Ed Friedlander, M.D., Pathologist

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Welcome to Ed's Pathology Notes, placed here originally for the convenience of medical students at my school. You need to check the accuracy of any information, from any source, against other credible sources. I cannot diagnose or treat over the web, I cannot comment on the health care you have already received, and these notes cannot substitute for your own doctor's care. I am good at helping people find resources and answers. If you need me, send me an E-mail at scalpel_blade@yahoo.com Your confidentiality is completely respected. No texting or chat messages, please. Ordinary e-mails are welcome.

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I'm still doing my best to answer everybody. Sometimes I get backlogged, sometimes my E-mail crashes, and sometimes my literature search software crashes. If you've not heard from me in a week, post me again. I send my most challenging questions to the medical student pathology interest group, minus the name, but with your E-mail where you can receive a reply.

Numbers in {curly braces} are from the magnificent Slice of Life videodisk. No medical student should be without access to this wonderful resource.

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Freely have you received, freely give. -- Matthew 10:8. My site receives an enormous amount of traffic, and I'm still handling dozens of requests for information weekly, all as a public service.

Pathology's modern founder, Rudolf Virchow M.D., left a legacy of realism and social conscience for the discipline. I am a mainstream Christian, a man of science, and a proponent of common sense and common kindness. I am an outspoken enemy of all the make-believe and bunk that interfere with peoples' health, reasonable freedom, and happiness. I talk and write straight, and without apology.

Throughout these notes, I am speaking only for myself, and not for any employer, organization, or associate.

Special thanks to my friend and colleague, Charles Wheeler M.D., pathologist and former Kansas City mayor. Thanks also to the real Patch Adams M.D., who wrote me encouragement when we were both beginning our unusual medical careers.

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Especially if you're looking for information on a disease with a name that you know, here are a couple of great places for you to go right now and use Medline, which will allow you to find every relevant current scientific publication. You owe it to yourself to learn to use this invaluable internet resource. Not only will you find some information immediately, but you'll have references to journal articles that you can obtain by interlibrary loan, plus the names of the world's foremost experts and their institutions.

Alternative (complementary) medicine has made real progress since my generally-unfavorable 1983 review. If you are interested in complementary medicine, then I would urge you to visit my new Alternative Medicine page. If you are looking for something on complementary medicine, please go first to the American Association of Naturopathic Physicians. And for your enjoyment... here are some of my old pathology exams for medical school undergraduates.

I cannot examine every claim that my correspondents share with me. Sometimes the independent thinkers prove to be correct, and paradigms shift as a result. You also know that extraordinary claims require extraordinary evidence. When a discovery proves to square with the observable world, scientists make reputations by confirming it, and corporations are soon making profits from it. When a decades-old claim by a "persecuted genius" finds no acceptance from mainstream science, it probably failed some basic experimental tests designed to eliminate self-deception. If you ask me about something like this, I will simply invite you to do some tests yourself, perhaps as a high-school science project. Who knows? Perhaps it'll be you who makes the next great discovery!

Our world is full of people who have found peace, fulfillment, and friendship by suspending their own reasoning and simply accepting a single authority that seems wise and good. I've learned that they leave the movements when, and only when, they discover they have been maliciously deceived. In the meantime, nothing that I can say or do will convince such people that I am a decent human being. I no longer answer my crank mail.

This site is my hobby, and I do not accept donations, though I appreciate those who have offered to help.

During the eighteen years my site has been online, it's proved to be one of the most popular of all internet sites for undergraduate physician and allied-health education. It is so well-known that I'm not worried about borrowers. I never refuse requests from colleagues for permission to adapt or duplicate it for their own courses... and many do. So, fellow-teachers, help yourselves. Don't sell it for a profit, don't use it for a bad purpose, and at some time in your course, mention me as author and William Carey as my institution. Drop me a note about your successes. And special thanks to everyone who's helped and encouraged me, and especially the people at William Carey for making it still possible, and my teaching assistants over the years.

Whatever you're looking for on the web, I hope you find it, here or elsewhere. Health and friendship!


More of Ed's Notes: Ed's Medical Terminology Page

Perspectives on Disease
Cell Injury and Death
Accumulations and Deposits
What is Cancer?
Cancer: Causes and Effects
Immune Injury
Other Immune
HIV infections
The Anti-Immunization Activists
Infancy and Childhood
Environmental Lung Disease
Violence, Accidents, Poisoning
Red Cells
White Cells
Oral Cavity
GI Tract
Pancreas (including Diabetes)
Adrenal and Thymus
Nervous System
Lab Profiling
Blood Component Therapy
Serum Proteins
Renal Function Tests
Adrenal Testing
Arthritis Labs
Glucose Testing
Liver Testing
Spinal Fluid
Lab Problem
Alternative Medicine (current)
Preventing "F"'s: For Teachers!
Medical Dictionary

Courtesy of CancerWEB


Once again, this is absolutely essential material. Given any of the definitions, you should be able to supply the word. Given any of the processes, you must be able to explain "how", "when", "where", and "why".

Describe the processes that give rise to transudates, and those that give rise to exudates.

Describe edema as seen in inflammation, heart failure, liver failure, and kidney failure. Describe the special cases of cerebral edema and "angioedema". Explain how lymphedema develops.

Describe in general terms the causes and consequences of hemorrhages.

Cite Virchow's triad for the causes of thrombosis, and recognize and give examples in each category. Explain why turbulent flow promotes thrombosis, why damaged endothelium promotes thrombosis, and how blood can become hypercoagulable. Describe the possible fates, good and bad, of a thrombus.

Describe the nature, causes, and significance of disseminated intravascular coagulation, and give its synonyms.

Describe things that embolize. Briefly discuss classic pulmonary thromboemboli, paradoxical emboli, and systemic thromboemboli. Give an account of the causes and consequences of amniotic fluid, air, fat, atherosclerotic, marrow, tumor, and therapeutic emboli.

Give a full account of the various types of infarcts. Mention two factors contributing to "reperfusion injury".

Define shock, and mention its major causes. Describe how whole-body hypoperfusion causes problems. Discuss the physiology of shock, and describe its stages (compensated, progressive, and irreversible). Describe the anatomic pathology that results from fatal shock. Tell how prolonged compensated shock affects the whole person.

Use the following terms correctly, and produce the term given a definition or description:

milk leg
mural thrombus
Trousseau's sign
Bringing out the Dead
Fluid and Hemodyamic
"Bringing Out the Dead"

Recognize the following gross items:

Be sure you can recognize the following under a microscope, with or without other pathologic lesions:

KCUMB Students
"Big Robbins" -- Hemodynamic
Lectures follow Textbook


* As he was dying of alcoholic liver disease, W.C. Fields was told he had excessive accumulation of water in his abdomen. He replied, "I knew that insipid, tasteless fluid would be the death of me!"


Hemodynamic Disorders
Taiwanese pathology site
Good place to go to practice

Hemodynamic disorders
Iowa Virtual Microscopy
Have fun

First Section
Chaing Mi, Thailand

Second Section
Chaing Mi, Thailand

Third Section
Chaing Mi, Thailand

Fourth Section
Chaing Mi, Thailand

Fluid and Hemodynamic
Photos, explanations, and quiz
Indiana U.


Lymphatic vessels in edema
They are not themselves plugged,
but are dilated from carring away fluid.

Child with anasarca
Neonatal catastrophic illness
Personal website

{19381} ascites

WebPath Photo


WebPath Photo

{13394} hydrocephalus
{13395} hydrocephalus

Hydrocephalus, untreated
From a Saddam-era Iraqi
propaganda website (!)

{08295} elephantiasis of leg, filariasis patient
{08259} elephantiasis of scrotum, filariasis patient

Normal lymphatic vessels
in fat, with lymphocytes

Lymphatic spread
Lung pathology series
Dr. Warnock's Collection

Pitting edema

WebPath Photo

HYPEREMIA AND CONGESTION: The two possible reasons for increased blood volume in a particular part of the body.

{10967} heart failure cells in the lung

{00029} nutmeg liver
{31889} real nutmeg

Hyperemia I
From Chile
In Spanish

Hyperemia II
From Chile
In Spanish

Nutmeg liver

KU Collection

Congested liver, live cells in zone 1
Slide from Andrea McCollum MD
Cuyahoga County Coroner's Office

Congested liver, dead cells in zone 3
Slide from Andrea McCollum MD
Cuyahoga County Coroner's Office


    There's no need to review the basics of hemostasis here (though for your convenience, "Big Robbins" does). Some terms:

      HEMORRHAGE: Blood cells that have escaped from a vessel. Hemorrhages range from hickies to exsanguinating hemoptysis.

      HEMATOMAS: Enough blood in the tissues to create a palpable mass. (Don't think the suffix "-oma" means only "tumor" -- it also refers to other masses. More about this later.)

      HEMOTHORAX: Blood in a pleural cavity. HEMOPERICARDIUM: Blood in the pericardial cavity. HEMOPERITONEUM: Blood in the peritoneal cavity. HEMARTHROSIS: Bleeding into a joint.

Fight Club

{07554} petechiae on eye, strangulation victim
{14287} petechiae on legs
{08059} petechiae on heart, leukemia case
{21433} petechiae on oral mucosa

Hemorrhage in a corpus luteum
Plentiful red cells
David Barber MD -- KCUMB

Intrapulmonary hemorrhage
Slide from Andrea McCollum MD
Cuyahoga County Coroner's Office

Broken aortic root
Utah Webpath

{07051} contusions, abuse

From Chile
In Spanish

Car wreck
WebPath Photo

Urbana Atlas of Pathology

CPR contusion on epicardium
Blood in the fat pad

Urbana Atlas of Pathology

{13104} hemorrhage into the pituitary; another really bad place to have a hemorrhage
{21233} petechiae in the mouth from a mouthguard. Not so troublesome.

      How much of your ~5 L of blood can you lose at once?

        10%... You donated a unit of blood. Thank you.

        20%... You will probably feel a little sick.

        40%... You will probably go into hypovolemic shock.

Bacon, Blood on the Floor
Painting, "Blood on the Floor", 1986

{06275} hemorrhage in the lung (blood in alveoli)
{06278} hemorrhage (blood in the stomach)

THROMBOSIS: The transformation of flowing blood from a liquid to a solid within the vessels or heart.

{11456} thrombi in the venous plexus around the prostate
{31952} thrombus in the superior saggital sinus
{11639} thrombus in the femoral vein

Thrombosis of intracerebral vein
Pittsburgh Pathology Cases

Vessel severed...

Plasma contacts Tissue Factor (TF)...

TF binds VII/VIIa...

VII/VIIa complex with TF activates IX and X...

And the rest happens like in your old textbooks.

{06299} thrombus on a venous catheter

{11039} lines of Zahn
{11132} lines of Zahn
{11451} lines of Zahn
{06530} lines of Zahn. The lines themselves are subtle. Thrombus in a coronary artery (left side). Cholesterol needles from a plaque that has ruptured into the bloodstream.

Fresh thrombus
Deep inside, lines of Zahn

From Chile
In Spanish

Post-mortem thrombus
From a "pop" site that erroneously
called this a pulmonary embolus

{06317} atrial mural thrombus
{11600} old cardiac mural thrombus

Mural thrombus
After heart attack
Utah Webpath

{19454} thrombus on ruptured plaque in coronary artery. Fresh thrombus at bottom. Starting to scar up at top.
{24781} thrombus in the carotid artery

{06287} thrombus on a heart valve

{06293} organizing thrombus, leg vein
{06305} organizing thromboembolus, lung

Pulmonary thromboembolus
Autopsy photo
KU Collection

Pulmonary thromboembolus
Main pulmonary artery has been opened

Carotid Artery Thrombosis
Australian Pathology Museum
High-tech gross photos

{06533} recanalized thrombus

Organizing venous thrombus
Great labels
Romanian Pathology Atlas

Recanalized thrombus
Teaching photo
from Hopkins

Recanalized thrombus
Small pulmonary artery

DISSEMINATED INTRAVASCULAR COAGULATION (the dreaded "DIC", "consumption coagulopathy", or "defibrination syndrome")

{12308} schistocytes

{21028} DIC: little thrombus in a glomerulus

Renal glomeruli with fibrin plugs

DIC from meningococcemia
but no schistocytes yet

Nice schistocytes
Lichtman's Atlas

Nice schistocytes
Lichtman's Atlas

Photomicrograph of skin
Belgian trauma site


From Chile
In Spanish

{10682} embolus, celiac trunk

{03182} saddle embolus
{10799} saddle embolus
{10802} saddle embolus
{11133} saddle embolus
{06311} pulmonary emboli
{20221} small pulmonary embolus
{20992} pulmonary embolus

AMNIOTIC FLUID EMBOLI ("amniotic fluid infusion")

{11663} amniotic fluid embolus

Amniotic fluid embolus


Amniotic fluid embolus

WebPath Photo

AIR EMBOLI ("gas emboli", etc.): Gas in the circulation. Bubbles coalesce and produce a mass of air that the pulse pressure just compresses, preventing the blood from being pushed. Recalls "vapor lock" in automobiles.

Air in jugular at autopsy
Prize photograph
Institute of Medical Illustrators

Fatal air embolus
Post-mortem scan & photo
Swiss "virtual autopsy" team


{29056} fat embolus in lung, oil red O stain
{29057} fat embolus in lung, oil red O stain

Fat Embolus
WebPath Photo

Fat Embolus
Oil red O
WebPath Photo

Fat Embolus
WebPath Photo

Fat Embolus
WebPath Photo

Fat Embolus
WebPath Photo

Fat Embolus
Brain -- oil red O
WebPath Photo

Fat embolus



{10889} atherosclerotic embolus
{25651} atheroembolus
{25652} atheroembolus


Bone Marrow Embolus
Tom Demark's Site

Bone Marrow Embolus
Slide from Andrea McCollum MD
Cuyahoga County Coroner's Office

Talc in the lung
Intravenous drug abuser
Utah Webpath

Crystals in the lungs of drug abusers
Lung pathology series
Dr. Warnock's Collection

Cancer embolus to pulmonary artery
Wikimedia Commons


Kidney infarct.

WebPath Photo

Coagulation necrosis.
Spleen infarct.
WebPath Photo

From Chile
In Spanish

{24501} infarct of hand following embolus to brachial artery

Infarcted bowel
Seen at surgery
U. of Pisa

Infarcted lung
Huge thromboembolus was present

Bowel infarct
WebPath Photo

Bowel infarct
Urbana Atlas of Pathology

Bowel infarct
Urbana Atlas of Pathology

Red lung infarct
Urbana Atlas of Pathology

Red infarct of the colon
Neglected peritonitis with
vascular compromise

Myocardial Infarct
Australian Pathology Museum
High-tech gross photos

{17390} hemorrhagic lung infarct

{17384} schematic infarct
{17385} schematic infarct
{17388} Zahn infarct of liver
{46489} real necrotic infarcts of the liver

SHOCK ("circulatory collapse"): Widespread hypoperfusion of the tissues

{06359} shock lung
{06362} shock liver
{06365} shock liver; histology; note central necrosis


* * * 


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