病理生理学PDF电子书下载

Chapter 1 Conspectus Of Disease 1

1．Concept of disease 1

2．Etiology of disease 1

3．Pathogenesis of disease 3

4．Outcome of disease 5

Chapter 2 Disorders Of Water And Electrolyte Metabolism 7

Body Fluid and Electrolyte Balance 7

1．Total fluid volume 7

2．Body fluid distribution 7

3．Body fluid composition 8

Osmolality of the Body Fluids 9

Mechanisms for Regulating Body Fluid and Electrolyte Balance 10

1．The sensation of thirst 10

2．Antidiuretic hormone 10

3．Aldosterone 12

4．The natriuretic peptide family 12

5．The guanylin family 13

Disorders of Water and Sodium Metabolism 14

1．Hyponatremia 14

2．Hypernatremia 14

3．Disorders of water and sodium metabolism with a normal serum sodium concentration 14

Hyponatremia 15

1．Hypovolemic hyponatremia 15

2．Hypervolemic hyponatremia 16

3．Normovolemic hyponatremia 17

Hypernatremia 17

1．Hypovolemic hypernatremia 18

2．Hypervolemic hypernatremia 19

3．Normovolemic hypernatremia 19

Isotonic Dehydration 19

Edema 20

1．Etiology and pathogenesis 20

2．Alterations of metabolism and function 22

Disorders of Potassium Metabolism 23

1．Potassium content and distribution 23

2．Maintenance of potassium balance 23

3．Potassium function 24

Hypokalemia 26

1．Etiology and pathogenesis 26

2．Alterations of metabolism and function 28

Hyperkalemia 30

1．Etiology and pathogenesis 30

2．Alterations of metabolism and function 31

Pathophysiological Basis of Prevention and Treatment 33

Disorders of Magnesium Metabolism 33

Hypomagnesemia 34

1．Etiology and pathogenesis 34

2．Alterations of metabolism and function 35

3．Principles of treatment 36

Hypermagnesemia 36

1．Etiology and pathogenesis 36

2．Alterations of metabolism and function 36

3． Pathophysiological basis of prevention and treatment 36

Disorders of Calcium and Phosphorus Metabolism 36

Function of Calcium and Phosphorus 37

Hypocalcemia 38

1．Etiology and pathogenesis 38

2．Alterations of metabolism and function 38

3．Pathophysiological basis of prevention and treatment 39

Hypercalcemia 39

1．Etiology and pathogenesis 39

2．Alterations of metabolism and function 39

3．Pathophysiological basis of prevent and treatment 40

Hypophosphatemia 40

1．Etiology and pathogenesis 40

2．Alterations of metabolism and function 40

3．Principles of treatment 41

Hyperphosphatemia 41

1．Etiology and pathogenesis 41

2．Alterations of metabolism and function 41

3．Principles of treatment 41

Case Presentation 41

Chapter 3 Acid-Base Balance And Disturbances 43

Acid-base Biochemistry 43

1．Generation of acids and bases 43

2．Henderson-Hasselbalch equation 44

Regulation of pH 44

1．Buffer systems 44

2．Respiratory regulation mechanisms 45

3．Renal regulation mechanisms 46

Laboratory Tests 48

1．PH 49

2．PaCO2 49

3．[HCO？] 49

4．Anion Gap(AG) 50

Simple Acid-base Disorders 50

1．Concept of simple acid-base disorders 50

2．Compensation for simple acid-base disorders 51

Metabolic Acidosis 51

1．Concept 51

2．Primary causes 51

3．Compensation 52

4．Alteration of metabolism and function 52

Respiratorv Acidosis 53

1．Concept 53

2．Primary causes 53

3．Compensation 53

4．Alteration of metabolism and function 54

Metabolic Alkalosis 54

1．Concept 54

2．Primary causes 54

3．Compensation 55

4．Alteration of metabolism and function 55

Respiratory Alkalosis 56

1．Concept 56

2．Primary causes 56

3．Compensation 56

4．Alteration of metabolism and function 56

Mixed Acid-Base Disorders 57

1．Metabolic alkalosis+Metabolic acidosis 57

2．Metabolic acidosis+Respiratory alkalosis 57

3．Metabolic acidosis+Respiratory acidosis 58

4．Metabolic alkalosis+Respiratory alkalosis 58

5．Metabolic alkalosis+Respiratory acidosis 58

6．Triple acid-base disorders 58

7．Judgment of acid-base disorders 58

Case Presentation 60

Chapter 4 Hypoxia 61

Parameters of Blood Oxygen 61

1．Partial pressure of oxygen(PO2) 61

2．Oxygen capacity(CO2max) 61

3．Oxygen content(CO2) 61

4．Oxygen saturation(SO2) 61

5．P50 62

Classification,Etiology and Pathogenesis of Hypoxia 62

1．Hypotonic hypoxia 62

2．Hemic hypoxia 63

3．Circulatory hypoxia 63

4．Histogenous hypoxia 64

Alterations of Function and Metabolism 64

1．Respiratory system 64

2．Circulatory system 65

3．Hemic system 66

4．Central nervous system 66

5．Cellular alterations 67

Factors Affecting the Tolerance to Hypoxia 67

1．Oxygen consumption rate 67

2．Compensatory ability of the body 68

Oxygen Therapy and Oxygen Intoxication 68

1．Pulmonary oxygen intoxication 68

2．Cerebral oxygen intoxication 68

Case Presentation 68

Chapter 5 Fever 70

Regulation of Normal Body Temperature 70

Etiology 71

1．Infectious factors 71

2．Non-infectious factors 72

Pathogenesis 72

1．Endogenous Pyrogens 72

Thermoregulation of Fever 74

1．Thermoregulating center 74

2．Routes of peripheral pyrogenic signals into thermoregulation center 75

3．Central mediators of fever 75

Alterations of Metabolism and Function 79

Pathophysiological Basis of Prevention and Treatment 80

Case Presentation 81

Chapter 6 Dysfunction Of Cell Signaling In Diseases 83

Major Pathways for Cell Signaling 83

1．G-protein-mediated cell signaling 83

2．Tyrosine kinase mediated signaling 84

3．Guanylyl cyclase(GC)mediated signaling 85

4．Intracellular and nuclear receptor signaling 85

Dysfunction of Cell Signaling in Diseases 86

1．Aberrant signal molecules in diseases 86

2．Aberrant receptors in diseases 86

3．Aberrant G-proteins in diseases 88

4．Aberrant intracellular signaling in diseases 89

5．Multiple signaling aberrations in diseases 90

6．Relationship between stimulants and pathological effects 91

Principles of Treatment 93

1．To regulate the level of extracellular molecules 93

2．To regulate the structure and the function of receptors 93

3．To regulate the level and modifications of intracellular messenger molecules and transducers 93

4．To regulate the level of nuclear transcription factors 94

Case Presentation 94

Chapter 7 Cell Proliferation,Differentiation,Apoptosis And The Related Diseases 96

Cell Proliferation and Diseases 96

1．Cell cycle and its control 96

2．Deregulation of cell proliferation and diseases 99

Cell Differentiation and Diseases 100

1．Control of cell differentiation 100

2．Differentiation and tumor 102

Cell Apoptosis and Diseases 102

1．Regulation of cell apoptosis 103

2．Abnormal cell apoptosis in diseases 105

Chapter 8 Stress And Stress-Related Diseases 108

Terminology of Stress 108

1．Stress 108

2．Stressor 108

3．General adaptation syndrome(GAS) 109

Neuroendocrine Responses 110

1．Locus Ceruleus-norepinephrine neurons-sympathetic/adrenal medulla axis 110

2．Hypothalamus-pituitary-adrenal cortex axis 111

3．Other hormones in stress 111

Cellular and Humoral Responses 112

1．Acute phase proteins 112

2．Heat shock proteins 113

Functional and Metabolic Responses 115

1．Central nervous system 115

2．Immune system 116

3．Cardiovascular system 117

4．Digestive system 117

5．Genito Urinary system 117

6．Metabolism 117

Stress-related Disease 118

1．Stress Ulcer 118

2．Stress and Cardiovascular Diseases 119

3．Stress and endocrine disorders 120

4．Stress and Psychosocial Disturbance 120

Pathophysiological Basis of Prevention and Treatment 121

Case Presentation 121

Chapter 9 Coagulation-Anticoagulation Balance And Imbalance of Haemostatic System 123

Overview of Haemostatic System 123

1．Vasospasm 123

2．Coagulation system 124

3．Anticoagulation System 126

4．Function of the fibrinolytic system 127

5．Role of endothelial cells 128

Imbalance in Haemostatic System 129

1．Bleeding Disorders 129

2．Thrombogenesis and thrombotic disorders 131

3．Blood vessel abnormity 133

4．Fibrinolytic factor abnormality 133

Disseminated Intravascular Coagulation 134

1．Etiology 134

2．Pathology 135

3．Pathogenesis 135

4．Factors influence the development of DIC 137

5．Clinical classification of DIC 137

6．Alterations of metabolism and function 138

7．Pathophysiological Basis of Prevention and Treatment 139

Case Presentation 140

Chapter 10 Shock 142

Etiology and Classification 142

1．Hypovolemic shock 142

2．Cardiogenic shock 142

3．Infectious shock 142

4．Anaphylactic shock 142

5．Neurogenic shock 143

Stages of Shock and Their Pathological Changes 143

1．Ischemic hypoxia stage 143

2．Stagnant hypoxia stage 145

3．Organic failure stage 146

Roles of Humoral Factors in Pathogenesis of Shock 147

1．Catecholamine and angiotensin 147

2．Cytokines 147

3．Adhesion molecules 148

4．Endothelium-derived vasoactive mediators 148

5．Activation of complement cascade 148

6．Lysosomal enzymes 148

7．Redox imbalance 148

Functional and Metabolic Changes 149

1．Neuroendocrine system 149

2．Cardiovascular system 149

3．Hematologic system 150

4．Immune system 150

5．Lung 150

6．Kidney 151

7．Gastrointestinal 151

8．Liver 151

9．Metabolic derangement 151

10．Cellular responses 152

Pathophysiological Basis of Prevention and Treatment for Shock 153

1．Volume replacement 153

2．Application of vasoactive drugs 153

3．Treatment on acidosis 153

4．Treatment of DIC or organic dysfunction(see related chapter) 153

5．Others 153

Multiple organ dysfunction syndrome 153

1．Systemic inflammatory response(SIRS) 154

2．Compensatory anti-inflammatory response syndrome(CARS) 155

3．Mixed antagonist response syndrome 155

Case Presentation 155

Chapter 11 Ischemia-Reperfusion Injury 157

Etiology of Ischemia-Reperfusion Injury 157

1．Duration of ischemia 157

2．Dependency on oxygen supply 157

3．The condition of reperfusion 157

Mechanisms of Ischemia-Reperfusion Injury 158

1．Injury of free radicals 158

2．Calcium overload 161

3．The endothelial injury and neutrophil activation 163

Alterations of Function and Metabolism during Ischemia-Reperfusion Injury 164

1．Myocardial ischemia-reperfusion injury 164

2．Cerebral ischemia-reperfusion injury 166

3．Hepatic ischemia-reperfusion injury 166

4．Renal ischemia-reperfusion injury 167

Pathophysiological Basis of Prevention and Treatment 167

1．Controlling reperfusion conditions 167

2．Antioxidants and free radical scavengers 167

3．Inhibitors of neutrophils activation 168

4．Calcium antagonists or calcium channel blocker 168

Case Presentation 168

Chapter 12 Heart Failure 170

Etiology and Classifications 170

1．Underlying causes 170

2．Precipitating factors 171

3．Classifications 172

Pathogenesis 172

1．Decreased myocardial contractility 172

2．Diastolic dysfunction 175

3．Asynergic myocardial contraction and relaxation 175

4．Endothelial dysfunction 176

Compensatory Responses 176

1．Cardiac compensation 177

2．Systemic compensation 177

3．Neurohormonal compensation 178

Alterations of Metabolism and Function 180

1．Congestion of pulmonary circulation 180

2．Congestion of systemic circulation 181

3．Low cardiac output 181

Principles of Treatment 181

1．General treatment 181

2．Improving cardiac functions 182

3．Reducing afterload and preload 182

4．Regression of ventricular hypertrophy 182

5．Controlling edema 182

Case Presentation 182

Chapter 13 Respiratory Failure 184

Etiology and Pathogenesis 184

1．Ventilatory disorder 184

2．Diffusion disorder 186

3．Ventilation and perfusion imbalance 187

4．Anatomic shunt 189

Alterations of Function and Metabolism 189

1．Acid-base imbalance and electrolyte imbalance 190

2．Respiratory system 190

3．Cardiovascular system 190

4．Central nervous system 190

Pathophysiological basis of Treatment 191

1．Treating the causes of respiratory failure 191

2．Increasing PaO2 191

3．Decreasing PaCO2 191

4．Treating the consequences of hypoxemia and hypercapnia,for example,the acidosis,heart failure etc． 191

Case Presentation 191

Chapter 14 Hepatic Failure 194

Etiology 194

Hepatic Insufficiency 194

1．Injury of Hepatocytes and Hepatic Dysfunction 194

2．Metabolic Disorders of Water and Electrolytes 195

3．Disorders in Production of Bile Salts and Elimination of Bilirubin Disorders 195

4．Hepatic Enteric Endotoxemia 195

Hepatic Encephalopathy 195

Etiology and Classification 196

Pathogenesis 196

1．Ammonia intoxication 196

2．False neurotransmitters and amino acid imbalance 198

3．The gamma-aminobutyric acid hypothesis 199

Precipitating Factors 200

Principles of Treatment 201

Hepatorenal Syndrome 202

Pathogenesis 202

1．Stimulated sympathetic nervous system 202

2．Activated renin-angiotensin-aldosterone system 202

3．Increased vasopressin release 202

4．Other humoral factors 202

Principles of Treatment and Prevention 203

Case Presentation 204

Chapter 15 Renal Failure 206

Basic Pathological Taches for Renal Failure 206

1．Dysfunction of glomerular filtration 206

2．Renal tubular dysfunction 207

3．Renal endocrine dysfunction 207

Acute Renal Failure 208

Etiology and Classification 209

1．Prerenal ARF 209

2．Intrarenal ARF 210

3．Postrenal ARF 210

Pathogenesis 210

1．Renal hemodynamic alterations 210

2．Renal glomerular injury 211

3．Renal tubular injury 211

4．Renal cell iniury and its mechanisms 212

Alterations of Metabolism and Function 213

1．The oliguric stage 213

2．The diuretic stage 215

3．The recovery stage 215

Pathophysiological Basis of Prevention and Treatment 216

Chronic Renal Failure 216

1．Etiology 216

2．Clinical courses 217

Pathogenesis 217

1．Mechanism of compensation 217

2．Mechanism of decompensation 218

Alterations of Metabolism and Function 219

1．Alteration of urine 219

2．Azotemia 219

3．Water,electrolytes and acid-base imbalance 220

4．Renal hypertension 221

5．Renal osteodystrophy 221

6．Tendency to hemorrhage 221

7．Renal Anemia 221

Uremia 222

1．Pathogenesis 222

2．Functional and Metabolic Alterations 223

Pathophysiological Basis of Prevention and Treatment 225

Case Presentation 225

Chapter 16 Brain Dysfunction 228

Introduction 228

1．Characteristics of brain structure,metabolism and function 228

2．Characteristics of brain diseases 228

Cognitive Disorders 229

1．Structural basis of cognition 229

2．Major manifestations of cognitive disorders 230

3．Etiology and pathogenesis 231

Principles for treatment of cognitive disorders 235

1．General neuroprotective treatments 235

2．Maintenance of normal neurotransmitter level 235

3．Surgery 235

Consciousness Disorder 235

1．The structural basis of the brain in consciousness and consciousness disorders 236

2．Major manifestations in consciousness disorders 236

3．The etiology and pathogenesis of consciousness disorder 237

4．Systemic disturbance caused by consciousness disorder 238

Principles of prevention and therapy 240

1．Urgent management 240

2．Making a definite diagnosis as soon as possible 240

3．Monitoring vital signs and consciousness state 240

4．Brain protections 240

Case Presentation 240