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Chapter One Chapter One Introduction to Introduction to Pathology Pathology What is pathology?

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  • 1. Chapter One Introduction to Pathology Section A What is pathology?

2. Definition of Disease

  • Disease may be defined as an abnormalalteration of structure or function in any part of the body.

3. Classification of Diseases:

  • Developmental genetic, congenital.
  • Inflammatory Trauma, infections, immune, etc.
  • Neoplastic tumors, cancers
  • Degenerative ageing.

4. Pathology

  • Study of what is abnormal or wrong or disease!
  • Scientific Study of Disease
  • NormalAbnormalTreat

5. Study of Disease:

  • Epidemiology
  • Etiology- Causes
  • Pathogenesis- Evolution
  • Morphology -Structural Changes
  • Clinical Significance Functional Changes
  • Clinical manifestation
  • Complications
  • Prevention

Pathology 6. Pathology focuses on 4 aspects of disease

  • ETIOLOGY:Cause of disease.
  • PATHOGENESIS:
  • Mechanisms of development of disease.
  • MORPHOLOGY:The structural alterations induced in cell and tissues.
  • FUNCTIONAL CONSEQUENCES:
  • Functional consequences of the morphologic changes, as observed clinically.
  • Knowledge of etiology remains the backbone:
  • Disease diagnoses
  • Understanding the nature of diseases
  • Treatment of diseases.

7. Etiology:

  • Environmental agents:
    • Physical
    • Chemical
    • Nutritional
    • Infections
    • Immunological
    • Psychological
  • Genetic Factors:
    • Age
    • Genes

Multifactorial: 8.

  • One etiologic agentone disease.
  • Several etiologic agentsone disease.
  • One etiologic agentseveral diseases.

9.

  • Diseases are caused due to internal or external factors.
  • Multifactorial:
    • No more one cause to one disease
  • Genetic factors affect acquired diseases and environment has profound effect ongenetic diseases.

10. Pathogenesis:

  • Sequence of events in the response of cells & tissues to a stimulus/pathogen starting from the initial stimulus to the ultimate expression of disease.
  • Gross and microscopic Structure, Function, Chemistry & molecular mechanisms.

11. Pathogenesis

  • The sequence events in the response
  • of the cells or tissues to the etiologic agent, from the initial stimulus to the ultimate expression of the disease.

12. Pathogenesis Immunologic, cytogenetic and molecular analyses oftissues and cells are increasingly becoming guides to render diagnoses, to assess prognosis, and to suggest therapy. 13.

  • W hile much still needs to be uncovered to link abnormal genes and the expression of disease, gone are the time when the mechanisms of most diseases wereunknown? or obscure? or mysterious?

14.

  • Morphologic change
  • Characteristic of the disease
  • Diagnostic of the etiologic proceess
  • Functional derangements
  • Clinical significance

MORPHOLOGY Morphology remains at the heart of diagnostic pathology. 15. Morphology:

  • Structural and associated functional changes in cells, tissues and organs that are characteristic of the disease or condition.

16. Renal Infarction 17. 18. 19. Normal glomerulus 20. Membranous GN 21. Clinical Significance:

  • Functional derangements and its clinical manifestations resulting from the morphologic changes.
  • Signs and symptoms, course and prognosis of disease depend on the morphology.

22. Pathology Summary:

  • Etiology :
    • Carcinogenesis. DNA Damage, Mutation.
  • Pathogenesis :
    • Uncontrolled cell division, tumor.
  • Morphology :
    • Enlarged lymphnodes, liver, spleen, microscopically lymphoma cells.
  • Clinical Features :
    • Fever, Wt loss, tumor-Ln, Liver, Spleen.

23. Section B What do pathologists do? 24.

  • Human Pathology
  • Experimental Pathology

Scopeof Pathology 25.

  • Human Pathology
  • Autopsy
  • Biopsy
  • Cytology

26.

  • Autopsy
  • The internal examination of the body after death performed scientifically for medical or legal purposes.

27. 28. 29. 30. 31. 32.

  • Roles:
  • to clarify the nature of many diseases.
  • to determine the cause of death and to collect evidence
  • to gather accurate statistics about disease incidence

33.

  • Biopsy
  • to establish a precise diagnosis by the removal and examination of tissue from the living body.

34. Tissue sections areembedded with paraffin. 35. stony hard lump or mass on palpation 36. 37. Diagnosis:Carcinoma of the breast The invasive duct carcinoma usually has an abundant fibrous stroma, so it is also refered to as scirrhous carcinoma. Dense collagenous background 38.

  • 3 Cytology
  • Single cells or clumps of cells exfoliated from their surrounding tissues.
  • Sputum, urine and abdominal fluid

39. Sputum smears ofcytology 40. Pap smear of CIN-III Large hyperchromatic nuclei, nuclear pleomorphism .There aresome interspersed neutrophils with lobated nuclei and much smaller size. 41. Diagnosis

  • What is Diagnosis?
    • The formal name(s) used to describe a patients disease
    • The process of identifying a disease based on the patients symptoms, the doctors findings, and the results of investigations and laboratory tests
  • What do you need to make a diagnosis?
    • A system of classification that supplies the necessary names, definitions, and criteria
    • The means to ascertain the defining characteristics of a disease in the individual patient

42. Sample Case: 43. Clinical Details:

  • 34 year , male
  • Neck swelling, 2-3 months,
  • Fever, weight loss,
  • no other lymphadenopathy
  • Lymphnode biopsy done

44. Right neck mass 45. Lymphnode Biopsy

  • Diffuse tumour
  • Capsule

46. Lymphnode Biopsy

  • Large cells
  • Mitotic figures

47. Histiocytic/Tcell NHL

  • Diffuse pattern no follicles.
  • Large cells with moderate cytoplasm
  • Plenty of mitotic figures, Nuclei are vesicular prominent nucleoli
  • Features suggest T-cell NHL malignant lymphoma.
  • Needs further marker studies for typing & management.
  • cancer Chemotherapy.

48.

  • Experimental Pathology

In vitro: Tissue culture Organ culture Cell culture In vivo: Experimental animals Nude mice 49.

  • Cell and tissue culture :
  • cellular environment can be modified and the responses to it monitored.

50.

  • Animal experiments
  • toobserve the effect of manipulations on the animal model of disease .

51. 52. Nude mice 53. Section C How do pathologists do? 54. RESEARCH METHODS

  • Macroscopic observation
  • Microscopic observation (HE)
  • EM
  • Immunohistochemistry
  • Hybridization
  • Cell Cultures, Medical Microbiology
  • Molecular Pathology PCR
  • Flow cytometry

55.

  • Gross Investigation
  • Size
  • Shape
  • Color
  • Weight
  • Morphologic features

56.

  • Congestive Splenomegaly: the volume of the spleen is increased and swollen, red-brown. Irregular tan-white fibrous plaques can be seen over the purple surface.

57. Renal Infarction 58. 59. 60. 61. 62.

  • Histopathological and Cytopathological Investigation
  • The microscopic examination of tissue and cell samples with LM on H.E. sections or smears.
  • Frozen sections sometimes for a very urgent diagnosis and histochemistry.

63. Renal Infarction 64. Liver cirrohsis 65. Liver carcinoma 66.

  • 3.Electron Microscopic Investigation
  • studydisorders at an organelle level and subcellular details.
  • transmission and scanning EM

67. 68. 69.

  • 4.Histochemical and Immunohistochemical Investigation
  • Histochemistryis the study of the chemistry of tissues after treated with specific reagents, so that the chemical features of individual cells can be visualised.

70. Normal glomerulus 71. Membranous GN 72. A masson trichrome preparation shows complete replacement of virtuallyall glomeruli by blue-staining collagen. Chronicglomerulonephritis: 73.

  • Immunohistochemistry
  • Ag-Ab complexes
  • The bound Ab is then visualized, using another Ab and a dye complex such as diaminobenzidine.

74. 75. 76. 77. 78. Section D about the subject ofPathology, How to learn pathology? 79. Pathology

  • Is the foundation of medical science and practice. Without pathology, the practice of medicine would be reduced to myths and folklore

80. Pathology The Status of Pathology in Medicine a bridging discipline the clinical practice of medicine basic science 81. Learning Pathology:

  • General Pathology
    • Common changes in all tissues.
      • E.g.. Inflammation, cancer, ageing.
  • Systemic Pathology
    • Specific changes in organs.
      • E.g.. Goiter, pneumonia, breast cancer.

82.

  • General pathology is concerned with the basic reactions of cells and tissues to abnormal stimuli that underlie all diseases.
  • Systemic pathology examines the specific
  • responses ofspecializedorgans and
  • tissues to more or less well defined stimuli.

83. Subdivisions of Pathology:

  • Histopathology
  • Cytopathology
  • Haematology
  • Microbiology
  • Immunology
  • Chemical Pathology
  • Genetics
  • Toxicology
  • Forensic Pathology
  • Histopathologist
  • Cytologist
  • Haematologist
  • Microbiologist
  • Biochemist
  • Geneticist
  • Toxicologist
  • Forensic Pathologist
  • Molecular Biologist

84.

  • Chinese proverb
  • I hear, I forget;
  • I see, I remember;
  • I do, I understand.

85. Past and Present.!

  • In the past, .. people mistook magic for medicine!
  • Now people mistake medicine for magic.!