Pathology2 Bfinalspart1
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The document provides an overview of several endocrine diseases and conditions that may affect the pancreas, kidneys, thyroid gland, parathyroid gland, and adrenal gland. It summarizes key pathological features of acute pancreatitis, diabetic kidney disease, thyroid disorders like Graves' disease and Hashimoto's thyroiditis, papillary carcinoma of the thyroid gland, parathyroid adenoma, and hemorrhage of the adrenal gland. Images are included to illustrate histological findings.
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Pancreas Patho B 2
The document discusses pathology of the pancreas. It begins by describing the anatomy and embryology of the pancreas. It then discusses various congenital anomalies that can affect the pancreas. It further describes acute pancreatitis in terms of etiology, pathogenesis, morphology, and clinical features. It concludes by discussing sequelae of acute pancreatitis, specifically chronic pancreatitis, including etiologic factors and pathogenesis.
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This document provides an overview of pancreatic anatomy, physiology, and diseases. It describes the normal anatomy and function of the pancreas, including its exocrine and endocrine components. It then discusses various congenital anomalies and diseases of the pancreas, focusing on acute and chronic pancreatitis. For both conditions, it outlines the etiology, pathology, clinical features, complications, and sequelae. It also describes specific conditions like pancreatic pseudocysts. In summary, the document is a comprehensive review of the pancreas and pancreatic diseases.
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The document discusses pancreatitis and pancreatic tumors. It defines acute and chronic pancreatitis, describing their causes as alcohol intake, gallstones, abdominal trauma or surgery. Acute pancreatitis results from inappropriate activation of pancreatic enzymes like trypsin, causing inflammation ranging from edema to necrosis and hemorrhage. Chronic pancreatitis is characterized by recurrent inflammation leading to irreversible fibrosis and dysfunction. Pancreatic cancer is also covered, noting it usually arises from ductal epithelium and often involves the pancreatic head, spreading via direct invasion and lymphatic and blood routes.
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The document provides information on the normal anatomy and histology of the pancreas. It notes that the pancreas has both exocrine and endocrine functions, is retroperitoneal in location, and drains into the duodenum via the pancreatic duct system. The endocrine portion is composed of islets of Langerhans that secrete insulin, glucagon, and somatostatin. Common congenital anomalies and acquired conditions of the pancreas are also described.
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The document discusses acute and chronic pancreatitis, including causes such as alcohol abuse, gallstones, and trauma. It describes clinical features such as severe epigastric pain and elevated serum amylase and lipase levels. Diagnostic tests include blood tests, imaging like CT scans and MRCP, and endoscopic ultrasound. Treatment depends on the severity and includes IV fluids, analgesics, antibiotics, and surgery for complications like pseudocysts or obstruction.
Pancreatitis by manjusb
The document discusses acute pancreatitis, including its increasing incidence, mortality rates, definition, etiology, pathophysiology, clinical features, diagnosis, and assessments like Ranson's criteria. It notes that acute pancreatitis is defined as acute inflammation of the pancreatic parenchyma leading to injury or destruction of acinar cells. Common causes include gallstones, alcohol abuse, metabolic factors like hypertriglyceridemia, drugs, trauma, and infections. Clinical features may include epigastric pain, nausea, vomiting, and jaundice. Diagnosis involves blood tests like serum amylase and lipase levels, as well as imaging like ultrasound and CT scan. Prognosis can be assessed using tools like Ranson
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Chronic pancreatitis is characterized by irreversible impairment of pancreatic function, unlike acute pancreatitis. The most common causes are gallstones, hyperparathyroidism, congenital malformations, and repeated episodes of acute pancreatitis. The pathogenesis involves mediators like monocyte chemoattractant protein that recruit inflammatory cells. Morphologically, there is atrophy, fibrosis, dilation and chronic inflammation. Clinical features include abdominal pain worsened by food or alcohol, weight loss, steatorrhea, and pancreatic diabetes. Complications include pseudocysts, obstructions, and pancreatic cancer. Treatment focuses on pain management, enzyme replacement, and nutritional support.
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The document discusses pathology of the pancreas. It begins by describing the anatomy and embryology of the pancreas. It then discusses various congenital anomalies that can affect the pancreas. It further describes acute pancreatitis in terms of etiology, pathogenesis, morphology, and clinical features. It concludes by discussing sequelae of acute pancreatitis, specifically chronic pancreatitis, including etiologic factors and pathogenesis.
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The pancreas is an organ located in the abdomen that plays an essential role in digestion and regulating blood sugar. It has both exocrine and endocrine functions. Diseases of the pancreas include pancreatitis, pancreatic cysts, and pancreatic cancer. Pancreatitis can be acute or chronic and is commonly caused by gallstones or alcohol abuse. Symptoms include abdominal pain and digestive issues. Treatment depends on the type and severity but may include nutrition support, antibiotics, surgery, or enzyme supplements. Precancerous conditions and pancreatic cancer are also discussed.
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The document provides information on the normal anatomy and histology of the pancreas. It notes that the pancreas has both exocrine and endocrine functions, is retroperitoneal in location, and drains into the duodenum via the pancreatic duct system. The endocrine portion is composed of islets of Langerhans that secrete insulin, glucagon, and somatostatin. Common congenital anomalies and acquired conditions of the pancreas are also described.
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The document discusses acute and chronic pancreatitis, including causes such as alcohol abuse, gallstones, and trauma. It describes clinical features such as severe epigastric pain and elevated serum amylase and lipase levels. Diagnostic tests include blood tests, imaging like CT scans and MRCP, and endoscopic ultrasound. Treatment depends on the severity and includes IV fluids, analgesics, antibiotics, and surgery for complications like pseudocysts or obstruction.
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The document discusses acute pancreatitis, including its increasing incidence, mortality rates, definition, etiology, pathophysiology, clinical features, diagnosis, and assessments like Ranson's criteria. It notes that acute pancreatitis is defined as acute inflammation of the pancreatic parenchyma leading to injury or destruction of acinar cells. Common causes include gallstones, alcohol abuse, metabolic factors like hypertriglyceridemia, drugs, trauma, and infections. Clinical features may include epigastric pain, nausea, vomiting, and jaundice. Diagnosis involves blood tests like serum amylase and lipase levels, as well as imaging like ultrasound and CT scan. Prognosis can be assessed using tools like Ranson
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Chronic pancreatitis is characterized by irreversible impairment of pancreatic function, unlike acute pancreatitis. The most common causes are gallstones, hyperparathyroidism, congenital malformations, and repeated episodes of acute pancreatitis. The pathogenesis involves mediators like monocyte chemoattractant protein that recruit inflammatory cells. Morphologically, there is atrophy, fibrosis, dilation and chronic inflammation. Clinical features include abdominal pain worsened by food or alcohol, weight loss, steatorrhea, and pancreatic diabetes. Complications include pseudocysts, obstructions, and pancreatic cancer. Treatment focuses on pain management, enzyme replacement, and nutritional support.
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The pancreas is a gland organ that participates in both the digestive and endocrine systems. It secretes enzymes and hormones. The pancreas develops from dorsal and ventral buds and has three parts: head, body, and tail. It contains exocrine acini that secrete enzymes and endocrine islets of Langerhans that secrete hormones like insulin. Congenital anomalies include annular pancreas and heterotopic pancreas. Acute and chronic pancreatitis can result from various causes and show necrosis, inflammation, and fibrosis. Cysts and pseudocysts can also occur. Pancreatic tumors include common ductal adenocarcinoma and rare endocrine tumors.
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This document discusses chronic pancreatitis, providing insights into its pathophysiology and management. It defines chronic pancreatitis as permanent pancreatic damage from long-term inflammation, fibrosis, and destruction of exocrine and endocrine tissue. Alcohol abuse is the most common cause, accounting for around two-thirds of cases. The pathophysiology is complex and incompletely understood. Pain is the most common symptom, and management focuses on pain control, treating steatorrhea, and managing diabetes mellitus complications. Diagnosis involves tests of pancreatic structure and function, and treatment involves medical, endoscopic, or surgical options depending on individual patient presentation and severity of disease.
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1. The document discusses several diseases of the pancreas including congenital problems like annular pancreas and pancreas divisum.
2. It covers acute and chronic pancreatitis, their causes, symptoms, prognosis, and treatment options including supportive care and surgery.
3. The document also discusses several types of pancreatic tumors and cysts, their diagnosis and treatment through surgery or other palliative options. It provides details on specific neuroendocrine tumors.
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This document provides an overview of chronic pancreatitis, including its pathophysiology, etiology, clinical features, diagnosis, and management. It discusses how chronic pancreatitis represents a continuous inflammatory and fibrosing process of the pancreas resulting in permanent dysfunction. The main causes are alcohol use and genetic factors. Patients present with abdominal pain in 95% of cases and can develop weight loss, steatorrhea, and diabetes. Diagnosis involves tests of pancreatic function and imaging tests looking for features like calcification. Treatment focuses on pain control, managing maldigestion with pancreatic enzyme replacement, and addressing complications like pseudocysts and stenosis.
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This document defines and discusses chronic pancreatitis. It begins by defining chronic pancreatitis as a progressive inflammatory disease of the pancreas that damages the gland and causes exocrine and endocrine dysfunction. It then classifies chronic pancreatitis into three main forms: chronic calcifying pancreatitis, chronic obstructive pancreatitis, and steroid-responsive pancreatitis. The document goes on to discuss risk factors, pathogenesis, clinical presentation, diagnosis, and management of chronic pancreatitis.
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1. Acute pancreatitis is an inflammation of the pancreas that can range from mild to severe and involve other remote organ systems.
2. It is commonly caused by gallstones or alcohol abuse.
3. Symptoms include epigastric pain, nausea, vomiting, and abdominal tenderness. Investigations include blood tests and imaging of the pancreas.
Acute and Chronic Pancreatitis- Their Causes, Symptoms and Treatments
Pancreatitis can be of two types: acute and chronic. The only difference between these two types of pancreatitis is that chronic pancreatitis usually lasts for several years but is not so severe like acute pancreatitis.
Before knowing about the treatments that are available for treating pancreatitis, it is essential to know the causes of the pancreatitis disease.
Acute Pancreatitis
The document provides an overview of acute pancreatitis including:
- It begins with anatomy and blood supply of the pancreas.
- Pathophysiology involves autodigestion from inappropriately activated pancreatic enzymes.
- Etiology is commonly gallstones, alcohol, or idiopathic.
- Clinical presentation includes severe abdominal pain and systemic complications can involve multiple organ systems.
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This document discusses chronic pancreatitis, including its causes, pathogenesis, classification, clinical presentation, diagnostic evaluation, complications, and surgical and non-surgical management. Some key points include:
- Gallstone disease is the most common cause, accounting for 70% of cases. Other causes include alcoholism, trauma, genetic factors.
- Pathogenesis involves reflux of infected bile or duodenal contents into the pancreatic ducts, causing inflammation and activation of pancreatic enzymes.
- Classification is based on etiology, presence of pancreatic duct obstruction, and clinical features such as pain pattern.
- Presentation includes recurrent upper abdominal pain, weight loss from malabsorption, and endocrine and exocrine pancreatic insufficiency
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The pancreas has both exocrine and endocrine functions. Its exocrine role includes secreting digestive enzymes from the ductal cells that help break down carbohydrates, lipids, and proteins. Its endocrine role involves the islets of Langerhans secreting hormones like insulin and glucagon to regulate blood sugar. Pancreatitis refers to inflammation of the pancreas and can be acute, recurrent, or chronic depending on factors like gallstones, alcohol use, metabolic issues, or postoperative complications. Symptoms include abdominal pain, nausea, and high amylase/lipase levels. Treatment involves pain relief, suppressing secretions, antibiotics, and sometimes surgery for complications or underlying issues.
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This document discusses the pancreas, including its blood supply, lymphatic drainage and role in producing enzymes. It covers congenital abnormalities of the pancreas as well as diseases like acute and chronic pancreatitis. Acute pancreatitis can result from factors like alcoholism, medications or trauma. Chronic pancreatitis is associated with long term damage and can lead to complications like pseudocysts. The document also discusses pancreatic cysts and neoplasms, including serous and mucinous cystadenomas. It provides an overview of pancreatic adenocarcinoma, including risk factors, staging and prognosis.
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This document provides an overview of the management of acute pancreatitis. It defines acute pancreatitis as the inflammation of the pancreas often associated with pancreatic duct dilation. It discusses the epidemiology, etiology, pathogenesis, clinical forms, investigations, risk assessment, treatment and prognosis of acute pancreatitis. The management involves resuscitation, assessing severity, treating any underlying causes, and monitoring for complications which can include pancreatic necrosis, infection and multi-organ failure. Severity is assessed using scoring systems like Ranson's criteria or CT severity index to determine prognosis and guide management.
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A 42-year-old woman presents with acute onset of epigastric pain radiating to the back along with nausea and vomiting. Physical exam reveals mid-epigastric tenderness and mild ileus on abdominal radiography. Ultrasonography of the abdomen is the most appropriate next step, as it can detect gallstones, the most common cause of acute pancreatitis in the United States. Serum lipase and amylase are also elevated in most cases of pancreatitis and help make the diagnosis.
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The pancreas is a gland organ that participates in both the digestive and endocrine systems. It secretes enzymes and hormones. The pancreas develops from dorsal and ventral buds and has three parts: head, body, and tail. It contains exocrine acini that secrete enzymes and endocrine islets of Langerhans that secrete hormones like insulin. Congenital anomalies include annular pancreas and heterotopic pancreas. Acute and chronic pancreatitis can result from various causes and show necrosis, inflammation, and fibrosis. Cysts and pseudocysts can also occur. Pancreatic tumors include common ductal adenocarcinoma and rare endocrine tumors.
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The document discusses diseases of the pancreas, including congenital anomalies, endocrine and exocrine pancreatic diseases, acute and chronic pancreatitis, and pancreatic tumors. It provides details on the causes, pathophysiology, clinical presentation, diagnosis, and treatment of each condition. Key points include the role of gallstones and alcohol as common causes of acute pancreatitis, the use of CT and lab tests to diagnose and determine severity, and supportive care along with surgical or endoscopic interventions for severe cases.
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This document summarizes acute and chronic pancreatitis. It covers the anatomy and physiology of the pancreas, pathophysiology, causes, symptoms, signs, diagnostic testing including labs and imaging, medical and surgical treatment options, and prognosis. The main causes of acute pancreatitis are biliary disease and alcohol use, while chronic pancreatitis is primarily caused by alcohol use long-term. Complications can include pseudocysts, abscesses, pancreatic necrosis, and pancreatic duct disruption. Treatment depends on the severity and includes pain control, antibiotics, nutritional support, enzyme replacement, and possible surgery.
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This document discusses chronic pancreatitis, providing insights into its pathophysiology and management. It defines chronic pancreatitis as permanent pancreatic damage from long-term inflammation, fibrosis, and destruction of exocrine and endocrine tissue. Alcohol abuse is the most common cause, accounting for around two-thirds of cases. The pathophysiology is complex and incompletely understood. Pain is the most common symptom, and management focuses on pain control, treating steatorrhea, and managing diabetes mellitus complications. Diagnosis involves tests of pancreatic structure and function, and treatment involves medical, endoscopic, or surgical options depending on individual patient presentation and severity of disease.
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1. The document discusses several diseases of the pancreas including congenital problems like annular pancreas and pancreas divisum.
2. It covers acute and chronic pancreatitis, their causes, symptoms, prognosis, and treatment options including supportive care and surgery.
3. The document also discusses several types of pancreatic tumors and cysts, their diagnosis and treatment through surgery or other palliative options. It provides details on specific neuroendocrine tumors.
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This document provides an overview of chronic pancreatitis, including its pathophysiology, etiology, clinical features, diagnosis, and management. It discusses how chronic pancreatitis represents a continuous inflammatory and fibrosing process of the pancreas resulting in permanent dysfunction. The main causes are alcohol use and genetic factors. Patients present with abdominal pain in 95% of cases and can develop weight loss, steatorrhea, and diabetes. Diagnosis involves tests of pancreatic function and imaging tests looking for features like calcification. Treatment focuses on pain control, managing maldigestion with pancreatic enzyme replacement, and addressing complications like pseudocysts and stenosis.
Git j club chronic pancreatitis 16.
This document defines and discusses chronic pancreatitis. It begins by defining chronic pancreatitis as a progressive inflammatory disease of the pancreas that damages the gland and causes exocrine and endocrine dysfunction. It then classifies chronic pancreatitis into three main forms: chronic calcifying pancreatitis, chronic obstructive pancreatitis, and steroid-responsive pancreatitis. The document goes on to discuss risk factors, pathogenesis, clinical presentation, diagnosis, and management of chronic pancreatitis.
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1. Acute pancreatitis is an inflammation of the pancreas that can range from mild to severe and involve other remote organ systems.
2. It is commonly caused by gallstones or alcohol abuse.
3. Symptoms include epigastric pain, nausea, vomiting, and abdominal tenderness. Investigations include blood tests and imaging of the pancreas.
Acute and Chronic Pancreatitis- Their Causes, Symptoms and Treatments
Pancreatitis can be of two types: acute and chronic. The only difference between these two types of pancreatitis is that chronic pancreatitis usually lasts for several years but is not so severe like acute pancreatitis.
Before knowing about the treatments that are available for treating pancreatitis, it is essential to know the causes of the pancreatitis disease.
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The document provides an overview of acute pancreatitis including:
- It begins with anatomy and blood supply of the pancreas.
- Pathophysiology involves autodigestion from inappropriately activated pancreatic enzymes.
- Etiology is commonly gallstones, alcohol, or idiopathic.
- Clinical presentation includes severe abdominal pain and systemic complications can involve multiple organ systems.
Lecture chronic pancreatitis
This document discusses chronic pancreatitis, including its causes, pathogenesis, classification, clinical presentation, diagnostic evaluation, complications, and surgical and non-surgical management. Some key points include:
- Gallstone disease is the most common cause, accounting for 70% of cases. Other causes include alcoholism, trauma, genetic factors.
- Pathogenesis involves reflux of infected bile or duodenal contents into the pancreatic ducts, causing inflammation and activation of pancreatic enzymes.
- Classification is based on etiology, presence of pancreatic duct obstruction, and clinical features such as pain pattern.
- Presentation includes recurrent upper abdominal pain, weight loss from malabsorption, and endocrine and exocrine pancreatic insufficiency
Common urinary symptom
This document discusses polyuria, which is excessive urine output of greater than 3 liters per day in adults. Polyuria can be caused by physiological factors like excessive fluid intake or anxiety, or pathological factors like endocrine, renal, or psychiatric conditions. It may occur due to increased solute excretion (solute diuresis) or increased water excretion due to a defect in ADH production or renal responsiveness (water diuresis). Other conditions discussed include proteinuria, hematuria, and urinary retention. Causes, diagnostic testing, and treatment approaches are provided for each condition.
Acute pancreatitis
"Love is like pancreatitis; it starts off slow, then builds in intensity until you become consumed and develop violent cramps." Dana Gould
Pancreatitis
The pancreas has both exocrine and endocrine functions. Its exocrine role includes secreting digestive enzymes from the ductal cells that help break down carbohydrates, lipids, and proteins. Its endocrine role involves the islets of Langerhans secreting hormones like insulin and glucagon to regulate blood sugar. Pancreatitis refers to inflammation of the pancreas and can be acute, recurrent, or chronic depending on factors like gallstones, alcohol use, metabolic issues, or postoperative complications. Symptoms include abdominal pain, nausea, and high amylase/lipase levels. Treatment involves pain relief, suppressing secretions, antibiotics, and sometimes surgery for complications or underlying issues.
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This document discusses the pancreas, including its blood supply, lymphatic drainage and role in producing enzymes. It covers congenital abnormalities of the pancreas as well as diseases like acute and chronic pancreatitis. Acute pancreatitis can result from factors like alcoholism, medications or trauma. Chronic pancreatitis is associated with long term damage and can lead to complications like pseudocysts. The document also discusses pancreatic cysts and neoplasms, including serous and mucinous cystadenomas. It provides an overview of pancreatic adenocarcinoma, including risk factors, staging and prognosis.
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This document provides an overview of the management of acute pancreatitis. It defines acute pancreatitis as the inflammation of the pancreas often associated with pancreatic duct dilation. It discusses the epidemiology, etiology, pathogenesis, clinical forms, investigations, risk assessment, treatment and prognosis of acute pancreatitis. The management involves resuscitation, assessing severity, treating any underlying causes, and monitoring for complications which can include pancreatic necrosis, infection and multi-organ failure. Severity is assessed using scoring systems like Ranson's criteria or CT severity index to determine prognosis and guide management.
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This document discusses hepatomegaly (enlargement of the liver). It begins by describing the normal anatomy and functions of the liver. It then discusses the various mechanisms that can cause hepatomegaly, including increased cell size/number, inflammation, infiltration, increased vascular/biliary space, and idiopathic causes. The main causes of hepatomegaly are listed as infective, congestive, degenerative/infiltrative, storage disorders, neoplasia, and toxins. The document concludes by describing the clinical presentation and examination findings of hepatomegaly.
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A 42-year-old woman presents with acute onset of epigastric pain radiating to the back along with nausea and vomiting. Physical exam reveals mid-epigastric tenderness and mild ileus on abdominal radiography. Ultrasonography of the abdomen is the most appropriate next step, as it can detect gallstones, the most common cause of acute pancreatitis in the United States. Serum lipase and amylase are also elevated in most cases of pancreatitis and help make the diagnosis.
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Hematology Rivas2008 Lecture4&5
The document discusses several clonal disorders of hematopoietic stem cells including:
1) Myelodysplastic syndromes which affect myeloid cell lines and cause cytopenias. Treatment is limited and includes transfusions, growth factors, and stem cell transplant.
2) Myeloproliferative disorders like polycythemia vera, essential thrombocythemia, and myelofibrosis which involve stem cell proliferation. Treatment focuses on controlling symptoms and reducing risks of thrombosis.
3) Chronic myeloid leukemia is driven by the Philadelphia chromosome and progresses from chronic to blast phase without treatment. Imatinib targets the abnormal BCR-ABL gene.
Renal pathology i
Congenital
Malformations, ectopic, cysts, dysplasia.
Acquired
Glomerular diseases
Tubulointerstitial diseases,
Renal calculi.
Neoplasms – carcinoma
Myeloproliferative disorders.ppt
This document discusses myeloproliferative disorders (MPDs), which are clonal stem cell diseases that result in increased and abnormal blood cell production. It describes the main MPDs: polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF). PV is characterized by elevated red blood cell counts. ET results in sustained elevated platelet counts. MF involves clonal stem cell changes that cause fibrosis of the bone marrow and enlargement of the spleen and liver. The document provides details on clinical features, diagnostic criteria, genetic mutations, outcomes, and treatment options for each condition.
Nephrotic Syndrome
1. Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia. The majority of cases in children are idiopathic or minimal change disease.
2. Secondary causes include systemic diseases, infections, medications, and genetic conditions.
3. Treatment involves corticosteroids as first line, with recurrence being common in minimal change disease. Kidney biopsy may be needed to identify secondary causes or steroid resistance.
Approach to a child with Hepatosplenomegaly
This document discusses hepatosplenomegaly, or the enlargement of the liver and spleen. It begins with an introduction and overview of hepatomegaly and splenomegaly. It then covers the various causes of hepatosplenomegaly including infections, hematological disorders, vascular congestion, tumors and infiltrations, storage disorders, and miscellaneous causes. The document provides details on evaluating a patient's history, physical examination findings, investigations, and treatment strategies for hepatosplenomegaly in both children and neonates. It concludes with references for further information.
Similar to Pathology2 Bfinalspart1 (20)
Pathology2 Bfinalspart1
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- 2. Diseases of the Endocrine Glands
- 4. Hemorrhage Saponified fat cells Necrotic Acini with Neutrophilic Infiltrates
- 6. Kimmelstiel-Wilson nodule Afferent arteriole Kimmelstiel-Wilson nodule/ nodular diabetic glomerulosclerosis Diffuse mesangial sclerosis Diffuse mesangial sclerosis Capillary Basement Membrane (thickened) Capillary Basement Membrane (thickened)
- 8. Neutrophils Abscess formation Neutrophils
- 10. Flattening of epithelium colloid colloid
- 11. Colloid/ Non-Toxic (Simple) Goiter, Thyroid Gland
- 13. Scallop appearance of Thyroid follicles papilla Tall epithelial cells
- 15. GC GC A A A GC A- Acini GC- Germinal Center L- Lymphocytic infiltration L L
- 16. GC Atrophic thyroid Follicles/ Acini fibrosis GC
- 17. Hurthle cells- lines residual thyroid follicles **Eosinopilic in Staining, granular cytoplasm, enlarged nuclei, squamous epithelial cells
- 19. s s s s papilla Thyroid follicles s- stroma Orphan Annie Eye- nuclei of cells (clear)
- 22. Hemorrhage, Adrenal Gland Blood vessel Area of hemorrhage Area of hemorrhage