Introduction To

Pathology
[Link] (MD, Assistant prof)
What is Pathology?

• Def. Pathology is study of disease/suffering (pathos/logos) and its

causation.
• Disease is any alteration of Health
• WHO Def. of Health: is a complete well being: Physically, Mentally
and Socially.
• Core substances in pathology:
1. Etiology 2, Pathogenesis 3, Morphology and 4, Manifestation
What is Pathology?

• Pathology is the scientific study of disease

• Pathology is the foundation of medical science & practice
• Pathology is a bridging discipline devoted to the study of the
structure & functional changes in cells, tissues & organs that
underlie diseases
History of Pathology
• Era of Medical Antiquity, the early dominance of animism, diseases
caused by mystification
• Era of Morbid Anatomy
Autopsies performed scientifically from about 1500A.D, 19 th century
in Germany by ROKITANSKY & ASCHOFF
Subdivisions of Pathology

• Histopathology: The investigation & diagnosis of disease from the

examination of tissues architectural organization
• Cytopathology: The investigation & the diagnosis of disease from the
examination of isolated cells
• Haematology: The study of the disorders of the cellular & coagulable
components of blood
• Toxicology: The study of the effects of known or suspected poisons
• Forensic pathology: The application of pathology to legal purposes
(e.g. investigation of death in suspicious circumstances and criminal
asualts)
• Chemical pathology : The study & diagnosis of disease from the
chemical changes in tissues & fluids
Techniques of pathology

• Light Microscopy- appreciates the structure of tissues & cells in

health & disease
• Histochemistry- is the study of the chemical component and their
distribution in tissues
• Immunohistochemistry- is histologic study employing antibodies and
antigen reaction to visualize substances in tissues sections or cell
preparations
• Electron Microscopy- study of disorders at very high magnification,
1,000,000 times; at organelle level & demonstration of viruses in
tissue samples
• Biochemical assays- Fluid & electrolyte homeostasis, serum enzyme
assays e.g. raised levels of cardiac enzymes in the blood
• Radioisotope techniques (Autoradiography): Scans diseases using
intake of different isotopes eg. Thyroid diseases by iodine isotopes
• Molecular Pathology- Uses advances of new science, molecular
pathology eg. in the study of genetic defects, using DNA technology;
eg. IN SITU HYBRIDISATION in different diseases [Link] molecule,
collagen. etc
General & Systematic
Pathology
• General Pathology: is teaching of our current understanding of the
causation, mechanisms and characteristics of the major categories
of disease (e.g. congenital, acquired, inflammation, tumors or
degenerations)
• Systematic Pathology: is teaching of our current knowledge of
specific diseases as they affect individual organs or systems
([Link], lung cancer, atheroma).
Learning Pathology

• Pathology is learned through a variety of media:

• Text book
• Relatively didactic lectures
• Tutorials
• Demonstrations (gross & microscopic
examination of diseased tissues)
• Post-mortem teaching
• Problem- solving orientated practical classes
What should we learn in pathology?

• A logical & orderly way of thinking about diseases &

their characteristics:
– Incidence and prevalence
– Etiology
– Pathogenesis
– Pathological (morphologic) features
– Clinical features (manifestations)
– Diagnoses
– Complications and sequelae
– Prognosis
Etiology of diseases

• Def. Etiology is cause of disease

• General Features of etiology
• Single or multiple causes of a disease
• Single cause a particular disease of different severity
• Some times no disease by the particular etiology
• Important terms related to etiology;
• Pathogenesity: the power of inflicting disease of by an etiology, particularly

of infectives.
• Susceptibility: The liability of a person to acquire a particular disease
• Associated factors: Factors contributing to the severity or occurrence of a
particular disease.
Classification of etiology

• Genetic : Inherited chromosomal abnormality or mutations

• Aquired: causes disease after birth
• Dietary deficiency: Usually multiple and complex deficiency
of diets. Not usually due to inadequate intake ([Link]
absorpition)
• Dietary over intake: Obesity, Diabetes M, Hypertension and
heart diseases
Classification of etiology

• Physical agents: Trauma, Heat and cold, electricity,

radiation, atmospheric pressure
• Chemicals: Drugs, Industrial products (agriculture or home
use)
• Infective microorganisms
• Immunologic
• Psychogenic: Aquired mental illness, addiction,
Psychosomatics (Peptic Ulcer)
 Morphology
• Def.: Structural alterations underlying diseases, progressively or regressively

to give different manifestations.

• The different morphologic alterations can be
• Early as Molecular
• Late as Gross (necked eye) changes
• Intermediates can be seen in microscopy :
• Routinely by Light microscopy or
• Electrone microscopy, not yet routine except, in few cases such as
renal diseases.
 Morphology cont’d…
• The morphologic changes are appreciated from the different samples
(specimens) that the clinicans send:
• Necropsy- Samples from dead body (postmortem examination, autopsy)
• Biopsy: Specimens from live patient Use of autopsy, representing the
lesion
• Body fluids- peritoneal, pleural, pericardial, joint spaces, CSF, Urine,
Blood, Cystic spaces fluid, Sputum etc.
• Surface scrapes- mucosal (eg. buccal, conjunctival) and skin surface
lesions sampling
• Aspirations: sampling of solid organs or inaccessible or small spaces by
needle eg. Bone marrow, L. nodes and endometrial cavity
• Washes: sampling of inaccessible spaces or surface by rinsing using
isotonic fluids.
• Brushing: sampling of small delicate spaces or surfaces such as bronchial
mucosa
PATHOGENESIS

• Def.: Development of disease altering the structure progressively or

even regressively. This is the knowledge it helps us predict the out come
of disease or prognosis.
• The mechanism through which the etiology (cause) operates to produce
the morphological alterations and clinical manifestations.

Manifestation
Def.: Characteristics representing underlying morphologic alterations
which they alter the Anatomical, Biochemical and Physiological which
the patient may complain or the clinician appreciates.
Diagnostic Pathology
• Biopsies are samples of tissue removed from a patient for diagnostic
purposes.
• Biopsies can be obtained by a variety of methods:
• Needle biopsy
• Endoscopic biopsy
• Incisional biopsy
• Excisional biopsy (resections)
• Cytology involves the examination and interpretation of dispersed cells
rather than solid tissues, usually for the diagnosis of cancer & pre-
cancerous lesions.
• These cells can be obtained by a variety of methods according to the
organ being investigated:
• Samples for cytology can be obtained by a variety of methods, according
to the organ being investigated

• 1. Exfoliative cytology: collects shaded cells from surfaces:

– Fluid cytology : cells withdrawn with the fluid in which they are
suspended
– Washings: cells flushed out of an organ using an irrigating fluid
– Brushing/Scraping: accessible or exposed surface

• 2. Fine –needle aspiration cytology: cells are collected by suctions of a

solid tissue using a thin needle attached to a syringe.
AUTOPSIES

• Autopsy (post- mortem examination)

• Autopsy means examination of a deceased body
• Necropsy: Tissue samples from autopsy
• Autopsies are used for:
– Determining the cause of death
– Audit of the accuracy of clinical diagnosis
– Education of undergraduates & postgraduates
– Research into the causes and mechanisms of disease
– Gathering accurate statistics about disease incidence
 Nomenclature of disease
• Common prefixes
• Primary vs Secondary
• Diseases without antecedent causes eg. Primary hypertension
• Disease with known underlying causes eg Secondary hypertension
• Stages of a disease eg. Primary tumor, Secondary tumor
• Acute vs chronic: Dynamicity of severity and onset
• Acute: Rapid onset and sharp or sever. Usually self resolve
• Chronic: Slow onset and of prolonged course
Nomenclature of disease
• Benign vs Malignant
• Benign: Non lethal and slow progression eg. benign tumor, benign
hypertension
• Malignant: Lethal and rapid course eg. Malignant tumor, Malignant
hypertension
• Hyper, Hypo and meta: Description of amount or status
• Hyperthyrodism
• Hypothyrodism
• Metaplasia (change of status) eg squamous metaplasia of endocervix
Common suffixes

• –itis: denotes Inflammatory eg appendicitis, colitis

• –oma: denotes swelling or mass eg Fibroma, carcinoma, lymphoma
• –osis: denotes state or condition not necessarily pathological eg
osteoporosis, osteoarthrosis, nephrosis
• –oid: denotes resemblance eg. Rheumatoid disease, Leukomoid
reaction, Mongoloid
• –plasia: related to proliferation or growth eg. Hyperplasia, dysplasia
• –opathy: recognized pathologic abnormality, but not specific eg
Lymphadenopathy, osteorathropathy
• –megaly: denotes enlargement eg. Splenomegaly, hepatomegaly
• -ithiasis: denotes concretions eg. Urolithiasis, Cholelithiasis
Epynomous names

• Def. Epynomous names: Disease naming after a person, place or

abbreviations, eg.:
• Grave’s disease, Hodgkin disease, Bantu’s disease, COPD (chronic obsructive
lung diseases), GOO (Gastric outle obstruction)
• Syndromes: Constellation of sign and symptoms characterizing a particular
disease eg. Cushing syndrome, Nephrotic syndrome
 Principles of disease
• Diagnosis: Giving specific name to a disease to have specific treatment or
any other management which they can be reproducible and evaluable.
• Differential diagnosis: List of diseases sharing many features that they need
farther work up to get specificity
• The process of making diagnoses involves: taking a clinical history to
document symptoms, examining the patient for clinical signs & if
necessary, performing investigations guided by the provisional
differential diagnoses based on signs & symptoms
• Prognosis: Prediction of the out come of a disease. That you may need
to discuss with the patient or relatives in planning management and
follow up works.
• Complication: The course of a disease which is unusual and could be
explainable or not