The position of pathology in medicine在线视频

In the last lesson we mentioned

what is pathology

What is the status of pathology in medicine

Pathology is divided into basic pathology and clinical pathology

Take basic pathology as example

Basic pathology is a bridging subject

Why is it called the bridging subject

It is based on the anatomy embryology cell biology physiology biochemistry and other subjects we’ve learned

At the same time it is also the mastery integration and application of the knowledge of various subjects we have learned

Pathology is different from other subjects that have been studied

It studies the changes in morphology, function and metabolism of tissues and cells

in the diseased state, the pathological states

and the relationship between these changes and various clinical signs and symptoms

to make a final diagnosis of the diseases

to research, to observe the fate and outcome of the diseases

through such processes

eventually to serve the clinical medicine

It is a bridging subject

from basic medicine to clinical medicine

The role of connection

Therefore basic pathology is a bridging subject

Let's make examples to illustrate the role of pathology as a bridging subject

Take coronary heart disease as an example

In histology classes

we have learned the basic tissue structure of arteries

Take medium-sized arteries as an example

The arteries in the circle of Willis coronary arteries renal arteries vertebral arteries etc

These arteries are all medium-sized arteries

The biggest feature of medium-sized arteries is its prominent inner elastic plate

Its media is a muscular layer

Therefore medium-sized arteries are also called muscular arteries

Arteries are divided into intima media and adventitia

In pathological states

in the circumstances of coronary heart disease

Take coronary for example

The intima of the artery is significantly thickened

Why is the intima thickened

It is due to the accumulation of white shiny foamy cells under the intima

We call it foam cell

What's the origin of these foam cells

They might come from the smooth muscle cell turning into phagocytic cells in the media

or they might come from macrophages from blood that engulf lipids

Those cells accumulate under the intima

causing significant thickening of the intima

When thickening progress to a certain degree

proliferation of connective tissue might occur

which is hyaline degeneration

meanwhile there's necrosis

this necrosis is composed by lots of lipids

grossly they look like atherosclerotic changes

so we call it atherosclerosis

Atheroma formation leads to

narrowing of the arteries

Blood flow is blocked by those plaques

When narrowing progress to a certain degree

angina might happen due to ischemia of heart tissue

If the arteries are completely blocked

blood supply fully stopped

the heart may present ischemic necrosis

We call it myocardial infarction

From this example

we can understand

What is the cause of coronary heart disease

What happened to its morphology

Why is there angina and myocardial infarction

Questions explained

This is basic pathology

Clinical pathology is a subject of clinical medicine

It is a subject in clinical medicine

Pathological diagnosis is the most authoritative first diagnosis, the first diagnosis

It is completely different from the clinical diagnosis made by clinicians

which is based on imaging tests like ultrasound X-ray CT scan or MRI

Why are they different

Firstly it answers the nature of diseases

The nature of the disease determines the type of surgery

even the extent of surgery

Especially during rapid freezing diagnosis

the decision must be made within 20 to 30 minutes

so that to give instructions to the surgeons

Which part can be excised

Which part cannot

Even to what extent the excision can be made

Hence in the pathological diagnosis so-called first diagnosis

there shouldn't be multiple diagnoses

The diagnosis must be unique

Pathological diagnosis can also guide clinical medication after surgery to determine the prognosis

Therefore clinical pathology is a subject of clinical medicine

Let's take an example to illustrate the status of pathology in clinical medicine

For example

a patient present with cough

blood-stained sputum occasionally

During a regular bronchoscopy

the doctor saw some roughness at the trachea carina

but no clear lesions can be seen

When observing with a fluorescent microbronchoscope

the doctor noticed a light stained fuzzy looking lesion with uneven density

Biopsy was made at this site

Result shows disappearance of respiratory epithelium under the microscope

and squamous cell metaplasia

Besides that

there are cells with big nuclei imbalanced nuclear-cytoplasmic radio

the pathologic mitotic figures also appear

So this is an early stage highly differentiated squamous cell carcinoma

The diagnosis was made

Operation was performed soon

Although this is cancer

it is in early stage

so the patient quickly recovered

In another case

the patient present with cough and dyspnea

went to the clinic for a medical examination

a CT scan

CT result showed

a high density subpleural mass in the thoracic cavity

The CT diagnosis was highly suspected cancer

a lung cancer

If it's really lung cancer

the treatment should be made

If it's not lung cancer

a different strategy should be made

A pre-surgical biopsy was performed

diagnosis was the so-called sclerosing hemangioma of the lung

The so-called sclerosing hemangioma is a benign tumor

This determines that although surgery is required the range of resection is limited

Great protection for the patient was made

Therefore pathology has a role in guiding clinical treatment in medicine practice

Another example

which indicates pathology have guiding role for medication and prognosis prediction after surgery

Patients with breast cancer need FISH analysis

which is a test of the chromosomes

It mainly shows whether the Her-2 gene is amplified

If the Her-2 gene does have amplification

target drug Herceptin can be applied to the patient

This is the precision medicine or targeted therapy which is currently advocated

According to immunohistochemistry

if there's positive stain of estrogen receptor in the nucleus

hormone therapy should be a great choice for the patients

Meanwhile if there's mutation in P53 gene

this indicates poor prognosis of the patients

Therefore pathology has a guiding role for medication and prognosis prediction

To conclude

what is the status of pathology in medicine

As for basic pathology

it is a bridging subject

Most of the students here will eventually become clinicians

If you want to be a clinician

studying anatomy and physiology is not enough

you need to learn many other subjects

as well as pathology

Pathology can connect you with clinical medicine

then you'll become a qualified clinician

This is the role of basic pathology as a bridge between sciences

Some students are determined to do pathological research and diagnosis after graduation

so they become pathologists

This is the role of pathology in clinical medicine

In the practice of clinical pathology

as we mentioned before

it determines the type and extent of surgery

it guides medication and predicts prognosis

So clinicians often highly respect pathologists

they call pathologists "doctor's doctor"

they also call the diagnosis made by pathologists "the golden standard"

they call the pathological diagnosis "the first diagnosis"

because pathological diagnosis is unique

As mentioned by the founder of cellular pathology Virchow

"Pathology is the soul of medicine"

The world-famous clinician Osler also said

"As is our pathology, so is our medicine."

Thereby pathology is highly appreciated in modern medicine

As mentioned by the famous respiratory physician academician Zhong Nanshan

"The level of clinical pathology is an important indicator for medical quality in a country"

That it for our class

Thank you for listening