INTRODUCTION TO INTRODUCTION TO STUDY STUDY

OF PATHOPHYSIOLOGYOF PATHOPHYSIOLOGY

Prof. J. Hanacek, M.D., Prof. J. Hanacek, M.D., Ph.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

StudyHealthy Diseased

The calligraphy done by the Korean artis Kim Hyun-Seung

PaPhy deals with the PaPhy deals with the dynamic aspectsdynamic aspects of of pathological pathological processesprocesses and diseases and diseases. It studies . It studies disordered disordered or or altered functionsaltered functions - - the physiologic mechanisms the physiologic mechanisms alteredaltered by disease in the living organismby disease in the living organism

PaPhy is a biomedical science dealing with PaPhy is a biomedical science dealing with functional functional changeschanges in diseased organism in diseased organism

PaPaPhyPhy is a is a biomedical sciencebiomedical science on the on the mechanismsmechanisms related to related to development and eliminationdevelopment and elimination of of pathological processespathological processes and diseases and diseases

Pathophysiology - definitions Pathophysiology - definitions /PaPhy//PaPhy/

• Pathophysiology deals with temporal and spatialtemporal and spatial dynamics dynamics in the intensityin the intensity of pathological processes of pathological processes

• Pathophysiology is devoted to study of protective protective and defensive mechanismsand defensive mechanisms of body tissue, organs of body tissue, organs and systems, and their role and systems, and their role in defence against in defence against noxae, in pathogenesis of disease, and in noxae, in pathogenesis of disease, and in sanogenesis 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 Pathophysiology is a modern integrativeintegrative

biomedical science biomedical science founded on basic and clinical founded on basic and clinical

research research that is concerned with the that is concerned with the mechanismsmechanisms

responsible for the initiation, development, and responsible for the initiation, development, and

treatment of pathological processestreatment of pathological processes in humans in humans

and animals. and animals.

IInternational Society for Pathophysiology (1998)nternational 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) a) WhatWhat is the cause/causesis the cause/causes of the disease, and of the disease, and

whywhy

the disease is developing the disease is developing

b) b) What are the mechanismsWhat are the mechanisms responsible for responsible for disease onset, progression, and recoverydisease onset, progression, and recovery

c) c) What are the mechanismsWhat are the mechanisms responsible for responsible for development of development of symptoms and signssymptoms and signs of of

diseasedisease 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 subjectsof unergraduate medical education

BiologyBiology – pathological processes begin frequently

at the cell level

Anatomy and histologyAnatomy and histology – macro- and microstructural

properties of the human body is essential

for understanding their pathology

BiochemistryBiochemistry – biochemical processes are changed

under pathological condition

BiophysicsBiophysics – biophysical properties of cells, tissues

and organs determine their structural

and functional characteristics

PhysiologyPhysiology – firstly, we have to understand the functions of the

healthy tissues, organs and systems of

the body,

than we are able to distinguish

pathological

functionsPathological anatomyPathological anatomy – to understand the

microstructural and

macrostructural changes under

pathological

conditions helps to understand functional

changes

and vice versa

Microbiology and immunologyMicrobiology 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

PharmacologyPharmacology – PaPhy enables the doctor to treat diseases rationally (causally)

Clinical subjectsClinical subjects – PaPhy is a theory of disease, clinic is medical practice

Humanistic subjectsHumanistic subjects (psychology, ethics, sociology,

antropology...) – psychologic and social factors play an

important role in disease development

The position of Pathophysiology in The position of Pathophysiology in undergraduate medical educationundergraduate medical education

• It becomes an integrative biomedicalIt becomes an integrative biomedical subjectsubject• It becomes a bridge between the It becomes a bridge between the subjects subjects of of sciences sciences and clinical medicineand clinical medicine• It is an important part of It is an important part of undergraduate undergraduate medical medical educationeducation THE MAIN TASKS OF THE MAIN TASKS OF PATHOPHYSIOLOGYPATHOPHYSIOLOGY • To teach mechanisms of diseasesTo teach mechanisms of diseases

• To help to understand the substance of To help to understand the substance of healthhealth ● To help students to understand the To help students to understand the logic of logic of life under pathological conditionslife under pathological conditions

Thanks to pathophysiology the medical student Thanks to pathophysiology the medical student

can understand the can understand the inner logic of the pathologicalinner logic of the pathological

processes,processes, their relationshiptheir relationshipss, and their biological , and their biological

significance.significance. On this basis student is able, as a On this basis student is able, as a

result, result, to built an individual model of disease to built an individual model of disease

in a given patientin a given patient

P A T H O P H Y S I O L O G YP A T H O P H Y S I O L O G Y

P H Y S I O L O G YP H Y S I O L O G Y

Pathology Pathology PharmacologyPharmacology MicrobiologyMicrobiology

NeurologyNeurology

Gynekology and ObtetricsGynekology and Obtetrics Surgery Surgery Internal medicineInternal medicine

AnatAnat BiolBiol HistolHistol BiochBioch ChemChem BiophysBiophys

„House of Medicine“

Foundations

Base plate

walls

Ceiling plate

Structure of pathophysiologyStructure of pathophysiology

1. General pathophysiology1. General pathophysiology

2. Special2. Special /organs, systems/ /organs, systems/ pathophysiologypathophysiology

1.1. General pathophysiologyGeneral pathophysiology – – contentcontent

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

bb) ) Etiology Etiology of disease of disease /aitiá = cause//aitiá = cause/

Deals withDeals with noxa noxaee (causes) (causes) which are involved in diseasewhich are involved in disease

onsetonset andand

withwith conditions conditions under which the causes are ableunder which the causes are able to induce to induce

diseasedisease

processesprocesses

((OpositOposit - - etiology of healthetiology of health: : deals withdeals with factors which factors which

promotepromote

the health)the health)

cc)) Pathogenesis Pathogenesis /pathos = pain, suffering, distress, genesis - /pathos = pain, suffering, distress, genesis - onset/onset/

Deals with Deals with mechanismsmechanisms involved in disease onset and involved in disease onset and

diseases diseases

development development ((pathomechanismspathomechanisms))

aa)) Nosology Nosology /nosos = disease; logos = science/ /nosos = disease; logos = science/ SSystematically ystematically describes thedescribes the specific type of disease specific type of disease and and this is this is the base for creation the base for creation classification classification systemsystem of diseasesof diseases

Essential terminology

dd)) Sanogenesis Sanogenesis /sanos = health/ /sanos = health/

Deals with Deals with mechanismsmechanisms involved in involved in recovery recovery from from

disease disease

to healthto health

ee)) Semiology Semiology /sémeion = sign, symptom/ /sémeion = sign, symptom/

Deals with Deals with symptoms symptoms and and signs signs of diseasesof diseases

SymptomsSymptoms – subjective feeling of disease – subjective feeling of disease

SignsSigns – objective parameters of changed functions – objective parameters of changed functions

andand

structures of bodystructures of body systems systems

ff)) Tanatogenesis Tanatogenesis /thanatos = death/ /thanatos = death/

Deals withDeals with process processes leading to deathes leading to death

2.2. Special pathophysiology - Special pathophysiology - is devoted to analysis and is devoted to analysis and explanation of pathomechanisms involved in functionalexplanation of pathomechanisms involved in functional disturbances of the organs and systems of thedisturbances of the organs and systems of the organism:organism:

Content of special pathophysiology:Content of special pathophysiology:

• hematologic disordershematologic disorders

• disorders of cardiovascular systemdisorders of cardiovascular system

• dysfunctions of dysfunctions of respiratoryrespiratory system system

• disorders of uropoietic systemdisorders of uropoietic system

• neurologic disordersneurologic disorders

• dysfunctions of dysfunctions of of endocrine systemof endocrine system

• metabolic disordersmetabolic disorders

• disorders of reproductive systemdisorders of reproductive system

• dysfunctions of dysfunctions of of GITof GIT

SPECIAL SPECIAL SECTIONS SECTIONS OF PATHOPHYSIOLOGYOF PATHOPHYSIOLOGY

• Clinical pathophysiologyClinical pathophysiology /clinical physiology//clinical physiology/

• Space pathophysiologySpace pathophysiology

• EExperimental pathophysiologyxperimental pathophysiology

• PPathophysiologyathophysiology of of eextreme - eventsxtreme - events

• Ocupational pOcupational pathophysiology and athophysiology and PaPhy of PaPhy of sportsportss

• Adaptation pathophysiologyAdaptation pathophysiology

● Cellular and molecular pathophysiology

● 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 functionsOne example of such new pathologic

mechanism is vicious circle (a complex of events that

reinforces itself through a feedback loop toward greater instability)

REMARKS TO PATHOGENESIS

Examples of vicious circle 1st example: Development of LV insufficiency1st example: Development of LV insufficiency

Mitral stenosisMitral stenosis decreaseddecreased cardiac output of left cardiac output of left ventricle ventricle

activation of activation of sympathetic n.s.sympathetic n.s.

vasoconstrictionvasoconstriction (skin, splanchnic, (skin, splanchnic,

kydney aa.)kydney aa.) heart rateheart rate

end – diastolic vol of LV end – diastolic vol of LV shorter diastola shorter diastola of LVof LV

arter resist

2nd example: Development of edema during RV failure2nd example: Development of edema during RV failure

Right ventricle failureRight ventricle failure hydrostatic pressure in hydrostatic pressure in venous system venous system

formation of edemaformation of edema

COLV activation COLV activation

sympathicsympathic

fluid volumefluid volume vasoconstriction vasoconstriction in venous systemin venous system

blood flowblood flow in kydneyin kydney

resorbtion Naresorbtion Na++ activation of activation of in kydney R - A- A system in kydney R - A- A system

volumeoverload

HippocratesHippocrates (460-370 BC)- he was the first to (460-370 BC)- he was the first to construct theories of the causes of disease construct theories of the causes of disease based onbased on what he had observed in his patientswhat he had observed in his patients His fundamental truth: His fundamental truth: „there are two factors „there are two factors acting acting alone or in combination which cause illness –alone or in combination which cause illness – the intrinsic or constitutional make-up of the the intrinsic or constitutional make-up of the person, person, and an extrinsic or environmental agentand an extrinsic or environmental agent“, is still “, is still valid. valid.

Once normal functions of the body had been Once normal functions of the body had been describeddescribed it was but a step to investigate states of it was but a step to investigate states of disease (fromdisease (from the end of 16the end of 16th th century) century)

HISTORY OF PATHOPHYSIOLOGYHISTORY OF PATHOPHYSIOLOGY

HISTORY OF PATHOPHYSIOLOGYHISTORY OF PATHOPHYSIOLOGY

• C. BernardC. Bernard (1813-1878)(1813-1878)--Introduction to Introduction to experimental experimental medicine (1865)medicine (1865)• Rudolf Wirchov Rudolf Wirchov - - he introduces term he introduces term „„pathologicalpathological physiologyphysiology““ to medical terminology• GalliotGalliot /1819 / - /1819 / - author of„Mauthor of„Manual in general anual in general pathology pathology and pathological physiologyand pathological physiology““ • A.F. HeckerA.F. Hecker / 1790/ - / 1790/ -author„Tauthor„Textbook in extbook in pathophysiologypathophysiology Excellent pathophysiologist from the past: Excellent pathophysiologist from the past: J.E. J.E. Purkyne, Purkyne, Prof.Prof. Pashutin,Pashutin, Prof. Pavlov /from Prof. Pavlov /from Russia/, Prof. Hans Selye /CanadaRussia/, Prof. Hans Selye /Canada-1907-1982-1907-1982/ -/ -Stress theory;Stress theory; ... ...

Methods usMethods useded in pathophysiological research in pathophysiological research

1. 1. ObservationObservation

2. 2. Animal experimentAnimal experiment

3. 3. Clinical Clinical – pathopysiological – pathopysiological studystudy

4.4. Elaboration of experimental Elaboration of experimental to to createcreate

modelsmodels of pathological processesof pathological processes – – animalanimal''s models, mathemathical s models, mathemathical models...models...Research at the Dept. of PathophysiologyResearch at the Dept. of Pathophysiology

It It is devoted to is devoted to research on PaPhy of research on PaPhy of respiratory system, respiratory system, especially toespecially to defensive mechanisms of the airways defensive mechanisms of the airways and lungsand lungs, and to visceral neurophysiology and PaPhy, and to visceral neurophysiology and PaPhy

1.1. Students should understand Students should understand fundamental general fundamental general and and

specific pathomechanisms involved in onset, specific pathomechanisms involved in onset, development and ending of diseasesdevelopment and ending of diseasesTo fulfil this aim is necessary:To fulfil this aim is necessary:

a) to knowa) to know and understandand understand pathophysiological pathophysiological

termsterms

b)b) to know and understandto know and understand essentialessential

pathomechanismspathomechanisms

c)c) toto connect separate pathomechanizms to connect separate pathomechanizms to

rational rational pathogenetic network pathogenetic network characteristiccharacteristic for for different different pathological processespathological processes d)d) to understand a pathologic process to understand a pathologic process as event as event whichwhich influence the whole bodyinfluence the whole body e) to understand e) to understand pathomechanizms as dynamic pathomechanizms as dynamic eventsevents

The main aims of teaching pathohysiology

The roles of studets and teachers in teaching prosessThe roles of studets and teachers in teaching prosess

a)a) Student has to study Student has to study,, not simply memorise facts not simply memorise facts

b)b) Individual study and seminars Individual study and seminars should be focused to should be focused to

obtain obtain

lasting knowledge on pathophysiologylasting knowledge on pathophysiology

c)c) Teacher will help students with creation of complex Teacher will help students with creation of complex

view onview on

pathogenesis of diseasespathogenesis of diseases

• The source of lasting knowledge is understanding of The source of lasting knowledge is understanding of the pathomechanismsthe pathomechanisms (Understunding is a kind of ecstasy)(Understunding is a kind of ecstasy)

TextbookTextbookss and other sorces and other sorces for study offor study of PaPhy PaPhy

●●Sylvia Anderson Price, Lorraine Mc Carty Wilson, Sylvia Anderson Price, Lorraine Mc Carty Wilson, Pathophysiology - Clinical concepts of disease processesPathophysiology - Clinical concepts of disease processes 6th edition 6th edition Mosby Year Book, St.Luis, Baltimore, Boston, Chicago, Mosby Year Book, St.Luis, Baltimore, Boston, Chicago, London, SydnyLondon, Sydny..

●●Stefan SilbernagelStefan Silbernagel, , Florian Lang: Florian Lang: Color Atlas of Pathophysiology Color Atlas of Pathophysiology Thieme, Stuttgart - New York, 2000, 406pp. Thieme, Stuttgart - New York, 2000, 406pp.

●●S.J. McPhee, V.R. Lingappa, W.F. Ganong, J.D.Lang:S.J. McPhee, V.R. Lingappa, W.F. Ganong, J.D.Lang:Pathophysiology of Disease An Introduction to Clinical Pathophysiology of Disease An Introduction to Clinical MedicineMedicine Prentice - Hall International Inc., 1995, 521pp.Prentice - Hall International Inc., 1995, 521pp.

●● Tatar M, Hanacek J. Pathophysiology. Topics for seminars.Tatar M, Hanacek J. Pathophysiology. Topics for seminars. Comenius University 2001, 220pp.Comenius University 2001, 220pp.

●Handouts of lectures on Pathophysiology – from Dept . of Pathophysiology JFM CU in Martin

HeadHead::ProfessorProfessor M. Tatar M. Tatar, M.D., Ph.D., M.D., Ph.D.Teaching staff:Teaching staff:Teachers:Teachers: Prof. Jan Hanacek, M.D., Ph.D.Prof. Jan Hanacek, M.D., Ph.D. - Vice-Head - Vice-Head

Prof. Milos Tatar, M.D., Ph.D.Prof. Milos Tatar, M.D., Ph.D.

Assoc. Prof.Assoc. Prof. R R.. Pecova, M.D., Ph.D. Pecova, M.D., Ph.D.

Assoc. Prof.Assoc. Prof. M M.. Brozmanova, RNDr., Ph.D. Brozmanova, RNDr., Ph.D.

Assoc. Prof. J. Plevkova, M.D., Ph.D.Assoc. Prof. J. Plevkova, M.D., Ph.D.

Technicians: Mr. MTechnicians: Mr. M.. Vrabec,Ing. Vrabec,Ing., Ms. L. Mazurova, Mrs. K. , Ms. L. Mazurova, Mrs. K.

StrbovaStrbova Mr. Mr. T.T. Zatko Zatko

PhD student: Mr. J. Halicka, M.D., Ms. S. Gavliakova, Ing.PhD student: Mr. J. Halicka, M.D., Ms. S. Gavliakova, Ing. Secretary: Mrs. M. IlovskaSecretary: Mrs. M. Ilovska

Staff involved in teaching process