Pathology

& Chemical Pathology

Sep 2, 2020 Pathology & Chemical Pathology 1

 Pathology:

It is a word composed of two parts:

<path> means disease.
<ology> means science.
It is a science which deals with the study of
disease, this include:

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 Etiology:
This mean the cause of the disease, this include:
Predisposing factors:
Factors which help the development of the
disease.
Exciting factors:
Direct cause of the disease.
Pathogenesis:
It is a mechanism by which the causative agent
produces the pathological changes in the tissue.

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 Pathological picture: Which include:
Gross picture (macroscopic picture):
These are the changes in tissue and organs
detected by naked eye examination.
Microscopic picture:
These are the changes in the tissues and organs
detected on microscopic examination.
Fate:
The end result of the disease condition either cure or
death of the patient
Complications:
Are additional pathological changes which may occur
during or after the termination of the usual course.
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 Classification of Pathology:

General Pathology:
This deal with the study of cell daptations,
necrosis, neoplasia, inflammation, vascular, fluid and
clotting derangements, and immunologic disease at the
cellular and tissue levels.
Systemic Pathology:
This deal with the study of the above phenomena
at the organ-system level.

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 Cont. classification of pathology:

In both General and Systemic Pathology, we

emphasize understanding etiology, pathogenesis, and
tissue changes both in terms of basic science (e.g.,
pathologic anatomy, biochemistry, pathophysiology and
molecular biology).
“also Pathology emphasize clinical 'relevance',
(e.g., the symptoms, signs, and disease conditions
produced) and how disease affects humans as living
beings, with social and psychological consequences
of illness”.

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 Cont. classification of pathology:

Anatomic Pathology:
Cytopathology (cells), Surgical Pathology (tissues),
Autopsy Pathology, also Dermatopathology, Neuropathology
Pediatric Pathology, other specialties.
Clinical Pathology:
Blood Bank, Chemical pathology,
pathology Coagulation and
Hematopathology, Immunology/Tissue Typing, Microbiology.
Forensic Pathology:
Medicolegal pathology (investigations, inspections,
autopsy, toxicology).
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 Chemical Pathology

Introduction

&

How to Interpret Test Results

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 What is Chemical Pathology?
“It is a study of biochemical pathways ,etiology and the
pathogenesis of the biochemical disorders”.
Service Discipline
–diagnosis / screening/ monitoring / therapeutic control.
–performs tests.
–provides advice.
»individual cases
»clinical care protocols
Major Clinical Science
–research into the biochemical basis of disease.
–clinical trials
–science of diagnosis
“Bridges preclinical and clinical subjects”
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 Chemical Pathology

Major interests
-Deals with all body fluids.
–Physiological systems
–Homeostasis
–Endocrinology
–Metabolism

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 The Clinical Process
History / Exam

Request

Report
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 Defining the Reference Range (@)

Defines the values of a biochemical test found in healthy

subjects against which patient values can be compared.

Ideal Diagnostic Test (@)

Rarely available in routine practice

– High sensitivity and specificity rarely coexist

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 Strategies to Improve Tests
 Select a more appropriate ‘Normal’ population

 Use a combination of tests - e.g.. LFT profiles

 Combine tests to achieve a diagnostic goal, e.g. noenatal

screening for PKU and hypothyroidism
 Sensitive first line test (low cost)

 Specific test for screen positives (higher cost)

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 Some factors which affect reference ranges

Age Time of day

Gender Weight
Diet Stimulus
Pregnancy
Time of month

These need to be borne in mind

when interpreting results

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 Interpretation of Biochemical Values

 Biochemical measurements must be made under

appropriate conditions.
 Any biochemical value must be interpreted in the light of
the appropriate reference range.
 An understanding of normal physiological regulation is
assumed.

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 Role of Chemical Pathology:

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 Defining the Reference Range
‘Normal’ Subjects

Test
Value

-2SD +2SD

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 Ideal Diagnostic Test
‘Normal’ Diseased

Test
Value

No false positives or negatives

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 Glucose Tolerance Test

>WHO Cutoffs
200 mg/dl
@ 2 hours
&/or
>140 mg/dl
@ 0 hours

Fasting Ref Range

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