病理學(xué)與病理生理學(xué)總論：緒論

1、Pathology You have a poor appetite, dizzy head and vision, depression and fright, vexation, agitation, irascibility, tidal fever, vacuity sweating, congestion, short of breath, general body weakness, irregular menses, poor sexual performance which are the results of endocrine disorders, menopausal c

2、omplex and aging; and You experience vacuity sweating, congestion, short of breath, palpitation, dizzy head and vision, and general lack of strength, which occur after a serious illness or chronic diseases.,A full evaluation of health conditions is necessary for the effective implementation of publi

3、c health interventions. However, terms to address the intermediate state between health and disease are lacking, leading the public to overlook this state and thus increasing the risks of developing disease.,Disease: An abnormal life process which is induced by disorders of homeostasis under the act

4、ion of certain causes and conditions. A pathologic process with disturbances of function, metabolism, and structure in the body, which are manifested by a characteristic set of signs and symptoms.,疾病是指機(jī)體在一定條件下，由病因與機(jī)體相互作用而產(chǎn)生的一個(gè)損傷與抗損傷作斗爭(zhēng)的過(guò)程。體內(nèi)有一系列功能、代謝和形態(tài)的改變，臨床出現(xiàn)許多不同的癥狀與體征，機(jī)體與外環(huán)境間的協(xié)調(diào)發(fā)生障礙。簡(jiǎn)言之，疾病是機(jī)體在一定條

5、件下受病因損害作用后，因機(jī)體自穩(wěn)調(diào)節(jié)紊亂而發(fā)生的異常生命活動(dòng)過(guò)程。,Section 2: Etiology Etiology studies the contributing factors that cause diseases including causative, predisposing, and precipitating factors. (1) Etiological factors / Causes of diseases (2)Conditions for / Precipitating factors of disease 誘發(fā)因素 (3) Predisposing fa

6、ctors of disease 潛在因素，發(fā)生條件,病因?qū)W(etiology)是研究疾病發(fā)生的原因與條件的科學(xué),stable angina,Clinical complain: chest pain,Predisposing factor :Concentric coronary stenosis,Cause,agitation,Precipitating factor,Precipitating factor,(1)Etiological factors /Causes of diseases A etiological factor causes a disease and determ

7、ines its characteristics. Classification of etiological factors Biological factors Physical factors Chemical factors Nutritional factors Immunological factors Hereditary factors Congenital factors Social and psychological factors,Biological factors Biological agents: microorganisms (such as bacteria

8、, virus, fungi, etc.), parasites, and their toxins and metabolic products.,Physical factors Physical agents include mechanical injuries, extremes of temperature, electricity and radiation.,Chemical factors Chemical agents: can damage cells by varies pathways. For instance, corrosive chemicals, such

9、as strong acids and alkalis, can destroy cells at the site of contact. Other chemicals are selective in their sites of action, such as binding of carbon monoxide to hemoglobin.,Nutritional imbalanceEither excesses or deficiencies of nutrients predispose cells to injury. For example, high lipids and

10、carbohydrates diet predispose a person to obese disease, atherosclerosis and diabetes. The most common nutritional deficiency is the lack in certain constituents, such as vitamins, calcium, and trace elements.,Immunological factors Although the immune response is a normal protective mechanism, it ma

11、y cause diseases when the response is inappropriately strong (allergy or hypersensitivity) misdirected (autoimmune disease) deficient (immunodeficiency disease),Genetic factors Genetic aberrancies may be caused by single or polygenic mutations. they are transmitted by defective genes, such as sickle

12、 cell anemia, and colorblindness. Gene mutation Chromosomal aberration,Congenital factors The disorders result from abnormal embryonic development, and most of them are nongenetic. For example, congenital birth defects, mental or physical, may be due to a developmental error during pregnancy. The fe

13、tus is usually susceptible to not only infectious diseases but also diet and drug-taking of the mother during intrauterine life;,harelip,anencephalus,Social and psychological factors Strong or persistent psychological stimulation or stress may lead to mental illness and may be related to some diseas

14、es, such as hypertension, peptic ulcer, coronary heart disease, and depression.,(2) Conditions for disease,Precipitating factor: intensify the effects of causative factors and promote the onset and development of diseases, including natural, physical, and social conditions. Risk factor,(3) Predispos

15、ing factors of disease A predisposing factor refers to the factor that influences the susceptibility or resistance to certain disease. It includes the genetic constitution, physiological make up, as well as various psychological characteristics. Genetic predisposition,Summary Specific causes and pre

16、disposing factors together determines the disease occurrence; precipitating factors influence the onset and development of illness. Some diseases only have one cause. However, many diseases are multifactorial in origin, such as hypertension, atherosclerosis and diabetes, etc Environmental and geneti

17、c factors,Section 3. Pathogenesis 發(fā)病學(xué)研究病因作用于機(jī)體之后疾病發(fā)生發(fā)展一般規(guī)律的科學(xué)The general rules and common mechanisms underlying the development of diseases (1) The basic mechanisms of disease 基本機(jī)制(2) General rules of disease development 疾病發(fā)生的一般規(guī)律(3)Outcome of disease 轉(zhuǎn)歸,(1) The basic mechanisms of disease Although

18、various specific mechanisms may underlie different disorders,they all generally involve the following four levels of deregulations:neural, humoral, cellular and molecular mechanisms.,Neural mechanism Neural system plays a central role in regulating entire life activities; the disturbance occurred in

19、 neural system and in periphery organs are mutually affected. Encephalitis B virus can damage neural system directly; some poisons may interrupt the metabolism of neural cells and the production and release of neurotransmitters.,Humoral mechanism (humoral factors, cytokines) Humoral regulation is cr

20、ucial in maintaining internal homeostasis. Humoral dysfunction generally indicates the alterations in number and in activities of some humoral factors( hormones, chemical mediators, cytokines). They function through endocrine, paracrine, and autocrine to regulate the metabolism and activities of the

21、 cells .,Cellular and molecular mechanism Cellular and molecular damages or alterations are fundamental in the development of disease. Strong acid and alkali destroy the cells with no selection; hepatitis virus damages specifically the hepatocytes.,整體水平,細(xì)胞水平,分子水平,研究疾病時(shí)功能代謝結(jié)構(gòu)的變化及其發(fā)生機(jī)制,器官水平,Integrated

22、 medicine, Systems biology,(2) General rules of disease development The general rules for a disease to take place and develop疾病發(fā)展的一般規(guī)律 Disruption of homeostasis by pathological insults 穩(wěn)態(tài)失衡 Bodys responses to damages and anti-damage activities疾病過(guò)程中損傷與抗損傷反應(yīng) Reversal role of cause-consequence in the d

23、isease process疾病過(guò)程中的因果轉(zhuǎn)化 Relationship between systemic and local alterations局部與整體相互影響,Regulation and disruption of homeostasis Homeostasis: the process whereby the internal environment of an organism tends to remain balanced and stable, which is required for optimum functioning. e.g., maintenance of

24、 temperature homeostasis. Disruption of homeostasis by harmful agents may cause diseases. e.g., hyperthermia,Responses of damages and anti-damages Damages induce anti-damage responses, and the interactions go through the whole process of diseases and determines the development of diseases Overdo of

25、anti-damages cause new injures e.g. Burning injury (damage)- constriction of small blood vessels: maintaining proper blood pressure (anti-damage). However, sustained vasoconstriction-hypoxia, cellular necrosis, and dysfunction.,Alternation of cause and result in disease process A cause of a disease

26、leads to a result, which can be a new cause for another results in the development of the disease, even forming vicious cycle, e.g. hemorrhagic shock.,vicious cycle,virtuous cycle,所謂因果轉(zhuǎn)化是指在原始病因作用下機(jī)體發(fā)生的某種變化又轉(zhuǎn)化為新的病因，引起新的變化，如此交替不已，形成一個(gè)鏈?zhǔn)降陌l(fā)展過(guò)程。,Correlation between systemic and local regulations Local al

27、terations and the systemic statues can affect each other and disease development. e.g., a severe furuncle will not only cause local inflammation, but also lead to systemic reactions of fever and elevated leukocytes. On the other hand, a furuncle may be caused by diabetes and could only be cured by p

28、roper control of diabetes.,(3) Outcome of disease -complete recovery, incomplete recovery, death The outcome of a disease is determined by the fight between the evil forces and the defending forces, correct diagnosis and treatment.,疾病的發(fā)生發(fā)展是一個(gè)連續(xù)的不斷變化的過(guò)程，有其開(kāi)始與結(jié)局。某些疾病特別是一些急性傳染病在疾病過(guò)程中表現(xiàn)出明顯的階段性，認(rèn)識(shí)疾病發(fā)展的階段

29、性及其轉(zhuǎn)歸是十分必要的。,疾病的經(jīng)過(guò) 1.潛伏期 即致病因素作用于人體到出現(xiàn)最初癥狀前的時(shí)期，不同疾病潛伏期長(zhǎng)短不一。掌握疾病潛伏期有利于傳染病及早隔離和預(yù)防治療。有些疾病如創(chuàng)傷、燒傷無(wú)潛伏期。 2.前驅(qū)期 即從疾病出現(xiàn)最初癥狀起，到出現(xiàn)典型癥狀前的時(shí)期。此期雖有臨床癥狀，但程度較輕，且多數(shù)無(wú)特異性，容易誤診。臨床上應(yīng)仔細(xì)診斷，早期治療。 3.癥狀明顯期 即出現(xiàn)該疾病典型表現(xiàn)的時(shí)期，此期診斷雖易，但病情最為嚴(yán)重，應(yīng)積極治療。 4.轉(zhuǎn)歸期 是疾病過(guò)程的最后時(shí)期，轉(zhuǎn)歸取決于損傷和抗損傷雙方力量的對(duì)比和/或是否得到及時(shí)、恰當(dāng)?shù)闹委?，疾病的轉(zhuǎn)歸有康復(fù)和死亡兩種形式。 上述對(duì)疾病階段性的分期，是針對(duì)某些疾病特別是急性傳染病而言，但有些疾病的階段性表現(xiàn)不典型。,病因消除，癥狀消失，受損組織細(xì)胞的功能、代謝和形態(tài)結(jié)構(gòu)完全恢復(fù)正常,Incomplete recovery The main symptoms and signs disappear but some patholo