Teaching in Pathology

Theory
Practicals

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Theory : Lectures
Clinico-pathological
correlations

Lectures are introduction to topics.

Reading a text book is essential for success in
Pathology

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Practicals:
- Histopathology
- Gross
- Microscopic

- Haematology
- Microscopic

- Clinical Chemistry
- Case discussions and evaluation of laboratory
data

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Examinations: Five Incourse Assessments
Each Assessment has two components:
i. Theory (60%)
(MCQs - Single response & True/False types,
Short answer questions & Long essay)
&
ii. Practical (40%)
Practical Examination
Materials used in the practical examinations are NOT
exactly those used in the practical classes but are the
same lesions. 4
 Lecture 1

Introduction to Pathology

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 PATHOLOGY

GREEK
Pathos - Suffering
Logos - Discourse

(Scientific study of disease (suffering -

Scientific study of the way things go wrong -
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 Pathology includes:
 Microbiolgy  Virology
 Haematology  Transfusion Medicine
 Chemical Pathology  Toxicology
 Genetics  Histocompatibility and

 Immunology  immunogenetics
Histopathology
 Neuropathology  Oral Pathology

 Forensic pathology  Veterinary pathology

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 Why study Pathology ?

- Study of disease is essential to the study of

medicine

- Understanding the mechanisms of disease is

invaluable for patient care

(diagnosis, treatment, prevention)

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 DISEASE

- Departure from the normal structure and

function of an organism

- Failed or inadequate adaptation to

changes in the internal and external
environment.
FAILED HOMEOSTASIS

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 DISEASE
- Disease often arises from perversion of
homeostasis
- Failures of homeostatic adaptation are
self-promoting (i.e one damn thing leads
to another)
- Encounters between the body and
‘invaders’ more often end in draws rather
than a clear win
- Rapid bodily response to injury often
leads to an over-kill 10
 DISEASE

- Inadequate response – the young

- Unwanted side effects of homeostatic

mechanisms i.e. the enemy within

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 DISEASE

- The young produce antibodies against

invaders
- The antibodies damage self tissues in
middle age
- Disease is the other side of the coin of
Survival

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Six definitions of ‘Normal” in common clinical use
Property Term Consequences
Distribution of diagnostic test Gaussian Ought to occasionally obtainmore values
results has a certain shape to haemoglobin etc.
Lies within a preset percentile Percentile All diseases have the same prevalence.
of previous diagnostic test Patients are normal only until they are
results worked up
Carries no additional risk of Risk factor Assumes that altering a risk factor alters
morbidity or mortality rise
Socially or politically aspired Culturally Confusion over the role of medicine in
to desirable society
Range of test results beyond Diagnostic Need to know predictive values that
which a specified disease is apply in our practice
with known probability,
present or absent
Range of test results beyond Therapeutic Need to keep up with knowledge about
which treatment does more treatment
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good than harm
Top 20 non-diseases (voted on bmj.com by readers), in
descending order of “non-diseaseness”

1. Ageing 11. Chidbirth

2. Work 12. Allergy to the 21st century

3. Boredom 13. Jet lag
4. Bags under the eyes 14. Unhappiness
5. Ignorance 15. Cellulite
6. Baldness 16. Hangover
7. Freckles 17. Anxiety about penis
size/penis envy
8. Big ears 18. Pregnancy
9. Grey or white hair 19. Road rage
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10. Ugliness 20. Loneliness
 Characteristics of Disease:
- Definition
- Nomenclature
- Aetiology (cause)
- Pathogenesis (mechanism)
- Manifestation (anatomical, functional, clinical)
- Complication
- Prognosis (outcome)
- Epidemiology
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 16
Characteristics of Disease
 Disease Nomenclature

Acute - rapid onset

Chronic - slow, prolonged
Benign - not likely to kill; recovery likely
Malignant - likely to kill; lethal; deadly;
recovery unlikely
Eponymous
names - persons, places
Syndromes - combinations of symptoms and
signs or lesions 17
 Prefixes:
Commonly used prefixes and their meanings are:
 ana-, meaning absence (e.g anaphylaxis)
 dys-, meaning disordered (e.g. dysplasia)
 hyper-, meaning an excess over normal
(e.g. hyperthyroidism)
 hypo-, meaning a deficinecy below normal (e.g.
hypothyroidism)
 meta-, meaning a change from one state to
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another (e.g. metaplasia)
 Suffixes:
Commonly used suffixes and their meanings are:
 -itis, meaning an inflammatory process (e.g appendicitis)
 -oma, meaning a tumour (e.g. carcinoma)
 -osis, meaning state or condition, not necessarily pathological
(e.g. osteoarthrosis)
 -oid, meaning bearing a resemblance to (e.g. rheumatoid disease)
 -penia, meaning lack of (e.g. thrombocytopenia)
 -cytosis, meaning increased number of cells, usually in blood
(e.g. leukocytosis)
 -ectasis, meaning dilatation (e.g.bronchiectasis)
 -plasia, meaning a disorder of growth (e.g. hyperplasia)
 -opathy, meaning an abnormal state lacking specific 19

characteristics (e.g.lymphadenopathy)
Classification of Disease:
 Congenital - Present at birth
 Acquired - Environmental
- Inflammatory
- Vascular disorders
- Metabolic
- Degenerative
- Growth disorders
- Iatrogenic
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 21
A General classification of Disease
Cause Disease Example
Inherited (genetic)
Congenital - Cystic fibrosis
Late appearing - Huntington’s disease
Consequent upon growth
or ageing - Senile dementia
Infective - Pneumonia
Inflammatory - Eczema (dermatitis)
Vascular - Myocardial Infarction
Metabolic/toxic - Diabetes
Physical or chemical trauma - A burn
Neoplastic - lung cancer
Environmental - Starvation
Idiopathic (unknown) - Sarcoidosis 22
How do we study disease?
 Post-mortem examination (autopsy; necropsy)
 Gross pathology (naked-eye – macroscopic)
 Light microscopy
 Histochemistry
 Immunohistochemistry / Immunofluorescence
 Electron microscopy
 Biochemical techniques (tissues, fluids)
 Haematological techniques
 Cytology
 Cell cultures
 Molecular pathology
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 Microbiology (microscopy, culture, sensitivity tests)
 Value of the Autopsy
 Assure quality control of medical care
• Establish or confirm cause of death
• Confirm, modify or refute clinical diagnises
• Monitor therapeutic responses
• Evaluate new operative, pharmacologic and diagnostic approaches
 Enhance education

 Foster research
• Discover new or previously unrecognised diseases
• Provide essential information on disease manifestations
• Provide essential organs and tissues for research and transplantation
 Heighten total patient care
• Offer general psychoemotional benefits to the family
• Establish basis of genetic counseling
 Improve public health 24
 Value of the Autopsy

 Investigate and identify environmental, occupational and life style related

diseases
 Evaluate new prostheses (e.g cardiac, vascular, orthopedic)
 Allow forensic diagnoses
 Improve hospital reimbursements and efficiency through more accurate
diagnostic-related groups (DRGs)
 Improve accuracy of vital statistics
 Provide information and assistance to legal and judicial systems

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Partial list of Infectious Diseases discovered or clarified
by Autopsy since 1950

Pneumocystis pneumonia
Legionnaire’s disease
Whipple’s disease
Viral hepatitis
Spongiform encephalopathy (Creutzfeldt-Jacob disease)
Progressive multifocal leukoencephalopathy
Acquired immunodeficiency syndrome
Microsporidiosis
Congenital infections (e.g toxoplasmosis, cytomegalovirus)
Disseminated fungal diseases 26