Arsi University

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Health Science College

Introduction to pathology

Dr. Birhanu
(Doctor of Medicine & Lecturer )
Email: [email protected]
 Pathology
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 Is a study(logos) of suffering(pathos).

 Is the scientific study of diseases.

 Is the bridging discipline between basic sciences and

clinical practice.

 It examines the structural and functional changes at

cell, tissue and organ levels underlying a disease.
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 Uses molecular, microbiologic, immunologic and

morphologic techniques to explain the reasons why signs
and symptoms manifested by patients develop.

 Pathology is the foundation of medical science and practice.

 Without pathology, the practice of medicine would be

reduced to myths and folklore.
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 Is traditionally divided into GENERAL PATHOLOGY and

SYSTEMIC(SPECIFIC) PATHOLOGY.

 General pathology: studies the basic response of cells

and tissues to abnormal stimuli that underlie any disease
process.

 Systemic(specific) pathology: studies the specific

responses of specialized organs and tissues to well-defined
stimuli.
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 There are four aspects of any disease that are core to the
field of pathology:
 Etiology

 Pathogenesis

 Morphologic changes

 Functional derangements and clinical manifestation.

 Core…
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 Etiology :
o Refers to the cause of a disease which can be
intrinsic(genetic) or extrinsic(acquired, e.g. Infectious,
nutritional, chemical or physical).
o Can be Primary(idiopathic). Disease Disease

Disease
Disease
Disease

•One etiologic
agent -
several
One etiologic agent- • Several etiologic diseases, as
one disease, as Malaria agents - one smoking.
disease, as
 Core…
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 Pathogenesis:
 Refers to the sequence of events that occur in cells and tissues
in response to the etiologic agent, from the initial stimulus to
the ultimate expression of the disease.

 The mechanism of disease development

 The pathogenic mechanism could take place in the latent or

the incubation period.

 It will lead to morphological changes.

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 Examples of pathogeneses of disease include:

 Inflammation: a response to many micro-organisms and
other harmful agents causing tissue injury

 Degeneration: a deterioration of cells or tissues in response

to, or failure of adaptation to, a variety of agents

 Carcinogenesis: the mechanism by which cancer-causing

agents result in the development of tumors
 Core…
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 Morphologic changes:
o Are the structural alterations that are either characteristic or
diagnostic of a disease.
o They include:
 Gross changes: include all the changes that can be detected
by the naked eye as changes in size, shape, surface (3 S),
color, consistency and cut section of the organ (3C).
 Microscopic changes: They include cellular and extracellular
changes that characterize the disease.
o May be disease specific, i.e. pathognomonic.
o Lead to Functional derangement and clinical manifestation
 Pathognomonic abnormalities
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 Are restricted to a single disease, or disease category, and

without them the diagnosis is impossible or uncertain.
 Are extremely useful clinically, because they are absolutely
diagnostic.
 Their presence leaves no doubt about the diagnosis.
 For example,
 Reed-Sternberg cells in Hodgkin's lymphoma;
 The presence of Mycobacterium tuberculosis is
pathognomonic of tuberculosis.
 Warthin-Finkeldey giant cells in measles.
 Koplik spots in measles
 Core…
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 Functional derangement and clinical

manifestation:
 Refers to alteration of the normal function.
 Is responsible for clinical features(signs and symptoms), fate or

course, and complications of the disease.

 Examples of functional abnormalities causing ill health include:

 Excessive secretion of nasal mucus in the common cold, hormones

having remote effects
 Insulin lack in diabetes mellitus
 Impaired nerve conduction
 Impaired contractility of a muscular structure.
 Disease & its Course
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 Disease is defined as an abnormal variation in structure or

function of any part of the body

 Latent interval & incubation period of a disease:

 The time lapse between introduction of a noxious agent and
manifestation of the disease.

 In the context of carcinogenesis, this time period is referred

to as the latent interval; it is often two or three decades.
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 In case of infectious causes, this period is called incubation

period & it is often measured in days or weeks.
 IP of----measles (8-10 days), mumps(12-25 days),
tetanus(1day-several months)…..
 Few etiological agents cause signs and symptoms
immediately after exposure.
 Convalescence period
 The time after disease manifestation until the patient regains
full health.
 Some diseases may be communicable from “carriers” in this
period.
 Common terms in the nomenclature of disease

 Primary and secondary

 They may be used to describe the causation of a
disease.

 Primary in this context means that the disease is

without evident antecedent cause.

 Other words which have the same meaning in this context

are essential, idiopathic and cryptogenic
 Common…
 Thus, primary hypertension is defined as abnormally high
blood pressure without apparent cause.
 Secondary means that the disease represents a
complication or manifestation of some underlying lesion.
 Thus, secondary hypertension is defined as abnormally high
blood pressure as a consequence of some other lesion (e.g.
renal artery stenosis).
 Acute and chronic
 Terms used to describe the dynamics of a disease.
 Acute conditions have a rapid onset, often but not always
followed by a rapid resolution.
 Common…
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 Chronic conditions may follow an acute initial episode, but

often are of insidious onset, and have a prolonged course
lasting months or years.

 Subacute, a term not often used now, is intermediate

between acute and chronic.

 Benign and malignant

 Benign and malignant are emotive terms used to classify
certain diseases according to their likely outcome.
 General classification of disease
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 The most widely used general classification of disease is that

based on pathogenesis or disease mechanisms.
 Congenital
 genetic
 non-genetic
 Acquired
 Inflammatory
 Hemodynamic
 Growth disorders
 Injury and disordered repair
 Disordered immunity
 Metabolic and degenerative disorders
 Causes of disease
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 Environmental
 Genetic or

 Both

Environmental factors
1. Physical agents
2. Chemicals
3. Nutritional deficiencies & excesses
4. Infections & infestations
5. Immunological factors
6. Psychogenic factors
Genetic
 These are hereditary factors that are inherited genetically from parents.
 Iatrogenic diseases
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 The broad meaning of iatrogenic disease is any ill health

induced by a medical practitioner's words or actions.
 Currently, iatrogenic diseases are restricted to those
attributable to practitioners' actions.
 All medical intervention is associated with some risk to the
patient.
 The probability that harm might result must be
outweighed by the probability that the patient will
benefit. If harm results, litigation may follow.
 Iatrogenic disease includes harm resulting from
investigations and treatment, from drugs and surgery.
 Subdivisions of clinical pathology
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 Pathology is a vast subject with many ramifications.

 Major subdivisions include:
 Histopathology: the investigation and diagnosis of disease
from the examination of tissues
 Cytopathology: the investigation and diagnosis of disease
from the examination of isolated cells
 Hematology: the study of disorders of the cellular and
coagulable components of blood
 Microbiology: the study of infectious diseases and the
organisms responsible for them
 Subdivisions…
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 Immunology: the study of the specific defense mechanisms

of the body
 Chemical pathology: the study and diagnosis of disease
from the chemical changes in tissues and fluids
 Genetics: the study of abnormal chromosomes and genes
 Toxicology: the study of the effects of known or suspected
poisons
 Forensic pathology: the application of pathology to legal
purposes (e.g. investigation of death in suspicious
circumstances).
 TECHNIQUES OF PATHOLOGY Examination
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(1) Gross Examination Of Tissues (Naked Eye

Examination).

(2) Microscopic Examination Of Tissues.

(3) Molecular Pathology Techniques.

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(1) Gross pathology-

 Approach which was especially used before microscopy was

applied to medical problems.

 It is still an important investigative method.

 The gross pathology of many diseases is so characteristic that a

fairly confident diagnosis can often be given before further
investigation by, for example, light microscopy.

 Useful gross features are 3S (size, shape, surface) and 3C

(consistency, color, cut section).
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(2) Microscopic Examination Of Tissues

A. Light microscopy
 Uses to examine cells(cytology) from cysts, body cavities,

sucked from solid lesions or scraped from body surfaces.

o Is used in cancer diagnosis and screening.

 If solid tissues are to be examined by light microscopy, the

sample must first be thinly sectioned to permit the

transmission of light and to minimize the superimposition of
tissue components.
 These sections are cut from tissue hardened by permeation

with and embedding in wax or, less often, transparent plastic.

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 The sections are stained to help distinguish between

different components of the tissue (e.g. nuclei, cytoplasm,
collagen).
 The Routinely used stains are Hematoxylin and Eosin
(H&E).
 Stain paraffin-embedded sections, frozen sections and
cytological smear.
 It is diagnostic in most of cases.
 Hematoxylin is a basic dye, stains the nucleus blue
because it has an affinity for nucleic acids.
 Eosin is an acidic dye, stains the cytoplasm pink to red.
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B. Electron microscope:
 Provide higher magnifications (1000 to 50, 000) than light
microscope by using a beam of focused electrons instead of light.

 Cellular organelles can be visualized.

 It is expensive and need longer time for tissue preparation, so it

is used mainly for research work.

 Used mainly for diagnosis of renal diseases and genetic

disorders.
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C. Immunofluorescence microscope:
 Immunofluorescence technique involves the detection of

immunologic deposits by using specific antibodies linked

to fluorescent dyes.
 The end product is fluorescent material that fade with

time.
 This Immunofluorescence technique requires a

fluorescence microscope.
 Immunofluorescence techniques are used mainly for

diagnosis of glomerular diseases and autoimmune

diseases.
 … Immunofluorescence microscope
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 Types of specimens for pathologic
examination
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1. Biopsy:
Is the removal of a selected portion of the diseased living tissue


or organ for pathological examinations to diagnose the disease.

Once the tissue is removed from the patient, it has to be



immediately fixed by putting it into adequate amount of 10%

formalin before sending it to the pathologist.

Tissue should be examined grossly (macroscopically) &



microscopically.

It is usually the gold standard for pathologic diagnosis.


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Types of biopsies:
 Punch biopsy: Removal of a small part of the diseased organs as
endoscopic biopsy and cystoscopic biopsy.

 Incision biopsy: Removal of a selected portion of the diseased

organs.

 Excision biopsy: Removal of the entire lesion and usually part of the
surrounding tissue.

 True- cut needle biopsy: A core of tissue is obtained by a large bore

needle introduced in the suspected area as in breast, liver and kidney.
 Types of specimen…
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2. Autopsy:
 Necropsy and postmortem examination are synonymous

 Is an examination of the dead body to identify the cause of

death.

 Tissue specimen is removed from dead bodies.

 This can be done for:

-- forensic (legal) or
-- clinical (medical) purposes
 Autopsy…
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 Medicolegal autopsies are performed to determine the

cause of death under the instruction of a legal authority.

 Non - medicolegal (clinical) autopsies are usually

performed on patients who die in hospital.

 Autopsy means to 'see for oneself'.

 In other words, rather than relying on clinical signs and symptoms
and the results of diagnostic investigations during life, here is an
opportunity for direct inspection and analysis of the organs.
 Autopsy…
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 Autopsies are useful for:

 Determining the cause of death
 Audit of the accuracy of clinical diagnosis
 Education of undergraduates and postgraduates
 Research into the causes and mechanisms of disease
 Gathering accurate statistics about disease incidence.
 For the medical undergraduate and postgraduate, autopsy is
an important medium for learning pathology.
 It is an unrivalled opportunity to correlate clinical signs with
their underlying pathological explanation.
 Types of specimen…
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3. Cytology:
 Examination of cells.
 The diseased cells are obtained by:

 Fine needle aspiration (FNA): A small bore needle is used

for aspiration of fluids (from ascites, pleural and pericardial

effusion) and cells from tumor masses that occur in
palpable sites as the breast, thyroid gland and lymph nodes.
 Exfoliative cytology: It is used in diagnosis of malignant

cells that are shed in urine, sputum and vaginal smears.

 Abrasive cytology: Cells are dislodged from skin or

mucous membrane by various tools.

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 Cytopathology is used in:

 Screening for early detection of cancer
 Diagnosis of symptomatic cancer
 Diagnosis of inflammatory condition, infections
 Surveillance of patients on cancer treatment.

 Advantage:
 It is cheap
 It takes less time
 It needs no anesthesia
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