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

Marc Imhotep Cray, M.D. 2
“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

“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 …

PATHOLOGY: SCIENTIFIC STUDY OF…
2
PATHOGENESIS 3
1 PATHO-
ETIOLOGY MORPHOLOGY
DISEASE
6 4
PROGNOSIS 5 COURSE
COMPLICATIONS

Ex: SCIENTIFIC STUDY OF DISEASE
P
PM
SEPTICAEMIA
E
ACUTE
N. meningitidis INFLAMMATION
MENINGES
MENINGITIS
P
C NH
DEATH
(IF UNTREATED) VENTRICULITIS SPREAD VIA CSF
ENDARTERITIS
HYDROCEPHALUS

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.

PATHOLOGY OBJECTIVE (2)
STRUCTURAL & FUNCTIONAL ALTERATIONS
induced by disease
CORRELATION
form
the basis by which attending
SIGNS and SYMPTOMS

are produced

SIGNS AND SYMPTOMS
DETECTED BY CLINICIAN & pathologist
PHYSIOLOGY & FUNCTION
ALTERS
ORGAN STRUCTURE
DETECTED BY PATHOLOGIST & clinician
PATHOMORPHOLOGY
LEVELS OF STUDY OF PATHOLOGY
• MOLECULAR
• CHEMICAL
• ULTRASTUCTURAL
• CELLULAR
• TISSUE PATHOMORPHOLOGY
• ORGAN

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

“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

WHAT MAY BE ADDED?
• NORMAL CELLS HYPERPLASIA or HYPERTROPHY

• FLUID EDEMA
• BLOOD CONGESTION
• INFLAMMATORY EXUDATE
• NEOPLASTIC CELLS TUMOR
• GAS EMPHYSEMA

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

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

Cell Injury Thus Reflects Two
Levels Of Severity
1. One compatible with recovery
2. The second irreversible
Morphologic changes in reversible and irreversible cell injury (necrosis).

(A) Normal kidney tubules with viable epithelial cells.
(B) Early (reversible) ischemic injury showing surface blebs, increased eosinophilia of cytoplasm, and swelling of occasional cells.
(C) Necrotic (irreversible) injury of epithelial cells,with loss of nuclei and fragmentation of cells and leakage of contents.
Robbins Basic Pathology 10e
COMPATIBLE WITH RECOVERY
CLASSIFICATION
Cell degeneration and infiltration can be
divided into several morphologic patterns
depending on metabolite(s) that accumulate
in cell

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

Cloudy Swelling (2)
This can be caused by many factors

Infections
Febrile illness
Excessive cold or heat
Anoxia
Malnutrition
Physical injury
Vascular disturbances

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

swelling

Hydropic or Vacuolar
Degeneration (2)
This degeneration is of particular prominence in
kidneys , often resulting from hypokalemia
And, in liver cells which are exposed to poisons

or toxins (such as carbon tetrachloride and
chloroform)

Hydropic/Vacuolar Degeneration(3)
On microscopic examination this appears as
small, clear vacoules dispersed throughout
cytoplasm
In severe casesvacoules coalesce and form large

clear spaces which may displace the nucleus
Progression is toward frank necrosis

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
“Integration of Basic Sciences and Clinical Medicine” nervous tissue as the result of disease
Marc Imhotep Cray, M.D.
Fatty Deposition
(Fatty Metamorphosis)
 This change is due to abnormal accumulation
of fat within parenchymal cells
Reversible Cell Injury: Intracellular Accumulations. Fatty liver showing large intracellular
vacuoles of lipid. Copstead LC, Banksia JL. Pathophysiology, 5th Ed. St. Louis, Missouri: Saunders-
Elsevier, 2013.
Fatty Deposition
(Fatty Metamorphosis) (2)
 Presence of fat represents an absolute increase in
intracellular fat and represents severe cell injury
Size of 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

Glycogen Degeneration (Infiltration)
Glycogen is normally abundant in liver and
muscle cells
In some conditions abnormal accumulations

occur producing visible glycogen vacoules
within cytoplasm or nuclei
Glycogen infiltration is found in

 Diabetes mellitus
 Glycogen storage diseases

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

cytoplasm has caused denaturation and
coagulation of cytoplasm

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

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

IRREVERSIBLE
NECROSIS
 Most of changes that indicate cellular death are
more prominent in nucleus than in cytoplasm
 Nuclear changes related to necrosis:
Margination of chromatin-chromatin condensing around
periphery of nucleus
 Chromatin clumping is reversible, but dissolution of entire

nucleus is not, and when nucleus is lost, cell will die
Pyknosis–small and dense nuclei
Karyolysis–complete lysis of the nuclei
Karyorrhexis–fragmented nuclei (generally seen in apoptosis)

Coagulation Necrosis
 This type of necrosis is characterised by cell
becoming an acidophilic mass, usually with
loss of nucleus, but>>>
 with remnants of enough basic shape to permit
recognition of cell boundaries
Coagulative necrosis. (A) A wedge-shaped kidney infarct (yellow) with preservation of outlines. (B) Microscopic view of edge
of the infarct, with normal kidney (N) and necrotic cells in the infarct (I). Robbins Basic Pathology 10e

Liquefaction Necrosis
 In this case there is a rapid and total enzymatic
dissolution of cells
 There is complete destruction of cell membrane
 This type of necrosis is seen often in brain
Liquefactive necrosis. An infarct in the brain shows dissolution of tissue.

Marc Imhotep Cray, M.D. Robbins Basic Pathology 10e 31
Enzymatic (Fat) Necrosis
 This presents with acute destruction of pancreas
 Results from release of pancreatic enzymes
outside of their normal confines=
Action upon fat by digestive enzymes
Cellular injury to pancreatic acini leads to release of powerful enzymes which damage fat by
production of soaps, and these appear grossly as soft, chalky white areas .
https://library.med.utah.edu/WebPath/CINJHTML/CINJ026.html

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
Caseous necrosis. Tuberculosis of the lung, with a large area of caseous necrosis
containing yellow-white (cheesy) debris. Robbins Basic Pathology 10e
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
Dry gangrene affecting the toes as a result of peripheral artery disease.

https://en.wikipedia.org/wiki/Gangrene
Fibrinoid Necrosis
 Seen principally w diseases of hypersensitivity
origin
 There is appearance of fibrin deposits in
connective tissue and in walls of blood vessels
Fibrinoid necrosis in an artery in a patient with polyarteritis nodosa. The wall

of the artery shows a circumferential bright pink area of necrosis with protein
deposition and inflammation. Robbins Basic Pathology 10e
Causes of Cell Injury
and Death
1) Anoxia
2) Physical Agents
3) Chemical Agents
4) Biologic Agents
5) Immune mechanisms derangements
6) Genetic Defects

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
Learn more:The Medical Database and Differential Diagnosis. pdf notes

---THE END---
Further Study:
Cell Injury and Cell Death.ppt
General & Systemic Pathology Concepts_ A Global Overview.ppt

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


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Towards Understanding the

Basic Medical Sciences

 Such an approach is seen to be more meaningful and relevant to

 Curriculum integration usually involves both horizontal and vertical

“Integration of Basic Sciences and Clinical Medicine”

Vertical: bringing together basic medial science and

“Integration of Basic Sciences and Clinical Medicine”

“Integration of Basic Sciences and Clinical Medicine”

“Integration of Basic Sciences and Clinical Medicine”

“Integration of Basic Sciences and Clinical Medicine”

2 To introduce the BASIC RESPONSES of the

• Correlation with clinical picture.

“Integration of Basic Sciences and Clinical Medicine”

SIGNS and SYMPTOMS

“Integration of Basic Sciences and Clinical Medicine”

DETECTED BY CLINICIAN & pathologist

PHYSIOLOGY & FUNCTION

DETECTED BY PATHOLOGIST & clinician

“Integration of Basic Sciences and Clinical Medicine”

i.e. how a disease process alters the “shape”

“Integration of Basic Sciences and Clinical Medicine”

AS A PRECEPT THERE IS BUT ONE

SOMETHING MUST BE ADDED TO THE ORGAN

“Integration of Basic Sciences and Clinical Medicine”

• NORMAL CELLS HYPERPLASIA or HYPERTROPHY

“Integration of Basic Sciences and Clinical Medicine”

“Integration of Basic Sciences and Clinical Medicine”

 The agents which cause cellular degeneration and/or

“Integration of Basic Sciences and Clinical Medicine”

Morphologic changes in reversible and irreversible cell injury (necrosis).

“Integration of Basic Sciences and Clinical Medicine”

This is seen most often in renal tubular cells,

Organs with this affect are slightly larger , firm

“Integration of Basic Sciences and Clinical Medicine”

This can be caused by many factors

Marc Imhotep Cray, M.D. 19

It is caused by same affects that produce cloudy

“Integration of Basic Sciences and Clinical Medicine”

And, in liver cells which are exposed to poisons

“Integration of Basic Sciences and Clinical Medicine”

In severe casesvacoules coalesce and form large

Progression is toward frank necrosis

Size of fat vacuole is not dependent on

There are multiple causes which lead to this

Fatty change is often preceded by cloudy swelling

“Integration of Basic Sciences and Clinical Medicine”

In some conditions abnormal accumulations

Glycogen infiltration is found in

“Integration of Basic Sciences and Clinical Medicine”

This degeneration implies that injury to cell

“Integration of Basic Sciences and Clinical Medicine”

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. 28

 Chromatin clumping is reversible, but dissolution of entire

Marc Imhotep Cray, M.D. 29

Marc Imhotep Cray, M.D. 30

 This type of necrosis is seen often in brain

Liquefactive necrosis. An infarct in the brain shows dissolution of tissue.

Marc Imhotep Cray, M.D. 32

Dry gangrene affecting the toes as a result of peripheral artery disease.

Fibrinoid necrosis in an artery in a patient with polyarteritis nodosa. The wall