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Pathophysiology
Department of Pathophysiology
Shanghai Jiao-Tong University School of Medicine
CHAPTER 1
General Introduction of Pathophysiology
•What is pathophysiology?
•Why do we study pathophysiology
？
•Main teaching content and Syllabus
What is pathophysiology?
■
Concept of Pathophysiology
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.
Why do we study pathophysiology？
■
Position
Pathophysiology is an important subject bridging
Basic sciences and clinical medicine.
pathophysiology
clinical
medicine
basic
sciences
bridge subject
Main teaching content and Syllabus
Content
■
●
Conspectus of disease
The general concept of diseases and general etiology and
pathogenesis of diseases.
Fundamental pathological process
●
Common changes of function,
metabolism and structure occurred in
the different diseases, e.g.
●
Systemic pathophysiology
Heart failure, respiratory failure, hepatic
failure, renal failure, e.g.
Syllabus
■
Format
Lecture
Time
42h
Teaching content
Introduction; Conspectus of disease; Apoptosis
and related disease; Water and electrolytes
imbalance; Acid-base imbalance; Fever; Stress;
Hypoxia; DIC; Shock; Ischemia-reperfusion
injury; Respiratory failure; Heart failure; Hepatic
failure; Renal failure.
Self-study
CBL
Signal transduction and related disease.
4h
Four case; Group learning.
李稻
赵倩、蒋益、黄莺
吴英里、韩玉慧
CHAPTER 2
Conspectus of Disease
•Concepts of Health and Disease
•Etiology of Disease
•Pathogenesis of Disease
•Outcome of Disease
Concepts of Health and Disease
Health
■
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.
●Factor
in health
▲ physical
▲ mental
▲ social
well-being
well-being
well-being
Sub-Health
■
There is a situation, in which the person dose not show
specific symptoms and signs of disease, but lives a lowquality of life both physically and mentally.
●Manifestation
▲physical
of sub-health
sub-health: fatigue & disability; hyponoia;
gastralgia; heart-throb, etc.
▲mental
angst
▲social
sub-health: angst; fidget; irascibility; insomnia, etc.
sub-health: not concerned with our roles within
society as a whole.
irascibility
■
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).
●Factor
in disease
▲disease
is caused by the
etiological factors.
▲base
Homeostasis
of disease is
deregulated homeostasis.
Neural regulated
deregulated
Humoral regulated
Signal regulated in cell
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.
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
▲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.
●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
The risk factor concept is epistemological in nature: it is
often not clear exactly what a risk factor contributes to
understanding and explanation.
Classification of etiological factors
■
●Factors
of environment
▲biological
▲physical
agents
▲chemical
●Inherited
▲gene
agents
agents
21三体综合症患儿
（先天愚型）
factors
mutation
▲chromosomal
Genetic aberrancies may be caused
by single or polygenic mutations.
aberration
【genetic predisposition】
The genetic mutations cause problems only when a
person is eposed to certain environmental agents.
●Congenital
factors
The disorders are of a developmental nature and most
of them are nongenetic.
“反应停”儿童
●Nutritional
imbalance
Either excesses or deficiencies of nutrients
predispose cells to injury.
●Immunological
factors
▲anaphylactic
reaction
▲autoimmune
disease
▲immunodeficiency
●Psychological
disease
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.
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
●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
▲hormones
▲chemical
mediators
▲cytokines
●Cellular
mechanism
●Molecular
mechanism
humoral factor
●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
▲hormones
▲chemical
mediators
▲cytokines
●Cellular
mechanism
●Molecular
mechanism
humoral factor
■
General Rules for Pathogenesis of Diseases
●Damage
and anti-damage responses
Damages are usually made when a variety of harmful
insults attack the body. During this process, antidamage responses are also induced in the body to
restore the normal situation.
Severe burn
pain
Infection (fever)
plasma loss
Damage
shock
ischemia & injury of Cells
Bp↓, blood volume↓
Stress
WBC↑, Blood coagulation↑
SAMS excitation(+)
C.O↑, Blood redistribution
Anti-infection↑, plasmaAnti-damage
loss↓
Rehabilitation
blood flow heart & brain↑
SAMS: Sympathetico-adrenal-medullay system; c.o: cardiac output
●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
Diseases are generally systemic whereas the local
pathological alterations caused by insults are
recognized to be representative of systemic diseases.
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.
•Complete recovery
Outcome of Disease
•Incomplete recovery
•Death
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.
Death
■
The cessation of heart-beats and breath is used as the
criterion of death of a body.
●Traditionally
▲agonal
death
stage
▲stage
of clinical death
▲stage
of biological death
●Brain
death
The functions of cerebrum and brain stem stop forever.
●Criteria
for brain death
▲irreversible
▲cessation
coma.
of spontaneous respiration.
▲norpurposeful
movement.
▲absence
of cephalic reflexes.
▲absence
of any electric activity of the brain.
▲absence
of cerebral circulation.
Human Vegetable
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: Terri Schiavo