Pharmacy/SEU/BPH3014/spring14/SRP 1

Clinical pathology
Spring semester 2014
Topic: Definition and scope of pathology

Health
Health is the level of functional or metabolic efficiency of a living organism.
In humans, it is the general condition of a person's mind and body, usually
meaning to be free from illness, injury or pain (as in "good health" or
"healthy").
The World Health Organization (WHO) defined health in its broader sense in
1946 as "a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity.

Disease
A disease is an abnormal condition that affects the body of an organism. It is
often construed as a medical condition associated with specific symptoms
and signs. It may be caused by factors originally from an external source,
such as infectious disease, or it may be caused by internal dysfunctions,
such as autoimmune diseases.
There are four main types of disease: pathogenic disease, deficiency
disease, hereditary disease, and physiological disease.

Pathology
Pathology is the study (logos) of disease (pathos). More specifically, it is
devoted to the study of the structural, biochemical, and functional changes
in cells, tissues, and organs that underlie disease.

Pathology attempts to explain the whys and wherefores of the signs and
symptoms manifested by patients while providing a rational basis for clinical
care and therapy. It thus serves as the bridge between the basic sciences
and clinical medicine, and is the scientific foundation for all of medicine.
Pathology study areas

General pathology: General pathology is concerned with the reactions of
cells and tissues to abnormal stimuli and to inherited defects, which are the
main causes of disease.
Systemic pathology: Systemic pathology examines the alterations in
specialized organs and tissues that are responsible for disorders that involve
these organs.

Pharmacy/SEU/BPH3014/spring14/SRP 2

The four aspects of a disease process that form the core of pathology are -

Etiology: Cause of the diseases. There are two major classes of etiologic
factors:
Genetic e.g., inherited mutations and disease-associated gene
variants, or polymorphisms
Acquired e.g., infectious, nutritional, chemical, physical.

Pathogenesis: This refers to the mechanisms of development of diseases.
Pathogenesis refers to the sequence of events in the response of cells or
tissues to the etiologic agent, from the initial stimulus to the ultimate
expression of the disease.

Molecular and morphologic changes: The biochemical and structural
alterations induced in the cells or tissues that are either characteristic of a
disease or diagnostic of an etiologic process.

Clinical manifestations: The functional consequences of these changes,
that is, the clinical manifestations (symptoms and signs) of disease, as well
as its progress (clinical course and outcome).


Case example: Malaria
Etiology:
A disease caused by protozoan parasites of the genus Plasmodium
transmitted to humans from infected female Anopheles mosquitoes. These
are- Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and P.
malariae, Plasmodium knowlesi (Recently identified as human malaria)

Pathogenesis: Life Cycle in Humans
The malaria parasite life cycle involves two hosts. During a blood meal, a
malaria-infected female Anopheles mosquito inoculates sporozoites into the
human host (1). Sporozoites infect liver cells (2) and mature into schizonts
(3), which rupture and release merozoites (4). After this initial replication in
the liver (exo-erythrocytic schizogony (A)), the parasites undergo
asexual multiplication in the erythrocytes (erythrocytic schizogony (B)).
Merozoites infect red blood cells (5). The ring stage trophozoites mature into
schizonts, which rupture releasing merozoites (6). Some parasites
differentiate into sexual erythrocytic stages (gametocytes) (7). Blood stage
parasites are responsible for the clinical manifestations of the disease.


Pharmacy/SEU/BPH3014/spring14/SRP 3



Molecular & morphological changes:
Parasitological Diagnosis under Light Microscopy reveals the
trophozoites in thin blood smear.
Malarial pigment liberated by destroyed red cells accumulates in the
phagocytic cells resulting in enlargement of the spleen and liver.
In falciparum malaria, there is massive absorption of haemoglobin by
the renal tubules producing blackwater fever.
Cerebral malaria is characterised by congestion.
Parasitised erythrocytes in falciparum malaria are sticky and get
attached to endothelial cells resulting in obstruction of capillaries of
deep organs such as of the brain leading to hypoxia and death.

Clinical manifestations:
Initial symptoms are non-specific headache, muscle aches, nausea,
vomiting, and then malarial paroxysms begin - shaking chill (10-15 min),
high fever. Other symptoms of uncomplicated malaria are splenomegaly,
hepatomegaly, and anemia.