INTRODUCTION TO STUDY

OF PATHOPHYSIOLOGY

Prof. J. Hanacek, M.D., Ph.D.,

What the pathophysiology is

Physiologia, ae, f.
gr. fysis = nature; logos = science

Pathophysiologia, ae, f.
gr. pathos = disease, pain, suffering
Physiology Pathophysiology

Life

Logic

Healthy Diseased
Study

The calligraphy done by the Korean artis Kim Hyun-Seung

 Pathophysiology - definitions
/PaPhy/

PaPhy is a biomedical science on the mechanisms

related to development and elimination of
pathological processes and diseases

PaPhy is a biomedical science dealing with functional

changes in diseased organism

PaPhy deals with the dynamic aspects of pathological

processes and diseases. It studies disordered or
altered functions - the physiologic mechanisms altered
by disease in the living organism
 Pathophysiology deals with temporal and spatial
dynamics in the intensity of pathological processes

Pathophysiology is devoted to study of protective

and defensive mechanisms of body tissue, organs
and systems, and their role in defence against
noxae, in pathogenesis of disease, and in
sanogenesis

Pathophysiology belongs to core subjects of

undergraduate medical education
Pathophysiology deals with logic of life
under pathological conditions

Pathophysiology help us to understand the logic

of life during development of pathological
processes

Pathophysiology creates a bridge between

sciences and clinical subjects in undergraduate
medical education
 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.

International Society for Pathophysiology (1998)

 Why pathophysiology is important for medical
students and physicians

1. 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

2. If doctors are able to understand the causes

and mechanisms of the disease, then they are able
to find the way how to influence them rationally
Relation among pathophysiology and other subjects
of unergraduate medical education

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
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
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 doctor to treat

diseases rationally (causally)

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
 The position of Pathophysiology in
undergraduate medical education

It becomes an integrative biomedical subject

It becomes a bridge between the subjects of
sciences and clinical medicine
It is an important part of undergraduate medical
education
THE MAIN TASKS OF PATHOPHYSIOLOGY
To teach mechanisms of diseases
To help to understand the substance of health
To help students to understand the logic of
life under pathological conditions
Thanks to pathophysiology the medical student
can understand the inner logic of the pathological
processes, their relationships, and their biological
significance. On this basis student is able, as a
result, to built an individual model of disease
in a given patient
House of Medicine

Neurology
Ceiling plate
Gynekology and Obtetrics
Surgery
Internal medicine
PATHOPHYSIOLOGY

Pathology Pharmacology Microbiology

walls

PHYSIOLOGY
Base plate

Anat Biol Histol Bioch Chem Biophys

Foundations
 Structure of pathophysiology

1. General pathophysiology

2. Special /organs, systems/ pathophysiology

1. General pathophysiology content

It deals with general pathologic processes, and
pathomechanisms: -thay are involved in pathogenesis of
more than one disease. It also contain explanation of some
basic medical terms

Examples of general pathological processes

inflammation, fever, hyperthermia, hypothermia, shock,
stress, edemas, disturbances of control mechanisms,
hyperreactivity, hyporeactivity, damage of genetic
information....
 Defensive and adaptive mechanisms
- non-specific and specific immunity, hypertrophy,
atrophy, hyperfunction, hypofunction, homeostasis

Incresed predisposition to onset of disease

(diathesis, athopy) due to genetic or/and
environmental factors
Essential terminology
a) Nosology /nosos = disease; logos = science/
Systematically describes the specific type of disease and this is
the base for creation classification system of diseases

b) Etiology of disease /aiti = cause/

Deals with noxae (causes) which are involved in disease onset and
with conditions under which the causes are able to induce disease
processes
(Oposit - etiology of health: deals with factors which promote
the health)

c) Pathogenesis /pathos = pain, suffering, distress, genesis - onset/

Deals with mechanisms involved in disease onset and diseases
development (pathomechanisms)
d) Sanogenesis /sanos = health/
Deals with mechanisms involved in recovery from disease
to health

e) Semiology /smeion = sign, symptom/

Deals with symptoms and signs of diseases
Symptoms subjective feeling of disease
Signs objective parameters of changed functions and
structures of body systems

f) Tanatogenesis /thanatos = death/

Deals with processes leading to death
2. Special pathophysiology - is devoted to analysis and
explanation of pathomechanisms involved in functional
disturbances of the organs and systems of the organism:
Content of special pathophysiology:
hematologic disorders
disorders of cardiovascular system
dysfunctions of respiratory system
disorders of uropoietic system
neurologic disorders
dysfunctions of of endocrine system
metabolic disorders
disorders of reproductive system
dysfunctions of of GIT
SPECIAL SECTIONS OF PATHOPHYSIOLOGY

Clinical pathophysiology
/clinical physiology/

Space pathophysiology
Experimental pathophysiology
Pathophysiology of extreme - events
Ocupational pathophysiology and PaPhy of sports

Adaptation pathophysiology
Cellular and molecular pathophysiology
REMARKS TO PATHOGENESIS

Pathogenesis of disease processes can not be

reduced to only quantitative changes of structures,
functions and mechanisms presenting in healthy
people

It is necessary to take into account development

of qualitatively new processes, which are harmful
for the body structure and functions

One example of such new pathologic mechanism is

vicious circle (a complex of events that reinforces itself through a
feedback loop toward greater instability)
Examples of vicious circle
1st example: Development of LV insufficiency

Mitral stenosis decreased cardiac output of left ventricle

activation of sympathetic n.s.

arter
resist
vasoconstriction
(skin, splanchnic, kydney aa.)

heart rate

end diastolic vol of LV shorter diastola of LV

2nd example: Development of edema during RV failure

Right ventricle failure hydrostatic pressure in

venous system
volume
overload formation of edema
COLV activation sympathic

fluid volume vasoconstriction

in venous system
blood flow
in kydney

resorbtion Na+ activation of

in kydney R - A- A system
 HISTORY OF PATHOPHYSIOLOGY
Hippocrates (460-370 BC)- he was the first to
construct theories of the causes of disease based on
what he had observed in his patients

His fundamental truth: there are two factors acting

alone or in combination which cause illness
the intrinsic or constitutional make-up of the person,
and an extrinsic or environmental agent, is still valid.

Once normal functions of the body had been described

it was but a step to investigate states of disease (from
the end of 16th century)
 HISTORY OF PATHOPHYSIOLOGY

C. Bernard (1813-1878)-Introduction to experimental

medicine (1865)

Rudolf Wirchov - he introduces term pathological

physiology to medical terminology

Galliot /1819 / - author ofManual in general pathology

and pathological physiology

A.F. Hecker / 1790/ -authorTextbook in pathophysiology

Excellent pathophysiologist from the past: J.E. Purkyne,

Prof. Pashutin, Prof. Pavlov /from Russia/, Prof. Hans
Selye /Canada-1907-1982/ -Stress theory; ...
Methods used in pathophysiological research

1. Observation
2. Animal experiment

3. Clinical pathopysiological study

4. Elaboration of experimental to create
models of pathological processes
animal's models, mathemathical models...

Research at the Dept. of Pathophysiology

It is devoted to research on PaPhy of respiratory system,
especially to defensive mechanisms of the airways
and lungs, and to visceral neurophysiology and PaPhy
 The main aims of teaching pathohysiology
1. Students should understand fundamental general and
specific pathomechanisms involved in onset, development
and ending of diseases
To fulfil this aim is necessary:
a) to know and understand pathophysiological terms
b) to know and understand essential pathomechanisms
c) to connect separate pathomechanizms to rational
pathogenetic network characteristic for different
pathological processes
d) to understand a pathologic process as event which
influence the whole body
e) to understand pathomechanizms as dynamic events
 The roles of studets and teachers in teaching prosess

a) Student has to study, not simply memorise facts

b) Individual study and seminars should be focused to obtain
lasting knowledge on pathophysiology

c) Teacher will help students with creation of complex view on

pathogenesis of diseases

The source of lasting knowledge is understanding of

the pathomechanisms
(Understunding is a kind of ecstasy)
Textbooks and other sorces for study of PaPhy
Sylvia Anderson Price, Lorraine Mc Carty Wilson,
Pathophysiology - Clinical concepts of disease processes
6th edition
Mosby Year Book, St.Luis, Baltimore, Boston, Chicago,
London, Sydny.
Stefan Silbernagel, Florian Lang:
Color Atlas of Pathophysiology
Thieme, Stuttgart - New York, 2000, 406pp.
S.J. McPhee, V.R. Lingappa, W.F. Ganong, J.D.Lang:
Pathophysiology of Disease An Introduction to Clinical
Medicine Prentice - Hall International Inc., 1995, 521pp.

Tatar M, Hanacek J. Pathophysiology. Topics for seminars.

Comenius University 2001, 220pp.
Handouts of lectures on Pathophysiology from
Dept . of Pathophysiology JFM CU in Martin
Staff involved in teaching process
Head:
Professor M. Tatar, M.D., Ph.D.
Teaching staff:
Teachers: Prof. Jan Hanacek, M.D., Ph.D. - Vice-Head
Prof. Milos Tatar, M.D., Ph.D.
Assoc. Prof. R. Pecova, M.D., Ph.D.
Assoc. Prof. M. Brozmanova, RNDr., Ph.D.
Assoc. Prof. J. Plevkova, M.D., Ph.D.
Technicians: Mr. M. Vrabec,Ing., Ms. L. Mazurova, Mrs. K. Strbova
Mr. T. Zatko

PhD student: Mr. J. Halicka, M.D., Ms. S. Gavliakova, Ing.

Secretary: Mrs. M. Ilovska