General & Systemic Pathology

INTRODUCTION TO
PATHOLOGY
University of Zambia,
School of Medicine,
Biomedical Sciences Dept.
 Introduction
Pathology
• is literally the study (logos) of suffering (pathos).
• is a bridging discipline involving both basic
science and clinical practice
• Is the study of the structural and functional
changes in cells, tissues, and organs that
underlie disease.
• Traditionally, the study of pathology is divided
into general and systemic, pathology.

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• Pathology is the foundation of medical science
and practice.
• Without pathology the practice of medicine would
be reduced to myths and folklore.
• The four aspects of a disease process that form
the core of pathology are
- Aetiology,
- Pathogenesis,
- Morphologic changes, and
- Clinical significance.
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 Aetiology
• Aetiology of a disease means
the cause of the disease.
• There are two major classes
of etiologic factors:
- intrinsic or genetic, and
- extrinsic or acquired.
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 Pathogenesis
• mechanism through which the cause
operates to produce the pathological and
clinical manifestations or
• the sequence of events in the response of
cells or tissues to the aetiologic agent,
from the initial stimulus to the ultimate
expression of the disease.

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 Morphologic changes
• are the structural alterations in cells or tissues
that are either characteristic of the disease or
diagnostic of the aetiologic process.
• The structural changes maybe gross or
microscopic changes.
• In addition, the morphologic changes will lead to
functional alteration & to the clinical signs &
symptoms of the disease.
• the structural or functional abnormality
responsible for ill health is known as a lesion
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 Pathognomonic Abnormalities

• Pathognomonic features are restricted to

a single disease, or disease category, and
without them the diagnosis is impossible
or uncertain. eg
• Reed-Sternberg cells are said to be
pathognomonic of Hodgkin`s lymphoma.
• The presence of Mycobacterium
tuberculosis, in the appropriate context, is
pathognomonic of tuberculosis.
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 Complications and Sequelae
• Diseases may have prolonged, secondary or distant
effects.
• Examples include the spread of an infective
organism from the original site of infection, where it
had provoked an inflammatory reaction, to another
part of the body, where a similar reaction to it will
occur.
• The course of the disease may be prolonged and
complicated if the body`s immunity is impaired.
• An aftereffect (secondary effect) of a disease is
called a Sequelae.
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Prognosis, Remission & Relapse

• The prognosis forecasts the known or

likely course of the disease and, therefore
the fate of the patient.
• Remission is the process of conversion
from active disease to quiescence.
• Later the signs and symptoms may
reappear; this is the process of relapse.

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 DIAGNOSTIC TECHNIQUES AND
SUBDIVISIONS OF CLINICAL PATHOLOGY

Histopathology
• the investigation and diagnosis of disease
from the examination of body tissues
under the microscope.
• the pathologist looks for abnormal
structures in the tissue.
• Histopathology is usually the gold
standard for pathologic diagnosis.

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 Cytopathology

• the investigation and diagnosis of disease from the

examination of isolated cells
• Compared to histopathological technique it is cheap,
takes less time and needs no anesthesia to take
specimens.
• There are different Cytopathologic methods including:
- Fine-needle aspiration cytology (FNAC)
- Exfoliative cytology
- Abrasive cytology

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 Haematology

• the study of disorders of the cellular and

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

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 Chemical pathology

• the study and diagnosis of disease from the

chemical changes in tissues and fluids
• Biochemical examination is a method by
which the metabolic disturbances of
disease are investigated by assay of
various normal and abnormal compounds
in the blood, urine, etc.
• Toxicology is the study of known or
suspected poisons
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 Microbiology

• the study of infectious diseases and the

organisms responsible for them
• Microbiological examination is a method
by which body fluids, excised tissue, etc.
are examined by microscopical, cultural
and serological techniques to identify
micro-organisms responsible for many
diseases.

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 Immunology

• is the branch of pathology which study the

specific defense mechanisms of the
body.
• Immunohistochemistry is a method used
to detect a specific antigen in the tissue in
order to identify the type of disease.

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 Genetics

• the study of abnormal chromosomes and genes

• Clinical genetics (Cytogenetics) is a method in
which inherited chromosomal abnormalities are
investigated using the techniques of molecular
biology.
• Different molecular techniques such as
fluorescent in situ hybridization, Southern blot,
etc... can be used to detect genetic diseases.

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 Forensic pathology

• is the application of pathology to legal

purposes.
• ie the investigation of death in
suspicious circumstances.
Autopsy
• Autopsy is examination of the dead
body to identify the cause of death. This
can be for forensic or clinical purposes.
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 NOMENCLATURE OF DISEASE

• Uniform nomenclature facilitates communication

and enables accurate epidermiological studies.
• Many standard conventions are used to derive
names of diseases. eg
- Primary and secondary
- Acute and chronic
- Benign and malignant
- Prefixes and suffixes
- Eponymous
- Syndromes
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 Primary And Secondary

• These words may be used to describe the

causation of disease.
• Primary/essential/idiopathic/cryptogenic in
this context means that the disease is
without evident antecedent cause.
• Thus, primary hypertension is defined as
abnormally high blood pressure without
apparent cause.

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• Secondary means that the disease represents a
complication or manifestation of some underlying lesion.
• Thus, secondary hypertension is defined as abnormally
high blood pressure as a consequence of some other
lesion.
• The words primary and secondary may be used to
distinguish between the initial and subsequent stages of
a disease, most commonly in cancer.
• The primary tumor is the initial tumor from which cancer
cells disseminate to cause secondary tumors elsewhere
in the body.

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 Acute And Chronic
• These are used to describe the dynamics of a
disease.
• Acute conditions have a rapid onset, often but not
always followed by a rapid resolution.
• Chronic conditions may follow an acute initial episode,
but often are of insidious onset, and have a prolonged
course lasting months or years.
• The terms are mostly used to qualify the nature of an
inflammatory processes.
• The words may be used by patients to describe some
symptoms, eg. An acute pain being sharp or severe.
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 Benign And Malignant
• these are emotive terms used to classify certain diseases
according to their likely outcome.
• Thus benign tumors remain localized to the tissue of
origin and are very rarely lethal, whereas malignant
tumors invade and spread from their origin and are
commonly lethal.
• Benign hypertension is relatively mild elevation of blood
pressure that develops gradually and causes insidious
injury to the organs of the body.
• Malignant hypertension is when the blood pressure rises
rapidly and causes severe symptoms and tissue injury.

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 Prefixes
• Commonly used prefixes and their meanings are:
• Ana – absence eg anaphylaxis
• Dys – disordered eg dysplasia
• Hyper – an excess over normal eg
hyperthyroidism
• Hypo – a deficiency below normal eg
hypothyroidism
• Meta – a change from one state to another eg
metaplasia
• Neo – new growth eg Neoplasia
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 Suffixes
• Commonly used suffixes and their
meanings are:
• -itis - meaning an inflammatory process eg
appendicitis
• -oma – meaning a tumors eg carcinoma
• -osis – meaning state or condition, not
necessarily pathological eg osteoarthrosis
• -oid – meaning bearing a resemblance to
eg rheumatoid arthritis
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• -penia – meaning lack of eg thrombocytopenia
• -cytosis – meaning increased number of cells,
usually in blood eg leukocytosis
• -ectasis – meaning dilation eg bronchiectasis
• -plasia – meaning a disorder of growth eg
hyperplasia
• -opathy – meaning an abnormal state lacking
specific characteristics eg lymphadenopathy

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 Eponymous Names
• An eponymous disease or lesion is named after a
person or place associated with it.
• Eponymous names are used commonly either when the
nature or cause of the disease or lesion is unknown, or
• long term usage has resulted in the name becoming
part of the language of medicine or
• to commemorate the person who first described the
condition.
• Eg Graves` disease, Paget disease of the nipple,
Crohn`s disease, Hodgkin`s disease, Reed-Sternbeg
Cells etc

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 Syndromes
• A syndrome is an aggregate of signs and
symptoms or a combination of lesions without
which the disease cannot be recognized or
diagnosed.
• Syndromes often have eponymous titles.
Examples include:
• Cushing`s syndrome: hyperactivity of the adrenal
cortex resulting in obesity, Hirsutism, hypertension.
• Renfield`s syndrome: a mental disorder where a
patient is obsessed with drinking human blood.

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 Course, outcome and clinical
consequences Of Disease
• The course of a disease in the absence of
any intervention is called the natural history
of the 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.
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 References and Credits
• Robbins SL and Kumar V (2007). Basic
Pathology (8th Edition).WB Saunders Co.
London.
• Underwood, J.C.E and Cross, S. S (2009).
General and Systematic Pathology (5th Edition).
Churchill-Livingstone, Edinburgh. ISBN: 978
0443068881
• Bezabeh M, et al (2004) A. general Pathology:
Lecture notes of health science students.
Published by Jimma Haramaya, Dedub and
Gondar Universities, Ethiopia.
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