Blok 2.

3 Dasardasar Patologi

Blok 2.3 Dasar-dasar Patologi

Lo :
Mahasiswa mampu menjelaskan mengenai
konsep patologi anatomi
Mahasiswa mampu menjelaskan mengenai
konsep umum tentang kanker
Mahasiswa
mengetahui
konsep
healing dari segi patologi anatomi

wound

Kontrak Kuliah patologi

Kuliah tepat waktu; keterlambatan mahasiswa mengikuti kuliah maks 15 mnt
Dosen memberitahu ke sekretariat blok atau ke sie pend mahasiswa jika berhalangan
hadir atau terlambat hadir
Jika tidak ada pemberitahuan dari dosen, mahasiswa diberi waktu menunggu dosen
selama 30 mnt. Jika selama 30 mnt dosen belum juga hadir, maka kuliah ditiadakan
dan mahasiswa dapat melanjutkan aktivitas
Setiap pertemuan diberlakukan kuis kontrol absen
Setiap tugas di kumpulkan tepat waktu
Berpakaian rapi dan sopan, alat komunikasi tidak berbunyi
Bahan ajar akan diberikan setelah kuliah via email ke sie pend mahasiswa
Buku referensi : Robbins and Cotran Basic Pathology , General and systematic
Pathology J.C.E.Underwood, dll
Sepakat ?!
3

INTRODUCTION TO
PATHOLOGY
Hasna Dewi, dr., Sp.PA., M.Kes.
Bagian Patologi, FKIK Universitas Jambi

Definition of pathology
The study ( logos) of disease (pathos) Scientific study of disease" .
"scientific study of the molecular, cellular, tissue, or organ system
response to injurious agents."
Pathology serves as a "bridge" or "link" between the preclinical
sciences (anatomy, physiology, etc.) and the courses in clinical
medicine.
explain the whys and wherefores of the signs and symptoms
manifested by patients while providing a sound foundation for rational
clinical care and therapy

What is the Disease?

State in which an individual exhibits an anatomical, physiological, or
biochemical deviation from the normal

an abnormal alteration of structure or function in any part of the

body.

What should we Know About A Disease

Definition.
Epidemiology Where & When.
Etiology What is the cause?
Pathogenesis - Evolution of dis.
Morphology - Structural Changes
Functional consequences
Management
Prognosis
Prevention

o
h
at

y
g
lo

Pathology focuses on 4 aspects of disease:

ETIOLOGY : Cause of disease why ?

PATHOGENESIS: Mechanisms of development of disease

How ?

MORPHOLOGY

PATHOLOGICAL CHANGES :

The

structural

alterations induced in cell and tissues lesion, what?

FUNCTIONAL

CONSEQUENCES

CLINICAL

SIGNIFICANCE

Functional results of the morphologic changes as observed

clinically (symptoms & sign), course and Sequelae
prognosis

also

Etiology = the CAUSE of a disease

Knowledge of

etiology remains the backbone of:

Disease diagnosis

Understanding the nature of diseases

Treatment of diseases.

If the cause of the disease is unknown it is called idiopathic

2 major classes of etiologic factors: genetic and acquired
(infectious, nutritional, chemical, physical, etc).

 An etiologic agent :

is the factor (bacterium, virus, etc.)

responsible for lesions or a disease state.

Predisposing Causes of Disease: Factors which make an
individual more susceptible to a disease (damp weather, poor
ventilation, etc.)

Etiology: What is the cause?

Environmental agents:
Physical
Chemical
Nutritional
Infections
Immunological
Psychological
Genetic Factors:
Age
Genes

Multifactorial:
As Diabetes,
Hypertension
Cancer

Pathogenesis
The sequence events in the response of the cells or
tissues to the etiologic agent, from the initial stimulus
to the ultimate expression of the disease, from the
time it is initiated to its final conclusion in recovery or
death
The mechanism through which the cause operates to
produce the pathological and clinical manifestations.

Morphology: Structural Changes

changes in disease
gross or microscopic changes
Ex : Tumor in a cancer, ulcer in an
Structural

infection, atrophy in dementia.

lead to functional alteration & to the
clinical signs & symptoms of the
disease

Structure
Normal squamous cell VS abnormal squamous cell

Function of organ, tissue,

Normal blood sugar VS abnormal blood sugar
cell

Observation of gross specimen:

a hypertrophic heart (left) and a normal heart (right)

Gross observation of a liver and mircoscopic changes

Morphology
Gross appearance:
size, shape
weight
color
consistency
surface
edge, section
Microscopic examination: for tissue sections fixed in
formalin then stained by HE (hematoxylin and eosin)
to be examined by light microscope for Histologic and
cytologic changes.

Hemangioma

IHC CD 31 (+)

Clinical Symptoms & Signs

Ascites,
cachexia,
cough,
dysphagia,
fever,
Symptom = subjective sign of disease Clinical symptoms
gynecomastia, hemoptysis, hepatomegaly,
are the patients complain
by its own words.palmar
splenomegaly,
icterus,usually
lymphadenopathy,
erythema
Chest pain, dizziness, loss of appetite, weakness,
Sign = objective symptom of disease Functional evidence of
numbness, headache, toothache
disease which can be determined objectively or by the observer

prognosis
Expected outcome of
the disease
the clinician's estimate
of the severity and
possible result of a
disease.

complication
Thediseasecan become
worse in its severity or show
a higher number of signs,
symptoms or new
pathological changes, become
widespread throughout the
body or affect other organ
systems an unfavorable
evolution of adisease

In summary, pathology studies:

Etiology Pathogenesis
Morphologic changes Clinical
features & Prognosis of all diseases

The concept of disease

Environmental
factors

Change
with
adaptation

Cell
Tissue
Organ

Inability
to adapt

Hypertrophy /hyperplasia
Atrophy
Lesion

Metaplasia

Injury
Death

Structural
change
Signs

Functional
change
Symptoms

Genetic factors

Etiology

S.aureus

Pathogenesis
Acute
inflammation

Morphological
and functional
features
Complications
& sequelae

Boil

Septicemia

Smoking ,
Polycyclic
AHC

Genetic
mutation

Lung cancer

Metastasis

HBV

Tugas
!

Immune
reaction
to
virus
infected
cells
Cirrhosis

Liver failure

High blood
sugar

I hear, I forget
I see, I remember
I do, I understand
Chinese Proverb..

Scope of Pathology
Anatomical Pathology

surgical pathology
cytopathology
forensic pathology
etc

Pathologists

Clinical Pathology

clinical chemistry
clinical
hematology/blood
banking
clinical
microbiology
etc

Branchs of pathology
General pathology

cell injury
tissue repair
hemodynamic disorders
inflammation
tumor

Systemic pathology

the
the
the
the
the
the
the

blood vessels and the heart

respiratory system
digestive system
urinary system
male and female genital system
nervous system
endocrine system

What does a PATHOLOGIST do?

SURGICAL PATHOLOGY
Interpret biopsies (e.g., skin, breast,
gastrointestinal tract)
Evaluate surgical resection specimens (e.g.,
colectomy, nephrectomy, mastectomy)
Frozen sections (intra-operational rapid
diagnosis)

What does a PATHOLOGIST do?

CYTOPATHOLOGY (e.g., Pap smears, FNA - Fine
Needle Aspiration)
CLINICAL PATHOLOGY
Hematology (Peripheral blood smear, bone marrow,
coagulation disorders).
Chemistry (Blood, urine, cerebrospinal fluid, effusions).
Microbiology.
Blood bank.

AUTOPSY PATHOLOGY
Final diagnosis, forensic pathology--criminal investigation

How to study pathology?

Background:
Basic medical sciences (anatomy, histology,
physiology, biochemistry, immunology,
microbiology, parasitology,et al)
Medical terms (e.g. hyperplasia, et al)
Clinical knowledge (physical examination,
laboratory tests, X-ray, CT, et al)

How to study pathology?

The key for studying pathology:

Characteristic

Functional
Changes
(Pathophysiology)

morphologic lesions (lesions)

Clinical manifestations

Pathogenesis
Etiology

Techniques of Pathology

Biochemical
Microbiological
Hematological
Cell/ tissue
culture

 Untuk dapat menilai perubahan sel , diperlukan teknik:

1. Pewarnaan rutin
dengan menggunakan Hematoksilin Eosin (HE)
2. Special stain
PAS (periodic acid-schiff) stain, Reticulin stain,
Amyloid stain, dll.
3. Reaksi enzym ( Histochemistry/ Histokimia )
4. Reaksi antigen-antibody (Immunohistokimia)
5. Cytogenetik
6. Molecular pathology ( FISH ( Fluorosence of Insitu
Hibridization)

 Histopatologi
- Selain melihat individual sel, dapat melihat pula
hubungan maupun arsitektur
- Didapat dari biopsi eksisi, insisi, operasi
- Segera difiksasi agar sel-sel jaringan tidak lisis dengan
direndam dalam cairan formalin 10% ( Bukan alkohol!!)
- Banyaknya cairan fiksasi 3x dari jaringan yang dikirim

 Potong beku ( Frozen section / Vries Coupe) (VC)

Suatu pemeriksaan jaringan di bagian patologi anatomi yang
dilakukan intraoperatif ( Ditunggu / cyto )
Laboratorium PA ada didalam ruang operasi
Menggunakan alat khusus, yang membuat proses pembuatan
preparat yang membutuhkan waktu lebih dari 8 jam, menjadi
kurang lebih hanya 15 menit.

 Fine Needle Aspiration Biopsy ( FNAB) / Biopsi jarum halus

- Suatu teknik baru pada pemeriksaan sitologi
- Pengambilan sampel jaringan dengan aspirasi, menggunakan jarum
spuit.
- Dipilih karena lebih minimal invasive daripada biopsi/ pembedahan.
- Pada massa tumor di permukaan tubuh, bila massa tumor yang
lebih dalam, menggunakan guide, biasanya bekerjasama dengan
bagian radiology

Papillary carcinoma, Thyroid

cancer

Pemeriksaan khusus
Immunohistokimia
- Pemeriksaan sel dengan menggunakan reaksi antigen dan antibody
- Dapat menentukan origin sel tumor.
- Membantu dalam penegakan diagnosis, penatalaksanaan selanjutnya
ataupun prognosis suatu penyakit.
- Misalnya : Apakah suatu tumor berasal dari mestase atau primer di
kelenjar getah bening?
- Lebih spesifik
- Dapat mengidentifikasi jenis virus tertentu, misalnya HPV pada
keganasan cerviks.

 Histokimia
- pewarnaan spesifik , dengan menggunakan enzim
- Misalnya: Congo red, PAS, trikrome, reticuline stain

Histochemistry using PAS stain

PASBM

 Dalam penentuan etiology maupun perubahan morfologi

sel atau jaringan, didapat dari :
1. Apusan cairan atau sekret
- apusan langsung
- apusan dari cairan yang telah disentrifusi
- apusan dari tindakan biopsi aspirasi
2. Biopsi
3. Operasi

 Pencitraan : X-ray, CT-scan

Radiology
Patologi klinik

Darah, urin, cairan

Patologi Anatomi Jaringan, apusan cairan ( pap smear, urine,

pus, efusi pleura, asites)

Urine PK : urinalisis dan sedimen

PA : sedimen untuk menilai ada atau tidak sel ganas

 Formulir permintaan pemeriksaan patologi anatomi

Dilengkapi, mulai dari data pasien, data klinis maupun
penunjang lain.

 As is our pathology, so is our medicine

Ask not what disease the patient has, but rather what
patient the disease has.

Sir William Osler (Canadian Physician)

Tipsjembatan keledai
CN I : olfactory nerve
Unsur golongan 1A (Alkali)H =
CN II : optic nerve
Hidrogen
CN III : occulomotor nerve
= Litium nerve
CN IV Li
: trochlear
Oleh Opa Oke
Hai
LiNa
Kau
CN V :Na
trigeminal
= Natriumnerve
Truk Trigu
CN VI : abducens nerve
Rebut Calon
K = Kalium
Abdul Pasang
CN VII: facial nerve
Suami Fransiska
Audio Glas
Rbvestibulocochlear
= Rubidium
CN VIII:
nerve (accoustic/auditory
PaAgus
nerve)
Cs = Sesium
Akhirnya Hilang
CN IX : glossopharyngeal nerve
= Fransium
CN X :Frvagal
nerve
CN XI : accesory nerve

Tipsrajin membaca ringkasan skema

TERIMAKASIH

Leiomyosarcoma

Actin (+)

(3)Ultrastructural observation
By using electron microscope)

Filtering membrane

SEM (scanning electron microscope)

Podocyte

Polymerase chain
reaction
(PCR)