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Respiratory tract

Open full size image Common Clinical Problems From Respiratory Tract Disease Pathological basis of respiratory signs and symptoms Sign or symptom Pathological basis Sputum Clear or mucoid Purulent With blood Excess secretion from bronchial mucous glands (e.g. in asthma and chronic bronchitis) Inflammatory exudate from respiratory tract infection Ulceration of airways or damage to pulmonary vasculature (e.g. lung tumours, pulmonary infarcts, bronchiectasis, aspergilloma) Cough Physiological reflex…

Cardiovascular system

Common Clinical Problems From Cardiovascular Disease Pathological basis of cardiovascular signs and symptoms Sign or symptom Pathological basis Angina Myocardial ischaemia — due to spasm, atheroma or thrombosis of coronary arteries Abnormal blood pressure Hypertension Mostly ‘essential’ (primary, idiopathic) due to ‘as-yet’ undefined genetic and environmental factors, or secondary to a disease resulting in increased levels of hormones which produce hypertensive effects Hypotension Reduction of actual…

How do pathologists help patient care?

The diagnosis and treatment of patients could not happen without the use of laboratory tests and their interpretation by pathologists. The history, symptoms and signs of an illness may be highly suggestive of a particular diagnosis but that diagnosis almost always requires a pathology test to confirm it before treatment can be given, for example, biochemical confirmation of a myocardial infarction before thrombolytic therapy, tissue diagnosis…

Ageing and death

As complex organisms become older, so each species accumulates a characteristic series of changes, and perhaps an enumeration of those changes might be all we need to know about ageing. However, things are not that simple: some of these changes are inevitable and others not — for instance, changes in arterial collagen are found in all elderly human aortas, but atheroma is not. So, should we…

Neoplasia and carcinogenesis

General Characteristics of Neoplasms (Tumours) ➤ Tumours arise due to accumulation of multiple genetic alterations (e.g. mutations, deletions, translocations) and epigenetic changes (e.g. promoter methylation) in cells driving clonal evolution ➤ These changes result in abnormal (neoplastic) cell growth, forming a mass of tumour cells, that persists in the absence of the initiating causes ➤ Malignant (invasive and metastatic) tumours develop in approximately 25% of individuals…

Inflammation

Inflammation is the local physiological response to tissue injury. It is not, in itself, a disease, but is usually a manifestation of disease. Inflammation may have beneficial effects, such as the destruction of invading microorganisms and the walling off of an abscess cavity, thus preventing spread of infection. Equally, it may produce disease; for example, an abscess in the brain would act as a space-occupying lesion…

Immunology and immunopathology

Defence Against Infection ➤ Nonspecific mechanisms include the barriers such as skin, lysozyme in some secretions, ciliary motion in the respiratory tract, complement proteins, and colonisation by commensal bacteria ➤ Innate mechanisms lack memory ➤ Adaptive immunity is characterised by specificity and memory The immune system evolved as a defence against infectious diseases. Individuals with deficient immune responses, if untreated, succumb to infections in early life.…

Ischaemia, infarction and shock

Blood suffers the various pathological processes that occur in all tissues but because blood is a tissue that circulates there is also a specific set of pathologies related to defects in flow. Thromboembolic events are major causes of morbidity and mortality in the UK and other developed countries. Common and serious disorders in which thromboembolic mechanisms participate include: myocardial infarction cerebral infarction pulmonary embolism. Ischaemia is…

Disorders of metabolism and homeostasis

Metabolic disorders may be congenital or acquired. Congenital metabolic disorders usually result from inherited enzyme deficiencies causing significant clinical consequences. Acquired metabolic disorders are often characterised by perturbations of the body's homeostatic mechanisms that normally maintain the integrity of fluids and tissues. The effect of acquired metabolic disorders is often diverse. Inborn Errors of Metabolism ➤ Single-gene defects due to inherited or spontaneous mutations ➤ Usually…

Responses to cellular injury

Cellular Injury ➤ Numerous causes: physical and chemical agents including products of microorganisms ➤ Various mechanisms: disruption, membrane failure, metabolic interference (respiration, protein synthesis, DNA), free radicals ➤ May be reversible, or end in cell death Cell survival depends upon several factors: a constant supply of energy, an intact plasma membrane, biologically safe and effective function of generic and specific cellular activities, genomic integrity, controlled cell…

Disorders of growth, differentiation and morphogenesis

Growth, differentiation and morphogenesis are the processes by which a single cell, the fertilised ovum, develops into a large complex multicellular organism, with coordinated organ systems containing a variety of cell types, each with individual specialised functions. Growth and differentiation continue throughout adult life, as many cells of the body undergo a constant cycle of replication, growth, death and replacement in response to normal (physiological) or…

What causes disease?

Causes of Disease ➤ Diseases are due to genetic, environmental or multifactorial causes ➤ Role of genetic and environmental factors can be distinguished by epidemiological observations, family studies or laboratory investigations ➤ Some diseases with a genetic basis may not appear until adult life ➤ Some diseases with environmental causes may have their effects during embryogenesis Diseases may be: entirely genetic — either inherited or prenatally…

What is disease?

What Is Disease? A disease is a condition in which an abnormality of the body causes a loss of normal health. The mere presence of an abnormality is insufficient to imply the presence of disease unless accompanied by ill health, although it may denote an early stage in the development of a disease. Therefore, the World Health Organization defines health as ‘ a state of complete…

What is pathology?

Pathology is the scientific study of disease . Pathology comprises scientific knowledge and diagnostic methods essential, first, for understanding diseases and their causes and, second, for their effective prevention and treatment. Pathology embraces the functional and structural changes in disease, from the molecular level to the effects on the individual patient, and is continually developing as new research illuminates our knowledge of disease. The ultimate goal…

Reference information for the clinical laboratory

Abstract Background Accurate reference intervals established in healthy subjects are essential for appropriate interpretation of laboratory test results and to assist clinicians in diagnosis, monitoring, and treatment of disease. To facilitate interpretation of laboratory tests, reference intervals must be appropriately stratified based on key covariates, including age, sex, and ethnicity, which may alter “normal” analyte concentrations. When establishing or implementing reference intervals, it is important to…

Primary immunodeficiencies and secondary immunodeficiencies

Abstract Background Over the last six decades, our understanding of human immunology, coupled with our ability to interrogate the immune system in detail, has gone through a period of rapid evolution. From the early pioneers of immunology, Sir Peter Medawar and Sir MacFarlane Burnet, who elucidated concepts such as tolerance in transplantation and cellular immunology, and the clonal selection theory of antibody diversity respectively, to Max…

Allergy testing

Abstract Background Immunoglobulin E (IgE)-associated allergen conditions are increasing worldwide, affecting the quality of life of millions of individuals and are a burden on the health care system. The increasing availability of clinically relevant allergenic molecules has begun to change the way allergen-specific IgE antibody diagnostics are performed. Allergic diseases, respiratory infections, and autoimmune conditions have similar clinical presentations, and self-reported symptoms have low positive predictive…

Monoclonal antibody therapeutics and immunogenicity

Abstract Background The introduction of monoclonal antibody drugs has had major impact in medicine, leading to extraordinary progress in the treatment of a wide variety of diseases, particularly malignancies and chronic inflammatory and autoimmune diseases. Content This chapter provides a general overview of monoclonal antibody drugs approved for clinical use, including the basic biology of antibodies, production, pharmacologic characteristics, nomenclature, and various clinical indications. Because of…

Transplant compatibility testing

Abstract Background Transplant compatibility testing is focused on developing an immune risk profile, which consists of three types of testing—human leukocyte antigen (HLA) typing, HLA antibody screening, and compatibility crossmatch. This immune risk profile is then put into clinical context by the transplant team to make clinical decisions. Content This chapter will begin by explaining the structure and clinically relevant properties of HLA. Typing methods for…