????: ??????????PATHOLOGY

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???? ??????????PATHOLOGY
By S. Pongsabutra MD.
6 June 2008
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Pre-Test

• Can you answer the following questions?
  
  
  1. What is
  the Pathology?
  
  2. How to
  Learn the Pathology?
  
  3. How clinical work and public
  health care concern with the Pathology?

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Topic Introduction to Pathology
And Forensic Medicine

By S. Pongsabutra MD.

• Contents of Learning
• 
  
• 1.The meaning and scope of pathology.
• 2. How to learn the Pathology.
• 3.The main cluster of diseases.(roots of
  diseases)
• 4. Application Pathology for the clinical work
  or other objectives such a tool of research work
  and public health care.

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1. What is Pathology

• Pathology is study the abnormal state of body
  particularly in morphology (structure) and
  function (physiology) of organ, tissue, and cell.
  Which have been changed from the normal by the
  influences of environments.
• Or
• Pathology is the medical science specialty
  practice concerned with all aspects of diseases
  
  
  
  ???? ?????????????????????????
  ??????????????????????????????????????????????????
  ??? ??? ???????? (?????????????????????????????
  ??????????)

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What is the disease

• Disease (disease) is the disordered of body
  function, (organ systems) resulting suffering,
  torture of the body which show off by symptoms
  signs of affected parts complained by that victim.

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General Pathology
?????????????????? ???????????????
(??????????????) ????????????????????????????? ?
?????? ????????

• ???????????? ????????
  1. Cellular Pathology
  2. Inflammation and
  Repair 3.
  Hemodynamic Disorders 4.
  Neoplasia
  5.Environmental
  Pathology 6.Genetic
  Diseases and Molecular basis of Disease
  
  ..etc..

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Systemic Pathology
(??????????????????????????????????????????????
???????)

• Disease of Organ system consisting
  of
  
  1 Cardiovascular system (CVS eg, heart, blood
  vessel.)
  2. Respiratory
  system ( RS )
  3. Gastrointestinal system include
  liver,biliary tract and pancrease (GI )
  4. Kidney Urinary Bladder (KUB)
  etc

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METHOD OF LEARNING
B. Practical study there
are 2 ways
A. THEORETICAL STUDY
Indirect study (study the Pathological changes in
life by Application the scientific tools and
laboratories to find out the lesions.)
Direct study (take out the affected cells
,tissues, organs from either the life or body for
direct examination the pathological changes in
the laboratory.)
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A. THEORETICAL STUDY
There are 6 main objects to study the DISEASES
-
1. Etiology
2.
Pathogenesis (the process or changing mechanism)
3. Pathological changes (structural
changeslesion) 4. Clinical feature (symptoms
and signs of patient due to structure
functional changes)5. Complication secondary
changes (both of structure and function) of the
other related organs ( ????????????????
????????????????????? )
6. Prognosis Prediction
the disease outcome on patient in the future
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B. PRACTICAL STUDY
??????????????????????? cell, tissues and organs
????????????????? ??? ?????????????????????????

??????? ??????????????????????????????????????
????????????????????????? ????????? ??? ?????????
??????? ??? ??????? ????????? ??????????
???????????????????????????????????????
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??????????????????????
Normal squamous cell vs
abnormal squamous cell? Structure
Normal tissue mucosal of small bowel vs abnormal
tissue mucosal of small bowel?
Normal organ liver vs abnormal organ liver
? Function Normal blood sugar vs
abnormal blood sugar? of man
between before and during involved in
diabetes mellitus
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(?????????????????????)
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Descriptive term Gross Pathology of Liver
Liver show focals loss of parenchymal tissues
(technical term is liquefaction necrosis)
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Descriptive term gross Pathology of Liver
Abnormal surface of liver shows diffuse small
nodular lesions size1-2 mm with shrinkageof
contour
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Severe, Diffuse dilatation of sinusoid with
reddish brown color cut surface
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Abnormal cut surface characterized
by multiple,nodules varying in
size, up to 1 cm. grey white color (neoplasia)
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Liver
Abnormal cut surface show diffuse small white
solid masses size vary from 1-3 mm.
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Descriptive term Histopathology
Opisthorchis in Hepatic bile duct
???????????. ?????????????
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Abnormal Changes characterized by necrosis of
Liver cells cords around Central vein
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Abnormal both in size, shape of liver Cells
with marked disorders arrangement (or loss of
normal) of architecture
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??????????????????????????????????????????????????
?????? (Anatomical and Functional changes ???)
??????????????????
???????????????????????????????????????????
???????????????????????????????????????????
??????????????????????????????????????????????????
?????????????????????
Basic Medical Science Knowledge such as Anatomy,
Physiology, Pathologyetc.
???????????????? 5 ??? ?? ????? ?????
?????????eg.????? ????????????? ??????????????
?? ???, ????, ????????????????????????????????
?????? ??????????????????

• ????????????? ????,?????????????????
  ??????????physics?????????? ??????????????????????
  ????????? ?????????????????organs function
  ?????????????? micro organism ??????? ??????
  ?????????? x-rays, MRI, CTscan ,..etc..???????????
  ????????????????? ??????????????????etc..

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3. Main Cluster of Diseases (root of diseases
life adaptation under the influence 0f
environments for survive)
????? 1
????? 2
????? 3
Congenital Disorders
Reaction ofself defensemechanism
inflammation Immune disorders
Formation of Tumor Non Neoplastic
Neoplastic
Congenitalanomaly
HereditaryDisease
????? 4
Genetics Diseases (???????????????????????????
?????????????????????????)
Abnormal Growth Development Acquired
gene mutation
Unclassified factors Metabolic disorders eg.
DM. (compatible with hereditary)
Degenerative Diseases
eg. Alzheimer Disease.etc.
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4. ??????????????????????????????????????
clinical work???? ????????????????????????????????
????????????????????
?????????? 17 ??
4.1 ????????????????????? ??????????? ????
??????????????
??????????(CC.) ??????????? ?????????????????????
????????????? ?????? 1 ????????
?????????????????????????????
???? ?????????????? ??????
???????????????????? 3-5 ???

?????????????? ??????????????????? ??????????????
????????? ??????????????????????????????
????????????

???? RS???????? ???? 20 ?????/????
????????????????? crepitation ???????????
???? CVS Heart
rate115/???? ??? apex beat ?????? 5 ICS lateral
to MCL??????????????????? diastolic murmur
???????? 4 ????????? ????????????????????

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????????????? ????????????????????????????????????
???????? ?????????????????????? ??????????????
?????????????????????? ???????????????????????????
???????????? ????

• - ???????????? (primary)??????????????
  ???????????? ????????? Heart , Lung?
  
  
  - ?????????????????????
• ??????????????????????????? ????????????????????
  ?????????????????????? ??????????????????????????
  ??????????
• ??????????????????????????? ???????????????????
  ?????????????????????????????????
• ?????????????????????????????????????
  ???????????????????
• ?????????????????????????

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???????????????? ?????????? ????????????????????
(Differential Diseases DD.)
Symptoms ?
Pericardium

Heart
Myocardium
Signs ?
Endocardium
Disease?

• Congenital??????????????????????
• Inflammation?------------- -
  Tumor? ------------

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??????????? ??????????? ??????????????????????????
??????????????????????????????
??????????(???????????????? CVS RS)
???????????????????????????????????????????????

- ????????????? 20 ?????/ ????. (??????????
?) - ????????????????? 115 ????? / ????.
(?????????? ?) - ??? Apex beat
????????????????????????????? 5th I.C.S
???????????????? MCL. ????????????
(???????????)
?????? Apex beat ?????????????? Diastolic
Murmur ???????? 4 ?
- ?????????? ?????????? Crepitation?
???????????
- ??????????????????.?

symptom and sign??????????????????????????????
??????????????????????????? ??????????????????,
????????? ???????????????????? ???????????????????
??????????? Pathological Anatomic Diagnosis??????
???Mitral stenosis with lt. ventricular
Hypertrophy and acute pulmonary edema, Bilateral
. ???????????? ??????????????? symptomsign
??????????????????????????????????????????????????
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?????????????????????,????????????????????????????
???????????????????????????????????????
?????????????????? ???????confirm
??????????????????????Physical Examination.

• ??? X - rays, EKG, ?????????????????????????????
  ????,??? ???????????? ????? ??????????
  ???????????????????????????????(????????????)
  ??????????????????????????????????????????????????
  (????????????????????????????????????????????????
  ???????????? EKG)
• - ????????????????????????????????????
  Immunology ????????? antigen - Antibody
  ?????????????????????????????????????????????? ?
  ???????? ?????????????????????????????????????????
  ?? Rhumatic Heart Disease (??????? Systemic
  Pathology) ???????????????????????????????????????
  ??????????????????????????????????

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???????????????????????????????????????????
-??????? ???????????? basic sciences Anatomy ,
Physiology ???????C.V.S ??? R.S microbiologyetc.
Pathology of C.V.S R.S
Anatomy or Structure
Physiology or Function
Heart ?,Pericaridium Myocardium Valves?

• sound and location of blood pass through valves
  during Heart systole and diastole
• funcion of valves-, rate of heart beatetc.
• - Respiratory rate and respiratory sound ---etc.

• Location 0f Heart and position of Valves relate
  to chest wall ? character of valves ?.
  - Lungpleura
  brochus l structure consistency, blood
  supplyetc.

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????????????????? ?????????????????????????????,?
???????????????????, ?????????????????????????????
?????????????????????????????????????????????-

Clinico Pathological Correlation (???
Anatomical Diagnosis Mitral stenosis with
lt.ventricular hypertrophy and acute pulmonary
edema,bilateral ???????????????????????????????)
Anatomic changes
Functional changes
Mitral Valve stenosis
Diastolic Murmur gr.4
Leaflets characterized by stiffness, fused
together ,narrow opening and shortening of
chordae tendinae
Difficulty of blood flow pass through Mitral
Valve stenosis during Lt. Atrium Systole and
Lt. Ventricle- Diastole create abnormal sound
called murmur
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Anatomic changes
Functional changes

Mitral Valve marked stenosis
Diastolic Murmur gr.4
Lead to output Systemic blood Volume less
than normal during lt.ventricular systole
H.R. 115 / min Compensate for normal blood
Volume 1st.. Step
Lt. Ventricular Hypertrophy increase strength
pump to return normal blood Volume 2st.. Step
Lt. Heart pump failure
Heart Overload
RR.20/min ???????????????? ?????????????????? O2
????????
??????????????????????????????????????????????????
???????
?????????????????????????????????????????????????
????????? RT. Atrium ??????????????????????????
??? Lt.Atrium ???
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Picture shows character of sclerotic heart Valve
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???? ????????? ????????????? ?????????
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????????? Cardiac muscles Fibres
??????????????????????????????????
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????????? ????????? ??????????( Pulmonary edema)
??????????????????????????????? alveolar cap.
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??????????????????????????????????

• 1. ???????????????????????????????????????????????
  ?????????????????
  
  
  2.
  ?????????????????????????????????????????????
  
  
  3.
  ??????????????????????????????????????????????????
  ??
  
  
  4. ???????????????????????????????????????
  ???????????
  
  5. ?????????????????????????
  ??????????????

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