HISTO MTAP 3

• Pathology

  The study of the structural and functional causes of human disease
• Four aspects of a disease process that form the core of pathology

  • Etiology
  • Pathogenesis
  • Morphologic change
  • Clinical Significance
• Adaptation


  Occurs when physiologic or pathologic stressors induce a new state that changes the cell but otherwise preserves its viability in the face of the exogenous stimuli
• Cellular Response to Injury

  • Cellular adaptations
  • Hyperplasia, hypertrophy
  • Atrophy
  • Metaplasia
  • Cell injury
  • Acute reversible injury
  • Irreversible injury -> cell death
  • Intracellular accumulations; calcification
  • Cellular aging
• Changes in cells


  • Hypertrophy
  • Atrophy
  • Hypoplasia
  • Hyperplasia
  • Neoplasia
  • Dysplasia
  • Metaplasia
  • Anaplasia
• Reversible injury


  Pathologic cell changes that can be restored to normalcy if the stimulus is removed or if the cause is mild
• Irreversible injury


  Permanent pathologic changes that cause cell death
• Patterns of cell death

  • Necrosis
  • Apoptosis
• Features of Necrosis and Apoptosis

  • Cell size
  • Nucleus
  • Plasma membrane
  • Cellular contents
  • Adjacent inflammation
  • Physiologic or pathologic role
• Necrosis


  More common type of cell death, involving severe cell swelling, denaturation and coagulation of proteins, breakdown of cellular organelles, and cell rupture
• Apoptosis


  Programmed cell death
• Autophagy


  An adaptive response of cells to nutrient deprivation; it is essentially a self cannibalization to maintain viability
• Changes in the nucleus during cell death

  • Pyknosis
  • Karyorrhexis
  • Karyolysis
• Causes of cell injury

  • Oxygen deprivation
  • Physical agents
  • Chemical agents and drugs
  • Infections agents
  • Immulologic reactions
  • Nutritional imbalances/ excesses
• General tissue patterns of necrosis

  • Coagulation necrosis
  • Liquefaction necrosis
  • Gangrenous necrosis
  • Caseous necrosis
  • Fat necrosis
  • Fibrinoid necrosis
• Mechanisms of cell injury

  • Depletion of ATP
  • Mitochondrial Damage
  • Influx of Calcium and loss of calcium homeostasis
  • Accumulation of oxygen derived free radicals (oxidative stress)
  • Defects of membrane permeability
  • Damage to DNA and proteins
• Inflammation


  The response of vascularized living tissue to injury. It may be evoked by microbial infection, physical agents, chemical, necrotic tissue, or immune reactions
• Components of inflammation


  • Vascular wall response
  • Inflammatory cell response
• Types of inflammation


  • Acute inflammation
  • Chronic inflammation
• Five cardinal signs of Inflammation

  • Calor (warmth)
  • Rubor (erythema)
  • Tumor (edema)
  • Dolor (pain)
  • Functio laesa (loss of function)
• Edema

  Excess fluid in interstitial tissue or body cavities
• Exudate

  Inflammatory, extravascular fluid with cellular debris and high protein concentration
• Transudate


  Excess, extravascular fluid with low protein content, ultrafiltrate of blood plasma resulting from elevated fluid pressures of diminished osmotic forces
• Pus

  Purulent inflammatory exudate rich in neutrophils and cell debris
• Purposes of Autopsy


  • Ascertain cause of death
  • Homicidal
  • Suicidal
  • Accidental
  • Natural causes
• Values of Autopsy


  • Studying nature of disease
  • See results of certain treatment
  • Reveals congenital & acquired abnormalities
  • Visualize normal & abnormal parts of the body
  • Elimination of fear
  • Recognition of familial or hereditary disorders
  • Reliable source of vital statistics
  • Aids in the study of epidemic diseases
• Who authorizes autopsy


  • Next of kin & 2 witnesses
  • spouse
  • children of legal age
  • father
  • mother
  • next nearest relative
• Pediatrics, stillbirths, prematures


  • father of legal age or "emancipated minor"
  • mother if of legal age without husband or dead
  • husband or minor husband
  • maternal grandparent (grandfather) if father is minor, not supporting wife, or mother is minor
• Cases referred to NBI or PNP

  • Accident
  • Suicide, homicide, poisoning, burns, criminal violence, trauma, unusual circumstances
  • Death w/o medical attendance
  • DOA (Dead on Arrival)
  • Abortion, death under anesthesia or surgery, alcoholism
• Autopsy Techniques


  • Virchow
  • Rokitansky
  • Ghon
  • Letulle
• Steps in Adult Autopsies

  • External description
  • Radiologic examination
  • Y shaped incision
  • Removal of material from abdomen for microbiology
  • Collection of effusions & exudates
  • Record diaphragm height & level of liver edge
  • Search for hernias
  • Incision of anterior abdominal musculature & breasts
  • Search for pneumothorax
  • Cut lower ribs
  • Removal of chest plate
  • Removal of thymus fat pad
  • Collection of pericardial contents
  • Collection of blood from heart or peripheral system for micro & biochemical studies
  • ID of carotid, subclavian, femoral arteries for embalmer
• Steps in Pediatric Autopsies

  • Potter & Craig (lungs, liver, kidney, thymus, brain – minimal requirement)
  • External examination, check for malformations
  • Examine placenta & umbilical cord
  • Skull opened
• The organ blocks can be studied in details
• Fast


  Awkward to handle
• Adult Autopsies


  1. External description

  2. Radiologic examination

  3. Y shaped incision

  4. Removal of material from abdomen for microbiology

  5. Collection of effusions & exudates

  6. Record diaphragm height & level of liver edge

  7. Search for hernias

  8. Incision of anterior abdominal musculature & breasts

  9. Search for pneumothorax

  10. Cut lower ribs

  11. Removal of chest plate

  12. Removal of thymus fat pad

  13. Collection of pericardial contents

  14. Collection of blood from heart or peripheral system for micro & biochemical studies

  15. ID of carotid, subclavian, femoral arteries for embalmer
• Pediatric Autopsies


  1. Potter & Craig (lungs, liver, kidney, thymus, brain – minimal requirement)

  2. External examination, check for malformations

  3. Examine placenta & umbilical cord

  4. Skull opened by Beneke technique

  5. Open chest cavity under water to show pneumothorax

  6. En masse removal is preferred
• Post Operative Autopsies


  1. Possible medico legal implications

  2. Most experienced pathologist

  3. Surgeon should be present

  4. Incision not carried out thru operative wounds

  5. Document with photographs

  6. Dictate descriptions, do not interpret
• Immediate Autopsy Program


  1. Rapid Sampling Phase: Done within minutes of death pronouncement, Samples from: heart, lung, liver, kidneys, adrenals, pancreas, skeletal muscles, aorta, colon, prostate, breast in females, Team of 6, Fixatives: 4% phosphate buffered formalin & 1% glutaraldehyde, Blood sample collected for chemistry

  2. Routine Phase: Uses standard dissection, fixation, & sampling
• Restricted Autopsies


  1. Restriction of skin incision

  2. Autopsies thru surgical wounds

  3. Autopsies thru anus & vagina

  4. Needle autopsies (liver, heart, lungs, kidneys)
• Special Problems in Autopsy: Adhesions, Hernias, Lesions on face, arms, hands need special permission, Pneumothorax, pneumomediastinum, subcutaneous emphysema, free air in abdomen