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The Disease Process

Chapter 1

Disease Defined

Any deviation of a homeostatic state!!

Homeostasis = state of stability

Diagnosis - DX

Determination of the nature of the disease

History (HX)

Physical Exam (PE)

Signs & symptoms

Laboratory tests

Medical imaging (CT scan, MRI, ultrasound)

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Manifestations of Disease

Signs – observed objective evidence of 

diseaseSymptoms – subjective indications of 

disease

Syndrome – combined set of signs &

symptoms occurring concurrently.

Mechanisms That Play a Role in Disease

Predisposing factors

Hereditary

Infections

Inflammation & repair 

Trauma

Effects of physical/chemical agents

Neoplasia/Cancer 

Immune Factors

Psychological Factors

Nutrition

Predisposing Factors

Age

Sex

Hereditary

Environment

Lifestyle

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Hereditary Diseases

Chromosomes – 23 pairs

Gene – basic unit of heredityHomozygous – identical genes from each

parent

Heterozygous – different genes from eachparent

Phenotype – observable physicalcharacteristic

Genotype – actual genetic makeup.

Classification of Hereditary Diseases

Medelian Disorders

Diabetes insipidus, Retinoblastoma

Cystic fibrosis, PKU, Sickle Cell Anemia

Hemophilia, Duchenne-type muscular dystrophy

x-linked

Chromosomal Disorders

Down syndrome

Multifactorial Disorders

Diabetes mellitus

Congenital heart

Body’s Natural Defense Systems

Natural mechanical & Chemical BarriersSkin, cilia, body pH, normal body flora

Inflammatory Response

White blood cells (neutrophils, macrophages)Phagocytosis

NK Cells (natural killer cells)

Immune responseHumoral Immunity

Cellular Immunity

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Agents capable of causing an

inflammatory response.

Process of Inflammation

Infection

Invasion and multiplication of pathogenicorganisms

Microorganisms

BacteriaFungi

Protozoa

Parasites

Rickettsiae

Virus

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Trauma

Leading cause of death in persons < 35 yrs

Trauma can be:Head trauma

Chest trauma

Abdominopelvic trauma

Neck & Spine

Extremities

Physical & Chemical Agents

Extreme heat & cold

Ionizing radiation

Extremes of atmospheric pressure

Electric shock

Poisoning

Near-drowning

Bites of insects, spiders, & snakes

Asphyxiation

Burns

Cellular Changes to Long Term

Irritants

Atrophy – decrease in cell size

Hypertrophy – increase in cell size

Hyperplasia – increase in # of cells

Metaplasia – changes to another cell type

Dysplasia – alteration in size & shape

Neoplasia – uncontrolled growth pattern

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Neoplasm & Cancer 

Neoplasm – means new growth

Tumor & neoplasm – the sameTumor/neoplasm can be either benign or 

malignant

Benign vs Malignant

Benign-does not invade surrounding tissue

or spread to distant sites

Malignant – infiltrates and destroys

surrounding tissues; may spread through

lymph system to other organsMetastasis

Immune Response

Humoral – B-cell lymphocytesActivated by antigens

B cells converted to plasma cells

Plasma cells produce immunoglobulins (antibodies)

Antibodys binds to antigen (Ag/Ab complex)

System removes the complex

Cellular – T-cell lymphocytesCytotoxic T lymphocytes – binds & kills directly

Helper T lymphocytes – helps in all phases of response

Suppressor T lymphocytes – controls immune systemhomeostasis

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Cell-mediated immunity, versus

humoral immunity

Immunologic Diseases

Allergy

Autoimmunity

Immunodeficiency

Allergy

Urticaria

Wheals, hives

Anaphylaxis

Chills, fever, pain, nausea, & vomitingAnaphylactic shock – life-threatening

Edema, stridor, dyspnea, incontinence

Hypersensitive reactions

Pruritus, flu like symptoms, erythema

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Autoimmunity

Recognizes non-self 

Produces antibodies to own tissueAntibodies attacks own organ systems

Gastrointestinal

Cardiovascular 

Endocrine

Musculoskeletal

Dermatologic

Immunodeficiency

B-cell & T-cell deficiency

Acquired Immunodeficiency syndrome (AIDS)

Lymphadenopathy

Hodgkin’s & other lymphomas

Immunocompromised

due to chemotherapy & irradiation.

Nutritional Imbalance

Malnourishment

Vitamin Deficiencies & Excesses

Mineral Deficiencies & Excesses

Obesity

Starvation

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Idiopathic & Iatrogenic Diseases

Idiopathic – no know cause

Iatrogenic – caused by treatmentNosocomial – acquired while in a hospital

Essential Steps to Diagnosis

Individual seeks medical Attention

HX

•Risk Factors

•Drug allergies

•Present therapy

•Onset of symptoms

PE

•Inspection

•Auscultation

•Palpation

•Percussion

DX Studies

•Laboratory Studies

•Radiographic studies

•Body Scans

•Endoscopy•Ultrasonography

Compare with normal findings

Integrate & Interpret

Formulate diagnosis, treatment plan, prognosis, & prevention