“IVMS and integration of basic and clinical sciences”

Towards Understanding the

Basic Medical Sciences Foundation of Clinical Medicine

Prepared and presented by Marc Imhotep Cray, M.D.

Medical Teacher http://www.imhotepvirtualmedsch.com/

Basic Pathology

Medical Diagnosis

CORRELATION

TO

“IVMS and integration of basic and clinical sciences”

The integration of basic and clinical sciences in undergraduate medical science

2

IVMS teaching philosophy is based on the integration of basic and

clinical sciences.

This means that the learning of basic science is placed in the context

of clinical medicine.

Such an approach is seen to be more meaningful and relevant to

students.

Curriculum integration usually involves both horizontal and vertical

integration and is the pattern that is becoming widespread throughout

the world.”

“IVMS and integration of basic and clinical sciences”

11 benefits of integrated learning in undergraduate medical education

3

1. Improved motivation and satisfaction 2. Professional socialization 3. Enhanced self reflection and self appraisal 4. Reinforced and deep learning 5. Prepares for life‐long learning 6. Improved understanding of biological principles, mechanisms & basic concepts 7. Heightened relevance of learning 8. Facilitates curriculum review 9. Promotes co‐operation between staff members from different disciplines 10. Enhances clinician reflections on the scientific basis of practice 11. Enhances basic scientists reflections on clinical applications and research From: Integration of basic and clinical sciences ‐ AMEE 2008 http://www.amee.org/documents/IntroductionMedical Education BradleyMattick.pdf

“IVMS and integration of basic and clinical sciences”

“What is Horizontal and Vertical Integration”

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Horizontal: bring together the disciplines, topics,

subjects of basic medial science or clinical medicine

Vertical: bringing together basic medial science and

clinical medicine

“IVMS and integration of basic and clinical sciences”

PATHOLOGY • PATH

– pertaining to a morbid process (disease)

• (from “pathos” = travail or sorrow (Greek)

• OLOGY

– the scientific study of …

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“Let’s exemplify vertical integration by briefly looking at how one relates

Basic Pathology to Medical Diagnosis

“IVMS and integration of basic and clinical sciences”

DISEASE

ETIOLOGY

PATHOGENESIS

PATHO- MORPHOLOGY

COURSE PROGNOSIS

COMPLICATIONS

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PATHOLOGY: SCIENTIFIC STUDY OF…

“IVMS and integration of basic and clinical sciences”

MENINGITIS

N. meningitidis

SEPTICAEMIA

ACUTE INFLAMMATION

MENINGES

SPREAD VIA CSF DEATH

(IF UNTREATED) VENTRICULITIS ENDARTERITIS

HYDROCEPHALUS

E

P

PM

P

NH C

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Ex: SCIENTIFIC STUDY OF DISEASE

“IVMS and integration of basic and clinical sciences”

PATHOLOGY OBJECTIVES

1 To introduce a NEW VOCABULARY of terms, definitions, and disease processes.

2 To introduce the BASIC RESPONSES of the human organism to injury.

• Correlation with clinical picture.

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“IVMS and integration of basic and clinical sciences”

SIGNS and SYMPTOMS

STRUCTURAL & FUNCTIONAL ALTERATIONS

PATHOLOGY OBJECTIVE (2)

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CORRELATION

induced by disease

form

the basis by which attending

are produced

“IVMS and integration of basic and clinical sciences”

& clinician

& pathologist

PHYSIOLOGY & FUNCTION

ORGAN STRUCTURE

SIGNS AND SYMPTOMS

PATHOMORPHOLOGY

DETECTED BY CLINICIAN

DETECTED BY PATHOLOGIST

ALTERS

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“IVMS and integration of basic and clinical sciences”

LEVELS OF STUDY OF PATHOLOGY

• MOLECULAR

• CHEMICAL

• ULTRASTUCTURAL

• CELLULAR

• TISSUE

• ORGAN

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PATHOMORPHOLOGY

“IVMS and integration of basic and clinical sciences”

PATHOMORPHOLOGY

• PATHO.. - the disease

• MORPH .. - the shape (structure)

• OLOGY .. - the study of

i.e. how a disease process alters the “shape” (structure) of cells, tissues and organs …… or ……

the “DAMAGE” caused by the disease process.

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“IVMS and integration of basic and clinical sciences”

“ORGANOMEGALY”

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AS A PRECEPT THERE IS BUT ONE CAUSE OF ORGANOMEGALY

AN ALTERATION OF MORPHOLOGY

“CHANGE IN SHAPE & / 0R SIZE”

SOMETHING MUST BE ADDED TO THE ORGAN

“IVMS and integration of basic and clinical sciences”

WHAT MAY BE ADDED?

• NORMAL CELLS

• FLUID

• BLOOD

• INFLAMMATORY

• NEOPLASTIC CELLS

• GAS

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HYPERPLASIA or HYPERTROPHY

EDEMA

CONGESTION

TUMOR

EMPHYSEMA

EXUDATE

“IVMS and integration of basic and clinical sciences”

HISTOPATHOLOGY /

PATHOMORPHOLOGY

OVERVIEW

Companion learning tools to the following general

pathology section:

IVMS General Pathology Lecture Notes.pdf

Images

IVMS-Gross Pathology, Histopathology, Microbiology and

Radiography High Yield Image Plates

WebPath

http://www-medlib.med.utah.edu/WebPath/webpath.html

“IVMS and integration of basic and clinical sciences”

CELLULAR DEGENERATION

AND INFILTRATION THEY ARE RELATED TO CHANGES WHICH MAY BE

REVERSIBLE

THE AGENTS WHICH CAUSE CELULAR

DEGENERATION AND OR INFILTRATION , WHEN

OCCURING OVER LONGER PERIODS OF TIME WILL

ULTIMATELY LEAD TO THE DEATH OF THE CELL

WITH MORPHOLOGIC CHANGES

“IVMS and integration of basic and clinical sciences”

CELL INJURY THUS REFLECTS

TWO LEVELS OF SEVERITY

1. ONE COMPATIBLE WITH RECOVERY

2. THE SECOND IRREVERSIBLE

“IVMS and integration of basic and clinical sciences”

COMPATIBLE WITH RECOVERY

CLASSAFICATION

CELL DEGENERATION AND INFILTRATION CAN BE DIVIDED INTO SEVERAL MORPHOLOGIC PATTERNS DEPENDING ON THE METABILITE(S) THAT ACCUMULATE IN THE CELL

“IVMS and integration of basic and clinical sciences”

CLOUDY SWELLING

THIS IS CHARACTERIZED MORPHOLOGICALLY BY A SLIGHT SWELLING OF THE CELLWITH GRANULARITY AND CLOUDINESS OF THE CYTOPLASM

THIS IS SEEN MOST OFTEN IN RENAL TUBULAR CELLS, HEPATIC CELLS AND CARDIAC MUSCLE.

ORGANS WITH THIS AFFECT ARE SLIGHTLY LARGER , FIRM AND PALE

“IVMS and integration of basic and clinical sciences”

CLOUDY SWELLING(2)

THIS CAN BE CAUSED BY MANY FACTORS INFECTIONS

FEBRILE ILLNESS

EXCESSIVE COLD OR HEAT

ANOXIA

MALNUTRITION

PHYSICAL INJURY

VASCULAR DISTURBANCES

“IVMS and integration of basic and clinical sciences”

HYDROPIC OR VACUOLOR

DEGENERATION THIS IS A MORE PRONOUNCED FORM OF

INTRACELLULAR EDEMA, AND ALTHOUGH IT IS

REVERSIBLE , IT RREFLECTS A MORE SERIOUS INJURY

TO THE CELL

IT IS CAUSED BY THE SAME AFFECTS THAT

PROUDUCE CLOUDY SWELLING

“IVMS and integration of basic and clinical sciences”

HYDROPIC OR VACUOLOR

DEGENERATION(2)

THIS DEGENERATION IS OF PARTICULAR PROMINENCE IN THE KIDNEYS , OFTEN RESULTING FROM HYPOKALEMIA

AND IN LIVER CELLS WHICH ARE EXPOSED TO POISONS OR TOXINS (SUCH AS CARBON TETRACHLORIDE AN CHLOROFORM)

“IVMS and integration of basic and clinical sciences”

HYDROPIC OR VACUOLOR

DEGENERATION(3)

ON MICROSCOPIC EXAMINATION THIS APPEARS AS

SMALL , CLEAR VACOULES DISPERSED

THROUGHOUT THE CYTOPLASM

IN SEVERE CASES THE VACOULES COALESCE AND

FORM LARGE CLEAR SPACES WHICH MAY DISPLACE

THE NUCLEUS

PROGRESSION IS TOWARD FRANK NECROSIS

“IVMS and integration of basic and clinical sciences”

FATTY DEPOSITION (FATTY METAMORPHOSIS)

THIS CHANGE IS DUE TO AN ABNORMAL

ACCUMULATION OF FAT WITHIN PARENCHYMAL

CELLS

“IVMS and integration of basic and clinical sciences”

FATTY DEPOSITION (FATTY METAMORPHOSIS)(2)

THE PRESENCE OF FAT REPRESENTS AN ABSOLUTE INCREASE IN INTRACELLULAR FAT AND REPRESENTS SEVERE CELL INJURY

THE SIZE OF THE FAT VACOULE IS NOT DEPENDENT ON THE PATHOLOGIC MECHANISM

THERE ARE MULTIPLE CAUSES WHICH LEAD TO THIS DEGENERATION

FATTY CHANGE IS OFTEN PRECEDED BY CLOUDY SWELLING

“IVMS and integration of basic and clinical sciences”

GLYCOGEN DEGENERATION (INFILTRATION)

GLYCOGEN IS MORMALLY ABUNDANT IN LIVER AND MUSCLE CELLS

IN SOME CONDITIONS ABNORMAL ACCUMULATIONS OCCUR PRODUCING VISIBLE GLYCOGEN VACOULES WITHIN THE CYTOPLASM OR NUCLEI

GLYCOGEN INFILTRATION IS FOUND IN DIABETES MELLITUS

GLYCOGEN STORAGE DISEASES

“IVMS and integration of basic and clinical sciences”

HYALINE DEGENERATION

IN THIS , THERE IS A REGRESSIVE CHANGE IN

THE CELLS IN THAT THE CYTOPLASM NOW

HAS A GLASSY EOSINOPHILIC APPEARANCE

THIS DEGENERATION IMPLIES THAT THE

INJURY TO THE CELL CYTOPLASM HAS

CAUSED DENATURATION AND COAGULATION

OF THE CYTOPLASM

“IVMS and integration of basic and clinical sciences”

MUCOID DEGENERATION

THIS DESCRIPTION REFERS TO THE EXTRACELLULAR ACCUMULATION OF MUCOPOLYSACCHARIDE AND GROUND SUBSATNCE WITHIN CONNECTIVE TISSUE

THIS CHANGE IS SEEN IN COLLAGEN DISEASES. THERE IS NO INTRA- CELLULAR DEFECT

“IVMS and integration of basic and clinical sciences”

CELL DEATH AND NECROSIS

• NECROSIS REFERS TO THE MORPHOLOGIC CHANGES

THAT FOLLOW CELL DEATH AND PERMIT VISIBLE

RECOGNITION THAT THE CELL HAS DIED

“IVMS and integration of basic and clinical sciences”

IRREVERSIBLE

NECROSIS

MOST OF THE CHANGES THAT INDICATE CELLULAR

DEATH ARE MORE PROMINENT IN THE NUCLEUS THAN

IN THE CYTOPLASM

“IVMS and integration of basic and clinical sciences”

COAGULATION NECROSIS

THIS TYPE OF NECROSIS IS CHARACTERISED BY THE CELL BECOMING AN ACIDOPHILIC MASS, USUALLY WITH THE LOSS OF THE NUCLEUS, BUT WITH REMNANTS OF ENOUGH BASIC SHAPE TO PERMIT RECOGNITIONOF THE CELL BOUNDARIES

“IVMS and integration of basic and clinical sciences”

LIQUEFACTION NECROSIS

IN THIS CASE THERE IS A RAPID AND TOTAL ENZYMATIC DISSOLUTION OF THE CELLS

THERE IS COMPLETE DESTRUCTION OF THE CELL WALL

THIS TYPE OF NECROSIS IS SEEN OFTEN IN THE BRAIN

“IVMS and integration of basic and clinical sciences”

ENZYMATIC NECROSIS

THIS PRESENTS WITH ACUTE DESTRUCTION OF THE PANCREAS

THIS FROM THE RELEASE OF THE PANCREATIC ENZYMES OUTSIDE OF THEIR NORMAL CONFINES

“IVMS and integration of basic and clinical sciences”

CASEOUS NECROSIS

THIS SEEN WITH TUBERCULOSIS INFECTIONS

THE CELLS ARE CHANGED TO A GRANULAR,

EOSINOPHILIC MASS OF AMORPHOUS FAT AND

PROTEIN GROSSLY LOOKING LIKE SOFT FRIABLE

CHEESE

“IVMS and integration of basic and clinical sciences”

GANGRENOUS NECROSIS

THIS IS RELATED TO ISCHEMIA AND A SUPERIMPOSED BACTERIAL INFECTION

THE INITIAL EVENT MAY HAVE BEEN A BACTERIAL INFECTION WHICH COMPROMISED THE VASCULARITY ALLOWING SAPROPHYTIC ORGANISS TO THRIVE -THEREBY FURTHER INCREASING THE ISCHEMIC CHANGE

“IVMS and integration of basic and clinical sciences”

FIBRINOID NECROSIS

THIS IS SEEN PRINCIPALLY WITH DISEASES OF HYPERSENSITIVITY ORIGIN

THERE IS THE APPEARANCE OF FIBRIN DEPOSITS IN THE CONNECTIVE TISSUE AND IN THE WALLS OF THE BLOOD VESSELS

“IVMS and integration of basic and clinical sciences”

CAUSES OF CELL INJURY

AND DEATH

1) ANOXIA

2) PHYSICAL AGENTS

3) CHEMICAL AGENTS

4) BIOLOGIC AGENTS

5) IMMUNE MCAHANISMSDERRANGEMENTS

6) GENETIC DEFECTS

“IVMS and integration of basic and clinical sciences”

DIFFERENTIAL DIAGNOSIS

38

INFLAMMATORY

VASCULAR

NEOPLASTIC

DRUGS

INFECTION

CONGENITAL

AUTOIMMUNE

TRAUMATIC

ENDOCRINE / METABOLIC “VINDICATE”

IS THE PROCESS.. - SUDDEN ONSET

- CARDINAL SIGNS/SYMPTOMS

- MASS

- HISTORY

- CARDINAL SIGNS/SYMPTOMS

- FROM BIRTH

- SYSTEMIC

- HISTORY

- Sn/Sx