BASIC

CONCEPT OF PATHOLOGY
Dr KASONDA
PEDIATRICIAN
15/ 05/ 2017
 LEARNING OBJECTIVES
a) Define pathology
b) Explain evolution of pathology
c) Identify subdivisions of pathology
d) Explain disease development
e) Classify categories of diseases
f) Explain cell injury and cell death
 Pathology
The word pathology is derived from two Greek words
pathos meaning suffering and logos meaning study.
It is a scientific study of structure and function of the
body in disease.
It deals with causes, effects, mechanisms and nature of
disease.
It is a bridging discipline involving both basic science
and clinical practice and is devoted to the study of the
structural and functional changes in the cell, tissue and
organs that underlies disease.
It attempts to explain the why and wherefores of the
signs and symptoms manifested by the patient while
providing a sound foundation for rational clinical care
and therapy.
 Evolution of Pathology
Evolution of Pathology began with the
following concepts from different era
Religious and superstitious beliefs to
rational approach (Antiquity to AD 1500).
The earliest concepts of disease were the
religious and superstitious beliefs that affliction
or disease was the outcome of curse or evil eye
of spirits.
The real practice of medicine began in the 460
to 377 BC (Before Christ). o Hippocrates
introduced ethical concepts in the practice of
medicine and admired/respected by the medical
profession by taking Hippocratic oaths at the
time of entry into practice of medicine.
Era of gross pathology (AD 1500 to 1800).
 In this era the discovery of science in diagnosis
involved studies by dissection of human body,
autopsy, and the use of microscope in
examining the diseased tissues of cells.
Era of technology development and cellular
pathology (AD 1800 to 1950s).
This era the technology of microscopy was
advanced to involve, different staining methods
or techniques, the use of electron microscope
to examine and view ultra structure of the cell
and its organelles.
During this era Papanicolaou in 1930s
developed the use of exfoliative cytology
for early detection of cervical cancer
 Era of modern pathology (1960s to
dawn of 21st century) o The major
advances in molecular biology in the
field of diagnosis and treatment of
genetic disorders, immunology and in
cancer. These includes
The description of the structure of DNA
Identification of chromosomes and their
numbers
Recombinant DNA technique
Mammalian cloning
 Subdivisions of
Pathology
Human pathology is the largest branch of pathology
It is conventionally divided into o General pathology
Which deals with general principles of disease i.e.
is concerned with the basic reaction of cells and tissue
to abnormal stimuli that underlies all diseases
Systemic pathology
Includes study of diseases pertaining to the specific organs and
body systems. This examine the specific responses of specialized
organs and tissue to more or less well defined stimuli
Histopathology used synonymously with anatomic
pathology, pathologic anatomy, or morbid anatomy, is
the classic method of study and still the most useful
one which has stood the test of time.
 Histopathology involves three (3) sub
divisions.
Surgical pathology which deals with
study of tissues removed from the living
body.
Forensic pathology and autopsy work
includes the study of organs and tissues
removed at post-mortem.
Cytopathology includes study of cells
shade off from lesions (exfoliative
cytology and fine needle aspiration
cytology of official and deep seated
lesion for diagnosis).
 Disease Development
Disease
This is loss of ease of body
It is the opposite of health, what is not healthy
is diseased
The four aspects of a disease process that
form the core of pathology are o
- Its cause or etiology
The mechanisms of its development, pathogenesis
The structural alterations induced in the cells and
organs of the body, morphologic changes
The functional consequences of the morphologic
changes, clinical significance
 Aetiology or Cause
Knowledge or discovery of the primary cause
remains the backbone on which a diagnosis
can be made, a disease understood or a
treatment developed
There are two major classes of etiologic
factors o Intrinsic or genetic o
Acquired/Environmental factor
Genetic factors are clearly involved in some
of the common environmentally induced
maladies, such as cancers and
atherosclerosis
The environment may also have profound
influences on certain genetic diseases
 Environmental Factors
Are many and are classified as follows o
Physical agents, among these are trauma,
radiations, extreme heat and cold,
electrical power, i.e. the application to the
body of an excess of physical energy in
any form.
Chemical poisoning, these are increasing with
the advances in industrial processing, some
act in general manner i.e. the toxic effect is to
all cells. Some act locally example acids and
caustics on the skin and mucous membrane
and some affect certain organs such as lungs,
kidneys, liver and pancreas.
 Nutritional deficiency and excess, these arise
as a result of poor supply, interference with
absorption, inefficient transport within the body
or defective utilisation.
The effect may be of a general nature as in
starvation or lack of oxygen.
They may cause specific damage e.g. in vitamin
deficiencies.
Dietary excess can the cause of many systemic
diseases such as cardiac diseases.
Infections and infestations, viruses, bacteria,
fungi, protozoa and metazoan all cause
diseases.
They may do so by causing destruction directly to
the tissue or damage can be due to toxins produced
by these microorganisms.
 Abnormal immunological reactions, the
immune process is normally protective
but in certain circumstances the
reaction may become deranged.
Hypersensitivity to various substances can
lead to alarming shock-like conditions-
anaphylaxis.
Immune process may act against the body
cells autoimmunity.
 Psychological factors cause and
influence disease process in several
ways.
Psychological stress may lead to mental
illness.
Their influence on the individuals symptoms
and reaction to established somatic disease
is apparent.
They are important components in disease
caused by addiction, e.g. alcohol and
tobacco.
Psychogenic factors are causally related to
diseases such as hypertension, peptic
ulcers, coronary artery thrombosis and
ulcerative colitis.
 Genetic Factors
Essentially are the results of activities of single
genes and groups of genes. Both normal and
abnormal gene influence susceptibility and
resistance to disease
Normal genes
Susceptibility of fair (light) skin to damage e.g. skin
cancer by the ultraviolet rays in sunlight. This is due
to lack of protective pigment melanin.
The blood group A is associated with increased
incidence of pernicious anaemia and gastric cancer.
Blood group B is associated with duodenal ulcer.
The human leucocytes antigen (HLA) is associated
with susceptibility and resistance to infections and
also to the occurrence of autoimmune disorders.
The blood group Duffy negative confers
resistance to infection by Plasmodium vivax
 Abnormal genes o Mutation give rise to
abnormalities of chromosomes and
components genes; the majority occur
spontaneously without known cause, in
some cases radiation, chemical or infective
agents are incriminated.
There are hereditary diseases where genetic
abnormality directly determines a disease, but
most of the diseases are multifactorial having
elements of both genetic and environmental.
There is acquired specific genetic
abnormality in stem cells, which potentiate
the development of malignant tumour
 Pathogenesis
Refers to the sequence of events in the
response of cells or tissues to the etiologic
agent, from the initial stimulus to the
ultimate expression of the disease
The study of pathogenesis remains on of the
main domain of pathology

Morphologic changes
Refers to the structural alterations in cells or
tissue that are either characteristic of the
disease or diagnostic of the etiologic process

 Functional Derangements and Clinical

Significance
The nature of the morphologic changes and
their distribution in different organs or tissues
influence normal function and determine the
clinical features, course and prognosis of the
disease.
All forms of organ injury start with molecular or
structural alterations in cells.
Cell-cell and cell-matrix interactions contribute
significantly to the response to injury, leading
collectively to tissue and organ injury which
are as important as cell injury in defining the
morphologic and clinical patterns of disease.
 The failure of adaptation as seen in
pathology may be due to o Inability to
respond adequately i.e. in overwhelming
infections for which the body has no answer.
A disease is partly the result of an adaptive
mechanism being turned against the host
instead of working to his benefit.
For example antibodies which aid to destruct harmful
parasites such as bacteria, they
can cause disease because of hosts tissue
become in anyway altered they may
themselves
be mistaken as alien and invoke a
destructive antibody response, as various
allergic disorders.
 Classification of Disease
A disease often originates from a perversion of a
survival mechanism.
Failure of adaptation tends to be self reinforcing and
progressive once a pathological process has started
one damn thing leads to another.
This is best seen in long-lasting (chronic) illness and is
often due to the inappropriate triggering of homeostatic
mechanisms.
When the body responds quickly to unfavourable
environmental events the response is often
overdone.
In normal circumstance if more leukocytes are
needed the bone marrow produces the appropriate
amount in pathological circumstances a great
excess released from the marrow.
 Pathological duels e.g. those between
bacteria and man tend to be fought to a draw
rather than outright victory. The reason for
this paradox is that natural selection favours
such a conclusion for parasite and host.
Reflection on the above mentioned theme
provides the beginning of a conceptual basic
for pathology.
Basing on body response disease can be
classified as o Congenital o Inflammatory
o Degenerative o Neoplastic
Disease usually development following failure
of cellular or tissue adaptation after injury or
damage by various agents

Overview of Cell Injury and Cell

Death
Cell injury results when cells are
stressed so severely that they are no
longer able to adapt or when cells
are exposed to inherently damaging
agents or suffer from intrinsic
abnormalities.
Injury may progress through a
reversible stage and culminate in cell
death.
 Reversible Cell Injury
In early stages or mild forms of injury
the functional and morphologic
changes are reversible if the
damaging stimulus is removed.
At this stage, although there may be
significant structural and functional
abnormalities, the injury has typically
not progressed to severe membrane
damage and nuclear dissolution.
 Cell Death
With continuing damage, the injury
becomes irreversible, at which time
the cell cannot recover and it dies.
There are two types of cell death o
Necrosis
Apoptosis
They differ in their morphology,
mechanisms, and roles in disease
and physiology
 When damage to membranes is severe, enzymes
leak out of lysosomes, enter the cytoplasm, and
digest the cell, resulting in necrosis.
Cellular contents also leak out through the
damaged plasma membrane and elicit a host
reaction (inflammation).
Necrosis is the major pathway of cell death in
many commonly encountered injuries, such as
those resulting from ischemia, exposure to
toxins, various infections, and trauma.
When a cell is deprived of growth factors or the
cell's DNA or proteins are damaged beyond
repair, the cell kills itself by another type of
death, called apoptosis, which is characterized by
nuclear dissolution without complete loss of
membrane integrity.
 Apoptosis is an active, energy-
dependent, tightly regulated type of
cell death that is seen in some
specific situations.
Whereas necrosis is always a
pathologic process, apoptosis serves
many normal functions and is not
necessarily associated with
pathologic cell injury.
 Causes of Cell Injury
The causes of cell injury range from the gross
physical trauma of a motor vehicle accident to the
single gene defect that result in a defective
enzyme underlying a specific metabolic disease.
Most injurious stimuli can be grouped into the
following categories o Oxygen deprivation
Hypoxia, or oxygen deficiency, interferes with aerobic
oxidative respiration and is an extremely important and
common cause of cell injury and death.
Hypoxia should be distinguished from ischemia, which is a
loss of blood supply in a tissue due to impeded arterial flow
or reduced venous drainage.
While ischemia is the most common cause of hypoxia, oxygen
deficiency can also result from inadequate oxygenation of the
blood, as in pneumonia, or reduction in the oxygen-carrying
capacity of the blood, as in blood loss anemia or carbon
monoxide (CO) poisoning.
 Chemical agents
An enormous number of chemical
substances can injure cells, even innocuous
substances such as glucose or salt, if
sufficiently concentrated, can so derange
the osmotic environment then cell injury or
death results.
Oxygen at sufficiently high partial
pressures is also toxic.
 Agents commonly known as poisons cause
severe damage at the cellular level by altering
membrane permeability, osmotic homeostasis,
or the integrity of an enzyme or cofactor, and
exposure to these poisons can culminate in the
death of the whole organism.
Even therapeutic drugs can cause cell or tissue
injury in a susceptible patient or if used
excessively or inappropriately.
Infectious agents
These range from submicroscopic
viruses to meter-long tapeworms, in
between are the rickettsiae, bacteria,
fungi, and protozoans
 Immunologic reactions
Although the immune system defends the body
against pathogenic microbes, immune reactions can
also result in cell and tissue injury.
Examples include autoimmune reactions against
one's own tissues and allergic reactions against
environmental substances in genetically susceptible
individuals.
Genetic defects
Genetic defects can result in pathologic changes as
conspicuous as the congenital malformations
associated with Down syndrome or as subtle as the
single amino acid substitution in hemoglobin S giving
rise to sickle cell anemia.
Genetic defects may cause cell injury because of
deficiency of functional proteins, such as enzymes in
inborn errors of metabolism, or accumulation of
damaged DNA or misfolded proteins, both of which
trigger cell death when they are beyond repair.
 Nutritional imbalances
Nutritional deficiencies remain a major
cause of cell injury.
Protein-calorie insufficiency among
underprivileged populations is only the most
obvious example.
Obesity markedly increases the risk for type
2 diabetes mellitus.
Diets rich in animal fat are strongly
implicated in the development of
atherosclerosis as well as in increased
vulnerability to many disorders, including
cancer.
 Physical agents
Trauma, extremes of temperatures,
radiation, electric shock, and sudden
changes in atmospheric pressure all have
wide-ranging effects on cells.
Aging
Cellular senescence leads to alterations in
replicative and repair abilities of individual
cells and tissues. All of these changes result
in a diminished ability to respond to damage
and, eventually, the death of cells and of the
organism.
 Key Points
Pathology is a scientific study of
structure and function of the body in
disease; it deals with causes, effects,
mechanisms and nature of disease.
Pathology is a bridge between medical
sciences and clinical medicine.
Human pathology is conventionally
divided into; o General pathology o
Systemic pathology o Histopathology
 Disease is loss of ease of body or is the opposite
of health, what is not healthy is diseased.
The study of pathology is important in medicine
and is advancing day by day.
Cell injury results when cells are stressed so
severely that they are no longer able to adapt
or when cells are exposed to inherently
damaging agents or suffer from intrinsic
abnormalities.
The causes of cell injury range from the gross
physical trauma of a motor vehicle accident to
the single gene defect that result in a defective
enzyme underlying a specific metabolic disease.
 Evaluation
What is pathology?
What are the three subdivisions of
histopathology?
Which factors contribute to disease
development?
What are the causes of cell injury
 References
Kumar, A. et al (2004). Robbins Basic
Pathology. WB: Saunders.
Spector, T.D. & Axford, J. S. (1999).
Introduction to General Pathology.
Edinburgh: Churchill Livingstone.
Walter, J.B, & Talbot, I. C. (1996).
General Pathology. New York:
Churchill Livingstone.
 T H A N K Y O U