B Med Sci (ORTHOPTICS)

B Med Sci (ORTHOPTICS)

PATHOLOGY UNITS 1 and 2

GENERAL PATHOLOGY HANDOUTS

LECTURE ATTENDANCE IS COMPULSORY

B.Med.Sci (Orthoptics) – Year 2 Students

PATHOLOGY COURSE

Contact:Karen Sisley

Senior Lecturer in Ocular Oncology

E-Floor Medical School

The Pathology Course for the B.Med.Sci (Orthoptics) will consist of two units in year 2:

Unit 1General Pathology: Contact Karen Sisley

The study of disease processes in general (e.g. inflammation, tumours etc), with some reference to how these processes affect ocular tissues.

Unit 2Microbiology: Contact Jonathan Shaw

The study of infectious agents (bacteria, viruses etc) how they affect the eye, and how their presence may affect safe orthoptic practice.

Assessments:Units 1 and 2: Combined examination (short written questions and answers)

Course Book:General and Systemic Pathology (Fourth Edition)

Underwood JCE (Editor)

Churchill Livingstone 2004 –

(ISBN: 0-443-07334 1)

NOTE: I have listed the course content below, but it is vital to attend the lectures to understand and be aware of each subject in the course.

In the second year there are structured lectures that will cover all aspects of disease processes and how they can cause ocular disease, with examples. It is up to you to support the lectures by additional reading, see the recommended lists. The structured Units 1 and 2 are then examined with a mixture of SAQs and also MCQs.

In the third year we get you to think for yourselves, so the units will rely and build upon the information you were provided with in the second year. It is therefore a good idea to reread your notes in preparation for the final year. The Pathology units in the final year are not examined, but the subjects covered and the lectures you are given are assessed in the form of assignments. This is designed so that you will develop your knowledge and get used to processing information in relation to disease processes, enabling you to graduate as competent practitioners able to think for yourselves.

LECTURE 1 INTRODUCTION TO DISEASE PROCESSES

Dr J Bury

LECTURE & PRIVATE STUDY

AIMS:

To understand and learn:-

definition of disease
characteristics and causes of diseases
the language used in naming and describing diseases
how diseases are classified into groups
how pathologists and others investigate diseases

SCOPE:

a) What is disease? Limits of normality

b) Disease characteristics

aetiology
pathogenesis
manifestations
results of disease
prognosis

Causes (general groups):

genetic factors
environmental factors

Language used in pathology:

acute/chronic
benign/malignant
prefixes and suffixes
Eponyms
syndromes

Principles and examples of disease classification

congenital disease

genetic

non-genetic

acquired disease

inflammatory diseases

vascular diseases

growth disorders

injury and repair

metabolic and degenerative diseases

c) Investigation of diseases:

brief history and scope of pathology
techniques in pathology/making diagnosis
general and systemic pathology

SUGGESTED READING

Course book:

General and systemic Pathology (4th Edition)

Ed. JCE Underwood, Churchill Livingstone, 2004

Chapter 2: Characteristics, classification and incidence of disease

LECTURE 2 GROWTH DISORDERS, NEOPLASMS

Dr K Sisley

LECTURE & PRIVATE STUDY

AIMS:

to understand the normal processes of growth and differentiation
to understand the important systemic and local abnormalities of growth and differentiation
to learn important groups of factors involved in carcinogenesis

SCOPE: (for emphasis, see lecture content)

a) Definitions: growth, differentiation and morphogenesis

b)Overview (only) of control and normal systemic growth: endocrine factors in postnatal growth and (briefly) foetal growth, and major categories of abnormality.

c)Normal and abnormal growth in single tissues hypertrophy, hyperplasia, atrophy and hypoplasia (physiological and pathological, with examples)

d)control of differentiation (overview)

teratogens and teratogenesis (principles of)

e)Acquired disorders of growth and differentiation, in single tissues metaplasia, dysplasis and neoplasia (“tumours”)

f)Important: Classification of neoplasms. Differences between benign and malignant neoplasms (pathology and effects). Tumour grading and staging.

g)An overview of carcinogenesis and its causes (major categories, with examples).

SUGGESTED READING

General and Systemic Pathology (4th Edition)

Ed. JCE Underwood, Churchill Livingstone, 2004

Chapter 5 (for a-e)

Chapter 11 (for f and g)

NOTE:

It would be ideal for you to read and understand all of the material in these chapters, as this would give you a broad view of some very exciting and important fundamental aspects of basic biology applied to man.

Material required for the course is listed (a-g), much is covered in course handouts, but background reading will support your understanding.

LECTURE 3a INFLAMMATION

Dr K Sisley

LECTURE & PRIVATE STUDY

AIMS:

To understand the basic principles of acute and chronic inflammation, with examples of how it affects the eye and other body tissues.

SCOPE:

FOR ACUTE AND CHRONIC INFLAMMATION:

a) Causes

b) Clinical and Macroscopic (i.e. “naked eye”) appearance

c) What happens in the tissues in early/late stages

d) blood vessel and fluid dynamics

e) cell types involved (microscopic features)

f) chemical mediators (acute inflammation)

g) beneficial and harmful effects

h) granulomatous disease

i) final results of inflammation

SUGGESTED READING

General and Systemic Pathology (4th Edition)

Ed. JCE Underwood. Churchill Livingstone, 2004

Chapter 10, “Inflammation”.

LECTURE 3b HEALING, REPAIR AND REGENERATION

Dr K Sisley

LECTURE AND PRIVATE STUDY

AIMS:

To learn how the body responds to injury of tissues.

SCOPE:

a) Causes and mechanisms of cell and tissue injury

b)The harmful and beneficial effects of radiation

c) Cells and tissues in injury. Ischemia and necrosis. Ulcers.

d) Ability of labile, stable and permanent cells to regenerate: consequences for specialised tissues.

e)Repair and organisation. Granulation tissue (not to be confused with granulomas – see chronic inflammation).

f)Healing (example skin) by primary and secondary intention. Healing of ulcers.

g)Factors which modify or impair healing.

SUGGESTED READING

General and Systemic Pathology (4th Edition)

Ed. JCE Underwood Churchill Livingstone, 2004

Chapter 6, Responses to cellular injury.

(You don’t need to know precise figures for the dosage of radiation – only relative amount of radiation e.g. “low exposure”, “high exposure” etc.)

LECTURE 4a DISORDERS OF THE IMMUNE SYSTEM

Dr K Sisley

LECTURE AND PRIVATE STUDY

AIMS:

1) To understand the components and functions of the immune system

2)To appreciate how the immune system can both prevent eye disease, and cause diseases affecting the eyes.

SCOPE:

1)Overview of the essential features and components of the immune system. Humoral and cellular immunity: cells involved. Complement and antibodies.

2) Congenital and acquired forms of immune deficiency (with examples). The effects of immunodeficiency. Opportunistic infections.

3)Hypersensitivity reactions Types 1 and IV and stimulatory hypersensitivity: Important systemic diseases, and examples of ophthalmic diseases, caused by these reactions (see below).

4)Autoimmune diseases: general concepts.

Organ-specific and non-organ specific autoimmune diseases.

Diseases caused by hypersensitivity reactions.

Type I Immediate hypersensitivity

Systemic anaphylaxis
Allergic (atopic, vernal) conjunctivitis (hay fever)
Asthma

Type II Antibody to cell-bound antigen hypersensitivity

Autoimmune haemolytic anaemia
Pemphigus
Lens-induced uveitis
Myasthenia gravis
Graves’ disease/thyroiditis (“stimulatory” variant)

Type III Immune complex hypersensitivity

Vasculitis (inflammation of blood vessels)

Type IV Delayed Type hypersensitivity

Tuberculosis
Corneal graft ( and other transplanted organ) rejection
Sympathetic ophthalmia
Sjogren’s Syndrome

NOTE:

Immunopathology is a large and interesting subject, but its details are somewhat complicated. It is important for you to know the principles of what is happening in various diseases (and to be able to give examples of diseases in categories of immune-mediated diseases). You should only learn enough detail of the mechanisms of disease processes to be able to distinguish between important categories of diseases (for example, the difference between a Type II and Type III hypersensitivity reaction).

You don’t need to know details of the different subclasses of immunoglobulins, different subclasses of T lymphocytes, changes in lymph nodes during the immune response, or precise details of the complement system.

Omit sections on organ transplantation and immune responses to tumours.

SUGGESTED READING

General and Systemic Pathology (4th Edition)

Ed. JCE Underwood. Churchill Livingstone, 2004

Chapter 8Ischaemia, infarction and shock

Chapter 13The Cardiovascular System

LECTURE 5 INTRODUCTION TO INFECTIOUS DISEASES

Dr J Shaw

LECTURE & PRIVATE STUDY

AIMS:

● to understand basic characteristics of bacteria including Chlamydia trachomatis

● to understand basic characteristics of viruses

● to understand the importance of hospital-acquired bacteria

SCOPE:

a) Overview

b) Bacteria- basic characteristics

c) Bacterial morphology

d) Bacterial growth

e) Antibiotics

f) Antibiotic resistance

g) Healthcare-associated infections

h) Chlamydia trachomatis

i) Viruses – basic characteristics

j) Virus growth

k) Virus structure

l) Virus laboratory diagnosis

m) Conclusions

SUGGESTED READING

Microbiology for the Health Sciences (8th ed), GRW Burton and PG Engelkirk, Lippincott Williams and Wilkins, 2006.

LECTURE6HEALTH SAFETY AND YOU

Professor R Jennings

LECTURE AND PRIVATE STUDY

AIMS:

To understand the means of transmission of micro-organisms, particularly in the healthcare setting
To gain an understanding of the means used to control infections, particularly hygienic measures and vaccines
To understand the pathogenesis strategy of the type 1 human immunodeficiency virus (HIV-1), its transmission and its control
To understand the pathogenesis strategy of the hepatitis B and C viruses (HBV and HCV), their transmission and their control

SCOPE:

a) Transmission of micro-organisms

b) Sources of microbial contamination in the healthcare setting

c) Protective procedures to avoid microbial spread

d) Blood-borne diseases in the healthcare setting

e) Routes of transmission of viruses

f) Structure and transmission of HIV-1

g) Pathogenesis of HIV-1 infection and development of AIDS

h) Risks for transmission of HIV-1

i) How HIV-1 infection is controlled

j) The nature and characteristics of the hepatitis viruses

k) Risk factors for HBV and HCV infection

l) HBV pathogenesis and the carrier state

m) The nature of HCV infection

n) Prions and their transmission

o) Summary of maintaining safety in the healthcare professions

LECTURE 7INFECTIONS OF THE EYE

Professor C W Potter

LECTURE AND PRIVATE STUDY

AIMS:

To understand the epidemiology, disease, treatment and prevention of the commoner bacterial infections of the eye

To understand the epidemiology, disease, treatment and prevention of the commoner virus infections of the eye
To appreciate the eye infections caused by protozoa in the UK and abroad

SCOPE:

(a) Peripheral infections of the eye

Molluscum contagiosum, staphylococcus

(b) Conjunctivitis

Staphylococcus, Chlamydia, gonococcus, herpes simplex, herpes zoster, adenovirus, Haemophilus influenzae

Pseudomonas aeruginosa, pneumococcus, adenovirus

(d) Infections spreading to the eye

Leptospira, Treponema pallidum, Onchocerca volvulus

(e) Congenital infections

Rubella, cytomegalovirus

(f) Protozoan infections

Toxoplasma, Toxocara, Onchocerca volvulus

SUGGESTED READING

Microbiology for the Health Services (8th ed.)

GRW Burton & PG Engelkirk, Lippincott Williams & Wilkins, 2006