Introduction to

Pathophysiology

By

Associate Prof. Atallah Elenezi

2024
 Learning Objectives

Upon completing this lecture students should be able to:

- Definition of key terms
- Contrast illness and diseases
- Restate the predisposing factors of disease
- Know the key principles of pathophysiology: cell injury, cell
adaptation, and cell death
- Summarize the process of inflammation, tissue repair, and
regeneration
- Discuss cancer and its related information
 Definition of Key terms
Pathophysiology: it derives from the intersection of two older,
related disciplines:
pathology (from pathos, suffering) and physiology
(from physis, nature).
- Pathology is the study and diagnosis of disease through the
examination of organs, tissues, cells, and bodily fluids.

- Physiology is the study of living organisms' mechanical, physical,

and biochemical functions of living organism..
 Definition of Key terms
Pathophysiology includes four interrelated topics:
etiology, pathogenesis, clinical manifestations, and
treatment implications.

Etiology refers to the study of the proposed cause or

causes of a particular disease process
 Definition of Key terms

Together, with pathophysiology, the term refers to the study of

abnormalities in the physiologic functioning of living beings.
OR
The study of how diseases affect the functioning of the body.
Pathophysiology includes the study of biological and physical
diseases as well as the physiological disturbance caused due to
various diseases.
 Disease and illness

“Good health” is really a state of balance in

the major aspects of our lives.
 Disease and illness
 Disease is the condition or state that occurs when
the individual is out of ease with his/herself. That is
out of balance.

 It is the time of imbalance that the immune system

which normally protects us may fail.

 A physiological or psychological dysfunction.

 Disease and illness
 Disease is a pathological condition of the
body that occurs in response to an
alteration in the normal body harmony or
functioning.

 The disease is usually tangible or

measurable. It may be the direct result of
trauma, physical agents, and poisons, or it
may be the indirect result of genetic
anomalies and metabolic and nutritional
disturbances.
 Disease and illness

 Illness describes the condition of a

person who is experiencing a disease. It
encompasses how individuals perceive
themselves as suffering from a disease.
Illness is highly individual and personal.

 A disease, on the other hand, is known

by its medical classification and
distinguishing features.
 Predisposing factors of disease
A predisposing factor is a condition or situation that may
make a person more at risk or susceptible to disease.

1. Heredity is a predisposing factor when a trait inherited

from a parent puts an individual at risk for certain
diseases.

2. Age is a risk factor related to the life cycle. Older adults

have unique problems that arise from the aging process
itself.
 Predisposing factors of disease
3. Gender is a predisposing factor when the disease is
physiologically based. For example: prostate cancer
occurs only in men and ovarian cyst occurs only in
women.

4. The external environment can be a risk factor.

Exposure to air, noise, and other environmental pollutants
may predispose individuals to disease.
 Predisposing factors of disease

5. Life choices may predispose some diseases. Lifestyle is

the consistent, integrated way of life of an individual, as
typified by mannerisms, attitudes, and possessions.
-:From the time a person is born, lifestyle is influenced by
 Modeling of family members and peers
 Education and knowledge
 Personal attitudes,
 Degree of self-confidence,
 Individual responsibilities,
 life’s opportunities
 The key principles of pathophysiology: cell
injury, cell adaptation, and cell death

The cell is the structural and functional unit of life. Bounded by a

cell membrane, which maintains the homeostasis of the cell interior,
it contains various membrane-bound compartments
or organelles within, which subserve specialized functions. These
membrane-bound organelles are characteristic of all eukaryotic
cells, including those in humans.
 The key principles of pathophysiology: cell
injury, cell adaptation, and cell death

The cell membrane binds all cells in the human body, forming a
dynamic interface between the intracellular and extracellular
environments.
It serves, or facilitates, the following functions:
1. The maintenance of cell shape and structure.
2. A transport function.
3. Intercellular communication, involving signal transduction
4. Intercellular adhesion. This is brought about by the fusion of
the membrane with other cell membranes via specialized
junctions.
5. Directed cell movement.
 Cell injury

 As cells encounter physiologic stresses or pathologic

stimuli, they can undergo adaptation, achieving a new
steady state and preserving viability and function.

 The principal adaptive responses are hypertrophy,

hyperplasia, atrophy, and metaplasia.

 If the adaptive capability is exceeded or if the external

stress is harmful, cell injury develops .
 Cell injury

 Within certain limits cell injury is reversible, and cells return

to a stable baseline; however, severe or persistent stress
results in irreversible cell injury and death of the affected
cells.

 Cell death is one of the most crucial events in the evolution

of disease in any tissue or organ.

 It results from diverse causes, including ischemia (lack of

blood flow), infections, toxins, and immune reactions.
Cell death is also a normal and essential process in
embryogenesis, the development of organs.
 CELLULAR ADAPTATIONS TO STRESS

 Adaptations are reversible changes in the number, size,

phenotype, metabolic activity, or functions of cells in
response to changes in their environment.

• Physiologic adaptation
• Pathologic adaptation
 Physiologic adaptations

Usually represent responses of cells to normal

stimulation by hormones or endogenous chemical
mediators (e.g., the hormone-induced enlargement
of the breast and uterus during pregnancy).
 Pathologic adaptations

Are responses to stress that allow cells to modulate

their structure and function and thus escape injury.
Such adaptations can take several distinct forms.
 Cellular adaptations to stress

Cellular adaptations to stress:

I. Hyperplasia (more cells)
II. Hypertrophy (bigger cells)
III. Atrophy (smaller cells)
IV. Metaplasia (different type of cells)
Cellular adaptations to stress
 Hyperplasia (more cells) .1

 Hyperplasia is characterized by an increase in cell

number.

 Hyperplasia is an adaptive response in cells

capable of replication.

 Hyperplasia can be physiologic or pathologic.

 Hyperplasia (more cells) .1

 The two types of physiologic hyperplasia are:

(1) hormonal hyperplasia, exemplified by the

proliferation of the glandular epithelium of the
female breast at puberty and during pregnancy;
and
(2) compensatory hyperplasia, that is, hyperplasia
that occurs when a portion of the tissue is removed or
diseased.
 Hyperplasia (more cells) .1

For example, when a liver is partially resected, mitotic

activity in the remaining cells begins as early as 12 hours
later, eventually restoring the liver to its normal weight.

The stimuli for hyperplasia in this setting are growth

factors produced by remnant hepatocytes in the liver.

After restoration of the liver mass, cell proliferation is

"turned off" by various growth factor inhibitors.
 Hyperplasia (more cells) .1

Pathologic hyperplasia:
Are caused by excessive hormonal or growth factor
stimulation.

For Example: if the balance between estrogen and

progesterone during the menstrual period is disturbed,
endometrial hyperplasia ensues, a common cause of
abnormal menstrual bleeding.

patients with hyperplasia of the endometrium are at

increased risk of developing endometrial cancer.
 Hypertrophy (bigger cells) .2

 Hypertrophy is an increase in the size of

cells resulting in increase in the size of the
organ in pure hypertrophy there are no new
cells, just bigger cells, enlarged by an
increased amount of structural proteins and
organelles.
 hypertrophy occurs when cells are
incapable of dividing.
 Hypertrophy (bigger cells) .2

 Hypertrophy can be physiologic or pathologic and is

caused either by increased functional demand or by
specific hormonal stimulation.

 Hypertrophy and hyperplasia can also occur together,

and obviously, both result in an enlarged organ.

 Examples of pathologic cellular hypertrophy include

the cardiac enlargement that occurs with hypertension.
 Atrophy (smaller cells) .3

 Shrinkage in the size of the cell by the loss of cell

substance is known as atrophy.

 When a sufficient number of cells is involved, the

entire tissue or organ diminishes in size, becoming
atrophic.

 It should be emphasized that although atrophic

cells may have diminished function, they are not
dead.
 Atrophy (smaller cells) .3

 Causes of atrophy include:

I. Decreased workload (e.g., immobilization of a
limb to permit healing of a fracture),
II. Loss of innervation,
III. Diminished blood supply,
IV. Inadequate nutrition,
V. Loss of endocrine stimulation. 6. aging (senile
atrophy).
 Atrophy (smaller cells) .3

 Although some of these stimuli are physiologic

(e.g., the loss of hormone stimulation in
menopause) and others pathologic (e.g.,
denervation), the fundamental cellular changes are
identical.

 The cell turns to a smaller size at which survival is

still possible; a new equilibrium is achieved
between cell size, diminished blood supply, and
nutrition.
 Atrophy (smaller cells) .3

 Atrophy results from decreased protein synthesis

and increased protein degradation in cells.

 Protein synthesis decreases because of reduced

metabolic activity.
3. Atrophy
(smaller
cells)
 Metaplasia (different type of cells) .4

 Is a reversible change in which one adult cell type

(epithelial or mesenchymal) is replaced by another
adult cell type.
 In this type of cellular adaptation, cells sensitive
to a particular stress are replaced by other cell
types better able to withstand the adverse
environment.
 Metaplasia is thought to arise by genetic
"reprogramming" of stem cells.
 Metaplasia (different type of cells) .4

 Epithelial metaplasia is exemplified by the

squamous change that occurs in the respiratory
epithelium in habitual cigarette smokers.

The normal ciliated columnar epithelial cells of the

trachea and bronchi are focally or widely replaced by
stratified squamous epithelial cells.
 Metaplasia (different type of cells) .4

 Epithelial metaplasia is exemplified by the squamous

change that occurs in the respiratory epithelium in habitual
cigarette smokers.

 The normal ciliated columnar epithelial cells of the

trachea and bronchi are focally or widely replaced by
stratified squamous epithelial cells.

 In fact, in a common form of lung cancer, squamous

metaplasia of the respiratory epithelium often coexists
with cancers composed of malignant squamous cells.
 4.
Metaplasia
(different
type of
cells)
Inflammation, tissue repair and regeneration

Inflammation plays a critical role in tissue repair and

regeneration.
Mechanism: After tissue injury, inflammatory
immune cells are recruited to the wound site,
facilitate wound debridement, and produce several
chemokines, cytokines, metabolites, and growth
factors that signal to activate other immune cells as
well as tissue-specific stem cells to initiate the tissue
repair and regeneration.
 Inflammation, tissue repair and regeneration

 Mammal tissues with high stem cell numbers and

proliferative capacity, such as the liver, blood, and
intestinal epithelium, are where regeneration is most
frequently seen.
What is healing?
Healing: by definition is the response of a body to any injury to
regain normal structure and function.
Healing involves two distinct processes:
a) Healing by regeneration
b) Healing by repair
 Inflammation, tissue repair and regeneration

 Healing by Regeneration Regeneration occurs through

proliferation of parenchymal cells and restoration of the
normal tissues. e.g., Regeneration by stem cells.

 Healing by repair: Repair occurs by proliferation of

connective tissue which usually results in fibrosis and
scar formation.
 Factors influencing healing

Local Factors The primary localizing factor that slows the healing
process is infection.

1. Wounds with inadequate blood flow heal more slowly, as in the

case of leg injuries with varicose ulcers.
2. Foreign objects, such as sutures, impede healing and trigger a
severe inflammatory response and infection.
3. Motion prevents a wound from healing
4. Granulation tissue development is delayed by ionizing radiation
exposure.
 Factors influencing healing

Systemic Factors

1. Age: Young people heal wounds more quickly than elderly and
disabled people, who have insufficient blood flow to the
damaged area.
2. Nutrition: A lack of components like protein, vitamin C, and zinc
causes the healing of wounds to be delayed.
3. Systemic infection hinders the healing of wounds.
4. Uncontrolled diabetics are more likely to get infections, which
causes their recuperation to take longer.
 Cancer

Cancer is a term most feared by individuals, is a group of diseases

expressed by this uncontrolled growth and spread of abnormal
cells that can cause death.

The term tumor, a swelling or an enlargement, is used

interchangeably with neoplasm.

A tumor may be benign or malignant, depending on its growth

pattern, cell characteristics, potential for the cells to move from one
part of the body to another (or metastasis), tendency to recur, and
capacity to cause death.
 Cancer

Cancers are generally divided into three categories: carcinomas,

sarcomas, and cancers of blood and lymph.

ETIOLOGY OF CANCER: cancer can start in any body tissue and

has no single cause. There are over 200 different types of cancer,
and most are multifactorial, meaning that many factors contribute to
the cancer.

Research indicates that all cancers arise because of complex

alterations in DNA that result in unrestrained cellular proliferation.
These cell mutations alter gene chemistry enough to produce
abnormal cells.
 CLASSIFICATION OF CANCERS

1. Carcinomas: Carcinomas, the largest group, are solid tumors of

epithelial tissue of external and internal body surfaces.
These tumors are found in the breast, colon, liver, lung, prostate, and
stomach and are often identified as such.

2. Sarcomas: which are less common than carcinomas, arise from

supportive and connective tissue such as bone, fat, muscle, and
cartilage.

3. Cancers of the Blood and Lymph: Cancers of blood and lymph

include leukemias, Hodgkin disease, and non-Hodgkin lymphoma.
 CANCER WARNING SIGNS

I. Change in bowel or bladder habits

II.A sore that does not heal
III.Unusual bleeding or discharge
IV.Thickening or lump in the breast or elsewhere
V. Indigestion or difficulty in swallowing
 DIAGNOSTIC PROCEDURES
FOR CANCER

I. Specific tests for early detection include blood

chemistry analysis, ultrasonography, radiography,
endoscopy, nuclear medicine scans, isotope scanning,
computed tomography (CT) scanning, and magnetic
resonance imaging (MRI).

II. Tumor markers also used for diagnosis.

 Grading and Staging Cancer

Grading helps in the diagnosis and treatment planning, provides a

possible prognosis, and allows for the comparison of treatment
results between different treatments.

Usually, four grades are used:

Grade 1: Tumor cells are well differentiated, closely resembling

normal parent tissue.
Grade 2: Tumor cells are intermediate in appearance, moderately or
poorly differentiated
Grade 3: Tumor cells are very abnormal and poorly differentiated.
Grade 4: Tumor cells are so anaplastic that recognition of the
tumor’s tissue origin is difficult.
 Treatment of Cancer

The major types of treatment against cancer are:

surgery, chemotherapy, radiation therapy, immunotherapy
or biotherapy, hormonal therapy, and stem cell and bone
marrow transplants.

The primary care provider or specialist may recommend

one or any combination of these treatments to combat a
particular form of cancer.