INTRODUCTION TO

PATHOLOGY ANATOMY

BETHY S HERNOWO
I. INTRODUCTION TO PATHOLOGY

Anatomical Pathology consist of General Pathology

and Organ Systems Pathology
General Pathology (GP) or basic of Anatomical
Pathology is concerned with the mechanism underline
this is process as manifest by pathogenesis and
morphologic changes
Organ Systems Pathology is designed to give the
student abroad prospected in pathology and consists of
pathology of cardio vascular systems, respiratory
system, reticular systems, central nerves systems and
so on.
Pathology, both basic science and clinical
practice are the study about structural
changes and functional changes in cells,
tissue and organ that underline disease by
the use of molecular, microbiologic,
immunology and morphologic techniques.
The four aspects of a disease process that
form a good diagnosis for pathology are :
Etiology or cause
In modern terms, there are the two mayor classes of
etiologic factors; Intrinsic or genetic and acquired (e.g.
infectious, nutritional, chemical and physical.
The concept, one etiologic agent to one disease, that is
no longer sufficient.
Genetics factors are clearly involved in some the
common environmentally induced such as
arteriosclerosis and cancer.
• Pathogenesis
– Pathogenesis refers to the sequence of event in the
response of the cells or tissues to the etiologic agent,
from the initial stimulus to the ultimate expression of
the disease.
– The study of pathogenesis remains one of the domains
of Pathology. Even when the initial infectious or
molecular cause is known it is many steps removed
from the expression of the disease.
– For example ; to understand cystic fibrosis is to know
not only the defective gene and gene product but also
the biochemical, immunology and morphologic events
leading to the formation of cystic and fibrosis in lung,
pancreas and other organs.
• Morphologic changes
– Morphologic changes refers the structural alterations in
cell or tissues that are either characteristic of the disease
or diagnostic of the diseases or diagnostic of etiologic
process.
• Functional derangements and clinical significance
– The nature of the morphologic changes and their
distribution into different organs or tissues influence
normal function and determine the clinical features
(symptoms and signs) course and prognosis of the disease.
1. CELLULAR ADAPTATIONS, CELL INJURY,
AND CELL DEATH
2. INFLAMATION
3. TISSUE RENEWAL AND REPAIR
4. HEMODYNAMIC DISORDERS
5. GENETIC DISORDERS
6. IMMUNITY
7. NEOPLASIA
8. INFECTIOUS DISEASES
CELLULAR INJURY AND
ADAPTATION
Cellular injury : If the limits of adaptive
response to a stimulus are exceeded or
when adaptation is not possible.

The cellular changes described 

reversible and irreversible injury.
Rudolf Virchow in
the 19th century is
known as the
father of modern
pathology. His
concept is about
all forms of organ
injury start with
molecular or
structural
alteration in cells.
CELLULAR ADAPTATION, CELL
INJURY& CELL DEATH

NORMAL CELLS
(HOMEOSTASIS)
STRESS, INJURIOUS STIMULUS
INCREASED DEMAND

INABILITY TO ADAPT

ADAPTATION CELL INJURY

CELL DEATH
Causes of cell injury
Oxygen deprivation
Hypoxia and extremely important and common cause of cell
injury and cell death, impinges on aerobic oxidative
respiration.
Hypoxia should be distinguished from ischemia, which is a
loss of blood supply from impeded arterial flow or reduced
venous drainage in a tissue. Ischemia tends to injury tissues
faster than hypoxia does.
Hypoxia : e.g. cardio respiratory failure (in adequate
oxygenation of the blood and anemia (loss of the oxygen
carrying capacity or carbon monoxide (carbon
monoxyhemoglobin that blocks oxygen carriage)
Depending on the severity of the hypoxic state, may adapt,
undergo injury or die.
Physical Agents
Include mechanism trauma
Extremes of temperature (burns and deep cold)
Sudden changes in atmospheric pressure
Radiation and electric shock
Chemical Agents and drugs
Glucose or salt in hyper tonic concentrations may cause injury
cell directly
Even oxygen in high concentration, is severely toxic.
Poisons such as arsenic, cyanide or mercuric salts may destroy
sufficient number of cells within minutes to hour to cause death
Other substances, environmental and air pollutant, insecticides
and herbicides, industrial and occupational hazard asasbestos,
CO, social stimuli as alcohol and narcotic drugs and ever
increasing variety of theraupetic drugs.
Infectious agents ; Viruses to large tapeworms
Immunologic reaction
Although the immune system serves in the defense
against biologic agents in fact can cause cell injury
The anaphylactic reaction to foreign protein or a
drug is a prime example and reaction to endogenous
self antigen are to be responsible for a number of
autoimmune diseases.
Genetic Derangements
Genetic defects as cause of cell injury are major interest
today.
Genetic injury may result in a defect as gross as the
congenital malformations in hemoglobin S in sickle cell
anemia. The many inborn errors of metabolism arise from
enzymatic abnormalities, usually an enzyme lack, are
excellent examples of cell damage due to subtle alterations
at the level of DNA.
Nutritional Imbalances
Even today, nutritional imbalance cause of cell injury e.g.
Protein calorie deficiencies, deficiencies of specific
vitamins. Excesses of lipids predispose to arteriosclerosis
(endemic in U.S) and obesity.
CELLULAR RESPONSE TO
INJURY
STIMULUS:
DECREASED NUTRIENT
CHRONIC IRRITATION (CHEMICAL, PHYSICAL)
METABOLIC ALTERATIONS, GENETIC, ACQUIRED
CELLULAR RESPONSE:
HIPERTROPHY, HIPERPLASIA, ATROPHY
METAPLASIA
NECROSIS, APOPTOSIS
HEMODYNAMIC DISORDERS

THIS CHAPTERS WILL DESCRIBE MAJOR

DISTURBANCES INVOLVING HEMODYNAMIC & THE
MAINTANANCE OF BLOOD FLOW, INCLUDING
EDEMA, HEMORRHAGE, TROMBOSIS, EMBOLISM,
INFARCTION & SHOCK.
NORMAL FLUID HOMEOSTASIS ENCOMPASSES
MAINTENANCES OF VESSEL WALL INTEGRITY AS
WELL AS INTRAVASCULAR PRESSURE &
OSMOLARITY WITHIN CERTAIN PHYSIOLOGIC
RANGE-
EDEMA: WATER EXTRAVASATION INTO THE
INTERSTITIAL SPACES
THROMBOSIS: NORMAL FLUID HOMEOSTASIS
ALSO MEANS MAINTAINING BLOOD AS LIQUID
UNTIL SUCH TIME AS INJURY NECESSITATES CLOT
FORMATION
EMBOLISM: CLOTTING AT INAPPROPIATE SITES
(THROMBOSIS) OR MIGRATION OF CLOTS
INFARTION: OBSTRUCTION BLOOD FLOW TO
TISSUES &LEADS TO CELL DEATH
HEMORRHAGE: INABILITY TO CLOT AFTER
VASCULAR INJURY
SHOCK: LOCAL BLEEDING CAN COMPROMISE
REGIONAL TISSUE PERFUSION , WHILE MORE
EXTENSSIVE HAEMORRHAGE CAN RESULT
HYPOTENTION (SHOCK) & DEATH
INFECTIOUS DISEASES
CAUSES:
BACTERIAL
VIRUSES
FUNGI
PROTOZOA
HELMINTHS
MYCOPLASMAS
RICKETTSIAE
CHLAMYDIAE
NEOPLASIA
NEOPLASIA:
“NEW GROWTH”
TUMOR
CANCER: THE COMMON TERM FOR ALL
MALIGNANT TUMOR
BENIGN TUMOR:
FIBROADENOMA MAMMAE
POLYP
ADENOMA
OSTEOMA
MALIGNANT TUMOR:
EPIDERMOID CARCINOMA
FIBROSARCOMA
OSTEOSARCOMA
ADENOCARCINOMA
TO BE CONTINUED