Pathology is the study and diagnosis of disease through examination of organs, tissues, cells and bodily fluids. The term encompasses both the medical specialty which uses tissues and body fluids to obtain clinically useful information, as well as the related scientific study of disease processes.
Additional recommended knowledge
History
The histories of both experimental and medical pathology can be traced to the earliest application of the scientific method to the field of medicine, a development which occurred in the Middle East during the Islamic Golden Age[1] and in Western Europe during the Italian Renaissance.[2] Most early pathologists were also practicing physicians or surgeons. Like other medical fields, pathology has become more specialized with time, and most pathologists today do not practice in other areas of medicine.
Origins of pathology
The concept of studying disease through the methodical dissection and examination of diseased bodies, organs, and tissues may seem obvious today, but there are few if any recorded examples of true autopsies performed prior to the second millennium. Though the pathology of contagion was understood by Muslim physicians since the time of Avicenna (980–1037) who described it in The Canon of Medicine (c. 1020),[3] the first physician known to have made postmortem dissections was the Arabian physician Avenzoar (1091–1161) who proved that the skin disease scabies was caused by a parasite, followed by Ibn al-Nafis (b. 1213) who used dissection to discover pulmonary circulation in 1242.[4] In the 15th century, anatomic dissection was repeatedly used by the Italian physician Antonio Benivieni (1443-1502) to determine cause of death.[2] Perhaps the most famous early gross pathologist was Giovanni Morgagni (1682-1771). His magnum opus, De Sedibus et Causis Morborum per Anatomem Indagatis, published in 1761, describes the findings of over 600 partial and complete autopsies, organised anatomically and methodically correlated with the symptoms exhibited by the patients prior to their demise. Although the study of normal anatomy was already well advanced at this date, De Sedibus was one of the first treatises specifically devoted to the corrolation of diseased anatomy with clinical illness.[5][6] By the late 1800s, an exhaustive body of literature had been produced on the gross anatomical findings characteristic of known diseases. The extent of gross pathology research in this period can be epitomized by the work of the Viennese pathologist (originally from Hradec Kralove in the Czech Rep.) Carl Rokitansky (1804-1878), who is said to have performed 20,000 autopsies, and supervised an additional 60,000, in his lifetime.[2][7]
Origins of microscopic pathology
Rudolf Virchow (1821-1902) is generally recognized to be the father of microscopic pathology. While the compound microscope had been invented approximately 150 years prior, Virchow was one of the first prominent physicians to emphasize the study of manifestations of disease which were visible only at the cellular level.[2][8] A student of Virchow's, Julius Cohnheim (1839-1884) combined histology techniques with experimental manipulations to study inflammation, making him one of the earliest experimental pathologists.[2] Cohnheim also pioneered the use of the frozen section; a version of this technique is widely employed by modern pathologists to render diagnoses and provide other clinical information intraoperatively.[9]
Modern experimental pathology
As new research techniques, such as electron microscopy, immunohistochemistry, and molecular biology have expanded the means by which biomedical scientists can study disease, the definition and boundaries of investigative pathology have become less distinct. In the broadest sense, nearly all research which links manifestations of disease to identifiable processes in cells, tissues, or organs can be considered experimental pathology.[10]
Pathology as a science
Pathology is a broad and complex scientific field which seeks to understand the mechanisms of injury to cells and tissues, as well as the body's means of responding to and repairing injury. Disease processes may be incited or exacerbated by a variety of external and internal influences, including trauma, infection, poisoning, loss of blood flow, autoimmunity, inherited or acquired genetic damage, or errors of development. One common theme in pathology is the way in which the body's responses to injury, while evolved to protect health, can also contribute in some ways to disease processes.[11] Elucidation of general principles underlying pathologic processes, such as cellular adaptation to injury, cell death, inflammation, tissue repair, and neoplasia, creates a conceptual framework with which to analyze and understand specific human diseases.
Adaptation to injury
Cells and tissues may respond to injury and stress by specific mechanisms, which may vary according to the cell types and nature of the injury. In the short term, cells may activate specific genetic programs to protect their vital proteins and organelles from heat shock or hypoxia, and may activate DNA repair pathways to repair damage to chromosomes from radiation or chemicals. Hyperplasia is a long-term adaptive response of cell division and multiplication, which can increase the ability of a tissue to compensate for an injury. For example, repeated irritation to the skin can cause a protective thickening due to hyperplasia of the epidermis. Hypertrophy is an increase in the size of cells in a tissue in response to stress, an example being hypertrophy of muscle cells in the heart in response to increased resistance to blood flow as a result of narrowing of the heart's outflow valve. Metaplasia occurs when repeated damage to the cellular lining of an organ triggers its replacement by a different cell type.[11]
Cell death
Necrosis is the irreversible destruction of cells as a result of severe injury in a setting where the cell is unable to activate the needed metabolic pathways for survival or orderly degeneration. This is often due to external pathologic factors, such as toxins or loss of oxygen supply. Milder stresses may lead to a process called reversible cell injury, which mimics the cell swelling and vacuolization seen early in the necrotic process, but in which the cell is able to adapt and survive. In necrosis, the components of degenerating cells leak out, potentially contributing to inflammation and further damage. Apoptosis, in contrast, is a regulated, orderly degeneration of the cell which occurs in the settings of both injury and normal physiological processes.[11]
Inflammation
Inflammation is a particularly important and complex reaction to tissue injury, and is particularly important in fighting infection. Acute inflammation is generally a non-specific response triggered by the injured tissue cells themselves, as well as specialized cells of the innate immune system and previously developed adaptive immune mechanisms. A localized acute inflammatory response triggers vascular changes in the injured area, recruits pathogen-fighting neutrophils, and begins the process of developing a new adaptive immune response. Chronic inflammation occurs when the acute response fails to entirely clear the inciting factor. While chronic inflammation can lay a positive role in containing a continuing infectious hazard, it can also lead to progressive tissue damage, as well as predisposing (in some cases) to the development of cancer.[11]
Tissue repair
Tissue repair, as seen in wound healing, is triggered by inflammation. The process may proceed even before the resolution of a precipitating insult, through the formation of granulation tissue. Healing involves the proliferation of connective tissue cells and blood vessel-forming cells as a result of hormonal growth signals. While healing is a critical adaptive response, an aberrant healing response can lead to progressive fibrosis, contractures, or other changes which can compromise function.[11]
Neoplasia
Neoplasia, or "new growth," is a proliferation of cells which is independent of any physiological process. The most familiar examples of neoplasia are benign tumors and cancers. Neoplasia results from genetic changes which cause cells to activate genetic programs inappropriately. Dysplasia is an early sign of a neoplastic process in a tissue, and is marked by persistence of immature, poorly differentiated cell forms. Interestingly, there are many similarities in the gene pathways activated in cancer cells, and those activated in cells involved in wound healing and inflammation.[11]
Pathology as a medical specialty
Physicians who practice pathology diagnose and characterize disease in living patients by examining biopsies and other specimens. For example, the vast majority of cancer diagnoses are made or confirmed by a pathologist. Pathologists may also conduct autopsies to investigate causes of death. The medical practice of pathology grew out the tradition of investigative pathology, and many of the academic leaders in pathology today are accomplished in both basic science research and diagnostic practice. However, as with other specialties in medicine, most modern physician-pathologists are employed in full-time practice, and do not perform original research.
Pathology is a unique medical specialty in that pathologists typically do not see patients directly, but rather serve as consultants to other physicians (often referred to as "clinicians" within the pathology community). However, in the United States and in many other countries, pathologists receive the same doctorate training, and undergo the same medical licensure process as other physicians. Pathology is a diverse field, and the organization of subspecialties within pathology vary between nations.
Anatomical Pathology
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Anatomical pathologists diagnose disease and gain other clinically significant information through the examination of tissues and cells. This generally involves gross and microscopic visual examination of tissues, with special stains and immunohistochemistry employed to visualize specific proteins and other substances in and around cells. More recently, anatomical pathologists have begun to employ molecular biology techniques to gain additional clinical information from these same specimens. Anatomic pathologists serve as the definitive diagnosticians for most cancers, as well as numerous other diseases.
- Surgical pathology is the most significant and time-consuming area of practice for most anatomical pathologists. Surgical pathology involves the gross and microscopic examination of surgical specimens, as well as biopsies submitted by non-surgeons such as general internists, medical subspecialists, dermatologists, and interventional radiologists.
- Cytopathology is concerned with the microscopic examination of whole, individual cells obtained from smears or fine needle aspirates.
- Molecular pathology refers to the use of nucleic acid-based techniques, such as in-situ hybridization, reverse-transcriptase polymerase chain reaction, and nucleic acid microarrays for specialised diagnostic studies of disease in tissues and cells.
- Autopsies are used to provide definitive evidence of the disease processes contributing to a person's death.
- Forensic pathology receive specialized training in determining the cause of death and other legally relevant information from the bodies of persons who died in a non-medical or potentially criminal circumstances.
Clinical pathology
Main article: Clinical pathology
Clinical pathology, also known as laboratory medicine, is the medical specialty concerned with diagnosing diseases based on the analysis of body fluids, such as plasma, urine, stool, respiratory or mucosal secretions, inflammatory exudates, and pleural, pericardial, peritoneal, synovial, or cerebrospinal fluid. The practice of clinical pathology is centered around the clinical laboratory. In modern clinical laboratories, many routine studies are largely automated. The clinical pathologist is responsible for overseeing the work of laboratory technicians, performing quality assurance to assure the validity of test results, performing interpretations of more complex studies, and serving as a consultant to clinicians so that the most appropriate studies can be performed for the diagnosis or assessment of an individual patient's condition. In some areas, non-pathologists, such as other physicians or Ph.D.'s may run clinical labs and perform functions within those specific labs which are similar to the role of a board-certified clinical pathologist.
Sub-specialties within clinical pathology include the following:
Oral and Maxillofacial pathology
In the United States, subspecialty-trained doctors of dentistry, rather than medical doctors, can be certified by a professional board to practice Oral and Maxillofacial Pathology.
Training of medical pathologists
Pathology in the United States
In the United States, pathologists are allopathic (MD,MBBS,MBChB,etc.) or osteopathic (DO) physicians, that have completed a four-year undergraduate program, four years of medical school training, and three to four years of postgraduate training in the form of a pathology residency. Training may be within two primary specialties, as recognized by the American Board of Pathology: Anatomic Pathology, and Clinical Pathology, each of which requires separate board certification. Many pathologists seek a broad-based training and become certified in both fields. These skills are complementary in many hospital-based private practice settings, since the day-to-day work of many clinical laboratories only requires the intermittent attention of a physician. Thus, pathologists are able to spend much of their time evaluating anatomic pathology cases, while remaining available to cover any special issues which might arise in the clinical laboratories. Pathologists may pursue specialised fellowship training within one or more sub-specialties of either anatomic or clinical pathology. Some of these sub-specialities permit additional board certification, while others do not.[12]
Pathology in the United Kingdom
In the UK pathologists are medical doctors registered with the UK General Medical Council. They will have completed an undergraduate medical education which in most countries lasts 4-6 years. The training to become a pathologist is under the oversight of the Royal College of Pathologists. Typically a one year training attachment is followed by an aptitude test. This is followed by further specialist training in surgical pathology, cytopathology, and post mortem pathology. There are two examinations run by the Royal College of Pathologists termed Part 1 and Part 2. The Part 2 examination is designed to test competence to work as an independent practitioner in pathology and is typically taken after 5 years specialist training. All post-graduate medical training and education in the UK is overseen by the Postgraduate Medical Education and Training Board. It is possible to take a specialist part 2 examination in paediatric pathology or neuropathology. It is possible to take a special diploma in dermatopathology or cytopathology, recognising additional specialist training and expertise.
Non-human pathology
Veterinary pathologists are veterinary practitioners who specialise in the diagnosis and characterization of veterinary diseases through the examination of animal tissue and body fluids. Veterinary pathologists are veterinarians with advanced training (board certification or Ph.D.) in either diagnostic pathology or research into the biological processes underlying disease (pathobiology). Diagnostic veterinary pathologists are further subcategorized as either anatomical pathologists or clinical pathologists. Clinical pathologists examine specimens such as blood, excretions or biopsy material to diagnose disease in living animals. Anatomical pathologists utilize post mortem examinations of dead animals to arrive at a diagnosis. Post mortem examinations entail a necropsy (an animal autopsy), histopathologic (microscopic) study of tissue specimens collected at the necropsy and sometimes specialized studies (radiographic, toxicologic, etc.)[13]
Plant pathologists are specialized scientists who investigate the causes of diseases in plants.
Notes
- ^ Toby E. Huff (2003), The Rise of Early Modern Science: Islam, China, and the West, p. 54, 246-247, 216-218. Cambridge University Press, ISBN 0521529948.
- ^ a b c d e [1] History of Pathology, at the USC School of Dentistry
- ^ Medicine And Health, "Rise and Spread of Islam 622-1500: Science, Technology, Health", World Eras, Thomson Gale.
- ^ Islamic medicine, Hutchinson Encyclopedia.
- ^ [2] A History of Medicine from the Biblioteca Centrale dell'Area Biomedica
- ^ [3] Founders of Modern Medicine: Giovanni Battista Morgagni. Medical Library and Historical Journal. 1903 October; 1(4): 270–277.
- ^ [4] Karl von Rokitansky at Whonamedit.com
- ^ [5] Rudolf Virchow at Whonamedit.com
- ^ [6] Jewish Encyclopedia entry on Julius Cohnheim
- ^ [7] Mission of the American Society for Investigative Pathology
- ^ a b c d e f Ramzi Cotran, Vinay Kumar, Tucker Collins (1999). Robbins Pathologic Basis of Disease, Sixth Edition. W.B. Saunders. ISBN 072167335X.
- ^ [8] Homepage of the American Board of Pathology
- ^ Veterinary Pathologist: Training - the Royal College of Pathologists.
See also
- Important publications in pathology
Pathology: Cancer, Tumors, neoplasia, and oncology (C00-D48, 140-239) |
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Benign tumors | Hyperplasia - Cyst - Pseudocyst - Hamartoma - Benign tumor |
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Malignant progression | Dysplasia - Carcinoma in situ - Cancer - Metastasis |
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Topography | lip, oral cavity and pharynx: Oral - Head/Neck - Nasopharyngeal
digestive system: tract (Esophagus, Stomach, Small intestine, Colon/rectum, Appendix, Anus) - glands (Liver, Bile duct, Gallbladder, Pancreas)
respiratory system: Larynx - Lung
bone, articular cartilage, skin, and connective tissue: Bone - Skin - Blood
urogenital: breast and female genital organs (Breast, Vagina, Cervix, Uterus, Endometrium, Ovaries) - male genital organs (Penis, Prostate, Testicles) - urinary organs (Kidney, Bladder)
nervous system: Eye - Brain
endocrine system: Thyroid (Papillary, Follicular, Medullary, Anaplastic) - Adrenal tumor (Adrenocortical carcinoma, Pheochromocytoma) - Pituitary |
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Misc. | Tumor suppressor genes/oncogenes - Staging/grading - Carcinogenesis - Carcinogen - Research - Paraneoplastic syndrome - List of oncology-related terms |
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Pathology: hematology (primarily C81-C96/200-208, D45-D47, D50-D77/280-289) |
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WBCs | hematological malignancy (lymphoma, leukemia, multiple myeloma), myeloproliferative disease, myelodysplastic syndrome -cytosis (Agranulocytosis, Leukocytosis, Lymphocytosis, Monocytosis) • -penia (Lymphopenia, Neutropenia) |
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RBCs/anemia/ hemoglobinopathy | nutritional anemia: Iron deficiency anemia, Plummer-Vinson syndrome, Megaloblastic anemia (Pernicious anemia) hereditary hemolytic anemia: G6PD Deficiency, Thalassemia, Sickle-cell disease/trait, Hereditary spherocytosis, Hereditary elliptocytosis, Hereditary stomatocytosis
acquired hemolytic anemia: Autoimmune (Warm), HUS, MAHA, PNH, PCH
aplastic anemia: Acquired PRCA, Diamond-Blackfan anemia, Fanconi anemia • Sideroblastic anemia • Hemochromatosis |
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Coagulation/platelets | coagulopathy: DIC • Hemophilia (A/VII, B/IX, C/XI, XIII) • Von Willebrand disease
Purpura: Henoch-Schönlein, ITP (Evans syndrome), TTP
primary hypercoagulable state: Protein C deficiency -
Protein S deficiency - Antithrombin III deficiency - Antiphospholipid syndrome - Factor V Leiden
other hemorrhagic conditions: Bernard-Soulier syndrome - Glanzmann's thrombasthenia - Grey platelet syndrome |
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Histiocytosis | WHO-I Langerhans cell histiocytosis - non-Langerhans-cell histiocytosis/WHO-II (Juvenile xanthogranuloma, Hemophagocytic lymphohistiocytosis) - malignant histiocytic disorders/WHO-III (Acute monocytic leukemia, Malignant histiocytosis, Erdheim-Chester disease) |
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Other | Asplenia/hyposplenism - Methemoglobinemia |
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Endocrine pathology: endocrine diseases (E00-35, 240-259) |
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Thyroid | Hypothyroidism (Iodine deficiency, Cretinism, Congenital hypothyroidism, Goitre, Myxedema) - Hyperthyroidism (Graves disease, Toxic multinodular goitre, Teratoma with thyroid tissue or Struma ovarii) - Thyroiditis (De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis) - Euthyroid sick syndrome |
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Pancreas | Diabetes mellitus (type 1, type 2, coma, angiopathy, ketoacidosis, nephropathy, neuropathy, retinopathy) - Hypoglycemia - Hyperinsulinism - Zollinger-Ellison syndrome |
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Parathyroid | Hypoparathyroidism (Pseudohypoparathyroidism) - Hyperparathyroidism (Primary, Secondary, Tertiary) |
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Pituitary | Hyperpituitarism (Acromegaly, Hyperprolactinaemia, SIADH) - Hypopituitarism (Simmonds' disease/Sheehan's syndrome, Kallmann syndrome, Growth hormone deficiency, Diabetes insipidus) - Adiposogenital dystrophy - Empty sella syndrome |
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Adrenal | Cushing's syndrome (Nelson's syndrome, Pseudo-Cushing's syndrome) - CAH (due to 21-hydroxylase deficiency) - Hyperaldosteronism (Conn syndrome, Bartter syndrome) - Adrenal insufficiency (Addison's disease) - Hypoaldosteronism |
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Gonads | ovarian dysfunction (Polycystic ovary syndrome, Premature ovarian failure) - testicular dysfunction (5-alpha-reductase deficiency) - general (Hypogonadism, Delayed puberty, Precocious puberty) |
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Other | Autoimmune polyendocrine syndrome - Carcinoid syndrome - Short stature (Laron syndrome, Psychogenic dwarfism) - Gigantism - Androgen insensitivity syndrome - Progeria - Multiple endocrine neoplasia (1, 2) |
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Nutritional pathology (E40-68, 260-269) |
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Malnutrition | Kwashiorkor - Marasmus |
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Other underconsumption | B vitamins: B1: Beriberi/Wernicke's encephalopathy, B2: Ariboflavinosis, B3: Pellagra, B6: Pyridoxine deficiency, B7: Biotin deficiency, B9: Folate deficiency, B12: Vitamin B12 deficiency
other vitamins: A: Vitamin A deficiency/Bitot's spots, C: Scurvy, D: Rickets/Osteomalacia
mineral: Zinc deficiency - Iron deficiency, Magnesium deficiency - Chromium deficiency |
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Hyperalimentation | Obesity - Hypervitaminosis A - Hypervitaminosis D |
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Metabolic pathology / Inborn error of metabolism (E70-90, 270-279) |
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Amino acid | Aromatic (Phenylketonuria, Alkaptonuria, Ochronosis, Tyrosinemia, Albinism, Histidinemia) - Organic acidemias (Maple syrup urine disease, Propionic acidemia, Methylmalonic acidemia, Isovaleric acidemia, 3-Methylcrotonyl-CoA carboxylase deficiency) - Transport (Cystinuria, Cystinosis, Hartnup disease, Fanconi syndrome, Oculocerebrorenal syndrome) - Sulfur (Homocystinuria, Cystathioninuria) - Urea cycle disorder (N-Acetylglutamate synthase deficiency, Carbamoyl phosphate synthetase I deficiency, Ornithine transcarbamylase deficiency, Citrullinemia, Argininosuccinic aciduria, Hyperammonemia) - Glutaric acidemia type 1 - Hyperprolinemia - Sarcosinemia |
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Carbohydrate | Lactose intolerance - Glycogen storage disease (type I, type II, type III, type IV, type V, type VI, type VII) - fructose metabolism (Fructose intolerance, Fructose bisphosphatase deficiency, Essential fructosuria) - galactose metabolism (Galactosemia, Galactose-1-phosphate uridylyltransferase galactosemia, Galactokinase deficiency) - other intestinal carbohydrate absorption (Glucose-galactose malabsorption, Sucrose intolerance) - pyruvate metabolism and gluconeogenesis (PCD, PDHA) -
Pentosuria - Renal glycosuria |
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Lipid storage | Sphingolipidoses/Gangliosidoses: GM2 gangliosidoses (Sandhoff disease, Tay-Sachs disease) - GM1 gangliosidoses - Mucolipidosis type IV - Gaucher's disease - Niemann-Pick disease - Farber disease - Fabry's disease - Metachromatic leukodystrophy - Krabbe disease
Neuronal ceroid lipofuscinosis (Batten disease) - Cerebrotendineous xanthomatosis - Cholesteryl ester storage disease (Wolman disease) |
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Fatty acid metabolism | Lipoprotein/lipidemias: Hyperlipidemia - Hypercholesterolemia - Familial hypercholesterolemia - Xanthoma - Combined hyperlipidemia - Lecithin cholesterol acyltransferase deficiency - Tangier disease - Abetalipoproteinemia
Fatty acid: Adrenoleukodystrophy - Acyl-coA dehydrogenase (Short-chain, Medium-chain, Long-chain 3-hydroxy, Very long-chain) - Carnitine (Primary, I, II) |
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Mineral | Cu Wilson's disease/Menkes disease - Fe Haemochromatosis - Zn Acrodermatitis enteropathica - PO43�' Hypophosphatemia/Hypophosphatasia - Mg2+ Hypermagnesemia/Hypomagnesemia - Ca2+ Hypercalcaemia/Hypocalcaemia/Disorders of calcium metabolism |
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Fluid, electrolyte and acid-base balance | Electrolyte disturbance - Na+ Hypernatremia/Hyponatremia - Acidosis (Metabolic, Respiratory, Lactic) - Alkalosis (Metabolic, Respiratory) - Mixed disorder of acid-base balance - H2O Dehydration/Hypervolemia - K+ Hypokalemia/Hyperkalemia - Cl�' Hyperchloremia/Hypochloremia |
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Purine and pyrimidine | Hyperuricemia - Lesch-Nyhan syndrome - Xanthinuria |
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Porphyrin | Acute intermittent, Gunther's, Cutanea tarda, Erythropoietic, Hepatoerythropoietic, Hereditary copro-, Variegate |
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Bilirubin | Unconjugated (Lucey-Driscoll syndrome, Gilbert's syndrome, Crigler-Najjar syndrome) - Conjugated (Dubin-Johnson syndrome, Rotor syndrome) |
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Glycosaminoglycan | Mucopolysaccharidosis - 1:Hurler/Hunter - 3:Sanfilippo - 4:Morquio - 6:Maroteaux-Lamy - 7:Sly |
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Glycoprotein | Mucolipidosis - I-cell disease - Pseudo-Hurler polydystrophy - Aspartylglucosaminuria - Fucosidosis - Alpha-mannosidosis - Sialidosis |
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Other | Alpha 1-antitrypsin deficiency - Cystic fibrosis - Amyloidosis (Familial Mediterranean fever) - Acatalasia |
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WHO ICD-10 mental and behavioural disorders (F · 290–319) |
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Neurological/symptomatic | Dementia (Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia) · Delirium · Post-concussion syndrome |
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Psychoactive substance | alcohol (drunkenness, alcohol dependence, delirium tremens, Korsakoff's syndrome, alcohol abuse) · opiods (opioid dependency) · sedative/hypnotic (benzodiazepine withdrawal) · cocaine (cocaine dependence) · general (Intoxication, Drug abuse, Physical dependence, Withdrawal) |
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Psychotic disorder | Schizophrenia (disorganized schizophrenia) · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder |
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Mood (affective) | Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia |
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Neurotic, stress-related and somatoform | Anxiety disorder (Agoraphobia, Panic disorder, Panic attack, Generalized anxiety disorder, Social anxiety) · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder (Ganser syndrome) · Somatoform disorder (Somatization disorder, Body dysmorphic disorder, Hypochondriasis, Nosophobia, Da Costa's syndrome, Psychalgia) · Neurasthenia |
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Physiological/physical behavioural | Eating disorder (anorexia nervosa, bulimia nervosa) · Sleep disorder (dyssomnia, insomnia, hypersomnia, parasomnia, night terror, nightmare) · Sexual dysfunction (erectile dysfunction, premature ejaculation, vaginismus, dyspareunia, hypersexuality) · Postpartum depression |
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Adult personality and behaviour | Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome · Ego-dystonic sexual orientation |
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Mental retardation | Mental retardation |
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Psychological development (developmental disorder) | Specific: speech and language (expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp) · Scholastic skills (dyslexia, dysgraphia, Gerstmann syndrome) · Motor function (developmental dyspraxia) Pervasive: Autism · Rett syndrome · Asperger syndrome |
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Behavioural and emotional, childhood and adolescence onset | ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech (stuttering · cluttering) |
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Nervous system pathology, primarily CNS (G00-G47, 320-349) |
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Inflammatory diseases of the CNS | Meningitis (Arachnoiditis) - Encephalitis - Myelitis - Encephalomyelitis (Acute disseminated) - Tropical spastic paraparesis |
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Systemic atrophies primarily affecting the CNS | Huntington's disease - Spinocerebellar ataxia (Friedreich's ataxia, Ataxia telangiectasia, Hereditary spastic paraplegia)
Spinal muscular atrophy: Werdnig-Hoffman disease - Kugelberg-Welander disease - Fazio Londe syndrome - MND (Amyotrophic lateral sclerosis (ALS), Progressive muscular atrophy (PMA), Progressive bulbar, Pseudobulbar, PLS) |
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Extrapyramidal and movement disorders | Parkinson's disease - Neuroleptic malignant syndrome - Postencephalitic parkinsonism - Pantothenate kinase-associated neurodegeneration - Progressive supranuclear palsy - Striatonigral degeneration - Dystonia (Spasmodic torticollis, Meige's syndrome, Blepharospasm) - Essential tremor - Myoclonus - Chorea (Choreoathetosis) - Restless legs syndrome - Stiff person syndrome |
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Other degenerative / demyelinating diseases | Alzheimer's disease - Pick's disease - Alpers' disease - Dementia with Lewy bodies - Leigh's disease - Multiple sclerosis - Devic's disease - Central pontine myelinolysis - Transverse myelitis |
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Seizure/epilepsy | Focal (Simple partial, Complex partial) - Generalised (Tonic-clonic, Absence, Atonic, Benign familial neonatal) - Lennox-Gastaut - West - Epilepsia partialis continua - Status epilepticus (Complex partial status epilepticus) |
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Headache | Migraine (Familial hemiplegic) - Cluster - Vascular - Tension |
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Vascular | Transient ischemic attack (Amaurosis fugax, Transient global amnesia) - Cerebrovascular disease (MCA, ACA, PCA, Foville's syndrome, Millard-Gubler syndrome, Lateral medullary syndrome, Weber's syndrome, Lacunar stroke) |
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Sleep disorders | Insomnia - Hypersomnia - Sleep apnea (Ondine's curse) - Narcolepsy - Cataplexy - Kleine-Levin syndrome - Circadian rhythm sleep disorder - Delayed sleep phase syndrome - Advanced sleep phase syndrome |
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Other | Hydrocephalus (Normal pressure) - Idiopathic intracranial hypertension - Encephalopathy - Brain herniation - Cerebral edema - Reye's syndrome - Syringomyelia - Syringobulbia - Spinal cord compression |
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Nervous system pathology, primarily PNS (G50-G99, 350-359) |
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Nerve, nerve root and plexus disorders | cranial nerve: V (Trigeminal neuralgia) - VII (Facial nerve paralysis, Bell's palsy, Melkersson-Rosenthal syndrome, Central seven) - XI (Accessory nerve disorder)
nerve root and plexus: Brachial plexus lesion - Thoracic outlet syndrome - Phantom limb
mononeuropathy: Carpal tunnel syndrome - Ulnar nerve entrapment - Radial neuropathy - Causalgia - Meralgia paraesthetica - Tarsal tunnel syndrome - Morton's neuroma - Mononeuritis multiplex |
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Polyneuropathies and other disorders of the PNS | Hereditary and idiopathic (Charcot-Marie-Tooth disease, Dejerine Sottas syndrome, Refsum's disease, Morvan's syndrome) - Guillain-Barré syndrome - Alcoholic polyneuropathy - Neuropathy |
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Diseases of myoneural junction and muscle | Myasthenia gravis - Primary disorders of muscles (Muscular dystrophy, Myotonic dystrophy, Myotonia congenita, Thomsen disease, Neuromyotonia, Paramyotonia congenita, Centronuclear myopathy, Nemaline myopathy, Mitochondrial myopathy) - Myopathy - Periodic paralysis (Hypokalemic, Hyperkalemic) - Lambert-Eaton myasthenic syndrome |
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Autonomic | Familial dysautonomia - Horner's syndrome - Multiple system atrophy (Shy-Drager syndrome, Olivopontocerebellar atrophy) |
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Pathology of the eye (primarily H00-H59, 360-379) |
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Eyelid, lacrimal system and orbit | eyelid: inflammation (Stye, Chalazion, Blepharitis) - Entropion - Ectropion - Lagophthalmos - Blepharochalasis - Ptosis - Blepharophimosis - Xanthelasma - Trichiasis
lacrimal system: Dacryoadenitis - Epiphora - Dacryocystitis
orbit: Exophthalmos - Enophthalmos |
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Conjunctiva | Conjunctivitis - Pterygium - Pinguecula - Subconjunctival hemorrhage |
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Sclera and cornea | Scleritis - Keratitis - Corneal ulcer - Snow blindness - Thygeson's superficial punctate keratopathy - Fuchs' dystrophy - Keratoconus - Keratoconjunctivitis sicca - Arc eye - Keratoconjunctivitis - Corneal neovascularization - Kayser-Fleischer ring - Arcus senilis - Band keratopathy |
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Iris and ciliary body | Iritis - Uveitis - Iridocyclitis - Hyphema - Persistent pupillary membrane - Iridodialysis - Synechia |
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Lens | Cataract - Aphakia - Ectopia lentis |
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Choroid and retina | Retinitis - Chorioretinitis - Choroideremia - Retinal detachment - Retinoschisis - Retinopathy (Hypertensive retinopathy, Diabetic retinopathy, Retinopathy of prematurity) - Macular degeneration - Retinitis pigmentosa - Retinal haemorrhage - Central serous retinopathy - Macular edema - Epiretinal membrane - Macular pucker |
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Optic nerve and visual pathways | Optic neuritis - Papilledema - Optic atrophy - Leber's hereditary optic neuropathy |
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Ocular muscles, binocular movement, accommodation and refraction | Paralytic strabismus: Ophthalmoparesis - Progressive external ophthalmoplegia - Palsy (III, IV, VI) - Kearns-Sayre syndrome
Other strabismus: Esotropia/Exotropia - Hypertropia - Heterophoria (Esophoria, Exophoria) - Brown's syndrome - Duane syndrome
Other binocular: Conjugate gaze palsy - Convergence insufficiency - Internuclear ophthalmoplegia - One and a half syndrome
Refractive error: Hyperopia/Myopia - Astigmatism - Anisometropia/Aniseikonia - Presbyopia |
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Visual disturbances and blindness | Amblyopia - Leber's congenital amaurosis - Subjective (Asthenopia, Hemeralopia, Photophobia, Scintillating scotoma) - Diplopia - Scotoma - Anopsia (Binasal hemianopsia, Bitemporal hemianopsia, Homonymous hemianopsia, Quadrantanopia) - Color blindness (Achromatopsia) - Nyctalopia - Blindness/Low vision |
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Pupil | Anisocoria - Argyll Robertson pupil - Marcus Gunn pupil/Marcus Gunn phenomenon - Adie syndrome |
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Infectious diseases | Trachoma - Onchocerciasis |
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Other | Nystagmus - Miosis - Mydriasis - Glaucoma - Ocular hypertension - Floater - Leber's hereditary optic neuropathy - Red eye - Keratomycosis - Xerophthalmia - Aniridia |
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See also congenital |
Circulatory system pathology (I, 390-459) |
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Hypertension | Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension (Renovascular hypertension) |
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Ischaemic heart disease | Angina pectoris (Prinzmetal's angina) - Myocardial infarction - Dressler's syndrome |
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Pulmonary circulation | Pulmonary embolism - Cor pulmonale |
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Pericardium | Pericarditis - Pericardial effusion - Cardiac tamponade |
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Endocardium/heart valves | Endocarditis - mitral valves (regurgitation, prolapse, stenosis) - aortic valves (stenosis, insufficiency) - pulmonary valves (stenosis, insufficiency) - tricuspid valves (stenosis, insufficiency) |
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Myocardium | Myocarditis - Cardiomyopathy (Dilated cardiomyopathy, Hypertrophic cardiomyopathy, Loeffler endocarditis, Restrictive cardiomyopathy) - Arrhythmogenic right ventricular dysplasia |
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Electrical conduction system of the heart | Heart block: AV block (First degree, Second degree, Third degree) - Bundle branch block (Left, Right) - Bifascicular block - Trifascicular block Pre-excitation syndrome (Wolff-Parkinson-White, Lown-Ganong-Levine) - Long QT syndrome - Adams-Stokes syndrome - Cardiac arrest - Sudden cardiac death Arrhythmia: Paroxysmal tachycardia (Supraventricular, AV nodal reentrant, Ventricular) - Atrial flutter - Atrial fibrillation - Ventricular fibrillation - Premature contraction (Atrial, Ventricular) - Ectopic pacemaker - Sick sinus syndrome |
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Other heart conditions | Heart failure - Cardiovascular disease - Cardiomegaly - Ventricular hypertrophy (Left, Right) |
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Cerebrovascular diseases | Intracranial hemorrhage/cerebral hemorrhage: Extra-axial hemorrhage (Epidural hemorrhage, Subdural hemorrhage, Subarachnoid hemorrhage) Intra-axial hematoma (Intraventricular hemorrhages, Intraparenchymal hemorrhage) - Anterior spinal artery syndrome - Binswanger's disease - Moyamoya disease |
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Arteries, arterioles and capillaries | Atherosclerosis (Renal artery stenosis) - Aortic dissection/Aortic aneurysm (Abdominal aortic aneurysm) - Aneurysm - Raynaud's phenomenon/Raynaud's disease - Buerger's disease - Vasculitis/Arteritis (Aortitis) - Intermittent claudication - Arteriovenous fistula - Hereditary hemorrhagic telangiectasia - Spider angioma |
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Veins, lymphatic vessels and lymph nodes | Thrombosis/Phlebitis/Thrombophlebitis (Deep vein thrombosis, May-Thurner syndrome, Portal vein thrombosis, Venous thrombosis, Budd-Chiari syndrome, Renal vein thrombosis, Paget-Schroetter disease) - Varicose veins / Portacaval anastomosis (Hemorrhoid, Esophageal varices, Varicocele, Gastric varices, Caput medusae) - Superior vena cava syndrome - Lymph (Lymphadenitis, Lymphedema, Lymphangitis) |
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Other | Hypotension (Orthostatic hypotension) |
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See also congenital (Q20-Q28, 745-747) |
Pathology of respiratory system (J, 460–519) |
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Acute upper respiratory infections | Upper respiratory tract infection · Common cold · Rhinitis · Sinusitis · Pharyngitis (Strep throat) · Tonsillitis · Laryngitis · Tracheitis · Croup · Epiglottitis |
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Influenza and Pneumonia | Influenza · Pneumonia (Viral, Bacterial, Bronchopneumonia) · Severe acute respiratory syndrome |
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Other acute lower respiratory infections | Bronchitis (Acute, Chronic) · Bronchiolitis |
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Other diseases of upper respiratory tract | Vasomotor rhinitis · Hay fever · Atrophic rhinitis · Nasal polyp · Deviated septum · Adenoid hypertrophy · Peritonsillar abscess · Vocal fold nodule · Laryngospasm |
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Chronic lower respiratory diseases | Emphysema · COPD · Asthma · Status asthmaticus · Bronchiectasis |
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Lung diseases due to external agents | Pneumoconiosis (Coalworker's pneumoconiosis, Asbestosis, Silicosis, Bauxite fibrosis, Berylliosis, Siderosis) · Byssinosis · Hypersensitivity pneumonitis (Farmer's lung, Bird fancier's lung) |
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Other, principally affecting the interstitium | Acute respiratory distress syndrome · Pulmonary edema · Hamman-Rich syndrome · Interstitial lung disease |
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Suppurative and necrotic conditions of lower respiratory tract | Lung abscess · Pleural effusion · Empyema |
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Other | Pneumothorax · Hemothorax · Hemopneumothorax · Mendelson's syndrome · Respiratory failure · Atelectasis · Mediastinal emphysema · Mediastinitis |
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see also congenital (Q30–Q34, 748) |
Oral Pathology: Oral pathology (K00-K14, 520-529) |
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Developmental Anomalies | Anodontia/Hypodontia - Hyperdontia - abnormalities of size and form of teeth (Concrescence, Fusion, Gemination, Dens evaginatus/Talon cusp, Dens invaginatus, Enamel pearl, Macrodontia, Microdontia, Taurodontism) - disturbances in tooth formation (Dilaceration, Regional odontodysplasia, Turner's hypoplasia) - other hereditary disturbances in tooth structure (Amelogenesis imperfecta, Dentinogenesis imperfecta, Dentin dysplasia) |
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Hard, Soft and Periapical Tissues | Attrition - Abrasion - Ankylosis - Dental caries - Denticles - Erosion - External resorption - Fluorosis - Gingivitis - Impaction - Internal resorption - Periodontitis - Pulpitis - Ulcer |
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Dentofacial Anomalies | Malocclusion - Micrognathism - Prognathism - Retrognathism - Temporomandibular joint disorder |
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Maxillomandibular anomalies | Odontogenic keratocyst - Torus mandibularis - Torus palatinus - Cherubism - Ameloblastoma |
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Salivary glands | Drooling - Benign lymphoepithelial lesion - Necrotizing sialometaplasia - Ranula - Sialadenitis - Sialolithiasis - Stomatitis - Xerostomia - Aphthous ulcer |
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Lip and Oral mucosa | Angular cheilitis - Erythroplakia - Hairy leukoplakia - Leukoplakia |
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Tongue | Geographic tongue - Fissured tongue - Glossitis - Glossodynia - Black hairy tongue |
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Digestive system - Gastroenterology (primarily K20-K93, 530-579) |
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Esophagus | Esophagitis - GERD - Achalasia - Boerhaave syndrome - Nutcracker esophagus - Zenker's diverticulum - Mallory-Weiss syndrome - Barrett's esophagus |
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Stomach/ duodenum | Peptic (gastric/duodenal) ulcer - Gastritis - Gastroenteritis - Duodenitis - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroparesis - Gastroptosis - Portal hypertensive gastropathy |
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Hernia | Inguinal (Indirect, Direct) - Femoral - Umbilical - Incisional - Diaphragmatic - Hiatus |
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Noninfective enteritis and colitis | IBD (Crohn's, Ulcerative colitis) - noninfective gastroenteritis |
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Other intestinal | vascular (Abdominal angina, Mesenteric ischemia, Ischemic colitis, Angiodysplasia) - Ileus/Bowel obstruction (Intussusception, Volvulus) - Diverticulitis/Diverticulosis - IBS other functional intestinal disorders (Constipation, Diarrhea, Megacolon/Toxic megacolon, Proctalgia fugax) - Anal fissure/Anal fistula - Anal abscess - Rectal prolapse - Proctitis (Radiation proctitis) |
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Liver/hepatitis | Alcoholic liver disease - Liver failure (Acute liver failure) - Cirrhosis - PBC - NASH - Fatty liver - Peliosis hepatis - Portal hypertension - Hepatorenal syndrome |
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Accessory digestive | Gallbladder (Gallstones, Choledocholithiasis, Cholecystitis, Cholesterolosis, Rokitansky-Aschoff sinuses)
Biliary tree (Cholangitis, Cholestasis/Mirizzi's syndrome, PSC, Biliary fistula, Ascending cholangitis)
Pancreas (Acute pancreatitis, Chronic pancreatitis, Pancreatic pseudocyst, Hereditary pancreatitis) |
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Other/general | Appendicitis - Peritonitis (Spontaneous bacterial peritonitis)
Malabsorption (celiac, Tropical sprue, Blind loop syndrome, Whipple's)
postprocedural: Gastric dumping syndrome - Postcholecystectomy syndrome
bleeding: Hematemesis - Melena - Gastrointestinal bleeding (Upper, Lower) |
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See also congenital |
Diseases of the skin and subcutaneous tissue (integumentary system) (L, 680-709) |
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Infections | Staphylococcus (Staphylococcal scalded skin syndrome, Impetigo, Boil, Carbuncle) - Cellulitis (Paronychia) - Acute lymphadenitis - Pilonidal cyst - Corynebacterium (Erythrasma) |
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Bullous disorders | Pemphigus - Pemphigoid (Bullous pemphigoid) - Dermatitis herpetiformis |
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Dermatitis and eczema | Atopic dermatitis - Seborrhoeic dermatitis (Dandruff, Cradle cap) - Diaper rash - Urushiol-induced contact dermatitis - Contact dermatitis - Erythroderma - Lichen simplex chronicus - Prurigo nodularis - Itch - Pruritus ani - Nummular dermatitis - Dyshidrosis - Pityriasis alba |
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Papulosquamous disorders | Psoriasis (Psoriatic arthritis) - Parapsoriasis (Pityriasis lichenoides et varioliformis acuta, Pityriasis lichenoides chronica) - Pityriasis rosea - Lichen planus - Pityriasis rubra pilaris - Lichen nitidus |
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Urticaria and erythema | Urticaria (Dermatographic urticaria, Cholinergic urticaria) - Erythema (Erythema multiforme, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Erythema nodosum, Erythema annulare centrifugum, Erythema marginatum) |
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Radiation-related disorders | Sunburn - Actinic keratosis - Polymorphous light eruption - Radiodermatitis - Erythema ab igne |
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Disorders of skin appendages | nail disease: Ingrown nail - Onychogryposis - Beau's lines - Yellow nail syndrome
hair loss: Alopecia areata (Alopecia totalis, Alopecia universalis, Ophiasis) - Androgenic alopecia - Telogen effluvium - Traction alopecia - Lichen planopilaris - Trichorrhexis nodosa
other follicular disorders: Hypertrichosis (Hirsutism) - Acne vulgaris - Rosacea (Perioral dermatitis, Rhinophyma) - follicular cysts (Epidermoid cyst, Sebaceous cyst, Steatocystoma multiplex) - Pseudofolliculitis barbae - Hidradenitis suppurativa
sweat disorders: eccrine (Miliaria, Anhidrosis) - apocrine (Body odor, Chromhidrosis, Fox-Fordyce disease) |
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Other | pigmentation (Vitiligo, Melasma, Freckle, Café au lait spot, Lentigo/Liver spot) - Seborrheic keratosis - Acanthosis nigricans - Callus - Pyoderma gangrenosum - Bedsore - Keloid - Granuloma annulare - Necrobiosis lipoidica - Granuloma faciale - Lupus erythematosus - Morphea - Calcinosis cutis - Sclerodactyly - Ainhum - Livedoid vasculitis |
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see also congenital (Q80-Q84, 757) |
Diseases of the musculoskeletal system and connective tissue (M, 710-739) |
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Arthropathies | Arthritis (Septic arthritis, Reactive arthritis, Rheumatoid arthritis, Psoriatic arthritis, Felty's syndrome, Juvenile idiopathic arthritis, Still's disease) - crystal (Gout, Chondrocalcinosis) - Osteoarthritis (Heberden's node, Bouchard's nodes)
acquired deformities of fingers and toes (Boutonniere deformity, Bunion, Hallux rigidus, Hallux varus, Hammer toe) - other acquired deformities of limbs (Valgus deformity, Varus deformity, Wrist drop, Foot drop, Flat feet, Club foot, Unequal leg length, Winged scapula)
patella (Luxating patella, Chondromalacia patellae)
Protrusio acetabuli - Hemarthrosis - Arthralgia - Osteophyte |
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Systemic connective tissue disorders | Polyarteritis nodosa - Churg-Strauss syndrome - Kawasaki disease - Hypersensitivity vasculitis - Goodpasture's syndrome - Wegener's granulomatosis - Arteritis (Takayasu's arteritis, Temporal arteritis) - Microscopic polyangiitis - Systemic lupus erythematosus (Drug-induced) - Dermatomyositis (Juvenile dermatomyositis) - Polymyositis - Scleroderma - Sjögren's syndrome - Behçet's disease - Polymyalgia rheumatica - Eosinophilic fasciitis - Hypermobility |
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Dorsopathies | Kyphosis - Lordosis - Scoliosis - Scheuermann's disease - Spondylolysis - Torticollis - Spondylolisthesis - Spondylopathies (Ankylosing spondylitis, Spondylosis, Spinal stenosis) - Schmorl's nodes - Degenerative disc disease - Coccydynia - Back pain (Radiculopathy, Neck pain, Sciatica, Low back pain) |
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Soft tissue disorders | muscle: Myositis - Myositis ossificans (Fibrodysplasia ossificans progressiva)
synovium and tendon: Synovitis - Tenosynovitis (Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome)
bursitis (Olecranon, Prepatellar, Trochanteric)
fibroblastic (Dupuytren's contracture, Plantar fasciitis, Nodular fasciitis, Necrotizing fasciitis, Fasciitis, Fibromatosis)
enthesopathies (Iliotibial band syndrome, Achilles tendinitis, Patellar tendinitis, Golfer's elbow, Tennis elbow, Metatarsalgia, Bone spur, Tendinitis)
other, NEC: Muscle weakness - Rheumatism - Myalgia - Neuralgia - Neuritis - Panniculitis - Fibromyalgia |
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Osteopathies | disorders of bone density and structure: Osteoporosis - Osteomalacia - continuity of bone (Pseudarthrosis, Stress fracture) - Monostotic fibrous dysplasia - Skeletal fluorosis - Aneurysmal bone cyst - Hyperostosis - Osteosclerosis
Osteomyelitis - Avascular necrosis - Paget's disease of bone - Algoneurodystrophy - Osteolysis - Infantile cortical hyperostosis |
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Chondropathies | Juvenile osteochondrosis (Legg-Calvé-Perthes syndrome, Osgood-Schlatter disease, Köhler disease, Sever's disease) - Osteochondritis - Tietze's syndrome |
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See also congenital conditions (Q65-Q79, 754-756) |
Diseases of the pelvis, genitals and breasts (N40-N99, 600-629) |
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Diseases of male genital organs | prostate: Benign prostatic hyperplasia - Prostatitis
testicle/epididymis: Hydrocele testis - Spermatocele - Testicular torsion - Orchitis - Epididymitis - Male infertility (Azoospermia, Oligospermia)
penis: Phimosis - Balanoposthitis - Balanitis - Priapism - Erectile dysfunction - Peyronie's disease
Hematospermia - Retrograde ejaculation |
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Disorders of breast | Chronic cystic mastitis - Mastitis - Gynecomastia - Galactorrhea - Mastodynia - Nipple discharge - Galactocele |
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Inflammatory diseases of female pelvic organs | Pelvic inflammatory disease: Salpingitis - Oophoritis - Hydrosalpinx - Parametritis - Vaginitis - Vulvitis |
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Noninflammatory disorders of female genital tract | Endometriosis (Adenomyosis) - prolapse (Cystocele, Rectocele, Urethrocele)
obstetric fistulae (Vesicovaginal fistula, Rectovaginal fistula)
Ovarian cyst - Endometrial polyp - Retroverted uterus - Asherman's syndrome - Hematometra - Leukorrhea
menstruation (Amenorrhoea, Oligomenorrhea, Menorrhagia, Menometrorrhagia, Metrorrhagia, Dysmenorrhea)
intercourse (Dyspareunia, Vaginismus) - Mittelschmerz
Atrophic vaginitis - Habitual abortion - Female infertility (Anovulation) - Ovarian hyperstimulation syndrome |
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See also congenital conditions (Q50-Q56, 752) |
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