Learning outcomes of the course unit
To provide scientific fundaments to the practice of medicine, defined as the capability to identify clinical conditions affecting human beings and to promote preventive or therapeutic to implement individual and community health. Once completed the Course, the Student will have a thorough knowledge and understanding of the etio-pathogenetic factors underlying the basic structural and functional alterations in humans, and the relative response mechanisms, at the different levels of integration (molecule, cells, tissues, organism).
Students should also be able to apply this knowledge, integrated with information from previous Courses, to he understanding of the pathophysiology of common human pathologies.
Sufficient bases of histology, anatomy, biochemistry, microbiology, immunology and physiology are required.
Course contents summary
The Course will concern:
- Cell Pathology
- Tissue responses to cell injury
- General Pathophysiology
Concepts of health, disease, and homeostasis. Aetiology and pathogenesis of molecular alterations. Intrinsic factors of disease: monogenic diseases (mendelian and non mendelian), polygenic multifactorial diseases, chromosomal diseases. Extrinsic factors of disease: physical, chemical and biologic causes of disease. Environmental diseases. Nutritional diseases: malnutrition, nutrition excess, carential diseases. Alterations of DNA, RNA and proteins. DNA repair. Mutations. Diseases due to RNA alterations. Protein damage: structural bases and functional consequences. Genotype and phenotype. Selected examples of protein alterations: alterations in structural proteins, hemoglobinopathies, channelopaties, alterations in transporters and receptors, intracellular and extracellular protein depositions.
Cellular pathology. Reversibile and irreversible cell injury. Adaptive mechanisms to cell injury: hypertrophy, hyperplasia, atrophy, metaplasia, dysplasia. Tesaurismosis, steatosis, and other storage diseases. Biotransformations: Phases of xenobiotic metabolism; Cytochromes P450, Metabolism of ethanol. Free radicals and disease: Production of ROS; Molecular and cellular targets of the oxidative stress; Scavenger enzymes and antioxidants. The ischemic-hypoxic stress: Mechanisms; Metabolic consequences; Reperfusion injury; The response to ischemic-hypoxic stress; Mechanisms of ischemic damage in myocardium and central nervous system. Cell aging and its relationships with human disease. Progeroid syndromes. Cell death: Accidental cell death (oncosis); Programmed cell death (apoptosis and other types). Necrosis and post-necrotic changes.
Oncology. Definitions, nomenclature, epidemiology. Tumor etiology: Chemical carcinogenesis; Radiation cancerogenesis; DNA and RNA oncogenic viruses; Nonviral carcinogenesis from biological agents; Heredity and tumors. Molecular oncology: The cell cycle and its control; Protooncogenes, oncogenes and oncoproteins; Oncosuppressor genes and their products; Altered DNA repair mechanisms and tumors; Defects of apoptosis and cancer; Karyotipic alterations in tumors. The natural history of cancer: Stem cells and cancer; Intiation and promotion; Multiphasic cancerogenesis; Tumor progression. The neoplastic cell: Cytological and metabolic alterations; Tumor angiogenesis; Invasivity; Metastasis
Pathophysiology of tissue injury and repair. Hemostasis: Phases and mechanisms; Hemorrhagic diseases due do defects in primary or secondary hemostasis. Consumption coagulopathies. Thrombosis, embolism, infarction. Innate immunity: The inflammatory process: Signals and Activating mechanisms; Events, types and evolution of inflammatory processes; Resolution; Chemical mediators of inflammation; Inflammatory lesions: abscesses, ulcers, granulomas; Systemic effects of inflammation: fever, acute phase response; Derangements of the inflammatory response. Tissue repair and regeneration: Stem cells and tissue regeneration; Tissue repair and its alterations; Wound healing; Fibrosis. Atherosclerosis.
Pathophysiology of the homeostatic networks. Thermoregulation and its alterations. Metabolic disorders: Disorders of lipoproteins and of lipid circulation; Disorders of purine metabolism; Metabolic alterations in diabetes; Disorders of porphirin metabolism (porphyrias, jaundice). Pathophysiology of blood cells and disorders of hematopoiesis; Anemias; Leukocyte disorders. Edema. Shock. Disorders of iron and copper metabolism. Eating disorders and obesity. Pathophysiology of endocrine disorders.
Moreover, these General Pathology subjects are treated in other Courses:
Fluid and Ion Balance Physiopathology (Hyper- and Hyponatremia; Dehydration and hyperhydration; Hyper- and Hypo-kalemia; Acidosis and alkalosis; Disorders of calcium, Phosphorus and Magnesium)
Cancer pathogenesis (Host-tumor relationships; Cachexia; Paraneoplastic sindrome; Tumor immunology; Biological bases of cancer therapy).
- Kumar, Abbas, Fausto, Aster (Eds). Robbins e Cotran – Le Basi Patologiche delle Malattie. 8 Edizione italiana, Elsevier Masson, 2010.
- Pontieri, Russo, Frati. Patologia Generale. 4° Edizione, Piccin, 2010.
Additional references will be suggested during the lectures.
Interactive oral lectures, based on the explanation of the main conceptual frame of each subject, supported by Powerpoint slides available to the students. Examples taken from the medical practice will be provided together with bibliographic references so as to stimulate students' questions. The course will be integrated with optional laboratory practice.
Assessment methods and criteria
No interim evaluation is programmed.
The final evaluation will consist in an oral examination.
Q u e s t i o n s / s t u d e n t : 2 ( f r o m t w o d i f f e r e n t e x a m i n e r s , o n e
q u e s t i o n / e x a m i n e r )
Questions will concern subjects listed in the detailed program.
Failure to answer to one question, or verified uncapability to define
correctly the subject, will prevent the successful completion of the exam.
After each question, the examiner will give an evalaution expressed in
m a r k s :
A. Very good knowledge and understanding. Very good capability of
applying knowledge to bio-medical problems. Corresponding to 30/30.
B. Good knowledge and understanding. Good capability to apply
knowledge to biomedical problems. Corresponding to 27-29/30.
C. Average knowledge and understanding. Average capability of
applying knowledge to bio-medical problems. Corresponding to 24-26/D. Sufficient knowledge and understanding. Sufficient capability of
applying information to bio-medical problems. Corresponding to 21-
2 3 / 3 0 .
E. Barely sufficient knowledge and understanding (with evident pitfalls).
Scarce capability of applying knowledge to bio-medical problems.
Corresponding to 18-20/30.
Full marks with laude will be reserved to students exhibiting, together an
overal evaluation of 30/30, capability of making judgments and good
communication ability and autonomous learning skills.
The final vote will be decided jointly by the examiners, who will have the
possibility to decide a vote not higher or lower than three grades from
the best or the worst vote derived from the mean of the two individual