Pathophysiology Department of Pathophysiology Shanghai
Jiao-Tong University School of Medicine
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CHAPTER 1 General Introduction of Pathophysiology Main teaching
content and Syllabus Why do we study pathophysiology What is
pathophysiology?
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Pathophysiology may be defined as the physiology of disease, of
disordered function, or derangement of function seen in disease
that is produced by the action of an etiologic agents on
susceptible tissues or organs. Pathophysiology includes also the
study of the mechanisms underlying disease. Concept of
Pathophysiology
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Why do we study pathophysiology bridge subject basicsciences
clinicalmedicine pathophysiology Pathophysiology is an important
subject bridging Basic sciences and clinical medicine.
Position
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Main teaching content and Syllabus Fundamental pathological
process Common changes of function, metabolism and structure
occurred in the different diseases, e.g. Content Conspectus of
disease The general concept of diseases and general etiology and
pathogenesis of diseases. Systemic pathophysiology Systemic
pathophysiology Heart failure, respiratory failure, hepatic
failure, renal failure, e.g.
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Syllabus Format Time Teaching content Lecture 42h Introduction;
Conspectus of disease; Apoptosis Lecture 42h Introduction;
Conspectus of disease; Apoptosis and related disease; Water and
electrolytes and related disease; Water and electrolytes imbalance;
Acid-base imbalance; Fever; Stress; imbalance; Acid-base imbalance;
Fever; Stress; Hypoxia; DIC; Shock; Ischemia-reperfusion Hypoxia;
DIC; Shock; Ischemia-reperfusion injury; Respiratory failure; Heart
failure; Hepatic injury; Respiratory failure; Heart failure;
Hepatic failure; Renal failure. failure; Renal failure. Self-study
Signal transduction and related disease. CBL 4h Four case; Group
learning. CBL 4h Four case; Group learning.
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CHAPTER 2 Conspectus of Disease Concepts of Health and
DiseaseConcepts of Health and Disease Etiology of DiseaseEtiology
of Disease Pathogenesis of DiseasePathogenesis of Disease Outcome
of DiseaseOutcome of Disease
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Health Concepts of Health and Disease The World Health
Organization affirms that health is more than the absence of
disease, but rather a state of complete physical, mental, and
social well-being, This definition sets a lofty goal for patients
seeking health as well as for health care professionals. health
Factor in health physical well-being mental well-being social
well-being
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Sub-Health Sub-Health There is a situation, in which the person
dose not show specific symptoms and signs of disease, but lives a
low- quality of life both physically and mentally. angst
Manifestation of sub-health Manifestation of sub-health physical
sub-health: fatigue & disability; hyponoia; gastralgia;
heart-throb, etc. gastralgia; heart-throb, etc. mental sub-health:
angst; fidget; irascibility; insomnia, etc. social sub-health: not
concerned with our roles within society as a whole. society as a
whole. irascibility
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Homeostasis Neural regulated Humoral regulated Signal regulated
in cell disease is caused by the etiological factors. base of
disease is deregulated homeostasis. Factor in disease Factor in
disease Disease Disease is referred as aberrant manifestation of
deregulated homeostasis caused by harmful agents. Disease is
defined as an abnormal life process which is induced by disorders
of homeostasis under the action of certain cause(s).
deregulated
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Senescence Senescence is a biological process of dyfunctional
change by which organisms become less capable of maintaining
physiological function and homeostasis with increasing survival.
This leads to a reduced probability of reproduction and an
increased susceptibility to death from both exogenous and
endogenous causes.
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Etiology of Disease Concept of Etiological Factors &
Predisposing Etiologic factors involved in diseases include
causative, predisposing and precipitating factors, which
contributes to the onset of diseases. Etiological factors
Etiological factors The factor that causes the disease and
determine the clinical features of the disease Among the
etiological factors, a wide range of extrinsic factors in the
environment and intrinsic factors in the body must be
considered.
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Predisposing factors Predisposing factors The function of these
factors is to intensify the effects of causative factors and
promote the onset and development of diseases. precipitating factor
The factors promotes the development of disease and influences the
timing of illness onset. risk factors risk factors The risk factor
concept is epistemological in nature: it is often not clear exactly
what a risk factor contributes to understanding and
explanation.
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Classification of etiological factors biological agents Factors
of environment Factors of environment physical agents chemical
agents Genetic aberrancies may be caused by single or polygenic
mutations. Inherited factors Inherited factors gene mutation
genetic predisposition The genetic mutations cause problems only
when a person is eposed to certain environmental agents.
chromosomal aberration 21
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Congenital factors Congenital factors The disorders are of a
developmental nature and most of them are nongenetic. Nutritional
imbalance Nutritional imbalance Either excesses or deficiencies of
nutrients predispose cells to injury.
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Immunological factors Immunological factors immunodeficiency
disease autoimmune disease anaphylactic reaction Psychological and
social factors Psychological and social factors Anxiety, strong or
persistent psychological stimulation or stress may lead to mental
illness and may be related to some diseases, such as hypertension,
peptic ulcer, coronary heart disease, and depression.
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Pathogenesis Pathogenesis of disease refers to the rules and
mechanisms underlying the development or evolutin of diseases. It
studies how the primary pathological agents cause disease in
organism and how the disease develops. Basic Mechanism of Disease
Neural mechanism Humoral mechanism Cellular mechanism Molecular
mechanism
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Neural mechanism Neural mechanism Neural system plays a central
role in regulating entire life activities; therefore, the disorders
in central nerve system will definitely affect the corresponding
periphery system. Humoral mechanism Humoral mechanism hormones
chemical mediators cytokines humoral factor Molecular mechanism
Molecular mechanism Cellular mechanism Cellular mechanism
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Neural mechanism Neural mechanism Neural system plays a central
role in regulating entire life activities; therefore, the disorders
in central nerve system will definitely affect the corresponding
periphery system. Humoral mechanism Humoral mechanism hormones
chemical mediators cytokines humoral factor Molecular mechanism
Molecular mechanism Cellular mechanism Cellular mechanism
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General Rules for Pathogenesis of Diseases Damage and
anti-damage responses Damage and anti-damage responses Damages are
usually made when a variety of harmful insults attack the body.
During this process, anti- damage responses are also induced in the
body to restore the normal situation. pain Infection (fever) plasma
loss pain Infection (fever) plasma loss shock ischemia & injury
of Cells Bp, blood volume shock ischemia & injury of Cells Bp,
blood volume Severe burn Damage Anti-damage Stress WBC, Blood
coagulation SAMS excitation(+) Stress WBC, Blood coagulation SAMS
excitation(+) C.O, Blood redistribution C.O, Blood redistribution
Rehabilitation blood flow heart & brain Rehabilitation blood
flow heart & brain Anti-infection, plasma loss SAMS:
Sympathetico-adrenal-medullay system; c.o: cardiac output
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Alternation of cause and result Alternation of cause and result
In the evolution of a disease, the cause of the disease can produce
a result, and this result can also become another cause in the
evolution proess of disease. benign circle vicious circle
Local-systemic relationship Local-systemic relationship Diseases
are generally systemic whereas the local pathological alterations
caused by insults are recognized to be representative of systemic
diseases.
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Outcome of Disease The course of a disease varies. An acute
disease has relatively sudden onset and lasts for a short term,
whereas a chronic disease, sometimes begins with an acute phase,
usually lasts for a long period of time. There are generally three
types of outcomes for a disease. Outcome of Disease Complete
recovery Incomplete recovery Death
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Complete recovery This is best outcome of a disease. In this
case, the pathologically altered metabolism, structure and function
are perfectly restored, and the symptoms and signs of the disease
disappear entirely. Incomplete recovery The main symptoms disappear
but some pathological changes are left behind, namely sequela.
Sequela is generally brought about by the compensatory response to
maintain a relatively normal activity.
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Traditionally death Traditionally death agonal stage agonal
stage stage of clinical death stage of clinical death stage of
biological death stage of biological death Death The cessation of
heart-beats and breath is used as the criterion of death of a body.
Brain death Brain death The functions of cerebrum and brain stem
stop forever.
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irreversible coma. cessation of spontaneous respiration.
norpurposeful movement. absence of cephalic reflexes. absence of
any electric activity of the brain. absence of cerebral
circulation. Criteria for brain death
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When cerebral function is lost, the reticular activating system
and brain stem can maintain a crude waking state known as a
vegetative state. Human Vegetable Human vegetable: Human vegetable:
Terri Schiavo
