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==An Introduction to General Pathology==
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#REDIRECT[[:Category:General Pathology]]
 
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* The term '''pathology''' is derived from:
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** '''Pathos''', or suffering
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** '''Logos''', or reasoning/logic.
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* Pathology is defined as the study of disease including:
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** '''Aetiology''' - causal factor(s)
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** '''Pathogenesis''' - the development of the disease within the body.
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** '''Lesions''' - the observable structural changes in the tissues and fluids of the body.
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** '''Pathophysiology''' - the functional changes in diseased tissues.
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** '''Sequel''' - the consequences of the disease in the body.
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** '''Remote effects''' - the effect of disease in one tissue on other tissues in the body.
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===Lesions===
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* Lesions are the abnormalities or changes seen in living tissues due to disease.
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* Observed in
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** The live animal
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** Tissues surgically removed from the live animal
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*** Biopsy/ excision
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** Animals soon after death
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*** Necropsy, post-mortem examination.
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====Decription of Lesions====
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* Descriptions of lesions is very important
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* Whole organs, tissues or individual lesions are described under headings such as
  −
*# Size
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*# Shape
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*# Colour
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*# Weight
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*#* Generally in relation to body weight
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*# Texture and Consistency
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*# Appearance of the cut surface
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*# Contents of hollow organs
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*# Position, relationships and effects on adjacent tissues
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===Disease===
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====Definition and Type====
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* '''Disease''' is  a definite morbid (illness producing) process, having a characteristic train of symptoms or signs.
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** May affect the whole body or any of its parts.
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** The disease's aetiology, pathology and prognosis may be known or unknown.
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* There are two main categories of disease.
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*# '''Acute'''
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*#* Characterised by sudden onset and short duration.
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*#* The outcome of acute disease may be:
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*#** Death
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*#** Resolution due to host defence response or clinical therapy
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*#** Progression to chronic disease
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*# '''Chronic'''
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*#* Characterised by insidious onset and protracted course.
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*#* The outcome of chronic disease may be:
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*#** Progressive destruction of tissue
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*#*** Compromises funtion and  endangers life,
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*#** The halting of the course of disease, with tissue repair by scarring.
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====Factors Involved in the Development of Disease====
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* There are three factors which conspire with each other to produce disease.
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*# '''The individual animal'''.
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*#* In particular, the animal's nutritional and immune status
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*#** This is modified by:
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*#*** Recent or concurrent disease
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*#*** Previous exposure to the agent(s) responsible
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*# '''The disease-causing agent(s)'''.
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*#* Most do not cause a uniform pattern of disease
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*#** Host defences are important in determining the presentation of the disease.
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*#* An agent's capacity to produce disease depends upon:
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*#** The dose
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*#** The virulence of the agent
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*#* Several agents may be involved.
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*#** Usually one agent debilitates, allowing others to exert a greater effect within the body
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*#* The presence of an agent does not necessarily mean it is the cause of the disease!
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*#* A pathogenic agent may be absent from the tissues, due to:
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*#** Clinical therapy
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*#** Host defence systems
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*# '''Environment''', for example:
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*#* Overcrowding of animals
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*#* Mixing animals from differing origins
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*#** Carriers are allowed to infect susceptible animals.
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*#*** Carriers are animals which harbour the pathogenic agent but do not show signs of disease.
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*#* Changes in management routine
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====Types of Agents Causing Disease====
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# '''Infectious organisms'''
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#* [[Viruses|Viruses]]
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#* [[Bacteria|Bacteria]]
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#* [[Fungi|Fungi]]
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#* [[Parasites|Parasites]]
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# '''Physical'''
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#* Trauma
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#* Pressure
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#* Heat
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#* Cold
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#* Radiation
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# '''Chemical'''
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#* Toxic organic and inorganic substances
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#* Toxins produced by infectious organisms
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# '''Nutritional'''
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#* Deficiencies of vitamins and trace elements
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#* Excess vitamins and trace elements
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# '''Genetic defects'''
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#* There is a very wide range of potential defects.
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#** Some are incompatible with life
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#** Others affect specific systems within the body
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====Aspects of Disease====
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* There are many aspects of a disease that must be considered in order to understand it in full.
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*# '''Incidence'''
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*#* How much of the disease is present?
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*#* Where is the disease found?
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*#* In what species is the disease seen?
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*# '''Aetiology'''
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*#* Causal agent(s)
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*#* Predisposing factors
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*# '''Transmission'''
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*#* How is the disease spread between individuals?
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*#* Is the disease zoonotic?
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*# '''Pathogenesis'''
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*#* How the causal agent(s) exert their effect within the body.
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*# '''Diagnosis'''
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*#* History
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*#* Clinical findings
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*#** Clinical examination
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*#** Clinical pathology
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*#* Biopsy or post-mortem examination
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*# '''Prognosis and Treatment'''
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*# '''Control and Prevention'''
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*#* The ideal situation
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====Post-Mortem Examination====
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* Post-mortem examination (PME) investigates the observable structural changes in the animal.
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* Information relating to the disease withing the body or specific tissue is gained from PME.
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** This includes information on the disease's
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*** Aetiology (cause).
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*** Pathogenesis (development).
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* Several types of changes are encountered at post-mortem examination.
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*# Those due to the '''disease'''
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*#* Lesions
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*# Those occuring '''immediately prior to death'''
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*#* Agonal
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*# Those occuring '''after death'''
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*#* Post-mortem
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====Techniques Involved in Pathological Examination====
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* '''Fluid examination'''
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** E.g. blood, urine, discharges from orifices and so on.
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* '''Cytology'''
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** Examination of cells in smears, aspirates and fluids.
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* '''Necropsy'''
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** Visual examination of the gross changes in the dead body.
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* '''Histopathology'''
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** Microscopic examination of:
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*** Tissues selected from the dead body after necropsy.
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*** Biopsy/excision materials from lesions in the living animal.
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* '''Histochemistry'''
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** Microscopic visualisation of enzymatic activity in tissues.
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* '''Immunological methods'''
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** Specific antibody activity can be detected in tissues and fluids.
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*** Examination of serum can show prior exposure to a particular infectious agent (i.e. specifice antibodies).
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** Specific antigens can be detected in tissues.
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*** When linked to a marking agent (e.g. a fluorescent dye), an antibody can localise its antigen in the tissue.
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* '''Electronmicroscopy'''
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** Electronmicrosopcy shows fine detail of the surfaces or internal structures of cells.
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* '''Bacteriology/ Virology/ Parasitology'''
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** These techniques allow the isolation and identification of pathogenic bacteria, viruses and parasites.
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* '''Toxicology'''
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** Analysis of tissues for particular poisons and toxins.
  −
 
  −
==General Pathology - Contents==
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==Degenerations and Infiltrations==
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  −
*  Degenerations and infiltrations are the morphological manifestation of an altered metabolism within the cell.
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** A particular kind of change within a cell or tissue may suggest that a specific type of alteration has occurred.
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* Degenerations and infiltrations are types of structural changes.
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** These are best considered at a cellular level.
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** These structural changes are deviations from the cell's normal structure and function.
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*** Parameters are outside the normal physiological range for the cell.
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* '''Degeneration'''
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** The tissue cell shows some change in itself.
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* '''Infiltration'''
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** Something accumulates in the cell or tissue.
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===Cellular Swelling===
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* Cellular swelling is
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** The earliest detectable degenerative change.
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** The mildest from of cellular degeneration.
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** The first stage in injury to a cell.
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** Caused by a variety of insults, e.g.
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*** Lack of oxygen (anoxia) to a tissue.
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*** Toxic influences.
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* Is due to the impairment of the integrity of the cell membrane.
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* Cellular swelling is characterised by a moderate swelling of the individual cells.
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** Due to an influx of water into the cell.
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====Gross Appearance====
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* Organs diffusely affected with cloudy swelling grossly appear pale.
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** This may be partly due to the swollen cells impeding the tissue's blood supply.
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* Without cutting into an organ, it may be difficult to appreciate a gross enlargement of it.
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** Each individual cell is increased in size, meaning the entire volume of the organ is also increased.
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** E.g. on cutting the liver or kidney capsule, the underlying swollen parenchyma bulges outwards, making the cut ends of the capsule retract.
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* The degree of gross swelling is not great.
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** Could be easily confused with early post-mortem changes in the organ.
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====Histological Appearance====
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* Individual cells appear somewhat swollen.
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* The cytoplasm appears more red in colour in hematoxylin and eosin (H&E) stained sections.
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* The nucleus of the cell remains normal.
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* Cellular swelling is best histologically appreciated in the liver and kidney in damage caused by circulating toxins that are not powerful enough to actually kill the cells.
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====Significance of Cellular Swelling====
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* Cellular swelling is an important stage in degeneration.
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** Not commonly observed on its own without more serious changes
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*** Not easy to identify at post-mortem unless the examination os perfomred very soon after the animal's death.
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**** Early post-mortem (autolytic) change in dead tissue looks rather similar.
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*** Cellular swelling is also reversible.
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**** When the toxin is no longer exerting its effect, the tissue returns to normal.
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*** Cellular swelling may be a transient stage in the more serious forms of degenerations which follow.
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===Hydropic Degeneration===
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  −
* Hydropic degeneration often indicates severe cellular damage due to viruses.
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** Is a more severe or advanced form of cellular swelling.
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* There are two types of hydropic degeneration, in which:
  −
*# The cells may swell up like a balloon prior to their destruction.
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*#* '''Balloning Degeneration'''
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*# There is a discrete bleb (vacuole) of fluid within the cytoplasm.
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*#* '''Vacuolar Degeneration'''
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====Ballooning Degeneration====
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  −
* May occur in a variety of conditions.
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** Is particularly seen in viral conditions of epithelial tissue.
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* [[Oral Cavity - Cavity & Gingiva#Foot and Mouth disease|Foot and Mouth Disease]] is the best example.
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** Foot and Mouth virus attacks the stratum spinosum of the epithelium of the tongue and feet.
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** Affected cells balloon up with water containing the replicating virus, swelling until they burst.
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*** The fluid contained in the cells then forms microvesicles (blisters) in the stratum spinosum.
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**** Blisters may later burst, shedding vast quantities of the virus.
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** On bursting, the edges of the erosions look ragged.
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*** Within weeks, the germinal epithelium at the base of the erosion regenerates the epithelium, leaving no trace of a scar.
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  −
====Vacuolar Degeneration====
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  −
* In vacuolar degeneration, excess water is transferred to the endoplasmic reticulum (ER).
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* The ER  swells and eventually fragments.
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** A fluid vacuole remains in the cytoplasm.
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* Commonly occurs in cells that are very metabolically active and have well developed pumping mechanisms.
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** E.g. as the hepatocyte, renal tubular epithelium and pancreatic acinar cell.
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  −
===Cellular Fatty Change===
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  −
* DOES NOT REFER TO THE THE FAT STORES OF THE BODY!
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** Fatty substances accumulate or increase within the cytoplams of specific cells.
  −
** In some instances, the fat stores may be involved in the transfer of fat to these specific cells.
  −
* Cellular fatty change is an important intracellular abnormality.
  −
** Principally concerns the intracellular fat in hepatocytes.
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* Fatty change is commonly seen in three organs of the body.
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** Prinicpally in the '''liver'''.
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** Also in the '''kidney''' and the '''heart'''.
  −
** This is  because these organs are either:
  −
*** Involved in the metabolism of fat, or
  −
*** Dependant upon lipids as an energy source.
  −
* Fatty change can be readily recognised at post-mortem.
  −
 
  −
==== Gross Appearance of Fatty Change====
  −
 
  −
* '''Liver'''
  −
** This is the main organ involved in fatty change.
  −
** May be greatly increased in size.
  −
** Is tan to yellowish in colour.
  −
*** Is normally reddish brown.
  −
** Very prone to rupture with slight pressure (friable).
  −
** Parenchyma bulges outwards on being freed from the constraint of the capsule when cut.
  −
** Parenchyma is dull, yellowish and greasy.
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* '''Kidney'''
  −
** The cortex appears paler.
  −
***N.B. This is normal in e.g. the cat!
  −
*** Diffuse paleness is not the prominent feature, unlike in the liver.
  −
* '''Heart'''
  −
** Anoxia, as a result of anaemia, causes fatty change.
  −
** The heart is flabby.
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** Fatty change may occur as streaks in the papillary muscles.
  −
*** I.e. those muscles furthest away from the blood supply.
  −
** Contractile ability is reduced, and blood is therefore not umped efficiently.
  −
 
  −
====Histological Appearance of Fatty Change====
  −
 
  −
* The fat either appears as globules or is contained in varying sizes of vacuoles in the cytoplasm.
  −
** In the heart, fat appears as groups of tiny vacuoles dispersed along the myofibrils.
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** In the liver and kidney, vacuoles tend to coalesce to form larger ones.
  −
*** One or more large globules may fill the cytoplasm.
  −
**** The nucleus is displaced to the periphery of the cell.
  −
* The nucleus remains normal.
  −
** Nuclear changes are only seen if the degree of fatty change becomes incompatible with the continued existence of the cell.
  −
* In hepatocytes, it is necessary to stain for fat in order to ellucidate if a vacuole in the cytoplasm is fat-containing.
  −
** Two further conditions may produce vacuoles in hepatocytes.
  −
*** [[General Pathology#Vacuolar Degeneration|Vacuolar hydropic degeneration]]
  −
*** Glycogen accumulation
  −
** Stains commonly used include Sudan 111, Sudan 1V, and Oil Red O.
  −
*** Stain fat varying shades of orange to red.
  −
** Sections must be prepared differently to the routine paraffin embedding (used e.g. in H&E staining).
  −
*** The strong solvents used in paraffin embedding dissolve the fat out of the cell.
  −
*** When staining for fat,  the tissue to be examined is frozen and sectioned in a cryostat before being stained.
  −
**** These sections are more than twice as thick as those attained by sectioning paraffin blocks
  −
***** There may be some overlap of cells on the section.
  −
***** Individual cells are less clear.
  −
 
  −
====Causes of Fatty Change====
  −
 
  −
=====Dietary and Metabolic=====
  −
a. Starvation - this is an increased mobilisation of fat from the body fat stores in response to
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energy needs occasioned by a reduction in dietary intake. These are transported in the blood
  −
as fatty acids, the liver is unable to cope with them all properly, and so they are stored here as
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neutral fats.
  −
b. Overeating - obesity where the dietary intake is greater than the energy expenditure and
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the fat is temporarily stored prior to movement to the body fat stores. It also occurs on a diet
  −
rich in fat.
  −
c. Lipotrope derangement - lipotropes are substances which hasten the removal of fat from
  −
the liver cells. Some are the amino acids that facilitate conjugation of the fat with proteins to
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form the lipoprotein that is excreted from the cell, and deficiency of these e.g. choline and
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methionine in the diet, lead to fatty change within the cells.
  −
Some poisons e.g. CCl4, phosphorus and alcohol also prevent stages leading to the
  −
formations of lipoproteins.
  −
 
  −
=====Metabolic diseases=====
  −
- those accompanying a deranged carbohydrate metabolism in which
  −
glucose is not made available for uptake into the tissues. Alternative pathways are resorted to
  −
for the production of energy needed by the cells, and this leads to fatty change.
  −
Examples are Diabetes mellitus in dogs where there is a deficiency of the hormone insulin
  −
which is required for cellular glucose utilisation, and Ketosis in ruminants where the drain on
  −
glucose reserves in sheep caused by twin lambs ( condition is called Pregnancy Toxaemia) or
  −
in the milk of high-yielding dairy cows shortly after parturition (Acetonemia), exhorts the
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body to find another source of energy, with consequent mobilisation of fat reserves and their
  −
transportation to the liver
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  −
=====Anoxia=====
  −
- an inadequate supply of oxygen to the tissues
  −
Any condition that reduces the oxygen supply to the tissues will cause fatty change in the
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liver. Anaemia ( a reduced numbers of red blood cells circulating in the blood ) caused by
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sustained loss of erythrocytes from the vessels as in chronic haemorrhage or the excessive
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destruction of erythrocytes within the vessels ( haemolysis ) are examples as are the various
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circulatory disorders such as ischaemia ( reduced blood supply to a tissue ) and chronic
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venous congestion ( slowing of blood flow through the vasculature ) due to a failing heart.
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  −
=====Toxins=====
  −
. A large number of toxins will cause fatty change in the liver. In these cases,
  −
consider the fatty change to be a more severe form of cellular swelling. Among these are;
  −
a. bacterial and fungal toxins- either produced in the bloodstream from circulating bacteria
  −
(septicaemia/bacteraemia) or produced elsewhere and absorbed into the bloodstream.
  −
b. chemical toxins such as CCl4, phosphorus, arsenic and lead.
  −
c. some plant and fungal toxins, will cause fatty change in the very early stages of
  −
poisoning.
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18
  −
Distribution of fatty change in the liver.
  −
The distribution of fatty change in the liver lobule tends to be throughout the whole lobule
  −
but occasionally there is a preferential localisation which may give some clue to inciting
  −
cause.
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Chronic venous congestion in the liver due to a failing heart ( a cause of anoxia ) will also
  −
produce fatty change. In conjunction with the fatty change the pooling of the blood in the
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centrilobular area due to ineffective flow back to the heart, gives a striking gross appearance
  −
of areas of yellow interspersed with red, and this has been described as a 'nutmeg liver'.
  −
The practical implication of this when found at post-mortem examination, is to examine the
  −
heart for the cause.
  −
Significance of fatty change
  −
It is important to remember that fatty change is reversible, provided that the underlying cause
  −
is brought under control. It may be difficult to decide whether the fatty change is due to a
  −
toxic effect or metabolic defect, from the distribution of the fat within the cell.
  −
In the former, fatty change can be considered as a more serious form of cellular swelling and
  −
you may see evidence of a further change in the cells, which is death of the cell (necrosis).
  −
But if the metabolic defect is prolonged for any period, the impairment of cellular function
  −
occasioned by the substantial amount of cytoplasmic fat, may also result in death of the cell.
  −
Wallerian Degeneration. This is a special form of fatty change in the nervous system, where
  −
damage to myelinated nerves results in the degeneration of the myelin that ensheaths them. It
  −
can be selectively stained and will be discussed further in the CNS lectures in Systematic
  −
Pathology.
  −
Extracellular accumulation of lipids
  −
Lipid may be present outside the cell in some conditions. Necrosis of cells containing lipid
  −
may release lipid into the extracellular space where they are visible. Cholesterol is released
  −
from cells or pooled from lipoproteins in crystalline form( cholesterol clefts )as a result of
  −
haemorrhage or tissue damage.
  −
 
  −
===Mucoid Degeneration===
  −
===Hyaline Degeneration===
  −
====Fibrinoid Degeneration====
  −
====Amyloidosis====
  −
===Glycogen Infiltration===
  −
===Cellular Inclusions===
  −
 
  −
==Necrosis==
  −
===Causes of Necrosis===
  −
===Gross and Histological Features of Necrotic Lesions===
  −
====Coagulation Necrosis====
  −
====Liquefactive Necrosis====
  −
====Caseation Necrosis====
  −
===Sequel to Necrosis===
  −
====Fat Necrosis====
  −
====Gangrene====
  −
 
  −
==Post Mortem Change==
  −
===Types of Post Mortem Change===
  −
====Rigor Mortis====
  −
 
  −
====Post Mortem Clotting of Blood====
  −
====Hypostatic Congestion====
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====Post Mortem Imbibition of Blood====
  −
====Inbibition of Bile Pigment====
  −
====Gaseous Distenstion of the Alimentary Tract====
  −
====Autolysis====
  −
====Putrefaction====
  −
 
  −
==Pigmentation and Calcification==
  −
 
  −
===Exogenous Pigmentation===
  −
====Carbon (Anthracosis)====
  −
====Pneumoconiosis====
  −
====Carotenoids====
  −
 
  −
===Endogenous Pigmentation===
  −
====Melanin====
  −
====Blood Pigments====
  −
=====Haemoglobin=====
  −
=====Haemosiderin=====
  −
=====Haematin=====
  −
=====Jaundice=====
  −
=====Haematoidin=====
  −
=====Porphyria=====
  −
====Lipofuscin====
  −
 
  −
 
  −
===Mineralisation===
  −
 
  −
====Calcification====
  −
=====Dystrophic=====
  −
=====Metastatic (Hypercalcaemia)=====
  −
 
  −
==Circulatory Disorders==
  −
 
  −
===Introduction====
  −
 
  −
====Venous Congestion and Hyperaemia====
  −
 
  −
====Oedema====
  −
 
  −
 
  −
====Dehydration====
  −
 
  −
====Shock====
  −
 
  −
====Haemorrhage====
  −
=====Rhexis=====
  −
=====Diapedesis=====
  −
 
  −
====Haemostasis====
  −
 
  −
====Thrombus====
  −
=====Causes=====
  −
=====Evolution=====
  −
=====Embolism=====
  −
=====Post Mortem Clots=====
  −
 
  −
====Disseminated Intravascular Coagulation====
  −
 
  −
==Inflammation==
  −
 
  −
===Cardinal Signs===
  −
 
  −
===Causes===
  −
 
  −
===Acute===
  −
====Introduction====
  −
====Sequence of Events====
  −
====Fluids====
  −
=====Serous=====
  −
=====Catarrhal=====
  −
=====Fibrinous=====
  −
=====Diptheritic=====
  −
=====Haemorrhagic=====
  −
=====Purulent=====
  −
=====Functions of Exudate=====
  −
=====Sequel to Exudation=====
  −
====Cells====
  −
=====Neutrophils=====
  −
=====Eosinophils=====
  −
=====Mast Cells=====
  −
=====Basophils=====
  −
 
  −
===Chronic===
  −
====Introduction====
  −
====Cells====
  −
=====Macrophages=====
  −
=====Lymphocytes=====
  −
====Types====
  −
=====Granulomatous Inflammation=====
  −
=====Granulation Tissue=====
  −
=====Lymphocytic Inflammation=====
  −
 
  −
===Changes in Inflammatory Cells Circulating in Blood===
  −
====Neutrophilia====
  −
====Neutopenia====
  −
====Eosinophilia====
  −
====Eosinopenia====
  −
====Lymphocytosis====
  −
====Lymphopenia====
  −
====Plasma Cells====
  −
====Monocytosis====
  −
 
  −
===Role of The Lymph Node in Inflammation===
  −
 
  −
===Healing and Repair===
  −
====Introduction====
  −
====Repair====
  −
=====Regeneration=====
  −
=====Replacement=====
  −
====In Particular Tissues====
  −
=====Skin=====
  −
======First Intention======
  −
======Second Intention======
  −
=====Bones=====
  −
=====Respiratory Tract=====
  −
=====Alimentary Tract=====
  −
=====Urinary Tract=====
  −
=====Genital Tract=====
  −
=====Central Nervous System=====
  −
 
  −
==Growth Disorders==
  −
 
  −
===Congenital===
  −
====Causes====
  −
====Malformations====
  −
=====Cyclops=====
  −
=====Bulldog Calf=====
  −
=====Cleft Palate=====
  −
=====Cystic Kidney=====
  −
=====Spina Bifida=====
  −
=====Hydrocephalus=====
  −
=====Cerebellar Hypoplasia=====
  −
=====Skeletal Malformations=====
  −
=====Skin Defects=====
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=====Muscular Defects=====
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=====Cardiac Defects=====
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=====Sexual Organ Malformation=====
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=====Metabolic Diseases=====
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===Growth Disorders During Life===
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====Atrophy====
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====Hypertrophy====
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====Hypoplasia====
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====Hyperplasia====
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====Metaplasia====
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====Dysplasia====
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====Anaplasia====
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====Neoplasia====
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=====Benign Tumours=====
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=====Malignant Tumours=====
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=====Aetiology of Tumours=====
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=====Phases of Tumour Growth=====
  −
=====Tumour Classification and Nomenclature=====
 
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