Introduction to Pathology

Module 1
For Pre-cleckship 1 students
Dr. Habte. S (MD, Pathologist, Ass.professor)
AMU
2014 EC

1o/08/14 Introduction to pathology 1

 Out lines
Definition of pathology
History pathology
Classification of pathology
The core aspects of disease in pathology
The diagnostic techniques used in pathology
Causes of diseases
The course, and outcome of diseases
Biological and clinical death

1o/08/14 Introduction to pathology 2

• What is pathology?

• What is disease ?

• What is death?

1o/08/14 Introduction to pathology 3

 Definition
• The word pathology came from the Latin words “patho” & “logy”.
• ‘Patho’ means disease /or suffering and ‘logy’ means study.
• Pathology is the study of disease by scientific methods.
• It is study of the structural & functional changes in cells, tissues, & organs
underlying diseases.
• It is scientific study of the molecular, cellular, tissue, or organ system response to
injurious agents.
• It serves as bridge b/n preclinical and clinical courses
• The ultimate goal of pathology is the identification of the causes of disease,
• Fundamental objective leading to successful therapy and to disease prevention.

1o/08/14 Introduction to pathology 4

• Diseases can be defined as an abnormal variation in structure or
function of any part of the body.
• Is a condition in which the presence of an abnormality of the body
causes a loss of normal health.
• The mere presence of an abnormality is insufficient to imply the
presence of disease unless it is accompanied by ill health.
• Disease is the clinical manifestation, through signs and symptoms, of
an underlying abnormality.

1o/08/14 Introduction to pathology 5

HISTORY OF PATHOLOGY
 Revolutionised by the application of microscopy to the study of
diseased tissues from about 1800.
 Louis Pasteur's demonstration that micro-organisms.
 Rudolf Virchow (1821-1902), a German pathologist,
 Recognised that the cell was the smallest viable constituent unit of
the body and,
 Contrived a new and lasting set of ideas about disease,
 Father of cellular pathology.

1o/08/14 Introduction to pathology 6

Autopsy → Organ pathology (1761)

LM → Cellular pathology (1854)

Ultrastructural pathology with the application of EM (20 century )

Immunopathology, Molecular pathology, Genetic pathology

1o/08/14 Introduction to pathology 7
Classication of pathology
A) Experimental pathology
B) Clinical pathology
Histopathology
Cytopathology
Hematology
Microbiology
Immunology
Chemical pathology
Toxicology
Forensic pathology
 Genetics
1o/08/14 Introduction to pathology 8
The core aspects of disease in pathology
 Pathology gives explanation of a disease by studying the four aspects of the
disease
1. Etiology
2. Pathogenesis
3. Morphological changes
4. Functional derangement & clinical manifestation.

1o/08/14 Introduction to pathology 9

1. Etiology
• Cause of the disease
• If the cause of the disease is known it is called primary etiology
• If the cause of the disease is unknown it is called idiopathic
• Knowledge or discovery of the primary cause remains the back bone on which a
diagnosis can be made, a disease understood & a treatment developed

1o/08/14 Introduction to pathology 10

• Two factors:-
Intrinsic or genetic
Acquired ( infectious, nutritional, chemical, physical…)

1o/08/14 Introduction to pathology 11

Etiology disease relationship

Disease Disease Disease

Disease Disease

One etiologic agent-

one disease, as Malaria
• Several etiologic •One etiologic
agents - one agent -
disease, as diabetes . several diseases,
as smoking.

1o/08/14 Introduction to pathology 12

2. Pathogenesis
• Mechanisms of disease development
• It refers to the sequence of events in the response of the cells or tissues to the
etiologic agent, from the initial stimulus to the ultimate expression of the disease
• Mechanism through which the cause operates to produce the pathological &
clinical manifestations.
• The pathogenic mechanism could take place in the latent or the incubation
period.
• It will lead to morphological changes.

1o/08/14 Introduction to pathology 13

3. Morphological changes
• The morphologic changes refer to the structural alterations in cells or tissues that
occur following the pathogenetic mechanisms.
• Can be seen with the naked eye or may only be seen under the microscope.
• Both the gross & the microscopic morphologic changes may only be seen in that
disease, i.e. they may be specific to that disease.
• The morphologic changes will lead to functional alteration & to the clinical signs &
symptoms of the disease.

1o/08/14 Introduction to pathology 14

4. Functional derangements and clinical significance
• The morphologic changes in the organ influence the normal function of the
organ.
• This determine the clinical features (symptoms and signs), course, and prognosis
of the disease.

1o/08/14 Introduction to pathology 15

The diagnostic techniques used in pathology
• The pathologist uses the following techniques to the diagnose diseases : -
A. Histopathology
B. Cytopathology
C. Hematopathology
D. Immunohistochemistry
E. Microbiological examination
F. Biochemical examination
G. Cytogenetics
H. Molecular techniques
I. Autopsy

1o/08/14 Introduction to pathology 16

Histopathology
• Studies the tissue under the microscope
• Tissues are obtained by biopsy
Biopsy – tissue sample from living person
• Biopsy – Incisional
- Excisional
• Tissue examined grossly (macroscopically) & microscopically
• It is usually the gold standard for pathologic diagnosis

1o/08/14 Introduction to pathology 17

Cytopathology
• Study the cells
• Used in:
.Screening for early detection of cancer
.Diagnosis of symptomatic cancer
.Diagnosis of inflammatory condition, infectious conditions
.Surveillance of pts treated with cancer

1o/08/14 Introduction to pathology 18

Ctd…
 Its advantage:-
• Cheap
• Takes less time
• Needs no anesthesia
Cytopathological methods:
1. FNAC
2. Exfoliative cytology
3. Abrasive cytology

1o/08/14 Introduction to pathology 19

Ctd…
1. FNAC
• Easy in superficial organs
• May need guidance in deep seated mass
2. Exfoliative cytology
• From cells that are shed from spontaneously into body fluids or secretion
3. Abrasive cytology
• Cells are dislodged rom skin or mucous membrane by various tools

1o/08/14 Introduction to pathology 20

 Normal Cell Cancerous Cell
1o/08/14 Introduction to pathology 21
Hematological examination

• This is a method by which abnormalities of the cells of the blood & their
precursors in the bone marrow are investigated to diagnose the different kinds of
anemia & leukemia.

1o/08/14 Introduction to pathology 22

Immunohistochemistry

• This is a method used to detect a specific antigen in the tissue in order to identify
the type of the disease

1o/08/14 Introduction to pathology 23

Microbiological examination

• This is a method by which body fluids, excised tissue, etc… are examined by
microscopical, cultural, serological techniques to identify microorganisms
responsible for many diseases

1o/08/14 Introduction to pathology 24

Biochemical examination

• This is a method by which the metabolic disturbances of disease are investigated

by assay of various normal & abnormal compounds in the blood, urine, etc…
Eg. High serum HCG level - choriocarcinoma

1o/08/14 Introduction to pathology 25

Clinical genetics (cytogenetics)
• This is a method in which inherited chromosomal abnormalities in the germ cells
or acquired chromosomal abnormalities in somatic cells are investigated using
the techniques of molecular biology.

1o/08/14 Introduction to pathology 26

Molecular techniques
• Different molecular techniques such as fluorescent in situ hybridization, southern
blot, etc… can be used to detect genetic diseases

1o/08/14 Introduction to pathology 27

Autopsy

• Autopsy is an examination of the dead body to identify the cause of death

• This can be for
-- forensic or
-- clinical purposes

1o/08/14 Introduction to pathology 28

Causes of diseases
• Disease is defined as an abnormal variation in structure or function of any part of
the body
Causes of disease
 Environmental
 Genetic or
 Both

1o/08/14 Introduction to pathology 29

Environmental factors
Are many & are classified into:-
1. Physical agents
2. Chemicals
3. Nutritional deficiencies & excesses
4. Infections & infestations
5. Immunological factors
6. Psychogenic factors

1o/08/14 Introduction to pathology 30

 1. Physical agents
 These include trauma, radiation, extremes of temperature, and
electric power.
These agents apply excess physical energy , in any form, to the body.
2. Chemicals
 Cyanide, strong acids and bases , PCM, etc.

1o/08/14 Introduction to pathology 31

3. Nutritional deficiencies and excesses
 Nutritional deficiencies may arise as a result of poor supply, interference with
absorption, inefficient transport within the body, or defective utilization.
 Deficiency of protein and energy, or vitamins or elements essential for specific
metabolic processes
 Dietary excess plays an important role in diseases in Western countries.
 Obesity, type 2 DM, hypertension, heart diseases.

1o/08/14 Introduction to pathology 32

4. Infections and infestations
• Viruses, bacteria, fungi, protozoa, and metazoa all cause diseases.
5. Immunological factors
• The abnormalities of the immune system include:-hypersensitivity
reaction, immunodeficiency and autoimmunity.

1o/08/14 Introduction to pathology 33

6. Psychogenic factors
• The mental stresses imposed by conditions of life, particularly in technologically
advanced communities, are probably contributory factors in some groups of
diseases.

1o/08/14 Introduction to pathology 34

Genetic factors
• These are hereditary factors that are inherited genetically from parents

1o/08/14 Introduction to pathology 35

The course, and outcome of diseases

• The course of disease is shown with a simplified diagram as follows.

Exposure Biological onset Clinical onset Permanent damage

Death
Latency period

• The course of a disease in the absence of any intervention is called the

natural history of the disease.
• Natural recovery, i.e. recovery without any intervention, can occur at any
stage in the progression of the disease.
1o/08/14 Introduction to pathology 36
• 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.

1o/08/14 Introduction to pathology 37

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.
f) The onset of permanent damage
g) Death

1o/08/14 Introduction to pathology 38

 Outcome of disease
• Following clinical onset, disease may follow any of the following trends:
a) Resolution can occur leaving no sequelae,
b) Resolution can occur leaving sequelae, or
c) It may result in death.

1o/08/14 Introduction to pathology 39

Clinical & biologic death
 Clinical death
 Is the reversible transmission between life and biologic 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.

1o/08/14 Introduction to pathology 40

Signs indicating clinical death are:-
 Absence of pulse or blood pressure.
 Unresponsive to the most painful stimulus.
The pupils are widely dilated.
Recovery can occur with resuscitation.

NB. 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.

1o/08/14 Introduction to pathology 41

 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.

1o/08/14 Introduction to pathology 42

Sure sign of biological death
 Bilaterally fixed and non reactive pupil
No corneal reflex
No vestibulo-cochlear reflex
No motor responses within the cranial nerve distribution for stimuli
No gag reflex
No respiratory movements occur when the patient is disconnected from the mechanical
ventilator

1o/08/14 Introduction to pathology 43

 End

1o/08/14 Introduction to pathology 44