Session 1:

Basic concepts of Pathology

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 Learning tasks
At the end of this session, students are expected to be
able to:
• Define pathology.
• Explain evolution of pathology.
• Identify subdivisions of pathology.
• Explain disease development.
• Classify categories of diseases.

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 Activity: Brainstorming
• What is Pathology?

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 Definition of Pathology
• Originated from two Greek words: pathos (suffering)
and logos (study of).
• Pathology is the scientific study of disease.
• Describes causes and effects of disease, and the
functional and structural changes that occur.
– Explains how these changes correlate with clinical
manifestations of the disease.
• Pathology gives the assist in the accurate diagnosis
and treatment of diseases.

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 Evolution of Pathology
Evolution of Pathology described with the following
concepts from different era:
1. Religious and superstitious beliefs to rational
approach (Antiquity to AD 1500).
2. Era of gross pathology (AD 1500 to 1800).
3. Era of technology development and cellular
pathology (AD 1800 to 1950s).
4. Era of modern pathology (1960s to dawn of 21st
century).

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Evolution of Pathology cont…
1. Religious and superstitious beliefs to rational
approach (Antiquity to AD 1500).
• Disease was the outcome of curse or evil eye of
spirits.

2. Era of gross pathology (AD 1500 to 1800).

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Evolution of Pathology cont…
3. Era of technology development and cellular
pathology (AD 1800 to 1950s).
• Advanced microscopy technology.
• Staining techniques were introduced.
– Papanicolaou in 1930s developed the use of exfoliative
cytology for early detection of cervical cancer.

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Evolution of Pathology cont…
4. Era of modern pathology (1960s to dawn of 21st
century).
• Major advances in molecular biology.
• Some of discoveries on molecular biology are:
– Description of the structure of DNA of the cell.
– Identification of chromosomes and their correct number.
– Recombinant DNA technique developed.
– Introduction of polymerase chain reaction (PCR).
– Mammalian cloning.
– Era of stem cell research.
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 Subdivision of Pathology
• Traditionally, Pathology is divided into two
subdivisions:
1. General pathology.
• It focuses on common cellular and tissue alterations
caused by pathologic stimuli in most tissues. e.g.
Inflammation, cancer, aging.
2. Systemic pathology.
• It examines the reactions and abnormalities of
different specialized organs. e.g. Goiter (thyroid),
pneumonia (lung), cirrhosis (liver).
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 Subspecialties of Pathology
• With the advancement of diagnostic tools, the
speciality of pathology has come to include some of
the following subspecialities:
i. Histopathology.
ii. Haematology.
iii. Chemical pathology.
iv. Immunopathology.
v. Medical genetics.
vi. Molecular pathology.

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 Histopathology
• It is also known as anatomic pathology, pathologic
anatomy or morbid anatomy.
• It is the classic method of studying different
pathologies.
• Most useful subspecialty which has stood the test of
time.
• The study includes structural changes observed by
naked eye and microscopy supported by numerous
special staining methods.

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 Subdivisions of Histopathology
1. Surgical pathology.
• Study of tissues removed from the living body.
2. Forensic pathology and autopsy work.
• Study of organs and tissues removed at postmortem
for medicolegal work and or for determining
sequence and cause of death.
3. Cytopathology.
• Study of cells shed off from lesions and from
superficial and deep-seated lesions for diagnosis.

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 Disease development
• Disease is defined as an abnormal variation in
structure or function of any part of the body.
• There are four (4) core aspects for disease
development:
1. Aetiology.
2. Pathogenesis.
3. Morphologic changes.
4. Functional derangements and clinical significance.

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 Aetiology
• Aetiology is the origin of a disease, including the
underlying causes and modifying factors.
• Aetiology forms the core of the Pathology.
• It refers to why a disease arises.
• Knowledge or discovery of the primary cause
remains the backbone on which diagnosis can be
made, disease is understood or treatment is
developed.

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 Aetiology
• There are two major classes of aetiologic factors:
i. Genetic (Intrinsic) factor.
ii. Acquired (Environmental) factor.
• There is an interaction of these aetiologic factors in
disease causation.
• Understanding the genetic and environmental factors
underlying diseases is a major theme of modern
medicine.

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 Aetiology:
Genetic factors
• These are the results of activities of single genes and
groups of genes.
• Both normal and abnormal gene influence susceptibility
and resistance to disease.
• Examples of diseases and their genetic predisposing
factor from normal genes.
– Susceptibility of fair (light) skin to damage e.g. skin cancer by
the ultraviolet rays in sunlight.
– Blood group B is associated with duodenal ulcer.
– The blood group Duffy negative confers resistance to infection
by Plasmodium vivax.

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 Aetiology:
Genetic factors cont…
Abnormal genes
• Mutations give rise to abnormalities of chromosomes
and components genes.
• Mutations occur spontaneously without known cause.
• In some cases mutations are caused by radiations,
chemicals or infective agents.

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 Aetiology:
Genetic factors cont…
• There are hereditary diseases where genetic
abnormality directly determines a disease. e.g.
Albinism.
• But most of genetic diseases are multifactorial
(genetic and environmental factors). e.g. Diabetes.
• There is acquired specific genetic abnormality in
stem cells, which potentiate the development of
malignant tumours.

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 Aetiology:
Environmental factors
• These include:
1. Physical agents.
2. Chemical agents.
3. Infections/infestations (Biological agents).
4. Nutritional imbalances.
5. Abnormal immunological reactions.
6. Psychological factors.

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 Aetiology:
Environmental factors cont…
1. Physical agents
• Physical agents include:
i. Trauma.
ii. Radiations.
iii. Extreme heat and cold.
iv. Electrical power.
v. Changes in atmospheric pressure.

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 Aetiology:
Environmental factors cont…
ii. Chemical agents
• These are increasing with the advances in industrial
processing, some act in general manner i.e. the toxic
effect is to all cells.
• Some act locally example acids and caustics on the
skin and mucous membrane.
• Some affect certain organs such as lungs, kidneys,
liver and pancreas.

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 Aetiology:
Environmental factors cont…
iii. Infections/infestations (Biological agents).
– Bacteria.
– Viruses.
– Fungi.
– Parasites.
• They cause diseases by direct destruction to the tissue
or due to toxins produced by these agents.

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 Aetiology:
Environmental factors cont…
iv. Nutritional imbalance (Nutritional deficiency or
excess).
• Nutritional deficiency result from poor supply,
interference with absorption, inefficient transport
within the body or defective utilisation of nutrients.
• Dietary excess can the cause of many systemic
diseases such as cardiac diseases.

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 Aetiology:
Environmental factors cont…
v. Abnormal immunological reactions
(Immunological factors)
• The immune process is normally protective but in
certain circumstances the reaction may become
deranged.
• Hypersensitivity to various substances can lead to
alarming shock-like conditions- anaphylaxis.
• Immune process may act against the body cells–
autoimmunity.

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 Aetiology:
Environmental factors cont…
vi. Psychological factors
• They cause and influence disease process in several
ways:
– Psychological stress may lead to mental illness.
– Their influence on the individual’s symptoms and reaction
to established somatic disease is apparent.
– They are important components in disease caused by
addiction, e.g. alcohol and tobacco.
– Psychogenic factors are causally related to diseases such
as hypertension, peptic ulcers.

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 Pathogenesis
• Mechanism on how etiologic factors trigger cellular
and molecular changes that give rise to the specific
functional and structural abnormalities that
characterize the disease.
• Pathogenesis describes how a disease develops.
• The study of pathogenesis remains the main domain
of pathology.
• Pathogenesis leads to morphologic changes.

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 Morphologic changes
• Structural alterations in cells or tissue that are either
characteristic of the disease or diagnostic of the
aetiologic process.
• They occur following the pathogenetic mechanisms.
• The structural changes in the organ can be seen by
naked eye or under the microscope.

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 Morphologic changes cont…
• Structural changes seen by naked eye are called gross
morphologic changes (macroscopic changes).
– Look for size, shape, consistency, colour of the affected
tissue/organ.
• Structural changes seen under the microscope are
called microscopic changes (histological changes).
• Morphologic changes will lead to functional
alteration and to the clinical signs & symptoms of the
disease.

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 Functional derangements and
Clinical significance
• The functional consequences of the morphologic
changes.
• Morphologic changes will determine:
i. Clinical features (symptoms and signs).
ii. Course of the disease.
iii. Prognosis of the disease.

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 Classification of diseases
• Basing on body response disease can be classified as:
1. Congenital diseases.
2. Inflammatory diseases.
3. Degenerative diseases.
4. Neoplastic diseases.

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 Key points
• Pathology is the scientific study of disease.
• It is broadly subdivided into General Pathology and
Systemic Pathology.
• Pathology has been evolved over the centuries from
supernatural beliefs to the present state of knowledge
of modern pathology.
• Pathology provides the scientific foundation for the
practice of medicine.
• Pathology gives explanations of a disease by studying
the four core aspects of the disease.
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 Review questions
1. Define Pathology
2. What are the era involved in evolution of Pathology?
3. Outline three (3) subdivisions of histopathology
4. Explain factors contribute to disease development?
5. How can diseases be classified basing on body
responses?

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 References
• Bezabeh M.; Tesfaye A.; Ergicho B. et al (2004): General
pathology lecture notes for Health Sciences students.
Ethiopia Public Health Training Initiative. Pg. 1-2.
• Kumar V. ; Abbas A. K. ; Aster J. C.;(2013): Robbins and
Contran Pathologic Basis of Disease (9th Ed.) Elsevier
Saunders, USA. Pg. 1.
• Mohan H.;(2010): Text book of Pathology (6th Ed.)
Jaypee Brothers Medical Publishers, India. Pg. 1-7.
• Sanchez A.; Barone J.;(2013): USMLE Step 1 Pathology
lecture notes. Kaplan Inc, USA. Pg. 1.

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