Transcript Introduction to Study of Pathophysiology

INTRODUCTION TO STUDY
OF PATHOPHYSIOLOGY
Prof. J. Hanacek, M.D., Ph.D.,
What the pathophysiology is
• Physiologia, ae, f.
gr. fysis = nature; logos = science
• Pathophysiologia, ae, f.
gr. pathos = disease, pain, suffering
Physiology
Pathophysiology
Life
Logic
Healthy
Study
Diseased
The calligraphy done by the Korean artis Kim Hyun-Seung
Pathophysiology - definitions
/PaPhy/
 PaPhy is a biomedical science on the mechanisms
related to development and elimination of
pathological processes and diseases
 PaPhy is a biomedical science dealing with functional
changes in diseased organism
 PaPhy deals with the dynamic aspects of pathological
processes and diseases. It studies disordered or
altered functions - the physiologic mechanisms altered
by disease in the living organism
• Pathophysiology deals with temporal and spatial
dynamics in the intensity of pathological processes
• Pathophysiology is devoted to study of protective
and defensive mechanisms of body tissue, organs
and systems, and their role in defence against
noxae, in pathogenesis of disease, and in
sanogenesis
• Pathophysiology belongs to core subjects of
undergraduate medical education
Pathophysiology deals with logic of life
under pathological conditions
Pathophysiology help us to understand the logic
of life during development of pathological
processes
Pathophysiology creates a bridge between
sciences and clinical subjects in undergraduate
medical education
 Pathophysiology is a modern integrative
biomedical science founded on basic and clinical
research that is concerned with the mechanisms
responsible for the initiation, development, and
treatment of pathological processes in humans
and animals.
International Society for Pathophysiology (1998)
• Why pathophysiology is important for medical
students and physicians
1. It helps them to find answers to important
questions related to disease processes:
a) What is the cause/causes of the disease, and why
the disease is developing
b) What are the mechanisms responsible for
disease onset, progression, and recovery
c) What are the mechanisms responsible for
development of symptoms and signs of disease
2. If doctors are able to understand the causes
and mechanisms of the disease, then they are able
to find the way how to influence them rationally
Relation among pathophysiology and other subjects
of unergraduate medical education
Biology – pathological processes begin frequently
at the cell level
Anatomy and histology – macro- and microstructural
properties of the human body is essential
for understanding their pathology
Biochemistry – biochemical processes are changed
under pathological condition
Biophysics – biophysical properties of cells, tissues
and organs determine their structural
and functional characteristics
Physiology – firstly, we have to understand the functions of the
healthy tissues, organs and systems of the body,
than we are able to distinguish pathological
functions
Pathological anatomy – to understand the microstructural and
macrostructural changes under pathological
conditions helps to understand functional changes
and vice versa
Microbiology and immunology – the subject help us to
understand of the mechanisms involved in
development of disease caused mainly by biologic
noxas and disorders of immune system
Pharmacology – PaPhy enables the doctor to treat
diseases rationally (causally)
Clinical subjects – PaPhy is a theory of disease, clinic is
medical practice
Humanistic subjects (psychology, ethics, sociology, antropology...)
– psychologic and social factors play an
important role in disease development
The position of Pathophysiology in
undergraduate medical education
• It becomes an integrative biomedical subject
• It becomes a bridge between the subjects of
sciences and clinical medicine
• It is an important part of undergraduate medical
education
THE MAIN TASKS OF PATHOPHYSIOLOGY
• To teach mechanisms of diseases
• To help to understand the substance of health
● To help students to understand the logic of
life under pathological conditions
Thanks to pathophysiology the medical student
can understand the inner logic of the pathological
processes, their relationships, and their biological
significance. On this basis student is able, as a
result, to built an individual model of disease
in a given patient
„House of Medicine“
Neurology
Gynekology and Obtetrics
Surgery
Internal medicine
Ceiling plate
PATHOPHYSIOLOGY
Pathology
Pharmacology
walls
Microbiology
PHYSIOLOGY
Base plate
Anat
Biol
Histol
Bioch
Foundations
Chem
Biophys
Structure of pathophysiology
1. General pathophysiology
2. Special /organs, systems/ pathophysiology
1. General pathophysiology – content
It deals with general pathologic processes, and
pathomechanisms: -thay are involved in pathogenesis of
more than one disease. It also contain explanation of some
basic medical terms
● Examples of general pathological processes –
inflammation, fever, hyperthermia, hypothermia, shock,
stress, edemas, disturbances of control mechanisms,
hyperreactivity, hyporeactivity, damage of genetic
information....
● Defensive and adaptive mechanisms –
- non-specific and specific immunity, hypertrophy,
atrophy, hyperfunction, hypofunction, homeostasis
● Incresed predisposition to onset of disease
(diathesis, athopy) – due to genetic or/and
environmental factors
Essential terminology
a) Nosology /nosos = disease; logos = science/
Systematically describes the specific type of disease and this is
the base for creation classification system of diseases
b) Etiology of disease /aitiá = cause/
Deals with noxae (causes) which are involved in disease onset and
with conditions under which the causes are able to induce disease
processes
(Oposit - etiology of health: deals with factors which promote
the health)
c) Pathogenesis /pathos = pain, suffering, distress, genesis - onset/
Deals with mechanisms involved in disease onset and diseases
development (pathomechanisms)
d) Sanogenesis /sanos = health/
Deals with mechanisms involved in recovery from disease
to health
e) Semiology /sémeion = sign, symptom/
Deals with symptoms and signs of diseases
 Symptoms – subjective feeling of disease
 Signs – objective parameters of changed functions and
structures of body systems
f) Tanatogenesis /thanatos = death/
Deals with processes leading to death
2. Special pathophysiology - is devoted to analysis and
explanation of pathomechanisms involved in functional
disturbances of the organs and systems of the organism:
Content of special pathophysiology:
• hematologic disorders
• disorders of cardiovascular system
• dysfunctions of respiratory system
• disorders of uropoietic system
• neurologic disorders
• dysfunctions of of endocrine system
• metabolic disorders
• disorders of reproductive system
• dysfunctions of of GIT
SPECIAL SECTIONS OF PATHOPHYSIOLOGY
• Clinical pathophysiology
/clinical physiology/
• Space pathophysiology
• Experimental pathophysiology
• Pathophysiology of extreme - events
• Ocupational pathophysiology and
PaPhy of sports
• Adaptation pathophysiology
● Cellular and molecular pathophysiology
REMARKS TO PATHOGENESIS
● Pathogenesis of disease processes can not be
reduced to only quantitative changes of structures,
functions and mechanisms presenting in healthy
people
● It is necessary to take into account development
of qualitatively new processes, which are harmful
for the body structure and functions
One example of such new pathologic mechanism is
vicious circle (a complex of events that reinforces itself through a
feedback loop toward greater instability)
Examples of vicious circle
1st example: Development of LV insufficiency
Mitral stenosis
decreased cardiac output of left ventricle
activation of sympathetic n.s.
arter
 resist
vasoconstriction
(skin, splanchnic, kydney aa.)
heart rate
end – diastolic vol of LV
shorter diastola of LV
2nd example: Development of edema during RV failure
Right ventricle failure
volume
overload
hydrostatic pressure in
venous system
formation of edema
COLV
 fluid volume
activation sympathic
vasoconstriction
in venous system
blood flow
in kydney
resorbtion Na+
activation of
in kydney
R - A- A system
HISTORY OF PATHOPHYSIOLOGY
 Hippocrates (460-370 BC)- he was the first to
construct theories of the causes of disease based on
what he had observed in his patients
His fundamental truth: „there are two factors acting
alone or in combination which cause illness –
the intrinsic or constitutional make-up of the person,
and an extrinsic or environmental agent“, is still valid.
 Once normal functions of the body had been described
it was but a step to investigate states of disease (from
the end of 16th century)
HISTORY OF PATHOPHYSIOLOGY
• C. Bernard (1813-1878)-Introduction to experimental
medicine (1865)
• Rudolf Wirchov
- he introduces term „pathological
physiology“ to medical terminology
• Galliot /1819 / - author of„Manual in general pathology
and pathological physiology“
• A.F. Hecker / 1790/ -author„Textbook in pathophysiology
Excellent pathophysiologist from the past: J.E. Purkyne,
Prof. Pashutin, Prof. Pavlov /from Russia/, Prof. Hans
Selye /Canada-1907-1982/ -Stress theory; ...
Methods used in pathophysiological research
1. Observation
2. Animal experiment
3. Clinical – pathopysiological study
4. Elaboration of experimental to create
models of pathological processes –
animal's models, mathemathical models...
Research at the Dept. of Pathophysiology
It is devoted to research on PaPhy of respiratory system,
especially to defensive mechanisms of the airways
and lungs, and to visceral neurophysiology and PaPhy
The main aims of teaching pathohysiology
1. Students should understand fundamental general and
specific pathomechanisms involved in onset, development
and ending of diseases
To fulfil this aim is necessary:
a) to know and understand pathophysiological terms
b) to know and understand essential pathomechanisms
c) to connect separate pathomechanizms to rational
pathogenetic network characteristic for different
pathological processes
d) to understand a pathologic process as event which
influence the whole body
e) to understand pathomechanizms as dynamic events
The roles of studets and teachers in teaching prosess
a) Student has to study, not simply memorise facts
b) Individual study and seminars should be focused to obtain
lasting knowledge on pathophysiology
c) Teacher will help students with creation of complex view on
pathogenesis of diseases
• The source of lasting knowledge is understanding of
the pathomechanisms
(Understunding is a kind of ecstasy)
Textbooks and other sorces for study of PaPhy
●Sylvia Anderson Price, Lorraine Mc Carty Wilson,
Pathophysiology - Clinical concepts of disease processes
6th edition
Mosby Year Book, St.Luis, Baltimore, Boston, Chicago,
London, Sydny.
●Stefan Silbernagel, Florian Lang:
Color Atlas of Pathophysiology
Thieme, Stuttgart - New York, 2000, 406pp.
●S.J. McPhee, V.R. Lingappa, W.F. Ganong, J.D.Lang:
Pathophysiology of Disease An Introduction to Clinical
Medicine Prentice - Hall International Inc., 1995, 521pp.
● Tatar M, Hanacek J. Pathophysiology. Topics for seminars.
Comenius University 2001, 220pp.
●Handouts of lectures on Pathophysiology – from
Dept . of Pathophysiology JFM CU in Martin
Staff involved in teaching process
Head:
Professor M. Tatar, M.D., Ph.D.
Teaching staff:
Teachers: Prof. Jan Hanacek, M.D., Ph.D. - Vice-Head
Prof. Milos Tatar, M.D., Ph.D.
Assoc. Prof. R. Pecova, M.D., Ph.D.
Assoc. Prof. M. Brozmanova, RNDr., Ph.D.
Assoc. Prof. J. Plevkova, M.D., Ph.D.
Technicians: Mr. M. Vrabec,Ing., Ms. L. Mazurova, Mrs. K. Strbova
Mr. T. Zatko
PhD student: Mr. J. Halicka, M.D., Ms. S. Gavliakova, Ing.
Secretary: Mrs. M. Ilovska