PATHOPHYSIOLOGY
1 AIM
Pathophysiology is a interdisciplinary course which has close relationship with many other medical disciplines, such as physiology, biochemistry, immunology, pathology, anatomy,histology and clinical medicines as well, it is a bridge between the basic medical sciences and clinical medicines.This course is intended to introduce the basic knowledge about disease entities, what we presently understand regarding the etiology, pathogenic mechanisms, impairment and adaptation of metabolism and organ’s function. The emphasis is put on the mechanisms of pathogenesis and mechanisms resulting in metabolism and function alterations. Included is essential background information on most important and prevailing pathologic processes and diseases syndrome. “master”is the stresses of lecture, which is necessary for students, others is the comprehensive contents, which is also encouraged for students. Some chapters and contents in the textbook do not included in this outline because of a limited lecture
hours for this course, these contents are also encouraged for students to study on one’s own, which, however, will not be included in the final exam.
2 Content
Chapter One introduction of pathophysiology
【AIM】
master：Concept of Pathophysiology, etiology and pathogenesis
comprehensive：the mechanism of disease the changes within the body hat result from diseases and its mechanisms.
【CONTENT】
General Concept of Pathophysiology: comprehensive the causes of disease – etiology the mechanism of disease -- the pathogenesis, emphasis on metabolism and function. the changes within the body that result from diseases and its mechanisms.
Chapter Two General Introduction to Disease
【AIM】
master：Concept of disease , health , Pathological process, Etiological factors; Outcome of Disease; Concept of Brain death and current concept of death.
comprehensive: Predisposing factors, Precipitating factor; Development of Disease,
【CONTENT】
1.Concept:
Health: state of complete well-being in some and psyche.
Disease: an abnormal life process under actions of pathogenic cause with disturbances of "homeostasis".
Pathological process: refer to a process in which some common ,regular alterations of function ,metabolism and structure take place in many difference diseases. eg. Fever, shock ,edema etc.
2.Etiology
(1). Etiological factors: the direct cause:
(2). Predisposing factors:
The factors that influences the susceptibility or resistance to diseases.
(3). Precipitating factor
The factor that promote, intensify the disease attack.
3.Development of Disease:
(1). General rules
a. Damage and Antidamage Responses
b. Interchange of Cause-Effect
c. Locus and Whole
(2) Basic Mechanisms
4. Outcome of Disease:
(1) Recovery: complete, incomplete
(2)Death:
① current concept of death: heart and breath stop forever over intense resuscitation
② Brain death: the functions of cerebrum and brain stem stop forever
Chapter Three Disorder of Water and Electrolytes Metabolism
【AIM】
master：Regulation of water and sodium balance; classification of Disorder of water and sodium; concept and effect of hypotonic dehydration, Hypertonic dehydration and Isotonic dehydration; Regulation of K+ metabolism, concepte and effect of Hypokalemia and Hyperkalemia;
comprehensive: Physiology of Water and Electrolytes Metabolism, Causes and Pathogenesis of hypotonic dehydration, Hypertonic dehydration and Isotonic dehydration; Physiology of K+ metabolism, Causes and Pathogenesis of Hypokalemia and Hyperkalemia; Physiology of Calcium , Phosphate metabolism and Magnesium; concept, Causes and Pathogenesi Effects of Hypocalcinemia, Hypercalcinemia ,Hypophosphatemia, Hyperphosphatemia, Hypomagnesium and Hypermagnesium.
【CONTENT】.
A. Physiology of Water and Electrolytes Metabolism
(1)Water and Electrolytes Constituent
(2)Intake and Excretion of Water
(3)Exchange of Fluid between Compartments
Two semi-permeable membranes.
Capillary membrane: colloid osmotic pressure
Cell membrane: crystal osmotic pressure.
(4) Regulation of water and sodium balance
a. Thirsty sense
b. ADH
c. Aldosterone(ALD)
d. Natriuretic hormones
2 Disorder of water and sodium
Basic pinciple of classification:
(1) Volume of body fluid
(2) Sodium concentration
(3) Osmotic pressure
B.Disorders of water and natrium metabolism:
1. Hyponatremia : serum [Na+]<135mmol/L.
1) Hypotonic dehydration (hyponatremia with volume loss) :
A. Causes and Pathogenesis
a) Volume loss from digestive tract, burned skin ,……
b) Volume loss from kidney
B. Effects:
Major loss of fluid: in ECF
Inadequate blood volume, skin dehydration--loss of skin turgor;……
2) Hyponatremia with volume normal or gain
A. Causes and Pathogenesis:
B. Effects:
Cell edema-brain edema:
2. Hypernatremia: serum [Na+]>150mmol/L
1) Hypertonic dehydration (hypernatremia with volume loss) : master
A) Causes and Pathogenesis
Great loss of water or hypotonic fluid
a) From skin: fever, heavy sweat....
b) From lung: hyperpnea
c) From digestive tract: diarrhea...
d) From kiney: diabetes insipidus, osmotic diuretics
Without appropriate water replacement.
B) Effects:
a) Alteration of body fluid: Major loss of fluid in ICF, Dehydration of brain cell Plasma volume: recruitment from ICF- beneficial to maintain circulation.
b): Heavy thirsty
2). hypernatremia with volume excess: iatrogenic…. rare
3) Idiopathic hypernatremia
3. volume disturbance with normal plasma [Na+]
1. Isotonic dehydration: dehydration with normal plasma [Na+]: master
A. Causes and Pathogenesis
Excessive fluid loss primarily from digestive tract, especially when kidney can maintain osmotic pressure normal (early stage)
B. Effects:
a) Alteration of body fluid Major loss of fluid: in ECF
b) Thirsty, Oliguria
2. Edema (volume gain with normal plasma [Na+]) See chapter 5
C. Disorders of K+ Metabolism
1 Physiology of K+ metabolism
(1). constituent of K+
(2). Regulation of K+ metabolism
1) Movement of K+ between intra- and extra-cellular fluid
2) Excretion of K+ by kidney
2. Hypokalemia : serum [K+] <3.5mmol/L: master
(1) Causes and Pathogenesis
a. Inadequate intake
b. Excessive loss:
From digestive tract....
From kidney
From skin
c. Increased K+ shift into cells
(2) Effects
a. On neuromuscular:
Acute hypokalemia: Hyperpolarized blocking
b. On heart:
Excitibility↑
Autorrhythmicity↑
Conductivity↓
Contractivity: acute --- ↑
Chronic --- ↓
c. On kidney: concentration ability of urine↓
3 Hyperkalemia :serum [K+] >5.5mmol/L: master
(1) Causes and Pathogenesis
a. Decreased urinary excretion of K+
b.Excessive K+ move out of cells
c.Inappropriate intake
(2) Effects
a. On muscle:in mild stage: excitibility↑ in severe stage: excitibility ↓: depolarized blocking
b. on heart: excitibility: in mild stage:↑ in severe stage:↓ conductivity: ↓ autorhythmicity ↓ Contractivity: ↓
D. Disorder of Calcium and Phosphate metabolism
1. Physiology of Calcium and Phosphate metabolism
(1) Constituent
(2) Regulation of calcium and phosphate metabolism
2 Hypocalcinemia: serum Ca2+< 2.1mmol/L
(1) Causes and Pathogenesis
(2) Effects
3 Hypercalcinemia: serum [Ca2+] >2.60mmol/L
(1) Causes and Pathogenesis:
(2)Effects
4 Hypophosphatemia
(1)Causes and Pathogenesis:
(2) Effects
5 Hyperphosphatemia
(1) Causes and Pathogenesis:
(2) Effects
E. Disorders of Magnesium
1. Physiology of Mg2+ metabolism
2. Hypomagnesium: serum [Mg2+] <0.8mmol/L
(1) Causes and Pathogenesis
(2) Effects
3. Hypermagnesium: serum [Mg2+] >1.20mmol/L
(1) Causes and Pathogenesis
(2) Effects
Chapter 4 Acid-Base Disturbances
【AIM】
master：Regulation of Acid-Base Balance; Laboratory parameters of Acid-Base Balance,Concept , Compensation and Effects of Metabolic Acidosis , Respiratory Acidosis ,Metabolic Alkalosis and Respiratory Alkalosis on Body.
comprehensive: Causes and Pathogenesis of Metabolic Acidosis , Respiratory Acidosis ,Metabolic Alkalosis and Respiratory Alkalosis; Mixed Acid-Base Disorders, formula of compensatory response.
【CONTENT】
A. Regulation of Acid-Base Balance: master
1. Chemical buffers
2. Regulation of Lung
3. Regulation of Kidney
4. Role of cells
B. Laboratory parameters of Acid-Base Balance: master
1. pH
2. PaCO2: "respiratory parameter"
3. Metabolic parameters: SB,AB, BE, CO2CP... Represent of HCO3- concentration
4. Anion Gap (AG)
C. Simple Acid-Base Disorders
1. Metabolic Acidosis (M.Aci) : master
(1) Concept : primary decrease of plasma [HCO3-]
(2) Causes and Pathogenesis
1) M.Aci with normal AG
2) M.Aci with AG↑
(3)Compensation
(4) Effects of Metabolic Acidosis on Body
2. Respiratory Acidosis (R.Aci) : master
(1) Concept : primary elevation of PaCO2
(2)Causes and Pathogenesis: Ventilation↓
(3)Compensation
(4) Effects of Respiratory Acidosis on Body
3. Metabolic Alkalosis (M.Alk) : master
(1) Concept : primary increase of plasma [HCO3-]
(2) Causes and Pathogenesis"
(3) Compensation
(4) Effects of Metabolic Alkalosis on Body
4. Respiratory Alkalosis (R.Alk) : master
(1) Concept : primary decrease of plasma CO2
(2) Cause and Pathogenesis: Ventilation↑
(3) Compensation
(4) Effects of Respiratory Alkalosis on Body
5. Mixed Acid-Base Disorders
(1) Mixing patterns
(2) Differentiation of Simple Acid-Base Disorders from Mixed Ones formula of compensatory response
Chapter 5 Edema
【AIM】
master：Concept, Causes and Pathogenesis of edema
comprehensive: character of edema, classification and Causes and Pathogenesis of all kinds of edama.
【CONTENT】
A. Concept : excessive accumulation of interstitial fluid
B. Causes and Pathogenesis
1. Disequilibrium of fluid exchange between inside and outside body Sodium and water retention
Kidney : the primary organ for volume regulation
(a) GFR↓
(b) Redistribution of RBF
(c) Increased reabsorption of Na+, H2O by proximal renal tubules:
(d) Increased reabsorption of Na+, H2O by distal renal tubules:
2. Disequilibrium of fluid exchange between intra- and extra-vessels
(a) Capillaries blood pressure↑
(b) Plasma colloid osmotic pressure↓
(c) Capillary permeability↑
(d) Lymphatic obstruction
Chapter six Hypoxia
【AIM】
master：Concept of hypoxia and parameters for blood oxygen; causes and Characteristics of blood oxygen and Pathogenesis of four kinds of hypoxia; Functional and Metaolic changes in hypoxia
comprehensive: Tolerance to hypoxia Oxygen, therapy and Oxygen toxicity
【CONTENT】
A. Concept of hypoxia and parameters for blood oxygen
B. . Etiology and Pathogenesis: master
1. Hypotonic hypoxia
(1) Causes
(2)Characteristics of blood oxygen and Pathogenesis
2. Hemic hypoxia
(1) Causes
(2) Characteristics of blood oxygen and Pathogenesis
3. Circulatory hypoxia
(1) Causes
(2) Characteristics of blood oxygen and Pathogenesis
4. Histogenous hypoxia
(1)Causes
(2)Characteristics of blood oxygen and Pathogenesis
C. Functional and Metaolic changes in hypoxia: master
1. Respiratory system
2. Circulatory system
3. Hemic system
4. CNS
5. Cells and tissures alteration
D. Tolerance to hypoxia
E. Oxygen therapy and Oxygen toxicity
Chapter seven Fever
【AIM】
master：Concept of Fever, Hyperthermia and physiological temperature increasing. Etiology and Pathogenesis of Fever, Concept of Endogenous pyrogen and Pyrogenic activator; the stages and characteristic of fever.
comprehensive: Metabolic and functional alterations during fever, Biological significance of Fever and pathophysiologic basis of fever therapy.
【CONTENT】
A. Concept:
1. Fever
2) Hyperthermia
3) physiological temperature increasing
B. Etiology and Pathogenesis of Fever: master
1. Pyrogenic activator:
2. Endogenous pyrogen (EP, Pyrogenic cytokines)
(1) EPs: IL-1, IL-6, TNF, Interferon (INF)
(2). ways of EP signal the CNS
(3)Operating mechanisms of EP
a. PGE2
b. CRH，cAMP，Ca2+，5-HT……
3. Endogenous cryogens: Febrile ceiling
C. Stages of Fever
1 Fervescence period:
2 Persistant febrile period
3 Defervescence period
D. Metabolic and functional alterations during fever
1 CNS
2 Immune system
3 Digestine system
4 Cardiovascular system
5 Metabolic changes
E. Biological significance of Fever (risk-benefit considerations)
F. pathophysiologic basis of fever therapy
Chapter eight Stress
【AIM】
master ： Concept of stress, Stressor; Stress responses: Locus ceruleus-norepinephrine/sympathetic /adrenal medulla axis, Hypothalamus-Pituitary-Adrenal Cortex System, Acute Phase responses and Acute Phase Protein, Heat Shock Protein, GAS (General Adaptation Syndrome), Stress ulcer,
comprehensive: Function and Metabolism responses, Essential Hypertension,
Myocardial ischemia and arrhythmias, stress related mental-psychogenic disorders
【CONTENT】
A. Concept of stress, Stressor:
B. Stress responses
1 Nervous and Hormones responses during Stress
(1). Locus ceruleus-norepinephrine/sympathetic /adrenal medulla axis:
(2). Hypothalamus-Pituitary-Adrenal Cortex System:
(3). Other hormones
2 Cellular & Humoral responses:
(1). Acute Phase responses and Acute Phase Protein (AP)
(2). Heat Shock Protein (HSP or Stress Protein)
3 Function and Metabolism responses
(1). Metabolism
(2). C.N.S
(3). Cardiovascular system
(4). Digestive system
(5). Immune system
(6). Blood system
(7). Urinary and Reproductive system
C. Stress Related Disease
1 GAS (General Adaptation Syndrome) :
2 Stress ulcer: Concept and Pathogenesis of stress ulcer
3 Other stress related diseases
(1). Essential Hypertension(EP)
(2). Myocardial ischemia and arrhythmias
(3)stress related mental-psychogenic disorders
Chapter 9 Shock
【AIM】
master：Concept of shock; Pathogenesis of shock; cause, characteristic, pathogenesis and compensation of stages of shock. Concept and pathogenesis of Pulmonary dysfunction, Hepatic dysfunction, Renal dysfunction, Cardiac dysfunction, MODS (multiple organs dysfunction syndrome), SIRS (systemic inflammatory response syndrome)
comprehensive: Etiology and classification of shock, Disturbances of cell metabolism and function Gastrointestinal dysfunction during shock.
【CONTENT】
A. Concept: : master Acute circulatory failure lead tissue perfusion reduced greatly, severe dysfunction of vital organs, cell damage and eventually death if without prompt rescue.
B. Etiology and classification of shock
(A) Classification on etiology
(B) Classification on initiation of shock
C. Pathogenesis: master
1. Vasoconstriction stage --- The early phase of shock , stage of ischemic anoxia
(1) Vasoconstriction mechanism
(2) Compensative significance in vasoconstriction stage Ⅰ
(3) Manifestation:
2. Stagnant anoxia stage --- The developed phase of shock, -reversible decompensatory stage
(1) mechanism of disturbances of microcirculation
(2) major effects of the disturbances
3. Vasofailure stage --- refractory phase of shock
DIC
Organs failure
D. Effects of shock
1. Disturbances of cell metabolism and function
2. Pulmonary dysfunction: master
3. Hepatic dysfunction: master
4. Renal dysfunction: master
5. Gastrointestinal dysfunction
6. Cardiac dysfunction: master
7. MODS (multiple organs dysfunction syndrome) SIRS (systemic inflammatory response syndrome) Concept and pathogenesis
Chapter 10 Disseminated Intravascular Coagulation DIC
【AIM】
master：Concept, Causes and pathogenesis of Disseminated Intravascular Coagulation;Predisposing and precipitating factors; Consequences of DIC
comprehensive: Types and stages of DIC, Pathophysiologic basis of DIC diagnosis and treatment
【CONTENT】
A Concept: master
B Causes and pathogenesis: master
1. Abnormal activation of clotting cascade
2. Fibrinolytic defect
C Predisposing and precipitating factors: master
1. Impairment of mononuclear phagocyte system
2. Hypercoagulable state
3. Disorders of microcirculation
4. Severe hepatic disorders
5. Defects in inhibitors of coagulation
D Types and stages of DIC
1. Stages
a) hypercoagulable stage
b) hypocoagulable stage
c) fibrinolytic stage
2. types
based on attacking velocity
based on compensation
E Consequences of DIC: master
1. Bleeding
2. Shock
3. organs, tissues damage
4. microangiopathic hemolytic anemia
F Pathophysiologic basis of DIC diagnosis and treatment
Chapter11 Ischemia-Reperfusion Injury
【AIM】
Master: Concept of Ischemia-Reperfusion Injury. Concept, classification and generation of Free Radicals. Effects of free radicals and calcium overload in the pathogenesis of Ischemia-Reperfusion Injury.
Comprehensive: Etiology and predisposing and precipitating factors of Ischemia-Reperfusion Injury. Alterations of metabolism and function in Ischemia-Reperfusion Injury. Pathophysiological basis of prevention and treatment.
【CONTENT】
A Concept: master
B Etiology and predisposing and precipitating factors of Ischemia-Reperfusion Injury.
1. Duration of ischemia
2. Collateral circulation
3. Dependency on oxygen supply
4. Condition of reperfusion
C Pathogenesis: master
1. Free radicals
(1) Xanthine oxidase pathway
(2) Neutrophils pathway
(3) Mitochondria pathway
2. Calcium overload
(1) Disorder of Na+/Ca2+ exchange
(2) Membrane permeability damage
3. Neutrophils activation
D Alterations of metabolism and function
1. Myocardial ischemia-reperfusion injury
(1) Reperfusion arrhythmias
(2) Myocardium stunning
(3) Alterations of myocardium ultra-structure and metabolism
2. Cerebral ischemia-reperfusion injury
3. Ischemia-reperfusion injury in other organs
E Pathophysiological basis of prevention and treatment
1. Control the reperfusion conditions
2. Scavenge the free radicals
3. Relive calcium overload
4. Improve the metabolism
Chapter 12 Pathophysiology of cardiovascular system
【AIM】
master：Concept of heart failure; Pathogenesis of heart failure: Disorders of myocardiac
contraction and Disorders of myocardial dilation and compliance; Adaptation and
compensation for heart failure; Effects of heart failure
comprehensive: Etiology of heart failure;
【CONTENT】
A. Heart Failure
(A) Concept: master
(B) Etiology
1. Primary disorders of myocardium
2. Overload of myocardium
(C) Pathogenesis: master
1.Disorders of myocardiac contraction
(1) Damage of myocardium
(2) Disturbances of myocardial energy metabolism
(3) Abnormalities in excitation-contraction coupling – disorders of Ca2+ transportation
2. Disorders of myocardial dilation and compliance
(1) Disorder of myocardial dilation
(2) Decreased ventricular compliance
(D) Adaptation and compensation for heart failure : master
1. mobilize pump reserve
2. myocardial remodeling
3. activation of neuro-hormoral factors
4. adaptation of cell, tissue to hypoperfusion
(E) Effects of heart failure: master
1. Effects of decreased cardiac output – forward failure
2. Effects of venous congestion – backward failure
Chapter 13 Pathophysiology of respiratory system Respiratory Failure
【AIM】
master：concept and classification of respiratory; Etiology and Pathogenesis of respiratory: concept and pathogenesis of Ventilation disorders, Diffusion disorders ,Mismatching of V/Q and True shunt. concept and pathogenesis of Acute respiratory failure in acute respiratory distress syndrome (ARDS); Consequences of respiratory failure :Alteration of circulatory system-Cor pulmonale ,CNS alteration-Pulmonary encephalopathy
comprehensive: Consequences of respiratory failure
【CONTENT】
A. Concept: :master
TypeⅠ: PaO2 < 60 mmHg Type Ⅱ: PaO2 ↓< 60 mmHg, PaCO2 ↑> 50 mmHg (6.67 kPa)
B. Etiology and Pathogenesis: master
1 Ventilation disorders
(1) Restrictive hypoventilation
(2) Obstructive hypoventilation
(3) Alteration of blood gases
2. Diffusion disorders
(1) Area of diffusion membrane↓
(2) Thickening of diffusion membrane
(3) Alteration of blood gases
3 Mismatching of V/Q
(1) V/Q↓: functional shunt (venous admixture)
(2) V/Q↑: dead space-like ventilation
(3) Alteration of blood gases
4 True shunt ↑
C. Acute respiratory failure in acute respiratory distress syndrome (ARDS)
1. pathogenesis of ARDS
2. pathogenesis of ARDS leading acute respiratory failure
D. Consequences of respiratory failure: master
1 Acid- Base Disturbances
(1) Respiratory Acidosis Hyperkalemia, Hypochloremia
(2) Metabolic Acidosis or Mixed Acidosis
(3) Respiratory Alkalosis
2 Alteration of Respiratory System
3 Alteration of circulatory system Cor pulmonale
4 CNS alteration Pulmonary encephalopathy
5 Alteration of kidney and digestive system
Chapter 14 Hepatic Pathophysiology
【AIM】
master：Concept of Hepatic Encephalopathy; Pathogenesis of Hepatic Encephalopathy:
Ammonia intoxication ,False neurotransmitters, Amino acid imbalance, GABA ↑.
comprehensive: Etiology Disorders of hepatic cell function; Disorders of Kupffer cell function; Jaundice with predominantly unconjugated hyperbilirubinemia; Jaundice with predominantly conjugated hyperbilirubinemia Effects of hyperbilirubinemia; Precipitating factors and Principles of therapy of Hepatic Encephalopathy
【CONTENT】
A. General introduction to disturbances of hepatic functions
1. Etiology
2. Disorders of hepatic cell function
3. Disorders of Kupffer cell function
B. Jaundice
(A) normal metabolism of bilirubin
(B) Jaundice with predominantly unconjugated hyperbilirubinemia
1. overproduction of bilirubin: hemolysis jaundice, etc
2. impaired hepatic uptake, conjugation of bilirubin : neonatal physiological jaundice,etc.
(C) Jaundice with predominantly conjugated hyperbilirubinemia
1. Hepatocellular jaundice
2. Intrahepatic cholestatic jaundice
3. Obstructive jaundice, etc
(D) Effects of hyperbilirubinemia
1. Effects of cholestasis
2. Kernicterus
C Hepatic Encephalopathy (HE) : master
(A) Concept: neuropsychiatric syndrome secondary to severe hepatic disease
(B) Pathogenesis
1. Ammonia intoxication
(1) Mechanism of blood NH3 ↑
(2) Toxic roles of NH3
2. False neurotransmitters
(1) production of False neurotransmitters
(2) False neurotransmitters in hepatic coma
3. Amino acid imbalance
(1) BCAA/AAA ↓: pathogenesis and effects in HE
(2) 5-HT ↑: pathogenesis and effects in HE
4. GABA ↑: pathogenesis and effects in HE
(C) Precipitating factors
(D) Principles of therapy
Chapter 15 Renal Pathophysiology
【AIM】
master：Concept of Acute Renal Failure (ARF); Etiology , classification and Pathogenesisof ARF;the mechanism of Oliguric; concept of Azotemia; Concept and Etiology and Pathogenesis of CRF; Concept of Uremia
comprehensive: Primary etiology of Renal failure; Primary functional impairments of kidney; Development courses of CRF; Pathogenesis of Uremia ;Functional and metabolic alterations in uremia.
【CONTENT】
A. General Introduction
1. Primary etiology
2. Primary functional impairments of kidney
(1) Glomerulus impairment
(2) Renal tubular impairment
(3) Disturbances of bioactive substances produced by kidney
B. Acute Renal Failure: master
(A) Concept of ARF
(B) Etiology and classification
(C) Pathogenesis
1. intrarenal hemodynamic disturbances - GFR↓
2. renal tubular impairment
(D) Effects of ARF
1. Oliguric type
(1)Oliguric phase: Alteration of urine Azotemia Water, Electrolytes and acid-base disorders
endocrinous Disturbances
(2) Diuresis phase
(3) Phase of functional recovery
2. non-oliguric type: characteristics
C Chronic Renal Failure: master
(A) Concept and Etiology
(B) Development courses of CRF
(C) Pathogenesis of CRF: Intact nephron hypothesis
1. glomerulosclerosis
2. tubulointerstitial injury
(D) Functional and metabolic alterations in CRF
1. Water, Electrolytes and acid-base disorders
2. Azotemia
3. renal hypertension
4. impairment of hemic system
5. renal osteodystrophy
E Uremia
(A) Concept
(B) Pathogenesis
1. renal Toxins
2. PTH
(C) Functional and metabolic alterations in uremia
四、Textbook: （教材）
陈主初主编《病理生理学》人民卫生出版社，北京，2001.8
王建枝主编《Pathophysiology》In press 人民卫生出版社，北京，2005.3
五、The recommended books include：（参考资料）
Kaufman.C E & Mckee.PA 《Essentials of Pathophysiology》中国协和医科大学出版社，北京，2002.1 (英文影印版)
王迪浔，金惠铭主编，《人体病理生理学》第二版，人民卫生出版社，北京，2002.8
Experiment 1 Hyperkalemia of Guinea Pig
Experimental procedure:
1. Weigh the guinea pig and anesthetize it with 10% ethyl carbamate at the dose of 1ml/100g by intraperitoneal injection。
2. Connect the electrocardio-leads to the guinea pig’s limbs as the following arrangement:
Black —— red
Green ——
3. Set parameters and print normal electrocardiogram.
4. Inject the 10% KCl solution 1ml by intraperitoneal injection → 5 minutes → 10% KCl 0.5ml → ……
5. When electrocardiogram of hyperkalemia is observed, personally select salvage plan
Options: 4% NaHCO3 or 10% CaCl2 or 50% glucose and insulin
6. Continue to inject KCl → ventricular fibrillation → dissect cavitas thoracis to observe the state of asystole.
Attention:
1. Be careful when catching the guinea pigs, do not flirt them at will to avoid scratch injury.
