Upload
saleem2000
View
18
Download
0
Embed Size (px)
DESCRIPTION
5нкенек
Citation preview
Chapter 1
Introduction to Pathology
Zhao Guoqiang
Introduction to Pathology
Definition of Pathology
Evolution of Pathology
Subdivision of Pathology
Methods for the study of pathology
Definition of Pathology
The word Pathology is derived from two Greek word ----
pathos meaning sufferinglogos meaning study
Definition of Pathology
Pathology is scientific study of structure and
function of the body in disease.
It deals with causes, effects, mechanisms and
nature of disease.
The knowledge and understanding of pathology is essential for all would-be doctors as well as general practitioners and specialists since unless they know the causes and mechanisms of disease and understand the language spoken by the pathologist in the form of laboratory reports, they would not be able to institute appropriate treatment or suggest preventive measures to the patient.
For the medical student, the discipline
of pathology forms a vital bridge
between initial learning phase of
preclinical science and the final phase
of clinical subjects.
Evolution of Pathology From religious beliefs to rational approach
(Antiquity to AD 1500)
Era of gross pathology (AD 1500 to 1800)
Era of technology development and cellular
pathology (AD 1800 to 1950s)
Modern pathology (1950s to dawn of 21st
century)
From religious beliefs to rational approach (Antiquity to AD 1500)
Hippocrates (Greece) 460-377 BCPermanently dissociated medicine from religious mysticism. Started study of patients symptoms as method of diagnosis.
Cornelius Celsus (Rome) 53 BC-7 ADDescribed 4 cardinal signs of inflammation (redness, heat, swelling, pain)
Hippocrates (Greece) 460-377 BC
Era of gross pathology (AD 1500 to 1800) Giovanni B Morgagni (Italy) 1682-1771
Introduced clinicopathologic correlation (CPC) in the study of disease
John Hunter (Scotland) 1728-1793Introduced pathology museum in the study of disease.
R.T.H. Laennec (France) 1781-1826Described several lung diseases such as various tuberculous lesions of lungs, bronchiectasis. Described cirrhosis of liver (later called Laennecs cirrhosis).Invented stethoscope.
John Hunter (Scotland) 1728-1793
R.T.H. Laennec (France) 1781-1826
Era of technology development and cellular pathology (AD 1800 to 1950s) Rudolf Virchow (Germany) 1821-1905
Father of cellular pathologyIntroduced histopathology as a diagnostic branch by his cellular theory
George N. Papanicolaou (USA) 1883-1962Father of exfoliative cytology Developed Pap smear for detection of cervical cancer in 1930s
Rudolf Virchow (Germany) 1821-1905
George N. Papanicolaou (USA) 1883-1962
Modern pathology (1950s to dawn of 21st century) Watson and Crick 1953
Described the structure of DNA Nowell and Hagerford 1960
Philadelphia chromosome in CML i.e. t(9;22) Gall and Pardue 1969
In Situ Hybridization Kary Mullis 1983
Introduced polymerase chain reaction (PCR)
Prof. Liang Boqiang 1899-1968
Prof. Qin Guangyu 1902-1969
Subdivision of Pathology General Pathology --- dealing with general
principles of disease
Systemic Pathology --- includes study of
diseases pertaining to the specific organs
and body systems
Subdivision of Pathology Histo-Pathology Experimental Pathology Molecular Pathology Chemical Pathology Geographic Pathology Immunology Haematology Medical Genetics
Methods for the study of Pathology
Autopsy
Biopsy
Cytology
What is Autoposy?
Autopsy means "see for yourself". It is a
special surgical operation, performed by
specially-trained physicians, on a dead
body. Its purpose is to learn the truth about
the person's health during life, and how the
person really died.
What is Bioposy?
A biopsy is the removal of a sample of tissue from the body for examination. The tissue
will be examined under a microscope to
assist in diagnosis. Therefore, only very small
samples are needed.
What is Cytology?
Cytology can also refer to
cytopathology, which analyzes cell
structure to diagnose disease .
(Xiao Ping) 4F
87330743
Chapter 2Cellular Adaptations and Cell Injury
Cellular Adaptations and Cell Injury
Cellular Responses to Stress and Noxious Stimuli
Cellular adaptations
Causes of cell injury
Mechanisms of cell injury
Morphology of cell injury
Human body is quite complex and is made of 70,000 billion cells.
In health, these cells remain in accord with each other.
However, most forms of diseases begin with cell injury and consequent loss of cellular function .
Injury is defined as an alteration in cell structure or function resulting from some stress that exceeds the ability of the cell to compensate through normal physiologic adaptive mechanisms.
Cells typically respond to potentially injurious stress in one of two ways:
Adaptation - Cells can alter their structure and/or biochemical processes in order to achieve a new "steady state" and maintain near-normal physiologic functions (homeostasis).
Injury - If stressed cells cannot adequately adapt, critical cell functions may be impaired, and the cell is said to be injured.
Reversible and irreversible injury
If injured cells recover their normal functions when the stress is removed, the injury is said to be reversible.
If the injury is severe enough, however, a Point of no return is reached and the cell suffers irreversible injury and dies.
Cellular Responses to Stress and Noxious Stimuli
Adaptation,
Reversible injury,
Irreversible injury (Cell death)
may be considered as different stages of a
progressive impairment of the cells normal
function and structure.
Cellular adaptations Atrophy
Hypertrophy
Hyperplasia
Metaplasia
Atrophy
Reduction of the number and size of parenchymal cells of an organ or its parts which was once normal is called atrophy.
It may occur from physiologic or pathologic causes.
Physiologic Atrophy
Atrophy of thymus after puberty
Atrophy of gonads after menopause
Atrophy of brain with aging
Pathologic Atrophy Malnutrition atrophy Denervation atrophy Disuse atrophy Pressure atrophy Endocrine atrophy Ischaemic atrophy
Atrophy of one kidney, gross
Atrophy, muscle fibers, microscopic
Hypertrophy
Hypertrophy is an increase in the size of parenchymal cells resulting in enlargement of the organ or tissue, without any change in the number of cells.
It may be physiologic or pathologic.
Physiologic Hypertrophy
Pathologic Hypertrophy
Hypertrophy of cardiac muscle
Hypertrophy of smooth muscle
Hypertrophy of skeletal muscle
Compensatory hypertrophy
. Hypertrophy, heart, gross
Hyperplasia Hyperplasia is an increase in the number
of parenchymal cells resulting in enlargement of the organ or tissue.
Hyperplasia occurs due to increased recruitment of cells from C0 (resting)
phase of the cell cycle to undergo mitosis,when stimulated.
Hyperplasia, prostate, gross
Metaplasia
Metaplasia is defined as a reversible change of one type of epithelial or mesenchymal adult cells to another type of adult epithelial or mesenchymal cells, usually in response to abnormal stimuli, and often reverts back to normal on removal of stimulus.
Metaplasia Epithelial metaplasia
1. Squamous metaplasia
2. Columnar metaplasia
Mesenchymal metaplasia
1. Osseous metaplasia
2. Cartilaginous metaplasia
Metaplasia, squamous, larynx, microscopic
Metaplasia, gastric columnar mucosa in esophagus, microscopic
Causes of cell injury
Hypoxia and ischaemia Physical agents Chemical agents and drugs Infection agents Immunologic reactions Genetic derangements Nutritional imbalances
Hypoxia and ischaemiaHypoxia is the most common causes of cell injury. The causes of hypoxia are as under:
The most common mechanism of hypoxic cell injury is by reduced supply of blood to cell i.e. ischaemia.
Oxygen deprivation of tissues may result from other causes as well e.g. in anaemia, CO poisoning, cardiorespiratory insufficiency, and increased demand of tissues.
Physical agentsPhysical agents in causation of disease are:
Mechanical trauma (e.g. road accidents); Thermal trauma (e.g. by heat and cold); Electricity; Radiation (e.g. ultraviolet and ionising); Rapid changes in atmospheric pressure.
Chemicals and DrugesImportant example include:
Chemical poisons such as cyanide, arsenic, mercury; Strong acids and alkalis; Environmental pollutants; Insecticides and pesticides; Oxygen at high concentration; Hypertonic glucose and salt; Social agents such as alcohol and narcotic drugs; Therapeutic administration of drugs.
Infection agentsInjuries by microbes include infections caused by :
Bacteria; Rickettsiae; Viruses; Fungi; Protozoa; Metazoa; Other parasites.
Immunologic reactionsImmunity is a double-edged sword
--- it protects the host against various injurious agents but it may also turn lethal and cause cell injury e.g.
Hypersensitivity reactions;
Anaphylactic reactions;
Autoimmune reactions.
Genetic derangementsGenetic defects as causes of cell injury are of major interest to scientists and physicians today.
The genetic injury may result in a defect caused by a chromosomal abnormality (e.g. the congenital malformations associated with Down syndrome).
Variations in the genetic makeup can also influence the susceptibility of cells to injury by chemicals and other environmental insults.
Nutritional imbalancesA deficiency or an excess of nutrients may result in nutritional imbalances.
Nutritional deficiency diseases may be due to overall deficiency of nutrients (e.g. starvation), of protein calorie (e.g. marasmus, kwashiorkor), of minerals (e.g. anaemia), or of trace elements.
Nutritional excess is a problem of affluent societies resulting in obesity, atherosclerosis, heart disease and hypertension.
Mechanisms of cell injury
Depletion of ATP
Membrane damage
Influx of intracellular calcium and loss
of calcium homeostasis
Accumulation of oxygen-derived free
radicals (oxidative stress)
Cellular and biochemical sites of damage in cell injury
Morphology of cell injury
Degeneration/Intracellular
Accumulations
Cell death
Degeneration and Intracellular Accumulations
In conventional description of morphologic
change, the term degeneration has been used to
denote morphology of reversible cell injury.
Currently, more acceptable terms of reversible
cell injury are applied to non-lethal cell injury.
One of the manifestations of metabolic
derangements in cells is the intracellular
accumulation of abnormal amounts of
various substances.
The stockpiled substances fall into three categories:
1. A normal cellular constituent accumulated in excess, such as water, lipids, proteins, and carbohydrates;
2. An abnormal substance, either exogenous, such as a mineral or products of infectious agents, or endogenous, such as a product of abnormal synthesis or metabolism;
3. A pigment.
Degeneration and Intracellular Accumulations
Cellular swelling Fatty change Hyaline change Amyloidosis Pigments Pathologic calcification
Cellular Swelling Cellular swelling is the first manifestation of
almost all forms of injury to cells. Other synonyms of cellular swelling used in the
past are: cloudy swelling (for gross appearance of the
affected organ) hydropic change (accumulation of water within
the cell) vacuolar degeneration (due to cytoplasmic
vacuolation)
Cellular Swelling
Grossly, the affected organ such as
kidney, liver or heart muscle is enlarged
due to swelling. The cut surface bulges
outwards and is slightly opaque.
Cellular Swelling Microscopically, it is characterised by
the following features:
1. The cells are swollen and the microvasculature compressed.
2. Small clear vacuoles are seen in the cells and hence the term vacuolar degeneration.
Fatty change (Steatosis)
The terms fatty change and steatosis describe abnormal accumulations of triglycerides within parenchymal cells.
Fatty change is often seen in the liver because it is the major organ involved in fat metabolism,
but it also occurs in heart, muscle, and kidney.
Fatty metamorphosis of liver, gross
. Fatty metamorphosis of liver, microscopic
Fatty change, liver, microscopic
Hyaline Change The word Hyaline means glassy (hyalos =
glass). Hyaline is a descriptive histologic term for
glassy, homogeneous, eosinophilic appearance of material in H.E stained sections and does not refer to any specific substance.
Hyaline change is associated with heterogeneous pathologic conditions and may be intracellular or extracellular.
Intracellular Hyaline Intracellular hyaline is mainly seen in
epithelial cells. For example:1. Hyaline droplets in the proximal tubular epithelial cells in cases of excessive reabsorption of plasma. 2. Mallorys hyaline represents aggregates of intermediate filaments in the hepatocytes in alcoholic liver cell injury.
Intracellular Hyaline
3. Nuclear or cytoplasmic hyaline inclusions seen in some viral infections.4. Russels bodies representing excessive immunoglobulins in the RER of the plasma cells.
Hyaline droplets in the renal tubular epithelium
Mallory's hyaline, liver, microscopic
Extracellular Hyaline Extracellular hyaline is seen in connective tissues.
A few examples of extracellular hyaline change are:1. Hyaline degeneration in leiomyomas of the uterus. 2. Hyalinised old scar of fibrocollagenous tissues. 3. Hyaline arteriosclerosis is renal vessels in hypertension and diabetes mellitus.4. Hyalinised glomeruli in chronic glomerulonephritis.
Uterus, leiomyoma, microscopic
Renal hyaline arteriolosclerosis with diabetes mellitus, microscopic