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Gastroenterology

What is Dyspepsia?

Indigestion, also known as dyspepsia, is a term used to describe one or more symptoms including a feeling of fullness during a meal, uncomfortable fullness after a meal, and burning or pain in the upper abdomen. Indigestion is common in adults and can occur once in a while or as often as every day. Most people with indigestion experience more than one of the following symptoms:

Fullness during a meal: The person feels overly full soon after the meal starts and cannot finish the meal.

Bothersome fullness after a meal: The person feels overly full after a meal—it may feel like the food is staying in the stomach too long.

Epigastric pain: The epigastric area is between the lower end of the chest bone and the navel. The person may experience epigastric pain ranging from mild to severe.

Epigastric burning: The person feels an unpleasant sensation of heat in the epigastric area.

Other, less frequent symptoms that may occur with indigestion are nausea and bloating—an unpleasant tightness in the stomach. Nausea and bloating could be due to causes other than indigestion.

H. pylori infection occurs when a type of bacteria called Helicobacter pylori (H. pylori) infects your stomach. This usually happens during childhood. This can be a cause for peptic ulcers, H. pylori infection may be present in more than half the people in the world and often positive in the stomachs of general population.

Most people don't realize they have H. pylori infection, because they never get sick from it. If you develop signs and symptoms of a peptic ulcer, your doctor will probably test you for H. pylori infection, because it can be treated with antibiotics.

Most people with H. pylori infection will never have any signs or symptoms. Often the infection remains silent and can cause ulceration or even cancer of stomach in few susceptible individuals. When signs or symptoms do occur with H. pylori infection, they may include:

  • An ache or burning pain in your abdomen
  • Abdominal pain that's worse when your stomach is empty
  • Nausea
  • Loss of appetite
  • Frequent burping
  • Bloating
  • Unintentional weight loss

    • Chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer. Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Chronic constipation may also cause excessive straining to have a bowel movement.

    Treatment for chronic constipation depends in part on the underlying cause. However, in many cases, a cause is never found. Improper bowel training during childhood can lead to chronic constipation in adult life.

    Signs and symptoms of chronic constipation include one or more of following:

  • Passing fewer stools than normal
  • Having lumpy or hard stools
  • Straining to have bowel movements
  • Feeling as though there's a blockage in your rectum that prevents bowel movements
  • Feeling as though you can't completely empty the stool from your rectum
  • Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum

    • Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract or cannot be eliminated effectively from the rectum, which may cause the stool to become hard and dry.

    Irritable bowel syndrome (IBS) is a common, chronic bowel disorder in which there is abdominal pain associated with change in consistency and frequency of stool. There are 3 different patterns of this disorder namely IBS- C (Constipation predominant) , IBS – D (Diarrhoea predominant) and IBS – M (Constipation + Diarhoea). The same patient can have different patterns at different times

    You may also experience abdominal bloating, mucus in the stool and the sensation of incomplete emptying after defecation. IBS is a chronic condition, although there may be times when the signs and symptoms are worse and times when they improve or even disappear completely. Similar symptoms can also occur in other serious bowel diseases especially if there is presence of blood in stool , weight loss, fever, loss of appetite and if the symptoms occur for the first time after the age of 50 years. If any of these are present then you must consult your doctor immediately.

    IBS is a multifactorial disorder where there is interplay of intestinal hypersensitivity , psychological stress and gut bacteria . This leads to abnormal intestinal movements and associated symptoms.

    Symptoms can be reduced by managing diet, lifestyle and stress. Certain drugs may be prescribed to alleviate your symptoms. Your doctor may advise certain laboratory investigations and colonoscopy to rule out a more serious disease. IBS is a chronic but not a life threatening disease and does not cause cancer.

    Triggers vary from person to person

    Stimuli that don't bother other people can trigger symptoms in people with IBS — but not all people with the condition react to the same stimuli. Common triggers include:

    Foods: The role of food allergy or intolerance in irritable bowel syndrome is not yet clearly understood, but many people have more severe symptoms when they eat certain things. A wide range of foods have been implicated — chocolate, spices, fats, fruits, beans, cabbage, cauliflower, broccoli, milk, carbonated beverages and alcohol to name a few. Stress: Most people with IBS find that their signs and symptoms are worse or more frequent during (periods) of increased stress. While stress may contribute to symptoms It is not the sole cause. Hormones: Researchers believe that hormonal changes play a role in this condition. Many women find that signs and symptoms are worse during or around their menstrual periods. Other illnesses: Sometimes another illness, such as an acute episode of infectious diarrhea (gastroenteritis) or too many bacteria in the intestines (bacterial overgrowth), can trigger IBS.

    Peptic ulcers occur when acid in the digestive tract injures or eats away the inner surface of the stomach and duodenum. The acid can create a painful open wound that can lead to complications.

    The digestive tract normally produces acid for digestion and is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of mucus protection is decreased, can lead to ulcer formation. The most common symptom of a peptic ulcer is upper abdominal burning or pain.

    Peptic ulcers include:

  • Gastric ulcers that occur in the stomach.
  • Duodenal ulcers occur in the first part small intestine (duodenum)
  • The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and long-term use of aspirin and certain other painkillers, such as ibuprofen and others. Stress and spicy foods do not cause peptic ulcers. However, they can make your symptoms worse..Smoking or tobacco in any form can lead to ulcer.

    • What is Gastroesophageal reflux (GERD) ?
    Gastroesophageal reflux is a physical condition in which acid from the stomach flows backward up into the esophagus. People will experience heartburn when excessive amounts of acid from the stomach refluxes into the esophagus.

    Many describe heartburn as a feeling of burning discomfort, localized behind the chest, that moves up toward the neck and throat. Some even experience the bitter or sour taste of the acid in the back of the throat. The burning and pressure symptoms of heartburn can last for several hours and often worsen after eating food and even mimics a heart attack.

    All of us may have occasional heartburn. However, frequent heartburn (two or more times a week), Food sticking, blood in throat or weight loss may be associated with a more severe GERD.

    Most people will experience heartburn if the lining of the esophagus comes in contact with too much stomach juice for too long a period of time. This stomach juice consists of acid and digestive enzymes, . The prolonged contact of acidic stomach juice with the esophageal lining injures the esophagus and produces a burning discomfort. Normally, a muscular valve at the lower end of the esophagus called the lower esophageal sphincter or "LES" keeps the acid in the stomach and out of the esophagus.

    In GERD the LES relaxes too frequently, which allows stomach acid to reflux, or flow backward into the esophagus.

    GERD can also have extra-esophageal manifestations like chest pain, asthma, chronic cough, ear, nose and throat problems which often avoid detection.

    What Is SIBO?

    Small intestinal bacteria overgrowth (SIBO) is exactly what it sounds like: too much bacteria in the small intestine. Everyone has bacteria in their gut; they play a key part in digestion. But if things get out of balance, problems can happen.

    SIBO can be treated, and sometimes lifestyle changes are all it takes.

    Causes

    SIBO usually starts when the small intestine doesn’t move food along well enough. This lets bacteria grow and stick around too long. If the “good” bacteria that help you digest food can’t keep up with the harmful bacteria, the “bad” germs can multiply too fast, and then you’ve got an imbalance that could cause SIBO symptoms.

    Symptoms

    Early signs are pain in your abdomen, queasiness, fatigue, feeling bloated, passing a lot of gas, and diarrhea or constipation. Many things can cause those problems, so you can’t know that it’s SIBO just based on how you feel.

    If you have SIBO and it worsens, your small intestine might not absorb enough food or nutrients. This could lead to weight loss or anemia, with your body not getting enough fuel or iron.

    Risk Factors

    Things that can make you more likely to develop SIBO include:

    Age. Older adults are more likely to have SIBO because they may make less of the gastric acid that breaks down food and are more likely to have diverticulosis.

    Anatomy. You may have a small intestine with an unusual shape. Differences in the structure or anatomy of your gut can make food move more slowly than normal and allow bacteria to grow. These may stem from diverticulosis (pouches in the small intestine), procedures like Roux-en-Y gastric bypass surgery, scar tissue from radiation or abdominal surgery, or a buildup of protein called amyloid in your small intestine. Blockages in the GI tract can cause SIBO, too.

    Chronic diseases such as diabetes, lupus, and connective tissue disorders like scleroderma can keep your small intestine from working right. An immune system weakened by HIV, immunoglobulin A deficiency, or other reasons can let too much bacteria grow where it shouldn’t.

    SIBO seems to be particularly common in people with inflammatory bowel disease such as Crohn’s disease and ulcerative colitis.

    Medicines are sometimes at the root of SIBO. Narcotics can slow things down, as can drugs that treat irritable bowel syndrome. Proton pump inhibitors that curb acid in your stomach and antibiotics that affect the bacteria living in your intestines can lead to SIBO.

    Diagnosis

    If you’ve had SIBO-like symptoms that don’t go away, see a gastroenterologist. This type of doctor specializes in the digestive system.

    At your appointment, you’ll probably take “ Glucose H2 Breath test” ( GHBT ) First, you’ll drink a 75 gram glucose mix. Then, over the next 3 hours, you will breathe into LACTOFAN - 2 machine 20 minutes interval. This air will be tested to see if it has high levels of hydrogen or methane to suggest SIBO.

    Treatment

    To treat SIBO, you’ll want to get your gut bacteria back in balance. That should ease your symptoms and help your body to better absorb more nutrients from your food.

    The treatment you’ll get depends the results of the breath test you took. If your sample had a lot of hydrogen in it, the main treatment is the antibiotic rifaximin. If your test showed high levels of methane, you’ll likely take rifaximin plus the antibiotic neomycin.

    It’s rare, but some people may need surgery if their SIBO stems from a problem with their intestine’s structure. If this causes your SIBO, you’ll need to see your doctor regularly after the operation to check on your digestive health.

    Lifestyle Changes to Help

    If you don’t have SIBO because of an anatomical problem, a simple step is to cut out sugary foods and drinks. This may be all it takes to feel better. You can also try quitting foods that seem to make your symptoms worse, then wait 3 days before bringing them back on your menu. This way, you’ll know whether a certain food triggers your symptoms. And avoid taking fiber supplements as well as any liquid medications (such as cough syrup) that use sugar alcohols for flavor.

    Your doctor may recommend a low-FODMAP diet. FODMAPs are a type of carbohydrate (FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.). Not every carb is a FODMAP. You’ll want to talk to a nutritionist or a doctor who’s knowledgeable about nutrition so you can know what you can eat and how to meet your nutritional needs on this plan.

    You might want to ask your doctor whether prebiotics and probiotics could help. You can get probiotics in fermented foods like yogurt (look for “live, active cultures” on the label), kefir (a yogurt-based drink), and kimchi (a traditional Korean relish). To get more prebiotics from foods, include lots of fruits, veggies, and whole grains. If you’re thinking about taking prebiotics or probiotics in supplements, talk with your doctor first to make sure they’re a good choice for you. Foods are always a good first step, since you’ll get lots of other nutrients that are good for you.

    Liver & Pancreas

    Pancreatitis is inflammation in the pancreas. The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. The pancreas produces enzymes that help digestion and hormones that help regulate the way your body processes sugar (glucose).

    Pancreatitis can occur as acute pancreatitis — meaning it appears suddenly and lasts for days. Or pancreatitis can occur as chronic pancreatitis, which is pancreatitis that occurs over many years.

    Mild cases of pancreatitis may go away without treatment, but severe cases can cause complications.

    Pancreatitis occurs when digestive enzymes become activated while still in the pancreas, irritating the cells of your pancreas and causing inflammation.

    With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A poorly functioning pancreas can cause digestion problems and diabetes.

    Conditions that can lead to pancreatitis include:

  • Alcoholism, Gallstones
  • Abdominal surgery, Certain medications
  • Cigarette smoking, Cystic fibrosis
  • Family history of pancreatitis
  • High calcium levels in the blood (hypercalcemia), which may be caused by an overactive parathyroid gland (hyperparathyroidism)
  • High triglyceride levels in the blood (hypertriglyceridemia)
  • Infection, Injury to the abdomen
  • Pancreatic cancer

    • Sometimes, a cause for pancreatitis is never found Signs and symptoms of pancreatitis may vary, depending on which type you experience.

    Acute pancreatitis signs and symptoms include:

  • Upper abdominal pain
  • Abdominal pain that radiates to your back
  • Abdominal pain that feels worse after eating
  • Fever, Rapid pulse
  • Nausea, Vomiting
  • Tenderness when touching the abdomen

    • Chronic pancreatitis signs and symptoms include:

  • Upper abdominal pain
  • Losing weight without trying
  • Oily, smelly stools (steatorrhea)

    • Disease affecting digestion refers to pancreatic diseases. Most common conditions are Acute or Chronic Pancreatitis, Pancreatic Cancer due to alcohol consumption, biliary stone, Pancreatic Pseudocyst and Cystic Fibrosis which is a genetic disorder.

    Hepatitis A & E are water born liver infections caused by the virus. These viruses are one of several types of hepatitis viruses that cause inflammation and affect your liver's ability to function. You are most likely to acquire hepatitis A or E virus from contaminated food or water. Mild cases of hepatitis A & E don't require treatment, and most people who are infected recover completely with no permanent liver damage. In childhood, hepatitis A is normally asymptomatic.

    Hepatitis A & E virus can be transmitted several ways, such as:

  • Eating food handled by someone with the virus who doesn't thoroughly wash his or her hands after using the toilet
  • Drinking or bathing in contaminated water
  • Eating raw shellfish from water polluted with sewage

    • Hepatitis A & E signs and symptoms, which typically don't appear until you have had the virus for a few weeks, may include:

  • Loss of appetite
  • Low-grade fever
  • Fatigue
  • Nausea and vomiting
  • Abdominal pain or discomfort, especially in the area of your liver on your right side beneath your lower ribs
  • Dark urine
  • Yellowing of the skin and eyes (jaundice)
  • Clay-coloured stool

    • Chronic pancreatitis signs and symptoms include:

  • Upper abdominal pain
  • Losing weight without trying
  • Oily, smelly stools (steatorrhea)

    • Disease affecting digestion refers to pancreatic diseases. Most common conditions are Acute or Chronic Pancreatitis, Pancreatic Cancer due to alcohol consumption, biliary stone, Pancreatic Pseudocyst and Cystic Fibrosis which is a genetic disorder.

    Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). For some people, hepatitis B infection becomes chronic, meaning it lasts more than six months. Having chronic hepatitis B increases your risk of developing cirrhosis — a condition that causes permanent scarring of the liver, liver failure or liver cancer.

    Most adults infected with hepatitis B recover fully, even if their signs and symptoms are severe. Infants and children are more likely to develop a chronic hepatitis B infection. A vaccine can prevent hepatitis B. Taking certain precautions can help to prevent spreading of HBV to others

    Signs and symptoms of hepatitis B, ranging from mild to severe, usually appear about 1-3 months after you've been infected. Signs and symptoms of hepatitis B may include: Abdominal pain, Dark urine, Fever, Joint pain, Loss of appetite, Nausea and vomiting, Weakness and fatigue, Yellowing of your skin and the whites of your eyes (jaundice).

    Hepatitis B infection is caused by the hepatitis B virus (HBV). The virus is passed from person to person through blood, semen or other body fluids.

    Common ways HBV is transmitted include:

  • Sexual contact. You may become infected if you have unprotected sex with an infected partner whose blood, saliva, semen or vaginal secretions enter your body.
  • Sharing of needles. HBV is easily transmitted through needles and syringes contaminated with infected blood. Sharing intravenous (IV) drug paraphernalia puts you at high risk of hepatitis B.
  • Accidental needle sticks. Hepatitis B is a concern for health care workers and anyone else who comes in contact with human blood.
  • Mother to child. Pregnant women infected with HBV can pass the virus to their babies during childbirth. However, the newborn can be vaccinated to avoid getting infected in almost all cases. Talk to your doctor about being tested for hepatitis B if you are pregnant or want to become pregnant
  • Acute vs. chronic hepatitis B
  • Hepatitis B infection may be either short-lived (acute) or long lasting (chronic).
  • Acute hepatitis B infection lasts less than six months. Your immune system can clear acute hepatitis B from your body, and you should recover completely within a few months. Most people who acquire hepatitis B as adults have an acute infection, but it can lead to chronic infection
  • Chronic hepatitis B infection lasts six months or longer. When your immune system can't fight off the acute infection, hepatitis B infection may last a lifetime and if not treated may lead to serious illnesses such as cirrhosis and liver cancer.
  • The younger you are when you get hepatitis B — particularly newborns or children younger than 5 — the higher your risk the infection becoming chronic. Chronic infection may go undetected for decades until a person becomes seriously ill from liver disease or is discovered incidentally.

    • Hepatitis C is a viral infection that usually causes chronic liver inflammation leading to serious liver damage. The hepatitis C virus (HCV) spreads through contaminated blood, contaminated syringe & unprotected sex. Can also rarely be transmitted from mother to foetus during delivery.

    Today, chronic HCV is usually curable with oral medication.

    Most people with HCV don't know they're infected, mainly because they have no symptoms, which can take decades to appear.

    Untreated chronic hepatitis C increases your risk of developing cirrhosis — a condition that causes permanent scarring of the liver, liver failure or liver cancer.

    Chronic hepatitis C is usually a "silent" infection for many years, until the virus damages the liver enough to cause the signs and symptoms of liver disease. Among these signs and symptoms are: Bleeding easily, Bruising easily, Fatigue, Poor appetite, Yellow discoloration of the skin and eyes (jaundice), Dark-colored urine, Itchy skin, Fluid buildup in your abdomen (ascites), Swelling in your legs, Weight loss, Confusion, drowsiness and slurred speech (hepatic encephalopathy), Spider-like blood vessels on your skin (spider angiomas).

    Every chronic hepatitis C infection starts with an acute phase. Acute hepatitis C usually goes undiagnosed because it rarely causes symptoms. When signs and symptoms are present, they may include jaundice, along with fatigue, nausea, fever and muscle aches. Acute symptoms appear one to three months after exposure to the virus and last two weeks to three months.

    Acute hepatitis C infection doesn't always become chronic. Some people clear HCV from their bodies after the acute phase, an outcome known as spontaneous viral clearance.

    Your risk of hepatitis C infection is increased if you:

  • Are a health care worker who has been exposed to infected blood, which may happen if an infected needle pierces your skin
  • IV drug abusers
  • Have HIV
  • Piercing or tattoo in an unclean environment using unsterile equipment
  • Blood transfusion or organ transplant
  • Hemodialysis

    • Liver is an organ that processes food we eat, stores energy and provides the body with a healthy immune system.

    Drinking too much alcohol can lead to three types of liver conditions - fatty liver, hepatitis and liver 'scarring' (cirrhosis). Any, or all, of these conditions can occur at the same time in the same person.

    Fatty liver
    Fatty Liver

    Alcoholic hepatitis

    Hepatitis means inflammation of the liver. The inflammation can range from mild to severe.

    Mild hepatitis may not cause any symptoms. The only indication of inflammation may be an abnormal level of liver chemicals (enzymes) in the blood, which can be detected by a blood test. However, in some cases the hepatitis becomes persistent (chronic), which can gradually damage the liver and eventually cause cirrhosis. A more severe hepatitis tends to cause symptoms such as: Feeling sick (nausea), Yellowing of the skin and the whites of the eyes (jaundice), caused by a high level of bilirubin, sometimes, pain over the liver. A very severe bout of alcoholic hepatitis can quickly lead to liver failure. This can cause deep jaundice, blood clotting problems, confusion, coma and bleeding into the guts. It is often fatal. Alcoholic cirrhosis

    Cirrhosis is a condition where normal liver tissue is replaced by scar tissue (fibrosis). The scarring tends to be a gradual process. The scar tissue affects the normal structure and regrowth of liver cells. Liver cells become damaged and die as scar tissue gradually develops. So, the liver gradually loses its ability to function well. The scar tissue can also affect the blood flow through the liver which can cause back pressure in the blood vessels which bring blood to the liver.

    Cirrhosis can happen from many causes other than alcohol - for example, persistent viral hepatitis and some hereditary and metabolic diseases. If you have another persistent liver disease and drink heavily, you are likely to increase your risk of developing cirrhosis.

    Liver is an organ that processes food we eat, stores energy and provides the body with a healthy immune system.

    Non-alcoholic fatty liver disease (NAFLD) is a very common disorder and refers to a group of conditions where there is accumulation of excess fat in the liver of people who drink little or no alcohol. The most common form of NAFLD is a non serious condition called fatty liver.

    In fatty liver, fat accumulates in the liver cells. Although having fat in the liver is not normal, by itself it probably does not damage the liver. Some people with NAFLD may have a more serious condition named non-alcoholic steatohepatitis (NASH). In NASH, fat accumulation is associated with liver cell inflammation and different degrees of scarring.

    NASH is a potentially serious condition that may lead to severe liver scarring and cirrhosis. Cirrhosis occurs when the liver sustains substantial damage, and the liver cells are gradually replaced by scar tissue, which results in the inability of the liver to work properly. Some patients who develop cirrhosis may eventually require a liver transplant (surgery to remove the damaged liver and replace it with a “new” liver).

    Nonalcoholic fatty liver disease usually causes no signs and symptoms. When it does, they may include: Enlarged liver, Fatigue, discomfort in the upper right abdomen.

    Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis are both linked to the following:

  • Overweight or obesity (Lean people may also suffer from NASH)
  • Insulin resistance, in which your cells don't take up sugar in response to the hormone insulin.
  • High blood sugar (hyperglycemia).
  • High levels of fats, particularly triglycerides, in the blood.
  • These combined health problems appear to promote the deposition of fat in the liver. For some people, this excess fat acts as a toxin to liver cells, causing liver inflammation and nonalcoholic steatohepatitis, which may lead to a buildup of scar tissue (fibrosis) in the liver.
  • Some patients with excessive fibrosis progress to cirrhosis.

    • Cirrhosis is a complication of many liver diseases characterized by abnormal structure and function of the liver. The diseases that lead to cirrhosis do so because they injure and kill liver cells, after which the inflammation and repair that is associated with the dying liver cells causes scar tissue to form. The liver cells that do not die multiply in an attempt to replace the cells that have died. This results in clusters of newly formed liver cells (regenerative nodules) within the scar tissue. There are many causes of cirrhosis including chemicals (such as alcohol, fat, and certain medications), viruses, toxic metals (such as iron and copper that accumulate in the liver as a result of genetic diseases), and autoimmune liver disease in which the body's immune system attacks the liver.

    Endoscopy & Colonoscopy

    A colonoscopy is an exam used to detect changes or abnormalities in the large intestine (colon) and rectum.

    During a colonoscopy, a long, flexible tube (colonoscope) is inserted into the rectum. A tiny video camera at the tip of the tube allows the doctor to view the inside of the entire colon.

    If necessary, polyps or other types of abnormal tissue can be removed through the scope during a colonoscopy. Tissue samples (biopsies) can be taken during a colonoscopy as well.

    During procedure the endoscopist takes enough precautions to make colonoscopy smooth and comfortable. Doing colonoscopy under sense (no sedition) gives you freedom to resume duty the same day and normal diet immediate after procedure.

    What is an upper GI endoscopy ?

    An upper GI endoscopy is a procedure to diagnose and treat problems in your upper GI (Gastrointestinal) tract. The upper GI tract includes your food pipe (esophagus), stomach, and the first part of your small intestine (the duodenum).

    This procedure is done using a long, thin flexible tube called an endoscope. The tube has a tiny light and video camera on one end. The tube is put into your mouth and throat after spraying lignocaine 10 %. Then it is slowly and carefully the tube pushed through your esophagus and stomach, and into your duodenum. Video images from the tube are seen on a monitor. To make your endoscopy smooth and safe all precautions are taken by the endoscopist. Three phase washing is done to ensure coss infection in subsequent cases.

    Pathology

    Pathology is a branch of medical science that involves the study and diagnosis of disease through the examination of surgically removed organs, tissues (biopsy samples), bodily fluids, and in some cases the whole body (autopsy). Aspects of a bodily specimen that may be considered include its gross anatomical make up, appearance of the cells using immunological markers and chemical signatures in the cells. Pathology also includes the related scientific study of disease processes whereby the causes, mechanisms and extent of disease are examined. Areas of study include cellular adaptation to injury, necrosis (death of living cells or tissues), inflammation, wound healing, and neoplasia (abnormal new growth of cells). Pathologists specialize in a wide range of diseases including cancer and the vast majority of cancer diagnoses are made by pathologists. The cellular pattern of tissue samples are observed under a microscope to help determine if a sample is cancerous or non-cancerous (benign). Pathologists also employ genetic studies and gene markers in the assessment of various diseases.

    Surgical Pathology is the most significant and time consuming branch of pathology with a primary focus on examining tissues with the naked eye or under a microscope for definitive diagnosis of disease. Surgically removed specimens are received from sources such as small biopsies of skin, core biopsies for the diagnosis of cancer, and the operating room where tumours are removed. Surgical pathology involves macroscopic (gross) and microscopic (histologic) tissue analysis where the molecular properties of tissue samples are assessed by immunohistochemistry or other laboratory tests. Histological sections of tissue are processed for microscopic viewing using either chemical fixation or frozen section. Frozen section processing involves freezing the tissue and generating thin frozen slices of the specimen which are mounted onto glass slides. Prior to viewing the tissue under a microscope, slides processed by chemical fixation or frozen section are either stained with chemicals or antibodies to reveal cellular components. Autopsy is a highly specialized surgical procedure that is performed by a pathologist and consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present. The principal aim of an autopsy or post-mortem examination is to determine the cause of death, the state of health of the person before they died, and whether any medical diagnosis and treatment before death was appropriate.

    Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. It is usually used to aid in the diagnosis of cancer, but also helps in the diagnosis of certain infectious diseases and other inflammatory conditions. Cytopathology is generally used on samples of free cells or tissue fragments that spontaneously exfoliate or are removed from tissues by abrasion or fine needle aspiration, in contrast to histopathology, which studies whole tissues.

    Molecular Pathology is a relatively recent discipline that has achieved remarkable progress over the past decade. It emphasizes the study and diagnosis of disease through the examination of molecules within organs, tissues or bodily fluids. Many diseases such as cancer are caused by mutations or alterations in the genetic code of a person, and identification of specific hallmark mutations allows clinicians to classify a disease and choose the appropriate treatment. As a result, molecular analysis is leading the way towards personalized medicine by allowing us to predict a patient’s response to certain anti-cancer therapy based on their own genetic make-up. Molecular Pathology includes the development of molecular and genetic approaches to the diagnosis and classification of human tumours and also to design and validate predictive biomarkers for prognosis of the disease, and susceptibility of developing certain cancers in individuals. The high levels of sensitivity provided by molecular assays allows for the detection of very small tumours that are otherwise undetectable by other means, and will likely result in earlier diagnosis, improved patient care and better outcomes for survival.