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					UNIVERSITY OF THE WESTERN CAPE
 SCHOOL OF NATURAL MEDICINE

     GENERAL PATHOLOGY
             301
             2008
                         INDEX
Module
Information…...………….……………………………………………...……………Pg 3

Module
Outcomes………………………………………………………...……………………Pg 3

Assessment………………………………………………….…………………………Pg 5

How to use the learning outcomes………………………………..………………….Pg 8

Module
descriptor………………………………………………...……………………………Pg 9

Lectures information………………………………………………………………..Pg 11

Lecture Timetable…..………………………………………………………………Pg 25




                                                         2
          UNIVERSITY OF THE WESTERN CAPE
           SCHOOL OF NATURAL MEDICINE


                       GENERAL PATHOLOGY


MODULE INFORMATION, RULES AND GUIDELINES

This guide has been put together in order to facilitate your progress through general
pathology 301. You are required to read the information carefully, and it is recommended
that you refer to the rules, advice and guidelines throughout the duration of the module.

MODULE DESCRIPTION AND CONTENTS

1) What is this module about?

The aim of the module is to instruct the learner in the general disease processes of the
body and to ensure that the student understands the language of disease. The learner is
expected to know the various pathological terms used, as well as the mechanisms by
which pathological conditions are brought about.

An understanding of physiology, immunology, histology and microbiology is vital to the
understanding of the principles covered in general pathology, and the learner is expected
to be able to integrate the various medical sciences.

General Pathology will form the basis for the work covered in Systemic Pathology.

2) Outcomes:

   Critical cross fields outcomes:

   Student must be able to:

   a)   Identify and solve problems
   b)   Work in a team
   c)   Organize and manage themselves
   d)   Collect, analyse and evaluate information
   e)   Communicate effectively
   f)   Use science and technology
   g)   Recognize problem solving contexts


                                                                                           3
h)   Reflect on and explore effective learning strategies
i)   Participate as a responsible citizen
j)   Be culturally and aesthetically sensitive
k)   Explore education and career opportunities
l)   Develop entrepreneurial opportunities

Specific outcomes:

a) The student must understand that pathology is a language all on its own, that one
   needs to understand the disease process at hand and in fact that the disease
   process undergoes an evolution.
b) The student must understand that:
        The behavior of the cell is often representative of the health of the
           organism as a whole.
        Often the first signs of disease may be identified at a cellular level.
c) The student should be able to identify:
        What the potential stressors to cells may be.
        How these stressors will evoke a response out of cells.
        The consequences of these responses.
d) The student should understand that the body will always strive to survive
   (homeostasis), and that the body’s response can contribute to the disease process
   itself.
e) The student must understand:
        The concept of a space occupying lesion.
        The concept of acute phase reactants.
        The concept that the symptomatic expression of a diseased organ may
           only be in the late phase of the disease.
f) The student must understand that the physiology of a patient changes with
   acidosis and alkalosis.
g) The student will learn that a fluid that is meant to move in the body, that does not
   move, will make the patient susceptible to infection and/or fibrosis (stasis =
   fibrosis).
h) The student will be introduced to Virchow’s Triad.
i) The student must fully comprehend the consequences of necrosis and must be
   aware that different types of tissue respond differently in different environments.
j) The student must be aware of the following basic principle:
        Hypercholesterolemia  Atherosclerosis  Myocardial infarction.
k) Students will understand that acute inflammation is a linear progression of events.
l) The student must understand that inflammation, although a response to a stimulus,
   may contribute to the overall pathology.
m) Chronic inflammation has a circular progression and students must understand the
   morphological consequences of this.
n) Students must comprehend how different tissues respond to stressors and the
   clinical consequences of these adaptations.
o) The student must understand:



                                                                                     4
               The dynamic balance between the host’s health and the virulence of the
                infective agent.
             That the pre-existing health of the patient, before infection, must be
                considered.
   p)   The student must clearly understand not only the cause of the altered cellular
        morphology, but the future consequences of altered cellular morphology.
        Prevention is better than cure
   q)   The student must understand what is meant by the term ‘tumour’, and to be able
        to classify tumours accordingly.
   r)   The student must understand what is benign and malignant, and must understand
        the principles of metastases.
   s)   The student must learn not to “be fooled” by a patient’s complaint of pain, it may
        not have a local cause.
   t)   The student must realize the role of chronic viral infections in carcinogenesis (e.g.
        Hepatitis B and EBV).
   u)   The student must understand the role of genomics in disease  hereditary
        predisposition.
   v)   The student must understand the concept of managing a patient.
   w)   The student must understand that the ‘self’ must be able to recognize the ‘self’,
        and that the immune system is one chapter of homeostasis.

3) Assesment:

3.1) Course assessment rules:

In the course theoretical aspects of general pathology are assessed. The course work mark
accounts for 60 % of the final mark, and the final examination mark accounts for 40 % of
the final mark.

        Final Mark = 60% CEM (Continuous Evaluation Mark) + 40% Final Exam

       Continuous Evaluation Mark:
        - Test 1 = 35%
        - Test 2 = 35%
        - Practical Test 1 = 20%
        - Assignment = 10%

       Final Exam:
        - Examination = 100%




                                                                                            5
3.2) Tests:

Each student will write 2 theory tests and 1 practical test of 1½ hour duration each. These
will take place during lecture times on the following dates:

      Test 1: 17 March 2008
      Test 2: 28 April 2008
      Practical Test: 5 May 2008

The work to be examined in each test will comprise of all work completed in lectures,
including self-study work, up until the end of the previous lecture. The lecturer will
confirm the work to be assessed in each test at the end of the last lecture before each test
date.

Please note that dates of these tests will not be changed for any reason, and examination
rules will be in effect during these times.

3.3) Assignments:

Assignment rules: Due dates and times should be strictly adhered to. If assignments are
not handed in on the specified date, deductions of 10% everyday after will be made
(maximum of 5 days, after which no late assignments will be accepted).

3.4) Assessment Rules:

Written tests and examination papers: Questions are the same for every candidate in
general pathology. They are phrased with care. It is entirely your responsibility to
interpret them. Questions about clarity can be asked at the beginning of the test or
examination session. Thereafter do not disturb examinations by asking invigilators for
guidance (which will not be given). All answers will be credited.

Missed evaluation: Any student who misses an evaluation will score zero for it ***unless
the reason is illness confirmed by a doctor's certificate or urgent personal
circumstances acceptable to the Head of the Department of Natural Medicine.
Students will then have to write a make-up test not later than 2 weeks after the first
test.

PLEASE NOTE: The methods of assessment may vary according to the modules
requirements. Students will be informed by the particular lecturer which methods
will be part of their continuous assessment.

Methods of assessment include: assignments, case studies, clinical skills, essay,
fieldwork, oral, patient study, poster, practical, project, research project, test.

Spot tests: Expect spot tests to occur, view these as a way of assessing your progress
rather than part of the continuous assessment.


                                                                                               6
4) Attendance:

Attendance of all lectures is to your benefit as class discussions on various topics of work
covered allow for even greater clarity. An attendance register will be circulated as to keep
track of the attendance. It can also be used as a track record for those who make use of
the consultation times as a way to not attend class.

5) Guidance:

The responsibility of learning work is yours. The responsibility for helping you in the
form of content of any lecture is the lecturers. The class representative can bring to the
attention of the lecturer any problems affecting the whole class.

It is the student’s responsibility to regularly (at least once a week) check the student
notice boards for further instructions or modifications to the teaching programme.

Pacing you studies: The work covered weekly is philosophical in Nature and for this
reason many may seem to struggle with the text. Therefore you need to read before your
lectures as well as do recapping to stay with in the range of the specific outcomes for the
course.

6) Assignments & Self-Study:

Please note that from time to time, the student will be given reading/work to do in their
own time (self-study). This will be at the discretion of the lecturer, and the responsibility
to do this work lie entirely with the student.

Assignments will be given to the student by the lecturer, with a due date. Valid reasons
must be submitted, in writing, to the lecturer if this due date can’t be met. This must be
done before the due date. A reduction of 5% on the total assignment mark will be in
effect for each day late.

Please note that all work covered in self-study and assignment format may and will
be examined in tests and exams.




                                                                                                7
1. How to use the learning outcomes

2. Module descriptor of Comparative Complementary Healing Systems

3. Lectures information

4. Assessment times

5. Lecture outline



1. HOW TO USE THE LEARNING OUTCOMES

The learning outcomes were designed to guide you to achieve the competencies needed
upon the completion of the module. These competencies include ‘what you should
know’, ‘what you should be able to do’, and ‘what you should be able to show’.

Before reading the outcomes, there are some general comments, which you should
appreciate:

      The learning outcomes should provide students with a useful aide memoir when
       revising the content dealt with in the lectures. That is, they should clarify to you
       what you should be able to do upon completing a particular topic.
      The outcomes have been prepared some months in advance, and may be
       provisional in some instances. However, if the lecturer decides to modify the
       outcomes for any lecture, this fact will be made absolutely clear to those students
       attending the lecture.
      Learning outcomes should be used in conjunction with any other handouts issued
       to students during lectures.
      If a lecturer does not, in your opinion, cover the learning outcomes, as outlined
       for a particular lecture, then ask her/him for a fuller explanation
      Keep the learning outcomes with you during all classes, and when consulting
       lecturers. Add any other information the lecturer may communicate to you
       regarding the expected outcomes of particular activities




                                                                                         8
2. MODULE DESCRIPTOR


HOME DEPARTMENT: SCHOOL OF NATURAL MEDICINE
MODULE TITLE: GENERAL PATHOLOGY 301

   2.      Introduction:

   Overview and purpose

The aim of the module is to instruct the learner in the general disease processes of the
body and to ensure that the student understands the language of disease. The learner is
expected to know the various pathological terms used, as well as the mechanisms by
which pathological conditions are brought about.

An understanding of physiology, immunology, histology and microbiology is vital to the
understanding of the principles covered in general pathology, and the learner is expected
to be able to integrate the various medical sciences.

General Pathology will form the basis for the work covered in Systemic Pathology.

  1.2    Module code:
  1.3    Credit value:
  1.4    Duration:
  1.5    Module type: University
  1.6    SAQA level:
  1.7    Pre-requisites:
  1.8    Co-requisites:
  1.9    Prohibited combinations:


   3.      Outcomes:

   Critical cross fields outcomes:

   Student must be able to:

   a)   Identify and solve problems
   b)   Work in a team
   c)   Organize and manage themselves
   d)   Collect, analyse and evaluate information
   e)   Communicate effectively
   f)   Use science and technology
   g)   Recognize problem solving contexts
   h)   Reflect on and explore effective learning strategies
   i)   Participate as a responsible citizen


                                                                                           9
j) Be culturally and aesthetically sensitive
k) Explore education and career opportunities
l) Develop entrepreneurial opportunities

Specific outcomes:

a) The student must understand that pathology is a language all on its own, that one
   needs to understand the disease process at hand and in fact that the disease
   process undergoes an evolution.
b) The student must understand that:
        The behavior of the cell is often representative of the health of the
           organism as a whole.
        Often the first signs of disease may be identified at a cellular level.
c) The student should be able to identify:
        What the potential stressors to cells may be,
        How these stressors will evoke a response out of cells
        The consequences of these responses.
d) The student should understand that the body will always strive to survive
   (homeostasis), and that the body’s response can contribute to the disease process
   itself.
e) The student must understand:
        The concept of a space occupying lesion.
        The concept of acute phase reactants.
        The concept that the symptomatic expression of a diseased organ may
           only be in the late phase of the disease.
f) The student must understand that the physiology of a patient changes with
   acidosis and alkalosis.
g) The student will learn that a fluid that is meant to move in the body, that does not
   move, will make the patient susceptible to infection and/or fibrosis (stasis =
   fibrosis).
h) The student will be introduced to Virchow’s Triad
i) The student must fully comprehend the consequences of necrosis and must be
   aware that different types of tissue respond differently in different environments.
j) The student must be aware of the following basic principle:
        Hypercholesterolemia  Atherosclerosis  Myocardial infarction.
k) Students will understand that acute inflammation is a linear progression of events.
l) The student must understand that inflammation, although a response to a stimulus,
   may contribute to the overall pathology.
m) Chronic inflammation has a circular progression and students must understand the
   morphological consequences of this.
n) Students must comprehend how different tissues respond to stressors and the
   clinical consequences of these adaptations.
o) The student must understand:
        The dynamic balance between the host’s health and the virulence of the
           infective agent



                                                                                    10
                That the pre-existing health of the patient, before infection, must be
                 considered
   p)    The student must clearly understand not only the cause of the altered cellular
         morphology, but the future consequences of altered cellular morphology.
         Prevention is better than cure
   q)    The student must understand what is meant by the term ‘tumour’, and to be able
         to classify tumours accordingly.
   r)    The student must understand what is benign and malignant, and must understand
         the principles of metastases.
   s)    The student must learn not to “be fooled” by a patient’s complaint of pain, it may
         not have a local cause.
   t)    The student must realize the role of chronic viral infections in carcinogenesis (e.g.
         Hepatitis B and EBV).
   u)    The student must understand the role of genomics in disease  hereditary
         predisposition.
   v)    The student must understand the concept of managing a patient.
   w)    The student must understand that the ‘self’ must be able to recognize the ‘self’,
         and that the immune system is one chapter of homeostasis.

   4.        Teaching Methods

   a)    Formal lectures
   b)    Practicals
   c)    Assignments
   d)    Self-Study

   5.        Main Content

CH1) Introduction to Pathology & Causation of Disease

The student must understand that pathology is a language all on its own, that one needs to
understand the disease process at hand and in fact that the disease process undergoes an
evolution.

Using this knowledge the student will:

   1) Learn about maintaining the patient’s health (Wellness)
   2) Identify a disease that has progressed and use the knowledge to return the patient
      to health.

At the end of this chapter the student should be able to:

       Define pathology and its sub-disciplines
       Define the terms: disease, diagnosis, prognosis, aetiology and pathogenesis
       Understand the diagnosis of disease
       Classify diseases.


                                                                                           11
    Discuss the 10 subdivisions of acquired diseases.

CH2) The Normal Cell

The student must understand that:

   1) The behavior of the cell is often representative of the health of the organism as a
      whole.
   2) Often the first signs of disease may be identified at a cellular level.

At the end of this chapter the student should be able to:

    Distinguish between and discuss epithelial cells, connective tissue cells, endothelial
     cells and mesothelial cells.
    Describe the nucleus and discuss its functions
    Discuss the functions of cell membrane
    Describe the cytoplasm and organelles.
    Diagram and explain the cell with all its structures.
    Understand and discuss cell interrelationships
    Describe and understand the function of the multinucleate giant cell.

CH3) Cell Injury

At the end of this chapter the student should be able to:

    List the injuries which affect the cell adversely.
    Describe the functional effects of such injury.
    Define necrosis, degeneration and infiltration.
    Define ischaemia, hypoxia and anoxia.
    Understand and describe how ischaemia can cause injury to a cell.
    Define a free radical; know how they are formed and what do they act on.
    Discuss the accumulation of water, fat, protein and glycogen in a cell.
    Describe the stages of water accumulation namely: cloudy swelling, vacuolar and
     hydropic degeneration.
    Describe the pathogenesis of fatty change and how it clinically affects the liver,
     heart and kidneys.

CH4) Cell Death And Necrosis - Gangrene

The student should be able to identify:
       - What the potential stressors to cells may be,
       - How these stressors will evoke a response out of cells
       - The consequences of these responses.




                                                                                          12
The student should understand:
       - The first Golden Rule: the body will always strive to survive (homeostasis)
       - Often the body’s response will contribute to the disease process itself.

At the end of this chapter the student should be able to:

      Define necrosis and discuss its development.
      Discuss the point of death.
      Define autolysis and discuss its first indications.
      Name and discuss types of necrosis.
      Know the differences between apoptosis and necrosis
      Define somatic death; state and discuss irreversible changes following death.
      Define gangrene and mention some examples.
      Name the effects of gangrene.
      Define and discuss moist, dry and gas gangrene.

CH5) Amyloid

The student must understand:
       - The concept of a space occupying lesion.
       - The concept of acute phase reactants.
       - The concept that the symptomatic expression of a diseased organ may only be
          in the late phase of the disease.

At the end of this chapter the student should be able to:

    Define amyloid and amyloidosis.
    Mention some staining methods for Amyloid and be able to recognize Amyloid in
     affected tissue.
    Name the mechanisms of disease in amyloidosis
    Give an aetiological classification of amyloidosis
    Describe the diagnosis of amyloid.
    Discuss the clinical effects of amyloidosis in the spleen, kidney, liver and GIT.

CH6) Calcification

The concept must be understood by students that the altered morphology of tissue may
affect function but may also attract calcification.

At the end of this chapter the student should be able to:

    Define heterotopic calcification and its recognition.
    Describe the types of heterotopic calcification under the following headings:
     Dystrophic calcification, Metastatic calcification
    Describe the causes of metastatic calcification with and without hypercalcaemia



                                                                                       13
    Define and describe calculi and calinosis
    Discuss the mechanism of calcification.

CH7) Pigmentation (Self-Study)

Observation - colour has meaning.

At the end of this chapter the student should be able to:

      Distinguish between exogenous and endogenous pigments.
      Name and discuss the exogenous pigments.
      Name and discuss the endogenous pigments under the following headings:
      Melanin (including disorders of melanin pigmentation)
        - Lipofuscin
        - Haemosiderin (including the deposition of haemosiderin)
        - Haematoidin
        - Bilirubin.

CH8) Jaundice

At the end of this chapter the student should be able to:

    Describe the metabolism of bilirubin
    Distinguish between unconjugated bilirubin and conjugated bilirubin.
    Define jaundice.
    Discuss and differentiate between jaundice due to the accumulation of
     unconjugated bilirubin vs jaundice due to the accumulation of conjugated bilirubin.
    Define cholestasis
    Describe both intrahepatic an extrahepatic cholestasis as well as the clinical effects
     of them.
    Name and discuss some genetic metabolic defects of jaundice.

CH9) Fluid and Electrolyte Balance

The student must understand that the physiology of a patient changes with acidosis and
alkalosis.

At the end of this chapter the student should be able to:

      Describe the distribution of body water.
      Discuss the mechanisms for the maintenance of body water.
      Describe the sodium regulatory mechanisms.
      Describe the balance of both intracellular and extracellular fluid.
      Discuss the electrolytes and some major imbalances that could occur.
      Discuss the following conditions in detail: pure water loss, pure water excess,


                                                                                         14
     sodium and water loss, sodium and water excess.
    Discuss acid-base balance under the following headings: plasma buffers,
     mechanisms, for hydrogen ion removal, acidosis and alkalosis.

CH10) Oedema

The student will be introduced to the second Golden Rule: A fluid that is meant to move
in the body, that does not move, will make the patient susceptible to infection and/or
fibrosis.

At the end of this chapter the student should be able to:

    Define oedema, anasarca, ascites, hydrothorax and hydropericardium
    Know the 5 patho-physiological mechanisms which play a role in causation of
     oedema
    Define and discuss the 2 types of oedema: exudates and transudates
    Discuss generalized oedema and explain the examples given.
    Discuss oedema of the brain, lungs and liver.
    Discuss localized oedema and explain examples given.
    Discuss the clinical features of oedema.

CH11) Hyperaemia and Congestion

The student will need to differentiate between local congestion and wide spread
congestion.

At the end of this chapter the student should be able to:

    Define hyperaemia, mention the different types of hyperaemia and their causes.
    Mention the pathological effects of congestion.
    Discuss the changes caused by long-standing congestion in the lungs, liver, and
     spleen.

CH12) Haemorrhage

At the end of this chapter the student should be able to:

      Define haemorrhage and give its classification.
      Discuss the causes of haemorrhage.
      Know what the effects of haemorrhage depend on.
      Describe the body’s responses to blood loss.




                                                                                       15
CH13) Shock

At the end of this chapter the student should be able to:

    Describe the symptoms of a patient who is in shock. Explain what would happen if
     the shock condition is not relieved.
    Describe the different types of shock, its clinical causes and presumed
     pathogenic mechanism.
    Explain the pathogenesis of shock.
    Discuss the morphology and pathology of shock.
    Define and discuss the causes of DIC
    Mention some causes of death in shock.

CH14) Thrombosis and Embolism

The student will be introduced to Virchow’s Triad

At the end of this chapter the student should be able to:

    Define haemostasis and the three mechanisms involved in haemostasis.
    Define a thrombus; discuss thrombus formation, as well as the main factors which
     contribute to thrombosis.
    Discuss venous thrombosis under the headings: phlebothrombosis and
     thrombophlebitis, giving their clinical symptoms and causes.
    Distinguish between a thrombus and an embolus.
    Describe arterial thrombus.
    Discuss thrombosis in the heart in detail.
    Describe the fate of thrombi.
    Mention the effects of an infection thrombus.
    Define an embolus and name the materials which can act emboli.
    Discuss and have an understanding of the different types of emboli including
     pulmonary, arterial systemic, gaseous, fat, tumour, amniotic fluid and foreign body
     embolism.

CH15) Ischaemia and Infarction

The student must fully comprehend the consequences of necrosis and must be aware that
different types of tissue respond differently in different environments.

The student must be aware of the following basic principle:
       Hypercholesterolemia  Atherosclerosis  Myocardial infarction.

At the end of this chapter the student should be able to:

    Define ischaemia.



                                                                                      16
    Define an infarct and mention its effects.
    Define the different types of hypoxia
    Discuss the causes, effects and factors determining the effect and severity of
     ischaemia.
    Describe the sequence of events in infarction.
    Give a classification of infarcts.
    Understand how the body’s reaction to infarction.
    Discuss cardiac infarction, infarction of the brain, pulmonary infarction, infarction
     in the kidney, splenic and intestinal infarcts.

CH16) Acute Inflammation

Students will understand that acute inflammation is a linear progression of events.

At the end of this chapter the student should be able to:

    Define inflammation
    List the causes of inflammation
    Know the clinical signs of inflammation
    Describe the microscopic features of inflammation
    Discuss vascular permeability and exudates formation in relation to acute
     inflammation.
    Describe the major groups of chemical mediators
    Describe the cells found in the inflammatory exudates, including
     ploymorphonuclear leucocytes, mononuclear phagocytes, lymphocytes and plasma
     cells.
    Describe the number of systemic reactions to acute inflammation.

CH17) Classification of Inflammation

The student must understand that inflammation, although a response to a stimulus, may
contribute to the overall pathology.

At the end of this chapter the student should be able to:

    List the factors which may modify the inflammatory response
    Discuss the classification of inflammation according to the nature of the
     inflammatory exudates.
    Discuss the classification of inflammation according to the duration of the
     inflammation.
    Discuss the classification of inflammation according to the site of the
     inflammation.
    Discuss the various outcomes of acute inflammation.




                                                                                         17
CH18) Chronic Inflammation

Chronic inflammation has a circular progression and students must understand the
morphological consequences of this.

At the end of this chapter the student should be able to:

    Describe the histological features of chronic inflammation
    Know the classification of chronic inflammation.
    Describe chronic osteomyelitis and chronic bronchitis under the non-specific
     classification of chronic inflammation.
    Define a granuloma.
    Describe granulomatous inflammation.
    Describe the causes of granulomatous inflammation.
    List the types of giant cells.
    Describe the systemic effects of chronic inflammation.

CH19) Healing & Repair

Students must comprehend how different tissues respond to stressors and the clinical
consequences of these adaptations.

At the end of this chapter the student should be able to:

      Define the number of ways that healing can take place
      Describe the different capacities for regeneration of the various cells of the body.
      Discuss the process of healing in the lung, liver and heart tissue.
      Discuss the mechanism of healing by first and second intention.
      Discuss the mechanism of repair.
      Discuss the factors contributing to wound strength.
      Know the general and local factors influencing healing.
      Describe the complications of wound healing.

CH20) Infection and some Infectious Diseases

The student must understand:
   - the dynamic balance between the host’s health and the virulence of the infective
       agent
   - that the pre-existing health of the patient, before infection, must be considered
   - co-morbid pathology.

At the end of this chapter the student should be able to:

    List the factors determining the body’s response to infection.
    Discuss the various relationships that humans may share with microbes.



                                                                                              18
      List the various ways pathogens may gain access to the body.
      Describe the various means of spread of infections.
      List and describe the various defenses’ the body has to disease organisms.
      Discuss the effects and cascade of events which occur when there is a break in the
       body’s defense mechanisms.
      Discuss viral disease and its example: measles
      Discuss chlamydial disease and its example: lymphogranuloma venereum
      Discuss rickettsial diseasse and its example: tick-bite fever.
      Discuss bacterial diseases and its examples: boil, lobar pneumonia and typhoid
       fever.
      Know the 4 stages of lobar pneumonia.

CH21) Tuberculosis

The student needs to decide what is causing the anatomical pathology: the infective
organism or the bodies response to the infective organism.
The student must understand HIV/ Immuno-compromization and the relationship with
Tuberculosis.

At the end of this chapter the student should be able to:

       Define the causative organism of TB
       Know the 3 ways it can be identified.
       Identify the 3 ways the infection may be acquired.
       Discuss the factors determining the virulence of the disease.
       Describe the development of the lesions of TB
       Define a tubercle.
       Define the Mantoux reaction.
       Differentiate between primary and secondary TB.
       Define a Ghon focus and complex.
       Identify the various sites that TB might present in.
       Describe the local spread of primary TB.
       Describe the vascular spread of primary TB.
       Describe the development of secondary TB.
       Discuss TB in the meninges, kidneys, bone, genitalia and adrenal glands.
       Discuss the treatment and prevention of the disease.
       Discuss the association of TB to HIV infections.
       Discuss atypical mycobacteria.

CH23) Disorders of Growth

The student must clearly understand not only the cause of the altered cellular
morphology, but the future consequences of altered cellular morphology. Prevention is
better than cure (Myocardial infarct, CIN)



                                                                                        19
At the end of this chapter the student should be able to:

      Classify the disorders of growth.
      Define atrophy and distinguish between atrophy, hypoplasia and agenesis.
      Discuss and differentiate between physiology atrophy and pathological atrophy.
      Explain the causes of atrophy.
      Distinguish between hyperplasia and hypertrophy.
      Discuss the causes of hyperplasia and some examples of hyperplasia.
      Discuss the causes of hypertrophy
      Understand the mechanisms of hyperplasia and hypertrophy
      Discuss abnormalities of cellular differentiation under the following headings:
          - Metaplasia
          - Dysplasia
          - Neoplasia
          - Anaplasia

CH24) Tumours and their Classification

At the end of this chapter the student should be able to:

      Be familiar with the different definitions of tumours.
      Be able to classify tumours in the 5 possible methods.
      Identify tumours of epithelial tissue, non-haemopoietic mesenchymal tissue,
       haemopoietic tissue and neural tissue.
      Identify the special classes of tumours.

CH25) The Characteristics of Malignancy

At the end of this chapter the student should be able to:

      Be familiar with the characteristics of benign and malignant tumours.
      Describe the clinical and histological presentation of benign vs malignant
       tumours.
      Describe the cytological characteristics of malignancy.
      Be familiar with diagnostic procedures of malignancy incl: clinical, histological,
       cytological and biochemical diagnosis.
      Discuss the prognosis of benign vs malignant tumours

CH26) The Spread of Malignant Tumours

“Don’t be fooled by a patient’s complaint of pain, it may not have a local cause.”

At the end of this chapter the student should be able to:

      Describe local spread of malignant tumours.


                                                                                         20
      Describe dissemination of malignant tumours
      Discuss lymphatic spread of carcinomas
      Discuss haematogenous spread of carcinomas
      Discuss spread through body cavities of carcinomas.
      Discuss spread by implantation of carcinomas.
      Discuss the five stages by which metastasis takes place.
      Discuss the factors that govern the development of metastasis.
      Discuss the clinical importance of the site and timing of metastases.

CH27) Carcinogenesis

The student must realize the role of chronic viral infections in carcinogenesis (Hepatitis B
and EBV).

At the end of this chapter the student should be able to:

      Discuss the aetiology and incidence of cancer.
      Discuss the intrinsic and extrinsic factors that may play a role in bringing about
       cancer namely: age, heredity, environment, radiation, chemicals and viruses.
      Discuss and differentiate between cell and tumour growth.
      Describe cancerous tranformation in cells.
      Discuss cancer genes as well as the role of oncogenes and oncoproteins.
      Discuss tumour suppressor genes
      Discuss the stroma of tumours as well as the progression of tumours.

CH28: Some Tumours of Epithelial Tissure: Skin (Assignment)

At the end of this chapter the student should be able to:

      Classify tumours of epithelial tissue.
      Identify and discuss benign tumours of the squamous epithelium.
      Identify and discuss pre-malignant tumours of the squamous epithelium.
      Identify and discuss malignant tumours of the squamous epithelium
      Identify and discuss benign tumours of the basal cell epithelium.
      Identify and discuss malignant tumours of the basal cell epithelium.
      Identify and differentiate between the 3 main types of naevi namely: junctional,
       compound and intradermal naevus
      Identify and discuss malignant tumours of pigmented cells.
      Describe the factors that play a role in the prognosis of malignant melanomas.

CH29) Some Tumours of Connective Tissue (Assignment)

At the end of this chapter the student should be able to:

      Discuss benign and malignant tumours of connective tissue in general.


                                                                                            21
      Discuss and give examples of tumours of fibrous tissue, tumours of nerve sheath
       origin, myxomatous tumours, tumours of fatty tissue, tumours of smooth muscle,
       tumours of striated muscle, tumours of cartilage and bone, as well as tumours of
       mesothelium, blood vessels and synovium.


CH30) Some Tumours of Lymphoid Tissue and Bone Marrow (Assignment)

At the end of this chapter the student should be able to:

      Classify tumours of lymphoid tissue and bone marrow
      Discuss tumours of lymphocytes.
      Differentiate between Hodgkins and Non-Hodgkins lymphomas.
      Discuss leukaemias and other myeloproliferative disorders.
      Discuss plasma cell dyscrasias.
      Discuss the clinical features of multiple myeloma.
      Discuss the histiocytoses and identify the various types.

CH31) Some Tumours of Childhood (Assignment)

At the end of this chapter the student should be able to:

      Discuss the development of tumours, distinguishing congenital malformations,
       tumour-like growths, benign tumours and true neoplasms.
      Discuss and give examples of embryonic tumours of infancy
      Identify the important tumours occurring in childhood.

CH32) The Effects of Tumours

At the end of this chapter the student should be able to:

      Explain the local effects of benign and malignant tumours
      Explain the general effects of malignant tumours
      Describe paraneoplastic syndromes and give examples under the following
       headings: endocrine, neuromyopathic, cutaneous, haematological and
       miscellaneous complications.

CH33) Tissue Responses to Ionising Radiation (Self-Study)

At the end of this chapter the student should be able to:

      Understand the basic principles of radiation.
      List naturally occurring elements which may emit radiation.
      Know the effects of ionizing radiation
      Have an understanding as to how radiation is measured.



                                                                                      22
      Discuss the sensitivity of cells to radiation.
      Discuss the effects of irradiation on tissues and the whole body.
      Understand the role of radiotherapy.


CH34) Disorders of Carbohydrate Metabolism: Diabetes Mellitus

The student must understand the role of genomics in disease  hereditary predisposition.

At the end of this chapter the student should be able to:

      Define Diabetes mellitus.
      Explain the action of insulin.
      Classify the types of diabetes.
      Differentiate between insulin-dependent (type I) and non-insulin dependent
       diabetes (type II).
      Describe the morphological changes in diabetes.
      Explain the clinical features and prognosis of diabetes.
      Discuss some other examples of disorders of carbohydrate metabolism.

CH35) Some Inherited and Metabolic Disorders (Self-Study)

The student must understand inter-related pathophysiology, linking Gout to Leukemia.

At the end of this chapter the student should be able to:

      Discuss hyperlipidaemia
      Discuss marfans syndrome
      Discuss cystic fibrosis
      Discuss the lysosomal storage diseases.
      Discuss mucoplysaccharidoses
      Discuss gout

CH36) Nutritional Disorders (Self-Study)

The student must understand what is meant by metabolic syndrome

At the end of this chapter the student should be able to:

      Define and discuss obesity and know the importance of its association with other
       diseases.
      Discuss and differentiate between kwashiorkor and marasmus.
      Know the substances that may be deficient in the deficiency diseases.
      Describe deficiencies causing anaemia with emphasis on the clinical
       manifestations.


                                                                                       23
      Describe the vitamin deficiencies with emphasis on the clinical manifestations.

CH37) Localised Auto-Immune Disease

The student must understand the concept of managing a patient.

At the end of this chapter the student should be able to:

      Discuss the 3 mechanisms proposed for the development of the self-tolerance
       against autoimmune diseases.
      Discuss the 5 mechanisms proposed for the development of autoimmune diseases.
      Know the 2 major groups of autoimmune diseases.
      Discuss Hashimoto’s disease.
      Discuss the autoimmune nature of insulin-dependent diabetes mellitus.

CH38) Generalised Auto-Immune Diseases

The student must understand that the ‘self’ must be able to recognize the ‘self’, and that
the immune system is one chapter of homeostasis.

At the end of this chapter the student should be able to:

      Be able to identify some generalized autoimmune diseases.
      Know the pathological features of the collagen-vascular disorders.
      Describe systemic lupus erythematosis with the emphasis on clinical and
       pathological manifestations.
      Describe rheumatoid arthritis with the emphasis on clinical and pathological
       manifestations.
      Describe sjogrens syndrome with the emphasis on clinical and pathological
       manifestations.
      Describe scleroderma with the emphasis on clinical and pathological
       manifestations.
      Describe dermatomyositis with the emphasis on clinical and pathological
       manifestations.

   STUDENT LEARNING RESOURCES

Prescribed Text Book:

Rippey, J.J. GENERAL PATHOLOGY 1994, Witwatersrand University Press,
      Johannesburg.

Recommended Books:

Kumar, V; Cotran, R.S; Robbins, S.L. BASIC PATHOLOGY. 1997. 6th Edition.
      W.B.Sanders Company, USA.


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3. LECTURER’S INFORMATION

      Lecturer: Dr Kristian Leisegang
      Contact Number: 021 887 2177
      Email: kristianfc@gmail.com

Your lecturer will handle all queries and concerns of students, and communicate all
important information to students (via class announcements and/or notice board and/or
class representatives).

An ‘open door’ policy is in operation, and you are welcome to speak to or contact the
lecturer directly with any queries or concerns.

For matters concerning the whole class, the elected class representative must serve as a
liaison person for the entire class

4. ASSESSMENT TIMES

Each student will write 2 theory tests and 1 practical test of 1½ hour duration each. These
will take place during lecture times on the following dates:

      Test 1: 17 March 2008
      Test 2: 28 April 2008
      Practical Test: 5 May 2008

5. LECTURE TIME TABLE:

Breakdown of Learning Time:

Total Lecture Time: 42 hours
Theory Lectures: 32 hours
Practical Time: 5 hours
Tests: 5 hours
Assignment: approx. 10 hours
Self-Study: 4 Chapters (Ch 7, 33, 35, 36)


     Date             Period                Topic           Venue            Assessment
   Monday              1-3                  CH 1-3         Room ???
   04/02/08
   Monday               1-3                 CH 4-6
   11/02/08
   Monday               1-3              CH 8-10
   18/02/08
   Monday               1-3              CH 11-13
   25/02/08


                                                                                           25
Monday     1-2     CH 14-15
03/03/08    3      Practical 1
Monday     1-3     CH16-18
10/03/08
Monday     1-2       Test 1             Test 1
17/03/08    3      Practical 2
Monday     1-2     CH 20-21
31/03/08    3      Practical 3
Monday     1-3     CH 23-25
07/04/08
Monday     1-2     CH 26-27          Assignment
14/04/08    3      Practical 4       Handed Out
Monday     1-3     CH 32-34
21/04/08
Monday     1-2       Test 2             Test 2
28/04/08    3      Practical 5
Monday     1-3   Practical Test 1   Practical Test 1
05/05/08
Monday     1-2      CH37-38          Assignment
12/05/08                                Due




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