Pathophysiology 1(conspectus Of Disease)

Pathophysiology DURGE RAJ GHALAN [email protected]

Pathophysiology

? Pathology

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Physiology

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Pathophysiology

Pathology

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Physiology

structural changes

normal function and

during diseases

metabolism

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Pathophysiology

Preface 4

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Physiology

Difference

Normal body

Pathophysiology

object of study

Diseased body

Pathology

angle of study

Function & Morphological change metabolism 5

Pathophysiology

Focuses on the functional and metabolic alterations and mechanisms underlying the development of diseases. 6

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 is Pathophysiology important? Why we need to learn Pathophysiology?

Position of Pathophysiology

Clinical Medicine

Basic Medical Sciences

Pathophysiology

Pathophysoiology is an essential introduction to clinical medicine. Understand the mechanisms of diseases how to treat the diseases.

know 9

Bleeding Haemorrhage

？

Stop bleeding 10

Why bleeding ? Bleeding Haemorrhage

？ 11

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 Ecchymosis Exhaustion of coagulation factor

Bleeding

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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 Function and Metabolism

Rules & mechanisms Of Diseases

Treatment principle of 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 20

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. 22

 Animal Experiment

Establish a lot of animal models for human diseases. 23

Pathophysiology

Conspectus of Disease 24 24

Concept of Disease

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Health and Disease Disease

Health

Sub-health

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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 27

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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Sub-Health 

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.

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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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extrinsic Physical agents

chemical agents Nutritional imbalance

Biological agents Causes of disease Psychological factors

Genetic factors

Immunological factors

Congenital factors

intrinsic

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Biological agents Referred as microorganisms and parasites.  Bacteria  Virus  Fungi  Rickettsia

……

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Physical agents  Extremes of temperature  Mechanical injuries  Radiation  Electricity ……

Steam / Boiled water

Scald 34

Physical agents Cold

Frostbite The coldest winter in China ? 35

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

Artheriosclerosis Diabetes

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Deficiencies of nutrients Lack of vitamins, calcium

……

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Deficiencies of nutrients False Milk Powder

Low / no protein

Fat ? X

Edema. √

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extrinsic Physical agents

chemical agents Nutritional imbalance

Biological agents Causes of disease Psychological factors

Genetic factors

Immunological factors

Congenital factors

intrinsic

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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 developmental error during pregnancy

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Psychological factors

Rush work

Bad interpersonal relationship

Emotional 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 48

Cause

virus

cold environment, fatigue…

Cold

Precipitating factors

Precipitating & Predisposing factor

Other diseases Heart failure…. 49

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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General rules for pathogenesis of diseases  Disruption of homeostasis  Process of damage and anti-damage  Alternation of cause and effect  Correlation between systemic and local regulations

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Homeostasis The internal environment of an organism tends to remain balanced and stable

Balanced and stable 52

Homeostasis T: 37 ℃

BP: systole: 90-120 mmHg

PH: 7.35-7.45

diastole: 60-90 mmHg

RBC, WBC, Pt…… Hormone level… …

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Disruption of homeostasis

Imbalanced and unstable

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Process of damage and anti-damage Anti-damage > damage — mend Anti-damage ≈ damage — deferment Anti-damage < damage — worse The development of disease is also a process of damage and anti-damage. 55

A factor may be both an anti-damage factor and damage factor

Anti-damage factor BP

Damage factor

early stage

severe Hypoxia prolonged

Burn constriction of small vessels 56

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 ↓

Blood return ↓

Microcirculation stasis

BP↓

Alternation of cause and effect

Capillary vessel open

Sympathetic nerve activation

Arteries and veins contraction

Tissue hypoxia 58

Correlation between systemic and local regulations Systemic

Local

Systemic and local changes may work each other

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Local sign

Diabetes

Folliculitis

Systemic Changes Fever, elevated leukocytes… 60

Fundamental mechanisms for diseases Although different diseases may have different mechanisms, they all general invlove the following four levels of deregulations:

1. Neural mechanism 2. Humoral mechanism 3. Cellular mechanism 4. Molecular mechanism 61

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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Endocrine cell

d n o y e B

d

n yo

Be

Target cell

Blood

Target cell

Endocrine 65

Neighboring Secrete cell Target cell

Target cell

Target cell

Paracrine 66

Secrete cell also target cell

Autocrine 67

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 strong acid and alkali  Destroy the cells without selection  Destroy the cells selectively

hepatitis virus 70

Molecular mechanism Alterations of different types of molecules.  Cytoskeleton proteins  Enzymes  Receptors  Pumps,  Channels …… 71

Outcome of disease

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Outcome of disease There are general three types of outcomes of diseases:

Complete recovery Incomplete recovery Death 73

Complete recovery  The best outcome of a disease  Metabolism, structure and function restore perfectly.  Symptoms and signs disappear entirely

Cold 74

Incomplete recovery  The main symptoms disappear  Some pathological changes are still there

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Incomplete recovery hypertrophy CO, BP… Normal

Heart disease

hypertrophy 76

Death Clinical death  The cessation of heartbeat and breath.  May be reversed by proper medical attempts Such as CPR (cardiopulmonary resuscitation) 77

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 78

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

Reversible Spontaneous respiration Cephalic reflexes Conscious

Brain death

Vegetative state

No

Yes

No

Yes

No

Yes

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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Summary       

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

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Thank you ! Department of Pathophysiology Hongmei TAN Email: [email protected]