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Dr Huzlinda Hussin MD (USM), MPath (UM) Pathologist Department of Pathology FMHS, UPM
What is pathology?
Pathology is literally the study (logos) of suffering (pathos) More specific- a bridging discipline involving both basic science and clinical practice and is devoted to the study of the structural and functional changes in the cells, tissues and organs that underlie disease. The study of pathology- general pathology (GP) and systemic pathology (SP). GP-basic reactions of cells and tissues to abnormal stimuli that underlie all diseases. SP-examines the specific responses of specialized organs and tissues to more or less well defined stimuli.
4 aspects of disease process that form the core of pathology are: 1. Etiology: cause of disease 2. Pathogenesis: mechanisms of disease development 3. Morphologic changes: structural alterations induced in cells and organs of the body 4. Clinical significance: functional consequences of the morphologic changes
1. Etiology or Cause
2 major classes of etiologic factors: 1. Intrinsic/ genetic- developmental, cytogenetic
defects.
2. Acquireda) b) c) d) e) f) Hypoxia and ischemia Physical agents- trauma (mechanical/thermal), radiation Chemicals & drugs Microbial agents- eg bacteria, virus,fungus, etc Immunologic agents- eg: hypersensitivity reactions, autoimmune disease, etc Nuritional derangements (excess or deficiency) -eg: marasmus (protein def), vit def , iron def anaemia, obesity, etc.
Knowledge of etiology remains the backbone: Disease diagnoses Understanding the nature of diseases Treatment of diseases.
2. Pathogenesis
Refers to the sequence of events in the response of cells of tissues to the etiologic agent, from the initial stimulus to the ultimate expression of the dz.
Eg: to understand cystic fibrosis- need to know not only the defective gene and gene products but also the biochemical, immunologic and morphologic events leading to the formation of cysts and fibrosis in the lung, pancreas and other organs
3. Morphologic changes
Refer to the structural alterations in cells or tissues that are either characteristic of the disease or diagnostic of the etiologic processtissue reaction to injury Characteristic of the disease Diagnostic of the etiologic process
outcome of injury
Sequential development of biochemical and morphologic changes in cell injury. Cells may become rapidly non-functional after the onset of injury, although they are still viable, with potentially reversible damage. A longer duration of injury may lead to irreversible injury & cell death and typically this precedes ultrastructural, light microscopic & grossly visible morphologic changes.
What two cellular changes are seen at the light microscope level in reversible cell injury?
1. Cellular swelling (hydropic change/ degeneration) 2. Fatty change
At the LM level, what cellular changes are seen in cellular swelling (hydropic)?
1. Small clear vacuoles (pinched off ER) 2. Hydropic change or vacuolar degeneration
Fatty change- hepatocytes (nucleus is squeezed into the periphery of the cytoplasm by fat vacuoles)
What are two examples of cells that are involved in and dependent on fat metabolism? Hepatocytes myocardial cells **Other occurs in muscle and kidney
In reversible cell injury, what induces fatty change in cells involved in and dependent on fat metabolism?
Hypoxic, toxic or metabolic injury
What is the cause of irreversible cell injury and what does it lead to?
1. Continued exposure to damaging stimulus 2. Leads to cell death