introduction to pathology s. pongsabutra
TRANSCRIPT
Pre Test (10 )
Introduction to PathologyBy
1. ! 1.1 .....? 1.2 Anatomy & Physiology ? ? 1.3 ..? ? ..? ? 1.4 ? ?
S. Pongsabutra2 5 June. 09
.... .... .... .....
Introduction to Pathology : (Clinico-Pathological Correlation ) 5. 1. 2. 3. 4.
[-] = (disease= dis+ease)=
1.
= = (
?)
()
, ? . ... ? ...
(AP)
(CP) excreta, *Autopsy Path. *Surgical Path. *Molecular Path. *Forensic Path. (Medicine). *Cytopathology & papsmear Examination ...etc
? ?? ? ?
()
() ( 1. Autopsy Pathology () ) . . ? ? 2.Surgical Pathology (biopsy) biopsy) 3. Cyto-Pathology Cyto 4.Molecular Pathology Gene Gene Gene ? Gene ?........... ...........
2.
() (Internal Homiostasis) 4
Basic Groups of Diseases
3. 3Formation of Tumor ; * Non Neoplastic tumor * Neoplastic tumor
1Congenital Disorders
2Reaction of self defense mechanism * inflammation * Immune disorders
( )
() ( )
Hereditary Disease
Congenital anomaly
* Genetics * Abnormal Growth & diseases Development eg. harelip, cleft palate etc.
4
Unclassified Diseases: * most 0f unclassified diseases usually are complex in nature such as metabolic ,degeneratives , neuropsychic diseases etc
1. Etiology = * ? !! 2. Pathogenesis
:
*Etiology* Pathogenesis *Pathological change= lesion * Clinical manifestation * Complication * Prognosis
?3. Pathological changes ? (= Lesion) 4. Clinical manifestation
(Pathophysiologic changes) 5.. Complication (secondary changes of the other related organs) ? 6. Prognosis ?
.... cell organelles Histological character . .Immunohistochemistry .. . ..... .........
Normal squamous cell vs abnormal squamous cell? Structure Normal mucosal small bowel vs abnormal mucosal small bowel ?(tissue) Normal organ liver vs abnormal organ liver? Function(Islets cells)
Normal blood sugar vs abnormal blood sugar? eg. Blood sugar between non diabetes and diabetes patients..etc..
Liver
Abnormal surface liver characterized by brownish yellow color and diffuse small nodular lesions size1-2 mm,
Liver
Abnormal cut surface liver characterized by multiple nodules (masses) varying in size, up to 1 cm. grey white color
Abnormal cut surface liver show diffuse small white masses, size vary from~ 1-3 mm.
Section shows cells characterized by abnormal shape, size and nuclei, together with loss of organ Architecture
Liver show alternated diffuse small dark lines and spots in background yellow brown color cut surface
Liver lobule shows dilated Central vein and sinusoidal spaces accompanied with necrosis of liver cell cords around central vein
Cut surface Liver shows diffuse dark green spots and focal darkgreen liquefaction areas 0.2-1 cm. in size
4.
Fact .: .. (S&S = clinical symptom and sign) ? (=) ? ? ? ? ( = )
Section shows 0rganism( fluke?) in the space which lining by glandular structure.
4.1 () (S&S)
19 1 3-5 ? PE. - 20 / . ( = ?) - 115 / . ? ( = ? ) - Apex beat
Basic Medical Science & Clinical sci.
* : Anatomy * : Physiology
*
Systemic Pathology & Clinical skill ( )
* Clinical skill , , , ?
* , ? ......
5th I.C.S;?
Mid Clavicular line?(?)
- Apex beat Diastolic Murmur 4 (?) Crepitation (), . ( ? )
:Relation between Anatomy, Physiology of C.V.S
() Related to (& ?)(PE.)
and
RS.
Normal Function of organs Normal structure 0f organs Heart & Lung Site, size & shape of heart (wall , chambers) Character of valves; location, leaflets and chordae tendinae; Characters of Lungs; Gross and micro. Consistency; Anatomic relation between the heart and lungs? .etc Heart & Lung -Heart :Function of chambers?;valves? . Circulation blood between heart and lung; rate and
: 17 ( OPD ) 1 : 3- 5 *
rhythm of Heart beat, sound character and site of blood flow through valves? - Lung; sound and rate of breath, ---etc
*20/ *115/ *Apex beat 5 ICS lateral to MCL with Diastolic murmur gr.4 and thrill on touching. * * crepitation
basic medical sciences Anatomy, Physiology, Systemic Pathology, Clinical skills (Physical examination)
4.2 clinic( symptom & sign )Clinico Pathological CorrelationAnatomic changes Functional changes
Anatomic changes Mitral Valve stenosisIncrease work load to heart caused
Functional changes Diastolic Murmur gr.4Lt.Ventricle contain blood Volume less than normal H.R. 115 / min = Compensate for normal blood Volume [1st.. Step]
Mitral Valve stenosis [ Leaflets characterized by sclerosis, fused together, result in narrow opening ]
Diastolic Murmur
gr.4 ?Lt. Ventricular Hypertrophy for increase blood Volume [2st.. Step]
Flow of blood through stenosed Mitral Valve during lt. Atrium systole and Lt.ventricle-Diastole, genesis murmur(diastolic murmur at Apex) and the same time volume blood through LV chamber is lessen than normal
Overload
Lt.ventricular failure = Lt. sided Heart failure=
(pulmonary edema) RT. Atrium chamber
RR. 20/min (=)
O2
Chronic Endocarditis of Mitral valve with marked stenosis and sclerosis. Acute pulmonary edema, marked *
4.3 symptom & sign -# ; X - rays, EKG, , Immunology Antibody. Group A Streptococci () ?. .........
Anatomical Diagnosis
= (Clinical Diagnosis ) Chronic Rheumatic Heart With Congestive Heart Failure Etiologic Diagnosis
4. 4 ; - 1. (group A streptococci) -2. (immunnological mediated inflammatory)
Lt. atrium Rt.atrium bicuspid valve Tricuspid valve) Lt. ventricle
, ?
Chordae tendinae
Interventricular septum
Normal Heart
Pathological changes: Heart valve
Mitral valve and chordae tendinae show sclerotic changes in chronic Rheumatic endocarditis
Mitral valves show fusion of the sclerotic leaflets with
marKed narrowing the Openning in Rheumatic heart dis.
left Ventricular hypertrophy
Abnormal Cardiac muscles Fibres,(larger than normal) with fine brown pigments in cytoplasm beside the nucleus
5.
1.1. 2. 3.
1. () 2. (Autopsy Examination and others specialty branches) 3. 4. 5. 6.
Interalveolar vessels show congestion and containing large amout of acidophilic homogeneous material with vacuoles in alveolar spaces
Clinical problems(sign& symptom)
Pathology is the key to open the secret 0f Diseases= STUDY ABNORMAL STATE OF BODY PARTICULAR IN MORPHOLOGICAL & FUNCTIONAL CHANGES OF ORGAN, TISSUE CELLS.
Basic medical sciences
Introduction to Pathology.
Post test
**. Introduction to Pathology ? . . ......?
2
Cell Pathology
Cell Pathology=
: * Review cell biology * cell adaptation * cell Injury ( degeneration & necrosis) * Somatic death
Cell Biology
Review cell biologyDefinition : ( (homeostasis) Function (Physiology ) Structure (Anatomy) * :
Ingestion & Egestion [excitation] * * *
Cell wall (membrane) Mitochondria Endoplasmic reticulum Nucleus
Basic Cell Structure Organelles
Cell wall (membrane) structure (Molecular level) Phospholipids Proteins, glycoprotein
(rER, sER) Endoplasmic Reticulum Nucleus Nuclear membrane
Products Mitochondria Cytoplasm Cell wall (Plasma membrane)
Function1. Barrier () 2. Molecules ions 3
Receptors Nuclear PoresCell = Smallest unit of life which having ability to be free living by interaction with the environment -Transmembrane Proteins bind Molecules molecules
Active transport- Na+, K+, Ca++ H+ ion - internal homeostasis molecules Na+ Pump
Diffusible- aminoacid, glucose Proteins
MitochondriaStructure- 1 9 - Cristae Cytoplasm
Endoplasmic reticulum rER FunctionStructure Function
- , (powerhouse of cell) ATP - generate Oxidative phospholylationphosphate glucose, fatty acid glucose fatty Acid ADP ATP, Mitochondria ATP Mitochondria Cytoplasm ATP ADP + ADP Mitochondria ATP
Ribosome Organelle rough Endoplasmic Reticulum rER
Enzymes Proteins Ribosomes ER Cytoplasm Aminoacids Proteins (Polypeptides) mRNA Amino acid Proteins cell
NucleusDefinitionStructure Function
Cell Pathology
cellNuceolus Nuclear wall Chromosomes Cytoplasm Nucleus Chromosomes 46 23 genebearer / chromatin Genetic material chromosomes / chromosomes DNA Histone / gene Function unit (Locus) Chromosome
(Gene)-
- Enzymes, Proteins -
(adaptation) (cell injury) (cell necrosis)
Cell adaptation
Types of cell Pathology 1. Cell adaptation 2. Cell injury ()Type of injury: Degeneration & Death)
maintain internal homeostasis ;
3. Somatic death (The whole cells of body )
* Atrophy decrease in size * Hypertrophy increase in size * Hyperplasia increase in cell number * Metaplasia = normal original Cell transformation to another type cell (adult cell) * Dysplasia = abnormal tissuesforming (= abnormal orientation, size and shape of cells)
Senile Atrophy Brain (brain change in old age)
Atrophy (adaptation of endometrium)
Hyperplasia (adaptation of endometrium)
Hypertrophy heart ( adaptation of heart muscle ) Squamous metaplasia (adaptation of endocervix mucosa)
Normal epidermis
Hyperplasia (adaptation of epidermis)
Cell Injury (Structural Damage and Functional Disorders)
Dysplasia (squamous epithelium of uterine cervix)
Type of cell InjuryReversible injuryDegeneration Structure changes Histologic picture Ultrastructure organellesFunctional changesDefect in chemical changes Cellular Accumulation eg.water, glycogen, fat, protiens, pigmentation
Injurious Agents: Extracellular Agents Physical agents eg. Heat, Cold, radiation, Trauma. Chemical agents eg. Organic & inorganic compounds, Toxins, enzymes. Hormonal disorders Intracellular Agents
Irreversible Injury=Necrosis (cell death) Structure changesNuclear changes Pyknosis karyorrhexis kariolysis Cytoplasmic changes
O2 deprivation Loss of intracellular Ca++ homeostasis Intracellular accumulation free radicals
Diagram 0f cell injury Cell membrane Mitochondria Loss of Essential Function More or Less depend on type And severity of Injurious agents Reversible or nonlethal injury Withdraw Causes Return to normal Irreversible or Lethal injury Cell death [necrosis] Endoplasmic reticulum Nucleus
Cell Biochemical defects Cell Oxygen ischemia ca++ homeostasis ---- - - --
Cells ischemia Mitochondria Biochemical changes Emergency pathway Cell Damage energy dependentloss Na+,Ca+Pump
Loss of intracellular Ca++ homeostasis (lack of energy)Hypoxia = aerobic metabolism stop
Extra Cellular Ca++ ( 1.06-1.32 mm. Mol.) Cell membrane-----------------------------------------------------------------Intracellular Ca++ ( < 0.1 Mol.) Mitochondria Endoplasmic reticulum Release Ca++ Cytosolic Ca++ Activate Enzymes Activity
Anaerobic glycolysis ATP
Ribosomes ER
Release Ca++
Ca++,Na+ K+ - - ER
Glycogen glucose Glycogen
glucose + Lactic acid () pH
Proteins
AT Pase
Phospholipase
Protease
Endonuclease
Chromatin (Nuclear changes)
ATP decrease
Lipid * cell membrane damage
* disruption protein of cell membrane * Cytoxkeleton damage
Nuclear chromatin damage
3. [Free radicals ]Intracellular normal MetabolismBy oxidative process
Morphological Changes in reversible injury ultra structure Changes Cell wall; bleb Mitochondria swelling ER. swelling detach ribosomes
Histological changesCell * cloudy swelling * Vacuolar changes in cytoplasm * Hyaline changes in cytoplasm * Pyknotic Nuclei : * Accumulation of endogenous Substances
+ [=free electron unstable molecules ](catalist) , ActivatedAutocatalytic reaction protein fat..
releaseFree radicals Again Damage to cell wall, Organelles
Cell DeathNecrosis Apoptosis * Programmed cell death = Gene , characterized by cell shrinkage intracytoplasmic debris (Apoptotic bodies) follow by nuclear pyknosis and removed by phagocytic cell
Pathological cell death occur follow irreversible degeneration or direct lethal injuryReversible injuly ( Intracellular Fat Deposition)
Type of Necrosis (Classify by Gross changes)Coagulative necrosis Liquefactive necrosis Fat necrosis Caseous necrosis
Morphological changes in cell death (Microscopic Necrosis)Nuclear changes Pyknotic nuclear deeply basophilic mass Karyorrhexis Karyolysis Cytoplasmic changes Homogeneous deeply acidophillic staining Vacuolation Autolysis
Special type necrosis
*Fibrinoid necrosis (micro change) *Gangrene : Dry or Wet type (grosschange)
Somatic Death = [dead of Body] * Vital organs Eg. R.S - CVS - CNS Brain death , reflex ( EEG )
Sequences of Dead Body temperature drop down to environmental temperature Rivor Mortis=body blood fall down by gravitation and accumulate in lower part of body Rigor Mortis= rigidity of body (first start on mandible) Putrefaction [Autolysis]
Post test Cell pathology
1. Organelle Mitochondria ? A. B. C. D. E. 2. @ Metaplasia A. B. 3. 4. 5.
Pathogenesis: O2
Cell Anoxia
mitochondria Anoxia
Defined technical terms
Mitochondria ATP ATP Anaerobic Metabolism glycolysis ( glycogen Glucose) + Lactic acid () ADP ATP ( cell) PH ( Cytoplasm) Enzymes
Glucose
Na+pump +, K+, H O cell, mitochondria, ER Na 2 Ribosomes , Clumping chromatin Proteins