Gross Pathology - Respiratory System Disorders

1. Lobar Pneumonia

• Stage 1 - Congestion (Days 1-2): Lung is heavy, boggy, red; sinks in water due to vascular engorgement and edema
• Stage 2 - Red Hepatization (Days 3-4): Lung is firm, airless, liver-like in consistency; cut surface shows reddish-gray; pleural fibrinous exudate present
• Stage 3 - Grey Hepatization (Days 5-7): Lung remains firm; cut surface turns grey-brown as RBCs lyse; leukocytes and fibrin fill alveoli
• Stage 4 - Resolution: Lung reverts toward normal; creamy exudate expressed from cut surface

2. Bronchopneumonia

• Scattered, patchy, grey-yellow consolidation foci, usually 3-4 cm
• Bilateral, basal predominant
• Poorly defined nodular areas centered on bronchioles
• Cut surface: pus can be expressed from bronchi

3. Emphysema

• Lungs are hyperinflated, pale, and voluminous - they bulge outward when the chest is opened and fail to collapse
• Cut surface shows enlarged air spaces (bullae and blebs), particularly in:
  • Centriacinar type: Upper lobes, apical segments; central spaces enlarged with spared distal alveoli in same lobule
  • Panacinar type: Lower lobes, anterior margins; uniform enlargement throughout acinus
  • Paraseptal type: Subpleural blebs/bullae, may cause spontaneous pneumothorax
• Lung is soft, spongy, and loses elastic recoil
• Bullae (>1 cm) and blebs are visible on pleural surface

4. Chronic Bronchitis

• Bronchial walls are thickened and red
• Lumens contain excessive mucus; mucus plugging visible
• Submucosal glands are enlarged (Reid index >0.5)
• Lung parenchyma may show secondary emphysematous changes

5. Bronchiectasis

• Permanent, irreversible dilatation of bronchi and bronchioles - up to 4x normal diameter
• Lower lobe predominance (gravity-dependent drainage)
• Dilated airways may be cylindrical, fusiform, or saccular (cystic)
• Airways filled with mucopurulent or purulent secretions
• Bronchial walls thickened and inflamed
• Surrounding parenchyma: fibrosis, atelectasis, or consolidation

6. Pulmonary Tuberculosis

• Ghon focus: Small (1-2 cm) peripheral subpleural caseous lesion, usually lower part of upper lobe or upper part of lower lobe
• Ghon complex: Ghon focus + ipsilateral hilar lymph node involvement (caseous)
• Caseous material is yellow-white, cheesy/crumbly

• Apical and posterior segments of upper lobes
• Cavitation in areas of caseation - irregular cavities with ragged walls
• Caseous yellow-white material in cavity walls
• Cavity may show thick fibrous wall with calcification in healing
• Miliary TB: Scattered millet seed-like (1-2 mm) yellow-white nodules throughout both lungs

7. Lung Abscess

• Cavity filled with pus (liquefied necrotic material)
• Size: 2 cm to several cm
• Surrounding zone of consolidation/fibrosis
• Wall: initially ragged, becomes fibrous with chronicity
• Air-fluid level visible on cut section
• Location: posterior segment right upper lobe / right lower lobe (aspiration-related)

8. Pulmonary Edema

• Lungs are heavy, wet, boggy
• Cut surface: frothy, blood-tinged fluid oozes out
• Bilateral, more pronounced in lower lobes
• In acute cases: weight of each lung may exceed 1 kg (normal ~350-400 g)

9. Diffuse Alveolar Damage (ARDS)

• Exudative phase: Heavy, firm, beefy-red lungs; wet appearance
• Organizing phase: Firm, rubbery, liver-like lungs
• Cut surface: congested, hemorrhagic
• Hyaline membranes line alveoli (visible microscopically)

10. Pulmonary Embolism / Infarction

• Saddle embolus straddles the pulmonary artery bifurcation (visible grossly)
• Pulmonary infarct: Hemorrhagic, wedge-shaped area with base on pleura; apex pointing toward hilus
• Initially dark red and firm; becomes pale yellow-white with time
• Pleural fibrinous exudate over the infarct zone

11. Lung Cancer (Carcinoma)

12. Pleural Effusion

• Fluid accumulation in pleural space
• Transudate: Clear, straw-colored (heart failure, cirrhosis)
• Exudate: Turbid, yellow; empyema = frank pus (cream/yellow, thick)
• Hemothorax: Frank blood
• Lung compressed - atelectasis visible on cut section

13. Pneumothorax

• Lung collapses toward hilus
• Pleural space contains air (not grossly visible, diagnosed by history/imaging, but at autopsy: collapsed lung, distended chest cavity)
• Causative blebs/bullae may be seen on pleural surface

14. Silicosis / Coal Worker's Pneumoconiosis (CWP)

• Silicosis: Firm, grey-black, silicotic nodules (1-3 mm) in upper lobes; may coalesce into progressive massive fibrosis (PMF) - large >2 cm fibrous masses
• CWP (Simple): Black coal macules (1-2 mm), peribronchiolar distribution
• CWP (Complicated/PMF): Large black fibrous nodules, cavitation in necrotic areas
• Lung: stiff, heavy, black (anthracotic pigment)

15. Asbestosis

• Diffuse interstitial fibrosis, lower lobe predominance
• Asbestos bodies (ferruginous bodies): Golden-brown, dumbbell-shaped bodies visible on cut section (best seen microscopically)
• Bilateral pleural plaques: white-grey, calcified areas on parietal pleura
• Honeycomb lung in advanced cases

16. Sarcoidosis

• Bilateral hilar lymphadenopathy (rubber-firm lymph nodes)
• Lung: non-caseating granulomas along lymphatics (peribronchial, perivascular, subpleural)
• Gross appearance: candle-wax drippings on pleural and bronchovascular surfaces
• Advanced: diffuse interstitial fibrosis, honeycomb lung

17. Fibrosing Alveolitis / UIP (Usual Interstitial Pneumonia / IPF)

• Small, firm, shrunken lungs
• Subpleural, basal predominance of fibrosis
• Cut surface: firm, rubber-like, with visible cystic spaces - honeycombing (multiple 0.5-2 cm cysts)
• Pleural surface: cobblestone/bosselated appearance due to subpleural scarring

Quick Memory Aid - Key Gross Descriptors

BSc Nursing 4th Semester - Pathology II & Genetics Syllabus

(As per Indian Nursing Council - INC)

Course Overview

Course Description

Competencies (Learning Outcomes)

1. Apply knowledge of pathology in understanding deviations from normal to abnormal
2. Rationalize various laboratory investigations in diagnosing pathological disorders
3. Demonstrate understanding of methods of collection of blood, body cavity fluids, urine, and feces for various tests
4. Apply knowledge of genetics in understanding various pathological disorders
5. Appreciate various manifestations in patients with diagnosed genetic abnormalities
6. Rationalize specific diagnostic tests in detection of genetic abnormalities
7. Demonstrate understanding of various services related to genetics

Course Outline

UNIT I - Special Pathology (5 Hours Theory)

1. Respiratory System

• Pulmonary Infections:
  • Pneumonia
  • Lung abscess
  • Pulmonary tuberculosis
• Chronic Obstructive Pulmonary Disease (COPD):
  • Chronic bronchitis
  • Emphysema
  • Bronchial Asthma
  • Bronchiectasis
• Tumors of Lungs

2. Cardiovascular System

• Atherosclerosis
• Ischemia and Infarction
• Rheumatic Heart Disease
• Hypertensive heart disease
• Congestive Cardiac Failure

3. Gastrointestinal System

• Peptic ulcer
• Carcinoma stomach
• Appendicitis
• Inflammatory Bowel Disease
• Carcinoma colon
• Hepatitis
• Cirrhosis of liver
• Carcinoma liver

4. Nervous System

• Cerebrovascular accident (stroke)
• Meningitis
• Encephalitis
• Brain tumors
• Demyelinating diseases (Multiple sclerosis)

5. Endocrine System

• Diabetes mellitus
• Thyroid disorders (Goiter, Hypothyroidism, Hyperthyroidism, Thyroid carcinoma)
• Adrenal disorders

6. Hematopoietic System

• Anemias (Iron deficiency, Megaloblastic, Aplastic, Hemolytic)
• Leukemia
• Lymphoma (Hodgkin's and Non-Hodgkin's)

UNIT II (Continuation of Special Pathology - 5 Hours)

7. Kidneys and Urinary Tract

• Glomerulonephritis
• Pyelonephritis
• Renal calculi
• Cystitis
• Renal Cell Carcinoma
• Renal Failure (Acute and Chronic)

8. Male Genital System

• Cryptorchidism
• Testicular atrophy
• Prostatic hyperplasia
• Carcinoma penis and prostate

9. Female Genital System

• Carcinoma cervix
• Carcinoma of endometrium
• Uterine fibroids
• Vesicular mole and Choriocarcinoma
• Ovarian cysts and tumors

10. Breast

• Fibrocystic changes
• Fibroadenoma
• Carcinoma of the breast

11. Musculoskeletal System

• Osteomyelitis
• Osteoporosis
• Fracture healing
• Tumors of bone

UNIT III - Laboratory Investigations (4 Hours)

• Blood:
  • Complete Blood Count (CBC)
  • Blood glucose (fasting, post-prandial, HbA1c)
  • Liver Function Tests (LFT)
  • Renal Function Tests (RFT) - BUN, creatinine
  • Lipid profile, cardiac enzymes
  • Blood culture and sensitivity
• Body Cavity Fluids:
  • CSF collection and examination
  • Sputum, wound discharge - for clinical pathology, biochemistry, microbiology
• Urine:
  • Physical characteristics, urinalysis
  • Urine culture and sensitivity
• Feces:
  • Stool examination: occult blood, ova, parasite, cyst, reducing substances
  • Methods and collection
• Semen Analysis:
  • Sperm count, motility, morphology and their importance in infertility

GENETICS SECTION (6 Hours)

Genetics Unit I (2 Hours)

• Cell structure - nucleus and structure of genes
• Chromosomes: sex determination
• Chromosomal aberrations
• Patterns of inheritance
• Mendelian theory of inheritance
• Multiple alleles and blood groups
• Sex-linked inheritance
• Mechanism of inheritance
• Errors in transmission (mutation)

Genetics Unit II (2 Hours)

• Conditions affecting the mother: genetic and infections
• Consanguinity, atopy
• Prenatal nutrition and food allergies
• Maternal age
• Maternal drug therapy
• Prenatal testing and diagnosis
• Effect of radiation, drugs, and chemicals
• Infertility and spontaneous abortion
• Neural tube defects and role of folic acid
• Down syndrome (Trisomy 21)

Genetics Unit III (2 Hours)

• Screening for:
  • Congenital abnormalities
  • Developmental delay
  • Dysmorphism

Genetics Unit IV (2 Hours)

• Cancer genetics: familial cancer
• Inborn errors of metabolism
• Blood group alleles and hematological disorders
• Genetic hemochromatosis
• Huntington's disease
• Genetic counseling
• Practical applications of genetics in nursing

Teaching-Learning Methods

• Lectures
• Discussions
• Explanation using slides, X-rays, and scans
• Visit to pathology lab, endoscopy unit, and OT
• Visit to clinical lab and biochemistry lab

Assessment

• Short answer questions
• Objective type questions

Recommended Textbooks

1. Harsh Mohan - Textbook of Pathology
2. Robbins & Cotran - Pathologic Basis of Disease
3. Satyanarayan U - Biochemistry
4. Standard genetics and nursing pathology references (latest editions)

Note: Pathology I (3rd semester) covers general pathology - cell injury, inflammation, neoplasia, fluid disturbances, and hematology basics. Pathology II (4th semester) focuses entirely on systemic/special pathology and genetics. Together they are assessed as one combined paper in the 4th semester university exam.