dr. Rizki Hanriko
Patolog
Departemen Anatomi, Histologi & Patologi Anatomi
FK UNILA
2017
ž Greek
pathos = suffering, logos = study
ž Pathology is the scientific study of disease.
ž Pathology comprises a large body of
scientific knowledge and diagnostic methods
that are essential:
¡ for understanding diseases and their
causes and
¡ for their effective prevention and
treatment.
ž Pathology
embraces the functional and
structural changes in disease, molecularà
effects on the individual patient.
ž The ultimate goal of pathology is the
identification of the causes of disease. This
fundamental objective leads to successful
therapy and to disease prevention.
ž Without pathology, the practice of medicine
would still rely on myths and folklore.
ž Plato
(424–348 bc) and Pythagoras (c. 580–c.
500 bc à supernatural forces.
ž Imbalance (‘isonomia’) − phlegm, black bile,
yellow bile and blood − Empedocles (490–430
bc) and Hippocrates (c. 460–370 bc).
ž Galen (129–c. 200) built on Hippocrates’
naturalistic ideas about disease by giving
them an anatomical and physiological basis.
ž Ibn
Sina (980–1037) − commonly known as
Avicenna − who, by his Canon of Medicine,
pioneered advances in medicine through
scientific discovery by observation,
experimentation and clinical trials.
ž In the 19th century, Rudolf Virchow, often
called the father of modern pathology,
proposed that injury to cells, the smallest
living units in the body, is the basis of all
disease. To this day, this concept underlies
all of pathology.
ž Autopsies
from about 300 bc and have thus
helped to clarify the nature of many
diseases.
ž Confined initially to the gross (rather than
micros) examination of the organs
ž Giovanni Morgagni (1682–1771), Matthew
Baillie (1761–1823), Carl von Rokitansky
(1804–1878) and Ludwig Aschoff (1866–1942)
à Correlated their findings with the clinical
signs and symptoms of the patients and with
the natural history of numerous diseases.
ž Pathology,
and indeed medicine as a whole, was
revolutionised by the application of microscopy
to the study of diseased tissues from about
1800.
ž 200 years ago nothing was known of bacteria,
viruses, ionising radiation, carcinogenic
chemicals, and so on.
ž Louis Pasteur’s (1822–1895) àmicroorganisms in
the environment could contaminate and impair
the quality of wine was a major advance in our
perception of the environment and our
knowledge that pathogens within it, invisible to
the naked eye, cause disease.
The impact of molecular pathology is exemplified
by advances in our knowledge of the biochemical
basis of congenital disorders and cancer.
ž Techniques with relatively simple principles (less
easy in practice) reveal the change of a single
nucleotide in genomic DNA resulting in the synthesis
of the defective gene product that is the
fundamental lesion in a particular disease
ž The application of modern scientific methods have
resulted in a clearer understanding of the ways in
which diseases result from disturbed normal cellular
and molecular mechanisms
ž
ž clinical
medicine cannot be practised
without an understanding of pathology;
pathology is meaningless if it lacks clinical
significance
ž Approximately 70% of clinical diagnoses are
estimated to rely on pathology
investigations.
ž In the USA, c. 90% of the objective data in
electronic patient records are derived from
pathology laboratories.
ž histopathology:
the investigation and
diagnosis of disease from the examination of
tissues
ž cytopathology: the investigation and
diagnosis of disease from the examination of
isolated cells
ž haematology: the study of disorders of the
cellular and coagulable components of blood
ž microbiology: the study of infectious
diseases and the organisms responsible for
them
ž immunology:
the study of the specific
defence mechanisms of the body
ž chemical pathology: the study and diagnosis
of disease from the chemical changes in
tissues and fluids
ž genetics: the study of abnormal
chromosomes and genes
ž toxicology: the study of the effects of
known or suspected poisons
ž forensic pathology: the use of pathology for
legal purposes (e.g. investigation of death in
suspicious circumstances).
ž Gross
pathology
ž Light microscopy
ž Histochemistry
ž Immunohistochemistry and
immunofluorescence
ž Electron microscopy
ž Biochemical techniques
ž Haematological techniques
ž Cell cultures
ž Medical microbiology
ž Molecular pathology
ž Disease
mechanisms
ž Systematic pathology
EX:
ž acute appendicitis is acute inflammation
affecting the appendix;
ž carcinoma of the lung is the result of
carcinogenic agents acting upon cells in the
lung,
ž behaviour of the cancerous cells thus formed
follows the pattern established for malignant
tumours; and so on.
List the chief characteristics:
ž Epidemiology
ž Aetiology
ž Pathogenesis
ž Pathological and clinical features
ž Complications and sequelae
ž Prognosis
ž Treatment.
Approaches:
ž problem-oriented
ž disease-oriented
ž taking
a clinical history to document
symptoms
ž examining the patient for clinical signs
ž if necessary, performing investigations
guided by the provisional diagnosis based on
signs and symptoms.
For example:
ž First decide which organ or body system seems
to be affected by the disease.
ž From the signs and symptoms, decide which
general category of disease (inflammation,
neoplasia, etc.) is likely to be present.
ž Then, using other factors (age, gender, previous
medical history, etc.), infer a diagnosis or a
small number of possibilities for investigation.
ž Investigations should be performed only if the
outcome of each one can be expected to
resolve the diagnosis, or influence management
if the diagnosis is already known.
ž Diagnostic
Pathology
ž Autopsies
¡ determining
the cause of death
¡ audit of the accuracy of clinical diagnosis
¡ education of undergraduates and
postgraduates
¡ research into the causes and mechanisms
of disease
¡ gathering accurate statistics about disease
incidence.
ž Causes
and agents of disease
ž The health of a nation
¡ documenting the incidence of disease in a
population
¡ Cancer registration data are most reliable
when based on histologically proven
diagnoses
ž Preventing disability and premature death
¡ Detection of early disease by population
screening.
Gastrointestinal pathology an atlas and text, 3 ed
Gastrointestinal and liver pathology, 2nd, 2012
Gastrointestinal and liver pathology, 2nd, 2012
SCLC