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By: Dr.Mahamad Yunus S.Nabooji Dept of Roganidana & V.V (drmahamadyunus@gmail.com)
BASIC PATHOLOGY
SHORT NOTES
(EXAM POINTS)
(For 2
nd
year BAMS)
By
Dr.Mahamad Yunus S.Nabooji
Associate Professor Dept of Roganidana & V.V
Shri.J.G.C.H.S.Ayurvedic Medical College Ghataprabha
Karnataka
Shri J.G.C.H.S
AYURVEIC MEDICAL
COLLEGE GHATAPRABHA,
KARNATAKA
By: Dr.Mahamad Yunus S.Nabooji Dept of Roganidana & V.V (drmahamadyunus@gmail.com)
INTRODUCTION TO PATHOLOGY AND ITS SUB-DIVISIONS
DEF: Pathos: suffering, logos : study. Thus the pathology is scientific study of changes (suffering) in the structure and function of the body in disease (impaired health) and it answers the disease in terms of its aetiology, pathogenesis, prognosis and treatment plan. Lesion: Characteristics changes occurred in cell or tissue as the result of disease. Aetiology: Causative factor Pathogenesis: Mechanism by which lesion or disease produced Prognosis: what is going to happen, curability or non-curability of the disease? Diagnosis : Naming the disease or answer to the pathogenesis Treatment: What can be done to disease? Prevention : how to avoid the complications and spread of the disease
BRACHES: Mainly two General pathology (dealing with general principles of disease)
and Systemic pathology ( study of disease pertaining to specific organ or tissue.
- Histopathology: Also known as tissue pathology or anatomic pathology. It includes surgical pathology (study of removed cell or tissue by biopsy), Experimental pathology ( study of disease in experimental animal) and forensic pathology (study of organ removed from post-mortem) 2) Cytopathology: Study of cells shed off from lesion (Exfoliative cytology) and fine needle aspiration cytology (FNAC) Haematology: Deals with disease of blood it includes laboratory haematology and clinical haematology
By: Dr.Mahamad Yunus S.Nabooji Dept of Roganidana & V.V (drmahamadyunus@gmail.com)
CELLUALR ADAPTATION
- Form of Reversible cell injury
- Capability of adjusting their structure and functions in response to various physiological and pathological stimuli (Mild to Moderate) is known as cell or cellular adaptation TYPES:
- Physiological: Occurs in response to an stimulus and ceases once the need of adaptation has ceased e.g. change in breast and uterus during pregnancy due to influence of harmones
- Pathological : Occurs in response to injury or pathogens by producing cell stress proteins , which protect from damage and help in recovery
- Atrophy : Reduction of cell size which result in shrinkage of cell or organ. Due to degradation of cell protein by lysosomal enzymes e.g. ischemic atrophy, disuse atrophy of muscle
- Hypertrophy : Increase in the size of cells which result in enlargement of cell or organ. Due to increased production of cellular protein, intracellular factor and growth factor e.g. Left ventricular hypertrophy
- Hyperplasia : Increased number of cells in an organ or tissue. Due to synthesis of DNA and Proliferation of cell by local production of growth factor e.g. Hyperplasia of endometrium and hyperplasia of prostate
- Metaplasia : Replacement of one adult cell type with another. Due to long time persist of cause leads to Metaplasia by the influence of different factors like growth, cytokines etc. e.g. Squamous metaplasia, columnar metaplasia (Note : Both Hyperplasia and Metaplasia are fertile soil for the development of malignancy in future if cause or stimuli is not removed)
By: Dr.Mahamad Yunus S.Nabooji Dept of Roganidana & V.V (drmahamadyunus@gmail.com)
INFLAMMATION
Definition: It is a tissue response at microcirculation (At the site of injury) level to nonself injurious agents. Types: different types based on different criteria Causes: Physical (Trauma, heat cold etc), chemical (Organic, inorganic poison ), Infective (Bacterial, viral etc), Radiation, immunological etc Mechanism of inflammation: Vascular Changes: on injury there is vasoconstriction lasting for few seconds , and then there is a vasodilatation leads to excess blood flow to injured area Cellular Changes : involvement of Polymorph nuclear cell, lymphocytes, macrophages and other WBCs On injury there is accumulation of cells in peripheral side of vessels by means of rolling , then cells slowly emigrate into extra vascular space here they kills the infective agent by means of phagocytosis Criteria Types Definition According to duration Acute Lasting for seconds, minutes or <48hrs Subacute or Chronic Lasting >48hrs, days, weeks, months or years According to histological feature (^) • Non specific (Majority of cases)
- Specific (E.g TB, Leprosy and syphilis) According to causative factors Aseptic due to sterile chemical agents Aseptic due to pathogens
- Cardinal features: Redness: Due to excess flow of blood Swelling: Due to accumulation of intravascular contents to interstitial space Heat: Due to change in thermoregulation as the result of injury Pain: due to peripheral nerve irritation by chemicals secreted on injury
By: Dr.Mahamad Yunus S.Nabooji Dept of Roganidana & V.V (drmahamadyunus@gmail.com)
SHOCK
Def: Also known as cardiovascular collapse, as the result of reduced circulating blood volume and or inadequate perfusion of cells and tissue. Pathogenesis: All forms of shock involve: Reduced effective circulatory volume, impaired tissue oxygenation, Release of inflammatory mediators. Types: Hypovolaemic shock: due to acute haemorrhage, Burns, Excessive use diuretics etc Cardiogenic shock: due to MI, Cardiac arrhythmias, pulmonary embolism etc Septic Shock: Due to Gram negative and positive bacterial infection Other shock: includes traumatic shock due to sever injury, neurogenic shock due to head injury Clinical features: Low blood pressure, low body temperature, feeble pulse, pale face, shallow respiration and cold clammy skin Stages: Reversible and irreversible stage of shock HAEMORRHAGE Def: Escape of blood from the rupture or non ruptured blood vessel is known as haemorrhage Types:
- Internal (bleeding within body) and external (bleeding out of body ) haemorrhage,
- Acute (sudden and massive bleeding) and chronic (small amount over a period) haemorrhage
- Class I Haemorrhage involves up to 15% of blood volume. There is typically no change in vital signs. Class II Haemorrhage involves 15-30% of total blood volume tachycardia, difference between the systolic and diastolic blood pressures. peripheral vasoconstriction. pale and be cool skin.. Blood transfusion is not usually required. Class III Haemorrhage involves loss of 30-40% of circulating blood volume, blood pressure drops, the heart rate increases, shock, diminished capillary refill, blood transfusion are usually necessary. Class IV Haemorrhage involves loss of >40% of circulating blood volume, aggressive resuscitation is required to prevent death. Causes: Trauma to the vessel, inflammation of vessel wall, vascular diseases like atherosclerosis, aneurysm etc, elevated pressure within vessel, low platelet count, haemophilia etc, Effect: the effect of blood loss depends on the amount, speed and site of blood loss. Up to 33% of sudden blood is fatal may cause death
By: Dr.Mahamad Yunus S.Nabooji Dept of Roganidana & V.V (drmahamadyunus@gmail.com) THROMBOSIS (Clot) Def: Process of formation of clot mass in circulation from the constituents of blood, the mass is called as clot or thrombus Pathophysiology: Epithelial injury, plate abnormality, alteration of blood flow, abnormality of coagulation system Types : Venous thrombosis (Deep or superficial vein) and Arterial thrombosis The effect of thrombosis will depend upon their location, size and nature of thrombi EMBOLISM Def: It is the process of partial or complete obstruction some part of cardiovascular system by mass (embolus) carried in circulation. This embolus may be a blood originated (thrombus) or fat (fat embolus) or air (air embolus) etc , Types:
- Venous, arterial, paradoxical (venous to artery)
- Solid, liquid and Gaseous embolism
- Bland (when embolus is sterile) and Septic ( infected embolus) ISCHAEMIA Def: It is deficient blood supply to a part of tissue relative to its metabolic needs Types: Complete ischemia and Partial Ischemia Pathophysiology: Ischemia either due to Hypoxia (low oxygen, low haemoglobin, or low blood supply), Mall nourishment of cell and inadequate clearance of metabolites Causes: Occlusion (due to thrombus or embolus), Trauma, Others (Atherosclerosis, hypoglycaemia etc) INFARCTION Def: It is the process of tissue death (necrosis) as the result of ischemia Causes: Occlusion (due to thrombus or embolus), Trauma, Others (Atherosclerosis, hypoglycaemia etc) Pathogenesis: As the result of injury or ischemia there will be slowly death of the cell or tissue as the result of changes in vascular and cellular level like irreversible form of cell injury Types :
- Anaemic and haemorrhagic infarction
- Recent and old infarction
By: Dr.Mahamad Yunus S.Nabooji Dept of Roganidana & V.V (drmahamadyunus@gmail.com)
IMMUNE RESPONSE
Def: specific reactivity induced in a host following an antigen stimulus is known as immune response. Types: Humoral or antibody mediated immune response and Cell mediated immune response Humoral immune response (HMI/AMI):
- Mediated by macromolecules found in extracellular fluids such as antibodies, c- proteins and antimicrobial component
- Provides primary defense against most extracellular bacteria and viruses of Respiratory or GIT
- Participate in immediate hypersensitivity and certain autoimmune diseases
- In response to antigen (foreign body) first the B-cell converted into Plasma cell (Matured B-cell), these cells will produce different chemicals like antibody etc with the help of T-helper cells. These secreted chemicals will take part in immune response Cell mediated immune response (CMI):
- Protects against fungi, viruses and intracellular bacteria
- Participate in Delay hypersensitivity and in certain autoimmune diseases
- Provide immunity against cancer.
- It works by the activation of phagocytes, antigen specific cytotoxic T-lymphocytes in response to antigen take part in immune response, here the antibodies are absent BASIC KNOWLEDGE OF AUTOIMMUNE DISEASES
- Normally immune system recognized its own tissue and tissue antigen as ‘SELF’ and not produces antibodies against them
- Autoimmunity is a condition when body produces antibodies and immunologically component T-cells against self antigen leads to structural and functional damage of tissue and leads to autoimmune diseases Autoimmune diseases: Classified into
- Haemocytolytic diseases: These conditions involve various cells of blood circulation. E.g. Autoimmune hemolytic anemia, leucopenia and thrombocytopenia
- Localised or organ specific diseases: Specific organs are target for autoimmune reactions. E.g. Grave’s disease, Addison’s disease, pernicious anemia etc
By: Dr.Mahamad Yunus S.Nabooji Dept of Roganidana & V.V (drmahamadyunus@gmail.com)
- Systemic or non- organ specific diseases: Immune system response against a variety of self antigen and involves damage to several organs and tissue system. E.g. Rheumatoid arthritis, SLE (systemic lupus erythemtosus) Mechanism: May occur either by Humoral or Cellular immune response against self antigen usually causes tissue damage or disease by TYPE-II and Type-III hypersensitivity. Sometimes there is Type-IV.
- The immune response can be arrested by immunosuppressive therapy IMMUNE DEFICIENCY DISEASE
- Diseases produced when the defense mechanism of the host is impaired
- Two types mainly primary immune deficiency diseases and secondary immune deficiency diseases
- Primary immune deficiency diseases produce when abnormalities in the development of immune mechanism
- Secondary immune deficiency diseases produce due to consequence of some other diseases, malnutrition, drugs etc.
- These immune deficiency diseases involve specific abnormal (depression) immune functions- Humoral immunity, cell mediated immunity or both – or nonspecific mechanisms such as phagocytosis and complement system
- Primary immune deficiency diseases includes Humoral immune deficiencies (e.g. X-linked agammaglobulinaemia etc.), cellular immune deficiencies (e.g. Thymic hypoplasia etc.), combined immune deficiencies (e.g. ataxia telangiectasia etc.), Disorders of complement (e.g. complement component and inhibitor deficiencies) and Disorders of phagocytosis (e.g. chronic granulomatous diseases etc.)
- Secondary immune deficiency diseases includes lymphoid malignancy, lymphatic leukemia AIDS, Hodgkin’s lymphoma etc.
By: Dr.Mahamad Yunus S.Nabooji Dept of Roganidana & V.V (drmahamadyunus@gmail.com)
NEOPLASM (TUMOUR)
Neo means new and plasia means growth , so neoplasia means abnormal growth of tissue or organ. It is also known as tumor , the branch which deals about neoplasm is oncology. Types: Benign (Non- Cancer, Non harmful) and Malignant (Cancer, Harmful) Nomenclature: By adding the suffix Oma – to the cell types from which it arises for e.g. Fibrous tissue : Fibroma, Bone: Osteoma, epithelial: Carcinoma, Mesenchymal tissue : Sarcoma Difference between Benign and Malignant Tumor Features Malignant Benign Capsulated Non-Capsulated Usually Capsulated Rate of growth Rapid, Expansile Slow, Progressive Metastasis Present Absent Size Usually large Usually small Surrounding tissue invade Compressed Spread Spread to other parts Non-spread Differentiation Undifferentiated Well differentiated Treatment Chemotherapy, Radiation Surgery, Radiation TNM classification of tumour (To know the spreading of tumour) T- Tumor Size N-Number of lymph node involved M- Metastasis T 0 : No Tumor N 0 : No lymph node involved M 0 : Metastasis Absent T 1 : 2 - 3cm N 1 : lymph node of one region involved M 1 : Metastasis Present T 2 : <5cm N 2 : lymph node of two region T 3 : 5 - 10cm T 4 : any size with Involment skin, muscle or other structure
By: Dr.Mahamad Yunus S.Nabooji Dept of Roganidana & V.V (drmahamadyunus@gmail.com)
NUTRITIONAL DISORDERS
- Macro nutrients: Required in large quantity e.g. Carbohydrate, Protein, fat etc
- Micro nutrients: Required in less quantity e.g. Vitamins and minerals
- An adequate amount of nutrients are required for the body to provide energy, if there is a over nutrition will cause over weight or obesity will responsible for many diseases like diabetes, hypertension, stone formation, degenerative diseases like OA, and increase the incidence of cancer.
- If there is Malnutrition then there will be growth retardation, mental illness, immunodeficiency disorders. It is occur in two form primary (Malnutrition due missing of one or all component) and secondary (due to mal absorption of component). Disorders of Micro Nutrients: - Vitamins : Vitamin A (Night blindness, reduced hair growth), Vitamin B 1 (wet and dry beriberi), Vitamin B 2 (Intestinal keratitis ), Vitamin B 3 ( Pellagra), Vitamin B 6 (Anaemia, convulsions), Vitamin B 12 ( Pernicious anaemia, nerve damage), Vitamin C (Scurvy), Vitamin D (Rickets, osteoporosis), Vitamin E (Nerve abnormality), Vitamin K (Defective blood coagulation). - Minerals : Calcium (OA, RA etc), Iron (Anaemia, sore mouth), Iodine (Goitre, Hypothyroidism, hair loss), Potassium (Hypokalemia, muscular weakness), Sodium (Hyponitremia, digestive disorders) Disorders of Macro nutrients: - Carbohydrate: Overweight, obesity, diabetes and cardiovascular diseases etc and due deficiency leads to mood swing, ketosis, reduced staming - Fat: deficiency increased the risk of atherosclerosis, behavioural problem, depression, cognitive decline etc Proteins: deficiency leads to Kwashiorkor and marasmus
By: Dr.Mahamad Yunus S.Nabooji Dept of Roganidana & V.V (drmahamadyunus@gmail.com)
CLASSIFICATION OF BACTERIA
Bacteria of medical importance measures **2 - 5 um (L) * 0.2-1.5 um (W) A) Depending on their shape:
- Cocci** oval or spherical shape Diplococci: Arranged in pairs, Streptococci: Arranged in chains, Staphylococci: Arranged in cluster or group, Tetrads: Group of four cocci Sarcina: Group of eight cocci 2) Bacilli: rod shaped, Coccobacilli: Length of bacteria is approximately same as width e.g. Brucella, Streptobacilli: These bacilli are arranged in chains e.g. Streptobacillus , Chinese latter or cuneiform pattern: Arranged at angels to each other e.g. Corynebacterium , Comma shaped: Curve appearance e.g. Vibrio, Spirilla: Rigid spiral form e.g. Spirillum 3) Spirochaetes : ( spiera: coil; chaite; hair ): These are slender, flexuous spiral forms e.g. Treponema. 4) Actionomycetes: (Actis: ray. Mykes: fungus): These are branching filamentous bacteria resembling fungi. They have a rigid cell wall. 5) Mycoplasmas: Cell wall deficient bacteria hence don’t possess a stable shape. They are very small in size (50-300nm in diameter)
- Rickettsiae and Chlamydiae: These are very small and obligate parasites. Due to their inability to grow outside living cells, B) Based on Gram stain: Gram positive Bacteria: e.g. Streptococcus, Staphylococcus, and Pneumococcus. Gram negative Bacteria: e.g. Salmonella typhi, Vibrio cholera C) Based on Acid fast stain: Acid fast stain Bacteria: e.g. M.Tuberculi, M. Leprae. Non acid fast stain Bacteria: e.g. C. Diphtheria, Bacillus D) Based on Spore: Sporing Bacteria: e.g. Bacillus, Clostridium , Non sporing
Bacteria: e.g. Streptococcus, staphylococcus etc
E) Based on motility : Motile Bacteria: e.g. Salmonella typhi, Non motile Bacteria: e.g. Strepto and Staphylococcus
By: Dr.Mahamad Yunus S.Nabooji Dept of Roganidana & V.V (drmahamadyunus@gmail.com)
CLASSIFICATION OF FUNGUS
Study of fungi is known as Mycology , All fungi are eukaryotic, their cell wall contain chitin, mannan and other polysaccharides, They divide asexually, sexually or by both processes Classification of fungi: Fungi are kept under phylum Thallophyata Taxonomical Classification: Zygomycetes, Ascomycetes, Basidiomycetes, Deuteromycetes Morphological classification: Yeast, Yeast like fungi, Moulds, Dimorphic fungi a) YEAST: Round to oval unicellular fungi , Reproduced by budding b) YEAST LIKE FUNGI: These are partially grows as yeast and partially as chains of elongated budding cells joined end to end forming pseudophytes. Example is Candida albicans c) MOULDS: They grow as branching filaments called hyphae usually 2-10um in width. Hyphae may be septate or non-septate, They reproduced from both sexual and asexual spores, Dermatophytes, aspergillus, penicillium are examples for moulds d) DIMORPHIC FUNGI: They exist as yeast in the host and in the culture at 37^0 c and as moulds forms in the soil and in the cultures at 22- 250 c, Blastomyces, dermatitidis, etc are the examples
- Diseases of fungus are known as MYCOSES mainly classified into, Superficial mycoses, Subcutaneous mycoses, Systemic mycoses, CLASSIFICATION OF VIRUSES The viruses are classified into different types B/o Nucleus: DNA and RNA virus B/o Symmetry: Helical and complex B/o Envelop: Capsid and non capsid virus SOURCE OF REFERENCE:
- Text book of Pathology – By Harsh Mohan, published by Jaypee Brothers Medical Publishers
- Text book of Microbiology – By C P Baveja, Published by Arya publications
