PATHOPHYSIOLOGY

CAUSES OF DISEASE
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CORE PATHOPHYSIOLOGIC CONCEPTS

1. Concept of Homeostasis

2. Concept of Disease and Illness

3. Framework for pathophysiology

4. Concepts of epidemiology

5. Implications for treatment

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WHAT IS PATHOPHYSIOLOGY
▸ Physiology - study of specific characteristics and functions a living organism and its
parts

▸ Pathos - Greek for suffering or disease

▸ Pathophysiology - the study of the disorder or breakdown of the human body’s

function

▸ new biology has allowed a deeper understanding of evolution, greater insights

into immune mechanisms and nearly every advance into cancer and AIDS.

▸ but, genetic manipulation raises sensitive and complex ethical and moral
questions - scientists can experiment with what genes do and how they do it

▸ scientific breakthroughs have changed medical practice especially mgt of

inherited diseases - diagnostic management of genetics may be common place
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1. CONCEPT OF HOMEOSTASIS
▸ Homeostasis has engendered a sense of order and unity to the study of biological
processes

▸ first described by American physiologist Walter B Cannon in his classic 1932 text, The
Wisdom of The Body, which elucidated the interdependence of the body systems

▸ eg; circulatory, endocrine, and nervous systems are no longer considered isolated units
operating independently

▸ we now better understand adaptive or compensatory manifestations of homeostasis as

functions related to total needs of the individual

▸ homeostasis is a dynamic process of continuous self-regulation and self -adjustment, its

study allows us to understand the many fluctuations and oscillations that occur
constantly within the body

▸ defined as: dynamic steady state, representing the net effect of all turn over mechanisms
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HOMESTATIC CONTROL MECHANISMS

▸ most homeostatic control mechanisms function on the principle of
negative feedback (there are few instances of positive feedback)

▸ In -ve feedback causes the controller to respond in an manner that

opposes and negates the deviation/s from normal

▸ the variable to be controlled just be “sensed” or regulated

▸ as such the controller responds by bringing the variable back to normal

▸ In +ve feedback the end products of an action cause more of that action
to occur in a feedback loop. This amplifies the original action. It is
contrasted with -ve feedback which is when the end results of an action
inhibit that action from continuing to occur
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NEGATIVE FEEDBACK
A common example of negative feedback is Homeostasis of body temperature
and blood pressure control
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POSITIVE FEEDBACK
▸ Blood Clotting: Once damage occurs to the blood vessel wall
for example, blood flow to the site carries more and more
platelets and fibrinogen until a clot forms that will keep the
injury from losing any more blood.

▸ Child birth and breast feeding:In childbirth, when the fetus’s

head presses up against the cervix, it stimulates nerves that tell
the brain to stimulate the pituitary gland, which then produces
oxytocin. Oxytocin causes the uterus to contract. This moves the
fetus even closer to the cervix, which causes more oxytocin to
be produced until childbirth occurs and the baby leaves the
womb. Breastfeeding is also a positive feedback loop; as the
baby suckles, the mother’s pituitary gland produces more of the
hormone prolactin, which causes more milk to be produced.

▸ Other examples: Menstrual cycle, digestion and nerve

signalling
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2. CONCEPT OF DISEASE AND ILLNESS

▸ disease can be viewed as a disruption of homeostasis

▸ it is the summation of deviations from normal

▸ in infectious disease for example, the infectious agent does not constitute disease but only evokes
the changes in the subject that ultimately manifest as disease. Attempted mgt with antibiotics alone
may not be a sufficient cure if proper attention is not directed to the intrinsic bodily process and the
external environment of the affected individual

▸ disease is dynamic, includes interplay between injury and reaction to injury which is a kaleidoscopic
series of actions and counteractions

▸ signs and symptoms may change daily as biological equilibrium shifts and compensatory
mechanisms are brought into play

▸ Every disease has a range of manifestations and a natural history that varies from individual to
individual, to understand and adequately manage disease one must take into account the
normal processes that have been altered, the nature of the disturbances, and the effects that
such disturbances have on their vital processes
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FACTORS AFFECTING DETERMINATION OF NORMALITY

▸ Genetic Variations- variations in disease, response to treatment and difference in
clinical presentation

▸ Age Differences- physiologic changes like hair color, skin turgor, organ size,

▸ Gender Differences- levels of sex and growth hormones,FBC

▸ Cultural Considerations- dietary considerations, male approval for female to seek

medical attention,

▸ Situational Differences- RBC count increases when person moves to high altitude

▸ Time variations-eg;circardian rhythm,

▸ Laboratory conditions- variation in methodology including reagent used

▸ Baseline evaluations- determination

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CIRCADIAN RYTHMS
Diagrammatic representation of the circadian rhythms of
plasma melatonin, core body temperature, subjective
alertness, task performance (reaction time, in seconds) and
triacylglycerol from human beings held in constant routine
conditions (i.e. awake, controlled light, posture, activity and
meals). The peak in the melatonin rhythm (panel a), shown
by the dotted line, and the low point of the temperature
rhythm (panel b) are within 1 h of each other. The low point
of the alertness and performance rhythms (panels c and d,
respectively) is shortly after the melatonin peak, and the
peak in triacylglycerol (panel e) is close to the melatonin
peak. Reproduced with permission from: Rajaratnam SM,
Arendt J. Health in a 24-h society. Lancet 2001; 358:
999-1005 72
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3. FRAMEWORK FOR PATHOPHYSIOLOGY

▸ Etiology

▸ Inheritance and environment - etiologic dvt of particular disease, physical enivironment vs genetic

▸ Etiologic classification of disease

▸ Inherited disease - altered or mutated genes

▸ Congenital (inborn) disease or birth defects - prenatal influences

▸ Metabolic disease - abnormal body chemistries

▸ Degenerative diseases - age and disease

▸ Neoplastic disease - malignant tumors

▸ Immunologic diseases - autoimmune diseases, immune system overreaction -eg hypersensitivity, under react (egAIDS)

▸ Infectious disease - caused by pathogens

▸ Physical agent-induced diseases - toxic chemicals, extreme temperatures, bioterrorism, food and waterborne disease

▸ Nutritional deficiency diseases - lack of wholesome diet including caloric intake, vitamins, proteins etc

▸ Iatrogenic diseases - caused by physician or health professional

▸ Psychogenic diseases - originate from emotional or mental causes

▸ Idiopathic diseases - disease of undetermined cause eg HTN, only 10% have secondary HTN
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FRAMEWORK WHEEL
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PATHOGENESIS
▸ development or evolution of a disease

▸ eg; pathogenesis of a staph infection - invasion of the body by the staph ultimately leads
to abnormalities

▸ Factors affecting

▸ Time - eg; in infectious disease length of time in which body is invaded is an

important effect on the reaction qualitative and quantitatively (is the disease in the
early or late stages, is it acute or chronic?)

▸ Quantity - vital in invasion, action and counteraction

▸ Location - a tumor eg benign skin tag vs an inoperable brain tumor

▸ Morphologic changes - the structural and associated functional alterations cells or

tissues that are either charecteristic of the disease or diagnostic of the etiologic
process
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CLINICAL MANIFESTATIONS
▸ signs and symptoms

▸ symptoms are subjective, syndrome is a collection of different signs and symptoms that occur together

▸ stages

▸ latent period -

▸ incubation period -

▸ prodromal period -

▸ acute phase -

▸ exacerbation -

▸ remission -

▸ convalescence -

▸ sequela -

▸ complication -

▸ acute or chronic
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4. CONCEPTS FOR EPIDEMIOLOGY

▸ the study of patterns of disease involving aggregates of

people, provides yet another import dimension

▸ information may be gained by examining the occurrence,

incidence, prevalence, transmission and distribution
diseases in large groups people or population

▸ a disease native to a local region - endemic

▸ a disease that spreads around the world - pandemic

▸
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FACTORS AFFECTING PATTERNS OF DISEASE

▸ Age

▸ Ethnic

▸ Gender

▸ Socioeconomic factors and lifestyle consideration

▸ Geographic location
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5. IMPLICATIONS FOR TREATMENT

▸ tmt for pathophysiologic disorders is “implied” by the

etiologic development, pathogenesis and clinical
manifestations

▸ Prevention is to narrow to be the sole goal of healthcare

▸ WHO defines health as complete physical, mental and

social well being and not just absence of disease or infirmity

▸ Epidemiologists suggest that treatment implications fall into

categories called level of prevention
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LEVELS OF PREVENTION

▸ Examples will be cited, search for definitions of the below

terms

▸ Primary prevention - eg;childhood vaccines, decreased

mortality from infectious disease

▸ Secondary prevention - yearly physical exams for early

detection and cures

▸ Tertiary prevention - medical and surgical

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TUTORIAL

▸ please read and understand your notes there are one or

two slides were you have to fill in your own notes, I have
posted a book for reference for you