Introduction to Pathology By S pongsabutra 3 June

Introduction to Pathology By S. pongsabutra 3 June 90.

Basic Groups of Diseases กลม 1 Congenital Disorders Hereditary Disease กลม 2 Reaction of Congenital anomaly * Genetics * Abnormal Growth diseases & Development eg. hare lip, cleft palate etc. กลม 3 of Formation Tumor ; self defense * Non Neoplastic mechanism * Neoplastic * inflammation * Immune disorders กลม 4 Unclassified Diseases: * most 0 f unclassified diseases usually are complex in nature such as metabolic , degeneratives , neuropsychic diseases …etc…

หวขอ การศกษาโรคในอ วยวะตางๆ *Etiology * Pathogenesis *Pathological change= lesion * Clinical manifestation * Complication * Prognosis

ตวอยางการเปรยบเทยบ Normal squamous cell vs abnormal squamous cell? Structure Normal mucosal small bowel vs abnormal mucosal small bowel? Normal organ liver vs abnormal organ liver? Function sugar? Normal blood sugar vs abnormal blood eg. Blood sugar between non diabetes and diabetes patients…. . etc…. .

Liver Abnormal changing surface liver– characterized by brownish yellow color and diffuse small nodular lesions size 1 -2 mm,

Abnormal change cut surface liver characterized by multiple nodules , varying in size, up to 1 cm. grey– white color

Liver Abnormal change cut surface liver show diffuse small white Solid masses, size vary from~ 1 -3 mm.

Abnormal histologic changes of cell characterized by shape, size and their nuclei, and loss of organ Architecture

Abnormal cut surface, diffuse dark red spots alternated with yellow –brown color cut surface

Abnormal histologic picture characterized by loss of Liver cells cords around the dilated Central vein and also dilated sinusoidal spaces

Abnormal cut surface shows multiple areas varying in size contain dark green liquefaction tissue dead

Histologic picture shows space lining with abnormal proliferate glandular structures around the foreign bodies

4. 2 ความรพนฐานโครงสรางและหนาทอวยวะเพอนำมาใชเปรยบ Anatomy, Physiology ของระบบC. V. S ; R. S เทยบ : ทคาดวามปญหา Normal Function of organs Normal structure 0 f organs Heart & Lung eg. Character of valves; leaflets and chordae tendinae; normal contour? Size and shape 0 f Heart. ventricular wall thickness. Character of Lungs both macromicro. Structure …etc. . -Heart & Lung : -rate and rhythm of Heart beat? - Sound of blood flow through valves? -Respiratory sound and rate ? ---etc…

44. ความสมพนธระหวางพยาธสภาพ อาการและสงตรวจพบทอวยวะนน กบ Clinico – Pathological Correlation Sign, Symptom VS Anatomical and Functional changes 0 f Heart (mitral valve lesion) with lungs (complication) Primary Anatomic changes Mitral Valve stenosis? [ Leaflets characterized by sclerosis, fused together, result in narrow opening ] Primary Functional changes Diastolic Murmur gr. 4? Flow of blood through Mitral Valve stenosis during lt. Atrium systole and Lt. ventricle-Diastole, genesis murmur at the same time volume blood through in LV chamber is lessen than normal

Anatomic changes Functional changes Mitral Valve stenosis Diastolic Murmur gr. 4 Lt. Ventricle contain blood Volume less than normal Increase work load to heart caused H. R. 115 / min = Compensate for normal blood Volume [1 st. . Step] Lt. Ventricular Hypertrophy for increase blood Volume [2 st. . Step] Overload เลอดคงในปอด ดนนำในหลอดเลอดซม เขาถงลมปอด ( pulmonary edema) แยงทอากาศ หลอดเลอดดำทคอคงโปง เนองจาก เลอดทนยอนกลบ ไหลเขา RT. Atrium Lt. sided Heart failure= การสบฉดเลอดลมเหลว RR. 20/min หายใจหอบ(=เรว )เหนอยเพ อใหได O 2 เทาเดม

Lt. atrium Rt. atrium bicuspid valve Tricuspid valve) Lt. ventricle Interventricular septum Chordae tendinae Normal Heart

Pathological changes: Heart valve Mitral valve and chordae tendinae show sclerotic changes in chronic Rhumatic endocarditis

Mitral valves show fusion of the sclerotic leaflets with mar. Ked narrowing the Openning in rhumatic heart dis.

Abnormal left Ventricular wall, hypertrophic change

Abnormal Cardiac muscles Fibres, (larger than normal) and contain large amount fine & brown pigment in cytoplasm

Pulmonary alveoli contain marked amout of acidophilic homogeneous material and vacuoles varying in size

Clinical problems (sign& symptom) Basic medical sciences

Cell Pathology เนอหาและวตถประสงคการเร ยนร : *Review cell biology *cell adaptation *cell Injury ( degeneration & necrosis) * Somatic death

Basic Cell Structure Organelles สวนประกอบซงเปนโครงสรางพนฐานทจำเปนของเซลล (r. ER, s. ER) Endoplasmic Reticulum Nucleus Nuclear membrane Products Mitochondria Cytoplasm Cell wall (Plasma membrane) Nuclear Pores Cell = Smallest unit of life which having ability to be free living by interaction with the environment

Cell adaptation หมายถงการปรบทงโครงสรางและการทำงานของเซลล ใหสอดคลองกบสภาพแวดลอมทเปลยนแปลง ไปเพอ maintain internal homeostasis โดยรวมของรางกายใว การปรบตวเกดการเปลยนรปรางขน หลายลกษณะ อาธ เชน ; * Atrophy decrease in size * Hypertrophy increase in size * Hyperplasia increase in cell number * Metaplasia = normal original Cell transformation to another type cell (adult cell) * Dysplasia = abnormal tissues

Senile Atrophy Brain) brain change in old age(

Atrophy (adaptation of endometrium)

Hyperplasia (adaptation of endometrium)

Squamous metaplasia (adaptation of endocervix mucosa)

Hypertrophy heart ( adaptation of heart muscle )

Normal epidermis

Hyperplasia (adaptation of epidermis)

Dysplasia (squamous epithelium of uterine cervix)

Cell Injury การบาดเจบและความเสยหายของเซล ส (Structural Damage and Functional Disorders(

Type of cell Injury Reversible injury Degener ation Structure changes Histologic picture Ultrastructure organelles Irreversible Injury =Necrosis (cell death) Structure changes Functional changes Defect in chemical changes Cellular Accumulation eg. water, glycogen, fat, protiens, pigmentation Nuclear changes Pyknosis karyorrhexis kariolysis Cytoplasmic changes

Injurious Agents : สาเหตการบาดเจบ Extracellular Agents • Physical agents eg. Heat, Cold, radiation, Trauma. • Chemical agents eg. Organic & inorganic compounds, Toxins, enzymes. • Hormonal disorders Intracellular Agents • O 2 deprivation • Loss of intracellular Ca++ homeostasis • Intracellular accumulation free radicals

Diagram 0 f cell injury ความเสยหาย Cell membrane Endoplasmic reticulum Mitochondria Nucleus Loss of Essential Function More or Less depend on type And severity of Injurious agents Reversible or nonlethal injury Withdraw Causes Return to normal Irreversible or Lethal injury Cell death [necrosis]

Loss of intracellular Ca++ homeostasis (lack of energy) Extra Cellular Ca++) ประมาณ 1. 06 -1. 32 mm. Mol(. Cell membrane---------------------------------Intracellular Ca++) ประมาณ < 0. 1 Mol. ) Mitochondria Endoplasmic reticulum Release Ca++ ปรมาณ Cytosolic Ca++ Activate Enzymes Activity AT Pase Phospholipase Protease Endonuclease ATP decrease Lipid * cell membrane damage * disruption protein of cell membrane * Cytoxkeleton damage Nuclear chromatin damage

3. ความเสยหายจากการสะสม อนมลอสระ [Free radicals[ Intracellular normal Metabolism By oxidative process พลงงาน + อนมลอสระ [=free electron unstable molecules ] สามารถเขารวมหรอจบกบสาร (catalist) ขางเคยงไดงาย โมเลกลของโปรตน , ไขมน และคารโบไฮเดรต Activated Autocatalytic reaction protein fat. . … release Free radicals Again Damage to cell wall, Organelles เชน

Morphological Changes in reversible injury ultra structure Changes • Cell wall; bleb Histological changes Cell * cloudy swelling • Mitochondria swelling * Vacuolar changes in cytoplasm • ER. swelling * Hyaline changes in cytoplasm • detach ribosomes * Pyknotic Nuclei : * Accumulation of endogenous Substances

Reversible injuly ( Intracellular Fat Deposition)

Cell Death Necrosis • Pathological cell death occur follow irreversible degeneration or direct lethal injury Apoptosis * Programmed cell death = การตายโดยอตโนมตเมอ หมดอายการใชงาน โดยการกำหนดจาก Gene , มากอนแลว characterized by cell shrinkage intracytoplasmic debris (Apoptotic bodies) follow by nuclear pyknosis and

Type of Necrosis (Classify by Gross changes) Coagulative Liquefactive Fat Caseous necrosis Special type necrosis *Fibrinoid necrosis (micro change) *Gangrene : Dry or Wet type (grosschange)

Morphological changes in cell death )Microscopic Necrosis( Nuclear changes • Pyknotic nuclear deeply basophilic mass • Karyorrhexis แตกออกเปนชน • Karyolysis ละลายหายไป Cytoplasmic changes • Homogeneous deeply acidophillic staining • Vacuolation • Autolysis

Sequences of Dead • Body temperature drop down to environmental temperature • Rivor Mortis=body blood fall down by gravitation and accumulate in lower part of body • Rigor Mortis= rigidity of body (first start on mandible) • Putrefaction [Autolysis]

Defined technical terms