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Pathology & Genetics for Nurses
K Swaminathan
PART I PATHOLOGY: SECTION 1: PATHOLOGY OF CELLS AND TISSUES
1:
Cellular Injury
INTRODUCTION
CELLULAR ADAPTATIONS
Hyperplasia
Hypertrophy
Physiologic Hypertrophy
Pathologic Hypertrophy
Atrophy
Metaplasia
Epithelial Metaplasia
Mesenchymal Metaplasia
CELL INJURY
Causes for Cell Injury
Mechanism of Cell Injury
Depletion of ATP
Alterations in Energy Metabolism of Cell
Damage to Cell Membrane
Mitochondrial Damage
Failure of Calcium Homeostasis
Mediators of Cell Injury
Free Oxygen Radicals
Morphological Patterns of Reversible Cell Injury
Cellular Swelling
Fatty Change
Morphology of Irreversible Cell Injury (Cell Death)
Necrosis
Types of Necrosis
Gangrene
Apoptosis
CALCIFICATION
2:
Inflammation
INTRODUCTION
ACUTE INFLAMMATION
Vascular Events
Cellular Events (Figure 1)
Margination
Rolling and Pavementing
Adhesion
Transmigration
Chemotaxis
Chemoattractants
Defects in the Functioning of Leukocytes
Chemical Mediators of Inflammation
Morphological Patterns of Acute Inflamamtion
Fate of Acute Inflammation
CHRONIC INFLAMMATION
General Features of Chronic Inflammation
Macrophage in Chronic Inflammation
Chronic Granulomatous Inflammation
Granuloma
Epitheloid Cell (Figure 8)
Pathogenesis
Giant Cells
3:
Healing and Repari
INTRODUCTION
REGENERATION
Repair by Connective Tissue—Granulation Tissue
Stage of Neovascularisation
Stage of Devascularisation
HEALING OF SKIN WOUND
Healing by Primary Intention
Healing by Secondary Intention
Healing of a Fracture of Bone
FACTORS INFLUENCING WOUND HEALING
4:
Fluid and Hemodynamic Disturbances
GENERAL FEATURES
EDEMA
Definition
Pathogenesis
Causes for Edema
Pathogenesis of Cardiac Edema
Pathogenesis of Renal Edema
Clinical Profile of Edema
HYPEREMIA AND CONGESTION
HEMORRHAGE
Causes for Hemorrhage
SHOCK
Definition
Etiology and Classification
Pathogenesis
Septic Shock
Causes
Release of Endotoxins
Stages of Shock
Initial Nonprogressive Phase
Progressive Decompensated Phase
Irreversible Phase
Clinical Features
THROMBOSIS
Definition
Normal Hemostasis
Sequence of Events in Normal Hemostasis (Figure 4)
Role of Vessel Wall
Role of Platelets
Role of the Coagulation System
Thrombogenesis
Endothelial Injury
Alterations in the Flow of Blood
Hypercoagulability of Blood
Pathology of Thrombus
Sites of Thrombi
Morphology
Cardiac Thrombus
Arterial Thrombi
Venous Thrombi
Fate of Thrombi
EMBOLISM
Definition
Types of Embolism
Pulmonary Thromboembolism
Arterial Embolism (Systemic Thromboembolism)
Fat Embolism
Amniotic Fluid Embolism
Air Embolism
Causes
INFARCTION
Definition
Causes
Types
Morphology of Infarct
5:
Neoplasia
INTRODUCTION TO NEOPLASIA
Definition
Nomenclature
Teratoma
Hamartoma
Choristoma
CHARACTERISTICS OF BENIGN AND MALIGNANT TUMORS
Differentiation
Cellular Features
Mitotic Activity
Cellular Arrangement (Polarity)
Functional Characters
Rate of Growth
Local Invasion
METASTASIS
Routes of Metastasis
Lymphatic Invasion
Hematogenous Invasion
Other Patterns of Invasion
Mechanism of Metastasis
CARCINOGENESIS
Synonym: Oncogenesis
Molecular Pathogenesis of Neoplasia
Mechanism
CLINICAL FEATURES OF NEOPLASIA
LABORATORY DIAGNOSIS OF NEOPLASIA
Histological Methods
Cytological Methods
Exfoliative Cytology
Fine Needle Aspiration Cytology
Newer Laboratory Methods for Diagnosis
SECTION 2: PATHOLOGY OF BLOOD VESSELS, HEART AND LUNGS
6:
Blood Vessels
NORMAL STRUCTURE
PATHOLOGY OF BLOOD VESSELS
Arteriosclerosis
Definition
Atherosclerosis
Definition
Epidemiology
Role of the Important Risk Factors in the Evolution of Atherosclerosis
Pathogenesis of Atherosclerosis
Morphology (Figure 1)
Clinical Implications of Atherosclerosis
ANEURYSMS
7:
Heart
INTRODUCTION
BLOOD SUPPLY
DISEASES OF HEART
Ischemic Heart Disease
Pathogenesis of Ischemic Heart Disease
Fixed Coronary Obstruction
Acute Changes in Plaque Morphology and Superadded Thrombi Formation
Platelet Aggregation and Vasospasm
Angina Pectoris
Definition
Patterns of Angina
Myocardial Infarction
Clinical Features
Rheumatic Heart Disease
Rheumatic Fever
Pathology—Acute Cardiac Lesions
Chronic Cardiac Lesions
Other Lesions of Rheumatic Fever
Infective Endocarditis
Causative Organisms
Pathology
Clinical Features
Complications
Pericardial Diseases
Cardiomyopathy
8:
Lungs
GENERAL FEATURES
DISORDERS OF LUNG
Pulmonary Infections
Bacterial Pneumonia
Lobar Pneumonia
Primary Atypical Pneumonia (Syn: Interstitial Pneumonia)
Pulmonary Tuberculosis
Organism
Pathogenesis
Pathology
Primary Tuberculosis
Secondary Tuberculosis
Miliary Tuberculosis
Pleural Involvement
Extrapulmonary Tuberculosis
Clinical Features—Primary and Secondary Tuberculosis
Diagnosis of Tuberculosis
CHRONIC OBSTRUCTIVE PULMONARY DISEASES (COPD)
Definition
Chronic Bronchitis
Emphysema
Bronchiectasis
Bronchial Asthma
Lung Abscess
Interstitial Lung Diseases
Causes
Pneumoconiosis
TUMORS OF LUNG: BRONCHOGENIC CARCINOMA
Etiological Factors
Classification
Pathological Changes
Adenocarcinoma
Small Cell Carcinoma
Spread of Tumors
Clinical Features
DISEASES OF PLEURA
SECTION 3: PATHOLOGY OF GASTROINTESTINAL AND RENAL SYSTEM
9:
Esophagus and Stomach
INTRODUCTION
ESOPHAGUS
Esophagitis
Tumors of Esophagus
Site of Tumors
Type of Tumors
Clinical Profile
STOMACH
Normal Structure
Histology
Acute and Chronic Gastritis
Clinical Profile
Acid Peptic Disease (Peptic Ulcer)
Pathogenesis
Morphology
Clinical Profile
Complications
Gastric Carcinoma
General Features
Etiological Factors
Gross Pathology
Microscopic Pathology
Spread
Clinical Profile
10:
Small Intestine and Large Intestine
NORMAL STRUCTURE
DISORDERS OF INTESTINES
Enteric Fever
Pathogenesis
Tumors of Intestine
Non-neoplastic Polyps
Colorectal Carcinoma
Etiopathogenesis
Gross Pathology
Microscopy
Clinical Profile
Carcinoid Tumor
GIT Lymphoma
11:
Liver
INTRODUCTION
Normal Structure
Functions of Liver
Histology
PATHOLOGY OF LIVER
Jaundice
Pathophysiology
Causes for Jaundice
Clinical Features
HEPATITIS
Hepatitis Viruses
Clinicopathological Syndromes—Acute Hepatitis
Chronic Hepatitis
Hepatitis—Carrier State
Diagnosis of Hepatitis
CIRRHOSIS
Definition
Classification
Morphological Classification
Etiological Classification
Pathogenesis
Alcoholic Liver Disease
Postnecrotic Cirrhosis
Biliary Cirrhosis
Hemochromatosis
Wilson's Disease
Alpha 1 Antitrypsin Deficiency
TUMORS OF LIVER
Hepatocellular Carcinoma
Etiological Factors
Cholangiocarcinoma
Hepatoblastoma
12:
Gallbladder
INTRODUCTION
CHOLELITHIASIS (GALLSTONE)
Risk Factors and Etiological Agents
Cholesterol Stones
Pigment Stones
Pathogenesis
Morphology
Cholesterol Stones
Clinical Implications of Calculi
CARCINOMA GALLBLADDER
13:
Exocrine Pancreas
NORMAL STRUCTURE
PANCREATITIS
Acute Pancreatitis
Etiological Factors
Pathogenesis
Pathology
Clinical Features
Chronic Pancreatitis
Pathology
Clinical Features
Carcinoma Pancreas
Pathology
Clinical Features
14:
Renal System
INTRODUCTION
FUNCTIONS OF THE KIDNEY
ANATOMY OF KIDNEY
Glomeruli
FUNCTIONS OF KIDNEY
Glomerular Filtration
Size Dependent Filtration
Charge Dependent Filtration
RENAL DISEASES
Clinical Profile of Renal Diseases
GLOMERULAR DISEASES
Pathogenesis
Mechanism of Glomerular Damage
Common Histological Alterations of Glomeruli in Glomerulonephritis
Histomorphological Profile of Various Forms of Glomerulonephritis
Acute Post-streptococcal Proliferative GN
Membranous Glomerulonephritis
Minimal Change Disease (Lipoid Nephrosis)
Rapidly Progressive Glomerulonephritis
Membranoproliferative Glomerulonephritis
IgA Nephropathy (Berger's Disease)
Secondary Glomerulonephritis
Diabetic Nephropathy
Lupus Nephritis
Chronic Glomerulonephritis
TUBULOINTERSTITIAL DISEASES
Pyelonephritis
Etiopathogenesis
Route of Spread
Pathology
Acute Pyelonephritis
Complications of Acute Pyelonephritis
Chronic Pyelonephritis
Renal Failure
Ischemic Acute Tubular Necrosis
Toxic Acute Tubular Necrosis
Chronic Renal Failure
UROLITHIASIS
Etiological Factors
Morphology
Clinical Features
TUMORS OF KIDNEY
Epithelial Tumors
Nephroblastic Tumors (Embryonal Tumors)
Nonepithelial Tumors
Miscellaneous
Metastatic Tumors
Renal Cell Carcinoma
Gross
Clinical Features
Spread
Nephroblastoma (Wilms’ Tumor)
CYSTITIS
Special Forms of Cystitis
SECTION 4: PATHOLOGY OF GENITAL SYSTEM
15:
Male Genital System
NORMAL STRUCTURE
CRYPTORCHIDISM (SYN—UNDESCENDED TESTIS)
Causes for Cryptorchidism
EPIDIDYMO-ORCHITIS
TUMORS OF TESTIS
Etiopathogenesis
Pathology
Clinical Features
Diagnosis
PROSTATE
Normal Structure
Nodular Hyperplasia of Prostate
Etiology
Carcinoma Prostate
Etiological Factors
Pathology
Spread
Clinical Features
TUMORS OF PENIS
Condyloma Acuminatum
Squamous Cell Carcinoma
16:
Female Genital System
PATHOLOGY OF CERVIX
Normal Structure
Cervical Intraepithelial Neoplasia (CIN)
Etiopathogenesis
Human Papilloma Virus and Cervical Cancer
Clinical Profile
Invasive Cervical Cancer
PATHOLOGY OF UTERUS
Normal Structure
Endometrium
Adenomyosis
Endometriosis
Pathogenesis
Leiomyoma
Endometrial Carcinoma
PATHOLOGY OF OVARIES
Normal Structure
Non-neoplastic Cysts of Ovary
Tumors of Ovary
Clinical Features
Surface Epithelial Tumors
Germ Cell Tumors
Sex Cord Stromal Tumors
Metastatic Tumors
Trophoblastic Diseases
Choriocarcinoma
17:
The Carcinoma of Breast
INTRODUCTION
Etiopathogenesis
CLASSIFICATION
Noninvasive Cancer
Invasive Cancers
PATHOLOGICAL FEATURES
SPREAD OF BREAST CANCER
CLINICAL PROFILE AND DIAGNOSIS
PROGNOSTIC FACTORS
SECTION 5: PATHOLOGY OF CENTRAL NERVOUS SYSTEM, BONES AND JOINTS
18:
Central Nervous Syste
GENERAL FEATURES
HYDROCEPHALUS
Definition
Causes
Pathological Changes
INFECTIONS
Meningitis
Clinical Profile
Encephalitis
Cerebrovascular Diseases
Ischemic Brain Damage
Intracranial Hemorrhage (Figure 2)
Tumors of Brain
Astrocytomas
Medulloblastoma
Meningioma
19:
Bones and Joints
GENERAL FEATURES
OSTEOMYELITIS
Pyogenic OM
Pathology
Clinical Profile
Complications of OM
OSTEOPOROSIS
TUMORS OF BONE
Osteogenic Sarcoma
Etiopathogenesis
Gross Pathology
Osteochondroma
Giant Cell Tumor (Osteoclastoma)
Ewing's Sarcoma
PATHOLOGY OF JOINTS
Osteoarthritis
Rheumatoid Arthritis
Pathogenesis
Pathology
Gouty Arthritis
SECTION 6: CLINICAL PATHOLOGY
20:
Introduction to Practical Hematology
BLOOD
Collection of Blood
Collection of Capillary Blood by Skin Puncture
Collection of Blood by Venipuncture
Anticoagulants
DETERMINATION OF HEMOGLOBIN
Other Methods for Estimating Hemoglobin
BLOOD CELL COUNTS
Erythrocytes (Erythros-red, Cytos-cell)
Leukocytes
Laboratory Determination of Cell Counts
Counting Chamber
Red Cell Count
Calculation
Normal Values
White Cell Count
Calculation
Normal Values
Platelet Count
Calculation
Normal Values
STUDY OF BLOOD SMEAR AND DIFFERENTIAL LEUKOCYTE COUNT
Steps in Staining
21:
Examination of Blood Films
INTRODUCTION
UNIFORM GRADING OF BLOOD PICTURE
Low Power Examination
Examination under High Dry Objective
Examination Under Oil Immersion Objective
Proper Field Selection
Study of RBC
Variation in the Size of RBC
Variation in shape of RBC
Color of RBC
RBC Inclusions
Basophilic Stippling
Howell-Jolly Bodies
Cabot Rings
Siderosomes and Pappenheimer Bodies
Malaria Parasites
Study of Leukocytes
Differential Count
Technique
Normal Counts
Variations in the Leukocyte Counts
Variations in Neutrophils
Variations in Lymphocytes
Variation in other White Blood Cells
Abnormal Cells
Quantitative and Qualitative Changes in Leukocytes
Study of Platelets
Estimation of Number of Platelets
Morphology of Platelets
Packed Cell Volume (PCV) or Hematocrit
Definition
Methods
Macromethod or Wintrobe's Method
Microhematocrit
MEASUREMENT OF PCV IN AUTOMATED INSTRUMENTS
Erythrocyte Indices
Introduction
Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin (MCH)
Mean Corpuscular Hemoglobin Concentration (MCHC)
Normal Values
Clinical Significance
Other Indices
Color Index
Mean Cell Diameter (MCD)
Red Cell Distribution Width (RDW)
Erythrocyte Sedimentation Rate (ESR)
Definition
Stages in ESR
Methods
Modified Westergren Method
Anticoagulant and Blood Ratio
Method
Wintrobe Method
Micro ESR Method
Factors Affecting ESR
Physiological Factors
Laboratory Factors
INTERPRETATION
22:
Examination of Bone Marrow
INTRODUCTION
INDICATIONS FOR BONE MARROW STUDY
INDICATIONS FOR BONE MARROW BIOPSY
COMMON SITES FOR BONE MARROW ASPIRATION
INSTRUMENTS
METHOD
INTERPRETATION
23:
Tests for Hemostasis
INTRODUCTION
BLEEDING TIME
Principle
Method
Normal Values
WHOLE BLOOD CLOTTING TIME
Principle
Method
BLOOD GROUPING AND TYPING
Blood Grouping System
Biochemical Basis of ABO Blood Group System (Table 1)
Determination of ABO Blood Group
RH TYPING
Introduction
Clinical Significance
Rh Grouping Procedures
COMPATIBILITY TESTING
Major Cross Match Technique
SCETION 7: LABORATORY PATHOLOGY
24:
Urine Analysis
INTRODUCTION
FORMATION OF URINE
COMPOSITION OF NORMAL URINE
COLLECTION OF URINE SPECIMEN
Containers
Methods of Obtaining Samples
Clean-voided Sample
Types of Sample
PRESERVATION
Preservatives
ROUTINE EXAMINATION OF URINE
Physical Examination of Urine
Volume
Appearance
Causes of Acidic Urine
Causes of Alkaline Urine
Specific Gravity
Fixed Specific Gravity
Estimation of Specific Gravity
Chemical Examination of Urine
PROTEINS IN URINE
Test for Detection of Proteins
Semiquantitative Precipitation Tests
Quantitative 24 hours Protein Determination
Bence Jones Proteinuria
SUGARS IN URINE
Glucose
Qualitative Tests for Sugar in the Urine
Reduction Tests
Non-glucose Reducing Sugars
Lactose
Fructose
Pentose
Galactose
Other Tests for Reducing Sugars
KETONES IN URINE (KETONURIA)
Other Causes of Ketonuria
Rothera's Test for Acetone and Acetoacetic Acid
Ferric Chloride Test for Diacetic Acid—Gerhardt's Test
Hart's Test for Beta-hydroxybutyric Acid
Reagent Tablet Test—Acetest
Colorimetric Reagent Strip Test
BLOOD IN URINE
Tests for Detection of Blood
BILE IN THE URINE
Tests for Detection for Bilirubin
Foam Test
Gmelin's Test
Fouchet's Test
Colorimetric Strip Reagent Test
Tests for Detection of Urobilinogen
Qualitative Ehrlich's Test
Qualitative Schlessinger Test
Colorimetric Reagent Strip Test
Test for Detection of Bile Salts
MICROSCOPIC EXAMINATION OF URINE SEDIMENT
Qualitative Technique
Precautions
Normal Sediment
Crystals in Acidic Urine
Crystals in Alkaline Urine
Organized Sediment
Quantitative Evaluation of the Urine Sediment—Addis Count
Detection of Bacteria
25:
Cerebrospinal Fluid (CSF) Examination
INTRODUCTION
FORMATION AND COMPOSITION OF CSF
Characteristics of Normal CSF
Composition of CSF
INDICATIONS OF CSF EXAMINATION
COLLECTION AND HANDLING OF CSF
Specimen Collection
Causes for Elevated CSF Pressure
Causes for Decreased CSF Pressure
Handling of CSF Sample
EXAMINATION OF CSF
Gross/Physical Examination
Microscopic Examination
Total Leukocyte Count
Differential Leukocyte Count
Biochemical Examination
Protein Estimation
Glucose Estimation
Chloride Estimation
Microbiological Examination
Microscopic Examination
Culture
Serological Examination
26:
Examination of Body Fluids
INTRODUCTION
PATHOPHYSIOLOGY OF EFFUSION
EXAMINATION OF PLEURAL FLUID
Introduction
Specimen Collection
Physical Examination
Microscopic Examination
Clinical Significance
Chemical Examination
Immunologic Studies
EXAMINATION OF PERICARDIAL FLUID
Introduction
Gross/Physical Examination
Microscopic Examination
Clinical Significance
Chemical Examination
Microbiological Examination
EXAMINATION OF PERITONEAL FLUID (ASCITIC FLUID)
Introduction
Indications for Abdominal Paracentesis
Physical Examination
Microscopic Examination
Clinical Significance
EXAMINATION OF SYNOVIAL FLUID
Introduction
Clinical Significance
Specimen Collection
Physical Examination
Clinical Importance
Microscopic Examination
Chemical Examination
Microbiological Examination
27:
Sputum Examination
INTRODUCTION
PRODUCTION AND NORMAL COMPOSITION OF SPUTUM
Composition of Sputum
Sputum Collection
Types of Specimen Collected
Concentration Method for Tubercle Bacilli in the Sputum
EXAMINATION OF THE SPUTUM
Physical Examination
Microscopic Examination
Unstained Specimen
Stained Sputum Smear
Differential Leukocyte Count
Culture Studies
28:
Semen Analysis
INTRODUCTION
COMPOSITION AND PRODUCTION OF SEMEN
CLINICAL APPLICATIONS OF SEMEN ANALYSIS
SPECIMEN COLLECTION AND TRANSPORTATION
ROUTINE EXAMINATION OF SEMEN
Physical Examination
Chemical Examination
Microscopic Examination
Motility of the Sperms
Sperm Count
Causes for Low Sperm Count
Sperm Morphology
SPERM FUNCTIONAL TESTS
29:
Stool Examination
INTRODUCTION
COLLECTION
Precautions in Collection
PRESERVATION
PHYSICAL EXAMINATION
Quantity
Consistency and Form
Color
Odor
Blood and Mucus in Stool
Parasites
Chemical Examination
Reaction and pH
Occult Blood
Principle
False-positive Reactions in Occult Blood Examination
False-negative Reactions in Occult Blood Examination
Other Chemical Tests
Microscopic Examination
APPENDIX
PART II: HUMAN GENETICS
30:
Historical Highlights
31:
Principles of Cytogenetics
CELL CYCLE
Mitosis
Prophase
Metaphase
Anaphase
Telophase
MEIOSIS
MEIOSIS I
Prophase
Leptotene
Zygotene
Pachytene
Diplotene
Diakinesis
Metaphase
Anaphase
Telophase
MEIOSIS II
SPERMATOGENESIS
OOGENESIS
32:
Morphology of Chromosomes
KARYOTYPING
Classification
The Denver System of Classification
The Paris System of Classification
Other Recent Methods to Study Chromosomes
Flow Cytometry
Fluorescence In Situ Hybridization (FISH)
Whole Chromosome Paint (WCP)
Clinical Applications for Karyotyping
Detection of Sex Chromatin
33:
Structure of DNA and Gene
INTRODUCTION
Structure of DNA
Mitochondrial DNA
Ribonucleic Acid (RNA)
Messenger RNA (mRNA)
Transfer RNA (tRNA)
Ribosomal RNA (rRNA)
Replication
Transcription
Translation
Genome
Gene
Code
Triplet Codon
Control of Gene Action
34:
Mutations
35:
Recombinant DNA Technology
VARIOUS TECHNIQUES OF RECOMBINANT DNA TECHNOLOGY
Southern Blotting Technique (Figure 1)
Applications
Northern Blotting Technique (Figure 2)
Dot Blotting
In Situ Hybridization Technique
Fluorescence In-Situ Hybridization (FISH) (Figure 3)
Polymerase Chain Reaction (PCR)
Applications
DNA Fingerprinting Technology
36:
Chromosomal Aberrations
CLINICAL PROFILES OF SOME OF THE COMMON CHROMOSOMAL ABERRATIONS INVOLVING THE AUTOSOMAL CHROMOSOMES
Down's Syndrome
Trisomy 21
Edward's Syndrome
Patau Syndrome
CLINICAL PROFILES OF SOME OF THE COMMON CHROMOSOMAL ABERRATIONS INVOLVING THE SEX CHROMOSOMES
Klinefelter's Syndrome
Turner's Syndrome
Other Sex Development Disorders
True Hermaphrodite
Pseudohermaphrodite
37:
Modes of Inheritance
INTRODUCTION
AUTOSOMAL DOMINANT PATTERN OF INHERITANCE
AUTOSOMAL RECESSIVE PATTERN OF INHERITANCE
X-LINKED PATTERN OF INHERITANCE
38:
Prenatal Diagnosis
39:
Genetic Counseling
GENETIC COUNSELOR
Functions of a Genetic Counselor
Other Functions of the Counselor
ETHICS IN PRENATAL DIAGNOSIS AND THE SUBSEQUENT ABORTIONS
Abortion Choices
Access to Prenatal Diagnosis Service
ETHICAL PROBLEMS FACED BY THE COUNSELOR
ETHICAL GUIDANCE IN GENETIC COUNSELING
40:
Analysis of Genetic Disorder—Role of Paramedical Personnel
41:
Recent Advances in Medical Genetics
INDEX
TOC
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