病理生理学 英文改编版PDF电子书下载

Chapter 1 Conspectus of Disease 1

Concept of Disease 1

Etiology of Disease 1

Pathogenesis of Disease 3

Outcome of Disease 4

Chapter 2 Water and Electrolytes Balance and Imbalance 6

Water and Sodiun Balance and Imbalance 6

Water and Sodium Balance 6

Total Fluid Volume and Distribution 6

Body Fluid Composition 7

Osmolality of the Body Fluids 8

Water Balance 8

Mechanisms for Regulation of Body Fluid and Electrolyte Balance 9

Disorders of Sodium and Water Metabolism 11

Hyponatremia 11

Hypernatremia 13

Isotonic Dehydration 14

Edema 15

Disorder of Potassium Metabolism 16

Normal Potassium Metabolism 16

Internal Potassium Distribution 16

Regulation of Potassium Homeostasis 17

Physiological Function of Potassium 19

Disorders of Potassium Metabolism 20

Hypokalemia and Potassium Deficiency 20

Hyperkalemia 24

Disturbances of Magnesium Metabolism 26

Normal Metabolism and Function of Mag-nesium 26

Intake and Excretion 26

Regulation of Magnesium Balance 27

Distribution and Content of Magnesium 27

Function of Magnesium 27

Hypomagnesemia 27

Definition 27

Etiology and Pathogenesis 27

Alterations of Metabolism and Function 28

Pathophysiology Basis of Prevention and Treatment 29

Hypermagnesemia 29

Definition 29

Etiology and Pathogenesis 29

AIterations of Metabolism and Function 29

Pathophysiology Basis of Prevention and Treatment 30

Disorders of Calcium and Phosphorus Meta-bolism 30

Calcium and Phosphorus Homeostasis 30

Calcium and Phosphorus Intake and Excre-tion 30

Content and Distribution of Calcium and Phosphorus within the Body 31

Regulation of Internal Calcium and Pho-sphorus Balance 31

Regulation of Intracellular Calcium and Phosphorus Balance 33

Function of Calcium and Phosphorus 34

Hypocalcemia 34

Definition 34

Etiology and Pathogenesis 35

Alteration of Metabolism and Function 35

Pathophysiological Basis of Prevention and Treatment 36

Hypercalcemia 36

Definition 36

Etiology and Pathogenesis 36

Alteration of Metabolism and Function 37

Pathophysiological Basis of Prevention and Treatment 37

Hypophosphaternia 37

Definition 37

Etiology and Pathogenesis 37

Alteration of Metabolism and Function 38

Pathophysiological Basis of Prevention and Treatment 38

Hyperphosphatemia 38

Definition 38

Etiology and Pathogenesis 38

Alteration of Metabolism and Function 38

Pathophysiological Basis of Prevention and Treatment 38

Case Presentation 38

Chapter 3 Acid-Base Balance and Imba-lance 40

Normal Acid-Base Balance 40

Concepts of Acid and Base 40

Sources of Acids and Bases 40

Sources of Acids 40

Sources of Bases 41

Regulation of Acid-Base Balance 42

Buffer Systems 42

Respiratory Regulation of Acid-Base Bala-nce 43

Reral Regulation of Acid-Base Palance 43

Parameters of Acid-Base Balance 45

pH 45

PaCO2 45

Standard Bicarbonate and Actual Bicarbo-nate 46

Buffer Base 46

Base Excess 46

Anion Gap 46

Simple Acid-Base Disturbance 46

Metabolic Acidosis 47

Etiology 47

Classification 47

Compensation 48

Changes of Acid-Base Parameters and Electrolytes 48

Alterations of Metabolism and Function 48

Principles of Prevention and Treatment 49

Respiratory Acidosis 49

Etiology 49

Compensation 49

Changes of Acid-Base Parameters and Electrolytes 50

Alterations of Metabolism and Function 50

Principles of Prevention and Treatment 50

Metabolic Alkalsosis 50

Etiology 50

Classification 51

Compensation 51

Changes of Acid-Base Parameters and Electrolytes 51

A1terations of Metabolism and Function 51

Principles of Prevention and Treatment 51

Respiratory Alkalosis 52

Etiology 52

Classification and Compensation 52

Changes of Acid-Base Parameters 52

Alterations of Metabolism and Function 52

Principles of Prevention and Treatment 52

Mixed Acid-Base Disturbances 52

Double Acid-Base Disturbances 53

Respiratory Acidosis and Metabolic Aci-dosis 53

Respiratory Alkalosis and Metabolic Alka-losis 53

Respiratory Acidosis and Metabolic Alka-losis 53

Metabolic Acidosis and Respiratory Alka-losis 53

High AG Metabolic Acidosis and Meta-bolic Alkalosis 53

Triple Acid-Base Disturbances 53

Respiratory Acidosis and High AG Meta-bolic Acidosis and Metabolic Alkalosis 53

Respiratory Alkalosis and High AG Meta-bolic Acidosis and Metabolic Alkalosis 54

Guidelines for the Diagnosis of Acid-Base Disturbances 54

Diagnosis of Simple Acid-Base Disturbances 54

Diagnosis of Mixed Acid-Base Disturbances 54

Differentiate Between Simple and Mixed Acid-base Disturbance According to Compensatory Formulas 54

Changes of PaCO2 and HCO3￣in Opposite Directions 55

Calculation of AG value is important for the difierentiation of the classes of simple metabolic acidosis and the diagnosis of mixed acid-base disorders 55

Case Presentation 55

Chapter 4 Fever 57

Etiology 58

Exogenous Pyrogens 58

Non-microbial Pyretic Substances 58

Pathogenesis 58

Endogenous Pyrogens 58

EP and the Thermoregulatory Center 59

Central Mediators of Fever 60

Stages and Manifestations 62

The Fervescence Stage 62

The Persistent Febrile Stage 62

The Defervescence Stage 62

Alterations of Metabolism and Function 62

Metabolism 63

Central nervous System 63

Cardiovascular System 64

Respiratory System 64

Digestive System 64

Self-defense 64

Pathophysiological Bosis of Prevention and Treatment 64

Case Presentation 65

Chapter 5 Stress 66

Etiology and Pathogenesis 66

Stressor 66

The Stress Response 67

Alterations of Metabolism and Function 71

Stress and Disease 72

General Adaptation Syndrome(GAS) 73

Stress Ulcer 73

Cardiovascular Diseases 73

Immune Dysfunctions 74

Posttraumatic Stress Disorder 74

Basic Principle of Prevention and Treatment for Stress Disorders 75

Case Presentation 75

Chapter 6 Hypoxia 76

Parameters of Blood Oxygen 76

Partial Pressure of Oxygen 76

Oxygen Binding Capacity of Haemoglobin 76

Oxygen Content in Blood 76

Oxygen Saturation of Haemoglobin 76

Classification,Etiology and Mechanisms of Hypoxia 77

Hypotonic Hypoxia 77

Etiology and Mechanisms of Hypotonic Hypoxia 77

Characteristics of Blood O2 77

Hemic Hypoxia 77

Etiology and Mechanisms of Hemic Hypoxia 77

Characteristics of Blood O2 78

Circulatory Hypoxia 78

Etiology and Mechanisms of Circulatory Hypoxia 78

Characteristic of Blood Oxygen 78

Histogenous Hypoxia 78

Etiology and Mechanisms of Histogenous Hypoxia 79

Characteristics of Blood O2 79

Alterations of Metabolism and Function in the Body 79

Alterations of Respiratory System 79

Compensatory Response 79

Injury Manifestation 80

Alterations of Circulatory System 80

Compensatory Response 80

lnjury Manifestation 81

Alterations of Hematologic System 81

Compensatory Response 81

Injury Manifestation 81

Alterations of Central Nerve System 81

Alterations of Tissues and Cells 82

Compensatory Response 82

Injured Manifestation 82

Pathophysiological Basis of Prevention and Treatment 83

Case Presentation 83

Chapter 7 Shock 84

Etiology and Classification of Shock 84

Classification According to Causes 84

Classification According to the Pathogene-sis of Shock Development 84

Pathogenesis of Shock 84

Microcirculatory Mechanisms 85

Ischemic Hypoxia Stage(Compensatory Stage) 85

Stagnant Hypoxia Stage(Reversible Decompensated Stage) 87

Refractory Stage(Microcirculatory Fai-lure Stage) 89

Cellular and Molecular Mechanisms 90

Alterations of Cellular Metabolism 90

Cell Injury and Apoptosis 91

Humoral Factors 91

Inflammatory Mediator and Inappropriate Inflammatory Response 92

Alterations of Metabolism and Function 93

Metabolic Derangement 93

Water,Electrolytes and Acid-Base Distur-bance 93

Organ Dysfunction 93

Features of Several Common Types of Shock 94

Hypovolemic Shock 94

Septic Shock 94

Anaphylactic Shock 94

Neurogenic Shock 94

Cardiogenic Shock 95

Pathophysiologic Basis of Prevention and Treatment 95

Improve Microcirculation 95

Blockage of Humoral Factors 95

Cell Protection 96

Organ Protection 96

Case Presentation 96

Chapter 8 Disturbances of Hemostasis 97

Coagulation Cascade and its Regulation 97

Coagulation System and its Functions 97

Extrinsic Coagulation Pathway 98

Intrinsic Coagulation Pathway 98

Roles of Platelet in Coagulation 99

Adhesion and Conformational Change of Platelets 99

Release Reaction of Platelets 99

Platelet Aggregation Follows Adhesion and Secretion 101

Anticoagulant Systems 101

Actions of Serine Protease Inhibitors and Heparin 101

Thrombomodulin-protein C System 101

Tissue Factor Pathway Inhibitor 102

Fibrinolytic System and its Function 102

Endothelial Cells Modulate Several Aspects of Normal Hemostasis 102

Coagulation and Anti-coagulation Disorders 104

Bleeding Caused by Coagulation Factor Disorders 104

Hereditary Coagulation Factor Disorders 104

Acquired Coagulation Factor Disorders 106

Hypercoagulable Status 106

Hereditary Risk Factors For Thrombosis(Hereditary Thrombosis-Related Coagulation Factor Disorders) 106

Acquired Risk Factors for Thrombosis-Secondary Hypercoagulable Status 109

Atrophy 110

P1asma Fibrinolysis Abnormalities 110

Bleeding-related Fibrinolysis Abnorma-lities—α2-Antiplasmin Deficiency 110

Thrombosis-related Fibrinolysis Abnor-malities 110

Platelet Disorders 110

Thrombocytopenia 110

Thrombocytosis 111

Qualitative Platelet Disorders 111

Vessel Wall Disorders 112

Disseminated Intravascular Coagulation(DIC) 112

Etiologies and Mechanisms of DIC 113

Extensive Tissue Injuries 113

Damage of Vascular Endothelial Cells 113

Destruction of Blood Cells and Activa-tion of Platelets 115

Pro-coagulants Entering Circulation 115

Factors Influencing the Formation and Development of DIC 116

Inappropriately Conditioned Monocytes-Macrophages 117

Impairment of Liver and Spleen Functions 117

Hypercoagulable Status 117

Dysfunction of Microcirculation 118

Clinical Classifications 118

Classification According to The Clinical Course 118

Classification According to the Compensatory Level 119

Alterations of Metabolism and Function 119

Bleeding 120

Organ Dysfunctions 121

Shock 122

Microangiopathic Hemolytic Anemia 122

Pathophysiological Basis of Prevention and Treatment of DIC 123

Reversing the Underlying Disorders Initiating DIC 123

Improving the Microcirculation 123

Reconstructing the Balance Among Coagulation,Anti-coagulation and Fibrinolysis 123

Case Presentation 123

Chapter 9 Ischemia-Reperfusion Injury 126

Etiology 126

Duration of Ischemia 126

Collateral Circulation 126

Dependency on Oxygen Supply 126

Condition of Reperfusion 126

Pathogenesis 126

Free Radicals 127

Calcium Overload 128

Neutrophils Activation 128

Alterations of Metabolism and Function 129

Myocardial Ischemia-repeffusion Injury 129

Cerebral Ischemia-repeffusion Injury 130

Ischemia-reperfusion Injury in Other Organs 130

Pathophysiological Basis of Prevention and Treatment 130

Control the Reperfusion Conditions 130

Scavenge the Free Radicals 131

Relieve Calcium Overload 131

Improve the Metabolism 131

Case Presentation 131

Chapter 10 Signal Transduction and the Related Disorders 133

General Concept 133

Signal Transduction 133

Transmembrane Signal Transduction 133

Key Elements of Signal Transduction 133

Relationship Between Stimulants and Pa-thological Effects 133

Major Pathways for Cell Signaling 134

G-Protein-Mediated Cell Signaling 134

Tyrosine Protein Kinase Mediated Signa-ling 134

Intracellular Receptor Signaling 135

Dysfunction of Cell Signaling in Diseases 135

Aberrant Receptors in Diseases 136

Aberrant G-Proteins in Diseases 137

Aberrant Intracellular Signal Molecules in Diseases 137

Multiple Signaling Aberrations in Diseases 139

Pathophysiologic Basis of Prevention and Treatment of Diseases 141

To Regulate the Level of Extracellular Molecules 141

To Regulate the Structure and the Func-tion of Receptors 141

To Regulate the Level and Modifications of Intracellular Messenger Molecules and Transducers 142

To Regulate the Level of Nuclear Trans-cription Factors 142

Case Presentation 142

Chapter 11 Abnormal Cell Proliferation,Differenfiation and Related Diseases 144

Deregulated Cell Proliferation and Diseases 144

Concept and Phases of the Cell Cycle 144

Regulation of the Cell Cycle 145

Regulation of the Cell Cycle by Intracell-ular Signals 146

Regulation of the Cell Cycle by Extracell-ular Signals 147

Role of Abnormal Cell Cycle in the Path-ogenesis of Disease 148

Overexpression of Cyclins 148

Increased Activation of Cdks and Muta-tion of their Substrates 148

Deficient Expression and Mutation of Ckis 149

The Impairment of Checkpoint System 149

Deregulated Cell Differentiation and Diseases 149

Regulation of Cell Differentiation 150

The Regulation on the Genomic Level 150

Regulation on Transcription and Post-transcription Levels 150

Extracellular Factors that Control Diif-erentiation 151

The Role of Abnormal Cell Differentiationin the Pathogenesis of Diseases 151

Chapter 12 Apoptosis and Related Dis-eases 154

Introduction 154

Features of Apoptotic Cells 154

Phases of Apoptosis 155

Influence Factors of Apoptosis 155

Biochemical Mechanism of Apoptosis 156

A Central Role for Caspases in Apoptosis 156

Apoptosis Pathways 157

Regulated Mechanism of Apoptosis 159

Regulation of the Extrinsic Pathway 159

Bcl-2 Family Proteins and Regulation of Apoptosis 160

Regulation of Apoptosis by IAP Family Members 161

p53 161

Apoptosis and Diseases 161

Regulation of Apoptosis in Treatment of Disease 165

Chapter 13 Heart Failure 166

Fundamental Knowledge 166

Histology of Myocardium 166

Physiology of the Whole Heart 167

Cellular Physiology of Ventricular and Atrial Myocytes 168

Biochemical Metabolic Particularity of Myocardium 169

Etiology 169

Classification 170

Right-Side Versus left-side Heart Failure 170

Acute Versus Chronic Heart Failure 170

Low-output Versus High-Output Heart Failure 171

Compensatory Responses 171

Cardiac Compensation 171

Systemic Compensation 172

Pathogenesis 173

Decreased Myocardial Contractility 174

Diastolic Dvsfunction 176

Altered Signal Transduction 176

Excessive Cardiac Hypertrophy 176

Clinical Manifestations 177

Left Heart Failure 177

Right Ventricular Failure 179

Pathophysiologic Basis of Prevention and Treatment 179

Etiologic Therapy 179

Avoiding Precipitating Factors 179

Improving Cardiac Functions 180

Reducing Afterload and Preload 180

Controlling Edema 180

Case Presentation 180

Chapter 14 Respiratory Failure 182

Etiology and Classification 182

Etiology 182

Classification 182

Pathogenesis 183

Ventilation Disorder 183

Gas-exchanging Dysfunction 186

Alterations of Metabolism and Function 190

Acid-Base Imbalance and Electrolyte Dis-turbance 190

Changes of Respiratory System 191

Changes of Circulatory System 191

Changes of Central Nervous System 192

Changes of Urinary System 193

Changes of Digestive System 193

Pathophvsiological Basis of Prevention and Treatment 193

Prevent and Remove of Reasons 193

Raise PaO2 193

Degrade PaCO2 193

Improve Internal Environment and Function of Critical Organ 193

Case Presentation 193

Chapter 15 Hepatic Failure 195

Etiology 195

Hepatic Insufficiency 195

Metabolic Disorders 195

Metabolic Disorders of Water and Electro-lytes 196

Disorders in Production of Bile Salts and Elimination of Bilirubin 197

Impaired Kupffer Cells Function 197

Hepatic Encephalopathy 197

Etiology and Classification 197

Pathaogenesis 198

Precipitating Factors of Hepatic Encepha-lopathy 202

Principles of Treatment 203

Hepatorenal Syndrome 203

Principles of Treatment and Prevention 205

Case Presentation 205

Chapter 16 Renal Failure 207

Acute Renal Failure 207

Etiology and Classification 207

Prerenal Acute Renal Failure 208

Intrarenal Acute Renal Failure 208

Posuenal Acute Renal Failure 208

Pathogenesis 209

Alterations of Metabolism and Function 210

Urinary Abnormalities 210

Hyperkalemia 210

Other Abnormalities 210

Pathophysiological Basis of Prevention and Treatment 210

Chronic Renal Failure 211

Etiology 211

Clinical Course of Chronic Renal Failure 211

Stage of Decreased Renal Reserve 211

Stage of Renal Insufficiency 211

Stage of Renal Failure 211

Stage of Uremia 211

Pathogenesis 212

Intact Nephron Hypothesis 212

Trade-Off Hypothesis 212

Glomerular Hyperfiltration Hypothesis 213

Alterations of Metabolism and Function 213

Disorders of Urine 213

Disorders of Water and Sodium Balance 213

Disorders of Potassium Balance 213

Metabolic Acidosis 214

Renal Azotemia 214

Renal Hypertension 214

Calcium,Phosphate and Bone Metabolism 214

Renal Anemia and Bleeding Tendency 214

Uremia 215

Etiology and Pathogenesis 215

Urea and Other Small Molecular Weight Molecules 215

Middle Molecules 216

Polypeptide Hormones 216

Alterations of Metabolism and Function 216

Neuromuscular Abnormalities 216

Cardiovascular and Pulmonary Abnorma-lities 216

Hematological Abnormalities 217

Gastrointestinal Abnormalities 217

Endocrine and Metabolic Abnormalities 217

Dermatologic Abnormalities 217

Inmunologic Abnormalities 217

Pathophysiological Basis of Prevention and Treatment 217

Case Presentation 218

Chapter 17 Brain Dysfunction 219

Cell Biology of the Brain 219

Neurons 219

Astrocytes 221

Oligodendrocytes 221

Microglia 221

Basic Knowledge on Consciousness 221

Anatomy 221

Physiology 222

Pathophysiology of Selected Brain Disorders 225

Parkinson's Disease 225

Epilepsy 226

Alzheimer's Disease 228

Stroke 231

Case Presentation 234

Chapter 18 Multiple Organ Dysfunction Syndrome 236

Overview 236

Systemic Inflarmmatory Response Syndrome(SIRS) 237

Etiology 237

Diagnostic Criteria of SIRS 238

Stages of SIRS 238

Pathogenesis of SIRS 239

Multiple Organ Dysfunction 245

Types of MODS 245

Alterations of Metabolism and Function During MODS 246

Pathophysiological Basis of Prevention and Treatment 248

Case Presentation 249

Chapter 19 Metabolic Syndrome 253

Etiology and Pathogenesis 253

Obesity and Abnormal Body Fat Distri-bution 253

Insulin Resistance 254

Independent Factors that Mediate Specific Components of the Metabolic Syndrome 254

Other Contributing Factors 255

Alterations of Metabolism and Function 255

Hyperglycemia 255

Obesity 256

Hypertension 257

Hypertriglyceridemia 257

Principles of Prevention and Treatment 258

Life-style Modification 258

Pharmacological Therapy 258

Other Managements 258

Case Presentation 259

English-Chinese Comparison 260