roga nidan basic pathology -part 1

Rog Nidan- Basic Pathology –Part 1

• Presented By – Prof.Dr.R.R.Deshpande (M.D in Ayurvdic Medicine & M.D. in Ayurvedic Physiology)

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• Mobile – 922 68 10 630• [email protected]

12/19/2016 1Prof.Dr.R.R.Deshpande

http://www.ayurvedicfriend.com/

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mailto:[email protected]

mailto:[email protected]

Rog Nidan –Basic Pathology

• This PPT is based on the –

• Syllabus of CCIM ( 2014) for 3rd BAMS of Rognidan

• Points are from Paper 1 Part A ,Point III – Basic Pathology


Basic Pathology

• 1. Introduction to pathology and its sub-divisions

• 2. Introduction to Cell Injury and Cellular adaptations

• 3. Definition and brief description of inflammation – Healing/repair


Basic Pathology

• 4. Definition and brief description of edema – shock – hemorrhage, Thrombosis , embolism, Ischemia and Infarction

• 5. Types of Immunity – different types of immune responses in the body – Basic knowledge of auto immune diseases, Acquired immune deficiency disease and hypersensitivity


Contents of this PPT

• 1) Cell Injury & Cell death ,Necrosis• 2) Oedema

• 3) Haemorrhage• 4) Shock

• 5) Thrombosis • 6) Embolism12/19/2016 5Prof.Dr.R.R.Deshpande

Cell Injury and Cell Death

• Cell is a restless, pulsating microcosm, constantly modifying its structure and function in response to changing demands and stress

• Cell tries its level best to maintain the internal environment within the normal limits i.e homeostasis


Cell Injury and Cell Death

• . But when cell exposes to the excess stress it fails to maintain the homeostasis

• In this situation cell adapts itself by changing its shape or its numbers.


Cell Injury due to free Radicals


Hypertrophy, Atrophy and Hyperplasia

• Examples of cellular adapatations –• If the stress is beyond the limits of cellular adaptation then the cell injury take place

• Up to some extend the cell injury is reversible but when the patho physiological stress is in excess and persistent then the irreversible cell injury occurs.


Atrophy & Hypertrophy


Hypertrophy & Hyperplasia


Causes of cell Injury

• 1) Hypoxia ---- low level of oxygen supply• 2) Chemical agents ---- Drugs and other chemicals

• 3) Physical agents --- Trauma, heat, cold etc.• 4)Micro organisms --- Bacteria, Viruses, Fungi etc.


Cell Injury


Causes of cell Injury

• 5) Immunological reactions --- Anaphylactic and allergic reactions

• 6) Genetic defects --- Gross congenital anomalies like Down’s syndrome and subtle effects like HbS in Sickle cell anemia

• 7) Nutritional imbalances -- Various vitamin deficiency related disorders or Ion deficiency anemia

• 8) Ageing – cataract, prostate enlargement etc.


Cell Death

• The principal adaptive responses are atrophy, hypertrophy, hyperplasia, and metaplasia

• If the adaptive capability is exceeded, cell injury develops.


Cell Death

• Within certain limits, injury is reversible, and cells return to a stable baseline; however, with severe or persistent stress, irreversible injury results, and the affected cells die

• There are two principal patterns of cell death are recognized and those are ---

• Necrosis and Apoptosis


Necrosis & Apoptosis


1) Necrosis

• It means the cell death

• It occurs after a loss of blood supply or after an exposure to toxins

• Characterized by cellular swelling, protein denaturation, and organelle breakdown.


1) Necrosis- Causes

• Hypoxia (O2 )

• Chemical and physical agents

• Microbial agents

• Immunological injury (Autoimmune diseases)


Types of Necrosis

• 1) Coagulative Necrosis• 2) Liquefaction Necrosis

• 3) Caseous Necrosis

• 4) Fat Necrosis• 5) Fibrinoid Necrosis 12/19/2016 20Prof.Dr.R.R.Deshpande

1) Coagulative necrosis

• Sudden stoppage of the blood supply may lead to coagulative necrosis

• It is seen commonly in heart ,kidneys, brain and spleen.


1) Coagulative necrosis

• In this type of the injury the acidosis develops which denatures the structural proteins as well as the enzyme proteins

• The important feature of this type is conversion of normal cell into thrombus. (Thromb stones)


Coagulative necrosis –Left Ventricle


2) Liquefactive necrosis

• It is characteristic of focal bacterial or sometimes fungal infections

• It is characterized by the accumulation of white cells

• In a surgical practice the most of the abscesses are of this type


Liquefactive necrosis in Brain


3) Caseous necrosis

• It is a special form of necrosis observed in a Tuberculous infection.

• The term "caseous" is derived from the cheesy, white gross appearance of the central necrotic area


Caseous Necrosis

Tuberculosis Lungs


3) Caseous necrosis

• Microscopically, the necrotic focus is composed of structureless, amorphous granular debris enclosed within a distinctive ring of granulomatous inflammation


4) Fat Necrosis

• This occurs in the abdominal emergency like acute pancreatitis• • It results from pathologic release of activated pancreatic enzymes into adjacent parenchyma or the peritoneal cavity.


4) Fat Necrosis

• Activated pancreatic enzymes escape from acinar cells and ducts, liquefying fat cell membranes and hydrolyzing the triglyceride esters contained within them

• The released fatty acids combine with calcium to produce grossly visible chalky areas


Fat Necrosis -Pancreas


5) Fibrinoid Necrosis

• It is characterized by the deposition of the fibrin like material and commonly observed in -----

• Rheumatoid arthritis and in Auto Immune Diseases like SLE.


Fibrinoid Necrosis


Apoptosis

• It occurs as a result of ---- • Set and internally controlled "suicide" program, ---

• After which the dead cells are removed with minimal disruption of the surrounding tissue.


Apoptosis

• This occurs in physiologic states when unwanted cells are to be eliminated • e.g., embryogenesis, menstrual discharge • As well as in a variety of pathologic states e.g., Irreparable mutational damage


Autoloysis

• It is the mechanism in which the cell death occurs due to its own hydrolytic enzymes liberated from lysosomes It is commonly observed in a post mortem change

• This is rapid in tissues ,which are rich in hydrolytic enzymes e.g. Pancreas & gastric mucosa.


Gangrene

• It is a type of necrosis of tissue with super added putrification.

• Types :• 1) Dry Gangrene: It is commonly observed in the toes and feet of old patients.

• It appears black due to the liberation of hemoglobin and reaction with H2S producing iron sulphate.


Gangrene


2) Wet Gangrene

• It Occur in the moist tissues (mouth, bowel, lungs, cervix etc.).

• It is very common in Diabeteic patients especially in the toe


2) Wet Gangrene

• The affected part becomes soft,edematous and blackish in colour

• The foul smell is the characteristic feature

• The Toxic products formed by bacteria are absorbed through blood and septicemia can develop in these patients


Dry & Wet Gangrene


3) Gas Gangrene

• It is caused by gas forming Gram positive anaerobic bacteria -- Clostridium perfringen

• The open, contaminated wound may develop this condition

• The affected par is swollen, painful and typical crepitus is heard, due to gas bubbles.


Gas Gangrene


Oedema

• Excess accumulation of the fluid in an interstitial space is called as ‘Oedema’.

• Oedema can be localized or may be generalized

• Generalized form is called as ‘Anasarca’.


Oedema

• There are four types of pressures which contribute in the exchange of the fluid.

• The hydrostatic pressure of plasma and interstitial oncotic pressure are responsible for the net outward flow of the fluid.


Oedema

• Whereas the interstitial hydrostatic pressure and plasma oncotic pressure lead the inward directional flow of the fluid.

• In the formation of the oedema the outward directional pressures are increased.


Unilateral Localised Oedema

• 1) Cellulitis

• 2) Deep vein thrombosis (DVT)

• 3) Filariasis

• 4) Gout.


1) Cellulitis

• It is an inflammation of the tissue • Affected part shows the signs of inflammation like swelling, redness, raised local temperature and pain

• The affected part show the tenderness.


Cellulitis


2) Deep Vein Thrombosis (DVT)

• The swelling in the calf muscles ----

• With signs of inflammation is the typical feature of DVT.

• Calf tenderness is a typical feature • Fear of Embolism – So Massage should not be done –otherwise fear of Pulmonary Embolism & death


Deep Vein Thrombosis

Calf Pain Defective valve


Deep Vein Thrombosis


3) Filariasis

• It is also known as Elephantitis

• The oedema is initially pitting but later on turns into non pitting due to fibrosis

• It is characterized by intermittent fever especially in the night.


Filariasis


4) Gout

• It is also an inflammatory condition secondary to raised level of serum uric acid

• The inflammatory response is very common behind the great toe

• The part becomes red and tender


Gout


B) Generalized Oedema

• Generalized form of oedema is common in ----

• Heart diseases like CCF• Nephrotic syndrome• Liver disorders• Hypothyroidism • Anaemia


Paedal oedema & Ascites in CCF


Generalised Oedema -- Causes

• 1) Anaemia with Hypoprotenemia• 2) Drug induced oedema• 3) Venous insufficiency

• 4) Angioneurotic oedema• 5) Myxoedema• 6) Premenstrual oedema


Oedema

Nephrotic Syndrome Myxoedema


1) Anaemia with Hypoproteinaemia

• In these conditions the oedema is common in an areolar tissue i.e periorbital & pedal edema

• The patient is pallor, the extremities are cold and complains recurrent stomatitis


2) Drug induced oedema

• Sudden onset with swelling of face and feet.• H/o steroids – Cushing’s syndrome (Moon shaped face) -- Side effects of the drugs like NSAIDs e.g. Diclofenac (Voveran), Ibuprofen (Brufen)

• Side Effect -- If the women is taking the oral contraceptive pills (Mala – D)


Steroid –Cushing’s syndrome


3) Venous Insufficiency

• It is very common in middle aged women

• Typically appears on the ankle region


4) Angioneurotic or Allergic Oedema

• It is the type of hypersensitivity reaction to the allergen.

• It releases the mast cells secretions (Histamine) into the tissues.

• Due to the Histamine the itching takes place. • The other symptoms of allergic reactions are oedema, rashes, dyspnoea and hoarsenes of the voice.


Angioedema


5) Myxoedema or Hypothyroidism

• The low level of thyroid hormones in the plasma reduces the BMR

• Secondary to this the water retention takes place in the body

• Patient complaints of heaviness in the body, lethargy, lack of confidence, bradycardia and puffiness


6) Premenstrual Oedema

• Due to the retension of water and sodium the oedema develops in premenstrual syndrome

• Many times Diuretics are given as a symptomatic releif


Haemorrhage

• Definition: It is defined as escape of blood from blood vessels due to trauma or disease • The clinical significance of hemorrhage depends on the volume, rate of blood loss and the site.


Haemorrhage

• 1) Haematoma -- Escape of blood in tissues with swelling

• 2) Ecchymosis --- Large extravasation of blood into skin and mucous membrane

• 3) Purpura --- Small areas of haemorrhages, below 1 cm in skin or mucus membrane.

• ii) Diapedesis -- Microscopic escape of RBC in loose tissue.


Haemorrhage

Petechiae & Purpura Patechiae & Purpura


Haematoma


Diapedesis


Skin lesions


Shock

• Definition –

• It is a clinical state of circulatory collapse and

• Inadequate perfusion of the cell and tissues

• Specially less blood supply to Brain 12/19/2016 75Prof.Dr.R.R.Deshpande

Shock


Types of Shock

• 1) Hypovolumic Shock• 2) Septicaemic Shock• 3) Cardiogenic shock

• 4) Neurogenic shock • 5) Anaphylactic shock


Shock: Types

• 1) Hypovolemic Shock: • Common in the conditions like ----

• Road accidents • Severe haemorrhage • Severe dehydration • In severe burns


Shock: Types

• 2) Septicemic Shock: • It is the severe condition secondary to infections

• The bacteria produces the exotoxins and endotoxins which are responsible for this type of shock


Shock: Types

• 3) Cardiogenic Shock ---• Heart is the pump of the body & if fails to pump the blood as per the demand of the tissues then the cardiogenic shock occurs

• It is observed in CCF and in cardiac arrhythmias.


Shock: Types

• 4) Neurogenic Shock ----- • Secondary to ---- • The severe painful conditions

• Emotional upsetting situation

• In spinal injuries especially in road traffic accidents


Shock: Types

• 5) Anaphylactic Shock ----• It is the Hypersensitivity type-1 reaction in which, the body gives over response to the antigens

• The mast cells degranulation, IgE antibodies response, histamine and other inflammatory mediators are responsible for the pathophylogical events

• 12/19/2016 82Prof.Dr.R.R.Deshpande

Shock -- Signs and Symptoms

• 1) Pulse --- Feeble with tachycardia

• 2) Low systolic B.P. < 60 mm of Hg

• 3) Severe perspiration (sweating increases), limbs are cold

• 4) Subnormal temperature (i.e. temperature decreases)


Thrombosis

• Definition ----- • It is defined as the formation of solid mass in a circulation from the constituents of the blood

• In the formation of the Thrombus the endothelial cells, platelets and the clotting factors play a central role


Harmful Effects of Thrombosis

• 1) Ischaemia --- Less Blood supply

• 2) Thrombo - embolism


Coronary Thrombosis


Fate of Thrombosis

• 1) Anti thrombotic mechanisms are also functioning in the body to arrest the on going Thrombus formation

• t-PA i.e tissue plasminogen activator is antithrombotic factor present in the body

• Plasminogen dissolves the fibrin and hence the clot too


Fate of Thrombosis

• 2) Organisation – Phagocytic cells start eating fibrin and cell debris. New fibroblasts develop

• 3) Propagation --- Thrombus enlarged in size.


Predisposing factors of Thrombosis

• 1) Advanced Age.• 2) Prolonged bed rest (Due to decrease movements ,circulation hampers )

• 3) Immobilization• 4) Use of O.C. pills• 5) Cigarette smoking – Nicotine causes vasoconstriction

• 6) Tissue damage due to burn & fracture.


Clinical Conditions which can Cause Thrombosis

• 1) Valvular defects in the Heart• 2) Atherosclerosis• 3) Varicose Veins – DVT• 4) Disseminated cancers• 5) Nephrotic Syndrome• 6) Late pregnancy and • 7) After delivery


Embolism

• Definition: Any mass carried in circulation and which cause partial or complete obstruction in the circulation.

• 1) Brain -- Stroke (CVA – Cerebro Vascular Accident) leads to hemiplegia.

• 2) Heart --- Heart attacks• 3) Kidney --- Renal failure – Oliguria (Initially polyuria then oliguria)

• 12/19/2016 91Prof.Dr.R.R.Deshpande

Embolism


Effects of embolism

• 1) Sudden death ( Many times due to Pulmonary Embolism )

• 2) Infarction- AMI (Acute Mycardial Infarction)

• 3) Gangrene


Ischaemia

• Less blood supply to the part of a tissue. This may be total or partial

• Effects:• 1) Tissue hypoxia.• 2) Inadequate supply of nutrients.• 3) Inadequate drainage of metabolites.


Infarction

• The necrosis of the tissue is called as Infarction• Infarction – Total stoppage of blood supply • It is secondary to circulatory insufficiency• Infarction takes place due to• 1) Thrombosis• 2) Embolism• 3) Ischaemia 12/19/2016 95Prof.Dr.R.R.Deshpande

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