocytic leukemia and eosinophilia, compare the WBCs to the WBCs seen in a normal blood smear; pay close attention to the relative numbers of WBCs. Relevant Background Information: 1. Disorders Associated With Erythrocytes - Anemias: Anemia refers to a variety of conditions in which there is a reduction in the number of erythrocytes or in the concentration of normal hemoglobin. Anemias are classified according to etiology (cause, such as decreased erythropoiesis, accelerated hemolysis, hemorrhage or biochemical defects) or by the morphology (size, color) of the red blood cells. Some useful terms for morphological classification are: Size Microcytic: small cell Normocytic: normal sized cell Macrocytic: large cell Color Hypochromic: pale cell Normochromic: cell with normal color Hyperchromic: dark cell Pernicious anemia is an example of a macrocytic, hyperchromic or macrocytic normochromic anemia. A few microcytes and tear shaped red blood cells may be present. Basophilic stippling (round, dark blue granules) and nucleated red blood cells may also be seen. Neutrophils showing hypersegmented nuclei are commonly encountered and these nuclei may be larger in size that a typical neutrophil. Pernicious anemia is most commonly diagnosed in people over 60 years of age and is rarely present in people below 40 years of age. This disease is caused by a deficiency of vitamin B12, which is often related to the fact that the gastric mucosa does not secrete the intrinsic factor (IF) needed for vitamin B12 absorption. There is strong evidence that pernicious anemia is an autoimmune disorder with a genetic predisposition. Clinical symptoms evolve slowly over a period of several months. Generally, the person develops weakness, shortness of breath and jaundice. The tongue may become red and raw or pale, sore and smooth. Gastrointestinal symptoms are usually present in the form of abdominal pain, diarrhea, nausea and vomiting. Degeneration of the white matter in parts of the CNS leads to several neurological symptoms, such as numbness and tingling of the extremities, loss of position sense, muscle weakness and decreased tendon reflexes. In more advanced cases, the person may become emotionally unstable or display personality changes. Iron deficiency anemia is an example of a microcytic, hypochromic anemia. This disease results when there is insufficient iron for normal hemoglobin synthesis. This can happen when iron loss or consumption exceeds iron intake, and may be associated with pregnancy, dietary deficiency or bleeding. The red blood cells are small and of different sizes, and pale (central pallor > 0.4 m). The reticulocyte count is usually within the normal range (unless following hemorrhage or iron therapy) and although the platelet count is normal, the platelets may appear smaller than usual. Patients with iron deficiency anemia display the typical symptoms of anemia – fatigue, irritability, breathlessness, palpitations, dizziness and/or headache. Other, less frequently encountered symptoms include epithelial cell defects involving the tongue, nails, mouth and stomach. There may be neurologic pain, vasomotor disturbances, numbness or tingling. 2.4 Sickle cell disease is inherited as an autonomic recessive gene. This mutated gene encodes abnormal hemoglobin S, in which the amino acid valine replaces a glutamino acid that is normally found in the beta chain of adult hemoglobin A. When hemoglobin S is deoxygenated, it crystallizes in the red blood cell; this leads to a distortion in the shape of the red blood cells, rapid destruction of red blood cells, reduced red blood cell number and anemia. In addition, masses of sickled red blood cells may block the lumen of small blood vessels and cause infarcts (areas of cell death) in various tissues; this is believed to be the cause of the severe pain in the abdomen, bone and joints that characterizes a clinical crisis. When a gene for hemoglobin S is inherited from only one parent, the individual is heterozygous for the condition and has sickle cell trait; these individuals are rarely severely affected. When the gene for hemoglobin S is inherited from both parents, the individual is homozygous and suffers from sickle cell anemia. These patients have profound anemia and recurrent infections. On a stained smear, the red blood cells appear normochromic and normocytic. Some sickle shaped cells are generally present, and the reticulocyte count is elevated. The platelet count is usually increased and there may be moderate neutrophilia. 2. Disorders Associated With Leukocytes: Leukemia and Eosinophilia Leukemia is an uncontrolled, abnormal proliferation of one or more of the leukocyte precursor cells. It is a cancer, then, of blood forming tissues. While the exact cause of leukemia is unknown, the following risk factors have been identified: aging, chemical exposure (some solvents (eg, benzene), some pesticides and herbicides), radiation exposure, genetic predisposition, certain viruses and cigarette smoking. Among the generalized symptoms that may appear are fatigue, weakness, discomfort, abnormal bleeding and easy bruising, weight loss, bone or joint pain, infection and fever, and enlargement of the liver, lymph nodes and spleen Leukemias are classified according to the rate at which the disease progresses and according to the type of cell that is malignant. Acute leukemia progresses quickly and can lead to death in a period of weeks to months. The blood forming cells remain in an immature state and are not functional. Chronic leukemia moves more slowly, over a period of years. The leukocytes involved do mature but they are barely functional. If the abnormal cells are primarily granulocytes or monocytes, the leukemia is called myelogenous. It the abnormal cells are lymphocyte originating in bone marrow, it is called lymphocytic (lymphomas are derived from lymphocytes in lymph nodes, the spleen, and other organs). Blood smears from patients with chronic lymphocytic leukemia (CLL) contain abundant small lymphocytes (60-95% out of as many as 20,000 to 200,000 leukocytes/mm3 blood). The lymphocytes present are generally small, mature cells that contain a nucleus with a small dent or cleft. The lymphocytes are generally fragile than normal lymphocytes; this may result in the rupture of some cells during preparation of the smear (smudge cells). 2.5 Eosinophilia is defined as an increase in the number of circulating eosinophils beyond normal (> 450 eosinophils/l blood). There may also be increased eosinophils in other body fluids and in tissues. There are several possible causes including malignancy, connective tissue diseases, parasitic diseases, allergies but in many cases the cause is unknown. Blood smears characteristically display a larger than normal density of eosinophils with normal morphology. Activity 2 Human Heart Anatomy Materials: models, charts and diagrams of the human heart Resources: Textbook: Photographic Atlas pages 658-668 pages 107-110 Procedure Identify the following structures using charts, models and diagrams available in the lab: apex base aorta myocardium endocardium bicuspid (mitral) valve coronary sinus chordae tendineae marginal artery pectinate muscle epicardium visceral pericardium middle cardiac vein inferior vena cava atrioventricular sulcus left common carotid artery 2.6 right atrium left atrium right ventricle left ventricle pulmonary trunk pulmonary veins tricuspid valve papillary muscles circumflex artery fossa ovalis left subclavian artery great cardiac vein superior vena cava right and left auricles interatrial septum left subclavian artery interventricular septum ligamentum arteriosum pulmonary semilunar valve inferior vena cava left common carotid artery aortic semilunar valve trabeculae carneae pulmonary arteries left coronary artery right coronary artery anterior interventricular artery brachiocephalic artery posterior interventricular artery posterior interventricular sulcus anterior interventricular sulcus Tips: 1. Describe out loud to your lab partner how blood flows through the heart, naming in order all of the chambers, valves, vessels, etc. Start with the inferior and superior vena cava and end with the aorta. Point to each structure on a human heart model. Use this chart to help you: Circulation of Blood Through The Heart 1. Inferior/Superior Vena Cava 15. Body Systems 14. Aorta 2. Right Atrium 13. Through the Aortic Semilunar Valve 3. Through the Tricuspid Valve 12. Left Ventricle 4. Right Ventricle 11. Through the Bicuspid (Mitral) Valve 5. Through the Pulmonary Semilunar Valve 6. Pulmonary Trunk 7. Pulmonary Arteries Activity 3 Materials: Per pair of students: Sheep heart specimen Dissecting pan Dissecting tools Pins Gloves Goggles (if needed) Bag for disposal or storage 2.7 10. Left Atrium 8. Lungs 9. Pulmonary Veins Sheep Heart Dissection Resources: Photographic Atlas: pages 111 and 116 Procedure: Properly dissect a sheep’s heart and identify the following structures: apex right ventricle right atrium aorta tricuspid valve bicuspid (mitral) valve coronary sinus brachiocephalic artery myocardium fossa ovalis atrioventricular sulcus 2.8 base parietal pericardium visceral pericardium inferior vena cava pulmonary veins pectinate muscle chordae tendineae aortic semilunar valve interventricular septum pulmonary semilunar valve ligamentum arteriosum right and left auricles left ventricle left atrium pulmonary trunk pulmonary arteries superior vena cava moderator band endocardium anterior interventricular sulcus posterior interventricular sulcus fibrous pericardium 1. Observe the pericardial sac (outer sac around the heart) and note how its attachment to the heart. 2. Cut open the pericardial sac and remove it carefully from its attachment point. Identify the layers of the pericardial sac – the outer, fibrous layer and the inner, serous, parietal pericardium. Then, identify the serous, visceral layer of the pericardium (also called the epicardium) adherent to the surface of the heart itself. 3. Carefully clear the adipose tissue that is on the surface of the heart and around the great vessels of the heart. The great vessels will appear as gray tubular structures buried in the fat. 4. Turn to page 111 and116 of the photographic atlas. Examine the external surface of the heart. Note the fat filled anterior interventricular sulcus on the anterior side of the heart surface. This sulcus is positioned obliquely on the anterior side of the heart and marks the boundary between the right and the left ventricles. Turn the heart over and examine the posterior surface; note the fat filled posterior interventricular sulcus which has a more vertical orientation. 5. Now, identify the apex (tip) and base of the heart. Locate the two ear like auricles. The auricles are flaps of tissue on the surface of the right and left atrial chambers. All tissue below the auricles makes up the walls of the right and left ventricles. 2.9 6. Compare the right and the left ventricles by compressing each. The wall of the left ventricle will feel firm and thick; the wall of the right ventricle will feel flabby and thin. How does the structure of each relate to its function? 7. Turn the heart over and view the anterior surface. Note that the apex of the heart is located in the left ventricle. 8. While viewing the anterior heart, locate the pulmonary trunk and the aorta as they emerge from the base of the heart. Follow the more anterior pulmonary trunk until it divides to form the right and left pulmonary arteries (occasionally, these arteries have been cut off – if that is the case, look at another specimen). Now, follow the aorta until you locate the brachiocephalic artery. You should be able to locate the ligamentum arteriosum, a remnant of fetal circulation, that connects the pulmonary trunk and the aorta. The ligamentum arteriosum may be buried in fat. 9. Turn the heart over so that you are again viewing the posterior side. Locate the openings into the left atrium; these openings were attached to the pulmonary veins which are usually trimmed away when the specimen is procured. The openings of the pulmonary veins are usually positioned inferior to the pulmonary arteries. It may help to insert a probe through these openings into the left atrium. 10. Next, identify the flat, thin walled superior and inferior vena cavae entering the right atrium. Connect these two vessels by inserting a blunt probe into the superior vena cava, through the right atrium and into the inferior vena cava. 11. Starting at the top of the pulmonary trunk, use scissors to cut inferiorly until you see the pulmonary semilunar valve. Locate the aortic semilunar valve by cutting through the wall of the aorta in the same fashion. Try to identify the openings of the right and left coronary arteries just above the valve leaflets of the aortic semilunar valve. 12. You are now ready to examine the internal structures of the heart. For this part of the dissection. Follow the directions on page 166 of the photographic atlas for this part of the procedure. 13. Clean all of the tools and the dissection tray with soap and water, being careful to remove any fat. Dispose of the heart in the biohazard bag at the front of the room. Clean and disinfect your lab bench. Activity 4 Microscopic Anatomy of Cardiac Muscle Materials Compound microscope Colored pencils Lens paper Lens cleaner Immersion oil Prepared slide of cardiac muscle Resources: Textbook: page 672: Fig 18.12 Procedure 1. Observe a prepared slide of cardiac muscle and identify the striations, nuclei, sarcolemma, and intercalated discs. 2. Make a labeled drawing in the Lab Activities Worksheet. 2.10 Checklist A. Blood Pathologies ____ Pernicious anemia ____ Iron deficiency anemia ____ Sickle cell anemia ____ Chronic lymphocytic leukemia ____ Eosinophilia B. Human and Sheep Heart Anatomy Structure Chambers Right atrium Left atrium Right ventricle Left ventricle Valves: Tricuspid valve Bicuspid (mitral) valve Pulmonary semilunar valve Aortic semilunar valve Muscle Pectinate muscle Papillary muscles Trabeculae carneae Moderator band Tissue Layers of the Heart Wall Epicardium (visceral pericardium) Myocardium Endocardium Pericardium Pericardial sac (fibrous layer/parietal serous layer) Epicardium (visceral pericardium) 2.11 Human Heart Sheep Heart Structure Human Heart Major Blood Vessels Aorta Brachiocephalic artery Left common carotid artery Left subclavian artery Pulmonary trunk Right and left pulmonary arteries Superior and inferior vena cava Right and left pulmonary veins Sheep Heart NA NA may be absent may be absent Remnants of Fetal Circulation Fossa ovalis Ligamentum arteriosum Coronary Circulation Right coronary artery Left coronary artery Anterior interventricular artery Posterior interventricular artery Circumflex artery Marginal artery Great cardiac vein Middle cardiac vein Coronary sinus Other Apex Base Chordae tendineae Interventricular septum Interatrial septum Right and left auricles 2. Microscopic Anatomy of Cardiac Muscle ____ intercalated discs ____ striations ____ sarcolemma 2.12 NA NA NA Lab 2 Pre-Lab Questions 1. Define the following terms: Macrocytic: ____________________________________________________________ ____________________________________________________________ Normochromic: __________________________________________________________ ____________________________________________________________ Etiology: ____________________________________________________________ ____________________________________________________________ Anemia ____________________________________________________________ ____________________________________________________________ Leukemia ____________________________________________________________ ____________________________________________________________ Eosinophilia ____________________________________________________________ ____________________________________________________________ Hematology ____________________________________________________________ ____________________________________________________________ Hemoglobin S____________________________________________________________ ____________________________________________________________ Smudge Cell ___________________________________________________________ ____________________________________________________________ Intrinsic factor ___________________________________________________________ ____________________________________________________________ 2.13 2. Match the term with the appropriate description: a. b. c. d. e. f. g. mediastinum fibrous pericardium parietal pericardium superior vena cava trabeculae carneae pulmonary veins papillary muscle h. pulmonary trunk i. interventricular septum j. coronary sinus k. ventricles l. inferior vena cava m. visceral pericardium n. fossa ovalis o. chordae tendineae ____ largest artery in the body ____ internal partition that divides the ventricles internally ____ three veins that deliver blood to the right artrium p. pectinate muscle q. aorta r. apex s. intercalated disc t. myocardium u. atria v. endocardium w. auricles ____ ____ ____ lines the internal surface of the fibrous pericardium ____ muscle that plays a role in valve function ____ lies in the left fifth intercostal space; points inferiorly towards the left hip ____ superior heart chambers ____ vessels that deliver blood to the left atrium ____ the medial cavity of the thorax ____ irregular ridges of muscle found in the internal walls of the ventricles ____ small protruding ear like flaps that increase atrial volume to a small degree ____ maintains a smooth surface for blood flow; lines heart chambers and covers heart valves ____ middle heart layer ____ remnant of fetal circulation located in the interatrial septum ____ also known as the epicardium ____ ridged bundles of muscle tissue in the anterior atrial walls ____ inferior chambers of the heart ____ outer, tough dense connective tissue layer of the pericardium ____ collagen cords connected to the AV valves; anchor the valves to papillary muscles 2.14 3. Identify the structures using the terms below: _____ interventricular septum _____ superior vena cava _____ brachiocephalic artery _____ tricuspid valve _____ left atrium _____ endocardium _____ pulmonary semilunar valve _____ aortic arch _____ right pulmonary veins _____ bicuspid (mitral) valve _____ right atrium _____ inferior vena cava _____ aortic semilunar valve _____ myocardium _____ left pulmonary veins _____ left common carotid artery _____ left ventricle _____ right ventricle _____ left subclavian artery _____ pulmonary trunk _____ right pulmonary artery _____ left pulmonary artery _____ descending aorta _____ epicardium 18 19 17 21 23 16 24 2.15 20 22 4. Match the terms below with the descriptions: a. b. c. d. e. right coronary artery marginal artery left coronary artery great cardiac vein pulmonary semilunar valve f. tricuspid valve g. aortic semilunar valve h. anterior interventricular artery i. middle cardiac vein j. posterior interventricular artery k. bicuspid valve These two structures prevent the backflow of blood into the atria _____ _____ These two structures prevent the backflow of blood into the ventricles _____ _____ These two structures arise from the base of the aorta and supply blood to coronary circulation _____ _____ These two vessels supply blood to the interventricular septum _____ _____ These two structures are tributaries of the coronary sinus _____ _____ This vessel supplies blood to the right ventricular wall _____ 5. Describe the location and position of the heart in the human body: _________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 6. Compare the function of the pulmonary circuit and the systemic circuit ___________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 2.16 Lab Activities Worksheet Name: _____________________ Week 2 Lab 1. Prepare sketches of each slide indicated below: Pernicious Anemia Iron Deficiency Anemia Macrocytic/Normo-hyperchromic Microcytic/Hypochromic Magnification: ______________ Magnification: ____________ Sickle Cell Anemia Chronic Lymphocytic Leukemia Normocytic/Normochromic Magnification ______________ Magnification: ________________ Eosinophilia Magnification: ___________ 2.17 2. Which chamber of the heart – left or right ventricle – has thicker walls? How does this difference reflect the functions of these two chambers? ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 3. After observing the models, identify one method that you could use to differentiate between the anterior and posterior surfaces of the heart: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 4. Identify one method that you could use to differentiate the right and left sides of the heart. _____________________________________________________________________ _____________________________________________________________________ 5. What structure is present in the right ventricle of the sheep’s heart, but not in the left ventricle? ______________________ 6. Make a labeled sketch of cardiac muscle as you observed it under the microscope. Label the nucleus, intercalated discs, sarcolemma and striations. Cardiac Muscle Magnification: 2.18 ___________ 7. Identify two differences between the structure of cardiac muscle tissue and skeletal muscle tissue. Cardiac muscle tissue 2.19 Skeletal muscle tissue