Welcome to department of pathology!

1. Welcome to department of pathology!

2. Introduction to Pathology By Gandi Li M.D. Department of Pathology West China School of Medicine Sep,2009

3. What is Disease? • Disease could reasonably be defined as internal problems that cause pain and/or interfere with a person's ability to work, play, and/or love others (by WHO)

4. What is Pathology? • Pathology is the scientific study of disease academically • More specifically, pathology is devoted to the study of the structural, biochemical, and functional changes in cells, tissues, and organs that underlie disease

5. What is Pathology? • By use of molecular, microbiologic, immunologic, and morphologic techniques, pathology attempts to explain the whys and wherefores of the signs and symptoms manifested by patients while providing a rational basis for clinical care and therapy

6. What is Pathology? • Pathology serves as the bridge between the basic medical sciences and clinical medicine , and is the scientific foundation for all of medicine • Pathology is also one of the most important methods to diagnose disease in clinical practice

7. Goal of studying pathology for medical students • Does become a physician or a pathologist? Physician or surgeon mostly • Be understand and analyze the relationship between pathologic changes and clinical manifestations • Be able to understand a pathological report correctly

8. Branches of pathology • General pathology • Cell injury • Inflammation • Repair • Hemodynamic disorders • Neoplasm • Systemic pathology

9. Four Cores of PathologyWhat? How? Why? • Etiology (causes of diseases) • Genetic • Acquired • Pathogenesis (mechanisms) • Pathological changes (lesions) • Morphological changes (anatomical pathology) • Functional changes (pathophysiology) • Molecular changes (molecular pathology) • Clinical manifestations (signs and symptoms) and sequelae (healing, complications, death)

10. How to study pathology? • The cores for studying pathology: Characteristic morphologic lesions (lesions) Functional Changes (Pathophysiology) Pathogenesis Etiology Clinical manifestations

11. What is the lesion? How develops it? Why? How to deal with it? Heart infarct: Left: gross appearance shows an infarct in left anterior wall of ventricle Right: microscopic picture of myocardial infarct. Note the myocardial fibers in right part lost the dark blue stain of nuclei. Heart infarct

12. How to study pathology? The difficulties for medical students • Medical terms and nomenclatures • For example • Hypertrophy Hyperplasia • Atrophy Metaplasia • The relationship between clinical manifestations and pathologic changes

13. How to study pathology? Background: • Basic medical sciences (anatomy, histology, physiology, biochemistry, immunology, microbiology, parasitology,et al) • Medical terms (e.g. hyperplasia, et al) • Clinical knowledge (physical examination, laboratory tests, X-ray, CT, et al)

14. How to study pathology? Approach to good result: • Lectures and textbooks • Kumar V, Abbas AK, Fausto N. Robbins and Cotran Pathologic Bases of Disease. 8th ed. Philadelphia: Elsever Saunders, 2009． • Kumar V, Cotran RS, Robbins SL. Basic Pathology. 8th ed. Philadelphia: WB Saunders, 2007.

17. Reading Material

18. How to study pathology? Approach to good result: • Laboratory practice: gross specimen and glass slides • Clinicopathologic conference (CPC) • Autopsy demonstration (real or video)

19. How to study pathology? Recommend internet web sites: • http://www-medlib.med.utah.edu/webPath/webpath.html • http://www.hxyx.com or http://219.221.200.61 • http://www.scu.edu.cn/ or http://202.115.96.43

23. 七年制学生在CAI教室上课

24. EXAMINATIONS AND GRADING • 60% Final examination • 20% Visual recognition skills by the projection of images of microscopic or gross material • 10% Scores of semi-semester examination • 10% Grade in practice (based on attendance of participation and homeworks)

25. What pathologists do? • Pathologists belong to clinicians • They do • SURGICAL PATHOLOGY • Interpret biopsies (e.g., skin, breast, gastrointestinal) • Evaluate surgical resection specimens (e.g., colectomy, nephrectomy, mastectomy) • Frozen sections (intra-operational rapid diagnosis)

26. What pathologists do? • CYTOPATHOLOGY (e.g., Pap smears, FNA - Fine Needle Aspiration) • CLINICAL PATHOLOGY • Hematology (Peripheral blood smear, bone marrow, coagulation disorders) • Chemistry (Blood, urine, cerebrospinal fluid, effusions) • Microbiology • Blood bank • AUTOPSY PATHOLOGY

30. the past

31. YEAR 2020 the future

32. “As is our pathology, so is our medicine” • “Ask not what disease the patient has, but rather what patient the disease has.” Sir William Osler (1849-1919) (Canadian Physician and medical historian, member of Big Four who established Johns Hopkin’s medical school)

33. Pathologist is doctor’s doctor

34. Summary of introduction • The definitions • disease pathology • lesion pathologist • The rule of pathology in medical education and clinical practice • How to study pathology

35. Chapter OneCellular Responses to Stress and Toxic Insults: Cellular Adaptations, Injury， and Death

37. In this Chapter • Overview: cellular responses to stress and noxious stimuli • Adaptation of cellular growth and differentiation • Overview of cell injury and cell death • Causes of cell injury • Morphologic Alterations in cell injury • Mechanisms of cell injury

38. Overview: Cellular Responses toStress and Noxious Stimuli • Homeostasis requires functional cooperation in widely distributed cells

39. atrophy, hypertrophy hyperplasia Metapllasia dysplasia degeneration intracellular accumulation

40. The relationships between normal, adapted, reversible injured and dead myocardial cells.

41. Cellular Responses to Injury • Nature and Severity of Injurious Stimulus Cellular Response • Altered physiologic stimuli: Cellular adaptations: • Increased demand, increased trophic stimulation Hyperplasia, hypertrophy • Decreased nutrients, stimulation Atrophy • Chronic irritation (chemical or physical) Metaplasia • Reduced oxygen supply; chemical injury; Cell injury: • microbial infection • Acute and self-limited Acute reversible injury • Progressive and severe Irreversible injury cell death • (including DNA damage) Necrosis • Apoptosis • Mild chronic injury Subcellular alterations in • various organelles • Metabolic alterations, genetic or acquired Intracellular accumulations; calcifications • Prolonged life span with cumulative Cellular aging • sublethal injury

42. Adaptation is a reaction to persistent stress • Concept of Adaptation: When cells encounter physiologic stresses or pathologic stimuli from outside and inside of body, they can alter themselves to achieve a new steady state and preserve viability • All kinds of adaptation may be considered as disorders of growth and/or differentiation • Cellular adaptation can be considered as a state between the normal, unstressed cell and injured, overstressed cell

43. Adaptation is a reaction to persistent stress • Cellular adaptation • Atrophy • Hypertrophy • Hyperplasia • Metaplasia • Dysplasia

44. Atrophy is a decrease in the size and function of a cell • Definition: (briefly, decrease in cell size) Shrinkage in the size of the parenchymal cells by loss of cell substances in a well developed organ or tissue is known as atrophy. Or: acquired shrinkage of cells, tissues or organs. • Simple atrophy (loss of cell size only) • Numerous atrophy (loss of cell size and number through apoptosis) • Differentiation: aplasia, hypoplasia

45. Testis: Right: Atrophied Left: Normal

46. Atrophy can be physiologic or pathologic • Physiologic atrophy is common during early development and hormone dependent organs. • Embryonic structures, such as the notochord（脊索） and thyroglossal duct（甲状腺舌骨导管）, undergo atrophy during fetal development • Thymus after adolescence • Endometrium, breast and ovary after menopause

47. Pathologic Atrophy • Decreased workload atrophy of disuse • Loss of innervation denervation atrophy • Diminished blood supply ischemic atrophy • Inadequate nutrition undernourished atrophy (cachexia) • Loss of hormone stimuli endocrine atrophy • Aging senile atrophy • Pressure pressed atrophy

48. Atrophy of the brain in an 82-year-old male with atherosclerotic disease. Atrophy of the brain is due to aging and reduced blood supply. Right: The meninges have been stripped. Note that loss of brain substance narrows the gyri and widens the sulci. Left: Normal brain of a 36-year-old male.

49. The kidneys of primary hypertension (primary granular shrinkage kidney)

50. Aneurysm of the aorta (right) with pressure atrophy of the Vertebral spine (left)