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Chapter 1 Conspectus Of Disease1

1．Concept of disease1

2．Etiology of disease1

3．Pathogenesis of disease3

4．Outcome of disease5

Chapter 2 Disorders Of Water And Electrolyte Metabolism7

Body Fluid and Electrolyte Balance7

1．Total fluid volume7

2．Body fluid distribution7

3．Body fluid composition8

Osmolality of the Body Fluids9

Mechanisms for Regulating Body Fluid and Electrolyte Balance10

1．The sensation of thirst10

2．Antidiuretic hormone10

3．Aldosterone12

4．The natriuretic peptide family12

5．The guanylin family13

Disorders of Water and Sodium Metabolism14

1．Hyponatremia14

2．Hypernatremia14

3．Disorders of water and sodium metabolism with a normal serum sodium concentration14

Hyponatremia15

1．Hypovolemic hyponatremia15

2．Hypervolemic hyponatremia16

3．Normovolemic hyponatremia17

Hypernatremia17

1．Hypovolemic hypernatremia18

2．Hypervolemic hypernatremia19

3．Normovolemic hypernatremia19

Isotonic Dehydration19

Edema20

1．Etiology and pathogenesis20

2．Alterations of metabolism and function22

Disorders of Potassium Metabolism23

1．Potassium content and distribution23

2．Maintenance of potassium balance23

3．Potassium function24

Hypokalemia26

1．Etiology and pathogenesis26

2．Alterations of metabolism and function28

Hyperkalemia30

1．Etiology and pathogenesis30

2．Alterations of metabolism and function31

Pathophysiological Basis of Prevention and Treatment33

Disorders of Magnesium Metabolism33

Hypomagnesemia34

1．Etiology and pathogenesis34

2．Alterations of metabolism and function35

3．Principles of treatment36

Hypermagnesemia36

1．Etiology and pathogenesis36

2．Alterations of metabolism and function36

3． Pathophysiological basis of prevention and treatment36

Disorders of Calcium and Phosphorus Metabolism36

Function of Calcium and Phosphorus37

Hypocalcemia38

1．Etiology and pathogenesis38

2．Alterations of metabolism and function38

3．Pathophysiological basis of prevention and treatment39

Hypercalcemia39

1．Etiology and pathogenesis39

2．Alterations of metabolism and function39

3．Pathophysiological basis of prevent and treatment40

Hypophosphatemia40

1．Etiology and pathogenesis40

2．Alterations of metabolism and function40

3．Principles of treatment41

Hyperphosphatemia41

1．Etiology and pathogenesis41

2．Alterations of metabolism and function41

3．Principles of treatment41

Case Presentation41

Chapter 3 Acid-Base Balance And Disturbances43

Acid-base Biochemistry43

1．Generation of acids and bases43

2．Henderson-Hasselbalch equation44

Regulation of pH44

1．Buffer systems44

2．Respiratory regulation mechanisms45

3．Renal regulation mechanisms46

Laboratory Tests48

1．PH49

2．PaCO249

3．[HCO？]49

4．Anion Gap(AG)50

Simple Acid-base Disorders50

1．Concept of simple acid-base disorders50

2．Compensation for simple acid-base disorders51

Metabolic Acidosis51

1．Concept51

2．Primary causes51

3．Compensation52

4．Alteration of metabolism and function52

Respiratorv Acidosis53

1．Concept53

2．Primary causes53

3．Compensation53

4．Alteration of metabolism and function54

Metabolic Alkalosis54

1．Concept54

2．Primary causes54

3．Compensation55

4．Alteration of metabolism and function55

Respiratory Alkalosis56

1．Concept56

2．Primary causes56

3．Compensation56

4．Alteration of metabolism and function56

Mixed Acid-Base Disorders57

1．Metabolic alkalosis+Metabolic acidosis57

2．Metabolic acidosis+Respiratory alkalosis57

3．Metabolic acidosis+Respiratory acidosis58

4．Metabolic alkalosis+Respiratory alkalosis58

5．Metabolic alkalosis+Respiratory acidosis58

6．Triple acid-base disorders58

7．Judgment of acid-base disorders58

Case Presentation60

Chapter 4 Hypoxia61

Parameters of Blood Oxygen61

1．Partial pressure of oxygen(PO2)61

2．Oxygen capacity(CO2max)61

3．Oxygen content(CO2)61

4．Oxygen saturation(SO2)61

5．P5062

Classification,Etiology and Pathogenesis of Hypoxia62

1．Hypotonic hypoxia62

2．Hemic hypoxia63

3．Circulatory hypoxia63

4．Histogenous hypoxia64

Alterations of Function and Metabolism64

1．Respiratory system64

2．Circulatory system65

3．Hemic system66

4．Central nervous system66

5．Cellular alterations67

Factors Affecting the Tolerance to Hypoxia67

1．Oxygen consumption rate67

2．Compensatory ability of the body68

Oxygen Therapy and Oxygen Intoxication68

1．Pulmonary oxygen intoxication68

2．Cerebral oxygen intoxication68

Case Presentation68

Chapter 5 Fever70

Regulation of Normal Body Temperature70

Etiology71

1．Infectious factors71

2．Non-infectious factors72

Pathogenesis72

1．Endogenous Pyrogens72

Thermoregulation of Fever74

1．Thermoregulating center74

2．Routes of peripheral pyrogenic signals into thermoregulation center75

3．Central mediators of fever75

Alterations of Metabolism and Function79

Pathophysiological Basis of Prevention and Treatment80

Case Presentation81

Chapter 6 Dysfunction Of Cell Signaling In Diseases83

Major Pathways for Cell Signaling83

1．G-protein-mediated cell signaling83

2．Tyrosine kinase mediated signaling84

3．Guanylyl cyclase(GC)mediated signaling85

4．Intracellular and nuclear receptor signaling85

Dysfunction of Cell Signaling in Diseases86

1．Aberrant signal molecules in diseases86

2．Aberrant receptors in diseases86

3．Aberrant G-proteins in diseases88

4．Aberrant intracellular signaling in diseases89

5．Multiple signaling aberrations in diseases90

6．Relationship between stimulants and pathological effects91

Principles of Treatment93

1．To regulate the level of extracellular molecules93

2．To regulate the structure and the function of receptors93

3．To regulate the level and modifications of intracellular messenger molecules and transducers93

4．To regulate the level of nuclear transcription factors94

Case Presentation94

Chapter 7 Cell Proliferation,Differentiation,Apoptosis And The Related Diseases96

Cell Proliferation and Diseases96

1．Cell cycle and its control96

2．Deregulation of cell proliferation and diseases99

Cell Differentiation and Diseases100

1．Control of cell differentiation100

2．Differentiation and tumor102

Cell Apoptosis and Diseases102

1．Regulation of cell apoptosis103

2．Abnormal cell apoptosis in diseases105

Chapter 8 Stress And Stress-Related Diseases108

Terminology of Stress108

1．Stress108

2．Stressor108

3．General adaptation syndrome(GAS)109

Neuroendocrine Responses110

1．Locus Ceruleus-norepinephrine neurons-sympathetic/adrenal medulla axis110

2．Hypothalamus-pituitary-adrenal cortex axis111

3．Other hormones in stress111

Cellular and Humoral Responses112

1．Acute phase proteins112

2．Heat shock proteins113

Functional and Metabolic Responses115

1．Central nervous system115

2．Immune system116

3．Cardiovascular system117

4．Digestive system117

5．Genito Urinary system117

6．Metabolism117

Stress-related Disease118

1．Stress Ulcer118

2．Stress and Cardiovascular Diseases119

3．Stress and endocrine disorders120

4．Stress and Psychosocial Disturbance120

Pathophysiological Basis of Prevention and Treatment121

Case Presentation121

Chapter 9 Coagulation-Anticoagulation Balance And Imbalance of Haemostatic System123

Overview of Haemostatic System123

1．Vasospasm123

2．Coagulation system124

3．Anticoagulation System126

4．Function of the fibrinolytic system127

5．Role of endothelial cells128

Imbalance in Haemostatic System129

1．Bleeding Disorders129

2．Thrombogenesis and thrombotic disorders131

3．Blood vessel abnormity133

4．Fibrinolytic factor abnormality133

Disseminated Intravascular Coagulation134

1．Etiology134

2．Pathology135

3．Pathogenesis135

4．Factors influence the development of DIC137

5．Clinical classification of DIC137

6．Alterations of metabolism and function138

7．Pathophysiological Basis of Prevention and Treatment139

Case Presentation140

Chapter 10 Shock142

Etiology and Classification142

1．Hypovolemic shock142

2．Cardiogenic shock142

3．Infectious shock142

4．Anaphylactic shock142

5．Neurogenic shock143

Stages of Shock and Their Pathological Changes143

1．Ischemic hypoxia stage143

2．Stagnant hypoxia stage145

3．Organic failure stage146

Roles of Humoral Factors in Pathogenesis of Shock147

1．Catecholamine and angiotensin147

2．Cytokines147

3．Adhesion molecules148

4．Endothelium-derived vasoactive mediators148

5．Activation of complement cascade148

6．Lysosomal enzymes148

7．Redox imbalance148

Functional and Metabolic Changes149

1．Neuroendocrine system149

2．Cardiovascular system149

3．Hematologic system150

4．Immune system150

5．Lung150

6．Kidney151

7．Gastrointestinal151

8．Liver151

9．Metabolic derangement151

10．Cellular responses152

Pathophysiological Basis of Prevention and Treatment for Shock153

1．Volume replacement153

2．Application of vasoactive drugs153

3．Treatment on acidosis153

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

5．Others153

Multiple organ dysfunction syndrome153

1．Systemic inflammatory response(SIRS)154

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

3．Mixed antagonist response syndrome155

Case Presentation155

Chapter 11 Ischemia-Reperfusion Injury157

Etiology of Ischemia-Reperfusion Injury157

1．Duration of ischemia157

2．Dependency on oxygen supply157

3．The condition of reperfusion157

Mechanisms of Ischemia-Reperfusion Injury158

1．Injury of free radicals158

2．Calcium overload161

3．The endothelial injury and neutrophil activation163

Alterations of Function and Metabolism during Ischemia-Reperfusion Injury164

1．Myocardial ischemia-reperfusion injury164

2．Cerebral ischemia-reperfusion injury166

3．Hepatic ischemia-reperfusion injury166

4．Renal ischemia-reperfusion injury167

Pathophysiological Basis of Prevention and Treatment167

1．Controlling reperfusion conditions167

2．Antioxidants and free radical scavengers167

3．Inhibitors of neutrophils activation168

4．Calcium antagonists or calcium channel blocker168

Case Presentation168

Chapter 12 Heart Failure170

Etiology and Classifications170

1．Underlying causes170

2．Precipitating factors171

3．Classifications172

Pathogenesis172

1．Decreased myocardial contractility172

2．Diastolic dysfunction175

3．Asynergic myocardial contraction and relaxation175

4．Endothelial dysfunction176

Compensatory Responses176

1．Cardiac compensation177

2．Systemic compensation177

3．Neurohormonal compensation178

Alterations of Metabolism and Function180

1．Congestion of pulmonary circulation180

2．Congestion of systemic circulation181

3．Low cardiac output181

Principles of Treatment181

1．General treatment181

2．Improving cardiac functions182

3．Reducing afterload and preload182

4．Regression of ventricular hypertrophy182

5．Controlling edema182

Case Presentation182

Chapter 13 Respiratory Failure184

Etiology and Pathogenesis184

1．Ventilatory disorder184

2．Diffusion disorder186

3．Ventilation and perfusion imbalance187

4．Anatomic shunt189

Alterations of Function and Metabolism189

1．Acid-base imbalance and electrolyte imbalance190

2．Respiratory system190

3．Cardiovascular system190

4．Central nervous system190

Pathophysiological basis of Treatment191

1．Treating the causes of respiratory failure191

2．Increasing PaO2191

3．Decreasing PaCO2191

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

Case Presentation191

Chapter 14 Hepatic Failure194

Etiology194

Hepatic Insufficiency194

1．Injury of Hepatocytes and Hepatic Dysfunction194

2．Metabolic Disorders of Water and Electrolytes195

3．Disorders in Production of Bile Salts and Elimination of Bilirubin Disorders195

4．Hepatic Enteric Endotoxemia195

Hepatic Encephalopathy195

Etiology and Classification196

Pathogenesis196

1．Ammonia intoxication196

2．False neurotransmitters and amino acid imbalance198

3．The gamma-aminobutyric acid hypothesis199

Precipitating Factors200

Principles of Treatment201

Hepatorenal Syndrome202

Pathogenesis202

1．Stimulated sympathetic nervous system202

2．Activated renin-angiotensin-aldosterone system202

3．Increased vasopressin release202

4．Other humoral factors202

Principles of Treatment and Prevention203

Case Presentation204

Chapter 15 Renal Failure206

Basic Pathological Taches for Renal Failure206

1．Dysfunction of glomerular filtration206

2．Renal tubular dysfunction207

3．Renal endocrine dysfunction207

Acute Renal Failure208

Etiology and Classification209

1．Prerenal ARF209

2．Intrarenal ARF210

3．Postrenal ARF210

Pathogenesis210

1．Renal hemodynamic alterations210

2．Renal glomerular injury211

3．Renal tubular injury211

4．Renal cell iniury and its mechanisms212

Alterations of Metabolism and Function213

1．The oliguric stage213

2．The diuretic stage215

3．The recovery stage215

Pathophysiological Basis of Prevention and Treatment216

Chronic Renal Failure216

1．Etiology216

2．Clinical courses217

Pathogenesis217

1．Mechanism of compensation217

2．Mechanism of decompensation218

Alterations of Metabolism and Function219

1．Alteration of urine219

2．Azotemia219

3．Water,electrolytes and acid-base imbalance220

4．Renal hypertension221

5．Renal osteodystrophy221

6．Tendency to hemorrhage221

7．Renal Anemia221

Uremia222

1．Pathogenesis222

2．Functional and Metabolic Alterations223

Pathophysiological Basis of Prevention and Treatment225

Case Presentation225

Chapter 16 Brain Dysfunction228

Introduction228

1．Characteristics of brain structure,metabolism and function228

2．Characteristics of brain diseases228

Cognitive Disorders229

1．Structural basis of cognition229

2．Major manifestations of cognitive disorders230

3．Etiology and pathogenesis231

Principles for treatment of cognitive disorders235

1．General neuroprotective treatments235

2．Maintenance of normal neurotransmitter level235

3．Surgery235

Consciousness Disorder235

1．The structural basis of the brain in consciousness and consciousness disorders236

2．Major manifestations in consciousness disorders236

3．The etiology and pathogenesis of consciousness disorder237

4．Systemic disturbance caused by consciousness disorder238

Principles of prevention and therapy240

1．Urgent management240

2．Making a definite diagnosis as soon as possible240

3．Monitoring vital signs and consciousness state240

4．Brain protections240

Case Presentation240