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Lecture notes about General Pathology, Lecture notes of Pathology

University of the East, Manila (UEM)Pathology
Prof. Joy Campuspos

the branch of medicine treating of the essential nature of disease, especially of the changes in body tissues and organs that cause or are caused by disease and the structural and functional manifestations of a disease.

Typology: Lecture notes

2020/2021

Uploaded on 02/11/2021

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OBJECTIVES
•Pathology -definition
•Branches/Divisions/subdivisions/
sections
•Tests/procedures utilized in pathology
•Disease
!- "the study of the structural and
functional causes of human disease #
!- "has branches, divisions,
subdivisions and sections #
!- "utilizes different tests to help in
the detection/diagnosis and
management of disease #
!- "the bridge of between other
medical fields#
•Surgical pathology – surgical
specimens dissected, processed
and examined in the histopathology
section of the laboratory. %
•Cytopathology/cytology – exfoliated
cells from the body, processed and
examined in the histopathology
section of the laboratory (e.g., Pap
smears). %
•Autopsy pathology – post mortem
examination to determine the cause
and manner of death %
•Forensic pathology – main field of
Forensic Medicine; autopsy
performed as part of the
investigation of a crime. %
•Oral and maxillofacial surgery
pathology #
A. Hematology – examination of the
blood (e.g., complete blood count,
coagulation tests, peripheral
bloodsmears...). %
B. Microscopy – examination of body
fluids other than blood (e.g. urinalysis,
fecalysis, malarial smears...) #
C. Microbiology – section of the clinical
(pathology) laboratory where
microorganisms (bacteria, fungi) are
grown, studied and identified (e.g.,
AFB, Gram stain…)#
D. Chemistry – includes evaluation of
blood sugar levels, cholesterol, uric
acid... #
E. Serology – evaluation fluids like the
serum portion of the blood for
diseases like hepatitis %
or other infectious diseases. #
F. Blood bank – where donated blood is
stored and tested. #
G. Immunology – the study of the
molecular and cellular components
that comprise the %
immune system including their
interaction %
OTHERS
•Molecular Pathology – branch of
pathology where tests are
performed using nucleic acids
PART I. PATHOLOGY
ANATOMIC PATHOLOGY
CLINICAL PATHOLOGY
@marsrozelle
PRELIM
UECDent
SUBJECT AND CODE: DGP3101
PROFESSOR: DR. LEILA T. SALERA
General Physiology
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OBJECTIVES

  • the study of the structural and functional causes of human disease
  • has branches, divisions, subdivisions and sections
  • utilizes different tests to help in the detection/diagnosis and management of disease
  • the bridge of between other medical fields
  • Surgical pathology – surgical specimens dissected, processed and examined in the histopathology section of the laboratory.
  • Cytopathology/cytology – exfoliated cells from the body, processed and examined in the histopathology section of the laboratory (e.g., Pap smears).
  • Autopsy pathology – post mortem examination to determine the cause and manner of death
  • Forensic pathology – main field of Forensic Medicine; autopsy performed as part of the investigation of a crime.
  • Oral and maxillofacial surgery pathology A. Hematology – examination of the blood (e.g., complete blood count, coagulation tests, peripheral bloodsmears...). B. Microscopy – examination of body fluids other than blood (e.g. urinalysis, fecalysis, malarial smears...) C. Microbiology – section of the clinical (pathology) laboratory where microorganisms (bacteria, fungi) are grown, studied and identified (e.g., AFB, Gram stain…) D. Chemistry – includes evaluation of blood sugar levels, cholesterol, uric acid... E. Serology – evaluation fluids like the serum portion of the blood for diseases like hepatitis or other infectious diseases. F. Blood bank – where donated blood is stored and tested. G. Immunology – the study of the molecular and cellular components that comprise the immune system including their interaction OTHERS
  • Molecular Pathology – branch of pathology where tests are performed using nucleic acids

PART I. PATHOLOGY

ANATOMIC PATHOLOGY

CLINICAL PATHOLOGY

General Physiology

(e.g.,FISH and PCR).

  • Drug testing laboratory Disease - An illness or sickness characterized by specific signs and symptoms The four aspects of disease:
  1. Etiology – cause (infectious, physical, chemical, toxin...)
  2. Pathogenesis – mechanism of disease development
  3. Morphologic change – structural and alterations induced in cells and tissues by the disease
  4. Functional derangements – functional consequences of the morphologic changes, the clinical significance, clinical manifestations (signs and symptoms) Example of disease: Tuberculosis
  5. Etiology – Mycobacterium tuberculosis, bacteria, bacilli (patient sample like the sputum is collected and sent to the laboratory to be examined in the Microbiology section, where AFB is done).
  6. Pathogenesis – an infected person coughs and releases the bacilli via droplet infection, which are inhaled by another person; the bacilli then resides in the newly infected person’s lungs, laying dormant for a time, until this person’s immune system goes down. 3. Morphologic change – the bacilli spreads causing damage to the lung tissue and bronchi (seen microscopically and grossly). 4. Functional derangements – the patient shows the clinical manifestations (signs and symptoms) associated with the infection (fever, coughing out blood or hemoptysis, weight loss, difficulty of breathing, weakness....) 1. Recall/review the difference between DNA and RNA. 2. Recall the central dogma of molecular biology. 3. Recall he different types of RNA 4. Mutation – permanent change in the DNA DNA to RNA to protein. Proteins can be structural or participate in metabolic activities (enzymes). One example of a protein is hemoglobin (structural). Hemoglobin has a heme and globin (alpha and a beta) portion, and has a very important function in the red blood cell. If during the assembly or the making of hemoglobin a mutation occurs (one amino acid along the chain has been replaced by another along the beta- globin chain), a disease/disorder will occur: In the 6th position of the beta-globin chain, glutamic acid has been replaced by valine (mutation) leading to the development of abnormal shaped red blood cells (sickle cell anemia).

PART II. DISEASE

PART III. THE GENOME & DISEASE

AUTOPSY

Fine Needle Aspiration Biopsy or Cytology (FNAB or FNAC).

CLINICAL PATHOLOGY DIVISION

MICROBIOLOGY SECTION

Unstained and stained peripheral blood smears

DISEASE

M2: Cellular Responses to Stress and Toxic Insults Adaptations

  • reversible functional and structural responses to changes in physiologic states (e.g., pregnancy) and some pathologic stimuli. Adaptive responses: a. Hyperplasia - increase in the number of cells b. Hypertrophy - increase in the size of tissue/organ c. Atrophy - decrease in the size of tissue organ d. Metaplasia - a change in the phenotype of cells If the cell is unable to adapt, cellular injury will occur. If the injury is mild and the cause (etiology) for the injury is transient, it would be a reversible injury and the cell will go back to its normal “homeostatic” state. However, if the injury is severe and progressive, irreversible injury will result and the cell/ tissue/organ will have permanent damage.
    • Injury – reversible or irreversible
    • Reversible injury – cells will be able to adapt and if the injury is mild and short, the cells go back to normal
    • Irreversible injury – cells will adapt until they cannot and this will result in either necrosis or apoptosis (both are examples of cell death)
    • Injury could lead to permanent morphologic change, e.g., scar formation
    • For example, liver disease such as alcoholic hepatitis
    • Etiology – excessive alcohol consumption
    • Pathogenesis – activation and release of enzymes to metabolize alcohol leading to accumulation of toxic alcohol metabolites
    • Inflammation, cloudy swelling and fatty change of the liver (reversible cellular injury)
    • Replacement of normal hepatocytes with fibrous (collagen) tissue leading to scar formation – liver cirrhosis
    • Formation of liver nodules (gross) Functional derangements – jaundice, edema, ascites, bleeding tendencies....

PART I. CELLULAR ADAPTATION

CELLULAR RESPONSE TO STRESS

AND TOXIC INJURY

MORPHOLOGIC CHANGES

Cellular adaptation:

  1. Hyperplasia
  2. Hypertrophy
  3. Metaplasia
  4. Atrophy All are reversible at a certain point All can be a physiologic response or pathological -The increase in the growth and number of cells (parenchyma) -The increase could lead to the increase in the size of the tissue -Causes: increase in stimulation like hormones, growth factors, drugs Example:
  • Thickening of the endometrial lining due to the increase in the number of endometrial glands secondary to stimulation of estrogen and progesterone.
  • Thickening of the gums as a side effect of a drug.
  • Thickened endometrium during endometrial hyperplasia when there is overstimulation of estrogen

CELLULAR ADAPTATION

HYPERPLASIA

The decrease in the size of a tissue and / organ Causes: decrease in stimulation, workload, injury Example:

  • The decrease in the thickness and the number of glands in the endometrium during menopause.
  • Hypoxic injury to the brain after a stroke
  • Paralysis

ATROPHY

  • The transformation or change of one adult cell type to another
  • The change of one tissue phenotype to another
  • Reversible; can be physiologic or pathologic
  • Example, from squamous epithelium to columnar (Barrett esophagus)
  • Cause: chronic irritation, infection, injury

METAPLASIA

Irreversible cell injury – cell death; if the damaging stimulus persists Two types of irreversible cell injury:

  1. Necrosis – always pathological
  2. Apoptosis – can either be physiological or pathological
  • The more common type of cell death, involving severe cell swelling, denaturation and coagulation if proteins, breakdown of cellular organelles, and cell rupture
  • Causes: hypoxia, physical agents, chemical agents, infectious agents, immunologic reactions, genetic derangements and nutritional imbalances
  • It is the sum of the morphologic changes that follow cell death in living tissue or organs 1. Denaturation of proteins 2. Enzymatic digestion of organelles and other cytosolic components Distinctive features: 1. Necrotic cells are more eosinophilic than viable cells. 2. Cells appear glassy due to glycogen loss. 3. Cells may be vacuolated. 4. Cell membranes are fragmented 5. Necrotic cells may attract calcium salts 6. Necrotic fatty soaps occur 7. There is nuclear pyknosis, karyolysis, and karyorrhexis 1. Coagulative necrosis 2. Liquefactive necrosis 3. Caseous necrosis 4. Gangrenous necrosis 5. Fat necrosis 6. Fibrinoid necrosis - Most common pattern - Protein denaturation with preservation of the cell and tissue framework – predominant feature - Characteristic of hypoxic death in all tissues except the brain - Necrotic tissue undergoes either heterolysis (digestion of lysosomal enzymes) or autolysis (digestion by its own lysosomal enzymes)

IRREVERSIBLE INJURY

NECROSIS APOPTOSIS

Always pathological Physiological or pathological Affect adjacent group of cells Affect single cells Cell size: increased Cell size: shrunken passive active Causes inflammatory reaction No inflammatory reaction Plasma membrane is disrupted Plasma membrane is intact CELLULAR INJURY - NECROSIS

TWO UNDERLYING PROCESS

DISTINCTIVE FEATURES

GENERAL TISSUE PATTERNS

COAGULATIVE NECROSIS

  • Predominated by autolysis and heterolysis, over protein denaturation
  • Necrotic area is soft and fluid-filled
  • Enzymes include proteases, DNases, lysosomal ezymes
  • Most frequently seen in localized bacterial infections (abscesses) and in the brain
  • Enzymatic digestion of cellular debris
  • Enzymatic digestion of surrounding tissues
  • Denaturation of cellular proteins
  • Not a specific pattern of necrosis
  • Coagulative necrosis applied to an ischemic limb
  • Superimposed bacterial infection = liquefactive pattern = wet gangrene - Characteristic of TB lesions - Gross: soft, friable, “cheesy” - Microscopic: amorphous eosinophilic material with cell debris - TB bacilli is partially resistant to digestion and phagocytosis leading to activation of macrophages forming giant cells and epithelioid cells - Recruitment of more macrophages, more inflammation, release of cytokines, and slow degradation of bacteria - Mycolic acid and other lipid constituent of bacterial cell wall = cheese like appearance of lesion (caseous necrosis) - Seen in adipose tissue - Lipase activation releases fatty acids from triglycerides - Fatty acids complex with calcium, creating calcium soaps - Gross: white, chalky areas (fat saponification) - Microscopically: vague cell outlines and calcium deposition

LIQUEFACTIVE NECROSIS

GANGRENOUS NECROSIS

CASEOUS NECROSIS

FAT NECROSIS