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1. Introduction To Pathology

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29 views

1. Introduction To Pathology

Uploaded by

dillasemera2014
Copyright
© © All Rights Reserved
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Introduction To Pathology

What Is Pathology

• Pathology literally is the study (logos) of suffering (pathos)


• Pathology is the scientific study of disease
• It involves the investigation of the causes of disease
and the associated changes at the levels of cells,
tissues, and organs, which in turn give rise to the
presenting signs and symptoms of the patient
• Pathologist is a physician who practices, evaluates, or
supervises diagnostic tests, using materials removed from
living or dead patients to determine the causes or nature of
disease changes

2
Four
Aspect
 Etiology
 Pathogenesis
 Morphologic change
 Functional derangements and clinical
features
Etiology
•Cause of the disease
•Primary (idiopathic)
•Secondary
• Genetic
• Acquired
• Infectious
• Non infectious
• Pathogenesis
Mechanism the etiology will operate to produce the
pathological and clinical manifestation
Morphologic
changes
• Structural alteration in cell/tissue that occur following the
pathogenesis
• Gross/microscopic
• Specific /non specific
Functional • morphologic changes in the organ
derangements influence the normal function of the
and clinical organ.
significance
• Diagnostic techniques
– Histopathological techniques
– Cytopathologic techniques
Diagnosti
c
techniqu
es techniques
1.Histopathological
 studies tissues under the microscope
 is usually the gold standard for pathologic
diagnosis.
Tissues for histopathological examination are
obtained by biopsy
2.Cytopathologic techniques
•Cytopathology is the study of cells from
various body sites to determine the cause or
nature of disease.
The main applications of cytology include
– Screening for the early detection of asymptomatic
cancer (for example pap smear cervical cancer )
– Diagnosis of cysts, inflammatory conditions and
infections of various organs
•It is cheap, takes less time and needs no anesthesia
to take specimens so more commonly used in our
country
Cytopathologic methods
1.Fine-needle aspiration cytology (FNAC)
•Aspirating the diseased organ using a very thin
needle under negative pressure.
• Superficial organs (e.g. thyroid, breast, lymph nodes,
skin and soft tissues) .
•Deep organs - the lung, mediastinum, liver, pancreas,
kidney, adrenal gland, and retroperitoneum are aspirated
with guidance by fluoroscopy, ultrasound or CT scan.
•FNAC is cheap, fast, & accurate in diagnosing many
diseases.
2. Exfoliative cytology
•the examination of cells that are shed spontaneously into
body fluids or secretions.
•Examples include sputum, cerebrospinal fluid, urine, effusions
in body cavities ( pleura, pericardium, peritoneum), nipple
discharge and vaginal discharge
3. Abrasive cytology
•The examination of cells that are dislodged by various
tools from body surfaces ( skin, mucous membranes, and
serous membranes). E.g. preparation of cervical smears
with a spatula or a small brush to detect cancer of the
uterine cervix at early stages
Other Diagnostic
•
techniques
Hematological examination: abnormalities of the
cells of the blood and their precursors in the bone
marrow are investigated
• Microbiological examination :to identify micro-
organisms responsible for many diseases
• Biochemical examination : biochemical analysis of
specimens

• Immunohistochemistry: using antibody-antigen


reactions
• Clinical genetics (cytogenetics): inherited
chromosomal abnormalities in the germ cells or
acquired chromosomal abnormalities are studied
Pathologist

Diagnostic
Autopsy
post-
Biopsy Cytology mortem
examination
8000
mammography

amputation
Pathologist

Diagnostic
Autopsy

Case - 1 year 6 months

cough, barking type stridor « croup »

 died after some hours

Why ?
Pathologist

Diagnostic Teaching
Autopsy

cough of 3 days (barking type)

acute-on-chronic laryngitis with sub-glottic


obstruction

bacterial laryngitis/tracheitis (pseudo-


membranous)
• Once the tissue is removed from the patient .the sample
must undergo this four process to be examined

 Fixation
 Processing: embedding
 Cutting
 Staining
Sample must be fixed by putting it
into adequate amount of 10%
Fixation Formaldehyde (10% formalin)
immediately  inactivate
degradative enzymes 
preserve cell and tissue
structure
The purpose of fixation
to prevent autolysis and bacterial decomposition and
putrefaction
 to coagulate the tissue to prevent loss of easily
diffusible substances
to fortify the tissue against the deleterious effects of the
various stages in the preparation of sections and tissue
processing.
 to leave the tissues in a condition which facilitates
differential staining with dyes and other reagents.
Embedding
&
• Sectioning
To permit thin sectioning fixed tissues are
infiltrated and embedded in a material that
imparts a firm consistency.
– Embedding materials include paraffin, used
routinely for light microscopy,

• The hardened block with tissue and surrounding


embedding medium is trimmed and placed for
sectioning in an instrument called a microtome
• The sections are placed on glass
slides and stained for light
microscopy or on metal

Microtome
Staining
• Most cells and extracellular material are completely
colorless, and to be studied microscopically tissue sections
must be stained (dyed).
• make various tissue components not only visible but also distinguishable
from one another
• Dyes stain material selectively, often behaving like acidic
or basic compounds and forming electrostatic (salt)
linkages with ionizable radicals of macromolecules in
tissue
• Cell components such as nucleic acids with a net negative
charge (anionic) have an affinity for basic dyes and are
termed basophilic
– For example, hematoxylin a basic dye stains DNA in the
cell nucleus, RNA-rich portions of the cytoplasm, and the
matrix of cartilage, producing a dark blue or purple color
• cationic (positive charge) components, such as proteins with
many ionized amino groups, stain more readily with acidic
dyes and are termed acidophilic
– For example, Eosin a acidic dye stains , other cytoplasmic
structures and collagen pink
• H ..stains the nucleus
blue/purple
• E ..stains the cytoplasm
Pink/Red
• Fixation
• Processing
• Cutting
• Staining
Hematoxylin - Eosin

HE
The causes of
disease
Disease can be caused by either
Environmental factor
Genetic factors
Both
Environmental
• Environmental causes of disease are many and are
classified into:
1. Physical agents: trauma, radiation, extremes of
temperature
2. Chemicals: drugs, acids …
3. Nutritional deficiencies & excesses
4. Infections & infestations: Viruses, bacteria, fungi,
protozoa
5. Immunological factors: Hypersensitivity reaction/
Immunodeficiency/ Autoimmunity
6. Psychogenic factors
Genetic Factors

• hereditary factors that are inherited


genetically from parents.
• Most disease have contribution both
from genetic and environmental factors
Course of disease
.

Incubation
period

Natural recovery, i.e. recovery


without any intervention, can occur
at any stage in the progression of
the disease.
Outcome and consequences of
disease
• Following clinical onset, disease may follow any
of the following trends:
a) Resolution can occur leaving no sequelae ,
b) The disease can settle down, but sequelae are
left, or
c) It may result in death.
Clinical & biologic death
Clinical death:
•Clinical death is defined as the period of respiratory, circulatory
and brain arrest during which initiation of resuscitation can
lead to recovery.
•The patient is without pulse or blood pressure and is
completely unresponsive to the most painful stimulus
•Some reflex reactions to external stimulation are preserved.
For example, during intubations, respiration may be restored
Biological Death:
which sets in after clinical death, is an irreversible state of
cellular destruction
Questions ?

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