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1、The Outline of Pathology(Minimal Requirements)for Nepalese Medical StudentsJan. 2003General PathologyIntroduction to pathologyUnderstand the concept and contents of pathology.Be familiar with its role in medical education, medical practice and research, the morphological study methods of pathology a
2、nd the history of pathology.Correctly use the following terms: anatomic pathology clinical pathology disease diagnosis etiology general pathology lesion pathogenesis pathological finding pathophysiology surgical pathologysystemic pathology Cell injury, adaptation and death: By the end of this chapte
3、r, the students will be able to:Understand the causes and the mechanisms of cellular injury (for example, hypoxic cell injury, free radicals).Understand the concepts and recognize the lesions of adaptation: atrophy, hypertrophy, hyperplasia, metaplasia.Recognize intracellular and extracellular accum
4、ulations in gross and light microscopic levels: hyaling change (vascular wall, connective tissue, intracellular).Be familiar with amyloid change, mucoid change, pathological pigmentation, pathological calcification.Recognize the morphological changes of reversible injury in gross and light microscop
5、ic levels: cellular swelling, hydropic change, fatty change.Define and correctly use necrosis, and distinguish the various categories of necrosis (coagulation, liquefaction, fibrinoid necrosis, enzymatic fatty necrosis, caseous necrosis, apoptosis). Tell how you know a cell is dead. Briefly describe
6、 the various forms of gangrene. Understand the definition of apoptosis, programmed cell death. Be familiar with the significance of apoptosis in physiologic and pathologic conditions.Be familiar with the main mechanism of cellular aging.Correctly use of the following terms:aplasia autolysis ballooni
7、ng change cachexiacell swelling cyst fatty change fibrinoid necrosis fistula gangrene heterolysis hypoplasia inclusion body karyolysis karyorrhexis pyknosis sinus Tissue repair: cell regeneration and fibrosisIn the end of this chapter, you will be able to understand the following definitions: regene
8、ration, repair, granulation tissue. Recognize the lesions of granulation tissue, fibrosis, wound healing (phase I and phase II).Be familiar with the molecular mechanism of regulation of cell proliferation (growth factors and their receptors, signal transduction pathway) and the significance of repai
9、r in the body survival. Be familiar with the capabilities of various tissues.Correctly use of the following terms: granulation tissue (notice the difference between granulation tissue and granuloma which you will meet in the chronic inflammation)fibrosis scar hyperplasia proliferation Hemodynamic di
10、sorders, thrombosis and shockIn the end of this block, the students will be able to:Hyperemia: Correctly understand the concepts of hyperemia and congestion, the difference between both. Recognize the morphologic changes of hyperemia and congestion, for example heart failure cells. Be familiar with
11、the classification, mechanism of hyperemia and its influences to the body.Hemorrhage:Understand the concepts of hemorrhage and related terms (hematoma, petechiae, ecchymoses, hemothorax, hemopericardium, hemoperitoneum and hemarthrosis etc).Thrombosis: Understand the concepts of thrombosis and throm
12、bi, the relationship between hemostasis and thrombosis, three primary influences predispose the thrombus formation, the so-called Virchow s triad: endothelial injury, stasis or turbulence of blood flow and blood hypercoagulability. Recognize the morphology of thrombi (red, white and mixed thrombi) a
13、nd the fate of the thrombus.Understand and correctly use of the concept of disseminated intravascular system (DIC).Embolism: Master the concepts: embolism, emboli and thromboembolism, especially the difference between thrombosis and embolism. Understand the classification of embolism, its influences
14、 to human body and the fate of emboli.Infarction: Understand the concept of infarction, the types of infarcts ( hemorrhagic infarct; anemic infarct; septic infarct may be either septic or bland). Be familiar with the factors that influence development of an infarct.Edema: What is edema? Be familiar
15、with the related terms: hydrothorax, hydropericardium, hydroperitoneum (ascites) and anasarca. Be familiar with its morphologic changes and clinical pathologic correlation.Shock will be learned in your Pathophysiology course!Correctly use the following Vocabulary Words:Hematoma RecanalizationPetechi
16、ae, vs. purpura vs. ecchymosis ThromboembolismHemopericardium vs. hemoperitoneum Saddle embolismvs. hemothorax vs. hemarthrosis Air, fat, amniotic fluid embolismVirchows triad Infarction Thrombosis EdemaHypercoagulability Anasarca Transudate vs. exudateEmbolus LymphedemaMural thrombi Hyperemia/Conge
17、stionOrganized thrombus Chronic Passive Congestion of liverHemorrhagic diathesis Nut-meg liverDisseminated intravascular coagulopathy Acute and chronic inflammationObjectives:After completion of this chapter,Master the basic pathologic changes of inflammation, particularly exudation, and the feature
18、s of the major types of inflammation. Recognize the various components in inflammatory exudate.Be familiar with the clinical process of inflammation. Understand the functions of the major inflammatory mediators. Required reading:Robbins Basic Pathology (7th ed.), pp XXX-XXXSuggested reading:Robbins
19、Pathologic Basis of Disease, (6th ed.), pp 260-326General and Systemic Pathology 2nd ed. , pp XXX-XXXNeoplasiaObjectives:After completion of this chapter, you should have mastered the following key concepts and principles:neoplasm (tumor) and neoplasia; the differences between neoplastic hyperplasia
20、 and non-neoplastic hyperplasia; general morphological features, patterns of growth of neoplasms; atypia; growth kinetics of neoplasm; pathways of metastasis; grading and staging; nomenclature and classification of neoplasms.You are also supposed to be familiar with the following topics:Common clini
21、cal manifestations of neoplasm; clinical features and gross and histologic appearances of frequently encountered neoplasms (papilloma, adenoma, squamous cell carcinoma, adenocarcinoma, etc.); the molecular basis of tumorigenesis; the mechanisms of tumor invasion and metastasis. You should also have
22、a general understanding of:Commonly seen tumorigenic agents and the mechanisms by which they cause neoplasms; the general principles of diagnosis and treatment of neoplasms.Required reading:Robbins Basic Pathology (7th ed.), pp XXX-XXXSuggested reading:Robbins Pathologic Basis of Disease, (6th ed.),
23、 pp 260-326General and Systemic Pathology 2nd ed. , pp XXX-XXXSystemic PathologyBlood vessel and Cardiovascular SystemArteriosclerosisObjectives, the student should be able to:1). Define atherosclerosis.2). Define and be able to discuss the epidemiology, risk factors, pathogenesis, complications and
24、 clinical significance of atherosclerosis.3). Describe the gross and microscopic morphology of a fatty streak，fibrous plaque and atheromatous plaque. Vocabulary Words/Related Terms:arteriosclerosis atherosclerosisarteriolosclerosis thrombosishyperlipidemia and hypercholesterolemiafatty streaks ather
25、omatous plaque/atheromafibrous plaque atherosclerotic aneurysmHypertensionObjective, the student should be able to:1). Organize and be able to discuss mechanisms of blood pressure regulation including cardiac influences, neural factors, hormonal factors, vasodilators-vaso constrictor agents; and the
26、 reninangiotensin system.2). Compare and be able to discuss the different types of hypertension essential, malignant, and secondary). Categorize the different types of secondary hypertension and give examples of each.3). Organize and be able to discuss the pathogenesis of essential hypertension incl
27、uding genetic influences, hormonal factors and environmental influences (stress, nutrition, sodium intake). Describe, compare and be able to discuss vascular morphologic changes of essential hypertension and malignant hypertension .4). Organize and be able to discuss clinical features, the gross and
28、 microscopic morphology, and the complications of hypertension including the heart, central nervous system, kidneys, blood vessels.Vocabulary Words/Related Terms:hypertension essential hypertension malignant hypertension left ventricular hypertrophysecondary hypertension concentric hypertrophyhyalin
29、e arteriolosclerosis Hyperplastic arteriosclerosis Ischemic heart diseaseObjectives, the student should be able to:1). Organize and be able to discuss the epidemiology, risk factors, pathogenesis, and different etiologies of coronary heart disease (ischemic heart disease).2). Organize and be able to
30、 discuss the pathogenesis, risk factors, morphology and clinical features of a myocardial infarct. Be able to describe the sequences of gross and microscopic morphologic changes which occur in a myocardial infarction from the acute phase to healed scarring. Learn the distribution of myocardial infar
31、ction related to site of coronary artery obstruction.3). List, describe and be able to discuss the different complications of myocardial infarction.4). Define chronic heart disease and sudden cardiac death. Vocabulary Words/ Related Terms:Coronary Heart Disease Papillary muscle dysfunctionCoronary a
32、rtery thrombosis Angina pectoris Acute pericarditis Myocardial infarction Sudden Cardiac DeathRheumatic heart disease, Infective Endocarditis, virus myocarditisObjectives, the student should be able to:1). Organize and be able to discuss the epidemiology, pathogenesis, gross and microscopic changes,
33、 clinical presentation and course of rheumatic heart disease.2). Organize and be able to discuss the epidemiology, pathogenesis, gross and microscopic morphology, clinical presentation and course of infectious endocarditis. Compare and contrast bacterial and rheumatic endocarditis.3). Define virus e
34、ndocarditis and describe the basic pathologic changes of virus endocarditisVocabulary words/Related TermsAschoff body rheumatic vegetations rheumatic endocarditis, myocarditis and pericarditis verrucous endocarditis fibrinous pericarditis (villose heart, “Bread and butter” pericarditis) chronic rheu
35、matic heart disease mitral stenosis combined mitral and aortic valve lesions acute and subacute endocarditis Constrictive pericarditis nonbacterial endocarditis CardiomyopathyObjectives, the student should be able to:1) Organize, be able to discuss, and compare the gross and microscopic changes, cli
36、nical presentation and course of the main cardiomyopathy (dilated, hypertrophic and restrictive cardiomyopathy).Vocabulary words/Related Termsdilated cardiomyopathy congestive cardiomyopathy hypertrophic cardiomyopathy Required reading:Robbins Basic Pathology (7th ed.), pp 325-394Suggested reading:G
37、eneral and Systemic Pathology 2nd ed., pp 307-360Respiratory systemObstructive Pulmonary Disease Objectives, the student should be able to:1). Organize and be able to discuss the incidence, etiology, pathogenesis, morphological change and clinical presentation of chronic bronchitis.2). Compare and b
38、e able to discuss panacinar (panlobular) emphysema, centriacinar (centrolobular) emphysema and periacinar (paraseptal) emphysema in the context of definition, clinical presentation including age and sex distribution, incidence, etiology, pathogenesis, gross and microscopic morphology, physiologic ch
39、anges, and clinical course-prognosis.3). Organize and be able to discuss bronchiectasis in relations to definition, predisposing conditions, pathogenesis, organisms typically cultured from bronchi, gross and microscopic morphology, and clinical course-prognosis.4). Organize the sequelae of chronic o
40、bstructive pulmonary disease (Cor pulmonale).Vocabulary Words/Related Terms: Define and use in proper context:Globet cell ciliate cell cigarette smokers chronic bronchitis Squamous metaplasia Reid index Emphysema Centriacinar (centrolobular) emphysemaPanacinar (panlobular) emphysema periacinar (para
41、septal) emphysema Bullous emphysemaBarrel chest Compensatory hyperinflation Interstitial emphysema Alpha 1-antitrypsin proteolytic enzymesBronchiectasisCor pulmonalePneumonia (pneumonitis)Objectives, the student should be able to:1).Organize and be able to discuss the etiology, pathogenesis (the hea
42、lth condition of host), classification and morphological lesions of pneumonia. 2). Compare lobar pneumonia, lobular pneumonia (bronchopneumonia) in terms of clinical presentation, radiographic presentation, histologic types, and clinical course-prognosis (complications).3). Organize and be able to d
43、iscuss atypical pneumoniaVocabulary Words/Related Terms: Define and use in proper context:Bacterial pneumonia Streptococcus pneumoniae consolidation Empyema HemoptysisPleuralitis fibrinFour stages of lobar pnemonia (congestion, red hepatization, gray hepatization and resolution) Bronchopneumonia aty
44、pical pneumonia Interstitial pneumonia mycoplasm chlamydiaHyaline membraneTuberculosisObjectives, the student should be able to:1). Outline and be able to discuss the etiology and pathogenesis of tuberculosis in terms of predisposing factors and epidemiologic factors (poorly health conditions, devel
45、oping countries, opportunistic infection to immunocompromised host, ect).2). Organize and be able to discuss tuberculosis in terms of difference between primary, secondary forms (age of host, infective pathway, localization of the lesion, gross and microscopic changes, radiography and sequelae).3).
46、Organize and be able to discuss pulmonary tuberculosis in terms of pathogenesis of Ghon complex, reactivation, cavitary, miliary and disseminated or isolated organ forms, morphology of each form, clinical presentation, and diagnosis.Vocabulary Words/Related Terms - Define and be able to use in conte
47、xt:Mycobacterium tuberculosis acid fast stain aerobe hypersensitivity (cell mediated immunity) tubercle Epithelioid cell Caseaous necrosis Langhans giant cell GranulomaPrimary tuberculosis Ghon complex (primary complex) Secondary tuberculosis Progressive tuberculosis cavitation“cold” abscess Tubercu
48、loma Miliary tuberculosis tuberculous lymphadenitis intestinal tuberculosisvertebrae tuberculosis renal tuberculosis bone and joint tuberculosis night sweet malaise anorexiaTumors of the LungObjectives, the student should be able to:1). Outline and be able to discuss the etiology and pathogenesis of lung carcinoma in terms ofpredisposing factors and epidemiologic factors (smoking, radiological factor, air pollution, etc).2). Organize and be able to discuss the classification of lung tumors on the basi