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7/27/2019 Towards Understanding the Basic Medical Sciences Foundation of Clinical Medicine
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
Towards Understanding theBasic Medical Sciences
Foundation of Clinical Medicine
Prepared and presented by:
Marc Imhotep Cray, M.D.
Basic Pathology
Medical Diagnosis
CORRELATION
TO
7/27/2019 Towards Understanding the Basic Medical Sciences Foundation of Clinical Medicine
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
The integration of basic and clinical sciences
in undergraduate medical science
2
IVMS teaching philosophy is based on the integration of basic and
clinical sciences
This means that the learning of basic science is placed in the context
of clinical medicine
Such an approach is seen to be more meaningful and relevant to
medical student learning in the BMS years
Curriculum integration usually involves both horizontal and vertical
integration and is the pattern that is becoming widespreadthroughout the world”
7/27/2019 Towards Understanding the Basic Medical Sciences Foundation of Clinical Medicine
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
“What is
Horizontal and Vertical Integration”
3
Horizontal: bring together the disciplines, topics,
subjects of basic medial science or clinical medicine
Vertical: bringing together basic medial science and
clinical medicine
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
PATHOLOGY• PATH
– pertaining to a morbid process (disease)
• (from “ pathos” = travail or sorrow (Greek)
• OLOGY
– the scientific study of …
4
“Let’s exemplify vertical integration by briefly
looking at how one relates
Basic Pathology to Medical Diagnosis
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
DISEASE
ETIOLOGY
PATHOGENESIS
PATHO-MORPHOLOGY
COURSEPROGNOSIS
COMPLICATIONS
5
PATHOLOGY: SCIENTIFIC STUDY OF…
3
4
5
6
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
MENINGITIS
N. meningitidis
SEPTICAEMIAACUTE
INFLAMMATIONMENINGES
SPREAD VIA CSFDEATH
(IF UNTREATED) VENTRICULITISENDARTERITISHYDROCEPHALUS
E
P
PM
P
NHC
6
Ex: SCIENTIFIC STUDY OF
DISEASE
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
PATHOLOGY OBJECTIVES
1 To introduce a NEW VOCABULARY of terms,
definitions, and disease processes.
2 To introduce the BASIC RESPONSES of thehuman organism to injury.
• Correlation with clinical picture.
7
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
SIGNS and SYMPTOMS
STRUCTURAL & FUNCTIONAL ALTERATIONS
PATHOLOGY OBJECTIVE (2)
8
CORRELATION
induced by disease
form
the basis by which attending
are produced
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
& clinician
& pathologist
PHYSIOLOGY & FUNCTION
ORGAN STRUCTURE
SIGNS AND SYMPTOMS
PATHOMORPHOLOGY
DETECTED BY CLINICIAN
DETECTED BY PATHOLOGIST
ALTERS
9
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
LEVELS OF STUDY OF PATHOLOGY
• MOLECULAR
• CHEMICAL
• ULTRASTUCTURAL• CELLULAR
• TISSUE
• ORGAN
10
PATHOMORPHOLOGY
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
PATHOMORPHOLOGY
• PATHO.. - the disease
• MORPH .. - the shape (structure)
• OLOGY .. - the study of
i.e. how a disease process alters the “shape”
(structure) of cells, tissues and organs …… or
……
the “DAMAGE” caused by the disease process
11
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
“ORGANOMEGALY”
12
AS A PRECEPT THERE IS BUT ONE
CAUSE OF ORGANOMEGALY
AN ALTERATION OF MORPHOLOGY
“CHANGE IN SHAPE & / 0R SIZE”
SOMETHING MUST BE ADDED TO THE ORGAN
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
WHAT MAY BE ADDED?
• NORMAL CELLS
• FLUID
• BLOOD• INFLAMMATORY
• NEOPLASTIC CELLS
• GAS
13
HYPERPLASIA or HYPERTROPHY
EDEMA
CONGESTION
TUMOR
EMPHYSEMA
EXUDATE
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
HISTOPATHOLOGY /
PATHOMORPHOLOGY OVERVIEW
Companion learning tools to the following general pathology section:
IVMS General Pathology Lecture Notes.pdf
Images
IVMS-Gross Pathology, Histopathology, Microbiology and Radiography High Yield Image Plates
WebPath
http://www-medlib.med.utah.edu/WebPath/webpath.html
14
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
Cellular Degeneration and
Infiltration They are related to changes which may be reversible
The agents which cause cellular degeneration and/or
infiltration , when occurring over longer periods of time, will ultimately lead to the death of the cell with
morphologic changes
15
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Marc Imhotep Cray, M.D.
Cell Injury Thus Reflects Two
Levels Of Severity
1. One compatible with recovery
2. The second irreversible
16
Morphologic changes in reversible and irreversible cell injury (necrosis).(A) Normal kidney tubules with viable epithelial cells.(B) Early (reversible) ischemic injury showing surface blebs, increased eosinophilia of cytoplasm, and swelling of occasional cells.(C) Necrotic (irreversible) injury of epithelial cells,with loss of nuclei and fragmentation of cells and leakage of contents.Robbins Basic Pathology 10e
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
COMPATIBLE WITH RECOVERY
CLASSIFICATION
Cell degeneration and infiltration can bedivided into several morphologic patternsdepending on metabolite(s) that accumulate
in cell
17
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
Cloudy Swelling
This is characterized morphologically by a slightswelling of the cell with granularity and cloudinessof the cytoplasm
This is seen most often in renal tubular cells,hepatic cells and cardiac muscle
Organs with this affect are slightly larger , firm
and pale
18
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Marc Imhotep Cray, M.D.
Cloudy Swelling (2)
This can be caused by many factorsInfections
Febrile illness
Excessive cold or heat Anoxia
Malnutrition
Physical injury
Vascular disturbances
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
Hydropic or Vacuolar
Degeneration
This is a more pronounced form of intracellular
edema (cloudy swelling ), and although reversible ,
it reflects a more serious injury to cell
It is caused by same affects that produce cloudy
swelling
20
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
Hydropic or Vacuolar
Degeneration (2)
This degeneration is of particular prominence inkidneys , often resulting from hypokalemia
And, in liver cells which are exposed to poisonsor toxins (such as carbon tetrachloride andchloroform)
21
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
Hydropic/Vacuolar Degeneration(3)
On microscopic examination this appears assmall, clear vacoules dispersed throughout
cytoplasm
In severe casesvacoules coalesce and form largeclear spaces which may displace the nucleus
Progression is toward frank necrosisVacuole: A space or vesicle within cytoplasm of
a cell, enclosed by a membrane and typically
containing fluid
A small cavity or space in tissue, especially in
nervous tissue as the result of disease
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Marc Imhotep Cray, M.D.
Fatty Deposition(Fatty Metamorphosis)
This change is due to abnormal accumulationof fat within parenchymal cells
23
Reversible Cell Injury: Intracellular Accumulations. Fatty liver showing large intracellular vacuoles of lipid. Copstead LC, Banksia JL. Pathophysiology, 5th Ed. St. Louis, Missouri: Saunders-Elsevier, 2013.
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
Fatty Deposition(Fatty Metamorphosis) (2)
Presence of fat represents an absolute increase inintracellular fat and represents severe cell injury
Size of fat vacuole is not dependent on
pathologic mechanism
There are multiple causes which lead to thisdegeneration
Fatty change is often preceded by cloudy swelling
24
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
Glycogen Degeneration (Infiltration)
Glycogen is normally abundant in liver andmuscle cells
In some conditions abnormal accumulations
occur producing visible glycogen vacouleswithin cytoplasm or nuclei
Glycogen infiltration is found in Diabetes mellitus
Glycogen storage diseases
25
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
Hyaline Degeneration
In this form of cellular degeneration , there is aregressive change in cells in that cytoplasm
now has a glassy eosinophil ic appearance
This degeneration implies that injury to cell
cytoplasm has caused denaturation and
coagulation of cytoplasm
26
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“Integration of Basic Sciences and Clinical Medicine”Marc Imhotep Cray, M.D.
Mucoid Degeneration
This description refers to extracellular accumulation of mucopolysaccharide andground substance within connective tissue
This change is seen in collagen diseases
There is no intra-cellular defect
27
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Marc Imhotep Cray, M.D.
Cell Death and Necrosis
• Necrosis refers to morphologicchanges that follow cell death and – permit visible recognition that cell has died
28
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Marc Imhotep Cray, M.D.
IRREVERSIBLE
NECROSIS
Most of changes that indicate cellular death aremore prominent in nucleus than in cytoplasm
29
Nuclear changes related to necrosis:
Margination of chromatin-chromatin condensing aroundperiphery of nucleus
Chromatin clumping is reversible, but dissolution of entire
nucleus is not, and when nucleus is lost, cell will die
Pyknosis –small and dense nuclei
Karyolysis –complete lysis of the nuclei
Karyorrhexis –fragmented nuclei (generally seen in apoptosis)
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Marc Imhotep Cray, M.D.
Coagulation Necrosis
This type of necrosis is characterised by cell
becoming an acidophil ic mass, usually withloss of nucleus, but>>>with remnants of enough basic shape to permit
recognition of cell boundaries
30
Coagulative necrosis. (A) A wedge-shaped kidney infarct (yellow) with preservation of outlines. (B) Microscopic view of edgeof the infarct, with normal kidney (N) and necrotic cells in the infarct (I). Robbins Basic Pathology 10e
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Marc Imhotep Cray, M.D.
Liquefaction Necrosis
In this case there is a rapid and total enzymaticdissolution of cells
There is complete destruction of cell membrane
This type of necrosis is seen often in brain
31
Liquefactive necrosis. An infarct in the brain shows dissolution of tissue.Robbins Basic Pathology 10e
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Marc Imhotep Cray, M.D.
Enzymatic (Fat) Necrosis
This presents with acute destruction of pancreas
Results from release of pancreatic enzymes outside of their normal confines= Action upon fat by digestive enzymes
32
Cellular injury to pancreatic acini leads to release of powerful enzymes which damage fat byproduction of soaps, and these appear grossly as soft, chalky white areas .https://library.med.utah.edu/WebPath/CINJHTML/CINJ026.html
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Marc Imhotep Cray, M.D.
Caseous Necrosis
This seen with tuberculosis infections
The cells are changed to a ranular, eosinophilic
mass of amorphous fat and protein
grossly looking like soft friable cheese
33
Caseous necrosis. Tuberculosis of the lung, with a large area of caseous necrosiscontaining yellow-white (cheesy) debris. Robbins Basic Pathology 10e
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Marc Imhotep Cray, M.D.
Gangrenous NecrosisThis is related to ischemia and a superimposed
bacterial infection initial event may have been a bacterial infection which
compromised vascularity allowing saprophytic organisms tothrivethereby further increasing ischemic change
34
Dry gangrene affecting the toes as a result of peripheral artery disease.
https://en.wikipedia.org/wiki/Gangrene
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Marc Imhotep Cray, M.D.
Fibrinoid Necrosis
Seen principally w diseases of hypersensitivity
origin
There is appearance of f ibrin deposits inconnective tissue and in walls of blood vessels
35
Fibrinoid necrosis in an artery in a patient with polyarteritis nodosa. The wallof the artery shows a circumferential bright pink area of necrosis with protein
deposition and inflammation. Robbins Basic Pathology 10e
C f C ll I j
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“Integration of Basic Sciences and Clinical Medicine”
Marc Imhotep Cray, M.D.
Causes of Cell Injury
and Death
1) Anoxia
2) Physical Agents
3) Chemical Agents
4) Biologic Agents5) Immune mechanisms derangements
6) Genetic Defects
36
DIFFERENTIAL DIAGNOSIS
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Marc Imhotep Cray, M.D.
DIFFERENTIAL DIAGNOSIS
37
INFLAMMATORY
V ASCULAR
NEOPLASTIC
DRUGS
INFECTION
CONGENITAL
AUTOIMMUNE
TRAUMATIC
ENDOCRINE / METABOLIC“VINDICATE”
IS THE PROCESS..
- SUDDEN ONSET
- CARDINAL SIGNS/SYMPTOMS
- MASS
- HISTORY
- CARDINAL SIGNS/SYMPTOMS
- FROM BIRTH
- SYSTEMIC
- HISTORY
- Sn/Sx
Learn more:The Medical Database and Differential Diagnosis. pdf notes
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“Integration of Basic Sciences and Clinical Medicine”
M I h t C M D 38
IVMS General Pathology Lecture Notes.pdf
Images
IVMS-Gross Pathology, Histopathology, Microbiology and
Radiography High Yield Image Plates
WebPathhttp://www-medlib.med.utah.edu/WebPath/webpath.html
Further Study:
---THE END---
Cell Injury and Cell Death.ppt
General & Systemic Pathology Concepts_ A Global Overview.ppt