Department of pathological physiology

Lecture 1

INTRODUCTION TO
PATHOPHYSIOLOGY

2020.
 Objectives
In this lecture we will be focus on :

1. Define Pathophysiology and pathology

2. Structure of pathophysiology
3. General nosology (disease, norm, health,
pathological reaction, pathological process,
pathological condition)
4. Etiology. Typical pathological process.
Pathogenesis
 Terminology
 Pathophysiology (consisting of Greek origin
words “pathos” = suffering; “physis” = nature,
origin; “logos” = “the study of”) refers to the study
of abnormal changes in body functions that are the
causes, consequences, or concomitants of disease
processes.
 The term «pathology» was first proposed by the
famous Greek physiologist Aristotle.
 Pathology is branch of medical science primarily
concerning the cause, origin and nature of disease.
 Terminology
 A subject to explore the rule of origin and
evolution of disease processes and the
fundamental mechanisms
 Pathophysiology:
 is the study of human physiologic function in
disease.
 is the science about etiology of disease,
pathogenesis, disease processes and outcome.
 Part of pathophysiology:
1. General nosology
2. Typical pathological processes
3. Systemic pathophysiology
 Pathophysiology is closely connected with
pathology.
Pathophysiology studies human physiologic function
in state of diseases, pathology is science about
structural changes in body tissues and organs in
disease. Pathology emphasizes the structural
changes. Pathophysiology focuses on the functional
and metabolic alterations and the mechanisms
 Pathophysiology constitutes a logical and
scientific basis of medicine. The main goal of
pathophysiology is study of the mechanisms of
disease.
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)

In 1791, a distinguished German doctor and
scientist, A.F. Hecker. (A.F. Hecker, 1763-1811)
From general pathology isolated pathological
physiology and wrote the first manual on
pathological physiology (Physiologia Pathologica).

In Russia, the founders of pathological physiology

were three outstanding scientists:. V.V. Pasuthin
(1845-1901), A.F. Focht (1848-1930), V.V.
Podvysotsky. (1857-1913) established the famous
scientific schools of pathophysiologists.
 Major Points in Learning
Pathophysiology

❖ The general concepts

❖ The etiology and pathogenesis

❖ The alterations in metabolism and functions

❖ The principles for the prevention and therapies

 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

Pathophysiology is integrative science between

such biomedical sciences as anatomy, physiology,
biochemistry and clinical sciences.
 The pathological physiology is related to the
other sciences. The following connections are:
a) to the sciences, which study illness causing environmental factors
(physics, chemistry, biology, microbiology, the social sciences), they
are necessary for etiology studying;
b) to the sciences, which study the organism properties and its vital
functions (cytology, embryology, histology, the normal
physiology, biochemistry, immunology, genetics), they create a
base for pathogenesis study;
c) to general theoretic sciences, which study an the disease (pathological
anatomy, pharmacology), in common with pathological physiology
create a total picture of the illness;
d) to the clinical sciences, helping to determine the basic etiological and
pathogenic principles of disease prevent, diagnostics and cure.
e) The clinic arises the problems and gives the necessary material for
their solvation to pathophysiologists.
The connect between the pathophysiology
and other disciplines
The experimental disease model is the artificial reproducing of
disease up the laboratory animals, which has the same lines of the
proper human disease.
But an experiment up animals does not give us the full picture of
the proper human disease, it enables to observe and to study the
disease course the beginning to its completion, that is impossible
in clinics. During the experiment one can control the
environmental conditions, which influence upon the illness course
and have the objective material for the scientific theories
construction.
The experiment can be divided into the acute and the chronic one.
The acute experiment is based on the surgical intervention in
animal organism. It examines the acute disorders in organism
(shock, collapse, sharp breathing insufficiency, blood circulation
insufficiency, etc).
The chronic experiment is a protracted one, shows the illness
development dynamics. It is used for chronic diseases modeling
(diabetes, atherosclerosis, arterial hypertension, ulcerous disease
etc).
 Methods of pathophysiology
In pathophysiology, many methods are used:
modeling, theoretical analysis, clinical research and
other methods.

MODELING
❖ is the main pathophysiology method
❖ is the main method of modeling diseases,
pathological processes, states and reactions
 General nosology
Nosology /nosos = disease; logos = science/
Systematically describes the specific type of disease and this is
the base for creation classification system of diseases

The general nosology includes such notions:

1. Health
2. Disease
3. Pathological process
4. Pathological state
5. Pathological reactions
• Health is the condition of complete physical,
psychic and social well- doing, but not only
diseases or the physical defects absence (WHCO
– World Health Care Organization).
• Health is the state of the organism when it
functions optimally without evidence of disease.

Criteria of health:
1. State of optimal wellness and absent of complaints for health.
2. Objective examination with diagnostic evaluation methods which
reveal absence of signs and symptoms of disease.
3. Absence of signs and symptoms after examination with different
laboratory tests of functional reserve of organs and physiologic
systems.
• Norm :
• is the state of optimum activity of an organism in
specific conditions of its existence.
• is statistic standard ranges resulting from mass
examination of population.
Normal standard derivations are connecting with
age and gender. Homeostatic and points vary widely
among individuals. Clinical reference points, or
norms, for measurable physiologic parameters are
statistically derived from group means but must
often be adjusted on the basis of age, gender, height,
or weight.
Disease (literally, “lack of ease”) – process
disrupting physiologic function and resulting in
characteristics signs and symptoms.
Disease
• is an objective state that is demonstrated by an
observable structural or functional abnormality
• is characterized by decreased physical and social
adaptation
• is an abnormal state in which part or all of the
body is not properly adjusted or is nor capable of
carrying on all its required functions
Disease – loss of homeostasis, or when physical
or mental capacities cannot be fully utilized
(interuption, cessation or disorder in the
function of an organ or system).

The disease is disturbance of human organism

vital activity under the influence of
extraordinary factors of external or inner
environment which is characterized by lowering
of capacity for work and adaptation with
simultaneous mobilization of protective forces.
 Classification of disease
Etiologic classification includes three broad categories:
1. Genetic - disease that originates from spontaneous or
inherited defect in the genetic control of cellular
development
2. Acquired – disease that originates from harmful effects
on environmental agents in a host who may or may not
be compromised
3. Multifactorial – disease that result from combination of
genetic and environmental factors
According to development, diseases are classified on:
1. Acute
2. Subacute
3. Chronic
Communicable disease – a disease that can be
transmitted from one person to another
Epidemic – a disease that affects many people in a
given region at the same time
Endemic – a disease that appears to be indigenous
to a particular area or region (not of epidemic
proportions)
Localized disease – disease is confined to one area
of body.
Systemic (generalized) disease – disease that
spreads throughout the body or to many systems
 Stages of a Disease.
1. latent period or incubation period when there are no symptoms,
but there are actions of etiologic agents. The incubation period of a
disease lasts from some hours to some days or years. The patient
must be isolated or hospitalized.
2. Prodromal period of a disease. The patient develops generalized
clinical symptoms of a disease. The doctor can make a preliminary
diagnosis in this period of disease development.
3. Dromal period – period of disease with appearance of specific
(typical) signs and symptoms. It is marked by all clinical
characteristics of a disease. In the dromal period the patient develops
all specific clinical symptoms. The doctor has to make the final, basic
diagnosis in this period of disease development.
4. Outcome of a disease:
• Convalescence
• Disability (chronic disease)
• Death
 Terminal state
► Preagonal state is characterized by the diverse duration (during
hours, days) of deep violations of the vitally important organism functions.
The dyspnea, the decreasing of the arterial pressure, the darkening down of
the consciousness, which are observed in this period. Gradually the pre-
agony gets across in the agony.
► Agonal state is characterized by the gradual turning down of all
organism functions. The agony lasts 2-4minutes, sometimes more.
► Clinical death is a reversible stage of the terminal state. It is
characterized by cessation of breathing, heartbeat and blood
circulation.
❖ Biological death is on irreversible cessation of the body’s
vital activity and physiological processes
Pathological process is a dynamic combination of
pathogenic and adaptive changes in tissues, organs
and their systems. Example: may have a less pronounced effect
on the body (soft tissue injury, burns, erosion), an increase in the scale
of the pathological process can lead to illness
Pathological reaction - is an inadequate response of
an organism to the action of ordinary or pathogenic
agents. Example: allergic reaction ( allergen can cause an attack of
bronchial asthma, hives etc.
Pathological state is a long-term deviation from the
norm of structure, functional properties of tissues,
organs and systems. Example: deformation of the valve
openings of the heart after endocarditis
 Cause of a Disease
One of the most important and difficult questions is the problem
of establishing the cause of a disease. The tactics of the
physician and the success of treatment of various diseases
depend on the correct solution of this problem. Pavlov believed
that a problem of etiology is the least investigated problem of
medicine. In the course of development of natural history the
theory of etiology of diseases has been changing. Each
etiological theory was influenced by the dominant ideas of the
time it was formed at. The old theory could not account for new
facts. There were two ways of doing research: either to deny the
facts or to change theories interpreting them.
The ancient medicine gave rise to the idea of a causative agent
as a major etiological factor. XVII –XVIII centuries witnessed
the development of a new doctrine known as mechanical
determinism.
 Theories
The mechanical determinism of XVII-XVIII
centuries was of great significance for the development
of the theory of pathology. Within a framework of
mechanical determinism some basic methods of
establishing causal connection (method of isolation,
method of similarity, method of differences, method of
attendant changes, method of remainder) were
elaborated. These methods are still of great importance
nowadays.
 Theories
The important stage in the
development of this scientific trend
was elaboration of the theory of
mechanical monocausalism.
The origin of this theory was
prompted by discoveries of
infectious pathology. Within a short
period of time the causative agents
of most widespread infectious
diseases were discovered which was
inspired by Paster’s idea that
diseases may be caused by infectious
agents. Many scientists
overestimated the importance of
microbes in the development of
diseases. Louis Pasteur
 Monocausalism was most fully reflected in the
conception of Genle-Kock:
• A certain microbe causes a certain disease, it can be found neither in healthy
people nor in people suffering from other diseases.
• A microbe can be isolated in a pure culture.
• Pure microbial culture will cause the disease whose causative agent it is
supposed to be in experiment.
• This conception was of great importance as it channeled the research into
discovering numerous microbes.
• However, there was some clinical evidence which contradicted this conception.
Firstly, the study of severe epidemics revealed that not all people get infected
and develop a disease. Nor all of those infected die. Secondly, there was
experimental evidence that a hen which is not subject to anthrax in ordinary
conditions dies if its legs are kept in cold water for a while. Thirdly, milkmaids
that had cowpox did not catch smallpox during epidemics.
• Finally, in 1884 Lefler discovered the fact of carriage of bacilli. He found
virulent streptococci and pneumococci on the mucous membranes of the
pharynx and on the tonsils of healthy people.
 Theories
Later a new theory of conditionalism gained popularity. The founder
of that theory was Ferworn. He formulated five principles of this
conception.

1. The first of them is as follows. There are no isolated and

absolute things. All processes or states are conditioned by other
processes or states.
2. There are no processes or states which are determined by a
single factor. All processes or states are conditioned by a large
number of factors (doctrine of multiple conditions).
3. Every process or state is unequivocally determined by the sum of
their conditions
4. Every process or state is identical to the sum of their conditions.
5. All conditions of any process or state are equally significant.

Conditionalism is a subjective idealism theory. Microbes alone can

not account for the origin of infectious processes. But we should not
underestimate the role of microbes in this process.
Another step in the development of the doctrine of etiology
is constitutionalism. The founders of this theory
believed that diseases may be caused by a constitution
type. These types are as follows: normal, asthenic or
hyperstenic constitution. Each type of constitution has its
own peculiarities. People of asthenic constitution are
subject to stomach ulcer and tuberculosis. People of
hyperstenic constitution are likely to suffer from
myocardial infarction or bronchial cancer.
This theory is based on the theses of formal genetics and
on genotype invariability. However, a genotype can change
under the influence of many exogenous and endogenous
factors. Therefore, this theory can not be considered true.
 Etiology
Etiology- (fr. Gk aitia, reason +logos, science) of causes
and conditions of disease occurrence. Etiology studies
general properties of pathogenic factors, basic categories of
pathogenic factors, significance of conditions in occurrence
of diseases, principles of etiotropic prophylaxis and
etiotropic therapy.
Etiology of disease – is knowledge of causative factors
or agents that cause different disturbances.
Etiology is used to study the causative agents including
microorganisms, environmental, social factors and personal
habits as contributing factors that causes disease.
 Etiology or causative factors are divided
into two groups:
1. Primary factors, that cause disease and play
main role in formation of symptoms and signs of
disease.
2. Secondary factors or conditions that may be
present or absent.
Primary and secondary etiologic factors may be external or internal.
External (or exogenous) etiologic factors are
agents from environment.
Internal (or endogenous) etiologic factors are
conditions in the body itself.
External primary agents are:
1. Biological - it is different microorganism
2. Physical – it is high and low environmental temperature, pressure,
electric current, physical acceleration and others
3. Chemical – it is acids, alkali, drugs, poisons and others
4. Mechanical – it is blow, hurt, strain
5. Social – it is stress, physiological agents
External secondary factors are: environmental agents, for
example climatic factors, abnormality of dietary intake, lifestyle etc.
Internal primary factors are: congenital defects, metabolic
disorders, necrotic tissue etc.
Internal secondary factors are: age, gender, height, weight,
immune status and others.
 Typical pathological processes
Typical pathological processes are components
of various diseases. Mainly characterized by
polyetiology and monopathogenesis
Some of the complex pathologic processes
contributing to the pathogenesis of many
diseases are called TYPICAL.
Typical pathologic processes include:
inflammation, allergy, hypoxia, tumor growth,
fever, infection and others.
 Typical pathological processes are
characterized:
1. Polietiology – independent of etiologic
factors or many reasons.
2. Monopathogenesis – universal mechanisms
of development, formed in evolution and
genetically controlled, or one pathogenesis.
3. Stereotypical manifestation
4. Components of different disease, but one
disease may consist from different
pathological processes.
Pathogenesis (fr. Gk pathos, disease + genesis,
origin) is the science of mechanisms of
development, course and outcome of diseases.
The science of pathogenesis includes:
mechanisms of stability of organism to the
action of pathogenic factors, general
mechanisms of development of diseases,
mechanisms of recovery, mechanisms of dying,
principles of pathogenetic prophylaxis and
pathogenetic therapy.
Pathogenesis is the mechanisms whereby
etiologic agents affect their damage, the reaction
pattern between causative factors and the body
itself refers to cause-effect relation.
Pathogenesis includes many phases of bodily
changes resulting in symptoms and signs of
diseases. Pathogenesis consists of the complexity
of specific disease mechanisms, which may refer
as on the one aspect “damage” (perturbing force)
and on the other aspect – “defense” (adaptive
response).
Mechanisms of disease are the dynamic processes that
includes compensatory and decompensatory stage of
disease.
Compensatory stage of disease include compensatory or
adaptive mechanisms, which maintain homeostasis due to
negative feedback loops.
Decompensatory stage is disturbances in homeostasis or
development of vicious cycles due to positive feedback
loops.
Decompensate state may be when: 1) the disruptive force is
very dangerous: too intense or prolonged; 2) is failure of
adaptive mechanisms;
The role of causal relationships in
the pathogenesis of the disease
Vicious circle (circulus vitiosus) - is a closed
chain of cause-and-effect relationships, when
some consistently arising effect becomes the
cause of new disorders.
A vicious circle can be closed at a variety of
levels of organization of the body (subcellular,
tissue, organ, systemic).
 Pathogenetic factors
The main link of pathogenesis is the main
change that is absolutely necessary for the
deployment of other links of pathogenesis and
without which a pathological process or disease
does not develop.
Secondary links of pathogenesis are
pathogenetic factors that have minor effects on
the development of the disease.
 Literature used for presentation:
1. Litvitsky P.F. Pathophysiology. In 2v. M-2003
2. Robbins and Cotran. Pathologic basis of
disease 9th edition 2014.
Thank you very much for your
attention!