Introduction To Pathology

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Pathology

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Branch of medicine that deals with the nature of disease and its pathogenesis- the structural and functional changes produced by injury to cells, tissues, organs or the entire organism

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Disease

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Generally, a departure from health; specifically, a particular destructive process with a cause and characteristic symptoms, signs and course

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Sign

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An objective indication or symptom of disease; what an observer sees or can measure

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Symptom

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A subjective indication of disease; what the patient feels or notices

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Complication

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A second disease or abnormalcondition occuring during the course of a primary disease

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cause of death

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The name of the disease, abnormality, trauma, etc. leading directly/ indirectly to death

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Manner of death

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NASHU Natural, accidental, suicide, homicide, undetermined. The way in which death is caused

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Diagnosis

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The act or process of deciding the nature of disease condition by a careful examination of the s/s's; also, the decision or opinion based upon examination

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Differental Dx

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A list of possible diagnoses

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Types of Pathology

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General Pathology
Systemic Pathology
Anatomic Pathology
Surgical Pathology
Cytopathology

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General Pathology

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Deals with types and mechanisms of disease
Mechanism
Morphological changes
Alterations

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Systemic Pathology

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Deals with types an mechanism of disease
Mainly dealt with in systems pathology

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Anatomic Pathology

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Cytopathology
Surgical Pathology
Autopsy Pathology
Dermatopathology
Neuropathology

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Surgical Pathology

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Microscopic examination of tissues

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Cytopathology

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The study of normal and abnormal cells in tissue and body fluids

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The triple Test

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Clinical examination
Imaging
Pathological diagnosis

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Dysplasia

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Disordered growth

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Three S's

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Size
Shape
Staining

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Vindicate Sleep

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V- Vascular
I- Inflammatory
N- Neoplastic
D- Degenerative
I- Intoxication
C- Congenital
A- Allergic/ autoimmune
T- Traumatic
E- Endocrine

S- Social
L- Legal
E- Enviromental
E- Economical
P- Psychological

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Hyperplasia

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Increase in the nmber of cells

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Hypertrophy

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Increase in hte size of cells

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Atrophy

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Decrease in the size of cells

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Cellular response to injury
Altered physiological stimuli
Increased demand, increased trophic stimulation

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Cellular adaptions
Hyperplasia
hypertrophy

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Cellular response to injury
Decreased nutrients, stimulation

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Cellular adaptations
Atrophy

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Cellular response to injury
Chronc irritation

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Cellular adaptation
Metaplasia

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Reduced oxygen supply; chemical injury; microbial infection

Acute and self-limited

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Cell injury
Acute reversible

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Reduced oxygen supply; chemical injury; microbial infection

Progressive and severe (including DNA damage)

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Cell injury
Irreversible injury -> cell death
Necrosis
Apoptosis

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Reduced oxygen supply; chemical injury; microbial infection

Mild chronic injury

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Cell injury

Subcelular alterations in various organelles

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Metabolic alterations, genetic or acquired

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Intracellular accumulations; calcifications

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Prolonged life span with cumulative sublethal injury

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Cellular aging

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Physiological Hyperplasia
Hormonal

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Hormonal
eg uterus
increase the functional capacity of a tissue when needed

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Etiology or cause

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2 major factors intrinsic or genetic & acquired

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Pathogenesis

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sequence of events in the response of cells or tissue to the etiologic agent, from the initial stimulus to the ultimate expression of the disease

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Morphologic chanes

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the structural alterations in the cells or tissues that are either characteristic of the disease or diagnostic of the etiological process

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Functional Derangements & clinical manisfestations

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Nature of morphologic changes & their distributions in different organs or tissue influence normal function & determine the clinical features, course and prognosis of the disease

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Cell injury

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adaptive response to stimulus is exceeded or in certain instances when the cell is exposed to an injurious agent or stress & function of cells

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Cell Death

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ultimate result of cellular injury, most crucial events in the evolution of disease of any tissue or organ

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Stages of progressive impairment

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Adaptation
reversible injury
cell death

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Necrosis

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type of cell death that occurs after such abnormal stresses as ischemia & chemical injury

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Apoptosis

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Cell dies through activation of an internally controlled suicide program

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Pathological calcification

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deposits of calcium at sites of cell death

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Cell aging

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accompanied by characteristic morphologic & functional changes

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Metaplasia

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cells change from one type to another usually from a noxious stimuli

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Physiological Hyperplasia
compensatory

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increase tissue mass after damage or partial resection

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Mechanism of hyperplasia

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generally caused by increase local production of growth factors, increase no. of growth factor receptors

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Pathological Hyperplasia

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most forms caused by excessive hormonal stimulation or growth factors acting on target cells

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Mechanism of Hypertrophy

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many pathways leading to the induction of a number of genes -> stimulate the synthesis of numerous cellular proteins

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Hypertrophy
Mechanical triggers

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such as stretch receptors

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Hypertrophy
trophic triggers

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polypeptide growth factors and vasoactive agents

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Physiological atrophy

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common during early development

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Pathologic Atrophy

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depends upon the underlining cause and can be local or generalized

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Atrophy of disuse

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Decreased workload
eg from an immobilized limb

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Denervation Atrophy

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Loss of innervation
muscle function dependant upon nerve supply

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Ischemia

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Diminished blood supply resulting in atrophy from cell loss

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Metaplasia

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a reversible change
one adult cell type is replaced by another cell type
most common type columnar to squamous

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Two main components of inflammation

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1-vascular wall response
2-inflammatory cell response

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Acute inflammation

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early onset, short duration, exudation(edema), polymorphonuclear cell emigration(neutrophil)

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Chronic inflammation

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later onset, longer duration, lymphocytes, and macrophages involved, inducing blood vessel proliferation and scarring

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Four classic clinical signs

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Heat(calor)
Redness(rubor)
Edema(tumor)
Pain(dolor)

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Exudate

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an inflammatory extravascular fluid that has a high protein concentration and cellular debris: specific gravity above 1.020

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Three major components of acute inflammation

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Alterations in vascular caliber
Structural changes in the microvasculature
Leukocyte emigration

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Three steps of extravasation(leukocyte delivery to the site of injury)

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1-Margination, rolling, and adhesion of the leukocytes to the epithelium
2-Transmigration across the endothelium(diapedesis)
3-Migration in interstitial tissues toward a chemotactic stimulus