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1、Conspectus of Disease疾病概论疾病概论-疾病的概念（疾病的概念（Concept of Disease）-病因学（病因学（Etiology）-发病学（发病学（Pathogenesis）1Concept of Healthn Traditional definition: The state of the organism when it functions optimally without any evidence of disease.n The definition of health from WHO: Without any evidence of disease,
2、 and a state of complete well-being physically, socially and psychologically. 2Concept of DiseasepDisease: An abnormal life process or a pathologic process which is induced by disorders of homeostasis under the action of certain causes and conditions, with a characteristic set of signs and symptoms.
3、pHomeostasis（稳态）: The body maintains a steady state of the internal environment in the face of continual environmental variation, which is required for optimum functioning.uSymptom: Subjective feeling of discomfort that can be reported by the affected individual.uSign: Objectively identifiable aberr
4、ation of the disease.uSyndrome: A collection of different signs and symptoms that occur together in specific disease.3Concept of Sub-healthA situation, in which the person does not show specific symptoms and signs of disease, but lives a low-quality of life both physically and mentally，with possible
5、 latent alterations, or functional alterations. e.g. chronic fatigue syndrome (CFS) 4Etiology of Disease Etiology studies the contributing factors that cause diseases, including:(1) Etiological factors / Direct causes of diseases (2) Conditions for / Precipitating factors of disease(3) Predisposing
6、factors of disease5An etiological factor causes a disease and determines its characteristics.Extrinsic CausesIntrinsic Causes1. Etiological Factors （Direct causes of diseases）6(1) Extrinsic Factors n Biological agents: microorganisms, parasites, and products（toxins, LPS, etc） n Chemical agents: non-
7、specific and specific n Physical agents: mechanical injuries, extremes of temperature, electricity, radiation, etcn Nutritional imbalance: excesses or deficiencies 7(2) Intrinsic Factorsn Genetic factors: gene mutation, chromosome aberration（e.g. sickle cell anemia, colorblindness）.n Epigenetic fact
8、ors: DNA methylation, histone code, ncRNA, chromosome remodeling.n Congenital factors: abnormal embryonic development (resulting from maternal infections, diet and drug-taking during pregnancy).n Immunological factors: immune response is deficient, inappropriately strong, or misdirected (immunodefic
9、iency, allergy, autoimmune diseases).n Psychological factors: anxiety, strong or persistent psychological stress (e.g. hypertension, peptic ulcer, coronary heart disease, and depression）.82.Conditions for disease Precipitating factors enhance the effects of causative factors and promote the onset an
10、d development of diseases, through influence upon the role of etiological factors or body condition:uNatural condition: exposed to cold environment -develop a colduPhysical condition: hypertension - vulnerable to myocardial infarctionuSocial condition: poor labor and hygiene conditions93.Predisposin
11、g factorsA predisposing factor refers to the factor that influences the susceptibility or resistance to certain disease:uGenetic constitution (Genetic predisposition)uPhysiological diathesisuPsychological characteristics 10Pathogenesis Pathogenesis studies the general rules and common mechanisms und
12、erlying the development of diseases, including how the primary pathological agents cause disease and how the disease develops.(1) Basic mechanisms of disease(2) General rules of disease development (3) Outcome of disease111. Fundamental mechanism of disease Mechanism of disease: to explain alteratio
13、n during disease, including how and why the symptoms and signs of the disease may occur and develop, how the body attempts to overcome the disease. Although various specific mechanisms may underlie different disorders, they all generally involve the following four levels of deregulations:uNeural dys
14、regulations uHormonal dysregulationsuOrganic dysregulationsuCellular and Molecular dysregulations 122. General rules for the onset and development of diseases(1)Disruption of homeostasis (2)Process of damage and anti-damage(3)Reversal role of cause and result(4)Correlation between systemic and local
15、 alterations 13(1) Regulation and disruption of homeostasisuHomeostasis: to keep the internal environment of an organism to remain balanced and stable. e.g. maintenance of body temperature homeostasis.uDisruption of homeostasis by harmful agents may cause diseases. e.g. fever. 14(2) Damages and anti
16、-damage responsesuDamages induce anti-damage responses, and their interactions go through the whole process of diseases, which determine the development and outcome of diseases.e.g. Microbeanti-infection (Physic barrier, Monocyte, Inflammation, Immunoreaction)uOverdo of anti-damages cause new injuri
17、es, becoming a damaging factor.e.g. allergy, or autoimmune diseases15 A cause of a disease leads to a result, which can be a new cause for another result in the development of the disease, even forming vicious cycle. e.g. hemorrhagic shock. (3) Reversal rule of cause and result Primary Primary cause
18、scausesResponseResponses sFurther Further alterationsalterations Secondary Secondary alterationsalterations(causes)(causes)16(4) Systemic and local regulations Local alterations and the systemic states can affect each other and disease development. e.g. a severe furuncle will not only cause local in
19、flammation, but also lead to systemic reactions of fever and elevated leukocytes, even sepsis. on the other hand, a furuncle may be a complication of diabetes and could only be cured by proper control of diabetes. 17Phases of A Disease潜伏潜伏前奏前奏高潮高潮尾声尾声LatencyProdromeClinic symptomsRecovery3. Outcome
20、of Disease18Outcome of a diseaseRecoveryDeathComplete recoveryIncomplete recoveryPrognosis: Probable course and outcome of a disease.19(1) Complete recovery The alterations of the function, metabolism, and structure of the body during the disease are perfectly restored, and the symptoms and signs of
21、 the disease are disappeared entirely.the etiological factors disappearthe pathologically altered metabolism, structure and function are perfectly restoredthe symptoms and signs of the disease disappear entirelyhomeostasis is recovered20(2) Incomplete recoverythe main symptoms and signs are absent,
22、but some pathological changes are still present in the body.Transition to chronicitySequela is generally brought about by the compensatory response to maintain a relatively normal activity. e.g. the permanent damage to the heart valve after rheumatic fever. 21(3) Death The body as a whole stop worki
23、ng forever. Brain dearth is the marker for the diagnosis. Brain death is a state of prolonged irreversible cessation of all brain activity with the complete absence of conscious and voluntary movements, responses to stimuli, brain stem reflexes, and spontaneous respirations. Brain Death (WHO criteri
24、a) lCessation of spontaneous respirationlIrreversible comalAbsence of cephalic reflexeslDilated or fixed pupilslAbsence of any electrical activity of the brainlAbsence of brain blood flow22Brain death (脑死亡)Vegetative state（植物状态）定义自主呼吸意识脑干反射恢复的可能性全脑功能不可逆丧失无丧失无无脑的认知功能丧失有有睡眠醒觉周期，但无意识有有Significance for
25、diagnosis of brain deathlIn favor of recording the time of deathlDefine the time to terminate for the rescuelIn favor of organ transplantation2324Case study A 34-year-old man was well until 3 days prior to admission, when he noted the onset of fever, weakness, fatigue, headache, sore throat, and a c
26、ough productive of white sputum. One day prior to admission he awakened with burning chest discomfort that was made worse by coughing and by deep breathing. He developed shortness of breath and was seen at a university infirmary, where he appeared acutely ill with a fever. A chest radiograph demonst
27、rated bilateral infiltrates consistent with pneumonia. An arterial blood gas analysis, done while the patient was breathing room air, was notable for significant hypoxemia (PaO2, 48mmHg; normal, 85-100mmHg). The patients shortness of breath increased markedly, and he was transferred to the hospital,
28、 where he was found to be cyanotic and febrile to 39.8 and to have a respiratory rate of 44/min with labored respirations. Examination of the sputum revealed a grossly bloody background, numerous neutrophils, and sheets of gram-positive cocci in clusters. Questions1.What disease did the patient suff
29、er from: bacterial infection or viral disease?2. What pathogenic mechanism accounts for this patients fever?3. What alterations of metabolism and function may occur in a patient suffering from fever?25专业英文词汇专业英文词汇 1.Pathophysiology 病理生理学2.Disease 疾病3.Bio-psycho-social medical model 生物心理社会医学模式4.Etiol
30、ogy 病因学5.Pathogenesis 发病学6.genetic predisposition 遗传易感性7.Prognosis 预后8.brain death 脑死亡9.Vegetative state 植物状态 26Learning Objectives l了解病理生理学的知识结构、基本内容及其与其它医学学科的关系。l熟悉病理生理学/疾病机制的研究方法。l熟悉健康的定义、疾病的概念。l掌握疾病发生的病因学。l掌握疾病发生发展的一般规律和基本机制。l掌握疾病转归概念。l熟悉脑死亡概念和判断标准。了解植物状态与脑死亡的区别。27Exercises1.1.简述生物、物理以及化学致病因素作用于
31、机体时具有哪些特点。简述生物、物理以及化学致病因素作用于机体时具有哪些特点。2.2.简述环境因素、遗传因素、以及社会和心理因素在疾病发生中的作用。简述环境因素、遗传因素、以及社会和心理因素在疾病发生中的作用。3.3.试述内源性病因的种类和基本概念试述内源性病因的种类和基本概念4.4.举例说明遗传易感性在疾病发生中的作用。举例说明遗传易感性在疾病发生中的作用。5.5.简述疾病发生发展的一般规律。简述疾病发生发展的一般规律。6.6.举例说明疾病过程中损伤和抗损伤相应的表现和在疾病发展中的意义。举例说明疾病过程中损伤和抗损伤相应的表现和在疾病发展中的意义。7.7.举例说明疾病过程中因果转化在疾病发展中的意义。举例说明疾病过程中因果转化在疾病发展中的意义。8.8.简述脑死亡的概念和判断标准。简述脑死亡的概念和判断标准。9.9.研究一个疾病的发病机制的基本策略和方法途径有哪些？研究一个疾病的发病机制的基本策略和方法途径有哪些？
