Towards Understanding the Basic Medical Sciences Foundation of Clinical Medicine

7/27/2019 Towards Understanding the Basic Medical Sciences Foundation of Clinical Medicine

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

Towards Understanding theBasic Medical Sciences

Foundation of Clinical Medicine

Prepared and presented by:

Marc Imhotep Cray, M.D.

Basic Pathology

Medical Diagnosis

CORRELATION

TO




The integration of basic and clinical sciences

in undergraduate medical science

2

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 widespreadthroughout the world”




“What is

Horizontal and Vertical Integration”

3

Horizontal: bring together the disciplines, topics,

subjects of basic medial science or clinical medicine

Vertical: bringing together basic medial science and

clinical medicine




PATHOLOGY• PATH

– pertaining to a morbid process (disease)

• (from “ pathos” = travail or sorrow (Greek)

• OLOGY

– the scientific study of …

4

“Let’s exemplify vertical integration by briefly

looking at how one relates

Basic Pathology to Medical Diagnosis




DISEASE

ETIOLOGY

PATHOGENESIS

PATHO-MORPHOLOGY

COURSEPROGNOSIS

COMPLICATIONS

5

PATHOLOGY: SCIENTIFIC STUDY OF…

3

4

5

6




MENINGITIS

N. meningitidis

SEPTICAEMIAACUTE

INFLAMMATIONMENINGES

SPREAD VIA CSFDEATH

(IF UNTREATED) VENTRICULITISENDARTERITISHYDROCEPHALUS

E

P

PM

P

NHC

6

Ex: SCIENTIFIC STUDY OF

DISEASE




PATHOLOGY OBJECTIVES

1 To introduce a NEW VOCABULARY of terms,

definitions, and disease processes.

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

• Correlation with clinical picture.

7




SIGNS and SYMPTOMS

STRUCTURAL & FUNCTIONAL ALTERATIONS

PATHOLOGY OBJECTIVE (2)

8

CORRELATION

induced by disease

form

the basis by which attending

are produced




& clinician

& pathologist

PHYSIOLOGY & FUNCTION

ORGAN STRUCTURE

SIGNS AND SYMPTOMS

PATHOMORPHOLOGY

DETECTED BY CLINICIAN

DETECTED BY PATHOLOGIST

ALTERS

9




LEVELS OF STUDY OF PATHOLOGY

• MOLECULAR

• CHEMICAL

• ULTRASTUCTURAL• CELLULAR

• TISSUE

• ORGAN

10

PATHOMORPHOLOGY




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

11




“ORGANOMEGALY”

12

AS A PRECEPT THERE IS BUT ONE

CAUSE OF ORGANOMEGALY

AN ALTERATION OF MORPHOLOGY

“CHANGE IN SHAPE & / 0R SIZE”

SOMETHING MUST BE ADDED TO THE ORGAN




WHAT MAY BE ADDED?

• NORMAL CELLS

• FLUID

• BLOOD• INFLAMMATORY

• NEOPLASTIC CELLS

• GAS

13

HYPERPLASIA or HYPERTROPHY

EDEMA

CONGESTION

TUMOR

EMPHYSEMA

EXUDATE




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

14

https://docs.google.com/file/d/0B-tlCbPSHvfZTGdGNkY1TXJfRWc/edit?usp=sharing

http://www.slideshare.net/drimhotep/ivms-high-yield-image-platesgross-pathology-histopathology-microbiology-and-radiography









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

15




Cell Injury Thus Reflects Two

Levels Of Severity

1. One compatible with recovery

2. The second irreversible

16

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 bedivided into several morphologic patternsdepending on metabolite(s) that accumulate

in cell

17




Cloudy Swelling

This is characterized morphologically by a slightswelling of the cell with granularity and cloudinessof 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

18




Cloudy Swelling (2)

This can be caused by many factorsInfections

Febrile illness

Excessive cold or heat Anoxia

Malnutrition

Physical injury

Vascular disturbances

19




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

20




Hydropic or Vacuolar

Degeneration (2)

This degeneration is of particular prominence inkidneys , often resulting from hypokalemia

And, in liver cells which are exposed to poisonsor toxins (such as carbon tetrachloride andchloroform)

21




Hydropic/Vacuolar Degeneration(3)

On microscopic examination this appears assmall, clear vacoules dispersed throughout

cytoplasm

In severe casesvacoules coalesce and form largeclear spaces which may displace the nucleus

Progression is toward frank necrosisVacuole: 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 abnormal accumulationof fat within parenchymal cells

23

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 inintracellular fat and represents severe cell injury

Size of fat vacuole is not dependent on

pathologic mechanism

There are multiple causes which lead to thisdegeneration

Fatty change is often preceded by cloudy swelling

24




Glycogen Degeneration (Infiltration)

Glycogen is normally abundant in liver andmuscle cells

In some conditions abnormal accumulations

occur producing visible glycogen vacouleswithin cytoplasm or nuclei

Glycogen infiltration is found in Diabetes mellitus

Glycogen storage diseases

25




Hyaline Degeneration

In this form of cellular degeneration , there is aregressive change in cells in that cytoplasm

now has a glassy eosinophil ic appearance

This degeneration implies that injury to cell

cytoplasm has caused denaturation and

coagulation of cytoplasm

26




Mucoid Degeneration

This description refers to extracellular accumulation of mucopolysaccharide andground substance within connective tissue

This change is seen in collagen diseases

There is no intra-cellular defect

27




Cell Death and Necrosis

• Necrosis refers to morphologicchanges that follow cell death and – permit visible recognition that cell has died

28




IRREVERSIBLE

NECROSIS

Most of changes that indicate cellular death aremore prominent in nucleus than in cytoplasm

29

Nuclear changes related to necrosis:

Margination of chromatin-chromatin condensing aroundperiphery 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 acidophil ic mass, usually withloss of nucleus, but>>>with remnants of enough basic shape to permit

recognition of cell boundaries

30

Coagulative necrosis. (A) A wedge-shaped kidney infarct (yellow) with preservation of outlines. (B) Microscopic view of edgeof 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 enzymaticdissolution of cells

There is complete destruction of cell membrane

This type of necrosis is seen often in brain

31

Liquefactive necrosis. An infarct in the brain shows dissolution of tissue.Robbins Basic Pathology 10e




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

32

Cellular injury to pancreatic acini leads to release of powerful enzymes which damage fat byproduction 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 ranular, eosinophilic

mass of amorphous fat and protein

grossly looking like soft friable cheese

33

Caseous necrosis. Tuberculosis of the lung, with a large area of caseous necrosiscontaining yellow-white (cheesy) debris. Robbins Basic Pathology 10e




Gangrenous NecrosisThis is related to ischemia and a superimposed

bacterial infection initial event may have been a bacterial infection which

compromised vascularity allowing saprophytic organisms tothrivethereby further increasing ischemic change

34

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 f ibrin deposits inconnective tissue and in walls of blood vessels

35

Fibrinoid necrosis in an artery in a patient with polyarteritis nodosa. The wallof the artery shows a circumferential bright pink area of necrosis with protein

deposition and inflammation. Robbins Basic Pathology 10e

C f C ll I j



“Integration of Basic Sciences and Clinical Medicine”


Causes of Cell Injury

and Death

1) Anoxia

2) Physical Agents

3) Chemical Agents

4) Biologic Agents5) Immune mechanisms derangements

6) Genetic Defects

36

DIFFERENTIAL DIAGNOSIS




DIFFERENTIAL DIAGNOSIS

37

INFLAMMATORY

V ASCULAR

NEOPLASTIC

DRUGS

INFECTION

CONGENITAL

AUTOIMMUNE

TRAUMATIC

ENDOCRINE / METABOLIC“VINDICATE”

IS THE PROCESS..

- SUDDEN ONSET

- CARDINAL SIGNS/SYMPTOMS

- MASS

- HISTORY

- CARDINAL SIGNS/SYMPTOMS

- FROM BIRTH

- SYSTEMIC

- HISTORY

- Sn/Sx

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



“Integration of Basic Sciences and Clinical Medicine”

M I h t C M D 38

IVMS General Pathology Lecture Notes.pdf

Images

IVMS-Gross Pathology, Histopathology, Microbiology and

Radiography High Yield Image Plates

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

Further Study:

---THE END---

Cell Injury and Cell Death.ppt

General & Systemic Pathology Concepts_ A Global Overview.ppt





https://drive.google.com/file/d/0B-tlCbPSHvfZMmJtZ0xMMGwtcE0/view?usp=sharing


https://drive.google.com/file/d/0B-tlCbPSHvfZTnVpcGNTVXB5RlE/view?usp=sharing


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