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

COURSE OUTLINE Matakuliah/Kode Subject/Code Pathophysiology / Patofisiologi SKS/ Paralel Credit/ Parallel 2 credits / A Jadwal Schedule Monday – Wednesday at GK1-406 Parallel A, (08.10 – 10.00) Dosen Teacher I Gede Purnawinadi, S.Kep., M.Kes.

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.

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.

Description of Student Grades Description of Grading Percentage Attendance 10 % Class Participation 5 % Assignment 15 % Unit Examination/Quizzes 20 % Mid-Semester Examination 25 % Final Examination TOTAL 100%

Textbook

Course Topics

Introduction to PATHOPHYSIOLOGY

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 penyakit atau dalam keadaan sakit atau abnormal. Dalam beberapa kasus tertentu, pemeriksaan patologis mutlak diperlukan sebagai dasar pembuatan patofisiologis penyakit.

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

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

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)

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.

Homeostasis Feedback loops utilize 3 components (2) positive feedback Definition = internal constancy or a stable internal environment A “body in balance” is in homeostasis Homeostatic regulation ---- works by using feedback loops 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

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.

Disease and Illness Homeostasis & disease Disease mechanisms 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)

Predisposing Factors (risk factors) 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

Preventive health care 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

The Cell & Disease Change in Type of Cell 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

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

Merupakan keadaan berkurangnya ukuran sel atau organ. 1. Atrofi Merupakan keadaan berkurangnya ukuran sel atau organ. Atrofi terjadi karena : Penurunan beban kerja sel  contoh : penggurangan massa dan tonus otot setelah tirah baring yang lama. Aliran darah yang tidak adekuat Malnutrisi Penurunan stimulasi hormonal dan saraf

Hipertrofi dibagi atas 3 macam, yaitu : Merupakan keadaan bertambahnya ukuran sel atau organ, yang berakibat membesarnya massa jaringan tanpa menambah jumlah sel. Hipertrofi dibagi atas 3 macam, yaitu : Hipertrofi fisiologik Hipertrofi kompensantorik Hipertrofi patologik

Hipertrofi fisiologik Peningkatan beban kerja yang bukan disebabkan oleh penyakit. Contoh : bertambahnya ukuran otot yang disebabkan oleh kerja fisik yang keras atau latihan beban.

Hipertrofi kompensantorik Terjadi ketika ukuran sel bertambah untuk mengambil alih sel-sel yang tidak berfungsi. Contoh : ginjal akan membesar kalau ginjal lain tidak berfungsi atau diangkat.

Hipertrofi patologik Merupakan respon terhadap penyakit. Contoh : pembesaran otot jantung karena jantung harus memompa lebih kuat utk melawan peningkatan resistensi pembuluh darah pada pasien hipertensi.

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

Pengantian tipe sel yang satu dengan tipe sel yang lain. 4. Metaplasia Pengantian tipe sel yang satu dengan tipe sel yang lain. Terdapat 2 macam metaplasia : Metaplasia fisiologik Metaplasia patologik

Metaplasia fisiologik Respon normal terhadap perubahan keadaan dan umumnya bersifat reversibel atau sementara. Contoh : respon tubuh yang normal terhadap inflamasi, monosit yang bermigrasi ke jaringan yang mengalami inflamasi akan berubah menjadi sel-sel makrofag.

Metaplasia patologik Perubahan akibat respon terhadap toksin dari luar atau stres dan umumnya bersifat ireversibel atau menetap. Contoh : pada perokok, sel epitel squamosa berlapis akan mengganti sel epitel kolumner bersilia pada saluran bronkus, walaupun sel-sel ini dapat bertahan lebih baik terhadap asap rokok tapi sel-sel ini tidak dapat mengeluarkan lendir untuk membersihkan jalan napas.

5. Displasia Diferensiasi abnormal sel-sel yang sedang membelah akan menghasilkan sel-sel dengan ukuran, bentuk, dan penampilan yg abnormal. Contoh : sel pada serviks dapat berubah menjadi tidak terkendali (kanker).

Cedera Sel Cedera pada sel dapat menimbulkan keadaan sakit karena sel kehilangan kemampuannya untuk beradaptasi. Cedera biasanya bersifat reversibel, atau dapat berlanjut menjadi permanen atau ireversibel.

Cedera sel dapat terjadi karena beberapa penyebab: Fisik  trauma, perubahan suhu, listrik, radiasi. Kimiawi  obat, racun, substansi toksik. Mikroorganisme  virus, bakteri, fungi, protozoa. Hipoksia  syok, hipoksemia. Defek genetik kelainan metabolisme malformasi Reaksi imunologis  reaksi hipersensivitas terhadap protein asing.

Kondisi berikut dpt menimbulkan cedera sel : Iskemia  kekurangan suplai darah pada area terlokalisasi, keadaan ini bersifat reversibel. Trombosis  pembentukan bekuan darah pada lapisan intima pembuluh darah. Embolisme  penyumbatan mendadak pembuluh arteri oleh bekuan darah atau benda asing. Infark  matinya sel-sel yang diperdarahi. Nekrosis  kematian jaringan.

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

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