BASIC CONCEPTS OF

DISEASE PROCESS
Introduction to Pathophysiology
Inflammation and Healing
Immunity and Abnormal Responses

Dakila B. Mangibin, RN
What is Pathophysiology
 Pathophysiology involves the study of
functional or physiologic changes in the body
that result from disease processes.
◦ As disease develops, the changes in the normal
anatomy and/or physiology of the may be obvious
or may be hidden, occurring at the cellular level.
 Hence, includes some as aspects of pathology – the
laboratory study of cell and tissue changes associated
with disease.
Seven Steps to Health
1. Be a non-smoker and avoid second-hand
smoke.
2. Eat 5-10 servings of vegetables and fruit a day.
 High fibre, lower fat foods.
 If you drink alcohol, limit your intake to 1-2 drinks
a day.
3. Be physically active on a regular basis: this will
also help you maintain a healthy body weight.
4. Protect yourself and your family from the sun.
5. Follow cancer screening guidelines.
6. Visit your doctor or dentist if you notice any
change in your normal state of health.
7. Follow health and safety instructions at home
and at work when using, storing and
disposing of hazardous materials.
The Language of Pathophysiology
 A disease or abnormal condition usually
involves changes at the organ level (Gross) as
well as at the cellular or microscopic level.
 Pathophysiology focuses on the effects of

abnormalities at the organ level but cellular

changes are usually integral to a full
understanding of these effects.
 Pathology laboratory studies – useful in
establishing the cause of the disease,
examine tissue specimens from
1. Biopsy procedures –excision of very small
amounts of living tissue.
2. Autopsy – collection of specimens for
examinations after death.
The Language of Pathophysiology
 Common terminologies frequently used in the
discussion of disease processes.
◦ Diagnosis – identification of a specific disease
through evaluation of signs and symptoms and
laboratory tests.
◦ Etiology – concerned with the causative factors in a
particular disease.
 Etiologic agents include congenital defects, genetic
disorders, microorganisms, immunologic dysfunction,
metabolic and degenerative changes, malignancies etc.
 Idiopathic – if the cause of the disease is unknown.
 Iatrogenic – if treatment or procedure is the cause of
disease.
◦ Predisposing factors – encompass the tendencies
that promote development of a disease in an
individual.
 Indicates high risk for the disease but not certain
development.
 Prevention of a disease – closely linked to etiology and
predisposing factor in avoiding certain specific disease
which include vaccination lifestyle modification
The Language of Pathophysiology
◦ Pathogenesis – refers to the development of the
disease or the sequence of events involved in the
tissue changes related to the specific disease process.

◦ Onset of disease – the start of the disease

manifestations, may be sudden and obvious or acute.

◦ Acute disease – indicates a short term illness that

develops rapidly with marked signs.

◦ Chronic disease – is often milder condition

developing gradually, but usually irreversible.
◦ Subclinical state – exist in some conditions where
pathologic changes occur, but no obvious
manifestations are exhibited.
◦ Latent or silent stage – no clinical signs are evident,
in infectious disease may be referred to as
incubation period.
◦ Prodromal period – comprises the time in the early
development of a disease when one is aware of a
change of the change but signs or vague.
The Language of Pathophysiology
◦ Manifestations – the clinical evidence or effects, the
sign and symptoms of disease.
◦ Signs – objective indicators of disease that are
obvious to someone other than the affected
individual.
◦ Symptoms – subjective feelings of the individual
with illness.
◦ Syndrome – collection of signs and symptoms that
usually occur together in response to a certain
condition.
◦ Diagnostic tests – laboratory tests that assist in the
diagnosis of a specific disease.
◦ Remissions (the manifestations subside) and
exacerbations (the signs increase)
◦ Precipitating factor – condition that triggers an
acute episode.
◦ Complications – new secondary or additional
problems that arise after the original disease
begins.
The Language of Pathophysiology
◦ Therapy – treatment measures used to promote
recovery or to slow the progress of a disease.
◦ Sequelae – potential unwanted outcomes of the
primary conditions, e.g., paralysis.
◦ Convalescence – the period of recovery and return
to the normal healthy state.
◦ Prognosis – defines the probability for recovery or
for other outcomes.
◦ Morbidity – indicates the disease rate within a
group.
◦ Mortality – indicates the relative number of deaths
resulting from a particular disease.
◦ Epidemiology - is the science of tracking the
pattern or occurrence of disease.
◦ Epidemics – occur when many cases of an infectious
disease within a given area.
 Pandemics – involves the high number =s of cases in
several regions and perhaps worldwide.
The Language of Pathophysiology
◦ Occurrence of a disease – tracked by two factors,
the incidence (number of new cases) and the
prevalence (number of new and old or existing
cases within a specified population and time
period)
◦ Communicable disease – infections that can be
transmitted from one person to another.
◦ Notifiable or reportable diseases – must be
reported by the MDs to certain designated
authorities.
The Language of Pathophysiology
 Terms used for common cellular adaptations.
◦ Atrophy refers to the decrease in size of cells,
resulting to a reduced tissue mass.
◦ Hypertrophy – refers to the increase in size of
individual cells, resulting in an enlarged tissue
mass.
◦ Hyperplasia – defined as an increased in tissue
number of cells resulting in an enlarged tissue
mass.
The Language of Pathophysiology
◦ Metaplasia – occurs when one mature cell type is
replaced by a different (more resistant) mature cell
type.
◦ Dysplasia – term applied to tissue in which the cell
vary in size and shape, large nuclei are frequently
present, and the rate of mitosis is increased.
◦ Anaplasia – refers to cells that are undifferentiated
and have variable nuclei and cell structure and
numerous mitotic figures. Associated with
malignancy or cancer and is a basis for grading a
tumor.
The Language of Pathophysiology
◦ Neoplasm – means “new growth”, commonly known
as tumor.
 Malignant neoplasms are referred to as cancer.
The Language of Pathophysiology
 Cell damage and necrosis
◦ Apoptosis – refers to the programmed cell death, a
normal occurrence in the body, which may occur
when cell development is abnormal , excessive cell
number are injured or aged.
Ways of injuring cells in the body:

1. Ischemia/hypoxia – cell injury resulting from deficit

in O2.
1. Anaerobic metabolism – occurs in the absence of O2
leading to decrease pH and further metabolic
impairment.
2. Physical agent
3. Mechanical damage
4. Chemical toxins – can be exogenous or endogenous
5. Microorganisms
6. Abnormal metabolites
7. Nutritional deficits
8. Imbalance of fluid and electrolytes
The Language of Pathophysiology
 Cell damage and necrosis
◦ Two stages of cell damage
1. Initial cell damage
2. Loss of function
 As the amount of damage increases, detectable
morphologic or structural changes occurs, i.e.,
inflammation.
◦ Necrosis – term used when a group of cells die.
 Liquefactive- dead cells liquefy under the influence of
certain cell enzymes, e.g., brain tissue necrosis p
microbial infection
 Coagulative necrosis – cell CHON are altered or
denatured and cells retain some form p death e.g., p
MI
 Fat necrosis – occurs when fatty tissue is broken down
into fatty acids in the presence of infections or certain
enzymes e.g., fatty necrosis in the mesentery.
 Caseous necrosis – form of coagulation necrosis in
which a thick, yellowish “cheesy” substance forms e.g.,
during PTB infections
The Language of Pathophysiology
 Cell damage and necrosis
◦ Infarction – term applied to an area of dead cells
resulting from lack of O2.
◦ Gangrene – refers to an area of necrotic tissue that has
been invaded by bacteria.
◦ Specific types of cells die at different rates.
 Brain cells die quickly (4-5minutes) when deprived of O2
 Heart muscles – can survive for approximately 30minutes.
 Brain death – provide s the criteria of somatic death (death
of the body) based on the lack of any electrical activity in
any neurons, as demonstrated in EEG and absence of
response.
INFLAMMATION
Inflammation
 The inflammatory response is one of the
non-specific defence mechanisms in the
body.
◦ Other defences include:
 1st – the barriers (skin, mucous membranes) and
secretions (tears and saliva)
 2nd – phagocytosis
 3rd – specific defences, the immune response.
◦ The inflammatory response is the response to any
cell or tissue injury by an agent.
◦ The acute inflammatory response consists of a
sequence of a sequence of events:
1. The release of chemical mediators from damaged
mast cells and platelets
2. Local vasodilatation and increased capillary
permeability
3. Formation of exudates
4. Movement of leukocytes to the sites
5. Phagocytosis for removal of the offending agent and
debris
Inflammation
 Signs of acute inflammation
1. Redness
2. Warmth
3. Swelling
4. Pain
5. Loss of function
 With extensive inflammation, systemic signs may be
present
◦ Mild fever
◦ Headache
◦ Fatigue
◦ Leukocytosis
 Chronic inflammation results in formation of fibrotic or
scar tissue
Inflammation
 Anti-inflammatory drugs include
◦ ASA and the NSAIDs which block prostaglandin
production at the site.
 These drugs also have antipyretic and analgesic
activity
◦ Glucocorticoids such as hydrocortisone are effective
anti-inflammatory and anti-allergic agents, but
significant adverse effects develop with long term
use.
Healing
 Healing may take place by regeneration where cells
are capable of mitosis and if the damaged area is
small.
 Fibrotic or scar tissue, consisting primarily of
collagen fibers, replaces normal tissue when damage
is extensive or cells are incapable of mitosis.
◦ Scar tissue lacks normal function and is non-elastic, tending
to shrink over time, possibly causing contractures, deformity
or strictures at a later time.
 Factors promoting healing include youth, good
circulation and nutrition, and lack of infection or
other disease.
Burns
 Burns are example if inflammation and
healing, are classified by the percentage of
body surface area damaged and the depth of
the skin damage in the burn area.
◦ Partial thickness involves the epidermis and the
part of the dermis.
◦ Full thickness burns destroy all skin layers thus, a
skin graft is required for healing.
◦ In some cases, eschar restricts circulation or
ventilation.
Burns
 Following severe burns, shock frequently occurs
because of fluid and CHON loss from the burn
wound.
◦ Infection is a threat because the protective skin barrier
is lost.
◦ Inhalation of toxic or irritating fumes may cause
respiratory impairment.
◦ Hypermetabolism and the increased demand for
nutrients for healing require dietary supplements.
◦ Healing burns is a prolonged process, and multiple skin
grafts may be required.
 Biosynthetic wound coverings have promoted healing in
many cases.