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General Pathology

Cell Injury & Death

  • Causes of cell injury.
  • Reversible and irreversible cell injury.
  • Mechanisms of cell injury: general biochemical mechanisms, hypoxia/ischaemia/reperfusion injury, free radical-induced cell injury, mechanisms of ionising radiation, chemical and viral-induced cell injury.
  • Structural changes of reversible and irreversible cell injury, macroscopic, microscopic and ultrastructural appearances.
  • Necrosis: definition, types of necrosis, including gangrene sequalar.
  • Apoptosis: definition, causes, morphology and mechanisms.
  • Systemic effects of cell injury.
  • Autolysis and post mortem changes.

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Cellular adaptations to injury

  • Growth disturbances: atrophy, hypertrophy, hyperplasia, metaplasia, dysplasia.
  • Subcellular alterations: lysosomes, endoplasmic reticulum, mitochondria and cytoskeletal changes. Heat shock proteins.
  • Intracellular accumulations: fatty change, cholesterol and cholesterolesters, proteins, glycogen.
  • Pigments: exogenous and endogenous. Lipofuscin, melanin, haemosiderin, bilirubin, haematin.

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Extracellular Pathology

  • Pathology of collagen, elastin, basement membranes.
  • Amyloid.
  • Pathological calcification; dystrophic and metastatic.
  • Uric acid deposition.

Ageing

Factors known to affect life span; common diseases of old age; theories to explain the ageing process.

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Tissue Responses to Injury

Inflammation

  • Definition; causes, difference between inflammation and infection.
  • Acute inflammation. Definition, classical clinical features. Vascular and cellular events. Chemical mediators. Special macroscopic appearances in certain tissues. Abscess formation. Beneficial and harmful effects of inflammation. Sequelae. The lymphatic system in inflammation. Systemic effects. Defects in the inflammatory response.
  • Chronic inflammation. Definition. Causes of chronic inflammation; primary causes and as a sequel to acute inflammation. Cells of chronic inflammation; central role of the macrophage. Chemical mediators.
  • Granulomatous inflammation: definition of a granuloma; causes; morphology. Special macroscopic appearances in certain tissues. Chronic ulceration. Sequelae.

Healing, Regeneration & Repair

  • Healing by regeneration with complete restitution.
  • Labile, stable and permanent cells. Stem cells.
  • Healing by repair (+ - regeneration) with scar formation.
  • Organisation by granulation tissue and fibrosis.
  • Molecular factors in the healing process: cell-cell interactions; the extracellular matrix and cell-matrix interactions; growth factors and cytokines.
  • Healing of skin wounds: healing by first intention, healing by second intention. Complications; contractures, keloid. Factors influencing wound healing.
  • Healing of bone fractures: organisation of haematoma, callus formation, lamellar bone formation, remodelling.
  • Factors affecting fracture healing. Complications of fractures.
  • Healing in the gastrointestinal tract, peritoneum and other tissue spaces, liver, kidney, muscle and neural tissue.

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Vascular Disturbances

Oedema:

definition, fluid collections in body cavities. Pathophysiological categories of oedema. Morphology. Clinical importance.

Hyperaemia and congestion:

causes, morphology and clinical importance.

Haemorrhage:

brief overview of causes, terminology and clinical significance.

Ischaemia:

definition, causes, effects on tissues and the modifying effects of duration of ischaemia, and differing susceptibilities of tissues. Clinical importance.

Thrombosis:

  • definition. Distinction from clot.
  • Components of a thrombus. Predisposing factors to thrombus formation. Virchow's triad. Morphology. Arterial thrombosis. Venous thrombosis. Thrombi on heart valves.

Fate of thrombi:

  • fibrinolysis, organisation, recanalisation, calcification.
  • Clinical effects of arterial and venous thrombosis.
  • Disseminated intravascular coagulation.

Embolism:

definition, types, causes, common sites and effects.

Infarction:

  • definition, causes, morphology of infarcts, variations seen in different organs, organisation and repair.
  • Factors effecting the development of an infarct. Gangrene. Clinical importance.

Shock:

definition, types of shock, causes, stages of shock, tissue changes in shock, clinical manifestations.

Atherosclerosis:

  • characteristics, clinical significance and detailed morphology of early and advanced lesions.
  • Epidemiology and risk factors.

Pathogenesis

role of endotheilial injury, inflammation, infection, disorded immunity, lipids and lipoproteins, fibrin and platelets, foetal events. Prevention.

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Neoplasia

  • Definition and terminology. Basic structure of neoplasms; neoplastic cells, stroma and angiogenesis.
  • Definition of benign and malignant tumours: characteristic differences, especially in terms of differentiation, growth rate, local invasion and metastases. Gross appearance of tumours and correlation with behaviour. Classification of neoplasms by histogenesis (cell of origin).
  • Nomenclature of neoplasms. Differentiation from hamartomas, choristomas and cysts.
  • The biology of neoplasms: immortalisation, DNA abnormalities, mitosis and apoptosis in neoplasms, metabolic abnormalities.
  • The molecular basis of cancer: oncogenes, suppressor genes, regulatory genes of apoptosis, DNA repair genes. Growth signals and growth-inhibitory signals. Molecular basis of immortalisation. Molecular basis of angiogenesis. Molecular basis of invasion and metastases.
  • Carcinogenic agents:
    • chemicals, radiant energy, viruses, bacteria, fungi and parasites.
    • Multistep hypothesis of carcinogenesis.
    • Epidemiology of cancer. Occupational and behavioural risks.
    • Host factors in carcinogenesis; age, gender, race, diet, inherited genomic instability, pre-malignant lesions and conditions.
    • Host defence, cell mediated and humoral immunity.

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Immunosurveillance.

  • Clinical effects of neoplasia: local effects, general effects; cachexia and paraneoplastic syndromes.
  • Laboratory diagnosis; morphological techniques, excision/biopsy, fine-needle aspiration, cytology, immunocytochemistry, flow cytometry
    • biochemical assays for tumour markers
    • molecular diagnosis
    • DNA microarray analysis
  • Prognostic factors: type of tumour, grading and staging of tumours. Tumour dormancy.

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Infections & Parasitic Diseases

Importance of infections & parasitic diseases.

  • Changing patterns; effects of travel, change in the environment, new infectious diseases.
  • Methods of identifying organisms in tissues.
  • Types of reaction in tissues to the presence of an organism. Interaction with hosts immune state.

General pathology of diseases caused by bacteria, viruses, fungi, parasites and prious.

Selected examples to illustrate mode of spread, tissue reaction, identification of organism in tissues, type of disease and host modifying factors.

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Environmental Pathology

Inhaled pollutants:

  • air pollution and occupational dust diseases (pneumoconiosis)*.
    * (Covered in lectures on respiratory diseases).
  • Enumeration of diseases associated with smoking.

Chemical injury:

  • organic and inorganic compounds, metals, gases, toxic mushrooms.
  • The pathology of alcohol (covered in 4th medical year) and drug abuse.
  • Adverse reactions of therapeutic drugs.

Physical agents:

mechanical trauma, thermal injury, atmospheric pressure, electrical injury, ultraviolet light, ionising radiation injury (mechanisms and morphological changes, complications of radiotherapy, whole body radiation).

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Nutritional Pathology

  • Causes and effects of malnutrition. Protein-energy malnutrition. Anorexia nervosa and bulimia.
  • Vitamin deficiencies and vitamin toxicity.
  • Trace elements and disease.
  • Obesity and its complications.

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Last updated 21 September 2016 Paul Smyth (Email).