CHAPTER 1

INTRODUCTION TO
PATHOPHYSIOLOGY

Andrea Abrams MSN, RN, CCRN, PHN

NR283

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HOMEOSTASIS
 Homeostasis—the maintenance of a relatively
stable internal environment regardless of
external changes
 When homeostasis is maintained, good
health is generally maintained.
 When homeostasis is not maintained,
disease may develop.

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HEALTH AND DISEASE
 Health
 Physical, mental, and social well-being
 Disease
 Deviation from the normal state of
homeostasis

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HEALTH INDICATORS
 “Normal” values occur within a range of values and
may vary depending on technology used for
measurement.
 Adjustments caused by the following:
 Age
 Gender
 Genetics
 Environment
 Activity level

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SEVEN STEPS TO HEALTH
 Be a nonsmoker and avoid second-hand smoke.
 Eat 5 to10 servings of vegetables and fruit a day. Choose high-
fiber, lower fat foods. Limit alcohol intake.
 Physical activity on a regular basis
 Protection from the sun
 Follow cancer screening guidelines.
 Doctor or dentist visit if any changes in the normal state of health
 Follow health and safety guidelines at home and at work when
using, storing, and disposing of hazardous materials.

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CONCEPT AND SCOPE OF
PATHOPHYSIOLOGY
 Functional (physiologic) changes in the body as a result
from disease
 Uses knowledge of basic anatomy and physiology.
 Includes aspects of pathology, which describes structural
changes in body tissues caused by disease.
 Cause and effect relationships, defined by signs and
symptoms, guide the study of a specific disease.

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PREVENTION OF DISEASE

 Has become a primary focus in health care

 Maintaining routine vaccination programs
 Participation in screening programs
 Community health programs
 Regular routine doctor visits

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STAGES OF RESEARCH PROCESS
 Stage 1
 “basic science”
 Identification of technology to be used
 Work done in the laboratory
 Might require animal or cell/tissue cultures
 Stage 2
 Small number of human subjects
 Stage 3
 Clinical trials
 Involving a large number of patients with the disease or risk of
the disease
 “double blind studies"

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MEDICAL HISTORY
 Current and prior illnesses
 Allergies
 Hospitalizations
 Treatment
 Specific difficulties
 Any type of therapy or drugs
 Prescription
 Nonprescription
 Herbal items, including food supplements

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NEW DEVELOPMENTS AND TRENDS

 Constant updating of information and knowledge

 Improved diagnostic tests
 Development of more effective drugs
 New technologies
 Extensive research in efforts to prevent, control, or cure many
disorders

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 NEW CHALLENGES
 Zika Virus
 First discovered in 1947
 Tropical Africa
 South East Asia
 Pacific Islands
 2015
 Confirmed cases in Brazil
 Now
 CDC identified the virus as an international threat.
 Increased research on diagnosis, spread, treatment and
prevention
 2019: measles, Jan to Apr 704 confirmed cases, 22 states,
2 in Sacramento as of May 1, 2019.
 2020: Covid 19 pandemic

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BASIC TERMINOLOGY
 Gross level
 Organ or system level
 Microscopic level
 Cellular level
 Biopsy
 Excision of small amounts of living tissue
 Autopsy
 Examination of the body and organs after death

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DISEASE PROCESS
 Diagnosis
 Identification of a basic disease
• Evaluation of signs and symptoms
• Laboratory tests
 Etiology
 Causative factors in a particular disease
• Congenital defects
• Inherited or genetic disorders
• Microorganisms
• Immunologic dysfunctions
• Degenerative changes
• Malignancy
• Metabolic, nutritional problems
• Trauma, burns, environmental factors

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CAUSES OF DISEASE
 Idiopathic
 Cause of disease is unknown.
 Iatrogenic
 Error/treatment/procedure may cause the disease.
 Predisposing factors
 Age, gender, inherited factors, environment etc.
 Prophylaxis
 Preserve health; prevent spread of disease
 Prevention
 Vaccinations; dietary/lifestyle modifications; prevention of potentially
harmful activities etc.

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CHARACTERISTICS OF DISEASE
 Pathogenesis
 Development of the disease
 Onset of disease
 Sudden/acute
 Insidious: gradual, vague or mild signs
 Acute disease
 Short-term, develops quickly
 High fever, severe pain etc.
 Chronic disease
 Develops gradually
 Milder symptoms, often intermitted with acute episodes

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CHARACTERISTICS OF DISEASE
(CONT.)
 Subclinical state
 Pathologic changes, no obvious manifestations
 Latent state
 No symptoms or clinical signs evident
 In infectious diseases: incubation period
 Prodromal period
 Early development of the disease
 Signs are nonspecific or absent
 Manifestations
 Clinical evidence with signs and symptoms
• Local: at site of the problem
• Systemic: general indicators of illness, i.e. fever

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CHARACTERISTICS OF DISEASE
(CONT.)
 Signs
 Objective indicators of disease
 Symptoms
 Subjective feelings
 Lesions
 Specific local change in the tissue
 Syndrome
 Collection of signs and symptoms
 Diagnostic tests
 Various laboratory tests
 Appropriate to manifestations and medical history

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CHARACTERISTICS OF DISEASE
(CONT.)
 Remissions and exacerbations
 Mark the course or progress of a disease
 Remission: period which manifestations subside
 Exacerbation: a worsening of severity
 Precipitating factor
 Condition that triggers an acute episode
 Complications
 New secondary or additional problems

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CHARACTERISTICS OF DISEASE
(CONT.)
 Therapy
 Measures to promote recovery/slow progress
 Sequelae
 Potential unwanted outcomes
 Convalescence or rehabilitation
 Period of recovery and return to healthy state

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DISEASE PROGNOSIS
 Morbidity
 Disease rates within a group
 Mortality
 Relative number of deaths resulting from the disease
 Autopsy
 Postmortem examination
 Epidemiology
 Tracking the pattern or occurrence of disease
 Major data collection centers: WHO and CDC

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DISEASE PROGNOSIS (CONT.)
 Occurrence of disease
 Incidence
• Number of new cases in a given population within a given time period
 Prevalence
• Number of new, old, or existing cases within a given population and time
period
 Epidemics
 A higher number of expected cases of an infectious disease occur
within an area
 Pandemic
 Involve a higher number of infectious diseases in many regions of
the globe

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DISEASE PROGNOSIS (CONT.)
 Communicable diseases
 Infectious disease that can spread from one person to another

 Notifiable or reportable diseases

 Must be reported by the physician to designated authorities
 Authority varies with local jurisdiction.
 Required diseases to be reported may change over time
 Reporting is intended to prevent further spread of the disease.

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OCCURRENCE OF DISEASE

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CELLULAR ADAPTATIONS
 Atrophy
 Decrease in the size of cells
 Results in reduced tissue mass.
 Hypertrophy
 Increase in cell size
 Results in enlarged tissue mass.
 Hyperplasia
 Increased number of cells
 Results in enlarged tissue mass.

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ABNORMAL CELL GROWTH PATTERNS

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CELLULAR ADAPTATIONS (CONT.)
 Metaplasia
 Mature cell type is replaced by a different mature cell type.
 Dysplasia
 Cells vary in size and shape within a tissue.
 Anaplasia
 Undifferentiated cells, with variable nuclear and cell structures
 Neoplasia
 “New growth”―commonly called tumor

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CELL DAMAGE
 Apoptosis
 Refers to programmed cell death
• Normal occurrence in the body
 Ischemia
 Deficit of oxygen in the cells

 Hypoxia
 Reduced oxygen in tissues
 Nutritional deficits
 Pyroptosis
 Results in lysis causing nearby inflammation.

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CELL DAMAGE (CONT.)
 Physical damage
 Excessive heat or cold
 Radiation exposure
 Mechanical damage
 Pressure or tearing of tissue
 Chemical toxins
 Exogenous: from environment
 Endogenous: from inside the body

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CELL DAMAGE (CONT.)
 Microorganisms
 Bacteria and viruses, for example
 Abnormal metabolites
 Genetic disorders
 Inborn errors of metabolism
 Altered metabolism
 Imbalance of fluids or electrolytes

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NECROSIS
 Necrosis: Dying cells cause further cell damage due to cellular
disintegration
 Liquefaction necrosis
 Dead cells liquefy because of release of cell enzymes
 Coagulative necrosis
 Cell proteins are altered or denatured―coagulation

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NECROSIS ( CONT.)
 Fat necrosis
 Fatty tissue broken down into fatty acids
 Caseous necrosis
 Form of coagulation necrosis
 Thick, yellowish, “cheesy” substance forms

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LIQUEFACTION NECROSIS IN THE
BRAIN

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COAGULATIVE NECROSIS OF THE
KIDNEY

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FAT NECROSIS IN THE MESENTERY

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NECROSIS (CONT.)
 Infarction
 Area of dead cells as a result of oxygen deprivation
 Gangrene
 Area of necrotic tissue that has been invaded by bacteria

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DRY GANGRENE OF THE TOE

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