1. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 0

2. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 1 Chapter 1 Mechanisms of Disease, Diagnosis, and Treatment Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 1

3. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 2 Learning Objectives  Explain how a pathologic condition affects the homeostasis of the body.  Describe the difference between signs and symptoms of disease, acute and chronic disease, benign and malignant disease.  Identify the predisposing factors of disease.  Describe the ways in which pathogens may cause disease.

4. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 3 Learning Objectives (cont’d.)  Track the essential steps in diagnosis of disease.  List the prevention guidelines for cancer.  Explain the inflammation response to disease.  Describe the hospice concept of care.  Name two ways an individual can practice positive health behavior.

5. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 4 Learning Objectives (cont’d.)  Describe the physiology of pain, how pain may be treated, and what is meant by referred pain.  Define the holistic approach to medical care.  Describe examples of alternative medical therapies.  Discuss the principles and goals of patient teaching.

6. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 5 Chapter 1 Lesson 1.1

7. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 6 Pathology at First Glance Homeostasis: internal stability of the body Pathology: abnormal condition causing measurable changes in structure and function Pathogenesis: development of disease in stages

8. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 7 Pathology at First Glance (cont’d.) Systemic health: Internal equilibrium Disease state: Inability to adapt to internal/external stressors or challenges Syndrome: Defined collection of signs and symptoms that characterize a condition

9. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 8 Pathology at First Glance (cont’d.) Signs  Abnormal objective findings  Examples: redness, swelling, purulent discharge, fever Symptoms  Subjective patient reports  Examples: difficulty swallowing, pain, fatigue, headache

10. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 9 Pathology at First Glance (cont’d.) Acute Illness  onset is usually abrupt  symptoms present themselves over hours to days  duration brief (<6 months) Chronic Illness  onset is slower  symptoms persist from acute/subacute phases  duration indefinite (> 6 months)

11. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 10 Mechanisms of Disease Genetic Diseases Genetic mutations: changes in the genetic code that:  are passed from one generation to the next  may occur spontaneously  may be caused by agents that disrupt the normal DNA sequence

12. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 11 Mechanisms of Disease (cont’d.) Modes of Inheritance for Genetic Diseases Autosomal dominant: single abnormal gene on only one of a chromosome pair will cause disease Autosomal recessive: same abnormal gene present on both chromosomes of a pair X-linked (sex-linked) recessive: abnormal gene is only located on an X chromosome

13. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 12 Mechanisms of Disease (cont’d.)  Infection  Modes of transmission include:  Direct or indirect physical contact  Body fluids/blood  Inhalation  Ingestion  Insect/animal

14. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 13 Mechanisms of Disease (cont’d.)  Infection  Pathogenic agents include:  Bacteria  Viruses  Fungi  Protozoa

15. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 14 Mechanisms of Disease (cont’d.)  Infection  Body’s defense systems against infection:  natural mechanical and chemical barriers  inflammatory response  immune response

16. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 15 Mechanisms of Disease (cont’d.)  Inflammation and Repair  Acute inflammatory response is marked by:  Redness  Heat  Swelling  Pain  Loss of function

17. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 16 Mechanisms of Disease (cont’d.)  Inflammation and Repair  Acute inflammatory response can be inhibited by:  Immune disorders  Chronic illness  Medications, especially steroids

18. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 17 Mechanisms of Disease (cont’d.)  Cancer  A group of diseases characterized by uncontrolled cell proliferation or growth.  The uncontrolled growth proliferates at the expense of healthy cells and tissues.  The uncontrolled growth can develop into masses of abnormal cells or tumors.

19. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 18 Mechanisms of Disease (cont’d.)  Cancer  Benign tumors  develop slowly  can arise from any tissue  usually remain encapsulated (self-contained)  rarely recur after surgical removal

20. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 19 Mechanisms of Disease (cont’d.)  Cancer  Malignant tumors  cells multiply rapidly  do not usually resemble the tissue of origin  invade surrounding tissue  often recurrent  infiltrate to distant sites (metastasize)

21. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 20 Mechanisms of Disease (cont’d.)  Cancer risk factors  tobacco smoke (active and passive)  heavy use of alcohol  exposure to environmental carcinogens  high fat/low fiber diet  excessive exposure to sunlight/UV light  sedentary lifestyle  exposure to radiation/radon

22. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 21 Mechanisms of Disease (cont’d.)  Cancer screening guidelines  Men  PSA test (prostate-specific antigen)  Testicular self-exam  Women  Pap smear  Mammogram  Breast self-exam

23. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 22 Leading Sites of New Cancer Cases and Deaths - 2003 Estimates

24. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 23 Mechanisms of Disease (cont’d.)  Cancer Treatment  surgery  radiation  chemotherapy  hormone therapy  immunotherapy  Palliative surgery

25. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 24 Mechanisms of Disease (cont’d.)  Hospice Care  comfort and supportive care for the patient and family during the terminal stages of illness and into the bereavement period  emphasis on palliative treatment  neither hastens nor postpones death  considers dying as a normal process  provides physical, psychological, and spiritual support  may be home-based or in a facility with dedicated hospice services/beds

26. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 25 Mechanisms of Disease (cont’d.)  Predisposing Factors  age  gender  lifestyle  environment  heredity

27. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 26 Mechanisms of Disease (cont’d.)  Non-changeable predisposing factors  age  gender  heredity

28. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 27 Mechanisms of Disease (cont’d.)  Changeable predisposing factors  Lifestyle  physical abuse and violence  poor nutrition  tobacco, drugs, and alcohol  Environment  air and water pollution  chronic stress

29. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 28 Mechanisms of Disease (cont’d.)  Preventive health care  positive personal health behaviors:  modification of identified risk factors  prophylactic medical services  environmental and workplace safety

30. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 29 Mechanisms of Disease (cont’d.)  Immune disorders  hypersensitivity reaction (allergy)  autoimmune disease  immunodeficiency disorder

31. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 30 Mechanisms of Disease (cont’d.)  Hypersensitivity reaction  Exposure to allergen, which acts as antigen  Triggers release of histamine, etc.  Symptoms produced (mild to life- threatening)

32. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 31 Mechanisms of Allergic Reaction

33. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 32 Mechanisms of Disease (cont’d.)  Aging Process  metabolic changes (e.g., decreased liver & kidney function)  decreased total body water  changes in body composition (e.g., increased adipose tissue, decreased muscle mass)  decreased bone density

34. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 33 Chapter 1 Lesson 1.2

35. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 34 Mechanisms of Disease  Pain Physiology  stimulation of nociceptors found on free nerve endings  impulses travel through spinal cord to brain  usually signals injury or tissue damage  may travel a parallel pathway along spinal cord to brain, resulting in referred pain in another part of the body

36. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 35 Mechanisms of Disease (cont’d.)  Pain Medications  analgesics  opioids (narcotics)  non-steroidal anti-inflammatory drugs (NSAIDS)  antidepressants  anticonvulsants  antispasmodics

37. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 36 Mechanisms of Disease (cont’d.)  Psychological Pain  feelings of sadness, despair, anger, depression, helplessness, hopelessness  thought processes may be impaired  sleep patterns may be disrupted  may exhibit changes in personality  may cry or show signs of withdrawal

38. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 37 Mechanisms of Disease (cont’d.)  Diagnosis of Disease  medical history  physical exam  laboratory tests (blood count, chemistry, etc.)  imaging tests (MRI, CT, X-ray, ultrasound, etc.)  biopsy  miscellaneous tests (pulmonary function, cultures, etc.)

39. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 38 Mechanisms of Disease (cont’d.)  Holistic Medical Care  Focuses on the needs of the whole person  physical  spiritual  psychological  social  emotional  intellectual

40. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 39 Mechanisms of Disease (cont’d.)  Cultural Diversity  Individuality based on numerous differences  race  ethnicity  language  culture  religious beliefs  values/life experiences

41. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 40 Mechanisms of Disease (cont’d.)  Alternative Medicine  Therapies complementary to traditional medicine:  osteopathy  acupuncture and acupressure  massage and reflexology  relaxation therapy  herbal/nutritional supplements  chiropractic  hypnosis

42. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 41 Mechanisms of Disease (cont’d.)  Genetic Counseling  Communication process that revolves around the occurrence of or potential for a genetic disorder within a family  Genetic testing may be recommended  Test results, risks of disease development, and available treatment options discussed

43. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 42 Mechanisms of Disease (cont’d.)  Gene therapy  Experimental intervention repairs or blocks the expression of specific genes to treat disease.  The disease treated with gene therapy may be either inherited or acquired.

44. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 43 Patient Teaching  Goals of patient teaching  facilitate patient compliance with the medical treatment plan  clarify information and instructions  foster patient independence and responsibility  establish trusting, therapeutic relationship

45. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 44 Patient Teaching (cont’d.)  Additional reasons for patient teaching  ease anxiety  facilitate greater sense of patient control  improve patient/family coping  highlight goals for recovery or acceptance  reduce unnecessary clinic visits and hospitalizations