Welcome to
Pathophysiology
Department of Pathophysiology Liaoning Medical College
Chapter 1
Introduction to Pathophysiology
Pathophysiology
= Pathology + Physiology?
Disseminated intravascular coagulation, DIC
Orthopnea
端坐呼吸
Left heart failure
Right heart failure
An essential introduction to clinical medicine that enables us to understand how the disease happens , develops and why the disease presents various clinical manifestations.
1. What is pathophysiology ?
患病机体为对象 研究疾病发生发展规律和机制 (Mechanis
m)
以功能与代谢变化为重点 揭示疾病本质,为疾病防治提供理论依据
( 1 ) Tasks
Conspectus of Disease
Basic pathological processes
Systemic pathophysiology
(2) Contents
① Conspectus of Disease (C2)
In this chapter, we will discuss the
concept, etiology , pathogenesis and
prognosis of diseases from a general
view.
Some common and collective pathological alterations in metabolism and function presented in a group of diseases.
Fever , Edema, Dehydration ,
Hypoxia, Acidosis, Shock, DIC
② Basic pathological processes ( C3-C12 )
Disease Cause Organ Pathological process
Pneumonia Streptococcus Lungs pneumoniae
Fever, Hypoxia, Shock, Acidosis
Epidemic meningitis
Meningitis Meninges diplococcus
Fever, Shock DIC
Relationship between basic pathological process and disease
基本病理过程由多种原因引起 , 疾病有特定病因 . 同一病理过程见于多种疾病,是疾病重要组成部分 . 一种疾病可出现多种病理过程 .
③ Systemic pathophysiology (C13-C19)
Some common outcome for the diseases in a certain system , termed syndrome
Heart failure Respiratory failure
Hepatic failure Renal failure
(3) Common research methods
Experimental research
Clinical research
Epidemiological analysis
Basic medicine Clinical medicine
Basic subject
Interdisciplinary subject
Bridge subject
2.Why do we study pathophysiology ?
3. How should we study pathophysiology ?
(1) Dare to question
(2) Learn actively
(3) Attach importance to practice
(4) Review the past courses
(5) Intensify English
(6) Pay attention to leading edge of science
Major points in pathophysiology
General definition Etiology (causative factors) Pathogenesis (mechanism) Alterations of metabolism and function Principles for prevention and treatment
Chapter 2
Conspectus of Disease
Concept of Disease
Etiology of Disease
Pathogenesis of Disease
Prognosis of Disease
Contents Contents
Part one
Concept of Disease
Disease
It is defined as abnormal life process which is induced by disorders of homeostasis under the action of certain cause (s).
机体在一定条件下,受病因损害作用,因机
体自稳调节紊乱而发生的异常生命活动过程
It is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (WHO, 1946)
Health
健康是指不仅是没有疾病或病痛,而且 是躯体、精神和社会上处于完好状态。
There is a situation in which the
person doesn’t show specific symptoms
and signs of disease, but lives a low-
quality of life both physically and
mentally.
Sub-health
Part two Etiology of Disease
Causes of diseases lead to onset of some disease and endue it characteristics.
1. Cause of diseases
(1) Biological agents
Microorganisms and parasites
Mechanical force
(2) Physical and Chemical Agents
Electricity
Trauma, Bone fracture
Temperature Frost bite, Fire burn
Electrical injury
Air pressure Diver’s disease
① Physical agents
Strong acid and strong base
Vegetable toxicant: poisonous mushroom
Animal toxicant : snake venom
Chemical toxicant : benzene , formaldehyde
Carbon monoxide
Heavy metal
② Chemical agents
(3) Nutritional imbalance
Oxygen
Water
Nutrients
Trace elements
Deficiency or Excess
a. Genetic mutation: Hemophilia, Sickle anemia
(4) Genetic factors
c. Genetic predisposition: Diabetes mellitus , Schizophrenia
b. Chromosome aberration :
Trisomy 21 , Hermaphrodism
(5) Congenital factors
Fetus is susceptible to the congenital factors imposed on the pregnant woman.
Infectious diseaseDrug-takingDiet , etc..
Most of them will not be transmitted to the younger generation.
Strong
Misdirect
Deficient Immunodeficiency disease ( AIDS )
Allergy ( pollen, food )
Autoimmune disease ( SLE, RA )
(6) Immunological factors
Immunological reaction :
(7) Mental, Psychological , Social factors
Stress disease : Peptic ulcer
Abnormal personality
Psychosomatic disease : Hypertension, CHD
2. Condition
Tubercle bacilli
Condition is the factors that accelerate or decelerate the onset of disease.
Precipitating factors (诱因) Factors that accelerate the onset of disease Risk factors (危险因素) : Close to a certain
disease , but can not distinguish cause or condition
Tuberculosis Malnutrition
Nutrition
Part three
Pathogenesis of disease
1. General rules for the onset and development of diseases
Process of damage and anti-damage Alteration of cause and result Local-systemic relationship
(1) Damage and anti-damage during diseases
Serious trauma
Tissue damageBleeding , BP↓Hypoxia
Sypathetic nervous system
Coagulation system
Vasoconstriction BP↑, HR ↑ Bleeding ↓
Damage Anti-damage
Traumatic shock Recover
PK
Vicious cycle during hemorrhagic shock
(2) Alternation of cause and result
(3) Local-systemic relationship
Intracranial infection Septicemia
Folliculitis Diabetes mellitus Furuncle
2. Fundamental mechanisms for disease
Neural Mechanism Humoral Mechanism Cellular Mechanism Molecular Mechanism
(1) Neural Mechanism
a. Directly impair CNS:
Japanese encephalitis virus
b. Influence neurotransmitter :
Orgnaophosphorus →↓Ach degradation
c. Nervous reflex:
Shock → BP↓ →↓Depressor reflex →SN(+)
Neural mechanism and humoral mechanism is also called neurohumor mechanism because the two often occur synchronously and participate in the development of disease.
(2) Humoral Mechanism
Changes of humoral factors result in
disorders of homeostasis.
(3) Cellular Mechanism
Direct injury to cells
Dysfunction of cell membrane: Na+-K+-pump
Dysfunction of cell organ: mitochondria
(4) Molecular Mechanism
Proteins and nucleic acid
Part four
Prognosis of Disease
This is the best outcome of a disease.
For example , flu.
In this case, the pathological altered metabolism, structure and function are perfectly restored, and the symptoms and signs of the disease disappear completely.
1. Complete rehabilitation
The main symptoms disappear but some pathological changes are left behind, namely sequela.
For example , the patients with polio will be paralytic in spite of proper treatment.
2. Incomplete rehabilitation
3. Death
The cessation of heart-beats and respiration
of a body was used as mark of death .
Because the stopped heart-beats are often maintained by appropriate emergency medical treatment, but, today, mark of death is brain death.
Brain Death
It is a state of permanent irreversible cess
ation of all brain function (枕骨大孔以上全脑死亡 ) .
Maybe some organs still work, but the bo
dy as a whole stops working.
1.Cessation of spontaneous respiration
2. Irreversible coma
3. Absence of brain-stem reflexes
The criteria for brain death from WHO
4. Fixed and dilated pupils
5. Absence of brain wave
6.Cessation of cerebral circulation
Make a definite death time.
Decide the termination of medical treatment.
Provide organ donors for transplantation.
Significance for definite diagnosis of brain death
Depressant drug overdose
Alcohol poisoning
Vegetative state
Some reversible clinical states should be excluded prior to diagnosis of brain death.
Hypothermia
脑死亡与植物状态临床鉴别
指标 脑死亡 植物状态定义自主呼吸意识脑干反射恢复的可能性
全脑功能丧失无丧失无无
脑认知功能丧失有有睡眠 / 醒觉周期,无意识有有
掌握健康、疾病、亚健康、死亡、
脑死亡的概念,脑死亡判断标准
熟悉病因、条件、诱因及其相互关系,
疾病发生发展的一般规律和基本机制
了解疾病经过及转归,脑死亡意义
教学要求