01 conspectus of disease
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Transcript of 01 conspectus of disease
Dr. Xiyun Dr. Xiyun DengDeng ( ( 邓锡云邓锡云 ))
Dept. of PathologyDept. of Pathology
Medical CollegeMedical College
Hunan Normal UniversityHunan Normal University
(( 湖南师范大学医学院病理学教研室湖南师范大学医学院病理学教研室 )) 1
PathophysiologyPathophysiology(病理生理学)(病理生理学)
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Overview of Overview of PathophysiologyPathophysiology
Concept of PathophysiologyConcept of Pathophysiology
Brief history of PathophysiologyBrief history of Pathophysiology
Methods of Pathophysiology researchMethods of Pathophysiology research
Pathophysiology ≠ Pathology + Physiology
Pathophysiology
Pathophysiology
Pathophysiology
Physiology
Physiology
Disease
Normal PathologyPathology
Function & Metabolis
m
Morphology
(Structure)
Pathophysiology
Pathophysiology
Definition: The discipline that describes the changes of the function and metabolism of the disease and the mechanisms involved.
Task: To reveal the nature of the disease and provide a theoretical basis for the prevention and treatment of disease.
Pathophysiology
Pathophysiology
PhysiologyPhysiology
Different Subjects
Normal Subjects Diseased Subjects
PathologyPathology
Different Viewpoints
Function & Metabolism
Morphology
Is a bridge between basic medical sciences and clinical medical sciences.
Guidance for clinical practices.
Why Is Pathophysiology Important?
Basic Medical
Sciences
ClinicalMedical Sciences
Pathophysiology
Histology & Embryology
AnatomyPhysiology
BiochemistryPathology
…
Internal MedicineSurgeryPediatricsOB/GYNInfection Diseases…
Brief History of Pathophysiology
Morgagni (1692~1771): Organ Pathology(Italian anatomist)
Virchow (1821~1902): Cell Pathology(German pathologist)
Bernard (1813~1878): Experimental Pathology(French physiologist)
Kazan University (1879-): Pathophysiology(Russian)
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Methods of Pathophysiology Methods of Pathophysiology ResearchResearch
Experimental researchExperimental research
Animal modelsAnimal models
Cell biology experimentsCell biology experiments
Molecular biology experimentsMolecular biology experiments
Epidemiological researchEpidemiological research
Clinical researchClinical research
Dept. of PathologyDept. of Pathology
Medical CollegeMedical College
Hunan Normal UniversityHunan Normal University
(( 湖南师范大学医学院病理学教研室湖南师范大学医学院病理学教研室 ))8
Chapter 1Chapter 1
Conspectus of Conspectus of DiseaseDisease
(疾病概论)(疾病概论)
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Conspectus of DiseaseConspectus of Disease
Concept of health and diseaseConcept of health and disease
Etiology of diseaseEtiology of disease
Pathogenesis of diseasePathogenesis of disease
Outcome of diseaseOutcome of disease
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Health (Classic Concept)Health (Classic Concept)
The state of the organism when it functions optimally without evidence of disease.
Health (WHO definition)Health (WHO definition)
Health indicates not only without any evidence of disease, but also a state of complete well-being physically, psychologically and socially.
Concept of Disease (Dis + ease)
An abnormal life process involving physical, mental and social problems which is induced by imbalance of homeostasis under the action of certain causes.
Diseases are manifested by a series of symptoms and signs.
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Symptom ( 症状 )
An abnormal feeling noticed by a patient.(headache, stomachache, fever, cough…)
Sign ( 体征 )
An objective indication of some medical fact or characteristic that may be detected by a physician.(body temperature, respiration, pulse, blood pressure…)
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Sub-Health (亚健康)(Sub-optimal Health Status, SHS)
A situation in which the person does not show A situation in which the person does not show specific symptoms or signs, but lives a low-quality of specific symptoms or signs, but lives a low-quality of life both physically and mentally. life both physically and mentally.
ManifestationsManifestations
PhysicallyPhysically Tiredness, low-spiritedTiredness, low-spirited
Psychologically Psychologically Irritable, stressfulIrritable, stressful
SociallySocially Bad human relations, lonely Bad human relations, lonely
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Sub-healthSub-health
HealthHealth DiseaseDisease
Relationship AmongRelationship AmongDifferent Health/Disease StatesDifferent Health/Disease States
Health
Disease
Sub-health
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Conspectus of DiseaseConspectus of Disease
Concept of health and diseaseConcept of health and disease
Etiology of diseaseEtiology of disease
Pathogenesis of diseasePathogenesis of disease
Outcome of diseaseOutcome of disease
2. Etiology
( 病因学 )The study of the many factors (causes and conditions) coming together to cause a disease.
Classifications:Causative factorsConditions
•Predisposing factors •Risk factors
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2.1 Causative Factors (原因 )
Extrinsic causesBiological
Chemical
Physical
Nutritional
Intrinsic causesGenetic
Congenital
Immunological
Psychological
A cause of a disease is an event that precedes the disease in a disease cause chain. Without this event, the disease either would not have occurred at all or would occur at a later time.
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1) Biological AgentsMicroorganisms and parasites ( 病原微生物和寄生虫 )
Bacteria
Viruses
Fungi
Rickettsia
Spirochete
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2) Chemical AgentsCorrosive chemicals
Strong acids or alkalis
Carbon monoxide
Formaldehyde
Nitrosamine
Polycyclic Aromatic Hydrocarbons, PAHs
……
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45,612 in China (2013)878 carcinogenic
3) Physical Agents
Mechanical forces Trauma
Extremes of temperature Burn/Freezing
Electric shock Shock
Radiation Irradiation damage
(X-ray, Gamma, UV, Microwave)
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Nutritional imbalancesNutritional imbalances
Nutritional deficiencyNutritional deficiency Nutritional excessNutritional excess
4) Nutritional Imbalances
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Vitamin deficiency (avitaminosis)
Vitamin A night blindness ( 夜盲症)Vitamin B1 beriberi ( 脚气病 )
Vitamin B3 pellagra ( 糙皮病 )
Vitamin C scurvy ( 坏血病 )
Vitamin D rickets ( 佝偻病 )
Vitamin K impaired coagulation ( 凝血病 )
Iron deficiency anemia ( 贫血 )
High lipids & carbohydrates obesity, atherosclerosis, diabetes
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2.1 Causative FactorsExtrinsic causes
Biological
Chemical
Physical
Nutritional
Intrinsic causesGenetic
Congenital
Immunological
Psychological 26
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Genetic factors
*Alterations in genetic materials Gene mutation Chromosomal aberration
Hereditary factors
Genetic Factors
Hemoglobin gene mutation Sickle-cell anemia
Factor VIII deficiency Hemophilia
Photopigments genes missing or damagedColor blindness
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Congenital FactorsCongenital Factors
Congenital heart defectCongenital heart defect
Congenital limb defectCongenital limb defect
A congenital disorder, or congenital disease, is a A congenital disorder, or congenital disease, is a condition existing at condition existing at birth or during the first month or during the first month of life (of life (neonatal disease). disease).
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Congenital factorsCongenital factors
*Harmful agents acting on fetus*Harmful agents acting on fetus
Cleft lip(( 唇裂 唇裂 ))
Anencephalus(( 无脑儿无脑儿 ))
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Immunological factors
Hypersensitivity (too strong) Immunodeficiency (too weak) Autoimmunity (misdirected)
Stress
Bad human relations
AnxietyAnxiety
Hypertension
Peptic ulcer
Heart disease
Depression
Cancer
……
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Psychological Factors
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Be joyful!
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Be forgiving!
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Mercy for the weak!
2.2 Conditions (条件)
Natural conditionWeatherGeology (location)
Prostate and breast cancer – high in the USLiver cancer – high in China
Physical conditionTirednessHypertension – easy to get myocardial infarction
Social conditionLaborHygiene Life style
Factors that by themselves are not sufficient to cause a disease but could influence the process or severity of disease.
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Conspectus of DiseaseConspectus of Disease
Concept of health and diseaseConcept of health and disease
Etiology of diseaseEtiology of disease
Pathogenesis of diseasePathogenesis of disease
Outcome of diseaseOutcome of disease
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Pathogenesis of Disease
The study of the rules and mechanisms underlying the development of the disease.
How the pathological agents cause disease?
How the disease develops?
3.1 General Rules of Disease 3.1 General Rules of Disease Development Development
Disruption of homeostasisDisruption of homeostasis
Alternation of cause and effectAlternation of cause and effect
Damage and anti-damageDamage and anti-damage
Local-systemic relationshipLocal-systemic relationship
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Four RulesFour Rules
3.1.1 Disruption of Homeostasis3.1.1 Disruption of HomeostasisWhat is homeostasis?What is homeostasis?Homeostasis (Homeostasis (homeohomeo = similar; = similar; stasisstasis = standing still) = standing still) refers to the process whereby the internal environment refers to the process whereby the internal environment tends to remain balanced and stable, which is required tends to remain balanced and stable, which is required for optimal functioning of the organism. for optimal functioning of the organism.
ExamplesExamplesTemperatureTemperaturepHpHBody fluidsBody fluidsElectrolytesElectrolytesOxygen levelOxygen level
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3.1.2 Alternation of Cause and 3.1.2 Alternation of Cause and Effect Effect ( (因果交替因果交替 ))
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Cause 1
Effect 1Cause 2
Effect 2Cause 3 ……
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Trauma
Hemorrhage
Blood volume↓
Blood pressure↓
Sympathetic nerve ↑
Vasoconstriction
Hypoxia
Microcirculation blood clotting
……
Vicious cycle
Example
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3.1.3 Damage and Anti-damage3.1.3 Damage and Anti-damage ( (损伤与抗损伤损伤与抗损伤 ))
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• Inter-connected, fighting.
Characteristics
• Balance determines disease
development.
Damage Anti-damage
Worse
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• Inter-connected, fighting.
Characteristics
• Balance determines disease
development.
Damage Anti-damage
Better
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• Inter-connected, fighting.
Characteristics
• Balance determines disease
development.
• Interchangeable.
Damage Anti-damage
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Trauma
Hemorrhage
Blood volume↓
Blood pressure↓
Sympathetic nerve ↑
Vasoconstriction
Hypoxia
MC blood clotting
……
Anti-damage → Damage
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3.1.4 Local-Systemic Relationship3.1.4 Local-Systemic Relationship
Inflammation (Furuncle) Inflammation (Furuncle) ((LocalLocal))
InfectionInfection
Fever Fever ↑↑WBCsWBCsSepsisSepsis((SystemicSystemic))
3.2 Fundamental Mechanisms of 3.2 Fundamental Mechanisms of DiseasesDiseases
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1)1) Neural mechanismNeural mechanism(( 神经机制神经机制 ))
22)) Humoral mechanismHumoral mechanism(( 体液机体液机制制 ))33)) Cellular mechanismCellular mechanism(( 细胞机制细胞机制 ))
44)) Molecular mechanismMolecular mechanism(( 分子机分子机制制 ))
Four MechanismsFour Mechanisms
Neural Mechanism Neural Mechanism (( 神经机制神经机制 ) )
◆ ◆ Rabies Rabies
virusvirus
VaccineVaccine
RabiesRabies
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◆◆Type B Encephalitis Virus Type B Encephalitis Virus Destroy Destroy CNS CNS Type Type
B Encephalitis B Encephalitis
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Humoral Mechanisms (Humoral Mechanisms ( 体液机体液机制制 ))
Humoral factorsHumoral factors
Hormones (estrogen, androgen, etc)Hormones (estrogen, androgen, etc)
Chemical mediators (histamine, Chemical mediators (histamine,
prostaglandins, etc)prostaglandins, etc)
Cytokines (ILs, TNFs, IFNs)Cytokines (ILs, TNFs, IFNs)
Humoral MechanismHumoral Mechanism
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Endocrine
Paracrine
Autocrine
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Cellular MechanismsCellular Mechanisms
Non-selective damageNon-selective damage
Direct damage to the cellDirect damage to the cell
(Strong acid or alkali)(Strong acid or alkali)
Selective damageSelective damage
Damage to cell membrane function (ion Damage to cell membrane function (ion
pump)pump)
Damage to the organelle (mitochondria)Damage to the organelle (mitochondria)
Damage to the cellDamage to the cell
Cell membrane damageCell membrane damage
Lysosome Lysosome damagedamage
Mitochondria damageMitochondria damage
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Receptors
Cell surface markers
Cytoskeleton (structural proteins)
Enzymes (kinases, phosphatases, etc)
Pumps
Channels
Molecular Mechanism (Molecular Mechanism ( 分子机分子机制制 ))
(( Molecular Pathology (Molecular Pathology ( 分子病理学分子病理学 )) ) )
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Enzyme deficiency:
Glucose-6-phosphate Glucose
Molecular Mechanism (Molecular Mechanism ( 分子机分子机制制 ))
G6PDH ↓↓
Glycogen Storage Disease(Liver)
Glucose-1-phosphate
Glycogen
Example
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Conspectus of DiseaseConspectus of Disease
Concept of health and diseaseConcept of health and disease
Etiology of diseaseEtiology of disease
Pathogenesis of diseasePathogenesis of disease
Outcome of diseaseOutcome of disease
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Outcome (Fate) of DiseaseOutcome (Fate) of Disease
Recovery Death
Complete recoveryIncomplete recovery
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Complete recovery
The best outcome of a disease.
The pathologically altered metabolism, structure and function are completely restored.
The symptoms and signs disappear entirely.
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Incomplete recovery
The main symptoms disappear but pathological changes still exist.
Sequela ( 后遗症 ) brought about by the compensatory response to maintain a relatively normal activity.
Heart disease Cardiac ventricular hypertrophyRheumatic feverDamage to the heart valvePolio Paralysis
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Death
Traditional concept
Cessation of heart-beats
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Death
A state of prolonged irreversiblecessation of all brain activities.
Modern concept
*Sign of death ━ brain death
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Irreversible coma
Absence of spontaneous respiration
No brain stem reflex
Flat EEG (brain wave)
Persistence of these signs for 30-60
min and for 6 h after coma
Criteria of brain death
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Saving medical resources
Having proper donors for organ
transplantation
The Significance of Brain Death Criteria