Towards understanding the basic medical sciences foundation of clinical medicine

Towards Understanding the Basic Medical Sciences Foundation of Clinical Medicine

Basic Pathology CORRELATION TO

Medical Diagnosis “Integration of Basic Sciences and Clinical Medicine�

Marc Imhotep Cray, M.D.

Prepared and presented by: Marc Imhotep Cray, M.D.

The integration of basic and clinical sciences in undergraduate medical science IVMS teaching philosophy is based on the integration of basic and clinical sciences  This means that the learning of basic science is placed in the context of clinical medicine  Such an approach is seen to be more meaningful and relevant to medical student learning in the BMS years  Curriculum integration usually involves both horizontal and vertical integration and is the pattern that is becoming widespread throughout the world”

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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“What is Horizontal and Vertical Integration” Horizontal: bring together the disciplines, topics, subjects of basic medial science or clinical medicine

Vertical: bringing together basic medial science and clinical medicine

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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“Let’s exemplify vertical integration by briefly looking at how one relates

Basic Pathology to Medical Diagnosis

PATHOLOGY • PATH – pertaining to a morbid process (disease) • (from “pathos” = travail or sorrow (Greek)

• OLOGY – the scientific study of …

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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PATHOLOGY: SCIENTIFIC STUDY OF… PATHOGENESIS PATHOMORPHOLOGY

ETIOLOGY

DISEASE PROGNOSIS

COURSE COMPLICATIONS

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Ex: SCIENTIFIC STUDY OF DISEASE P SEPTICAEMIA

E N. meningitidis

MENINGITIS

PM ACUTE INFLAMMATION MENINGES

P DEATH (IF UNTREATED)

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

C

NH

VENTRICULITIS ENDARTERITIS HYDROCEPHALUS

SPREAD VIA CSF

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PATHOLOGY OBJECTIVES 1 To introduce a NEW VOCABULARY of terms, definitions, and disease processes.

2 To introduce the BASIC RESPONSES of the human organism to injury.

• Correlation with clinical picture.

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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PATHOLOGY OBJECTIVE (2) STRUCTURAL & FUNCTIONAL ALTERATIONS induced by disease CORRELATION

form the basis by which attending

SIGNS and SYMPTOMS are produced “Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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SIGNS AND SYMPTOMS DETECTED BY CLINICIAN

& pathologist

PHYSIOLOGY & FUNCTION

ALTERS ORGAN STRUCTURE DETECTED BY PATHOLOGIST

& clinician

PATHOMORPHOLOGY “Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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LEVELS OF STUDY OF PATHOLOGY • • • • • •

MOLECULAR CHEMICAL ULTRASTUCTURAL CELLULAR TISSUE PATHOMORPHOLOGY ORGAN

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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PATHOMORPHOLOGY • PATHO.. - the disease • MORPH .. - the shape (structure) • OLOGY .. - the study of

i.e. how a disease process alters the “shape” (structure) of cells, tissues and organs …… or …… the “DAMAGE” caused by the disease process

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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“ORGANOMEGALY” AN ALTERATION OF MORPHOLOGY “CHANGE IN SHAPE & / 0R SIZE” AS A PRECEPT THERE IS BUT ONE CAUSE OF ORGANOMEGALY SOMETHING MUST BE ADDED TO THE ORGAN

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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WHAT MAY BE ADDED? • • • • • •

NORMAL CELLS HYPERPLASIA or HYPERTROPHY FLUID EDEMA BLOOD CONGESTION INFLAMMATORY EXUDATE NEOPLASTIC CELLS TUMOR GAS EMPHYSEMA

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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HISTOPATHOLOGY / PATHOMORPHOLOGY OVERVIEW Companion learning tools to the following general pathology section: IVMS General Pathology Lecture Notes.pdf Images IVMS-Gross Pathology, Histopathology, Microbiology and Radiography High Yield Image Plates

WebPath http://www-medlib.med.utah.edu/WebPath/webpath.html

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Cellular Degeneration and Infiltration  They are related to changes which may be reversible  The agents which cause cellular degeneration and/or infiltration , when occurring over longer periods of time, will ultimately lead to the death of the cell with morphologic changes

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Cell Injury Thus Reflects Two Levels Of Severity 1. One compatible with recovery 2. The second irreversible

“Integration of Basic Sciences and Clinical Medicine�

Marc Imhotep Cray, M.D.

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COMPATIBLE WITH RECOVERY CLASSIFICATION Cell degeneration and infiltration can be divided into several morphologic patterns depending on metabolite(s) that accumulate in cell

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Cloudy Swelling This is characterized morphologically by a slight swelling of the cell with granularity and cloudiness of the cytoplasm This is seen most often in renal tubular cells, hepatic cells and cardiac muscle Organs with this affect are slightly larger , firm and pale

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Cloudy Swelling (2) This can be caused by many factors Infections Febrile illness Excessive cold or heat Anoxia Malnutrition Physical injury Vascular disturbances

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Hydropic or Vacuolar Degeneration This is a more pronounced form of intracellular edema (cloudy swelling ), and although it is reversible , it reflects a more serious injury to the cell It is caused by the same affects that produce cloudy swelling

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Hydropic or Vacuolar Degeneration (2) This degeneration is of particular prominence in the kidneys , often resulting from hypokalemia And in liver cells which are exposed to poisons or toxins (such as carbon tetrachloride an chloroform)

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Hydropic/Vacuolar Degeneration(3) On microscopic examination this appears as small, clear vacoules dispersed throughout the cytoplasm In severe cases the vacoules coalesce and form large clear spaces which may displace the nucleus Progression is toward frank necrosis

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

Vacuole: A space or vesicle within cytoplasm of a cell, enclosed by a membrane and typically containing fluid A small cavity or space in tissue, especially in nervous tissue as the result of disease

Fatty Deposition (Fatty Metamorphosis) This change is due to an abnormal accumulation of fat within parenchymal cells

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Fatty Deposition (Fatty Metamorphosis) (2) presence of fat represents an absolute increase in intracellular fat and represents severe cell injury size of the fat vacuole is not dependent on pathologic mechanism There are multiple causes which lead to this degeneration Fatty change is often preceded by cloudy swelling “Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Glycogen Degeneration (Infiltration) Glycogen is normally abundant in liver and muscle cells In some conditions abnormal accumulations occur producing visible glycogen vacoules within the cytoplasm or nuclei Glycogen infiltration is found in  Diabetes mellitus  Glycogen storage diseases “Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Hyaline Degeneration In this form of cellular degeneration , there is a regressive change in the cells in that the cytoplasm now has a glassy eosinophilic appearance

This degeneration implies that injury to cell cytoplasm has caused denaturation and coagulation of cytoplasm

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Mucoid Degeneration This description refers to extracellular accumulation of mucopolysaccharide and ground substance within connective tissue This change is seen in collagen diseases There is no intra-cellular defect

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Cell Death And Necrosis • Necrosis refers to morphologic changes that follow cell death and – permit visible recognition that cell has died

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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IRREVERSIBLE NECROSIS Most of changes that indicate cellular death are more prominent in nucleus than in cytoplasm

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Coagulation Necrosis This type of necrosis is characterised by the cell becoming an acidophilic mass, usually with the loss of the nucleus, but with remnants of enough basic shape to permit recognition of the cell boundaries

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Liquefaction Necrosis In this case there is a rapid and total enzymatic dissolution of the cells There is complete destruction of the cell wall This type of necrosis is seen often in brain

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Enzymatic Necrosis This presents with acute destruction of the pancreas Results from the release of the pancreatic enzymes outside of their normal confines

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Caseous Necrosis This seen with tuberculosis infections The cells are changed to a granular, eosinophilic mass of amorphous fat and protein grossly looking like soft friable cheese

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Gangrenous Necrosis This is related to ischemia and a superimposed bacterial infection initial event may have been a bacterial infection which compromised vascularity allowing saprophytic organisms to thrive thereby further increasing ischemic change

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Fibrinoid Necrosis This is seen principally with diseases of hypersensitivity origin There is the appearance of fibrin deposits in the connective tissue and in the walls of the blood vessels

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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Causes of Cell Injury and Death 1) Anoxia 2) Physical Agents 3) Chemical Agents 4) Biologic Agents 5) Immune mechanisms derangements 6) Genetic Defects

“Integration of Basic Sciences and Clinical Medicine�

Marc Imhotep Cray, M.D.

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DIFFERENTIAL DIAGNOSIS IS THE PROCESS..

VASCULAR - SUDDEN ONSET INFLAMMATORY- CARDINAL SIGNS/SYMPTOMS NEOPLASTIC - MASS DRUGS - HISTORY INFECTION- CARDINAL SIGNS/SYMPTOMS CONGENITAL- FROM BIRTH AUTOIMMUNE - SYSTEMIC TRAUMATIC - HISTORY “VINDICATE” ENDOCRINE / METABOLIC- Sn/Sx “Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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---THE END--Further Study: IVMS General Pathology Lecture Notes.pdf Images IVMS-Gross Pathology, Histopathology, Microbiology and Radiography High Yield Image Plates WebPath http://www-medlib.med.utah.edu/WebPath/webpath.html

“Integration of Basic Sciences and Clinical Medicine” Marc Imhotep Cray, M.D.

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