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