Chapter 1 Conspectus Of Disease

1．Concept of disease

2．Etiology of disease

3．Pathogenesis of disease

4．Outcome of disease

Chapter 2 Disorders Of Water And Electrolyte Metabolism

Body Fluid and Electrolyte Balance

1．Total fluid volume

2．Body fluid distribution

3．Body fluid composition

Osmolality of the Body Fluids

Mechanisms for Regulating Body Fluid and Electrolyte Balance

1．The sensation of thirst

2．Antidiuretic hormone

3．Aldosterone

4．The natriuretic peptide family

5．The guanylin family

Disorders of Water and Sodium Metabolism

1．Hyponatremia

2．Hypernatremia

3．Disorders of water and sodium metabolism with a normal serum sodium concentration

Hyponatremia

1．Hypovolemic hyponatremia

2．Hypervolemic hyponatremia

3．Normovolemic hyponatremia

Hypernatremia

1．Hypovolemic hypernatremia

2．Hypervolemic hypernatremia

3．Normovolemic hypernatremia

Isotonic Dehydration

Edema

1．Etiology and pathogenesis

2．Alterations of metabolism and function

Disorders of Potassium Metabolism

1．Potassium content and distribution

2．Maintenance of potassium balance

3．Potassium function

Hypokalemia

1．Etiology and pathogenesis

2．Alterations of metabolism and function

Hyperkalemia

1．Etiology and pathogenesis

2．Alterations of metabolism and function

Pathophysiological Basis of Prevention and Treatment

Disorders of Magnesium Metabolism

Hypomagnesemia

1．Etiology and pathogenesis

2．Alterations of metabolism and function

3．Principles of treatment

Hypermagnesemia

1．Etiology and pathogenesis

2．Alterations of metabolism and function

3． Pathophysiological basis of prevention and treatment

Disorders of Calcium and Phosphorus Metabolism

Function of Calcium and Phosphorus

Hypocalcemia

1．Etiology and pathogenesis

2．Alterations of metabolism and function

3．Pathophysiological basis of prevention and treatment

Hypercalcemia

1．Etiology and pathogenesis

2．Alterations of metabolism and function

3．Pathophysiological basis of prevent and treatment

Hypophosphatemia

1．Etiology and pathogenesis

2．Alterations of metabolism and function

3．Principles of treatment

Hyperphosphatemia

1．Etiology and pathogenesis

2．Alterations of metabolism and function

3．Principles of treatment

Case Presentation

Chapter 3 Acid-Base Balance And Disturbances

Acid-base Biochemistry

1．Generation of acids and bases

2．Henderson-Hasselbalch equation

Regulation of pH

1．Buffer systems

2．Respiratory regulation mechanisms

3．Renal regulation mechanisms

Laboratory Tests

1．PH

2．PaCO2

3．[HCO？]

4．Anion Gap(AG)

Simple Acid-base Disorders

1．Concept of simple acid-base disorders

2．Compensation for simple acid-base disorders

Metabolic Acidosis

1．Concept

2．Primary causes

3．Compensation

4．Alteration of metabolism and function

Respiratorv Acidosis

1．Concept

2．Primary causes

3．Compensation

4．Alteration of metabolism and function

Metabolic Alkalosis

1．Concept

2．Primary causes

3．Compensation

4．Alteration of metabolism and function

Respiratory Alkalosis

1．Concept

2．Primary causes

3．Compensation

4．Alteration of metabolism and function

Mixed Acid-Base Disorders

1．Metabolic alkalosis+Metabolic acidosis

2．Metabolic acidosis+Respiratory alkalosis

3．Metabolic acidosis+Respiratory acidosis

4．Metabolic alkalosis+Respiratory alkalosis

5．Metabolic alkalosis+Respiratory acidosis

6．Triple acid-base disorders

7．Judgment of acid-base disorders

Case Presentation

Chapter 4 Hypoxia

Parameters of Blood Oxygen

1．Partial pressure of oxygen(PO2)

2．Oxygen capacity(CO2max)

3．Oxygen content(CO2)

4．Oxygen saturation(SO2)

5．P50

Classification,Etiology and Pathogenesis of Hypoxia

1．Hypotonic hypoxia

2．Hemic hypoxia

3．Circulatory hypoxia

4．Histogenous hypoxia

Alterations of Function and Metabolism

1．Respiratory system

2．Circulatory system

3．Hemic system

4．Central nervous system

5．Cellular alterations

Factors Affecting the Tolerance to Hypoxia

1．Oxygen consumption rate

2．Compensatory ability of the body

Oxygen Therapy and Oxygen Intoxication

1．Pulmonary oxygen intoxication

2．Cerebral oxygen intoxication

Case Presentation

Chapter 5 Fever

Regulation of Normal Body Temperature

Etiology

1．Infectious factors

2．Non-infectious factors

Pathogenesis

1．Endogenous Pyrogens

Thermoregulation of Fever

1．Thermoregulating center

2．Routes of peripheral pyrogenic signals into thermoregulation center

3．Central mediators of fever

Alterations of Metabolism and Function

Pathophysiological Basis of Prevention and Treatment

Case Presentation

Chapter 6 Dysfunction Of Cell Signaling In Diseases

Major Pathways for Cell Signaling

1．G-protein-mediated cell signaling

2．Tyrosine kinase mediated signaling

3．Guanylyl cyclase(GC)mediated signaling

4．Intracellular and nuclear receptor signaling

Dysfunction of Cell Signaling in Diseases

1．Aberrant signal molecules in diseases

2．Aberrant receptors in diseases

3．Aberrant G-proteins in diseases

4．Aberrant intracellular signaling in diseases

5．Multiple signaling aberrations in diseases

6．Relationship between stimulants and pathological effects

Principles of Treatment

1．To regulate the level of extracellular molecules

2．To regulate the structure and the function of receptors

3．To regulate the level and modifications of intracellular messenger molecules and transducers

4．To regulate the level of nuclear transcription factors

Case Presentation

Chapter 7 Cell Proliferation,Differentiation,Apoptosis And The Related Diseases

Cell Proliferation and Diseases

1．Cell cycle and its control

2．Deregulation of cell proliferation and diseases

Cell Differentiation and Diseases

1．Control of cell differentiation

2．Differentiation and tumor

Cell Apoptosis and Diseases

1．Regulation of cell apoptosis

2．Abnormal cell apoptosis in diseases

Chapter 8 Stress And Stress-Related Diseases

Terminology of Stress

1．Stress

2．Stressor

3．General adaptation syndrome(GAS)

Neuroendocrine Responses

1．Locus Ceruleus-norepinephrine neurons-sympathetic/adrenal medulla axis

2．Hypothalamus-pituitary-adrenal cortex axis

3．Other hormones in stress

Cellular and Humoral Responses

1．Acute phase proteins

2．Heat shock proteins

Functional and Metabolic Responses

1．Central nervous system

2．Immune system

3．Cardiovascular system

4．Digestive system

5．Genito Urinary system

6．Metabolism

Stress-related Disease

1．Stress Ulcer

2．Stress and Cardiovascular Diseases

3．Stress and endocrine disorders

4．Stress and Psychosocial Disturbance

Pathophysiological Basis of Prevention and Treatment

Case Presentation

Chapter 9 Coagulation-Anticoagulation Balance And Imbalance of Haemostatic System

Overview of Haemostatic System

1．Vasospasm

2．Coagulation system

3．Anticoagulation System

4．Function of the fibrinolytic system

5．Role of endothelial cells

Imbalance in Haemostatic System

1．Bleeding Disorders

2．Thrombogenesis and thrombotic disorders

3．Blood vessel abnormity

4．Fibrinolytic factor abnormality

Disseminated Intravascular Coagulation

1．Etiology

2．Pathology

3．Pathogenesis

4．Factors influence the development of DIC

5．Clinical classification of DIC

6．Alterations of metabolism and function

7．Pathophysiological Basis of Prevention and Treatment

Case Presentation

Chapter 10 Shock

Etiology and Classification

1．Hypovolemic shock

2．Cardiogenic shock

3．Infectious shock

4．Anaphylactic shock

5．Neurogenic shock

Stages of Shock and Their Pathological Changes

1．Ischemic hypoxia stage

2．Stagnant hypoxia stage

3．Organic failure stage

Roles of Humoral Factors in Pathogenesis of Shock

1．Catecholamine and angiotensin

2．Cytokines

3．Adhesion molecules

4．Endothelium-derived vasoactive mediators

5．Activation of complement cascade

6．Lysosomal enzymes

7．Redox imbalance

Functional and Metabolic Changes

1．Neuroendocrine system

2．Cardiovascular system

3．Hematologic system

4．Immune system

5．Lung

6．Kidney

7．Gastrointestinal

8．Liver

9．Metabolic derangement

10．Cellular responses

Pathophysiological Basis of Prevention and Treatment for Shock

1．Volume replacement

2．Application of vasoactive drugs

3．Treatment on acidosis

4．Treatment of DIC or organic dysfunction(see related chapter)

5．Others

Multiple organ dysfunction syndrome

1．Systemic inflammatory response(SIRS)

2．Compensatory anti-inflammatory response syndrome(CARS)

3．Mixed antagonist response syndrome

Case Presentation

Chapter 11 Ischemia-Reperfusion Injury

Etiology of Ischemia-Reperfusion Injury

1．Duration of ischemia

2．Dependency on oxygen supply

3．The condition of reperfusion

Mechanisms of Ischemia-Reperfusion Injury

1．Injury of free radicals

2．Calcium overload

3．The endothelial injury and neutrophil activation

Alterations of Function and Metabolism during Ischemia-Reperfusion Injury

1．Myocardial ischemia-reperfusion injury

2．Cerebral ischemia-reperfusion injury

3．Hepatic ischemia-reperfusion injury

4．Renal ischemia-reperfusion injury

Pathophysiological Basis of Prevention and Treatment

1．Controlling reperfusion conditions

2．Antioxidants and free radical scavengers

3．Inhibitors of neutrophils activation

4．Calcium antagonists or calcium channel blocker

Case Presentation

Chapter 12 Heart Failure

Etiology and Classifications

1．Underlying causes

2．Precipitating factors

3．Classifications

Pathogenesis

1．Decreased myocardial contractility

2．Diastolic dysfunction

3．Asynergic myocardial contraction and relaxation

4．Endothelial dysfunction

Compensatory Responses

1．Cardiac compensation

2．Systemic compensation

3．Neurohormonal compensation

Alterations of Metabolism and Function

1．Congestion of pulmonary circulation

2．Congestion of systemic circulation

3．Low cardiac output

Principles of Treatment

1．General treatment

2．Improving cardiac functions

3．Reducing afterload and preload

4．Regression of ventricular hypertrophy

5．Controlling edema

Case Presentation

Chapter 13 Respiratory Failure

Etiology and Pathogenesis

1．Ventilatory disorder

2．Diffusion disorder

3．Ventilation and perfusion imbalance

4．Anatomic shunt

Alterations of Function and Metabolism

1．Acid-base imbalance and electrolyte imbalance

2．Respiratory system

3．Cardiovascular system

4．Central nervous system

Pathophysiological basis of Treatment

1．Treating the causes of respiratory failure

2．Increasing PaO2

3．Decreasing PaCO2

4．Treating the consequences of hypoxemia and hypercapnia,for example,the acidosis,heart failure etc．

Case Presentation

Chapter 14 Hepatic Failure

Etiology

Hepatic Insufficiency

1．Injury of Hepatocytes and Hepatic Dysfunction

2．Metabolic Disorders of Water and Electrolytes

3．Disorders in Production of Bile Salts and Elimination of Bilirubin Disorders

4．Hepatic Enteric Endotoxemia

Hepatic Encephalopathy

Etiology and Classification

Pathogenesis

1．Ammonia intoxication

2．False neurotransmitters and amino acid imbalance

3．The gamma-aminobutyric acid hypothesis

Precipitating Factors

Principles of Treatment

Hepatorenal Syndrome

Pathogenesis

1．Stimulated sympathetic nervous system

2．Activated renin-angiotensin-aldosterone system

3．Increased vasopressin release

4．Other humoral factors

Principles of Treatment and Prevention

Case Presentation

Chapter 15 Renal Failure

Basic Pathological Taches for Renal Failure

1．Dysfunction of glomerular filtration

2．Renal tubular dysfunction

3．Renal endocrine dysfunction

Acute Renal Failure

Etiology and Classification

1．Prerenal ARF

2．Intrarenal ARF

3．Postrenal ARF

Pathogenesis

1．Renal hemodynamic alterations

2．Renal glomerular injury

3．Renal tubular injury

4．Renal cell iniury and its mechanisms

Alterations of Metabolism and Function

1．The oliguric stage

2．The diuretic stage

3．The recovery stage

Pathophysiological Basis of Prevention and Treatment

Chronic Renal Failure

1．Etiology

2．Clinical courses

Pathogenesis

1．Mechanism of compensation

2．Mechanism of decompensation

Alterations of Metabolism and Function

1．Alteration of urine

2．Azotemia

3．Water,electrolytes and acid-base imbalance

4．Renal hypertension

5．Renal osteodystrophy

6．Tendency to hemorrhage

7．Renal Anemia

Uremia

1．Pathogenesis

2．Functional and Metabolic Alterations

Pathophysiological Basis of Prevention and Treatment

Case Presentation

Chapter 16 Brain Dysfunction

Introduction

1．Characteristics of brain structure,metabolism and function

2．Characteristics of brain diseases

Cognitive Disorders

1．Structural basis of cognition

2．Major manifestations of cognitive disorders

3．Etiology and pathogenesis

Principles for treatment of cognitive disorders

1．General neuroprotective treatments

2．Maintenance of normal neurotransmitter level

3．Surgery

Consciousness Disorder

1．The structural basis of the brain in consciousness and consciousness disorders

2．Major manifestations in consciousness disorders

3．The etiology and pathogenesis of consciousness disorder

4．Systemic disturbance caused by consciousness disorder

Principles of prevention and therapy

1．Urgent management

2．Making a definite diagnosis as soon as possible

3．Monitoring vital signs and consciousness state

4．Brain protections

Case Presentation