Pathology

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Pathology (from Greek pathos, feeling, pain, suffering; and logos, study of; see also -ology) is the study of the processes underlying disease and other forms of illness, harmful abnormality, or dysfunction. Within biology but also a branch of medicine, it means specifically the study and diagnosis of the structural and functional changes in molecules, cells, tissues and organs that underlie disease. Pathology as a field of knowledge hence forms the basis of the scientific reasoning behind the practice of medicine.

Contents 1 Scope of pathology 2 Pathologists' work 3 Tools of pathology 4 Branches of pathology 4.1 Medicine 4.2 Dentistry 4.3 Experimental pathology 4.4 Other 5 Related sciences 6 Other uses of "pathology" 7 See also 8 External links

[edit] Scope of pathology

The primary goal of pathology is the study of the four main aspects of a disease:

• Etiology: what causes the disease
• Pathogenesis: the mechanism by which a certain etiological factor causes disease
• Morphologic changes: the structural changes induced in the cells, tissues and organs
• Clinical significance: the functional consequences of the morphologic changes

[edit] Pathologists' work

Because the public rarely meets pathologists, their work is not well understood. Pathology is a large and diverse field that allows a pathologist to participate in multiple areas of the field or focus their scope to a specific area. Essential to everyday surgeries, pathologists are responsible for processing and reporting on all specimens generated during surgery. Tissue samples are taken from the submitted specimens, stained, and processed for microscopic evaluation. Microscopic examination searches for disease of any type and this information is returned to the surgeon via a pathology report. They, along with Pathologists' Assistants and Medical Technologists, process specimens at medical laboratories for interpretations. In other words, when a doctor refers to a "laboratory result", they are not referring to a number generated by a black box; instead, it is the interpretation of a value by a pathologist or a technologist. It is also important to understand that a different laboratory might produce a different value on the same specimen. Pathologists are also called upon to perform autopsies; they are usually assisted by Dieners. Autopsies represent less than 5% of the workload of a typical modern pathologist. There exists a subspecialty in pathology that allows for the training of medical examiners who wish to pursue forensics.

Pathologists usually do not see patients, but do on occasion such as when performing bone marrow biopsies and aspirates or fine needle aspirations of superficial nodules. Thus, it is best considered a form of diagnostic medicine. In addition to the diagnosis of disease, including cancer, and the administration of medical laboratories, pathologists often participate in the teaching of medical students (pathology is a core course in the medical curriculum). Pathologists express their opinion as a pathology report addressed to the doctor requesting it. Since pathologists most often communicate with other doctors, they are sometimes nicknamed "the doctor's doctor." Pathology is often considered the most scientific branch of medicine because of the available avenues of research involving human material. Finally, the circulation of laboratory data is a central issue in medical informatics and the current tendency towards electronic medical records.

[edit] Tools of pathology

The techniques used most often in the study of the disease process and hence diagnosis are:

• Gross pathology: the recognition of disease based on macroscopic examination of surgical specimens generated at the time of surgery or at autopsy.
• Histology: the microscopic study of tissues. Histopathology is the science of diagnosing diseases on the basis of the histological aspect of the diseased tissues.
• Cytology: the study of detached cells. Cytopathology is the science of diagnosing diseases on the basis of the cytological aspects of detached cells. The most common application of this technique is the Pap smear.
• Clinical chemistry: the gathering, detection, and reporting of an incredible array of chemical measures found by the analysis of collected body samples.
• Immunology: the use of specific immune markers and antibodies to aid in the diagnosis of disease.
• Flow cytometry: analysis of a process that allows for the identification of specific cells.
• Molecular Biology techniques, like PCR and FISH are increasingly useful to diagnose diseases, especially microbiological and cancer diagnoses.

[edit] Branches of pathology

[edit] Medicine

In the United States, pathologists are medical doctors (MD) or doctors of osteopathic medicine (DO), that have completed a four year undergraduate program, four years of medical school training, and four to five years of postgraduate training in the form of a pathology residency. Training may be within two primary specialties, as recognized by the American Board of Pathology:

• Anatomic Pathology, the science of diagnosing diseases based on the appearance of tissues, both gross and microscopic.
• Clinical Pathology, the science of diagnosing diseases based on the analysis of body fluids like blood, urine, etc.

Most pathologists seek a broad based training in both fields and thus require four years of postgraduate training known as residency. Board certification examination is required. Boarding requirements are set by the American Board of Pathology. Following the general training, many pathologists continue on to more specialized training within specific fields of pathology. This speciality training is termed a fellowship. Multiple fellowship opportunities are available within both Anatomical and Clinical Pathology. Examples of fellowhips include General Surgical Pathology, Gastrointestinal Pathology, Genitourinary pathology, Hematopathology, Dermatopathology, Microbiology, and Clinical Chemistry. These are but a few of the numerous fields within pathology. Some of the speciality areas of pathology are board certified while others are not. Pathologists, like all other medical doctors, require a medical license from the State they are working in to practice their field. This entails meeting continuing medical education requirements to maintain licensure.

[edit] Dentistry

The American Board of Oral and maxillofacial pathology certifies dentistry doctors, not medical doctors, to practice this sub-specialty of pathology.

[edit] Experimental pathology

Experimental pathology (or investigative pathology), is the study of disease mechanisms and pathophysiology.

Most of the work of investigative pathologists is carried out in the laboratory. Tissue culture, polymerase chain reaction (PCR), ELISA, western blot, southern blot, northern blot and many other biotechnological methods are required to identify differences between normal and disease states in different cell types with regards to DNA, RNA, and protein as well as determining the influence of these differences on the organism as a whole.

[edit] Other

• Plant pathology
• Veterinary pathology
• Parasitology

• Speech pathology is an unrelated area mostly involved in helping patients with stroke or speech impediments.
• Psychopathology is also used in mental health, denoting the study of mental illness.

[edit] Related sciences

• Anatomy, either gross or microscopic (histology)
• Nosology: the science of classifying, or naming, diseases
• Epidemiology: the science of associating diseases with risk factors, regardless of known pathological relationships. An epidemiological association is often the first step in establishing an etiological (causal) relationship between a risk factor and a disease.

[edit] Other uses of "pathology"

Pathological is used to describe a person's actions in such a way as to credit the action to a disease process, e.g. pathological purchasing or pathological consumption, pathological narcissism, pathological liar, pathological gambling, pathological jealousy. Pathological is also used casually, to signify an abnormal state, e.g. a "pathological attitude" or a "pathological woman hater".

Pathological is also used in mathematics, physics, and statistics to describe an exceptionally (or awkwardly, or inconveniently) atypical example or set of data, often one which does not abide by rules or succumb to treatment that other similar cases usually do:

• Pathological (mathematics)
• Pathological science

Computer science uses this term in a slightly different sense with regard to the study of algorithms. Here, an input (or set of inputs) is said to be pathological if it causes atypical behavior from the algorithm, such as a violation of its average case complexity, or even its correctness. For example, hash tables generally have pathological inputs: sets of keys that collide on hash values. The term is often used pejoratively, as a way of dismissing such inputs as being specially designed to break a routine that is otherwise sound in practice.

Forensic Engineers often use the term to describe the underlying causes of distress in structures or machinery in order to specify repairs.

[edit] See also

• Important publications in pathology

[edit] External links

• Immunohistochemistry protocols and troubleshooting
• United States and Canadian Academy of Pathology
• Pathology notes for Med students
• Pathology Service Associates, LLC
• College of American Pathologists
• Royal College of Pathologists (UK)
• Pathological Society

v·d·e Major subfields of biology
Anatomy - Astrobiology - Biochemistry - Bioinformatics - Botany - Cell biology - Ecology - Developmental biology - Evolutionary biology - Genetics - Genomics - Marine biology - Human biology - Microbiology - Molecular biology - Origin of life - Paleontology - Parasitology - Pathology - Physiology - Taxonomy - Zoology

v·d·e Pathology: Tumors, neoplasia, and oncology (C00-D48, 140-239)
Benign tumors	Hyperplasia - Cyst - Pseudocyst - Hamartoma - Benign neoplasm
Malignant progression	Dysplasia - Carcinoma in situ - Invasive cancer - Metastasis
Topography	Anus - Bladder - Blood - Bile duct - Bone - Brain - Breast - Cervix - Colon/rectum - Endometrium - Esophagus - Eye - Gallbladder - Head/Neck - Liver - Kidney - Larynx - Lung - Mediastinum (chest) - Mouth - Ovaries - Pancreas - Penis - Prostate - Skin - Small intestine - Stomach - Tailbone - Testicles - Thyroid
Misc.	Tumor suppressor genes/oncogenes - Staging/grading - Carcinogenesis - Carcinogen - Research - Paraneoplastic syndrome - List of oncology-related terms

v·d·e Pathology: hematology (primarily C81-C96/200-208, D45-D47, D50-D77/280-289)
WBCs	hematological malignancy (Lymphoma, leukemia) -cytosis (Agranulocytosis, Leukocytosis, Lymphocytosis, Monocytosis) • -penia (Lymphopenia, Neutropenia)
RBCs/anemia/ hemoglobinopathy	nutritional anemia: Iron deficiency anemia, Plummer-Vinson syndrome, Megaloblastic anemia (Pernicious anemia) hereditary hemolytic anemia: G6PD Deficiency, Thalassemia, Sickle-cell disease/trait, Hereditary spherocytosis, Hereditary elliptocytosis, Hereditary stomatocytosis acquired hemolytic anemia: Warm autoimmune hemolytic anemia, HUS, MAHA, PNH aplastic anemia: Acquired PRCA, Diamond-Blackfan anemia, Fanconi anemia • Sideroblastic anemia • Hemochromatosis
Coagulation/platelets	coagulopathy: DIC • Hemophilia (A, B, C, XIII) • Von Willebrand disease Purpura: Henoch-Schönlein, ITP, TTP primary hypercoagulable state: Protein C deficiency - Protein S deficiency - Antithrombin III deficiency other hemorrhagic conditions: Bernard-Soulier syndrome - Glanzmann's thrombasthenia - Grey platelet syndrome
Histiocytosis	WHO-I Langerhans cell histiocytosis - non-Langerhans-cell histiocytosis/WHO-II (Juvenile xanthogranuloma, Hemophagocytic lymphohistiocytosis) - malignant histiocytic disorders/WHO-III (Acute monocytic leukemia, Malignant histiocytosis, Erdheim-Chester disease)
Other	Asplenia/hyposplenism - Methemoglobinemia

v·d·e Endocrine pathology of psychological interest (E00-35)

thyroid Hypothyroidism (Iodine deficiency, Cretinism, Congenital hypothyroidism, Goitre) - Hyperthyroidism (Graves-Basedow disease, Toxic multinodular goitre) - Thyroiditis (De Quervain's thyroiditis, Hashimoto's thyroiditis) pancreas Diabetes mellitus (type 1, type 2, coma, angiopathy, neuropathy, retinopathy) - Zollinger-Ellison syndrome parathyroid Hypoparathyroidism - Hyperparathyroidism pituitary hyperfunction (Acromegaly, Hyperprolactinaemia, ) - Hypopituitarism Kallmann syndrome, Growth hormone deficiency) - Hypothalamic-pituitary dysfunction adrenal Cushing's syndrome) - Congenital adrenal hyperplasia (due to 21-hydroxylase deficiency) - Bartter syndrome) - Adrenal insufficiency (Addison's disease) gonads - 5-alpha-reductase deficiency - Hypogonadism - Delayed puberty - Precocious puberty other - - Psychogenic dwarfism - Androgen insensitivity syndrome -

v·d·e Nutritional pathology (E40-68, 260-269)
Malnutrition	Kwashiorkor - Marasmus
Other underconsumption	B vitamins: B1: Beriberi/Wernicke's encephalopathy, B2: Ariboflavinosis, B3: Pellagra, B7: Biotin deficiency, B9: Folate deficiency, B12: Vitamin B12 deficiency other vitamins: A: Vitamin A deficiency/Bitot's spots, C: Scurvy, D: Rickets/Osteomalacia mineral: Zinc deficiency - Iron deficiency, Magnesium deficiency - Chromium deficiency
Hyperalimentation	Obesity - Hypervitaminosis A - Hypervitaminosis D

v·d·e Eye disease - pathology of the eye (H00-H59, 360-379)
Adnexa	eyelid: inflammation (Stye, Chalazion, Blepharitis) - Entropion - Ectropion - Lagophthalmos - Blepharochalasis - Ptosis - Blepharophimosis - Xanthelasma - Trichiasis - Madarosis lacrimal system: Dacryoadenitis - Epiphora - Dacryocystitis orbit: Exophthalmos - Enophthalmos
Eyeball	{| class="navbox collapsible nowraplinks" style="margin:auto; background:white;"
[[[:Template:Fullurl:Template:]] v]·[[[:Template:Fullurl:Template talk:]] d]·[[[:Template:Fullurl:Template:]] e]
Conjunctiva	Conjunctivitis (Allergic conjunctivitis) - Pterygium - Pinguecula - Subconjunctival hemorrhage
Fibrous tunic	sclera: Scleritis cornea: Keratitis - Corneal ulcer - Snow blindness - Thygeson's superficial punctate keratopathy - Fuchs' dystrophy - Keratoconus - Keratoconjunctivitis sicca - Arc eye - Keratoconjunctivitis - Corneal neovascularization - Kayser-Fleischer ring - Arcus senilis - Band keratopathy
Iris and ciliary body	Iritis - Uveitis - Iridocyclitis - Hyphema - Persistent pupillary membrane - Iridodialysis - Synechia
Lens	Cataract - Aphakia - Ectopia lentis
Choroid	Choroideremia - Choroiditis (Chorioretinitis)
Retina	Retinitis (Chorioretinitis) - Retinal detachment - Retinoschisis - Retinopathy (Bietti's crystalline dystrophy, Coats disease, Diabetic retinopathy, Hypertensive retinopathy, Retinopathy of prematurity) - Macular degeneration - Retinitis pigmentosa - Retinal haemorrhage - Central serous retinopathy - Macular edema - Epiretinal membrane - Macular pucker - Vitelliform macular dystrophy - Leber's congenital amaurosis - Birdshot chorioretinopathy

|- style="white-space:nowrap;background:#ddddff;text-align:right;background-color: LightYellow" ! Optic nerve and visual pathways | colspan="1" style="text-align:left;width:100%;font-size:95%;" | Optic neuritis - Papilledema - Optic atrophy - Leber's hereditary optic neuropathy - Dominant optic atrophy - Optic disc drusen - Glaucoma - Toxic and nutritional optic neuropathy - Anterior ischemic optic neuropathy
|- style="white-space:nowrap;background:#ddddff;text-align:right;background-color: LightYellow" ! Ocular muscles,
binocular movement,
accommodation and refraction | colspan="1" style="text-align:left;width:100%;font-size:95%;background:#f7f7f7;" | Paralytic strabismus: Ophthalmoparesis - Progressive external ophthalmoplegia - Palsy (III, IV, VI) - Kearns-Sayre syndrome Other strabismus: Esotropia/Exotropia - Hypertropia - Heterophoria (Esophoria, Exophoria) - Brown's syndrome - Duane syndrome
Other binocular: Conjugate gaze palsy - Convergence insufficiency - Internuclear ophthalmoplegia - One and a half syndrome
Refractive error: Hyperopia/Myopia - Astigmatism - Anisometropia/Aniseikonia - Presbyopia
|- style="white-space:nowrap;background:#ddddff;text-align:right;background-color: LightYellow" ! Visual disturbances and blindness | colspan="1" style="text-align:left;width:100%;font-size:95%;" | Amblyopia - Leber's congenital amaurosis - Subjective (Asthenopia, Hemeralopia, Photophobia, Scintillating scotoma) - Diplopia - Scotoma - Anopsia (Binasal hemianopsia, Bitemporal hemianopsia, Homonymous hemianopsia, Quadrantanopia) - Color blindness (Achromatopsia, Dichromacy, Monochromacy) - Nyctalopia (Oguchi disease) - Blindness/Low vision
|- style="white-space:nowrap;background:#ddddff;text-align:right;background-color: LightYellow" ! Pupil | colspan="1" style="text-align:left;width:100%;font-size:95%;background:#f7f7f7;" | Anisocoria - Argyll Robertson pupil - Marcus Gunn pupil/Marcus Gunn phenomenon - Adie syndrome - Miosis - Mydriasis - Cycloplegia
|- style="" ! Infectious diseases | colspan="1" style="text-align:left;width:100%;font-size:95%;" | Trachoma - Onchocerciasis
|- style="" ! Other | colspan="1" style="text-align:left;width:100%;font-size:95%;background:#f7f7f7;" | Nystagmus - Glaucoma/Ocular hypertension - Floater - Leber's hereditary optic neuropathy - Red eye - Keratomycosis - Xerophthalmia - Phthisis bulbi
|- | colspan="2" style="text-align:center;width:100%;font-size:95%;" | See also congenital |}

v·d·e Pathology of respiratory system (J, 460-519)
Acute upper respiratory infections	Upper respiratory tract infection · Common cold · Rhinitis · Sinusitis · Pharyngitis (Strep throat)  · Tonsillitis · Laryngitis · Tracheitis · Croup · Epiglottitis
Influenza and Pneumonia	Influenza · Pneumonia (Viral, Bacterial, Bronchopneumonia) · Severe acute respiratory syndrome
Other acute lower respiratory infections	Bronchitis (Acute, Chronic)  · Bronchiolitis
Other diseases of upper respiratory tract	Vasomotor rhinitis · Hay fever · Atrophic rhinitis · Nasal polyp · Deviated septum · Adenoid hypertrophy · Peritonsillar abscess · Vocal fold nodule · Laryngospasm
Chronic lower respiratory diseases	Emphysema · COPD · Asthma · Status asthmaticus · Bronchiectasis
Lung diseases due to external agents	Pneumoconiosis (Coalworker's pneumoconiosis, Asbestosis, Silicosis, Bauxite fibrosis, Berylliosis, Siderosis) · Byssinosis · Hypersensitivity pneumonitis (Farmer's lung, Bird fancier's lung)
Other, principally affecting the interstitium	Acute respiratory distress syndrome · Pulmonary edema · Hamman-Rich syndrome · Interstitial lung disease
Suppurative and necrotic conditions of lower respiratory tract	Lung abscess · Pleural effusion · Empyema
Other	Pneumothorax · Hemothorax · Hemopneumothorax · Mendelson's syndrome · Respiratory failure · Atelectasis · Mediastinal emphysema  · Mediastinitis
see also congenital (Q30-Q34, 748)

v·d·e Oral Pathology: Oral pathology (K00-K14, 520-529)
Developmental Anomalies	Anodontia/Hypodontia - Hyperdontia - abnormalities of size and form of teeth (Concrescence, Fusion, Gemination, Dens evaginatus/Talon cusp, Dens invaginatus, Enamel pearl, Macrodontia, Microdontia, Taurodontism) - disturbances in tooth formation (Dilaceration, Regional odontodysplasia, Turner's hypoplasia) - other hereditary disturbances in tooth structure (Amelogenesis imperfecta, Dentinogenesis imperfecta, Dentin dysplasia)
Hard, Soft and Periapical Tissues	Attrition - Abrasion - Ankylosis - Dental caries - Denticles - Erosion - External resorption - Fluorosis - Gingivitis - Impaction - Internal resorption - Periodontitis - Pulpitis - Ulcer
Dentofacial Anomalies	Malocclusion - Micrognathism - Prognathism - Retrognathism - Temporomandibular joint disorder
Maxillomandibular anomalies	Odontogenic keratocyst - Torus mandibularis - Torus palatinus - Cherubism - Ameloblastoma
Salivary glands	Drooling - Benign lymphoepithelial lesion - Necrotizing sialometaplasia - Ranula - Sialadenitis - Sialolithiasis - Stomatitis - Xerostomia - Aphthous ulcer
Lip and Oral mucosa	Angular cheilitis - Erythroplakia - Hairy leukoplakia - Leukoplakia
Tongue	Geographic tongue - Fissured tongue - Glossitis - Glossodynia - Black hairy tongue

v·d·e Urinary system - Pathology - Nephrology (N00-N39, 580-599)
Diseases of the glomerulus	Glomerulonephritis - Focal segmental glomerulosclerosis - Membranoproliferative glomerulonephritis - Membranous glomerulonephritis - Nephritic syndrome - Post-streptococcal glomerulonephritis - Nephrotic syndrome (Minimal change disease) - IgA nephropathy - Lupus nephritis - Diabetic nephropathy - Rapidly progressive glomerulonephritis
Tubulointerstitial diseases of the kidney	Interstitial nephritis - Pyelonephritis - Hydronephrosis - Pyonephrosis - Balkan nephropathy - Reflux nephropathy
Renal failure	Acute renal failure (Acute tubular necrosis) - Chronic renal failure
Diseases of the renal tubule and other disorders of kidney and ureter	Renal osteodystrophy - Nephrogenic diabetes insipidus - Renal tubular acidosis - Nephroptosis - Ureterocele
Other diseases and disorders of urinary system	Cystitis (Interstitial cystitis, Trigonitis) - Neurogenic bladder - Vesicointestinal fistula - Urethritis - Urethral stricture - Urinary tract infection - Kidney stone
Tumors of the kidney	Renal cell carcinoma - Wilms' tumor (children)
See also congenital conditions (Q60-Q64, 753)