1. GENERAL PATHOLOGY C603 INTRODUCTION
Course Directors
Ashley Inman, M.D.
Phone:
Thomas E. Davis, M.D., Ph.D.
Page:

2. Pathology C603 Academic Coordinator
Jennifer Deppen
Med Sci Room 128

3. Course Syllabus

4. Course Learning Objectives
At the successful completion of our course, students will:
Explain the pathophysiologic basis of general cellular and tissue responses to disease processes.
Describe the pathophysiologic changes which occur in different disease process associated with a given organ system.
Recognize gross and histologic tissue changes associated with general types of disease processes.
Correlate gross and microscopic tissue changes that accompany different disease processes.
Correlate pathophysiologic changes with diagnostic and therapeutic approaches to different disease processes.

5. RESOURCES FOR C603
Robbins Pathologic Basis of Disease 9th edition (2014) with website (
General Pathology C603 lab manual
Robbins Review of Pathology (Practice questions) 3rd edition (2009)
Gross specimens and microscopic slides in lab plus practice quizzes

6. Robbins Pathologic Basis of Disease 9th Edition

7. Robbins Pathologic Basis of Disease 9th Edition

8. ONCOURSE RESOURCES FOR C603
Lecture and lab schedules
Digital copy of lab manual w/ links to gross images, microscopic images, and digital slides
IUSM Virtual Microscopy site
QBank
Lab clinical case powerpoints

9. GRADING POLICY Honors: Top 10-20% High Pass: Top 51-79%
Pass: At least 75% of the top score
Fail: Less than 75% of the top point-score in the class

10. EXAMS IN C603 1st Lecture Exam: 200 points
2nd Lecture Exam: points
Final Lecture Exam: 300 points
1st Lab Exam: points
2nd Lab Exam: points
Final Lab Exam: points
Total Points in Course: points

11. EXAM FORMAT Lecture Exams: Lab Exams: Written exam
Computer exams with randomization of questions and answer choices
Multiple choice
Lab Exams:
Written exam
Includes gross specimens, images, and glass slides
Some of which you may not have seen before, but you should be able to apply your knowledge and observations to arrive at the correct answer

12. EXAM CONTENTS ALL examinations are CUMULATIVE
Lecture material is fair game on lab exams and vice versa
Some questions similar to or identical to review book questions
Will be expected to integrate material:
Pathology
Lab data (chemistry, hematology)
Clinical presentation
Signs (what the doc sees); symptoms (what the patient feels and expresses)
Radiology

13. LABORATORY
MS 102, 104, 106
Group assignments in lab manual and posted outside of lab
Monday/Wednesday or Tuesday/Thursday rotation
1:00-3:00 PM
Attendance is mandatory

14. In C603 and in Your Medical Practice
1. You cannot possibly know everything 2. However, you are responsible for everything

15. If you understand the gross and microscopic pathology, then you can….
Recognize and diagnose the disease OR order the correct tests
Treat the patient; sometimes that is being able to provide a prognosis to the patient and their family
Ideally, you can prevent the pathology (disease)

16. Learning Objectives for Lecture 1
1. List examples of gross pathology associated with changes in: size, color, shape, consistency, and location
2. Describe gross and microscopic changes associated with accumulation of amyloid and iron
3. Diagram and label the gross patterns of tissue necrosis: coagulative necrosis, liquefactive necrosis, caseous necrosis, fat necrosis, and gangrenous necrosis

17. GROSS OBSERVATIONS
Size
Shape
Color
Consistency/texture
Location

18. SIZE Increased: Decreased:
HYPERTROPHY: increase in cell size (no new cells; just bigger cells)
HYPERPLASIA: increase in cell number
Decreased:
ATROPHY: once normal, now smaller
HYPOPLASIA: never normal in size (developmental disorder)
Accumulations of material may also increase the overall size of the organ
AMYLOIDOSIS
Fat

19. Hypertension
Infarction

20. Hypertrophic Left Ventricle

21. Normal and Hyperplastic Adrenal Glands

22. Hypertrophy of Uterus During Pregnancy

23. Hypertrophy of Uterus During Pregnancy

24. Atrophy of Kidney

25. AMYLOIDOSIS causes heart and renal failure
Gross – organ enlarged; waxy appearance; firm
Micro - pink, fluffy extracellular (protein) material in tissue stained with H&E
Congo Red Stain- orange on light microscopy and Apple-green birefringence when polarized
Beta-Pleated Sheet by x-ray diffraction

26. Examples of Amyloid Disease Multiple myeloma Dialysis patients
Inflammation
Medullary CA
Type of Amyloid
Lambda or kappa
B-2 microglobulin
SAA
Procalcitonin

28. LIVER WITH AMYLOIDOSIS

29. Congo Red (Lt. Microscope)
Congo Red polarized
H&E Stain (Lt. Microscope)

30. SHAPE Shape of lesions may indicate the pathologic process
Infarcts are wedge-shaped (arterial blood vessels distribute in an inverted “tree-like” fashion)

31. Spleen Infarction

32. COLOR Organs may acquire color or lose their natural color
FAT = yellow
BILE = green
MELANIN = black-brown
SCAR = white-tan
IRON = rust
CARBON = black

33. When liver accumulates FAT (as in alcoholism) it becomes enlarged and pale to yellow-orange in color
Normal liver color
(unfixed specimen)
Fatty liver
(unfixed specimen)

34. When a SCAR forms in the myocardium of the heart (post MI), the color changes from red/tan to gray/white
Old infarct
(scar)

35. Melanoma

37. Lung with Anthracosis

38. CONSISTENCY Organs become stiff, hard, soft, waxy or greasy in disease
Alcoholism and hepatitis cause extensive fibrosis (cirrhosis/scar tissue) in the liver and the liver is pale, shrunken and firm with round NODULES (firm, circumscribed areas)
Tumors are often firmer than the surrounding tissue
Calcification within tissues often has a “gritty” texture when cut

39. LOCATION
Some pathologic processes occur in specific locations (organ specific, tissue specific)
FAT NECROSIS occurs in the pancreas (enzymatic fat necrosis) and breast (traumatic fat necrosis)
Splenic infarctions tend to be subcapsular
Also, tumors in the cortex of the kidney are usually glandular in origin (adenocarcinoma)

40. Fat necrosis in the pancreas

41. Renal Cell Carcinoma in Kidney Cortex

42. LOCATION (2) CYST- fluid-filled sac; kidney, ovary
BULLA- fluid-filled sac in the lung or skin
Uterus- LEIOMYOMAS in the myometrium
METASTASES- multiple nodules of tumor

43. Cysts

44. Bullae in Skin

45. Bullae in Lung

46. Bullae in Lung

47. Leiomyoma in Uterus

48. Liver Metastases

49. Gross Observation in Liver Disease
Size:
Larger = fatty change; amyloidosis
Shape:
Cirrhosis = nodular
Color:
Bile = green
Rust = hemochromatosis
Yellow = fat; jaundice
Consistency/Texture:
Firm = fibrosis/cirrhosis; tumors
Soft = abscess

50. Icteric Sclera

51. Cirrhosis or Fibrosis of the Liver

52. Liver shows cirrhosis and bile stasis (green color)

54. Liver Hemochromatosis

56. HEMOCHROMATOSIS Genetic Secondary
A. Iron overload due to transfusions for anemias
B. Increased oral intake (rare)

57. TYPES OF NECROSIS COAGULATIVE LIQUEFACTIVE CASEATION
FAT (ENZYMATIC or TRAUMATIC)
GANGRENOUS
FIBRINOID
Infarcts
Abscess
TB Granuloma
Pancreas and Breast
Lower extremities or bowel
Immune-mediated vascular damage

58. Coagulative Necrosis After Myocardial Infarction

59. Living heart muscle
MI and acute Inflammation

60. Liquefactive Necrosis in Brain
Brain Abscess

61. Abscess or “pus pocket”

62. Caseous Necrosis (tuberculosis)

63. Granuloma with Central Necrosis

64. Enzymatic Fat Necrosis in Pancreas

65. Viable pancreas below and Fat Necrosis above

66. Gangrenous Necrosis

67. MICROSCOPIC OBSERVATIONS
Can often use same principles as gross observations
Size
Shape
Color
Location
Will discuss more during lab 2 (Wednesday and Thursday)