PATHOPHYSIOLOGY

1. UNIVERSITAS KLABATAirmadidi, Manado 95371 - SULUT - INDONESIA ☎ (62) 431 891035 - ☏ (62) 431 891036 - ✉ mail@unklab.ac.id PATHOPHYSIOLOGY Faculty of Nursing

2. COURSE OUTLINE

3. Course Description Pathophysiology describes the mechanisms which lead from the primary cause via individual malfunctions to a clinical picture and its possible complications. Knowledge of these mechanisms serves patients when the task is to develop a suitable therapy, alleviate symptoms, and avert imminent resultant damage caused by the disease.

4. Course Methodology This will be demonstrated initially through introductory of the course outline and reading material including the textbook, and incorporated with class discussion as well as individual and group assignment. A dynamic and interesting class interactive will be incorporated, and a series of quizzes and examination will be administered to evaluate the effective of the course. Mid-semester and final exam will be applied as the core indicators of the well absorption of class lectures and materials from all students.

5. Description of Student Grades

6. Textbook

7. Course Topics

8. Introduction toPATHOPHYSIOLOGY

9. An understanding of pathophysiology requires a review of normal physiology — how the body functions day to day, minute to minute, at the levels of cells, tissues, organs, and organisms. • Patofisiologi  Ilmu yang mempelajari perubahan fisiologis yang diakibatkan oleh proses patologis. • Definisi patologis menurut KKBI (Kamus Besar Bahasa Indonesia)  Segala sesuatu yang berkenaan dengan ilmu tentang penyakitatau dalam keadaan sakit atau abnormal. • Dalam beberapa kasus tertentu, pemeriksaan patologis mutlak diperlukan sebagai dasar pembuatan patofisiologis penyakit.

10. Terms Used In Pathophysiology • Pathology = study of disease • Pathogenesis = the development of a disease • Diseases develops in stages • Infectious disease example: (A)incubation (b)disease (c)convalescence • Pathophysiology = the study of the functional changes associated with a specific disease • How the disease affects specific functions of the body • Subjective findings • The patient’s symptoms • Described by the patient----(the patient’s history) • Objective findings • Health provider’s findings---( the physical exam) • Occurrence of disease defined by 2 factors • Incidence = # new cases per unit of time • Prevalence = # new & old cases per unit of time

11. Disease terminology • Etiology = cause of the disease • Idiopathic = disease with unknown cause • Iatrogenic = disease caused by human intervention • Congenital diseases = diseases occurring at birth • Syndrome = common cause of different signs & symptoms • Remission = period when symptoms & signs of disease abates • Exacerbation = period when symptoms & signs increase • Endemic disease = disease native to local area • Epidemic = many people affected in a given area • Pandemic = many people affected in large areas • Incubation = latent period of the disease before develop signs & symptoms • Prognosis = probability for recovery • Morbidity = disease rates within a group • Mortality = death rates within a group • Epidemiology = how the disease occurs & spreads through an area

12. FUNDAMENTALS OF PATHOPHYSIOLOGY Homeostasis(Maintaining balance) Disease and illness (Cause, Development, Stages, Stress, and disease) Cell physiology (Cell components, Cell division, Cell functions, Cell types) Pathophysiologic changes (Cell adaptation, Cell injury, Cell degeneration, Cell aging, Cell death)

13. Homeostasis Every cell in the body is involved in maintaining a dynamic, steady state of internal balance, called homeostasis. Any change or damage at the cellular level can affect the entire body. When homeostasis is disrupted by an external stressor — such as injury, lack of nutrients, or invasion by parasites or other organisms— illness may occur. Many external stressors affect the body's internal equilibrium throughout the course of a person's lifetime. Pathophysiology can be considered as what happens when normal defenses fail.

14. Homeostasis • Feedback loops utilize 3 components • (1) receptor (2) control center (3) effector • 2 types of feedback loops • (1) negative feedback • Restores any change back to normal • Resembles “teeter-totter” • Stabilizing • Most common • (2) positive feedback • Exaggerates the change • Resembles “domino effect” • Stimulating • Least common • Definition = internal constancyor astable internal environment • A “body in balance” is in homeostasis • Homeostatic regulation ---- works by using feedback loops

16. MAINTAINING BALANCE Three structures in the brain are responsible for maintaining homeostasis of the entire body: medulla oblongata, which is the part of the brain stem associated with vital functions such as respiration and circulation. pituitary gland, which regulates the function of other glands and, a person's growth, maturation, and reproduction. reticular formation, a network of nerve cells (nuclei) and fibers in the brain stem and spinal cord that help control vital reflexes such as cardiovascular function and respiration.

17. Disease and Illness Homeostasis & disease • Disease is the failure to maintain homeostatic conditions Disease mechanisms • Genetic = mutated or abnormal genes • Pathogens (microscopic organisms) • Loss of control mechanisms (e. G. Diabetes, immune problems) • Degenerative changes (normal aging) • Environmental hazards (trauma, chemicals) • Nutritional factors • Tumors (benign & malignant)

18. Predisposing Factors (riskfactors) • Age • Young are prone to accidents • Getting diseases such as diabetes, heart disease, and certain cancers increase with age • Very old are prone to drug interactions • Sex • More frequent in woman: MS, osteoporosis • More frequent in men: gout, Parkinson’s disease • Lifestyle • Examples of harmful lifestyle: • Perilous occupation • Smoking • Excess alcohol • Poor nutrition • Sedentary activity

19. Environment • Air pollution • Water pollution • Poor living conditions • Excessive noise • Chronic psychological stress • Heredity • Deals with genetic predisposition (inheritance) • Genetic predisposition + certain type of environment = mental retardation , lung cancer, etc. • Preventive health care • The best treatment of a disease is prevention !! • Deals with altering risk factors that can be changed

20. The Cell & Disease Changes in Growth • Changes in size of individual cell • Atrophy = decrease in cell size • Hypertrophy = increase in cell size • Changes in actual number of cells • Hyperplasia, Dysplasia, & Anaplasia = increase in rate of reproduction • Hyperplasia = increase in number of normal cells • Dysplasia = increase in number of atypical cells • Anaplasia = increase in number of frankly abnormal cells Change in Type of Cell • Change of one type of cell into another type (metamorphoses) • Metaplasia =change to different mature cell type

22. Cell damage is the main reason to lose homeostasis • Deficiency of oxygen (hypoxia) = most common reason • Mechanism of progression: ischemia -to- necrosis -to- gangrene • Cell death • Once it occurs, lysis occurs with release of lysosomal enzymes • This causes inflammation • After inflammation, the dead cells(tissue) is either: • Replaced by scar tissue • Regenerated to resemble original tissue

23. 1. Atrofi • Merupakankeadaanberkurangnyaukuranselatau organ. • Atrofi terjadikarena : • Penurunanbebankerjasel  contoh: pengguranganmassadan tonus otot setelah tirah baring yang lama. • Alirandarah yang tidak adekuat • Malnutrisi • Penurunanstimulasi hormonal dansaraf

25. 2. Hipertrofi • Merupakankeadaanbertambahnyaukuranselatau organ, yang berakibatmembesarnyamassajaringantanpamenambahjumlahsel. • Hipertrofidibagiatas 3 macam, yaitu : • Hipertrofifisiologik • Hipertrofikompensantorik • Hipertrofipatologik

26. Hipertrofifisiologik • Peningkatanbebankerjayangbukandisebabkanolehpenyakit. • Contoh : bertambahnyaukuranotot yang disebabkanolehkerjafisik yang kerasataulatihanbeban.

28. Hipertrofikompensantorik • Terjadiketikaukuranselbertambah untuk mengambilalihsel-sel yang tidak berfungsi. • Contoh : ginjalakanmembesar kalauginjal lain tidak berfungsiataudiangkat.

30. Hipertrofipatologik • Merupakanresponterhadap penyakit. • Contoh : pembesaranototjantung karenajantungharusmemompalebihkuatutkmelawanpeningkatanresistensipembuluhdarah padapasienhipertensi.

32. 3. Hiperplasia Meningkatnya jumlah sel sehingga merubah ukuran dari organ. Contoh : pembesaran dari epithelium sel mammae pada anak remaja putri atau pada ibu hamil.

34. 4. Metaplasia • Pengantiantipesel yang satu dengan tipesel yanglain. • Terdapat 2 macam metaplasia : • Metaplasiafisiologik • Metaplasiapatologik

35. Metaplasiafisiologik • Respon normal terhadap perubahankeadaandanumumnyabersifatreversibel atau sementara. • Contoh : respontubuh yang normal terhadap inflamasi, monosit yang bermigrasikejaringan yang mengalamiinflamasiakanberubah menjadisel-selmakrofag.

37. Metaplasiapatologik • Perubahan akibat responterhadap toksindariluarataustresdanumumnyabersifatireversibel atau menetap. • Contoh : pada perokok, selepitelsquamosaberlapisakanmenggantiselepitelkolumnerbersiliapadasaluranbronkus, walaupunsel-selini dapat bertahanlebihbaikterhadap asaprokoktapisel-selini tidak dapat mengeluarkanlendir untuk membersihkan jalan napas.

39. 5. Displasia • Diferensiasi abnormal sel-sel yangsedangmembelahakanmenghasilkansel-sel dengan ukuran, bentuk, danpenampilanyg abnormal. • Contoh : sel padaserviks dapat berubah menjadi tidakterkendali (kanker).

41. CederaSel • Cederapada sel dapat menimbulkankeadaansakitkarenaselkehilangankemampuannya untuk beradaptasi. • Cederabiasanyabersifatreversibel, atau dapat berlanjut menjadi permanen atauireversibel.

42. Cederasel dapat terjadi karena beberapapenyebab: • Fisik trauma, perubahansuhu, listrik, radiasi. • Kimiawi obat, racun,substansitoksik. • Mikroorganisme virus, bakteri, fungi, protozoa. • Hipoksia syok, hipoksemia. • Defekgenetikkelainanmetabolismemalformasi • Reaksiimunologisreaksihipersensivitasterhadap protein asing.

43. Kondisiberikutdptmenimbulkancederasel : • Iskemiakekurangansuplaidarah pada area terlokalisasi, keadaaninibersifatreversibel. • Trombosispembentukanbekuandarah padalapisanintimapembuluhdarah. • Embolismepenyumbatanmendadakpembuluharteriolehbekuandarah ataubendaasing. • Infarkmatinyasel-sel yang diperdarahi. • Nekrosiskematianjaringan.

45. Diagnosis & Treatment • “SOAP” protocol: “S” = subjective “O” = objective “A” = assessment “P” = plan • Subjective Findings = the patient’s symptoms • Obtained by taking a medical history • includes: • Chief complaint (cc) • present illness (PI) • past history (PH) ------- med/ surg/ allergies/ lifestyles • family history (FH) • Objective Findings = the patient’s physical manifestations • Obtained by doing a physical exam • Then vita signs ------ T, P, BP, RR, Pain • go from head to toes! • Includes techniques of: • inspection • auscultation • palpation • percussion

46. Assessment = arriving at a diagnosis • Differential diagnoses • Includes all possibilities • Lab • Basically a study of body fluids • Diagnostic tests • Imaging • X-ray, US, CAT, MRI, isotope scans • Endoscopies • Biopsies • Skin tests • Plan = all possible treatments with associated complications & prognoses • Includes a “Treatment Plan” • individualize • modalities available: • do nothing (primun non nocere) • Talk (counseling) • Medication • Surgery • Includes a Prognosis