PATHOLOGY II AND PHYSIOPATHOLOGY
Academic year and teacher
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- Versione italiana
- Academic year
- 2022/2023
- Teacher
- FRANCESCO DI VIRGILIO
- Credits
- 15
- Didactic period
- Primo Semestre
Training objectives
- The integrated course of Pathology II and pathophysiology aims to provide students with the basic elements for understanding the etio-pathogenetic mechanisms of diseases (causes, modalities of progression, competing factors, environment-genome interactions), structural alterations and control mechanisms at the various levels of organ integration. These knowledge will be combined with those relating to the pathogenetic mechanisms in the overall homeostasis of the organism, to the etiology, to the pathogenesis of the main morbid processes and the descriptions of the fundamental laboratory indicators in the diagnosis and prognosis of a disease.
In the discussion of some topics of the program, the principles of medical and translational research will be presented.
Some topics will be updated according to the sex/gender approach.
Didactic approaches aimed at improving relational skills will be considered.
At the end of the course, students will know:
the methods of interaction of the main factors of disease of physical, chemical and biological origin with the human body;
the methods of reaction to exogenous and endogenous damage factors of the main homeostatic systems of the organism (thermal, hydroelectrolytic, immunological homeostasis);
the main elementary and complex alterations of cell proliferation processes;
the elementary pathogenetic factors involved in the main systemic syndromes and the relative modalities of presentation;
the main pathologies that have a prevalence in the female sex;
the main haemato-chemical alterations caused by both the most important organ pathologies and the most important systemic syndromes;
the main factors of variability of blood chemistry parameters.
and they will be able to:
trace clinical signs and symptoms to the underlying etio-pathogenetic processes;
interpret the modalities of interaction of the homeostatic systems at the organ and organism level for the purposes of the genesis of a specific pathophysiological process;
analyze a laboratory report in detail and place it in the correct clinical-diagnostic perspective. Prerequisites
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Modulo: 014863/2 - PATOLOGIA GENERALE
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Basic knowledge of general pathology. Knowledge of microbiology and human physiology. Passing exams of Physiology I, Pathology I and immunology, Microbiology
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Modulo: 015304/3 - PATOLOGIA CLINICA
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Basic knowledge of general pathology. Knowledge of microbiology and human physiology. Passing exams of Physiology I, Pathology I and immunology, Microbiology Course programme
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Modulo: 014863/2 - PATOLOGIA GENERALE
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GENERAL PATHOLOGY
Immunopathology. Humoral and cell-mediated immunity deficiency. Combined Deficits: SCID. Immunocomplex disorders. Arthus reaction. Serum sickness.
General pathology of infectious diseases: localization of the infectious agent and immune response. PAMPs and DAMPs. Septic inflammation and sterile inflammation.
Autoimmune and autoinflammatory diseases: distinctive elements. Organ and systemic autoimmune diseases (outline). Intrinsic and extrinsic inflammasomopathies. Cryopyrinopathies and familial Mediterranean fever. Interleukin 1beta as a pharmacological target.
Pathology of cell proliferation and differentiation: hyperplasia, hypertrophy, atrophy, metaplasia.
Tumors: general information. Definition of benignity and malignancy, histopathological classification. Dysplasia; carcinoma in situ and other preneoplastic lesions. Chemical and physical carcinogenesis. Initiation and promotion. Ames test. Progression and metastasis. The epithelium-mesenchymal transition and its inverse. Intravasation and extravasation. The metastatic niche. Graduation and staging. Cancer epidemiology.
Molecular genetics of cancer: oncogenes and tumor suppressors. Oncogenic viruses. The Rous sarcoma virus. The src gene. Cell oncogenes. Multiple Alterations in Human Cancers. Growth factors, receptors and cancer. The Src protein and the Ras protein. The tumor suppressor genes: Rb, and TP53. Alterations of cycle and cell death. Telomerases. Genetic instability of cancer cells. Tumorigenesis is a multiphasic process. Tumor tissue: heterotypic interactions and angiogenesis. Conventional anti-tumor therapies. Anti-tyrosine kinase "target" therapies. Imatinib / Gleevec. The vemurafenib. The crizotinib. Resistance to target therapies. Methods of DNA and RNA analysis. The hallmarks of cancer.
Immunity in tumors. The theory of immunosurveillance. Tumor-host relationships. Inflammation and tumors. Tumor editing. The tumor microenvironment. Characteristics of immune cell populations present in the tumor microenvironment. Soluble immunomodulatory factors present in the tumor microenvironment. The tumor microenvironment as an immunosuppressive environment. Mechanisms of evasion from the control of the immune system. "Hot" tumors and "cold" tumors. The suppressor myeloid cells. Immunological checkpoints. Immunological checkpoint inhibitors. Immunogenic cell death and drugs capable of causing it. Innovative adoptive and cellular immunotherapies. Immune checkpoint inhibitors, passive immunotherapy, bispecific antibodies, CAR T cells.
Neoplastic cell: biochemical and metabolic properties. Warburg effect.
Paraneoplastic syndromes. Neoplastic cachexia.
PHYSIOPATHOLOGY
Pathology of thermoregulation: hyperthermia and hypothermia. Central endogenous hyperthermia: Fever. Peripheral endogenous hyperthermia: malignant hyperthermia. Exogenous hyperthermia: heat stroke.
Homeostasis of body fluids. The volume: components; modifications, control, maintenance. Alterations in water balance and acid-base balance. Metabolic acidosis; respiratory acidosis; metabolic alkalosis; respiratory alkalosis. The anion gap.
Diabetes insipidus.
Changes in plasma protein concentration: diagnostic implications. Edema. Mechanisms of edema formation. Classification of edema.
Outline of hematopoiesis. Proliferative alterations of hematopoietic precursors: Acute lymphoid leukemia; chronic lymphoid leukemia; acute myeloid leukemia; chronic myeloid leukemia; acute pro-myelomonocytic leukemia; Hodgkin's lymphoma; non-Hodgkin's lymphomas; myelodysplasia.
Anemias: definition and classification. Reduced erythropoiesis anemias, haemolytic anemias, blood loss anemias. Compensation mechanisms. Main blood groups and group incompatibility. Hemolytic disease of the newborn (MEN).
Metabolic syndrome. Obesity and related diseases
Atherosclerosis. Pathogenetic mechanisms, formation of atheroma. Classification of injuries and complications.
Pathophysiology of carbohydrate metabolism. Blood glucose control. Type I and II diabetes mellitus: pathophysiology of diabetes and complications.
Hemostasis: components and phases. Alterations of haemostasis. Hemorrhagic diseases.
Thrombosis. Virchov's triad. Arterial and venous thrombosis.
Embolism. Types of embolism.
Ischemia, hypoxia and heart attack. Hypoxia classification. Types of heart attack.
Damage from reperfusion. Disseminated intravascular coagulation.
Hypertension and hypotension.
The shock. Definition. Shock classification. Shock compensation phases and mechanism. More frequent complications in shock.
Cardiac pathophysiology. Elements of cardiac physiology. Systolic volume, cardiac output, ejection fraction, fractional shortening. Congenital heart defects. Fallot's Tetralogy. Ischemic disease. Myocarditis and myocardiopathies. Rheumatic disease. Main arrhythmias. Heart failure. Insufficient molecular mechanisms of adaptation of the heart. Cardiac compensation mechanisms. The decompensated heart: systemic repercussions. The cor pulmonale.
Pulmonary pathophysiology. Obstructive pulmonary disease and restrictive pulmonary disease. Bacterial and viral pneumonia. Complications of bacterial pneumonia. Tuberculosis. Mycobacteriosis. Sarcoidosis. Chronic bronchitis. Emphysema. Atelectasis. Cystic fibrosis. Asthma. Hypoxia and Cyanosis. Respiratory failure, impaired ventilation, perfusion, diffusion. Ventilation / perfusion mismatch. Pulmonary fibrosis.
Changes in liver function. Main causes of liver disease. Hyperbilirubinemia. Jaundice. Cirrhosis. Hepatic insufficiency.
Outline of the pathology of the gastrointestinal tract. Esophagitis, gastritis, main intestinal pathologies. Celiac disease. Inflammatory bowel diseases.
The microbiota and the microbiome. Microbiota and intestinal inflammatory diseases. Microbiota and cancer. The bacterial ecosystems of the human body. Commensalism, mutualism and pathogenicity. Microbiota-immune system interaction. Probiotics.
Alterations in renal function. Glomerulonephritis. Nephritic and nephrotic syndrome. Acute and chronic renal failure. Kidney stones.
Hyperuricaemias. Gout.
GENDER MEDICINE
The woman as a target of self-aggressive pathologies: systemic lupus erythematosus, rheumatoid arthritis, myasthenia gravis and hidradenitis suppurativa.
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Modulo: 015304/3 - PATOLOGIA CLINICA
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CLINICAL PATHOLOGY
Variability and error in laboratory analyzes.
Treatment of biological samples.
Blood concentration of the main electrolytes.
Complete blood count. Differential leukocyte count. Peripheral blood smear.
Coombs test.
Coagulation test.
Markers of myocardial infarction.
The interpretation of the laboratory report.
Diagnosis of heart failure / heart failure: natriuretic factors.
Tuberculosis diagnostics: Mantoux, interferon release test, culture and molecular diagnostics.
Spirometry.
Basic elements of blood gas analysis.
Generic indicators of inflammation: C reactive protein (the pentraxins), serum amyloid, ferritin, albumin, erythrocyte sedimentation rate.
Liver damage markers.
Laboratory diagnostics of celiac disease.
Laboratory diagnostics of renal failure.
Laboratory diagnostics of systemic lupus erythematosus, rheumatoid arthritis, myasthenia gravis.
The main tumor markers.
The use of 18-fluorine deoxy-glucose in tumor diagnostics: basic principles.
Seminar lessons:
1. From the bench to the bedside
2. Introduction to the clinical analysis laboratory
3. Principles of Transfusion Medicine Didactic methods
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Modulo: 014863/2 - PATOLOGIA GENERALE
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The course provides frontal lectures and online assisted teaching. The on-line teaching hours of moodle platform certification service consist in the deepening of some topics presented during the frontal lessons.
Two practical exercises are also provided: 1) preparation of blood smears, staining and microscopic observation for the identification of normal and pathological pictures; 2) preparation of cell cultures and study of cell functions. Histopathology
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Modulo: 015304/3 - PATOLOGIA CLINICA
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The course provides frontal lectures and online assisted teaching. The on-line teaching hours of moodle platform certification service consist in the deepening of some topics presented during the frontal lessons. Learning assessment procedures
- The learning assessment will be carried out through a written test consisting of 62 questions and lasting 50 minutes. Each question is formulated as multiple choice (4 or 5 options) regarding every educational goal as defined above.
Each question will have the same weight. The questions will be prepared in order to ascertain the knowledge of Pathophysiology and General Pathology (30 questions) and Clinical Pathology (16 questions) and Oncology (16 questions). Answers will be awarded 0.5 points for each correct answer, 0 points for each missing answer and -0.2 points for each incorrect answer.
The exam mark is assigned in a scale out of thirty rounding the fractions of the vote. The minimum score to pass the exam is 18, while the maximum mark, 30 cum laude, will be attributed to those who pass the score of 30. Reference texts
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Modulo: 014863/2 - PATOLOGIA GENERALE
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- Robbins and Cotran, The pathological basis of diseases, 8th Edition, Ed. Elsevier
- Pontieri, Russo, Friars, General Pathology, III Edition, Ed. Piccin.
- Rubin and Strayer. General Pathology, Ed. Piccin
- Weinberg RA. La biologia del cancro, Ed. Zanichelli.
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Modulo: 015304/3 - PATOLOGIA CLINICA
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Italo Antonozzi - Elio Gulletta. Medicina di Laboratorio, Logica e Patologia clinica, Piccin Editore.
Michael Laposata. Medicina di Laboratorio. La diagnosi di malattia nel laboratorio clinico. Piccin editore.
Marcello Ciaccio - Giuseppe Lippi. Biochimica Clinica e Medicina di Laboratorio. EdiSES Università.
