general pathology c603 introduction course directors ashley inman, m.d. [email protected] phone:...
TRANSCRIPT
GENERAL PATHOLOGY C603
INTRODUCTION
Course Directors
Ashley Inman, [email protected]
Phone: 274-1690
Thomas E. Davis, M.D., Ph.D. [email protected]
Page: 312-7297
Course Syllabus
Course Learning Objectives
At the successful completion of our course, students will:• Explain the pathophysiologic basis of general cellular and tissue responses to disease processes.•Describe the pathophysiologic changes which occur in different disease process associated with a given organ system.•Recognize gross and histologic tissue changes associated with general types of disease processes.•Correlate gross and microscopic tissue changes that accompany different disease processes.•Correlate pathophysiologic changes with diagnostic and therapeutic approaches to different disease processes.
RESOURCES FOR C603
•Robbins Pathologic Basis of Disease 9th edition (2014) with website (www.expertconsult.com)•General Pathology C603 lab manual•Robbins Review of Pathology (Practice questions)
3rd edition (2009)•Gross specimens and microscopic slides in lab plus
practice quizzes
Robbins Pathologic Basis of Disease 9th Edition
Robbins Pathologic Basis of Disease 9th Edition
ONCOURSE RESOURCES FOR C603
• Lecture and lab schedules•Digital copy of lab manual w/ links to gross images,
microscopic images, and digital slides• IUSM Virtual Microscopy site•QBank• Lab clinical case powerpoints
GRADING POLICY
•Honors: Top 10-20% •High Pass: Top 51-79% •Pass: At least 75% of the top score •Fail: Less than 75% of the top point-score in the
class
EXAMS IN C603
•1st Lecture Exam: 200 points•2nd Lecture Exam: 200 points•Final Lecture Exam: 300 points•1st Lab Exam: 100 points•2nd Lab Exam: 100 points•Final Lab Exam: 100 points
•Total Points in Course: 1000 points
EXAM FORMAT
• Lecture Exams:• Computer exams with randomization of questions and
answer choices •Multiple choice
• Lab Exams:•Written exam•Multiple choice• Includes gross specimens, images, and glass slides• Some of which you may not have seen before, but you should be
able to apply your knowledge and observations to arrive at the correct answer
EXAM CONTENTS
•ALL examinations are CUMULATIVE• Lecture material is fair game on lab exams and vice
versa•Some questions similar to or identical to review
book questions•Will be expected to integrate material:• Pathology• Lab data (chemistry, hematology)• Clinical presentation• Signs (what the doc sees); symptoms (what the patient feels and
expresses)• Radiology
LABORATORY
•MS 102, 104, 106• Group assignments in lab manual and posted outside of lab•Monday/Wednesday or Tuesday/Thursday rotation • 1:00-3:00 PM• Attendance is mandatory
In C603 and in Your Medical Practice
1. You cannot possibly know everything
2. However, you are responsible for everything
If you understand the gross and microscopic pathology, then you can….• Recognize and diagnose the disease OR order the correct tests• Treat the patient; sometimes that is being able to provide a
prognosis to the patient and their family• Ideally, you can prevent the pathology (disease)
Learning Objectives for Lecture 1
1. List examples of gross pathology associated with changes in: size, color, shape, consistency, and location2. Describe gross and microscopic changes associated with accumulation of amyloid and iron3. Diagram and label the gross patterns of tissue necrosis: coagulative necrosis, liquefactive necrosis, caseous necrosis, fat necrosis, and gangrenous necrosis
GROSS OBSERVATIONS
• Size• Shape• Color• Consistency/texture• Location
SIZE
• Increased:• HYPERTROPHY: increase in cell size (no new cells; just
bigger cells)• HYPERPLASIA: increase in cell number
•Decreased:• ATROPHY: once normal, now smaller• HYPOPLASIA: never normal in size (developmental disorder)
•Accumulations of material may also increase the overall size of the organ • AMYLOIDOSIS• Fat
Hypertension Infarction
Hypertrophic Left Ventricle
Normal and Hyperplastic Adrenal Glands
NormalHyperplastic
Hypertrophy of Uterus During Pregnancy
Hypertrophy of Uterus During Pregnancy
Atrophy of Kidney
AMYLOIDOSIS causes heart and renal failure
• Gross – organ enlarged; waxy appearance; firm• Micro - pink, fluffy extracellular (protein) material in tissue
stained with H&E• Congo Red Stain- orange on light microscopy and Apple-green
birefringence when polarized• Beta-Pleated Sheet by x-ray diffraction
Examples of Amyloid
Disease
•Multiple myeloma
• Dialysis patients
• Inflammation
•Medullary CA
Type of Amyloid
• Lambda or kappa
• B-2 microglobulin
• SAA
• Procalcitonin
LIVER WITH AMYLOIDOSIS
H&E Stain (Lt. Microscope)
Congo Red polarizedCongo Red (Lt. Microscope)
SHAPE
•Shape of lesions may indicate the pathologic process
• Infarcts are wedge-shaped (arterial blood vessels distribute in an inverted “tree-like” fashion)
Spleen Infarction
COLOR
• Organs may acquire color or lose their natural color• FAT = yellow• BILE = green•MELANIN = black-brown• SCAR = white-tan• IRON = rust• CARBON = black
Normal liver color(unfixed specimen)
Fatty liver(unfixed specimen)
When liver accumulates FAT (as in alcoholism) it becomes enlarged and pale to yellow-orange in color
Old infarct(scar)
When a SCAR forms in the myocardium of the heart (post MI), the color changes from red/tan to gray/white
Melanoma
Lung with Anthracosis
CONSISTENCY
•Organs become stiff, hard, soft, waxy or greasy in disease
• Alcoholism and hepatitis cause extensive fibrosis (cirrhosis/scar tissue) in the liver and the liver is pale, shrunken and firm with round NODULES (firm, circumscribed areas)• Tumors are often firmer than the surrounding tissue• Calcification within tissues often has a “gritty” texture when
cut
LOCATION
•Some pathologic processes occur in specific locations (organ specific, tissue specific)
• FAT NECROSIS occurs in the pancreas (enzymatic fat necrosis) and breast (traumatic fat necrosis)• Splenic infarctions tend to be subcapsular• Also, tumors in the cortex of the kidney are usually glandular
in origin (adenocarcinoma)
Fat necrosis in the pancreas
Renal Cell Carcinoma in Kidney Cortex
LOCATION (2)
•CYST- fluid-filled sac; kidney, ovary
•BULLA- fluid-filled sac in the lung or skin
•Uterus- LEIOMYOMAS in the myometrium
•METASTASES- multiple nodules of tumor
Cysts
Bullae in Skin
Bullae in Lung
Bullae in Lung
Leiomyoma in Uterus
Liver Metastases
Gross Observation in Liver Disease
• Size:• Larger = fatty change; amyloidosis
• Shape:• Cirrhosis = nodular
• Color:• Bile = green• Rust = hemochromatosis• Yellow = fat; jaundice
• Consistency/Texture:• Firm = fibrosis/cirrhosis; tumors• Soft = abscess
Icteric Sclera
Cirrhosis or Fibrosis of the Liver
Liver shows cirrhosis and bile stasis (green color)
Liver Hemochromatosis
HEMOCHROMATOSIS
• Genetic• Secondary A. Iron overload due to transfusions for anemias B. Increased oral intake (rare)
TYPES OF NECROSIS
• COAGULATIVE
• LIQUEFACTIVE
• CASEATION
• FAT (ENZYMATIC or TRAUMATIC)
• GANGRENOUS
• FIBRINOID
• Infarcts
• Abscess
• TB Granuloma
• Pancreas and Breast
• Lower extremities or bowel
• Immune-mediated vascular damage
Coagulative Necrosis After Myocardial Infarction
Living heart muscle MI and acute Inflammation
Liquefactive Necrosis in Brain
Brain Abscess
Abscess or “pus pocket”
Caseous Necrosis (tuberculosis)
Granuloma with Central Necrosis
Enzymatic Fat Necrosis in Pancreas
Viable pancreas below and Fat Necrosis above
Gangrenous Necrosis
MICROSCOPIC OBSERVATIONS
• Can often use same principles as gross observations• Size• Shape• Color• Location
• Will discuss more during lab 2 (Wednesday and Thursday)