UNIT I: Introduction to

pathophysiology

Hammad
KMU-INS
Nursing lecturer
At the end of this unit each learners will be
able to:
 Define Pathology & Pathophysiology
 Differentiate among Pathophysiology and other biomedical sciences
 Discuss the basic concepts of disease and its development.
 Briefly discuss each of the five components of the disease process:
 Prevalence
 Etiology
 Pathogenesis
 Clinical manifestation
 Outcomes
 PATHOLOGY

 Pathology is a Greek word pathos meaning “disease” and

logos means study thus pathology is a branch of science
that deals with the study of all structural and functional
abnormalities (cell, tissues, organ, body fluids) that take
place as a result of disease. It is the result of disease and
change in homeostasis.
 Definitions

o The branch of medicine dealing with the essential nature

of disease, especially changes in body tissues and organs
that cause or are caused by disease.

o The study of the structural & functional manifestations of

a disease.

o It is the science or study of a disease and is essentially the

backbone of pathophysiology.
Homeostasis

1. The human body strives to maintain internal stability.

2. The process of maintaining normal balance within the

body is called homeostasis.
Pathologists specialized fields

Two common specialties

 1. Anatomic pathology – pathologists who perform
autopsies to determine cause of death

 2. Clinical pathology – pathologists who review lab

specimens to determine evidence of abnormal tissue,
presence of chemicals
Branches of anatomical pathology

 General pathology:
It deals with the study of the common basic changes in all
tissues
as a result of disease e.g cell injury, necrosis, inflammation.

 Systematic pathology:
It deals with the study of morphological (structural) changes in
tissues and organs of a particular system as a result of disease
e.g pathology of respiratory system pathology of nervous system
etc.
.

 Special pathology:
It deals with the application of the basic changes learned in
general pathology to the various specific disease e.g diabetes
atherosclerosis etc.
 Diagnostic pathology (Histopathology): It deals with the study
of tissue abnormalities using gross and microscopic examination of
biopsy samples.
 Cytopathology: it deals with the study of cellular changes.
 Surgical pathology: It refers to Histopathological examination of
biopsy samples surgically removed from living bodies.
 Post-mortem pathology: It deals with the pathological
examination of human carcass after death, also known as autopsy
or necropsy.
Cont

 Forensic pathology: It is the sub specialty of pathology that

focusses on the medico-legal investigation of the cause of death by
examination of a dead body. Forensic means law court (latin word).

 Physiological pathology: It deals with the study of alterations in

the functions of organs and systems of the body as a result to a
disease. It is also known as pathophysiology e.g pathophysiology
of indigestion, diarrhea, abortion etc.
 Immunopathology: It deals with the study of disease mediated by
.immune reactions. Such as immunodeficiency diseases,
autoimmune (immune system mistakenly attacks body) diseases and
hypersensitivity (IgE anaphylactic, allergic dermatitis, allergic
conjunctivitis reactions).

 Molecular pathology: It deals with the study of alterations that

take place at the molecular level (DNA damage) as a result to a
disease. E.g bloom s'syndrome, fanconi’s anemia.

 Experimental pathology: It is the study of disease that have been

created or induced experimentally to analyze the structural and
functional abnormalities in tissue to better understand the
mechanism of underline disease. Usually laboratory used in
experimental pathology e.g mice rabbit etc .
Pathophysiology

 Pathos = disease, pain, suffering

logos = science

  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.
 Pathophysiology – the study of abnormal functions in the body and
how disease processes work.
 Difference between Pathology and Pathophysiology

 Pathology deals with the analysis and examination of bodily

fluids, infection & abnormalities.

 The term “patho” means that there is an associated disease.

 Pathophysiology is the study of the physiologic changes occurring

in the body of an organism due to a disease.

 Pathophysiology is a biomedical science dealing with functional

changes in diseased organism
• Why pathophysiology is important for Nursing
students

It helps them to find answers to important questions related to disease

processes:

a) What is the cause/causes of the disease, and why the disease is

developing?

b) What are the mechanisms responsible for disease onset, progression,

and recovery

c) What are the mechanisms responsible for development of

symptoms and signs of disease

Relation among pathophysiology and other science

 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
Cont

 Biophysics – biophysical properties of cells, tissues

and organs determine their structural
and functional characteristics

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

healthy tissues, organs and systems of the body,
than we are able to distinguish pathological
functions
 Pathological anatomy – to understand the microstructural and

macrostructural changes under pathological conditions helps to

understand functional changes and vice versa
 Cont
 Microbiology 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

 Pharmacology – PaPhy enables the Nurses to treat diseases rationally

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

practice

 Humanistic subjects (psychology, ethics, sociology, antropology...)

– psychologic and social factors play an important role in disease

development
Main tasks of pathophysiology

 To help students to understand the logic of life under pathological

conditions
 To help to understand the substance of health
 To teach mechanism of disease
BASIC CONCEPTS. OF DISEASE AND
ITS DEVELOPMENT
 Disease
oThe Oxford English Dictionary defines disease as
“a condition of the body or some part or organ of
the body in which its functions are disrupted or
deranged”.

oFrom an ecological point of view, disease is defined

as “a maladjustment of the human organism to the
environment”.

oThe term disease literally means without ease, the

opposite of ease-when something is wrong with
bodily function.
Disease Etiology
 Etiology basically means “What are the possible causes for the
disease”.
 Etiological Factors
The factors that cause the disease & determine the clinical features of
the disease. Etiologic factors include predisposing & precipitating
factors, which contributes to the onset of diseases.
 Among the etiological factors, a wide range of extrinsic factors in
the environment & intrinsic factors in the body must be considered.
There may be more than one cause of a disease, for example: A
person may have high blood pressure because it runs in the family, he
is overweight, does not exercise regularly or has bad eating habits.
 Cont
 Predisposing/Non modifiable Factors
 The function of these factors is to intensify the effects of
causative factors and promote the onset & development of
diseases; e.g. gender, age, race, genetic background,
environmental conditions etc.

 Precipitating/Triggering Factors
 These factors promotes the development of disease and
influences the timing of illness onset e.g. emotional changes,
temperature, exercise, are the precipitating factors for angina.
 Risk factors
o Any attribute, characteristic or exposure of an individual that
increases the likelihood of developing a disease.
o Important risk factors are underweight, unsafe sex, high blood
pressure, tobacco and alcohol consumption and unsafe water, poor
sanitation & hygiene.
o Etiologic classification of disease

o Inherited or familial

o Usually comes from one or both parents. Not all of these diseases
are inherited, some may occur from environmental influences.
Example: everyone in the family gets sick from the water (familial)
Congenital

Diseases that are present at birth. These diseases may or

may not be inherited. They may just be caused by a birth
defect.
Not all hereditary diseases present are congenital
Not all congenital diseases are hereditary
Cont

Infectious Diseases
These are derived from an invasion of living pathogenic
organisms such as bacteria, viruses, fungi, protozoa etc.

Traumatic Diseases
These diseases are caused by some sort of physical injury.
Examples: motor vehicle accidents, extreme heat or cold
and radiation exposure.

Degenerative Diseases
These are caused by the degeneration of some tissue of
the body. They usually come with age. Example:
osteoporosis and osteoarthritis.
Immunologic Disease

This is when the disease causes an exaggerated or low

response by the immune system against the invasion of
foreign antigen. Example. Grave’s Disease, HIV, SLE etc.

 Neoplastic Diseases
These diseases are caused by abnormal cell growth in
the body that can lead to benign or malignant tumors.

 Metabolic Disease
This disease occurs because of some disturbance in the
metabolic processes in the body; e.g. DM.
 Molecular Disease
These diseases result from a defect in a single molecule
in the body. Many of these disease are genetic e.g.
sickle cell anemia.

 Psychogenic Disease

Physical disease caused by emotional or mental stress.

The mind changes the body’s physiology so that body
parts break down e.g. ulcers, asthma.
 Iatrogenic Disease
Disease caused as a result of adverse effects or complication of
medical treatment or advice.

 Iatrogenesis are actions by healthcare professionals, such as

doctors, psychologists, pharmacists, nurses and dentists.

 These are caused by: Chance, negligence, faulty procedures,

medical error like wrong
prescriptions, adverse effects & interactions of prescription
drugs, nosocomial infections, blood transfusion etc.
 Nutritional Disease

These are caused by deficiencies in proteins, calories or

vitamins. Example: malnutrition, anemia etc.

 Idiopathic Disease

These diseases are caused from unknown sources e.g.

more than 90% of hypertension cases have absolutely
no cause.

 Toxic: Caused from the ingestion of poison.

Basic Mechanism of Disease

 Neural mechanism
 Humoral mechanism
 Cellular mechanism
 Molecular mechanism
 ● Neural mechanism

Neural system plays a central role in regulating the entire life

activities; therefore, the disorders in CNS will definitely affect
the corresponding peripheral system. Neural mechanisms are
structures such as neurons, neural circuits and regions of the
brain. They are also substances such as neurotransmitters and
hormones. Neural mechanisms regulate aggression and
examples, including the limbic system, serotonin and
testosterone.
 ● Humoral mechanism

 The humoral immune response

is mediated by antibody molecules
that are secreted by plasma cells.
 Hormones
 Chemical mediators
 Cytokines

● Cellular mechanism: Cellular mechanisms are (I) cell cycle

regulation, (II) induction of DNA damage and DNA repair, and (III)
specific targeting of topo2.

● Molecular mechanism: Genetic and biochemical testing

General Rules for Pathogenesis of Diseases

 ● Damage and anti-damage responses

Damages are usually made when a variety of harmful insults attack
the body. During this process, anti- damage responses are also
induced in the body to restore the normal situation.
DISCUSS

 Prevalence
 Etiology
 Pathogenesis
 Clinical Manifestation
 Outcomes
Prevalence

The proportion of people who have the disease (existing

cases plus new cases) over the total population for a given
time period
Prevalence
(P) Quantifies the number of existing cases of disease in
a population during a period of time.

o P = Number of existing cases of disease/Number in total

population (during a period of time)

o Example: City A has 7000 people with arthritis on Jan

1st, 2012.

o Population of City A = 70,000

o Thus the prevalence of arthritis on Jan 1st = .10 or 10%.
o Prevalence is often expressed as a percentage, calculated
by multiplying the ratio by 100.
Disease occurrence in a sample of community over time
What is the prevalence of disease in Year 2?
 What is the numerator?

 5 cases in Year 1 + 7 cases in Year 2 = 12

 What is the denominator?

 Total sample size = 30

 Prevalence = 12/30 = 0.4

 The prevalence of disease in Year 2 is 40%
What is the prevalence of disease in Year 3?

 What is the numerator?

 5 cases in Year 1 + 7 cases in Year 2 + 4 cases in Year 3
= 16
 What is the denominator?
 Total sample size = 30
 Prevalence = 16/30 = 0.533
 The prevalence of disease in Year 3 is 53.3%
ETIOLOGY

 Etiology is the study of causation, or origination. The

word is derived from the Greek aitiología, "giving a
reason for". More completely, etiology is the study of the
causes, origins, or reasons behind the way that things are,
or the way they function, or it can refer to the causes
themselves.
 1. Intrinsic Etiology
 Intrinsic means coming from within. Therefore, any
pathological, or disease-causing, change that has occurred
from inside the body has occurred as a result of intrinsic
factors.
 Examples : Inherited conditions such as hemophilia,
 Endocrine disorders such as diabetes
 Neoplastic disorders such as abnormal cell growth.
 Immune system disorders such as allergies
2. Extrinsic Etiology

 This means the cause of the disease, or pathological

change, came from outside of the body.
 Such as Infectious agents like bacteria, viruses, fungi,
and parasites
 Animal bites or stings
 Chemicals, electricity, and radiation
3. Idiopathic Etiology

 The etiology of un-known cause is said to be idiopathic

etiology. It does not mean that there is no cause, there
must be a cause but we do not know the cause in light of
our knowledge and technology.
Pathogenesis

 The development of a disease is referred to as

pathogenesis (-genesis = origin or development).
 The sequence of events that leads from cause of disease
to structural and functional abnormalities, to how the
disease manifests itself and finally to the resolution or
recovery of the disease.
 Example: common cold

1. Cause = exposure and inoculation of cold virus

2. Incubation time = virus multiplies

3. Manifestation = host begins to have signs and

symptoms (sore throat, itchy eyes, runny nose, etc.)

4. Recovery = return to previous state of health

Predisposing factors
* Factors that increase probability of a person’s becoming
ill
 1. Age
Newborn babies
 1) Immature immune system
 2) Liver enzymes necessary for detoxification of some
substances are often lacking
 3) Fewer nutritional reserves
 4) Less body fat to insulate against cold
Cont.

 Elderly
 1) Decrease in immune function
 2) Decline in homeostatic mechanisms
 3) Depression; isolation; malnutrition

 2. Sex - some diseases are more prone to one gender

than the other
 1. Men more likely to develop gout
 2. Women more likely to develop osteoporosis
Cont

 3. Genetic makeup (familial tendencies for: diabetes,

asthma, migraines, etc.)
 4. Stress - increases body’s production of
corticosteroids, which decreases immune system
function.
 Cont

 5. Lifestyle - personal habits in regard to diet, exercise,

weight control, smoking, alcohol consumption, sexual
practice
 6. Occupation - exposure to loud noises, pollutants,
repetitive movements, heavy equipment, high places, etc.
Clinical Manifestations of a Disease
The features of the disease i.e. signs & symptoms that
can be identified by history taking and physical
assessment.

Subclinical stage
This is the stage when a person is functioning normally
with no symptoms but the disease is still growing inside
the body.
 Symptoms: are said to be what the patient is able to tell the
physician or nurse, is wrong with them: Example: Nausea,
malaise and pain.
 Signs: are said to be what can be observed by the physician or
nurse. Example: Fever, Redness, swelling & palpable mass.
Cont

-A complication: is when a new or separate process

arises because of some change in the
original disease.
-Resolution: is when the host returns back to the normal
state without complications.
Resolution can occur without any treatment,
with treatment or from the body’s natural
defenses.
-Prognosis: is a forecasting of the probable course and
outcome of a disease, especially of the
chances of recovery.
 Outcomes

o The course of a disease varies.

o An acute disease has relatively sudden onset and lasts for

a short term, whereas a chronic disease, sometimes begins
with an acute phase, usually lasts for a long period of time.

o There are generally three types of outcomes for a

disease.
Cont
 Complete Recovery

o This is the best outcome of a disease.

o In this case, the pathologically altered metabolism,

structures & functions are perfectly restored and the
signs & symptoms of disease disappear entirely.

 Incomplete Recovery
o The main symptoms disappear but some pathological
changes are left behind.
 .
 Death
The cessation of heart-beats and respiration are usually used as the
criterion of death of the body.

 Traditionally Death occurs in the following Stages

 Agonal stage: Tissue changes that occur immediately before

death i.e. vascular congestion, pulmonary edema, foreign
materials aspiration etc.
 Stage of clinical death: Cessation of all vital bodily
functions. The heart stops beating, lungs cease to function, brain
activity no longer exists.
 Stage of biological death: Biological death of a patient
means death of tissues of the Kidneys, Heart, Lungs, Brain etc.
 .Brain death

 The functions of cerebrum & brain stem stop forever.

 Criteria for brain death

 Irreversible coma
 Cessation of spontaneous respiration.
 No-purposeful movement
 Absence of cephalic reflexes
 Absence of any electric activity of the brain
 Absence of cerebral circulation
Man is the Architect of his life…