pathophysiology 1(conspectus of disease)
TRANSCRIPT
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Pathophysiology
Pathology Physiology+
?
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Pathophysiology
Pathology Physiology+
structural
changes during
diseases
normal function
and metabolism
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Pathophysiology
PrefacePreface
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Pathophysiology
Pathophysiology
Physiology
Physiology
object of study
Normalbody
Diseasedbody
PathologyPathology
angle of study
Function & metabolism
Morphologicalchange
Differenc
e
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Pathophysiology
Focuses on the functional and metabolic
alterations and mechanisms underlying
the development of diseases.
Pathophysiology
A subject to explore the rule of origin and evolution of disease processes and the underlying mechanisms. An Important preclinical science on which the practice of clinical medicine is based.
Why we need to learn
Pathophysiology?
??Why is Pathophysiology
important?
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Position of Pathophysiology
Basic M
edica
l S
cience
s B
asic M
edica
l S
cience
s
Clin
ical
Med
icine
Clin
ical
Med
icine
Pathophysiol
ogy
Pathophysoiology is an essential introduction to clinical medicine.
Understand the mechanisms of diseases know how to treat the diseases.
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Bleeding
Haemorrhage
？Stop bleeding
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Bleeding
Haemorrhage
？
Why bleeding ?
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Trauma bleeding
Tie up the wound with bandage
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Trauma bleeding
Transfuse blood or fluid
to maintain BP
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Trauma bleeding
Drugs (Promote coagulation)
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Disseminated Intravascular Coagulation /
DIC bleeding
Thrombosis
Exhaustion ofcoagulation factor
Bleeding
Ecchymo
sis
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Disseminated Intravascular Coagulation /
DIC bleeding
Drugs Promote coagulation aggravate thrombosis
Anti-coagulation (heparin)
Thrombosis Exhaustion of
coagulation factor Bleeding
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Task of Pathophysiology
Rules & mechanismsOf Diseases
Function andMetabolism
Treatment principleof Diseases
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Content of Pathophysiology
Conspectus of Disease
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Content of Pathophysiology
Fundamental pathological processes
Disorders of Water and Electrolyte Metabolism
Acid-Base Disturbance
Hypoxia, Fever, DIC
Shock, Ischemia-Reperfusion Injury
Apoptosis……
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Content of Pathophysiology
Pathophysiology of critical systems and organs in diseased body
Heart Failure
Respiratory Failure
Hepatic Failure
Renal Failure
Brain Dysfunction
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Research Methods
Clinical Observation
Animal Experiment
Epidemiological Study
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Clinical Observation
Very useful, but has limitation.
Give proper diagnose and treatment ASAP.
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Animal Experiment
Establish a lot of animal models for human diseases.
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Pathophysiology
Conspectus of Disease
Conspectus of Disease
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Concept of DiseaseConcept of Disease
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Health and Disease
Health
Sub-health
Disease
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WHO Health Definition：
Health indicates the absence of disease
or infirmity.
Not only without any evidence of disease,
it is a state of complete physical,
psychological and social well-being.
WHO: World Health Organization
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Disease
Disease is referred as aberrant manifestation of deregulated homeostasis caused by harmful agents.
Disease reflects an opposite situation of health.
Disease is an abnormal life process under the actions of certain cause and condition, with disturbances of function, metabolism and structure in the body, which are manifested by a series of symptoms and signs.
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The sub - health condition refers to a
state at which the person doesn’t show
specific symptoms and signs of disease, but
lives a low-quality of life both physically and
mentally.
It is a state between health and disease.
Sub-Health
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Etiology of disease Etiology is a science to study the contributing factors that cause diseases.
Causes of diseases
Predisposing factors
Precipitating factors
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Causes of disease
A wide range of extrinsic and
intrinsic factors are involved.
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Biological agents
Genetic factorsPsychologicalfactors
Immunologicalfactors
Congenital factors
Nutritional imbalance
Causes of disease
extrinsic
intrinsic
Physical agents
chemical agents
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Biological agents
Bacteria
Virus
Fungi
Rickettsia ……
Referred as microorganisms and parasites.
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Physical agents Extremes of temperature Mechanical injuries Radiation Electricity ……
Steam / Boiled water
Scald
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Physical agents
Cold
Frostbite
The coldest winter in China ?
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Physical agents
Squeeze
Crush injury
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Chemical agents
Strong acid & alkalis Heavy metal Carbon monoxide Alcohol
……
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Nutritional imbalance
Excesses of nutrients
Deficiencies of nutrients
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Excesses of nutrients
Obesity
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Excesses of nutrients
High lipid, high carbohydrate
ArtheriosclerosisDiabetes
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Lack of vitamins, calcium
……
Deficiencies of nutrients
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Deficiencies of nutrients
False Milk Powder
Fat ?
Edema.
X
√
Low / no protein
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Biological agents
Psychologicalfactors
Immunologicalfactors
Nutritional imbalance
Causes of disease
extrinsic
intrinsic
Physical agents
chemical agents
Genetic factors
Congenital factors
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Genetic factors
Some Diseases
may be caused
by gene absence
or mutation.
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Congenital factors
Hare lip
Due to the developmen
tal error during
pregnancy
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Psychological factors
Rush work Bad interpersonal relationship
Emotional responseEmotional response
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Predisposing factors
A Predisposing factor refers to the factor that influences the susceptibility or resistance to certain disease.
Genetic constitution
Physiological diathesis
Psychological characteristics
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Precipitating factors
It implies that the factors intensify the roles of causative factors and promote the onset and development of diseases.
Natural conditions
Physical condition
Social condition
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Precipitating & Predisposing factor
Cold
Cause
Precipitating factors
Other diseasesHeart failure….
cold environment, fatigue…
virus
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Pathogenesis of disease
Pathogenesis of disease refers to the rules and mechanisms underlying the development or evolution of the disease.
It studies how the primary pathological agents cause disease in organism and how the disease develops.
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1. Disruption of homeostasis
2. Process of damage and anti-damage
3. Alternation of cause and effect
4. Correlation between systemic and local regulations
General rules for pathogenesis of diseases
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Homeostasis
Balanced and stable
The internal environment of an organism tends to remain balanced
and stable
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Homeostasis
T: 37 ℃ BP: systole: 90-120 mmHg
diastole: 60-90 mmHg
PH: 7.35-7.45
RBC, WBC, Pt……
Hormone level……
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Disruption of homeostasis
Imbalanced and unstable
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Anti-damage > damage — mend
Anti-damage ≈ damage — deferment
Anti-damage < damage — worse
Process of damage and anti-damage
The development of disease is also a process of damage and anti-damage.
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Anti-damagefactor
Damagefactor
Burn
constriction of small vessels
early stage
severe prolonged BP
Hypoxia
A factor may be both an anti-damage factor and damage factor
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Alternation of cause and effect
In the development of a disease, the cause of the disease leads to a result.
The result can be another cause of the disease in the evolution process.
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Bleeding Cardiac output ↓ BP↓ Sympathetic nerve
activation
Arteries and veins contraction
Tissue hypoxia
Capillary vessel open
Blood return ↓
Microcirculation stasis
Alternation of cause and effect
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Correlation between
systemic and local regulations
Systemic Local
Systemic and local changes may work each other
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Diabetes Folliculitis
Systemic Changes
Localsign
Fever, elevated leukocytes…
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Fundamental mechanisms for diseases
1. Neural mechanism
2. Humoral mechanism
3. Cellular mechanism
4. Molecular mechanism
Although different diseases may have different mechanisms, they all general invlove the following four levels of deregulations:
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Neural mechanism Neural system plays a central role in regulating life activities.
Disorders of neural system will definitely affect other systems.
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Neural mechanism
Damage neurons directly
Interrupt the metabolism of neuron cells
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Humoral mechanism
Endocrine
Paracrine
Autocrine
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Blood
Target cell
Endocrine cell
Endocrine
Target cell
Beyond
Beyond
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Secrete cell
Paracrine
Target cell
Target cell
Target cell
Neighboring
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Autocrine
Secrete cell also target cell
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Cellular mechanism
Cellular damage is fundamental
in the development of diseases.
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Cellular mechanism
Disturbance of cell membrane transporting system
Disturbance of mitochondria
Disturbance of lysosome
Disturbance of cellular metabolism
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Cellular mechanism
Destroy the cells without selection
Destroy the cells selectively
strong acid and alkali
hepatitis virus
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Molecular mechanism
Cytoskeleton proteins
Enzymes
Receptors
Pumps,
Channels ……
Alterations of different types of molecules.
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Outcome of disease
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Complete recovery
Incomplete recovery
Death
Outcome of diseaseThere are general three types of outcomes of diseases:
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Complete recovery
The best outcome of a disease
Metabolism, structure and function restore perfectly.
Symptoms and signs disappear entirely
Cold
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The main symptoms disappear
Some pathological changes are
still there
Incomplete recovery
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Incomplete recovery
Heart disease hypertrophy
CO, BP…
Normal
hypertrophy
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Clinical death
The cessation of heartbeat and breath.
May be reversed by proper medical attempts
Such as CPR (cardiopulmonary
resuscitation)
Death
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Brain death
Real death A state of prolonged irreversible cessation of all brain activity.
With the complete absence of conscious voluntary movements responses to stimuli brain stem reflexes spontaneous respiration
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WHO criteria of Brain death
Cessation of spontaneous respiration
Irreversible coma
Absence of cephalic reflexes and dilated pupils
Absence of any electrical activity of brain
Absence of brain blood flow
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Have you ever heard
vegetative state ?
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Brain death and vegetative state
Brain death Vegetative state
Reversible No Yes
Spontaneous respiration
No Yes
Cephalic reflexes
No Yes
Conscious No No
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Significance of brain death
Judging the death time
Whether the rescue goes on
Organ transplantation
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Task and content of Pathophysiology
Concept of health and disease
Causes of disease, predisposing and precipitating factors of disease
General rules for pathogenesis of disease
Fundamental mechanisms for diseases
Outcomes of disease
Concept and criteria of brain death
Summary
