PATHOLOGY

Ben D. Sarabia, RMT

MLS 304 LEC
College of Medical Technology
Medina College – Ozamiz City
PATHOLOGY
 PATHOLOGY
• Study of the structural, biochemical, and functional
changes in cells, tissues, and organs that underlie the
disease.

General Pathology – reactions of cells and treatment to

abnormal stimuli.

Systemic Pathology – examines the alterations in

specific organs and treatment that are responsible
for the disorder.
 FATHER OF MODERN PATHOLOGY

“Virtually, all forms of

disease start with
molecular or structural
alterations in cells.”
Rudolf Virchow
 2 MAJOR METHODS UNDER GENERAL PATHOLOGY

1. AUTOPSY
• Autopsy is the examination of the whole body.
• Also called: _____________________
• Systematic examination of a cadaver (dead body) for
study or for determining the cause of death.

2. BIOPSY
• Examination of cells or tissues from a living
organism.
• Excised material may be studied in order to diagnose
disease or to confirm findings of abnormality.
 ASPECTS OF DISEASES FORMING THE CORE OF
PATHOLOGY
• Etiology
• Pathogenesis
• Morphologic changes
• Clinical significance

Terms to Remember:
• Pathogenesis
• Pathologist – Head of the Clinical Pathology Lab
• Medical Technologist – is the one who performs
the diagnostic analysis on the human blood, urine,
body fluids and different samples or specimens that
are accepted in the lab.
 TYPES OF PATHOLOGY
1. General
• Basic reaction of cells and tissues to abnormal
(pathologic) stimuli that underlie all diseases.
• It focuses on the observation or what we are
observing here are the common changes in all
tissues.
2. Systemic
• Specific responses of specialized organs and tissues.
• Study of specific or particular responses of
specialized organs and tissues to well-defined stimuli
– focuses on the specific changes in organs.
 DIVISIONS OF PATHOLOGY
1. Gross Pathology and Microscopic Pathology
2. Anatomic(al) Pathology
3. Clinical Pathology
 GROSS & MICROSCOPIC PATHOLOGY
• The recognition of disease based on macroscopic
and microscopic examination of the surgical
specimens generated at the time of surgery or at
autopsy.
• Macroscopic – examining the sample without the
help of a microscope.
• Microscopic – with the help of a microscope
 ANATOMIC PATHOLOGY
• The study of changes in the function, structure, or
appearance of organs or tissues, including postmortem
examinations and the study of biopsy specimens.

a. Surgical Pathology – the study of the gross appearance

and histology of the tissues removed during surgery.
b. Autopsy Pathology – the study of the gross appearance
and histology of the tissues that were removed
following death.
c. Exfoliative Cytology – branch of general cytology which
deals with microscopic study of the cells that have been
desquamated from the epithelial tissues.
 CLINICAL PATHOLOGY
• Diagnosis and monitoring of diseases through
the examination of blood, body fluids
secretions, and tissue biopsy specimens for
chemical, morphological, microbiological, and
immunological abnormalities.
 MAIN SECTIONS IN THE CLINICAL PATHOLOGY
LABORATORY

1. Clinical Chemistry
2. Hematology
3. Blood banking / Immunohematology
4. Microbiology
5. Clinical Immunology and Serology
 CLINICAL CHEMISTRY & TOXICOLOGY
• Division of clinical pathology involving
biochemical analysis on human samples outside
the body.
• Main sample: __________
• Test performed:
 HEMATOLOGY
• Involves the assessment of the cellular elements
in blood samples.
• Test performed:

• Hematopathologist – a pathologist that

specialized in the examination of bone marrow
and lymphnode biopsies, they are expert in the
field of anemia, leukemia, and lymphomas.
 BLOOD BANKING
• A division of clinical pathology that deals with
collection, storage, compatibility and safety of
blood and its various components for the
purpose of human transfusion.
• Test performed:
 MICROBIOLOGY
• A division of clinical pathology involved in
isolation, culture, and identification, of micro-
organisms in biological samples.

IMMUNOLOGY AND SEROLOGY

• The discipline in which infectious diseases are
diagnosed by detecting antibodies in serum and
other body fluids.
 HISTOTECHNOLOGY
• Is the art and science performed by the
Histotechnologist to produce a tissue section of
good quality that will enable the pathologist to
diagnose the presence or absence of disease.

HISTOPATHOLOGIC TECHNIQUES
• Involves different procedures that
have been adopted for the
preparation of materials and
tissue for microscopic
examination.
 HISTOLOGY
• Branch of biology which studies the microscopic
anatomy of biological tissues.

4 Basic Types of Animal Tissues

I. Muscle Tissue
II. Nervous Tissue
III. Connective Tissue
IV. Epithelial Tissue
 MUSCLE TISSUE
• Soft tissue that composes muscles in animal bodies,
and gives rise to muscles’ ability to contract. It is
formed during embryonic development through a
process known as myogenesis.
 NERVOUS TISSUE
• Also called: __________
• Main tissue component of the nervous system.
 Nervous system regulates and controls the bodily functions
and also the activities.
 It consist of two parts: _____________ & _____________
 Neuron or nerve cell – it receives and transmit impulses.
 Neuroglial/Glial cells – it assist in the propagation of never
impulses as well as also they provide nutrients to the
neurons.
 CONNECTIVE TISSUE
General Connective Tissue
• Loose Connective Tissue
• Dense Connective Tissue

Special Connective Tissue

• Cartilage
• Bone
• Blood
• Lymph
• Hematopoietic
 EPITHELIAL TISSUE
• Epithelial tissues line the outer surface of organs and
blood vessels throughout the body, as well as the
inner surfaces of cavities in many internal organs
CELLULAR INJURY
Ben D. Sarabia, RMT
MLS 304 LEC
College of Medical Technology
Medina College – Ozamiz City
 CELLULAR INJURY
• Results when cells are
stressed so severely
that they are no longer
able to adapt.

• When cells are exposed

to inherently damaging
agents or when they
suffer from intrinsic
abnormalities.
 CELLULAR INJURY CAUSES
1. Oxygen deprivation: __________
• Reduced aerobic oxidative respiration
• Extremely important and common cause for
cellular injury.
Reduced blood flow: ______
• There is an inadequate oxygenation of the
blood due to cardiorespiratory failure.
• There is a decreased oxygen carrying capacity
of the blood.
Results to: ____________________
 CELLULAR INJURY CAUSES
2. Physical agents
• Mechanical trauma
• Extreme temperature
• Sudden changes in atmospheric pressure
• Radiation
• Electric shock
 CELLULAR INJURY CAUSES
3. Chemical agents and Drugs
• Simple chemicals
• Oxygen at high concentrations
• Trace amounts of poisons
• Environmental and air pollutants, insecticides,
and herbicides
• Industrial and occupational hazards
• Recreational drugs
 CELLULAR INJURY CAUSES
4. Infectious agents
• Bacteria
• Viruses
• Fungi
• Parasites
 CELLULAR INJURY CAUSES
5. Immunologic reactions
• Endogenous self-antigens
• Immune reactions to many external agents

6. Genetic derangements

7. Nutritional imbalances
 TYPES OF CELLULAR INJURY
A. Reversible Cell Injury
• At early stages or mild form
• If damaging stimulus is removed
• Hallmarks:
a. Reduced oxidative phosphorylation with resultant
depletion of energy stores (ATP)
b. Cellular swelling caused by changes in ion
concentration and water influx.
 TYPES OF CELLULAR INJURY
B. Cell Death (Irreversible Injury)
• Severe and progressive
• This is the end for the irreversible injury
• The event of biological cell that cease to carry out its
function. It may be the result of the natural process of the
old cells that are dying and are being replaced by the new
ones.
• Cell death can also be the result from different factors
such as diseases, localized injury, or if there is a death of
an organism of which the cells are part of.
 TYPES OF CELLULAR INJURY
• Necrosis
• “accidental” and unregulated form of cell death
• From damage to CM and loss of ion hemostasis
• Lysosomal enzymes enter cytoplasm → digest cell →
morphological changes (NECROSIS)
• Cellular contents leak in EC → Inflammatory response
 REVERSIBLE INJURY
When checked under the light microscope can be
Characterized by:
• Generalized swelling of the cell and its organelles
• Blebbing of the plasma membrane
• Detachment of ribosomes from the endoplasmic
reticulum
• Clumping of nuclear chromatin
 TWO FEATURES REVERSIBLE INJURY
1. Cellular Swelling
• First manifestation of almost all forms of injury to cells.
• Cells in here are capable of maintaining the ionic and
fluid homeostasis.
• There is a failure of energy dependent ion pumps in
the plasma membrane.
• Ultrastructural changes of reversible injury:
 Plasma membrane alterations
 Mitochondrial changes
 Dilation of the endoplasmic reticulum, with
detachment of polysomes.
 Nuclear alterations
 TWO FEATURES REVERSIBLE INJURY
1. Fatty change
• Due to:
___________________
___________________
• Manifested by the appearance of lipid
vacuoles in the cytoplasm.
• Seen in cells involved in and dependent on fat
metabolism,
 CELL DEATH
2 Types of Cell Death
1. Apoptosis
2. Necrosis
 CELL DEATH
APOPTOSIS
• Form of cell death that is generally triggered by
normal healthy processes in the body.
• Can also occur as a defence mechanism during
healing process, is almost always normal and
beneficial to an organism.

NECROSIS
• Cell death that is triggered by external factors or
disease.
• It is considered an “unprogrammed” cell death
process at this time.
 FEATURE NECROSIS APOPTOSIS
CELL SIZE Enlarged Reduced
NUCLEUS Fragmentation into
nucleosome-size
fragments
PLASMA Disrupted Intact
MEMBRANE
CELLULAR Enzymatic digestion Intact
CONTENTS
ADJACENT
INFLAMMATION
PHYSIOLOGIC OR Invariably pathologic Often physiologic
PATHOGENIC ROLE
 NECROSIS
1. COAGULATIVE NECROSIS
• This is brought by intercellular enzyme that
were set free on the death of the cell.
• The architecture of the dead tissues is
preserved for a span of at least some days.
• Denatures not only the structural proteins but
also the intracellular enzymes.
• This type is seen most often in the heart after
an infarction, as well as kidneys and adrenal
glands.
COAGULATIVE NECROSIS
 NECROSIS
2. LIQUEFACTIVE NECROSIS
• Transformation of the tissues into liquid
viscous mass
• Usually seen in focal bacteria and fungal
infections
• Accumulation of leukocytes and liberation of
enzymes.
 NECROSIS
3. GANGRENOUS NECROSIS
• Non-specific form of necrosis
• Refers to massive death of the tissue caused b
a combination of ischemia and superimposed
by bacterial infection.
 NECROSIS
4. CASEOUS NECROSIS
• Most often encountered in the foci of
tuberculous infections.
• Conversion of destroyed cells into granular,
friable mass made up of a mixture of
coagulated protein and fats.
 NECROSIS
5. FAT NECROSIS
• Not specific pattern of necrosis which is your
fat necrosis.
• Release of pancreatic lipase (enzyme) into the
pancreas and peritoneal cavity.

6. GASEOUS NECROSIS
• Combination of coagulative and liquefactive
necrosis is caused by dead cells that are not
completely digested by macrophages.
• Caused by fungal and mycobacterial infections
 NECROSIS
7. FIBRINOID NECROSIS
• The shape and size of tissues get irregular and
then late causes the cell death.

8. AVASCULAR NECROSIS
• When the blood supply is limited to the
tissues, the demise of the bone tissue
happens and this is where avascular necrosis
appears/ happens.
 BIOPSY
3 TYPES OF BIOPSIES
1. Excisional biopsy – this is when an entire lump or
suspicious area is removed.
2. Incisional or Core biopsy – when only a small tissue
is removed with preservation of the histological
architecture of the tissue’s cells.
3. Fine Needle Aspiration Biopsy (FNAB) – when a
sample of tissue or fluid is removed within a needle.
 BIOPSY
OTHER TYPES OF BIOPSIES
• Punch biopsy – done with a circular blade that
ranges from size of 1mm-8mm.
• Shave biopsy – done with either a small scalpel
blade or a curved razor blade.
• Curretage biopsy - done on the surface of tumors
or small epidermal lesions with minimal to known
topical anaesthetic drug using a round curette
blade.
 AUTOPSY
• It is also called as ___________ or ___________
• After death examination of the body and
dissection of its internal organs to confirm or
determine the cause of death.
• Can uncover the existence of diseases that were
not detected during life or to examine the extent
of injuries may have contributed to a person’s
death.
 PRELIMINARIES FOR POSTMORTEM
EXAMINATION (PME)
1. Written consent from the next of kin-abide by
the extent or restrictions allowed.
2. Death certificate
3. Medical abstract/ Clinical data
4. Medico-legal clearance
PME IS PERMITTED WITHOUT CONSENT IN THE
FOLLOWING CIRCUMSTANCES:
1. When it is ordered by the police or coroner
2. When it is necessary to complete the death
certificate.
3. When the deceased himself has given consent
before he died.
4. Deceased military personnel who dies in
active/training duty or military service
THE CORONER HAS AUTHORITY IN THE FOLLOWING CASES:
1. All natural deaths occurring in the hospital within 24hrs. of
admission, unless the case was attended by a private physician
within 36hrs of death.
2. Newborns in the first 24 hours of life
3. All injury cases, old or recent
4. All abortion cases
5. All violent, accidental, and sudden deaths of unknown or suspicious
cases
6. All cases without medical attendance within 36hrs prior to the hour
of death
7. All deaths due to drowning, hanging or strangulation, shooting, stab
wounds, burns, electricity, lightning, tetanus, and etc.
8. All homicides and suicides
9. All cases in which there is suspicion of poisoning
10. Stillborns
11. Prematures
 AUTOPSY
• Postmortem changes, when a person dies the
primary changes that occur will be the
circulatory failure, the respiratory failure and the
CNS failure
• Then the secondary change will follow and are
seen postmortem examination
 ALGOR MORTIS
• This is the first demonstrable change after
death. This is the cooling of the body to equalize
the environment.
• At room temp. you will feel that the
temperature will become:
______ for the 1st hour
______ for the next 12 hours
______ for the next 12-18 hours
 ALGOR MORTIS
• As a rule, the body cools at ______ (for 50% of
the cases)
• Faster in: _______________________________
• Delayed in: ______________________________
• Algor mortis is not a reliable indicator as to the
time of death
 RIGOR MORTIS
• Rigidity of the body due to what hardening of
the skeletal and muscles cause by a series of
physiochemical events after death.
• Starts in ______ after death (head & neck)
• Complete within _______
• Stiffness remain for ________
• Persist for about ________
• Hasten stiffness: warm environment and also
the infants
• Delay stiffness: cold temperature and also for
obese individuals
 LIVOR MORTIS
• Purple discoloration of the dead body.
 The blood gravitates to the skin vessels which
become toneless and dilate after circulation
ceases
• Becomes evident as early as _____ after death
• Fully evident: _________
POSTMORTEM CLOTTING OF BLOOD
DISCOLORATION OF TISSUES
PUTREFICATION
 MAIN TYPES OF AUTOPSIES
1. Medico-Legal Autopsy
Death is classified into on of five headings:
a. Natural
b. Accident
c. Homicide
d. Suicide
e. Undetermined
2. Clinical or Pathological Autopsy
• Performed to diagnose a particular disease
• It aims to determine, clarify, or confirm medical
diagnoses that remained unknown or unclear prior to the
patient’s death.
 PHYSICAL EXAMINATION
1. External Examination
2. Internal Examination
• Toxicology
• Biochemical test
• Genetic testing
 EXTERNAL EXAMINATION
• Photograph
• Note the clothing, position
• Evidence-residues
• Samples of hair and nails
• After external evidence is collected – the body is
removed from the bag then it will be undressed
and will be examined for the body wounds.
• Clean the body, weighed, measured
• General description of the body as regards to
ethnicity, sex, age, hair color and length, eye
color and other distinguishing features.
• Handheld voice recorder
 INTERNAL EXAMINATION
• Y shaped incision – can be made starting at
the top of each shoulder and running down
the front of the chest, meeting at the point of
the sternum,.
• T shaped incision – made from the tips of
both shoulders, in a horizontal line across the
region of the collar bones to meet at the
sternum in the middle.
• Single vertical cut – is made from the middle
of the neck.
 AUTOPSY
A. Autopsy of ______________
• This is where each organ is take out one by one.
• Good for demonstrating pathologic change in
individual’s organ-high risk autopsies and for
limited autopsies
• ADVANTAGE: Simple to perform; systematic
examination of the organs.
• DISADVANTAGE: Destroys anatomic relationships
 AUTOPSY
B. Autopsy of ______________
• Organs are taken out en-bloc
• ADVANTAGE: Fast and easy. Organs can be
removed and stored for later dissection.
• DISADVANTAGE: Bulky and it’s difficult to handle
for a single prosecute. The organs dissected
rarely returned to the respective sides.
Artefactual postmortem injuries may occur and
subsequent autopsies are not possible.
 AUTOPSY
C. Autopsy of ______________
• Organs are taken examined in-situ
• ADVANTAGE:
 Practical for single examiner
 Good preservation of the anatomic structures
 Good preservation also of the pathologic anatomic
relationship
• DISADVANTAGE:
 Requires a certain degree of expertise and skill
 Thorough examination cannot be possible
 If cause of death is determined less attention is
paid to other pathologies
 AUTOPSY
D. Autopsy of ______________
• Where organs are examined in 3 separate blocks.
• ADVANTAGE:
 Anatomic relationships are preserved
without a bulky mass of organs.
 The systems that are examined are within
their structural integrity.
 There is a good observation of pathologic
lesions.
• DISADVANTAGE:
 Not ideal for multiple organ involvement
 Requires skill and time
A healthy, relaxed, sedentary 70 kg man who is killed
instantly in an accident will usually have organ
weights in these ranges:

Right lung ______

Left lung ______
Heart ______
Liver ______
Adrenal ______
Thyroid ______
Spleen ______
Brain ______