Pathology Introduction

Title - 1 Never does a man portray his character more vividly than when he is proclaiming the character of another…! Winston Churchill 1874-1965, Former British Prime Minister Apr-08 Pathology An Introduction…. Dr. Venkatesh Murthy Shashidhar Associate Professor of Pathology Fiji School of Medicine. Title - 3 Clinical Bridging Subject Foundation Apr-08 Pathology Title - 4 Medical Knowledge: • • • • • • • • Epidemiology – Where & When.. Etiology – What is the cause? Pathogenesis - Evolution of dis. Morphology - Structural Changes Clinical Significance – relate.. Management Prognosis Prevention Apr-08 Title - 5 When we know “Where, Why, When & What, then we can answer the all important question How (to solve) - Shashi….! Apr-08 Title - 6 What is Disease? • dis + ease (not at ease…) • WHO def. Complete physical, mental and social well being not merely absence of disease… • “Expression of discomfort due to structural or functional abnormality” • What is normal ? “norm” Apr-08 Title - 7 Disease Types: • Inflammatory / Neoplastic / Degenerative • Acute / Chronic – Acute – short days to weeks. – Chronic – long – months to years. • Congenital / Familial / Acquired • Genetic / Environmental • Mild / Moderate / Severe Apr-08 Title - 8 Disease & Person: • Physical / Mental • Disease can cause Stress & stress causes disease. • “Person is more important than disease” • “Pat on the back” helps more often than medicine. – I care…! Apr-08 Title - 9 Pathology • “Scientific Study of Disease” • Study of what is abnormal or wrong or disease…! • Normal  Abnormal  Treat • Diagnosis of disease is the aim of clinical pathology * • Without diagnosis….Quackery…! Apr-08 Title - 10 What is Diagnosis? • The formal name(s) used to describe a patient’s disease. • Based on the symptoms & Signs and the results of Pathology tests • Needs Knowledge of different diseases, their characteristics. • Important for management & knowing prognosis. Apr-08 Title - 11 Pathology “Is the foundation of medical science and practice. Without pathology, the practice of medicine would be reduced to myths and folklore” Apr-08 Title - 12 History of Pathology • “animism” – Philosophies of Plato – God/devil • Magic – Primitive thoughts • Humors – Phlegm – excess/def – c300 • Abiogenesis – Spontaneous – to c1800 • Environmental – Modern - from 1850. • Genetic – Molecular – from 20th century Apr-08 Title - 13 Past and Present….! In the past, .. people mistook magic for medicine…! Now people mistake medicine for magic….! Apr-08 Title - 14 Scope of Pathology • • • • • • • Clinical Pathology Experimental Pathology Molecular Pathology Forensic Pathology Chemical / Microbiology Immunopathology Genetics & Disease. Apr-08 Title - 15 Subdivisions of Pathology: • • • • • • • • • Histopathology Cytopathology Haematology Microbiology Immunology Chemical Pathology Genetic Pathology Toxicology Forensic Pathology Apr-08 Title - 17 Learning Pathology: • General Pathology – Common changes in all tissues. • E.g.. Inflammation, cancer, ageing. • Systemic Pathology – Specific changes in organs. • E.g.. Goiter, pneumonia, breast cancer. Apr-08 Title - 18 “While much still needs to be uncovered to link abnormal genes and the expression of disease, gone are the time when the mechanisms of most diseases were unknown? or obscure? or mysterious?” Apr-08 Title - 19 Disease Disease Disease Disease Disease One agent  One disease - Malaria Several agents  One disease - Diabetes One agent  Several diseases - Smoking Apr-08 Title - 20 Etiology: What is the cause? • Environmental agents: – Physical – Chemical – Nutritional – Infections – Immunological – Psychological Multifactorial: Diabetes, Hypertension Cancer • Genetic Factors: – Age – Genes Apr-08 Title - 21 Causes of cell injury and disease • • • • • • • Oxygen deprivation ( hypoxia, ischemia) Nutritional imbalances Physical agents Chemical agents and drugs Infectious agents Immunologic reactions Genetic derangements Apr-08 Title - 22 Pathogenesis: Development • “Sequence of events in the response of cells & tissues to a stimulus/pathogen” starting from the initial stimulus to the ultimate expression of disease.” • Gross and microscopic Structure, Function, Chemistry & molecular mechanisms. Apr-08 Title - 23 Morphology: Structure Change • Structural changes in disease. –Tumor in a cancer. –Ulcer in a infection. –Atrophy is dementia. • Gross & Microscopic. Apr-08 Title - 24 Clinical Significance: • Patient Signs and symptoms are related to underlying pathology… – Why a malaria patient has fever? – Why not diarrhoea? • Prognosis of disease depends on inside pathology. • What treatment is suitable for this patient? • Is he going to recover or die soon? Apr-08 Title - 25 Classification of Diseases: • Developmental – genetic, congenital. • Inflammatory – Trauma, infections, immune, etc. • Neoplastic – tumors cancers • Degenerative – ageing. Apr-08 Sample Patient Case: Title - 27 Clinical Details: • 34 year Fijian male. • Neck swelling, 2-3 months. • Fever, weight loss. • no other abnormality. • Biopsy of mass done. Apr-08 Title - 28 Right neck mass • • • • • • • • • Temp 39.2 ESR – 120 mm/h LDH – High Hb – 7.2 Sugar - normal. Bilirubin - High WBC – 28,370 Lymphocytes 78% Biopsy of mass done. Apr-08 Title - 29 Lymphnode Biopsy •Diffuse tumour •Capsule Apr-08 Title - 30 Lymphnode Biopsy •Large cells •Mitotic figures Apr-08 Title - 31 Lymphoma / T NHL • • • • • • • Enlarged lymph nodes.. Fever, weight loss. Loss of lymphnode archetecture Large cells with less cytoplasm Diffuse pattern – no follicles. Plenty of mitotic figures T-cell NHL – malignant lymphoma. Apr-08 Title - 32 Self Directed Tutorials th ..! Next Thursday 24 Apr-08 Title - 33 Pathology Summary: • • • • “Scientific Study of Disease” Scope of Pathology Subdivisions of Pathology Study of Pathology – Etiology: What causes disease?. – Pathogenesis: How does disease develop? – Morphology: Structural change in disease? – Clinical Significance: Link to clinical F? Apr-08 Title - 34 I hear, I forget I see, I remember I do, I understand Chinese Proverb.. Apr-08