LORMA COLLEGES

COLLEGE OF PHYSICAL AND RESPIRATORY THERAPY

City of San Fernando, La Union
GENERAL PATHOLOGY
Prepared by: MAVERICK KAYPEE A. COLET, MASE, PTRP

MODULE 1: INTODUCTION TO PATHOLOGY

I. LEARNING OUTCOMES
Upon completing this module students should be able to:
 define pathology.
 identify the works of a pathologist.
 discuss the core aspects of disease in pathology.
 identify the different branches of pathology.
 describe the various categories of the causes of diseases.
 discuss the course, outcome, consequences of diseases.

II. LEARNING CONTENT

- Definition of Terms
- Branches of Pathology
- Core Aspects of Pathology
- The Causes of Disease
- Course of the Disease
- Outcome and consequences of Disease
- Clinical and Biological Death

III. OVERVIEW
This instructional module provides maximum of two hours’ worth of materials on concepts relevant to
the introduction of Pathology. Its purpose is to give the students a background on some terms and concepts
necessary for better understanding of Pathology. On successful completion of this module, the students will be
able to realize the learning outcomes stated. Since this is an introductory module, it will serve as a good
foundation for the next modules.

IV. DISCUSSION: INTRODUCTION TO PATHOLOGY

PATHOLOGY
 Pathology is "Scientific study of disease" Study of structural and functional changes in
disease.
 "Pathology deals with knowledge of what causes disease, how disease starts, progresses & it
explains the reason for signs and symptoms of patient"
 The word "pathology" is derived from two Greek words, pathos meaning "disease or suffering"
and logos meaning "study". Hence, pathology is the study of diseases. It includes the study of
its nature, causative factors and mechanism of development including the structural,
biochemical and functional changes that occur in different disease conditions and the outcome
of the illness.
1
  Pathology is a branch of medical science that involves the study and diagnosis of disease
through the examination of surgically removed organs, tissues (biopsy samples), bodily fluids,
and in some cases the whole body (autopsy). Aspects of a bodily specimen that may be
considered include its gross anatomical make up, appearance of the cells using immunological
markers and chemical signatures in the cells.
 Pathology also includes the related scientific study of disease processes whereby the causes,
mechanisms and extent of disease are examined. Areas of study include cellular adaptation to
injury, necrosis (death of living cells or tissues), inflammation, wound healing, and neoplasia
(abnormal new growth of cells).

PATHOLOGIST
 Pathologists specialize in a wide range of diseases including cancer and the vast majority of cancer
diagnoses are made by pathologists. The cellular pattern of tissue samples are observed under a
microscope to help determine if a sample is cancerous or non-cancerous (benign). Pathologists also
employ genetic studies and gene markers in the assessment of various diseases.
 Pathologists use gross, microscopic, immunologic, genetic and molecular modalities to determine the
presence of disease, and frequently work closely with surgeons, radiologists, and oncologists.
 Pathologists can sub-specialize in different areas, such as gastroenterology, gynecologic pathology,
blood diseases, clotting disorders, microbiology, lung and breast cancers, and more. For every sub-
specialty in medicine or surgery, there is a pathologist counterpart, helping to make the correct
diagnosis and guide the care of the patient.
 For a person to qualify as a pathologist, they need to complete a medical degree and a residency
program that leads to certification from approved boards.
 Pathologists work as part of a team to take care of patients. Knowing pathology provides a sound
foundation for rational clinical care and therapy.

BRANCHES OF PATHOLOGY
 General pathology
o General pathology describes a complex and broad field that involves the study of the
mechanisms behind cell and tissue injury, as well as understanding how the body responds to
and repairs injury.
o Examples of areas that may be studied include necrosis, neoplasia, wound healing,
inflammation and how cells adapt to injury. Thorough understanding in these areas is applied in
the diagnosis of disease.
o General pathology is also the term used to describe anatomical and clinical pathology.
o This field covers areas of pathology, but at a less specialist level. A person working in general
pathology would be trained in the areas of laboratory analysis, such as hematology and clinical
chemistry. However, they would have a less detailed knowledge than a person who specializes
in one of these fields.
 Anatomical pathology
o This field is concerned with the study and diagnosis of illness through microscopic analysis of
samples from bodily fluids, tissues organs and sometimes the entire body or autopsy.
o Factors that may be examined include the cell appearance, anatomical make up and chemical
signatures within cells.
o On examining a biopsy, the following aspects are considered:

2
  Gross anatomical make-up of the sample
 Microscopic appearance of cells
 Chemical signatures in the sample
 Immunological markers present in the cells
 Molecular biology of the cells, organs, tissues and sometimes whole body
o Anatomical pathology is further classified into sub specialties, examples of which include:
 Surgical pathology
 This involves the examination of specimens obtained during surgery such as a
breast lump biopsy obtained during mastectomy
 Histopathology
 This refers to the examination of cells under a microscope after they have been
stained with appropriate dyes.
 Samples of bodily tissues and organs are prepared and examined in order to
detect and diagnose disease.
 The architecture of tissue is observed at a microscopic level and the relationship
between different cell and tissue types is examined.
 Cytopathology
 In cytopathology, cells that have been shed into bodily fluids or have been
obtained by scraping or aspirating tissue are examined.
 Typical examples include cervical smear, sputum and gastric washings. Bodily
fluids and tissues are examined at the cellular level in order to screen for and
diagnose disease and help aid treatment decisions.
 A cytologist will examine how cells look, form and function.
 Forensic pathology
 Involves the post mortem examination of a corpse for cause of death using a
process called autopsy.
 Forensic pathology is the examination of an autopsy in order to discover the
cause of death.
 The external appearance is first assessed to check for evidence of wounds or
suffocation, for example. Surgical procedures are then begun and the internal
organs are studied to see whether internal injuries exist and are connected to
external ones.
 Dermatopathology
 Concerns the study of skin diseases.
 Clinical pathology
o Also referred to as laboratory medicine, clinical pathology concerns the analysis of blood, urine
and tissue samples to examine and diagnose disease.
o Examples of the information clinical pathology laboratories may provide include blood count,
blood clotting and electrolyte results.
o A clinical pathologist is usually trained in microbiology, hematology or blood banking, but not at
the same expert level as someone who specializes in one of these fields.
o A clinical pathologist may come across problems that demand specific expertise, at which point
they would need to consult a colleague who is more specialized.
o Clinical pathologists play a similar role to that of general pathologists, although they would not
be involved in anatomical pathology.
 Chemical Pathology or Biochemistry

3
 o Biochemists or chemical pathologists examine all aspects of disease, identifying changes in
various different substances found in the blood and bodily fluids such as proteins, hormones
and electrolytes, since these changes can indicate and provide clues about disease or disease
risk.
o For example, a biochemist may assess cholesterol and triglyceride levels in order to determine
heart disease risk. They may also look for and measure tumor markers, vitamins, poisons,
medications and recreational drugs.
 Genetics
o Genetics involves performing tests on chromosomes, biochemical markers and DNA taken from
bodily fluids and tissues in order to detect genetic illnesses.
o There are three main branches of genetics and these include the following:
 Cytogenetics
 This is the analysis of chromosomal abnormalities at the microscopic level.
 Biochemical genetics
 The search for specific disease markers using biochemical techniques.
 Molecular genetics
 Gene mutations are searched for and analyzed using DNA technology
 Hematology
o This field is concerned with various different disease aspects that affect the blood, including
bleeding disorders, clotting problems, and anemia, for example.
o Another area of hematology is transfusion medicine, which involves performing blood typing,
cross-matching for compatibility and managing large amounts of blood products.
o An example of a test a hematologist may perform is a blood clotting test to check whether a
patient’s dose of warfarin needs increasing or decreasing.
 Immunology
o Immunologists perform immune function tests to establish whether or not a patient is suffering
from an allergy and if so, what they are allergic to.
o Many diseases also arise as a result of the immune system having an abnormal reaction to
healthy cells or tissues and launching an immune attack against them. This is referred to as a
autoimmune disease. There is a range of immunological tests that can detect markers of
autoimmune diseases such as rheumatoid arthritis, diabetes and lupus.
 Microbiology
o Microbiology is concerned with diseases caused by pathogenic agents such as bacteria,
viruses, parasites and fungi.
o Samples of blood, bodily fluid and tissue are tested to establish whether infection exists, and the
field of medical microbiology is also engaged with identifying new species of microorganisms.
o Other areas encompassed by microbiology include control of infection outbreaks and
researching the problems resulting from bacterial antibiotic resistance. One of the principal roles
of the microbiologist is to make sure that antimicrobial drugs are prescribed and used
appropriately.

CORE ASPECTS OF PATHOLOGY

 Knowledge of pathology helps in better understanding of patient and his disease.
 Diseases is expression of "discomfort" due to structural or functional abnormality. This abnormality can
be caused by various agents.
4
 Pathology gives explanations of a disease by studying the following four aspects of the disease.
o Etiology,
o Pathogenesis,
o Morphologic changes and
o Functional derangements and clinical significance.

 Etiology
o Etiology of a disease means the cause of the disease or the study of cause / causative agent of
disease
o If the cause of a disease is known it is called primary etiology.
o If the cause of the disease is unknown it is called idiopathic.
o Knowledge or discovery of the primary cause remains the backbone on which a diagnosis can
be made, a disease understood, & a treatment developed.
o There are two major classes of etiologic factors:
i. Intrinsic/genetic: including inherited mutations, polymorphisms, etc.
ii. Acquired: like chemical, physical, nutritional, infectious, etc.
o The etiology is followed by pathogenesis.
 Pathogenesis
o Pathogenesis means the mechanism through which the cause operates to produce the
pathological and clinical manifestations.
o The pathogenetic mechanisms could take place in the latent or incubation period.
o It is the mechanism of development of a disease. It includes sequence of events by which cells
or tissues respond to etiologic agent, from the initial stimulus to the ultimate expression of the
disease.
o Study of pathogenesis of a disease can prove very helpful in innovating new therapies to tackle
the disease at molecular and cellular levels.
o Example: in cystic fibrosis, it is not enough to know the gene causing it but also the biochemical,
immunologic or morphologic events leading to the formation of cysts or fibrosis in the lungs,
pancreas and other organs.
o Pathogenesis leads to morphologic changes.

 Morphologic Changes
o The morphologic changes refer to the structural alterations in cells or tissues that occur
following the pathogenetic mechanisms.

5
 o The structural changes in the organ can be seen with the naked eye or they may only be seen
under the microscope.
o Those changes that can be seen with the naked eye are called gross morphologic changes &
those that are seen under the microscope are called microscopic changes.
o Both the gross & the microscopic morphologic changes may only be seen in that disease, i.e.
they may be specific to that disease.
o Therefore, such morphologic changes can be used by the pathologist to identify (i.e. to
diagnose) the disease. In addition, the morphologic changes will lead to functional alteration &
to the clinical signs & symptoms of the disease.
 Functional Derangements and Clinical Significance
o The morphologic changes in the organ influence the normal function of the organ. By doing so,
they determine the clinical features (symptoms and signs), course, and prognosis of the
disease.

In summary, pathology studies:

Etiology  Pathogenesis  Morphologic changes  Clinical features & Prognosis of all diseases.

Example: Complex etiology, pathogenesis, pathology, and symptomatology of Parkinson's disease

 Understanding of the above core aspects of disease (i.e. understanding pathology) will help one to
understand how the clinical features of different diseases occur & how their treatments work. This
understanding will, in turn, enable health care workers to handle & help their patients in a better &
scientific way. It is for these reasons that the health science student should study pathology.
 In addition, the pathologist can use the morphologic changes seen in diseases to diagnose different
diseases. There are different diagnostic modalities used in pathology. Most of these diagnostic
techniques are based on morphologic changes.
 Virtually, all forms of organ injury start with molecular/structural alterations in the cell. The concept first
put in the 19th century by RUDOLF VIRCHOW (known as the FATHER OF PATHOLOGY)

THE CAUSES OF DISEASE

 Diseases can be caused by either environmental factors, genetic factors or a combination of the two.

6
A. Environmental factors
Environmental causes of disease are many and are classified into:
1. Physical agents
2. Chemicals
3. Nutritional deficiencies & excesses
4. Infections & infestations
5. Immunological factors
6. Psychogenic factors

1. Physical agents
o These include trauma, radiation, extremes of temperature, and electric power. These agents
apply excess physical energy, in any form, to the body.
2. Chemicals
o With the use of an ever-increasing number of chemical agents such as drugs, in industrial
processes, and at home, chemically induced injury has become very common.
o Their effects vary:
 Some act in a general manner, for example cyanide is toxic to all cells.
 Others act locally at the site of application, for example strong acids and caustics.
 Another group exhibit a predilection for certain organs, for example – the effect of
paracetamol and alcohol on liver. Many toxic chemicals are metabolized in liver and
excreted in kidney, as a result, these organs are susceptible to chemical injury.
3. Nutritional deficiencies and excesses
o Nutritional deficiencies may arise as a result of poor supply, interference with absorption,
inefficient transport within the body, or defective utilization.
o It may take the form of deficiency either of major classes of food, usually protein and energy, or
vitamins or elements essential for specific metabolic processes, e.g. iron for haemoglobin
production. Often, the deficiencies are multiple and complex.
o On the other hand, dietary excess plays an important role in diseases in Western countries.
Obesity has become increasingly common, with its attendant dangers of type 2 diabetes, high
blood pressure and heart disease.
4. Infections and infestations
o Viruses, bacteria, fungi, protozoa, and metazoa all cause diseases. They may do so by causing
cell destruction directly as in virus infections (for example poliomyelitis) or protozoal infections
(for example malaria).
o However, in others the damage is done by toxins elaborated by the infecting agent as in
diphtheria and tetanus. Like chemicals, they may have a general effect or they may show a
predilection for certain tissues.
5. Immunological factors
o The immune process is essential for protection against micro-organisms and parasites.
However, the immune system can be abnormal which can lead to diseases.
o The abnormalities of the immune system include:
 Hypersensitivity reaction
 This is exaggerated immune response to an antigen. For example, bronchial
asthma can occur due to exaggerated immune response to the harmless pollen.
 Immunodeficiency
 This is due to deficiency of a component of the immune system which leads to
increased susceptibility to different diseases. An example is AIDS.
7
 Autoimmunity

 This is an abnormal (exaggerated) immune reaction against the self antigens of
the host. Therefore, autoimmunity is a hypersensitivity reaction against the self
antigens. For example, type 1 diabetes mellitus is caused by autoimmune
destruction of the beta cells of the islets of Langerhans of the pancreas.
6. Psychogenic factors
o The mental stresses imposed by conditions of life, particularly in technologically advanced
communities, are probably contributory factors in some groups of diseases.

B. Genetic Factors
These are hereditary factors that are inherited genetically from parents.

COURSE OF THE DISEASE

 The course of a disease in the absence of any intervention is called the natural history of the disease.
The different stages in the natural history of disease include:
a) Exposure to various risk factors (causative agents)
b) Latency, period between exposure and biological onset of disease
c) Biological onset of disease; this marks the initiation of the disease process, however, without
any sign or symptom. Following biological onset of disease, it may remain asymptomatic or
subclinical (i.e. without any clinical manifestations), or may lead to overt clinical disease.
d) Incubation (induction) period refers to variable period of time without any obvious signs or
symptoms from the time of exposure.
e) The clinical onset of the disease, when the signs and symptoms of the disease become
apparent. The expression of the disease may be variable in severity or in terms of range of
manifestations.
f) The onset of permanent damage, and
g) Death
 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 AND BIOLOGICAL DEATH

Clinical death
 Clinical death is the reversible transmission between life and biologic death.
 Clinical death is defined as the period of respiratory, circulatory and brain arrest during which initiation
of resuscitation can lead to recovery.
 Clinical death begins with either the last agonal inhalation or the last cardiac contraction. Signs
indicating clinical death are:
o The patient is without pulse or blood pressure and is completely unresponsive to the most
painful stimulus.
o The pupils are widely dilated
8
 o Some reflex reactions to external stimulation are preserved. For example, during intubations,
respiration may be restored in response to stimulation of the receptors of the superior laryngeal
nerve, the nucleus of which is located in the medulla oblongata near the respiratory center.
o Recovery can occur with resuscitation.

Biological Death
 Biological death (sure sign of death), which sets in after clinical death, is an irreversible state of cellular
destruction.
 It manifests with irreversible cessation of circulatory and respiratory functions, or irreversible cessation
of all functions of the entire brain, including brain stem. However, one should notice that there are
internationally accepted criteria to diagnose biological death.

V. REFERENCES
1. Emanuel Rubin, and John L. Farber, Essential Pathology, Philadelphia, 1990
2. William Boyd; Textbook of Pathology, structure and Function in disease, Philadelphia, 8th edition, 1987
3. James E. Pointer; Alan B. Fletcher; Basic life support, California, 1986
4. F.B. Walter and M.S Israel; General Pathology, Churchill Livingston Edinburgh and London, 4th edition,
1974
5. Macfarlane, Reid, callander, Illustrated Pathology, Churchill Livingstone, 5th edition, 2000.
6. Cotran RS, Kumar V, Collins T.Robins pathologic basis of diseases. Philadelphia, J.B. Saunders Company.
6th edition 1999
7. Muir’s Textbook of Pathology 15th edition
Websites:
 https://www.mcgill.ca/pathology/about/definition
 https://www.cap.org/member-resources/articles/what-is-pathology
 https://www.news-medical.net/health/What-is-Pathology.aspx
 www.cartercenter.org/.../GeneralPathology.pdf
 peoria.medicine.uic.edu/.../
 http://www.uhs.nhs.uk/OurServices/Pathology/Pathology.aspx
 www.cma.ca/.../General-Pathology-e.pdf
 http://www.pathology.med.pro/disciplines.html
Images:

9
 https://www.researchgate.net/figure/Complex-etiology-pathogenesis-pathology-and-symptomatology-of-
Parkinsons-disease_tbl4_259394442
 https://pediaa.com/what-is-the-difference-between-pathophysiology-and-pathogenesis/
 https://www.slideshare.net/fmmgmcriacin/death-59914133

10