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Practical Pathology for Dental Students
Harsh Mohan, Sugandha Mohan
SECTION 1: TECHNIQUES IN PATHOLOGY
EXERCISE 1:
Microscopy
LIGHT MICROSCOPE
Stand
Body
Optical System
Light/Illumination System
Magnification and Resolving Power of Light Microscope
Use and Maintenance of a Light Microscope
NEWER APPLICATIONS OF LIGHT MICROSCOPE
Teaching Microscopes
Image Analysers and Morphometry
Telepathology
OTHER TYPES OF MICROSCOPY
Dark Ground Illumination (DGI)
Phase Contrast Microscopy
Polarising Microscope
Fluorescent Microscope
Electron Microscope (EM)
Transmission Electron Microscopy (TEM)
Scanning Electron Microscopy (SEM)
EXERCISE 2:
Routine Histopathology Techniques and Staining
FIXATION
Types of Fixatives
1. FORMALIN
2. GLUTARALDEHYDE
3. BOUIN’S FLUID (PICRIC ACID)
4. CARNOY’S FIXATIVE (ALCOHOL)
5. OSMIUM TETRAOXIDE
DEHYDRATION
CLEARING
IMPREGNATION
TISSUE PROCESSORS
Open (Hydraulic) Tissue Processor
Closed (Vacuum) Tissue Processor
EMBEDDING AND BLOCKING
SECTION CUTTING (MICROTOMY)
Procedure for Microtomy
ROUTINE STAINING (H & E)
Haematoxylin
Procedure for Staining
Results
EXERCISE 3:
Frozen Section and its Staining
FROZEN SECTION
Applications
Merits
Demerits
Methods for Frozen Sections
FREEZING MICROTOME USING CO2 GAS
REFRIGERATED MICROTOME (CRYOSTAT)
STAINING OF FROZEN SECTIONS
Rapid H & E Staining
Toluidine Blue Staining
EXERCISE 4:
Special Stains and Immunohistochemistry
SPECIAL STAINS
Sudan Black/Oil Red O
Result
van Gieson
Result
Masson’s Trichrome
Result
Reticulin
Result
Congo Red
Result
Periodic Acid-Schiff (PAS)
Result
Methyl Violet
Result
Prussian Blue/Perl’s Reaction
Result
IMMUNOHISTOCHEMICAL STAINS
Technique of IHC
Interpretation
Applications of IHC
EXERCISE 5:
Surgical Pathology Request Form
DESIGN OF THE REQUEST FORM
SAMPLE REQUEST FORM
SECTION 2: CLINICAL PATHOLOGY AND BASIC CYTOPATHOLOGY
EXERCISE 6:
Urine Examination I: Physical and Chemical
A. ADEQUACY OF SPECIMEN
Specimen Collection
Methods of Preservation of Urine
B. PHYSICAL EXAMINATION
Volume
Colour
Odour
Reaction/pH
Specific Gravity
1. Urinometer
2. Refractometer
3. Reagent Strip Method
Significance of Specific Gravity
C. CHEMICAL EXAMINATION
Proteinuria
Qualitative Tests for Proteinuria
1. Heat and Acetic Acid Test
2. Sulfosalicylic Acid Test
3. Heller’s Test
4. Reagent Strip Method
Quantitative Estimation of Proteins in Urine
1. Esbach’s Albuminometer Method
2. Turbidimetric Method
Causes of Proteinuria
Test for Bence Jones Proteinuria
Glucosuria
Qualitative Tests
1. Benedict’s Test
2. Reagent Strip Test
Quantitative Test for Glucose
Causes of Glucosuria
Ketonuria
Tests for Ketonuria
1. Rothera’s Test
2. Gerhardt’s Test
3. Reagent Strip Test
Causes of Ketonuria
Bile Derivatives in Urine
Tests for Bile Salts
1. Hay’s Test
2. Strip Method
Tests for Urobilinogen
1. Ehrlich’s Test
2. Reagent Strip Test
Significance
Tests for Bilirubin (Bile Pigment) in Urine
1. Fouchet’s Test
2. Foam Test
3. Reagent Strip Test
Blood in Urine
1. Benzidine Test
2. Orthotoluidine Test
3. Reagent Strip Test
AUTOMATED URINALYSIS
EXERCISE 7:
Urine Examination II: Microscopy
A. COLLECTION OF SAMPLE
B. PREPARATION OF SEDIMENT
C. EXAMINATION OF SEDIMENT
1. Cells in Urine
RBCs
WBCs
Epithelial Cells
2. Casts in Urine
Hyaline Cast
Red Cell Cast
Leucocyte Cast
Granular Casts
Waxy Casts
Fatty Cast
Epithelial Cast
Pigment Cast
3. Crystals in Urine
Crystals in Acidic Urine
i) Calcium Oxalate
ii) Uric Acid
iii) Amorphous Urates
iv) Tyrosine
v) Cystine
vi) Cholesterol Crystals
vii) Sulphonamide
Crystals in Alkaline Urine
i) Amorphous Phosphates
ii) Triple Phosphates
iii) Calcium Carbonates
iv) Ammonium Biurates
4. Miscellaneous Structures in Urine
i) Spermatozoa
ii) Parasites
iii) Fungus
iv) Tumour Cells
D. AUTOMATION IN URINE MICROSCOPY
EXERCISE 8:
Basic Cytopathologic Techniques and their Applications
EXFOLIATIVE CYTOLOGY
Applications of Exfoliative Cytology
Female Genital Tract
Respiratory Tract
Gastrointestinal Tract
Urinary Tract
Body Fluids
Buccal Smears for Sex Chromatin
Fixation of Smears in Exfoliative Cytology
Staining of Smears in Exfoliative Cytology
Papanicolaou Stain
H & E Stain
Romanowsky Stain
ASPIRATION CYTOLOGY
Applications of FNA
Procedure for FNA
Radiological Imaging Aids for FNA
Advantages of FNA over Surgical Biopsy
IMPRINT CYTOLOGY
SECTION 3: HAEMATOLOGY
EXERCISE 9:
Types of Blood Samples, Anticoagulants and Blood Collection
TYPES OF BLOOD SAMPLES
1. Whole Blood
2. Serum
3. Plasma
ANTICOAGULANTS
1. EDTA
2. Sodium Citrate
3. Double Oxalate
4. Heparin
5. Sodium Fluoride
BLOOD COLLECTION
EXERCISE 10:
Haemoglobin Estimation
METHODS FOR ESTIMATION OF HAEMOGLOBIN
Cyanmet Haemoglobin Method
Procedure
Calculations
Advantages
Disadvantages
Oxyhaemoglobin Method
Procedure
Advantages
Disadvantages
Electronic Counter Method
Disadvantage
Direct Reading Electronic Haemoglobinometers
Disadvantage
Sahli’s Method
Procedure
Advantages
Disadvantages
Other Methods
Normal Values of Haemoglobin
Errors in Haemoglobinometry
QUALITY CONTROL IN HAEMOGLOBIN ESTIMATION
EXERCISE 11:
Counting of Blood Cells
WBC COUNT
Methods
Visual Haemacytometer Method
Procedure
Calculations*
Precautions
Electronic Method
Advantages
Disadvantages
Normal Range for WBC Count
Causes of Increased WBC Count (Leucocytosis)
Causes of Decreased WBC Count (Leucopenia)
RBC COUNT
Methods for RBC Counts
Visual Haemacytometer Method
Procedure
Calculations
Electronic Method
Advantages
Disadvantages
Normal Range for RBC Count
Cause of Decreased RBC Count
Cause of Increased RBC Count
PLATELET COUNT
Methods for Counting Platelets
Visual Method
Rough Visual Method for Platelet Counting
Electronic Method
Disadvantages
Normal Platelet Count
Conditions Causing Thrombocytopenia
Conditions Causing Thrombocytosis
ABSOLUTE EOSINOPHIL COUNT (AEC)
Methods
Diluting Fluid
Improved Neubauer Chamber Method
Fuchs-Rosenthal Counting Chamber Method
Normal Range for AEC
Causes of Abnormal AEC
EXERCISE 12:
Preparation and Staining of Peripheral Blood Smear
THIN BLOOD SMEAR
Slide Method
Procedure
Qualities of a Good Blood Smear
Parts of a Thin Blood Smear
Cover Glass Method
Procedure
Spin Method
Procedure
THICK BLOOD SMEAR
STAINS FOR BLOOD SMEAR
Staining of Thin Blood Smear
Leishman’s Stain
Giemsa Stain
Procedure
Staining of Thick Blood Smear
Autostainers
Precautions in Staining of PBS
EXERCISE 13:
Differential Leucocyte Count
EXAMINATION OF PBS FOR DLC
MORPHOLOGIC IDENTIFICATION OF MATURE LEUCOCYTES
Polymorph (Neutrophil)
Lymphocyte
Monocyte
Eosinophil
Basophil
METHODS OF DLC
Visual Counting
Automated Counting
PATHOLOGIC VARIATIONS IN DLC
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophil
EXERCISE 14:
ESR, PCV (Haematocrit) and Absolute Values
ERYTHROCYTE SEDIMENTATION RATE
Principle
Mechanism of ESR
Phases in ESR
Methods of ESR
1. Westergren’s method
Procedure
2. Wintrobe’s Method
3. Micro-ESR Method
4. Automated ESR Method
Clinical Significance of ESR
Supportive Diagnostic Uses
Monitoring Prognosis of Diseases
PACKED CELL VOLUME OR HAEMATOCRIT
Methods for Estimation of PCV
1. Macro (Wintrobe’s) Method
2. Microhaematocrit Method
3. Electronic Method
Clinical Significance of PCV
ABSOLUTE VALUES (RED CELL INDICES)
1. Mean Corpuscular Volume (MCV)
2. Mean Corpuscular Haemoglobin (MCH)
3. Mean Corpuscular Haemoglobin Concentration (MCHC)
4. Red Cell Distribution Width (Rdw)
Significance of Red Cell Indices
EXERCISE 15:
Screening Tests for Haemostasis
BLEEDING TIME
Methods for Bleeding Time
1. Finger Tip Method
2. Duke’s Method
3. Ivy’s Method
Clinical Application of Bleeding Time
CLOTTING TIME
Methods for Clotting Time
1. Capillary Tube Method
2. Lee and White Method
Clinical Applications of Clotting Time
SECTION 4: HISTOPATHOLOGY
EXERCISE 16:
Degenerations and Necrosis
HYALINE CHANGE IN LEIOMYOMA
COAGULATIVE NECROSIS (INFARCT) KIDNEY
LIQUEFACTIVE NECROSIS (INFARCT) BRAIN
EXERCISE 17:
Intracellular Accumulations and Amyloidosis
FATTY CHANGE LIVER
AMYLOIDOSIS KIDNEY
AMYLOIDOSIS SPLEEN
EXERCISE 18:
Derangements of Body Fluids
CVC LUNG
CVC LIVER
THROMBUS ARTERY
EXERCISE 19:
Inflammation: Acute and Chronic
ABSCESS LUNG
ACUTE APPENDICITIS
CHRONIC INFLAMMATORY GRANULATION TISSUE
EXERCISE 20:
Granulomatous Inflammation
TUBERCULOUS LYMPHADENITIS
FIBROCASEOUS TUBERCULOSIS LUNG
TUBERCULOSIS INTESTINE
MILIARY TUBERCULOSIS SPLEEN
EXERCISE 21:
Other Specific Infections and Infestations
ACTINOMYCOSIS SKIN
ASPERGILLOSIS LUNG
RHINOSPORIDIOSIS NOSE
CYSTICERCOSIS SOFT TISSUE
EXERCISE 22:
Primary Epithelial Tumours-I
SQUAMOUS CELL PAPILLOMA
SQUAMOUS CELL CARCINOMA
JUVENILE POLYP RECTUM
COLORECTAL ADENOCARCINOMA
EXERCISE 23:
Primary Epithelial Tumours-II
COMPOUND NAEVUS
MALIGNANT MELANOMA
BASAL CELL CARCINOMA
EXERCISE 24:
Mesenchymal and Metastatic Tumours
FIBROMA
FIBROSARCOMA
METASTATIC CARCINOMA LYMPH NODE
METASTATIC SARCOMA LUNG
EXERCISE 25:
Atherosclerosis and Vascular Tumours
ATHEROMA AORTA
CAPILLARY HAEMANGIOMA SKIN
CAVERNOUS HAEMANGIOMA LIVER
LYMPHANGIOMA TONGUE
EXERCISE 26:
Cysts and Tumours of the Jaws and Salivary Glands
RADICULAR CYST
AMELOBLASTOMA
PLEOMORPHIC ADENOMA
WARTHIN’S TUMOUR
EXERCISE 27:
Common Diseases of Bones
PYOGENIC OSTEOMYELITIS
TUBERCULOUS OSTEOMYELITIS
OSTEOCLASTOMA
OSTEOSARCOMA
APPENDIX:
Normal Values
WEIGHTS AND MEASUREMENTS OF NORMAL ORGANS
LABORATORY VALUES OF CLINICAL SIGNIFICANCE
INDEX
TOC
Index
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