INTRODUCTION
TO
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
Study
Diseased
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 dynamics of pathological
processes, with temporal and spatial characteristic,
and with changes of intensity in 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, their role 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, and 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
Final definition
 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
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
Relation among pathophysiology and other subjects
of unergraduate medical education
Sciences
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, medical ethics,
sociology, antropology,
phylosophy, demography...)
– psychologic and social factors play an important
role in pathogenesis of diseases
Learning outcomes
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
Medical students construct their own
virtual house of medicine
„House of Medicine“
Neurology
Gynekology and Obtetrics
Surgery
Internal medicine
Ceiling plate
PATHOPHYSIOLOGY
Pathology
Pharmacology
walls
Microbiology
PHYSIOLOGY
Base plate
Anat
Biol
Histol
Bioch
Foundations
Chem
Biophys
Structure of pathophysiology
1. General pathophysiology
2. Special /organs, systems/ pathophysiology
General pathophysiology 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....
General pathophysiology also deals with
● 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 pathophysiological (clinical)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 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 /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, and with symptoms
and signs characteristic for dieing process
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 – e.g.:
• 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
NOTES 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 also 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)
In positive feedback a change in the homeostatic condition is detected
by receptors and the information is transmitted to the control centre.
The control centre activates effectors which generate a response which
increases the stimulus further reinforcing the initial change. Therefore,
positive feedback acts to reinforce or strengthen the stimulus or charge.
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
volume
overload
hydrostatic pressure in systemic
venes
formation of edema
COLV
 fluid volume
activation sympathic
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 (1821-1902)-the father of modern pathology, he
introduces also term „pathological physiology“ to medical terminology
• Galliot
(1819)-author of„Manual in general pathology and pathological
physiology“
• A.F. Hecker
(1763-1811)
-author„Textbook in pathophysiology“
(1790)
Excellent pathophysiologist from the past: J.E. Purkyne, Prof.
Pashutin, Prof. Pavlov /from Russia/, Prof. Hans Selye /Canada1907-1982/ -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
Students should understand fundamental general and specific
pathomechanisms involved in onset, development and ending
of diseases
For reaching this aims is necessary:
a) to know and understand pathophysiological terms
b) to know and understand essential pathomechanisms
c) to connect separate factual knowledge and pathomechanisms to
rational pathogenetic network characteristic for different
pathological processes and diseses
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 best way how to obtain lasting knowledge is
understanding of the pathomechanisms
(Understunding is a kind of ecstasy)
Textbooks and other sorces for study of PaPhy
● Silbernagel S, Lang F. Color Atlas of Pathophysiology
Thieme, Stuttgart - New York, 2nd Edition 2010, 433pp.
ISBN: 978-3-13-116552-7
● McPhee SJ, Hammer GD. Pathophysiology of Disease – An
Introduction to Clinical Medicine, Sixth Edition,2010, McGraw Hill
Medical, New York-Toronto, 736pp. ISBN: 978-0-07-162167-0
● Handouts of lectures on Pathophysiology – from Dept of
Pathophysiology, JFM CU in Martin (yearly updated)
● Tatar M, Hanacek J. Pathophysiology. Topics for seminars.
Comenius University 2001, 220pp.
 Huether SE, McCance KL. Understanding Pathophysiology, Fifth
Edition, Elsevier Mosby 2012, 1159pp. ISBN:978-0-323-07891-7
Staff involved in teaching process
Head of Department:
Professor M. Tatar, M.D., Ph.D.
Teaching staff:
Teachers: Prof. J. Hanacek, M.D., Ph.D. - Vice-Head
Prof. M. Tatar, M.D., Ph.D.
Assoc. Prof. M. Brozmanova, RNDr., Ph.D.
Assoc. Prof. R. Pecova, M.D., 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: J. Halicka, MD, Ms. S. Gavliakova, Ing.
Secretary: Mrs. M. Ilovska