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-Seun

 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
• Pathophysiology deals with temporal and spatial
dynamics in the intensity of pathological processe

• 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
2. If doctors are able to understand the causes
disease
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
Pathological anatomy – to understand the
functions
microstructural and
macrostructural changes under
pathological
conditions helps to understand functional
changes
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
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,
● 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 /aitiá = 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
c ) Pathogenesis /pathos = pain, suffering, distress, genesis -
promote
onset/
the health)
Deals with mechanisms involved in disease onset and
diseases
d) Sanogenesis /sanos = health/
Deals with mechanisms involved in recovery from
disease
to health
e) Semiology /sémeion = 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
● It is necessary to take into account
healthy
development
people
of qualitatively new processes, which are
harmful
forexample
One the body
ofstructure
such newand functions
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,
 Once
and an extrinsic
normal or environmental
functions of the body agent “, is still
had been
valid.
described
it was but a step to investigate states of
disease (from
 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 of„Manual in general
pathology
and pathological physiology“
• A.F. Hecker / 1790/ -author„Textbook in
pathophysiology
Excellent pathophysiologist from the past: J.E.
Purkyne, Prof. Pashutin, Prof. Pavlov /from
Russia/, Prof. Hans Selye /Canada-1907-1982/ -
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
Researchmodels...
at the Dept. of Pathophysiology
t 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
To fulfil this aim isand ending of diseases
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
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

• The source
view on of lasting knowledge is understanding of
the pathomechanisms
pathogenesis of diseases
(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