Chapter 1

Concepts of
Health and Disease

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Pathophysiology
• The term pathophysiology, may be defined as the physiology of
altered health.
• The term combines the words pathology and physiology.
• Pathology (from the Greek pathos, meaning “disease”) deals
with the study of the structural and functional changes in cells,
tissues, and organs of the body that cause or are caused by
disease.
• Physiology deals with the functions of the human body.
• Thus, pathophysiology deals not only with the cellular and organ
changes that occur with disease but with the effects that these
changes have on total body function.

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Health

• Health as a “state of complete physical, mental, and

social well-being and not merely the absence of disease
and infirmity,”

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Disease
• A disease is considered an acute or chronic illness that one
acquires or is born with that causes physiological
dysfunction in one or more body system.
• Each disease generally has specific signs and symptoms
that characterize its pathology and identifiable etiology.
• Iatrogenic: disease and/or injury as a result of medical
intervention.
• Nosocomial diseases: diseases acquired as a consequence
of being in a hospital environment.
• Idiopathic disease: is disease with no identifiable cause.

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(Pathology) focuses on 4 aspects of
disease:

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1. Etiology

• The causes of disease are known as etiologic factors.

• Among the recognized etiologic agents are:
– Biologic agents (e.g., bacteria, viruses),
– Physical forces (e.g., trauma, burns, radiation),
– Chemical agents (e.g., poisons, alcohol),
– One’s genetic inheritance,
– Nutritional excesses or deficits.

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Factors that cause disease:
• One way to view the factors that cause disease is to group
them into categories according to whether they were
present at birth or acquired later in life.
• Congenital conditions are defects that are present at birth,
may be caused by:
– Genetic influences,
– Environmental factors (e.g., viral infections in the
mother, maternal drug use, irradiation, or gestational
position in utero),
– A combination of genetic and environmental factors.

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Factors that cause disease:
• Acquired defects are those that are caused by events that occur after
birth.
• These include:

– Injury,
– Exposure to infectious agents,
– Inadequate nutrition,
– Lack of oxygen,
– Inappropriate immune responses,
– Neoplasia.

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2. Pathogenesis

• Pathogenesis explains how the disease process evolves.

• In other words, pathogenesis is the sequence of cellular
and tissue events that take place from the time of initial
contact with an etiologic agent until the ultimate
expression of a disease.

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3. Morphology and Histology

• Morphology refers to the fundamental structure or form

of cells or tissues.
• Morphologic changes are concerned with both the gross
anatomic and microscopic changes that are characteristic
of a disease.

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3. Morphology and Histology

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3. Morphology and Histology

• Histology deals with the study of the cells and

extracellular matrix of body tissues.
• A lesion represents a pathologic or traumatic
discontinuity of a body organ or tissue.
• histopathology can be defined as :
• The microscopic study of diseased tissue, is an important
tool in anatomical pathology, since accurate diagnosis of
many diseases like cancers, usually requires
histopathological examination of samples.

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Clinical Manifestations

• Diseases can manifest in a number of ways.

– Sometimes the condition produces manifestations,
such as fever, that make it evident that the person is
sick.
– In other cases, the condition is silent at the onset
and is detected during examination for other
purposes or after the disease is far advanced.

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Clinical Manifestations

• Signs and symptoms are terms used to describe the

structural and functional changes that accompany a
disease.
• A symptom is a subjective complaint that is noted by the
person with a disorder, whereas a sign is a manifestation
that is noted by an observer.

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Clinical Manifestations

• Pain, difficulty in breathing, and dizziness are symptoms

of a disease.
• An elevated temperature, a swollen extremity, and
changes in pupil size are objective signs that can be
observed by someone other than the person with the
disease.

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Clinical Manifestations
• Signs and symptoms may be related to the primary disorder
or they may represent the body’s attempt to compensate
for the altered function caused by the pathologic condition.
• Many pathologic states are not observed directly.
• For example, one cannot see that a person is hemorrhaging
or that he or she has decreased pulmonary gas exchange.
Instead, what can be observed is the body’s attempt to
compensate for changes in function brought about by the
disease, such as the tachycardia that accompanies blood
loss or the increased respiratory rate that occurs with
pneumonia.

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Clinical Manifestations

• A syndrome is a compilation of signs and symptoms

(e.g., chronic fatigue syndrome) that are characteristic of
a specific disease state.
• Complications are possible adverse extensions of a
disease or outcomes from treatment.
• Sequelae are lesions or impairments that follow or are
caused by a disease.

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Diagnosis

• A diagnosis is the designation as to the nature or cause

of a health problem.
• The diagnostic process requires:
– A careful history,
– Physical examination (PE),
– Diagnostic tests.

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Diagnosis

• The history is used to obtain a person’s account of his or

her symptoms and their progression, and the factors that
contribute to a diagnosis.
• The PE is done to observe for signs of altered body
structure or function.
• The diagnostic tests are ordered to validate what is
thought to be the problem. They are also performed to
determine other possible health problems that were not
obtained from the history and PE, but may be present
given the signs and symptoms identified.

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Clinical Course
• The clinical course describes the evolution of a disease.
• A disease can have an acute, subacute, or chronic course.
• An acute disorder is one that has sudden onset and typically
lasts for a short duration
• Chronic disease implies a continuous, long-term process.
• Subacute disease is intermediate or between acute and
chronic. It is not as severe as an acute disease and not as
prolonged as a chronic disease.

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Clinical Course

• The spectrum of disease severity for infectious diseases,

such as hepatitis B, can range from preclinical to
persistent chronic infection.
• During the preclinical stage, the disease is not clinically
evident but is destined to progress to clinical disease.
• As with hepatitis B, it is possible to transmit a virus
during the preclinical stage.
• Subclinical disease is not clinically apparent and is not
destined to become clinically apparent. It is diagnosed
with antibody or culture tests.

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Clinical Course

• Clinical disease is manifested by signs and symptoms. A

persistent chronic infectious disease persists for years,
sometimes for life.
• Carrier status refers to a person who harbors an
organism but is not infected, as evidenced by antibody
response or clinical manifestations. This person still can
infect others.
• Carrier status may be of limited duration or it may be
chronic, lasting for months or years.

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Epidemiology and Patterns of Disease

• Epidemiology is the study of disease occurrence in human

populations.
• Epidemiology looks for patterns of people affected with a
particular disorder, such as age, race, dietary habits, lifestyle,
or geographic location.

• Whether something happens than how it happens.

• Whether smoking itself is related to cardiovascular
disease and whether the risk of heart disease decreases
when smoking ceases.

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Morbidity and Mortality

• Morbidity and mortality statistics provide information

about the functional effects (morbidity) and death-
producing (mortality) characteristics of a disease.
• Morbidity describes the effects an illness has on a
person’s life.
• Mortality statistics provide information about the causes
of death in a given population.

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Preventing Disease

• Basically, leading a healthy life contributes to the

prevention of disease.
• There are three fundamental types of prevention—
primary prevention, secondary prevention, and tertiary
prevention.

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Preventing Disease

• Primary prevention is directed at keeping disease from

occurring by removing all risk factors.
– Administration of folic acid to pregnant women and
women who may become pregnant to prevent fetal
neural tube defects.

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Preventing Disease
• Secondary prevention detects disease early when it is still
asymptomatic and treatment measures can effect a cure or
stop the disease from progressing.
– PE (blood pressure measurement), laboratory tests
(cholesterol level determination).
• Tertiary prevention is directed at clinical interventions
that prevent further deterioration or reduce the
complications of a disease once it has been diagnosed.
– Provision for regular ophthalmologic examinations for early
detection of retinopathy, education for good foot care.

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Divisions of Pathology
• 1) General pathology:
– The basic reactions of cells and tissues to abnormal stimuli that
underlie all diseases
– Involved the mechanisms and characteristics of the principle types of
disease processes
– It explores and explains the development of basic pathologic
mechanisms:
– Cell injury.
– Inflammation – Haemodynamic (circulatory)
– repair and regeneration
disorders
– Neoplasia. – Genetic disorders,
– Infection
– Immunopathology,
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Divisions of Pathology
• 2) Systemic pathology:
• Descriptions of specific diseases as they affect individual
organs or organ systems. It relates pathologic
mechanisms discussed in the General Pathology to
various organ systems
• Examples: cardiovascular pathology, renal pathology,
dermatopathology, endocrine pathology, gastrointestinal
pathology, Dermatopathology (SKIN), Hepatobiliary
System and Pancreas. Etc.

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Subdivisions of Pathology
• Histopathology
• Cytopathology
• Hematology
• Forensic pathology
• Chemical pathology
• Microbiology
• Immunology

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Subdivisions of Pathology (1)
• Histopathology: Investigation and diagnosis of disease
from the
• examination of tissues.
• (e.g., Surgical specimen, Microscopic sections)

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Subdivisions of Pathology (2)
• Cytopathology:
• Investigation and diagnosis of disease from the
examination of isolated cells.
• (e.g., Pap smears, FNA -Fine Needle Aspiration).

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Subdivisions of Pathology (3)
• Hematology: Study of disorders of the cellular and
coagulable components of the blood.
• (e.g. Peripheral blood smear, bone marrow, coagulation
disorders)

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Subdivisions of Pathology (4)
• Forensic pathology:
• Application of pathology to legal purposes e.g.
investigation of death in suspicious circumstances (e.g.
autopsy)

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Subdivisions of Pathology (5)
• Chemical pathology:
• Investigation of biochemical disorders (e.g. blood, urine,
cerebrospinal fluid, effusions)

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Subdivisions of Pathology (6)
• Immunology:
• Study of specific defense mechanisms of the body and
the diseases that arise from them (e.g, AIDS, allergic
disorders)

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Subdivisions of Pathology (7)
• Microbiology:
• Study of infectious diseases
• (e.g, Malaria, influenza)

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Prefix Meaning
• Ana- Absence, example : Anaphylaxis
• Dys- Disordered … ex : Dysplasia
• Hyper- Excess over normal … ex : Hyperthyroidism
• Hypo- Deficiency below normal … ex : Hypothyroidism
• Meta- Change from one state to another…ex : Metaplasia

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Suffix
• -it is: Inflammatory process .. Ex : Appendicitis
• -emia: Vascular.. Ex : Ischemia
• -oma: Tumour .. Ex: Carcinoma
• -osis: State or condition .. Ex : Osteoarthrosis
• -oid: Bearing a resemblance to.. Ex :Rheumatoid disease
• -penia: Lack of .. Ex :Thrombocytopenia
• -cytosis: Increased number of cells .. Ex : Leukocytosis
• -ectasis: Dilation Bronchiectasis

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