10/14/24, 10:00 Patho Exam 1 Study
AM Guide
Introduction to Pathophysiology
• Pathophysiology: the study of abnormalities in physiologic functioning of living beings
o Structural & functional changes in cells, tissues, & organs of the body that cause or are caused by disease
• Disease: disruption of homeostasis, disease is dynamic (always changing, they either get worse or they get better), it represents
the sum of the deviations from normal
• Framework for Pathophysiology
o Etiology: proposed causes or reasons for disease; classifications of diseases
▪ Inherited (sickle cell, down syndrome), Congenital (fetal alcohol, cleff), Metabolic (diabetes),
Degenerative (osteoarthritis), Neoplastic (cancer), Immunologic (HIV), Infectious (staph/strep), Induced by
physical agents
(drugs, asbestos), Nutritional deficiency (anorexia), Iatrogenic (bladder infections from unsterile catheter),
Psychogenic (depression), Nosocomial (MRSA), Risk factor (alcohol, smoking, obesity) (Look at first
powerpoint slides for definions)
▪ If you don’t know the etiology of a disease, you just treat the clinical manifestations
o Pathogenesis: mechanisms whereby a disease leads to typically observed clinical manifestations
▪ How the disease process evolves, from the initial stimulus, how it’s thought to alter physiologic function
▪ Description of how etiologic factors are thought to alter physiologic function and lead to the development of
clinical manifestations
▪ Affected by time, quantity (how much exposure you had to the disease affects if you’ll get it or not), location,
morphologic changes (the changes in the cells structure)
o Clinical Manifestations: signs & symptoms
▪ Symptom: subjective feeling of abnormality in the body (what the patient describes)
▪ Sign: manifestation noted by an observer (local or systemic) (visual)
▪ Syndrome: etiology of signs & symptoms not yet determined; not labeled as a disease—collection of different
signs and symptoms that occur together
o Treatment implications: understanding the first three may imply treatment
• Stages & Clinical Course
o Latent Period: (2 definitions) time between exposure of tissue to injurious agent & first appearance of signs and/or
symptoms OR refers to period during an illness when signs/symptoms temporarily become mild or silent (has disease
w/no symptoms)
o Prodromal: first signs/symptoms appear or onset of disease occurs (vague symptoms)
o Subclinical: patient functions normally; disease processes well established
▪ Remissions and exacerbations fall under this
o Acute Clinical: short-lived, <6 months; may have severe manifestations
o Chronic Clinical: >6 months, sometimes following an acute course
o Exacerbation: increase severity/signs/symptoms
o Remission: decrease severity/signs/symptoms; may indicate disease is cured
o Convalescence: stage of recovery after disease/injury/surgical procedure
o Sequela: subsequent pathologic condition resulting from an acute illness
• Concepts of Normality in Health & Disease
o Individual Factors
▪ Cultural considerations: each culture defines health & illness that reflects their experience
▪ Age & Biologic factors linked: normal value for one person isn’t the same for another depending on age
▪ Gender differences: normal value for men may not be normal for women; relevant in health & disease
o Other Factors
▪ Situational differences: determine if a derivation from normal should be considered abnormal or an adaptation
mechanism
▪ Time variations: may impact how the body responds day to night or at varying times
▪ Statistical normality: estimate of disease in a normal population based on bell shaped curve
▪ Reliability: test’s ability to give same results in repeated measurements (false positives, NO lab tests 100%
reliable)
▪ Sensitivity: probability that a test will be positive when applied to a person with a particular condition
▪ Specificity: probability that a test will be negative when applied to a person without a particular condition
(usually better than sensitivity)
• https://www.youtube.com/watch?v=LCndoLgoPVk
▪ Validity: degree to which a measurement reflects the true value of what it intends to measure
▪ Predictive value: extent to which a test can differentiate between presence or absence of a person’s condition
• Concepts of Epidemiology
o Epidemiology: study of patterns of disease in human populations; examining the occurrence, incidence, prevalence,
transmission, & distribution of diseases in populations
▪ Goals: to define disease, identify outbreaks, assist in development & evaluation of treatment protocols, &
develop prevention strategies
about:blan 1/
k 21
,10/14/24, 10:00 Patho Exam 1 Study
AM Guide
▪ *Essential understanding for effective prevention & treatment
o Epidemic: disease spreads to many individuals at the same time
o Endemic: infectious disease that is routinely found amount certain populations--native to local region
o Pandemic: affect large geographic regions--worldwide epidemic
o Incidence: number of new cases occurring in a specific time period
o Prevalence: number of existing cases within a population during a specific period of time
• Implications for Treatment
o Levels of Prevention:
▪ Primary: prevention of disease by altering susceptibility [reduce exposure] (immunizations)
▪ Secondary: early detection, screening, & management of disease (mammograms)
▪ Tertiary: treatment, rehabilitation, supportive care, reducing disability, & restoring effective functioning
(chemo/radiation)
Homeostasis & Adaptive Responses to Stressors
• Homeostasis: state of equilibrium that is maintained by a dynamic process of feedback & regulation
o Stress: state of tension that can lead to disharmony or threatened homeostasis
▪ Amount of stress a person can tolerate depends on adaptive capacity of person
▪ If adaptation is successful, homeostasis is maintained or restored
• Allostasis: ability to successfully adapt to challenges/the overall dynamic process of adaptive change that maintains or re-
established homeostasis necessary to maintain survival & well being
• Homeostasis Control Mechanisms
o Negative Feedback: causes the controller to respond in a manner that opposes deviation from normal
o Positive Feedback: displaces a system away from its steady-state
▪ Blood clotting, oxytocin comes from pituitary to cause contractions
• Stress as a Concept
o Real or perceived, evokes “fight or flight” reaction (& a pathology if not managed/dealt with)
o General Adaptation Syndrome: reflects the changes in body’s systemic response
▪ Alarm: SNS, arousal of body defenses
▪ Resistance: adaptation, fight or flight & adrenocortical hormones are high/returned body to homeostasis
▪ Exhaustion: stressor too great or prolonged/body can no longer return to homeostasis; pathology can occur here
o *If the hypothalamus senses a stressful stimulus in the internal or external environment, the hypothalamus secretes
corticotropin-releasing hormone & 2 things happen:
1. Sympathetic nervous system & adrenal medulla secrete catecholamines (epinephrine & norepinephrine)
nerve signal->medulla->adrenaline->increased HR, respirations, blood sugar
2. Anterior pituitary secretes adrenocorticotropic hormone; the adrenal cortex secretes glucocorticoids (cortisol &
aldosterone)
ACTH->cortex->glucocorticoids->liver releases glucose for energy
o Stressors & Risk Factors
▪ Stressors: agents or conditions capable of producing stress/endanger homeostasis; external or internal, vary in
scope, intensity & duration
▪ Risk factor: not stressor but conditions that increase the likelihood of encountering a stressor/increase
probability that a disease will occur (lifestyle, age, gender)
▪ Precipitating factor: event that causes a pathologic disorder
o Neurohormonal Mediators of Stress & Adaptation
▪ Catecholamines: play a role in alleostasis (norepinephrine & epinephrine), mediates fight-or-flight
▪ Norepinephrine: constricts blood vessels & raises BP, reduces gastric secretions (makes you get sick when
you’re stressed), increases night & far vision
▪ Epinephrine: enhances myocardial contractility, increases HR & cardiac output, causes bronchodilation,
increases the release of glucose from the liver (glycogenolysis) & elevates blood glucose levels
▪ Endorphins & Enkephalins: endogenous opioids--proteins found in brain (body’s natural pain relievers); raise
pain threshold, produce sedation & euphoria
▪ Immune Cytokines: secreted by macrophages during stress response; enhance immune system response,
prolonged stress can suppress immune functioning
▪ Sex Hormones: affect stress responses, thus influencing allostasis; may help explain gender responses during
stress (estrogen & testosterone)
▪ Oxytocin: produced during childbirth & lactation, associated with bonding & social attachment, thought to
moderate stress response & produce a calming effect
▪ Adrenocortical Steroids: critical to maintenance of homeostasis, may synergize or antagonize effects of
catecholamines (cortisol & aldosterone)
▪ Cortisol: activated by ACTH, primary glucocorticoid/stimulates gluconeogenesis, affects protein
metabolism/anabolic effect, promotes appetite & food-seeking behaviors, has anti-inflammatory effects &
immunosuppressive agents
about:blan 2/
k 21
, 10/14/24, 10:00 Patho Exam 1 Study
AM Guide
▪ Aldosterone: primary mineralocorticoid, promotes reabsorption of sodium & water, increases BP
• Adaptation, Coping, & Illness
o Adaptation: biopsychosocial process of change in response to new or altered circumstances, internal or external
o Coping: behavioral adaptive response to a stressor using culturally based coping mechanisms
o Distress: perceived inability to cope with a stressor
o Illness: both physiological & psychological; stimulus for the stress response
o Physical Indicators of High Stress Level:
▪ Increased BP & muscle tension, tachycardia, increased respirations, diaphoresis, fatigue, tension headache,
nausea, vomiting, diarrhea, change in weight/appetite, restlessness, insomnia
o Psychological Indicators of High Stress Level:
▪ Anxiety, depression, alcohol abuse, change in activity patterns, exhaustion, loss of self esteem, increased
irritability, loss of motivation, decreased productivity, inability to concentrate, increased illness
Pain
• Pain: complex physiologic & perceptual phenomenon; unpleasant sensory & emotional experience associated with actual or
potential tissue damage
o Subjective—pain when the patient says there is
o Affective, behavioral, beliefs & attitudes, sensory, physiologic
o Pain tolerance: degree of pain an individual can withstand
▪ Influenced by cultural perceptions, expectations, role behaviors, & physical & mental health
▪ Decreased with repeated pain, fatigue, anger, boredom, apprehension, & sleep deprivation
▪ Increased by alcohol consumption, persistent use of pain medication, hypnosis, warmth, distracting activities,
& strong beliefs or faith
▪ Varies greatly among people & in the same person over time
o Pain threshold: point of pain recognition
▪ Does not vary significantly among people or in the same person over time
▪ Intense pain at one location may cause increase in threshold in another location (perceptual dominance)
• Individual with many painful sites may report only most painful
• After dominant pain is diminished, individual may then identify other painful areas
o Single most common medical complaint; affects our ability to function/move
▪ Sometimes referred to as the 5th vital sign
o Purpose
▪ Learn that something is harmful, know something is going on
▪ Occurs before injury occurs; to prevent damage
▪ Sets limits on activity which forces inactivity which is required for healing
o Physiology
▪ Nociception: special receptors that respond only to noxious stimuli & generate nerve impulses which the brain
interprets as pain
• Activity is transmitted to spinal cord by two types of neurons:
o Large, myelinated A delta fibers (fast pathway)--transmits sharp, localized sensations
o Small, unmyelinated C fibers (slow pathway)--transmits dull, aching, poorly localized
sensations
• Four Stages
o Transduction: conversion of a stimulus to an action potential at the site of tissue injury
▪ Chemical substances released with cellular damage (histamines, serotonin,
prostaglandins); sensitize the primary afferent (carry towards) nociceptors that carry
painful stimuli
o Transmission: neuronal action potential is transmitted to & through CNS so it can
be perceived (A delta & C fibers)
▪ Impulse goes to brain, processed in dorsal horn, transmitted to the brain
▪ Nociceptive pathways w/Sensory Dermatomes (referred pain)
o Perception: Result of neural processing of pain sensations in the brain--involves several brain
structures; includes an awareness & interpretation of the meaning of sensation
▪ Can be described in terms of pain threshold & tolerance
o Modulation: inhibition of nociception (opioids work during this phase); efferent fibers
descending from the brain stem alter pain
o Types: Physiologic or Pathologic
▪ Classified according to duration, source, location, or referral pattern
▪ Symptom of underlying problem rather than a primary disorder
▪ Acute: results from tissue injury & resolves in <6 months
▪ Chronic: exists when pain lasts more than expected healing time, >6 months
about:blan 3/
k 21
AM Guide
Introduction to Pathophysiology
• Pathophysiology: the study of abnormalities in physiologic functioning of living beings
o Structural & functional changes in cells, tissues, & organs of the body that cause or are caused by disease
• Disease: disruption of homeostasis, disease is dynamic (always changing, they either get worse or they get better), it represents
the sum of the deviations from normal
• Framework for Pathophysiology
o Etiology: proposed causes or reasons for disease; classifications of diseases
▪ Inherited (sickle cell, down syndrome), Congenital (fetal alcohol, cleff), Metabolic (diabetes),
Degenerative (osteoarthritis), Neoplastic (cancer), Immunologic (HIV), Infectious (staph/strep), Induced by
physical agents
(drugs, asbestos), Nutritional deficiency (anorexia), Iatrogenic (bladder infections from unsterile catheter),
Psychogenic (depression), Nosocomial (MRSA), Risk factor (alcohol, smoking, obesity) (Look at first
powerpoint slides for definions)
▪ If you don’t know the etiology of a disease, you just treat the clinical manifestations
o Pathogenesis: mechanisms whereby a disease leads to typically observed clinical manifestations
▪ How the disease process evolves, from the initial stimulus, how it’s thought to alter physiologic function
▪ Description of how etiologic factors are thought to alter physiologic function and lead to the development of
clinical manifestations
▪ Affected by time, quantity (how much exposure you had to the disease affects if you’ll get it or not), location,
morphologic changes (the changes in the cells structure)
o Clinical Manifestations: signs & symptoms
▪ Symptom: subjective feeling of abnormality in the body (what the patient describes)
▪ Sign: manifestation noted by an observer (local or systemic) (visual)
▪ Syndrome: etiology of signs & symptoms not yet determined; not labeled as a disease—collection of different
signs and symptoms that occur together
o Treatment implications: understanding the first three may imply treatment
• Stages & Clinical Course
o Latent Period: (2 definitions) time between exposure of tissue to injurious agent & first appearance of signs and/or
symptoms OR refers to period during an illness when signs/symptoms temporarily become mild or silent (has disease
w/no symptoms)
o Prodromal: first signs/symptoms appear or onset of disease occurs (vague symptoms)
o Subclinical: patient functions normally; disease processes well established
▪ Remissions and exacerbations fall under this
o Acute Clinical: short-lived, <6 months; may have severe manifestations
o Chronic Clinical: >6 months, sometimes following an acute course
o Exacerbation: increase severity/signs/symptoms
o Remission: decrease severity/signs/symptoms; may indicate disease is cured
o Convalescence: stage of recovery after disease/injury/surgical procedure
o Sequela: subsequent pathologic condition resulting from an acute illness
• Concepts of Normality in Health & Disease
o Individual Factors
▪ Cultural considerations: each culture defines health & illness that reflects their experience
▪ Age & Biologic factors linked: normal value for one person isn’t the same for another depending on age
▪ Gender differences: normal value for men may not be normal for women; relevant in health & disease
o Other Factors
▪ Situational differences: determine if a derivation from normal should be considered abnormal or an adaptation
mechanism
▪ Time variations: may impact how the body responds day to night or at varying times
▪ Statistical normality: estimate of disease in a normal population based on bell shaped curve
▪ Reliability: test’s ability to give same results in repeated measurements (false positives, NO lab tests 100%
reliable)
▪ Sensitivity: probability that a test will be positive when applied to a person with a particular condition
▪ Specificity: probability that a test will be negative when applied to a person without a particular condition
(usually better than sensitivity)
• https://www.youtube.com/watch?v=LCndoLgoPVk
▪ Validity: degree to which a measurement reflects the true value of what it intends to measure
▪ Predictive value: extent to which a test can differentiate between presence or absence of a person’s condition
• Concepts of Epidemiology
o Epidemiology: study of patterns of disease in human populations; examining the occurrence, incidence, prevalence,
transmission, & distribution of diseases in populations
▪ Goals: to define disease, identify outbreaks, assist in development & evaluation of treatment protocols, &
develop prevention strategies
about:blan 1/
k 21
,10/14/24, 10:00 Patho Exam 1 Study
AM Guide
▪ *Essential understanding for effective prevention & treatment
o Epidemic: disease spreads to many individuals at the same time
o Endemic: infectious disease that is routinely found amount certain populations--native to local region
o Pandemic: affect large geographic regions--worldwide epidemic
o Incidence: number of new cases occurring in a specific time period
o Prevalence: number of existing cases within a population during a specific period of time
• Implications for Treatment
o Levels of Prevention:
▪ Primary: prevention of disease by altering susceptibility [reduce exposure] (immunizations)
▪ Secondary: early detection, screening, & management of disease (mammograms)
▪ Tertiary: treatment, rehabilitation, supportive care, reducing disability, & restoring effective functioning
(chemo/radiation)
Homeostasis & Adaptive Responses to Stressors
• Homeostasis: state of equilibrium that is maintained by a dynamic process of feedback & regulation
o Stress: state of tension that can lead to disharmony or threatened homeostasis
▪ Amount of stress a person can tolerate depends on adaptive capacity of person
▪ If adaptation is successful, homeostasis is maintained or restored
• Allostasis: ability to successfully adapt to challenges/the overall dynamic process of adaptive change that maintains or re-
established homeostasis necessary to maintain survival & well being
• Homeostasis Control Mechanisms
o Negative Feedback: causes the controller to respond in a manner that opposes deviation from normal
o Positive Feedback: displaces a system away from its steady-state
▪ Blood clotting, oxytocin comes from pituitary to cause contractions
• Stress as a Concept
o Real or perceived, evokes “fight or flight” reaction (& a pathology if not managed/dealt with)
o General Adaptation Syndrome: reflects the changes in body’s systemic response
▪ Alarm: SNS, arousal of body defenses
▪ Resistance: adaptation, fight or flight & adrenocortical hormones are high/returned body to homeostasis
▪ Exhaustion: stressor too great or prolonged/body can no longer return to homeostasis; pathology can occur here
o *If the hypothalamus senses a stressful stimulus in the internal or external environment, the hypothalamus secretes
corticotropin-releasing hormone & 2 things happen:
1. Sympathetic nervous system & adrenal medulla secrete catecholamines (epinephrine & norepinephrine)
nerve signal->medulla->adrenaline->increased HR, respirations, blood sugar
2. Anterior pituitary secretes adrenocorticotropic hormone; the adrenal cortex secretes glucocorticoids (cortisol &
aldosterone)
ACTH->cortex->glucocorticoids->liver releases glucose for energy
o Stressors & Risk Factors
▪ Stressors: agents or conditions capable of producing stress/endanger homeostasis; external or internal, vary in
scope, intensity & duration
▪ Risk factor: not stressor but conditions that increase the likelihood of encountering a stressor/increase
probability that a disease will occur (lifestyle, age, gender)
▪ Precipitating factor: event that causes a pathologic disorder
o Neurohormonal Mediators of Stress & Adaptation
▪ Catecholamines: play a role in alleostasis (norepinephrine & epinephrine), mediates fight-or-flight
▪ Norepinephrine: constricts blood vessels & raises BP, reduces gastric secretions (makes you get sick when
you’re stressed), increases night & far vision
▪ Epinephrine: enhances myocardial contractility, increases HR & cardiac output, causes bronchodilation,
increases the release of glucose from the liver (glycogenolysis) & elevates blood glucose levels
▪ Endorphins & Enkephalins: endogenous opioids--proteins found in brain (body’s natural pain relievers); raise
pain threshold, produce sedation & euphoria
▪ Immune Cytokines: secreted by macrophages during stress response; enhance immune system response,
prolonged stress can suppress immune functioning
▪ Sex Hormones: affect stress responses, thus influencing allostasis; may help explain gender responses during
stress (estrogen & testosterone)
▪ Oxytocin: produced during childbirth & lactation, associated with bonding & social attachment, thought to
moderate stress response & produce a calming effect
▪ Adrenocortical Steroids: critical to maintenance of homeostasis, may synergize or antagonize effects of
catecholamines (cortisol & aldosterone)
▪ Cortisol: activated by ACTH, primary glucocorticoid/stimulates gluconeogenesis, affects protein
metabolism/anabolic effect, promotes appetite & food-seeking behaviors, has anti-inflammatory effects &
immunosuppressive agents
about:blan 2/
k 21
, 10/14/24, 10:00 Patho Exam 1 Study
AM Guide
▪ Aldosterone: primary mineralocorticoid, promotes reabsorption of sodium & water, increases BP
• Adaptation, Coping, & Illness
o Adaptation: biopsychosocial process of change in response to new or altered circumstances, internal or external
o Coping: behavioral adaptive response to a stressor using culturally based coping mechanisms
o Distress: perceived inability to cope with a stressor
o Illness: both physiological & psychological; stimulus for the stress response
o Physical Indicators of High Stress Level:
▪ Increased BP & muscle tension, tachycardia, increased respirations, diaphoresis, fatigue, tension headache,
nausea, vomiting, diarrhea, change in weight/appetite, restlessness, insomnia
o Psychological Indicators of High Stress Level:
▪ Anxiety, depression, alcohol abuse, change in activity patterns, exhaustion, loss of self esteem, increased
irritability, loss of motivation, decreased productivity, inability to concentrate, increased illness
Pain
• Pain: complex physiologic & perceptual phenomenon; unpleasant sensory & emotional experience associated with actual or
potential tissue damage
o Subjective—pain when the patient says there is
o Affective, behavioral, beliefs & attitudes, sensory, physiologic
o Pain tolerance: degree of pain an individual can withstand
▪ Influenced by cultural perceptions, expectations, role behaviors, & physical & mental health
▪ Decreased with repeated pain, fatigue, anger, boredom, apprehension, & sleep deprivation
▪ Increased by alcohol consumption, persistent use of pain medication, hypnosis, warmth, distracting activities,
& strong beliefs or faith
▪ Varies greatly among people & in the same person over time
o Pain threshold: point of pain recognition
▪ Does not vary significantly among people or in the same person over time
▪ Intense pain at one location may cause increase in threshold in another location (perceptual dominance)
• Individual with many painful sites may report only most painful
• After dominant pain is diminished, individual may then identify other painful areas
o Single most common medical complaint; affects our ability to function/move
▪ Sometimes referred to as the 5th vital sign
o Purpose
▪ Learn that something is harmful, know something is going on
▪ Occurs before injury occurs; to prevent damage
▪ Sets limits on activity which forces inactivity which is required for healing
o Physiology
▪ Nociception: special receptors that respond only to noxious stimuli & generate nerve impulses which the brain
interprets as pain
• Activity is transmitted to spinal cord by two types of neurons:
o Large, myelinated A delta fibers (fast pathway)--transmits sharp, localized sensations
o Small, unmyelinated C fibers (slow pathway)--transmits dull, aching, poorly localized
sensations
• Four Stages
o Transduction: conversion of a stimulus to an action potential at the site of tissue injury
▪ Chemical substances released with cellular damage (histamines, serotonin,
prostaglandins); sensitize the primary afferent (carry towards) nociceptors that carry
painful stimuli
o Transmission: neuronal action potential is transmitted to & through CNS so it can
be perceived (A delta & C fibers)
▪ Impulse goes to brain, processed in dorsal horn, transmitted to the brain
▪ Nociceptive pathways w/Sensory Dermatomes (referred pain)
o Perception: Result of neural processing of pain sensations in the brain--involves several brain
structures; includes an awareness & interpretation of the meaning of sensation
▪ Can be described in terms of pain threshold & tolerance
o Modulation: inhibition of nociception (opioids work during this phase); efferent fibers
descending from the brain stem alter pain
o Types: Physiologic or Pathologic
▪ Classified according to duration, source, location, or referral pattern
▪ Symptom of underlying problem rather than a primary disorder
▪ Acute: results from tissue injury & resolves in <6 months
▪ Chronic: exists when pain lasts more than expected healing time, >6 months
about:blan 3/
k 21
