INTRODUCTION TO STUDY OF PATHOPHYSIOLOGY

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INTRODUCTION TO STUDY OF PATHOPHYSIOLOGY

• Prof. J. Hanacek, M.D., Ph.D.,

Technical co - operation Lila Surinová,
Ing.M.Vrabec
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What the pathophysiology is
Physiologia, ae, f. gr. fysis nature
logos science
Pathophysiologia, ae, f. gr. pathos
disease, pain, suffering
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Physiology
Pathophysiology
Life
Logic
Healthy
Diseased
Study
The calligraphy done by the Korean artis Kim
Hyun-Seung
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Pathophysiology - definitions
/PaPhy/
? Pathophysiology is a biomedical science on
the mechanisms of development and elimination
of pathological processes
? PaPhy is a biomedical science dealing with
functional changes in diseased organism
? PaPhy deals with the dynamic aspects of
pathological processes. It studies
disordered or altered functions - the
physiologic mechanisms altered by disease in
the living organism
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Pathophysiology deals with temporal and
spatial dynamics 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 noxas, in pathogenesis of
disease, and in sanogenesis
Pathophysiology belongs to core subjects of
undergraduate medical education
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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
subjects of sciences and clinical subjects
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? 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)
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Why pathophysiology is important for
medical students and physicians

• It helps them to find answers to important
• questions related to disease processes
• a) What is the cause of the disease, and why
  the
• disease is developing
• b) What are the mechanisms responsible for
• disease onset and progression
• c) What are the mechanisms resposible for
• development of symptoms and signs of
  disease

2. If doctors are able to undetstand the causes
and mechanisms of the disease, then they are
able to treat them rationally
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Relation among pathophysiology and 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
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Biophysics biophysical properties of cells,
tissues and organs determin
their structural and
functional characteristics Physiology firstly,
we have to understand the
functions of the healthy men, than we
are able recognize pathologic
functions
Pathological anatomy to understand the
ultrastructural and macrostructural
changes under pathological
conditions helps to
understand functional changes
and vice versa
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Microbiology and immunology they help 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 teaches theory of
disease Humanistic subjects (psychology, ethics,
sociology...) psychologic and
social factors play an
important role in disease development
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The position of Pathophysiology in undergraduate
medical education

• It becomes an integrative biomedical discipline

• It becomes a bridge between the subjects of
• sciences and clinical medicine

• It is an important part of pre-gradual 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
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Thanks to pathophysiology the medical student
can understand the inner logic of the
pathological processes, their relationship, and
their biological significance. On this basis
student is able, as a result, to built an
individual model of disease in a given patient
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House of Medicine
Neurology Gynekology and Obtetrics
Surgery Internal medicine
P A T H O P H Y S I O L O G Y
Pathology
Pharmacology
Microbiology
P H Y S I O L O G Y
Anat
Biol
Histol
Bioch
Chem
Biophys
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Structure of pathophysiology
1. General pathophysiology
2. Special /organs, systems/ pathophysiology

• General pathophysiology content
• It deals with general pathologic processes,
  and
• pathomechanisms involved in pathogenesis of
  more
• than one disease. It also contain
  explanation of
• some terms

? General pathological processes inflammation,
fever, hyperthermia, hypothermia, shock,
stress, edemas, disturbances of control
mechanisms, hyperreactivity,
hyporeactivity, damage of genetic information....
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? Defensive and adaptive mechanisms -
non-specific and specific immunity, hypertrophy,
atrophy, hyperfunction, hypofunction,
homeostasis
? Incresed predisposition to onset of disease
(diathesis) due to genetic or/and environmental
factors
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Terminology
a) Nosology /nosos disease logos science/
Systematically describes the disease and this
is the base for classification of diseases
b) Etiology of disease /aitiá cause/
Deals with noxas 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)
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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
f) Tanatogenesis /thanatos death/ Deals
with dieing process
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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

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SPECIAL KINDS OF PATHOPHYSIOLOGY

• Clinical pathophysiology
• /clinical physiology/

• Space pathophysiology

• Experimental pathophysiology

• Pathophysiology of extreme - events

• Pathophysiology of work and sport

• Adaptation pathophysiology

? Cellular and molecular pathophysiology
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? Pathogenesis of disease processes can not
be reduced to only quantitative changes of
existing structures, functions and mechanisms
? It is necessary to take into account
development of qualitative new changes, Which
are harmful for the body structure and functions
One example of such new mechanism is circulus
vitiosus
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Examples of circulus vitiosus

• First example Development of LV
  insufficiency
• Mitrál stenosis cardiac output of
  left ventricle
• activation of sympathetic n.s.
• vasoconstriction
• (skin, splanchnic arter, kydney)
• heart rate
• end diastolic vol shorter
  diastola of LV
  

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• 2nd example Development of edema during LV
  failure.
• LV failure
  hydrostatic pressure in
• venous system
  
• 
  formation of edema
• COLV activation
  sympathic
• 
  
• ? fluid volume
  vasoconstriction
• in venous system
• 
  blood flow
• in kydney
  
  
• resorbtion Na
  activation of
• in kydney R -
  A- A system

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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)

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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 ofManual in general
  pathology
• and pathological physiology

• A.F. Hecker / 1790/ -authorTextbook in
  pathophysiology

Excellent pathophysiologist from the past J.E.
Purkyne, Prof. Pashutin, Prof. Pavlov /from
Russia/, Prof. Hans Selye /Canada-1907-1982/
-Stress theory ...
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Methods used in pathophysiological research
1. Observation
2. Animal experiment
3. Clinical pathopysiological study
4. Elaboration of experimental models of
pathological processes animals models,
mathemathical models...
Research at the Dept. of Pathophysiology
It is devoted to research of PaPhy of
respiratory system, especially to defensive
mechanisms of the airways and lungs
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The main aims of teaching pathohysiology

• 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
pathomechanizms 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 event
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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)

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Textbooks and other sorces for study of PaPhy
?Sylvia Anderson Price, Lorraine Mc Carty Wilson,
Pathophysiology - Clinical concepts of disease
processes Fourth edition, 1992 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
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Staff involved in teaching process
Head of Department of Pathophysiology Professor
M. Tatar, M.D., Ph.D. Teaching
staff Teachers Prof. Jan Hanacek, M.D.,
Ph.D. Prof. Milos Tatar, M.D., Ph.D.
Assoc. Prof. R. Pecova, M.D., Ph.D. Mrs. M.
Brozmanova, RNDr., Ph.D. Mrs.
J. Plevkova, M.D., Ph.D. Technicians Mr. M.
Vrabec, Ing. Ms. L. Mazurova, Ms. M.
Slastanova, Mr. T. Zatko Secretary Mrs M.
Ilovska